Dr. Dan Kalish discusses the principles and applications of functional medicine, emphasizing foundational practices for improving patient outcomes and the importance of integrating lifestyle changes.
Foundational Knowledge: Dr. Kalish stresses the importance of mastering basic physiological principles and lab interpretations over trendy treatments in functional medicine.
Adrenal Focus: He highlights the significance of addressing adrenal health before implementing advanced protocols to ensure patients can handle stress and detoxification.
Personalized Approach: The discussion emphasizes the need for individualized care rather than generic protocols, considering each patient’s unique biochemistry.
Historical Context: Dr. Kalish reflects on his early work with gluten and gut health, showcasing how functional medicine has evolved and gained recognition over the years.
Practical Strategies: The conversation includes practical advice on dietary adjustments, exercise, and integrating supplements like pregnenolone and makuna to optimize health.
Dr. Justin Marchegiani: Hey guys, it's Dr. Justin Marchegiani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth. com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
J, and or our colleagues and staff to help dive into any pressing health issues you really want to get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. And we are live with Dr. Dan Kalish, my mentor and friend, um, Dr. Dan, when he first started his mentorship and his functional magic Medicaid, um, medicine education program, I think it was that 2006, 2007, almost 18 years now.
I'm like, wow, it feels like a century ago, but I was one of Dr. Dan's first students. And I thought Dr. Kalish did an amazing job teaching, laying out physiological. Principles, biochemistry, really looking at things from a clinical application standpoint, what works to help get patients better. So I'm really excited to have Dr.
Dan on today's podcast. Dan, how we doing, man? Good to see you.
Dr. Dan Kalish: Yeah, very good. Good to chat with you again. It's been a little while.
Dr. Justin Marchegiani: Yeah, it has. It's been a bit. So what are you up to today? I mean, I kind of put you in the category with Dr. Bland of like the fathers of functional medicine, definitely one of the OGs.
So it's great to have you on the show here.
Dr. Dan Kalish: Yeah, I know at age 60, I realized, you know, it's over a 30 year career. So just the The fact that I've lasted this long kind of qualifies for something. But you know, I'm I'm as always maybe even more so interested in this, you know lab interpretation Like how do and that's become I think more and more as the years go by my niche and really understanding and going deep Not into like the newer labs and the newfangled fancy stuff, but you know deeper into the more fundamental tests and and figuring out ways to teach that and disseminate that information so that practitioners have a really good founding in the basics, you know.
And um, I think with an industry that's growing as quickly as functional medicine it's kind of tempting to do only the newest and latest stuff and a lot of practitioners miss out on Developing their skills for the essential fundamental part. So I'm kind of stuck in that lane and as new practitioners come in more and more We see just how important it is to learn the basics that you learned, you know 20 years ago almost right?
Organic acids adrenals how to really do a good gi program And all that
Dr. Justin Marchegiani: I mean back in the early 2000s. A lot of the practitioners were coming out They were just really throwing people on lots of hormones lots of hormonal creams and the adrenals were kind of this like lost hormonal system that really wasn't addressed, which was so important for stress and inflammation.
And it's that backup generator for hormone production for most women. And so, that was kind of that area that you really made a niche and really hyper focused on the adrenals where most people were just like, here's some testosterone, here's some progesterone, here's some estrogen cream. And I felt like that was a big area you focused on.
I felt like a lot of other people kind of philosophically, they would go into like, Strong detox programs, strong gut killing programs, and you had this idea which, I mean, it's, it's prophetic and it has served me with 10, 000 plus patients under my belt is you've got to build up that person's constitution, their body's immune system, their ability to handle a detox program, to handle gut killing, because that is actually stress on the body.
So we got to build up it. That stress handling capacity system first. And I think you're one of the first person in my life that brought that philosophical construct.
Dr. Dan Kalish: Yeah. You know, Tim has taught me that and I still see it. I still see missing that idea as one of the most common mistakes that bad patient outcomes.
Because the doctor might be doing the right GI protocol or right detox protocol, but if the patient's not ready for it yet, it can backfire big time. And I think it's so tempting, especially for the younger doctors, to jump on what's really the most important thing and do that first and not to lay the foundation of the adrenals and the lifestyle.
Um, so you're setting the patient up so you can do this more advanced work later. And that even with, I mean, even with students that we just signed up this year, you know, doctors who are new to functional medicine, they just want to jump in and do the gut protocols and detox protocols on day one. And as you've learned, right, it just It doesn't always work.
It can work, but it doesn't always work, and you're, you're always better if you're well prepared and you get the, the groundwork done on the adrenals first, and that is so counterintuitive to people. It really is. Dr. Justin
Dr. Justin Marchegiani: Marchegiani And I'm gonna put the link for the Kalish Institute. com. Kalish with a K, institute.
com, I'll put the link in the description so you guys can look at it. If you're a practitioner or even you're a patient and you want more information. Please go see Dr. Dan's website when I have clinicians and friends text me, they're like, who should I go see? I want to get into this functional medicine thing.
They're like, should I do IFM? Should I do A4L? I'm like, go see Kalish because in the end, you have all this fancy information you have, but. It has to be wrapped in a philosophical clinical framework that is tested to get patient outcomes. If you don't get a patient outcome, I don't care. If it's New England Journal of Medicine article, I don't care.
If it's some other doctor, uh, talking about it or lecturing around the country, it has to have clinical outcomes, meaning getting patients better, getting them feeling better. If it's not on that framework, forget about it.
Dr. Dan Kalish: Yeah, it's so true. You know, and it's hard. I think it's hard for clinicians to differentiate with all the information and noise out there.
What's actually going to move the needle with a patient versus just what's maybe got some research behind it, but doesn't have any practical application of utility to it. You know, it's really hard to differentiate that. Um, and then you end up stuck with a beautifully designed program that doesn't do any good and the patient doesn't feel any better.
And that's really not the point, is it? You know? Yeah.
Dr. Justin Marchegiani: Yeah. Exactly. And you are one of these people. I remember in the late 90s, you were working with Bill Timmons and you were working with even Dr. Diana Schwarzwein, an endocrinologist. And you were, I remember this one thing where you're like, shit, these, all these patients have these hormonal issues.
And you were doing this thing where you were just cutting gluten out for the first time. This is when gluten wasn't even a thing. Now you go into restaurants, you've got the gluten free everywhere. Like this is 25 years before gluten was ever talked about. And you were working with mainstream endocrinologist cutting gluten out, or you were working with Dr.
Timmons and in doing saliva testing before that was even big. So you were like way ahead of your time before these things were even on anyone's radar.
Dr. Dan Kalish: Yeah, so funny. I remember the first time when I was in a restaurant in Arizona, I was doing a conference and the waiter came up to me and said, We have like gluten free items on the menu.
And I just started laughing. I was like, yeah, no idea what you're talking to do. And it was, but it was like this cutting edge restaurant, you know, they're like, I was like, Oh man, you're like 10 years past the time. Um, and you know, and I think the thing about it now, if you think about. Like the present day right now, today is that, you know, is this what they call a hockey stick graph, right?
When, as businesses grow and you. And for a long time we were kind of on the flat part of the hockey stick and then it started to go up. Now I feel like we're like on the stick itself. The growth of functional medicine and the, uh, you know, the numbers of people rushing in on the patient side, it's just, it's hard to comprehend.
And then on the practitioner side, equally large numbers of people rushing in. But, um, how do they know what to do? You know, and how can you tell that the functional medicine practitioner you're seeing is any good or not? Like patients don't really have a way to assess.
Dr. Justin Marchegiani: So if you're walking in, right, if you're walking in, like forget, like, obviously there's like podcasts and videos, you can find someone that resonates with you, but if let's say you're just going in blind and you're calling up a functional medicine doctor, like what are the top three or five things you're doing to assess, can they help me?
Dr. Dan Kalish: Yeah, I guess talking to other patients that have been through their program, you know, and Again, I hate to just keep saying this but you know Just making sure that they have basic lab assessment skills because a lot of people don't so a lot of people are just throwing gobs and gobs of supplements at people and just hoping that it works and not really Understanding the fundamentals of the physiology that we're trying to correct, you know And that, that just ends badly for patients, you know, it just ends up causing side effects and problems and nobody that we work with has a supplement deficiency that can be solved just by guessing, you know, things are so, so individual, the biochemistry is so different that, um, having a.
Practitioners just doing generic programs. It's not going to work.
Dr. Justin Marchegiani: And you're one of the big people out of the gates where you were doing stool testing before it was really even a big thing. I remember your personal story, what you had the e histoparasite, right? Yeah,
Dr. Dan Kalish: exactly. Yeah.
Dr. Justin Marchegiani: And if you could have a big gut infection, it's impacting absorption or creating gut permeability and just lighting up your immune system, stressing out your adrenals.
I mean, You just won't heal. I remember back in the day, you were one of the big people really on top of the gut before that was even fashionable.
Dr. Dan Kalish: Yeah, I know. And now it's all microbiome, microbiome, microbiome, you know. And um, here's the interesting thing that I'm learning now is that a lot of the things that we did 30 years ago to help improve patient health, which were gut centric, that really made huge differences for all kinds of different conditions as you've seen in your own practice.
A lot of that was working. for different reasons than we understood at the time, you know. And now that the science has really evolved on the microbiome, you can see the complexity with which these gut bacteria, the good ones, are regulating everything from your brain, to your immune system, to your heart.
To your metabolism, like you're in control. It's like the movie alien or something where that was inside that person, you know, it was like the gut, the good gut bacteria are actually like completely in control of things. And if you don't kind of get with that part of the program, then you're just going to constantly be.
Working against yourself, you know, uh, it's more profound than you would think even and we saw this in all these years of naturopathic medicine, but to see the science play out behind it where now you can see the exact mechanisms makes it kind of more real
Dr. Justin Marchegiani: and that's why I like just having a really good foundational diet and lifestyle so important because I'll see people that go to conventional medical practitioners and they'll have them on hormones and hcg and and all these peptides but I'm like dude your diet sucks you're eating lots of junky fats you're not breaking down your food and it's like if we just Cut out the glyphosate and the GMOs and get organic food in there.
Maybe you're eating some fermented foods and some healthy saturated fats. What's that doing to the microbiome where we're not even focusing on it, but it's just a downstream kind of trickle.
Dr. Dan Kalish: Yeah, exactly. In fact, we had a doctor a few weeks ago in the mentorship class who tested herself and her gut microbiome test was perfect.
And then I spent the next 10 minutes describing to her how she was eating and she kept saying, yep. Yep. Yes. Yep. Yep So in other words, you can kind of reverse engineer it if you if you see a certain if you see a perfect microbiome There's only a few ways to get there food wise.
Dr. Justin Marchegiani: Mm
Dr. Dan Kalish: hmm. It's just what you said, you know Fermented foods have to be in it the diet polyphenols and large amount Fiber and large amount and not too crazy with the sugar and carbs and alcohol If you get all that dialed in and it's fresh, farm fresh food, then your microbiome does its job.
And if you're not doing that, any, any variation from that, you're pretty much in trouble.
Dr. Justin Marchegiani: Dr. Justin Marchegiani How are you adjusting macronutrients today? So like we talk about fiber, are we talking like more like non starchy vegetables? Were you doing more safe starches? And then how do you know when someone's doing too much?
Are you just looking at gas? Are you saying, hey, you're insulin resistant? Your, your waist is too big. Maybe we got to be more leafy greens versus starch. How do you adjust that?
Dr. Dan Kalish: Yeah, there's a couple of ways. I think the easiest way for a lot of people is just to cut out all the starchy carbs completely for two weeks
Dr. Justin Marchegiani: in the beginning.
Yeah.
Dr. Dan Kalish: And then to start to titrate them back in, you know, with like, and like, usually we'll do like a quarter cup of rice with each meal and then a half a cup with rice, you know, and if you kind of gradually bring the starchy carbs back, well, here's, here's the thing. And you want to have it so that the starchy carbs are enhancing your energy.
Yeah. Not making you more tired.
Dr. Justin Marchegiani: Yes. And
Dr. Dan Kalish: I, I know for me, like, if I have, like, let's say a cup of rice at, and it's just an easy thing to measure. That's why I use rice, you know, it's easy to measure. Um, so if I have a cup of rice at lunch, I'll for sure be, you know, feeling like taking a nap an hour or two later.
And if I have zero, zero starchy carbs at lunch, You know, my energy is good the rest of the day. If I have zero starchy carbs at dinner, then I crave sweet. So I do my starchy carbs dinner, you know, so for each individual patient, you can, I think there's also a timing issue that's going to vary about when you deliver, you know, the right amount of starchy carbs, figure that out and then figure out when's the best time to deliver it so that you keep the insulin levels right where they should be.
Um, and I think we could almost solve all health problems if we all just walked around every day thinking, Where's my insulin? Where's my insulin? Where's my insulin? Don't screw up my insulin. Don't screw up my insulin, right? I mean, that's like, turns out to be one of the biggest keys to all of this. And every time you screw your insulin levels up, you're gonna be paying the price for a while.
Dr. Justin Marchegiani: Dr. Justin Marchegiani And I tell patients like, I've kind of coined it functional glucose tolerance, right? Where you take your blood sugar before a meal. Dr. Justin Marchegiani And then you look at at least one to two hours after. We want to be back below a hundred within hour two. Definitely hour three.
Cause it's, the higher your blood sugar goes, the more insulin you make, right? So if your blood sugar kind of snakes along, we're making less insulin. So that's a good, if people are more science y or geeky and they want to measure it, get like a, the Keto Mojo meter. This is a good one cause it Bluetooth connects and it graphs it on your phone so you can see it.
I tell patients pick a random breakfast, random lunch, random dinner and see where you're at. And if your blood sugar is going more than 120 to 140 and taking more than two to three hours to get back down below a hundred, then you're probably doing too much. Adjust the carbs or Do a 5 10 minute walk after the meal.
That can lower blood sugar 20 30%. 5 10 minute walk. That's it.
Dr. Dan Kalish: Marchegiani
Dr. Justin Marchegiani: Crazy. Yeah. So I'll tell people, go to an interval training. It's Thanksgiving. You're gonna carve it up. Go to an interval training in the morning. 15 minute sprints or something like that. That kind of clears out some of the glycogen.
Mm-hmm . And then when you excess carb, just do a five, 10 minute walk after the meal and that will give your muscles that extra ability to pull out those extra carbohydrates when you eat it.
Dr. Dan Kalish: Yeah. It makes a huge difference. You know what I've done recently too is I have a, well I've had standing desk I'm at right now and I have a me too know a treadmill that I use.
I'm not on it right now 'cause bouncing up and down on video is kind of rude.
Dr. Justin Marchegiani: Yep.
Dr. Dan Kalish: But I spent. At least two or three hours on the treadmill, at least. Um, that's made a huge difference. Dr. Justin Marchegiani Me too. Dr. Neal Schwartz I just don't like to sit anymore, basically. For long periods of time. Dr.
Justin Marchegiani Okay. And
Dr. Justin Marchegiani: at the desk, I've gotten, I'll put the link. I got the Rhythm Fun one. I mean, it's a hundred bucks on Amazon. I think it goes four or five miles per hour. It can do an incline, too. I walk 15, 000 steps a day on a slow day with patients. It's amazing. Game changer. I mean, people talk about exercise, just walking is a game changer.
Um, but obviously resistance training helps, but just if you're just doing like a 30 minute workout, but then you're sitting all day long, that is totally not good either. So you want kind of that balance, right? Dr. Justin Marchegiani
Dr. Dan Kalish: Yeah, that's what I realized for sure. You have to have just constant movement.
Basically, we need to be moving pretty much all day long. Dr. Justin Marchegiani
Dr. Justin Marchegiani: 100%. So the stand desk and the walking has been a big one. Um, now I kind of switch gears a little bit. Pregnenolone. Pregnenolone. One of my favorite supplements. And you're like the only person that really has ever talked about it on there.
Dr. Dan Kalish: I know. Pregnenolone. It's not the, it is like nobody, I've never heard any practitioner ever really do like a lecture on Pregnenolone. And it is hands down the most effective thing for everything. It's like big, my big fat Greek wedding with the, you know, Yes! Windex. Yeah, yeah. Windex for everything. Exactly.
So like, if your cortisol is high and you're stressed, it works. If your cortisol is low and you're exhausted. If you're anxious, it gets you less anxious. If you need more energy, it gives you more energy. I mean, it does numbers on your blood sugar like you couldn't even believe, right? And that nobody ever uses pregnenolone.
And, I mean, I don't know about you, but I, I can't remember the last person that had a side effect from it. Like, the side effects are like almost zero. I don't know. And
Dr. Justin Marchegiani: when you do a liquid, you can titrate it up anyway and find a dose that works almost always if there is an issue.
Dr. Dan Kalish: Yeah. So that is like my favorite of all time.
I think that and Makuna, those two are like
Dr. Justin Marchegiani: for the dopamine. Yeah.
Dr. Dan Kalish: Makuna for the dopamine. You have to do it. You can't just take it on your own. You need somebody who knows what they're doing to do the Makuna stuff. But um, Yeah, why are these things not, I don't know. I think what happens too is, uh, you know, the supplement industry tends to get pretty caught up in the latest, newest fad type thing.
And pregnenolone has been around since, what, the 50s. So it doesn't have any cachet to it anymore, you know. Um, It's just been sort of left in the dustbin of, you know, clinical nutrition. Dr. Justin Marchegiani
Dr. Justin Marchegiani: Yeah. And I see, and I see some doctors like Brownstein or there's a couple other, they'll use Cortef or they'll do a lot of bioidentical cortisol.
But the problem with that is, is when the adrenals get really depleted, the mineral corticoids also go downhill. And so your ability to hold on to potassium. and, and sodium in your electrolytes goes down. And so then if you can't do that, you need sodium and potassium for the sodium potassium pump to work.
So now we're going back to cell physiology 101. So if the sodium potassium aren't there, not cause you're not eating it, but because you're peeing it out cause your adrenals are too weak. And so then that's where pregnenolone I think really plays a big role. And so I've been really playing around with getting the electrolytes dialed in with the pregnenolone that supercharges the, the, the, the cell physiology to work better.
Dr. Dan Kalish: Yeah. Yeah. That makes total sense. We do one without the other. It's not going to be nearly as effective, you know?
Dr. Justin Marchegiani: Exactly. Yeah. So that's pretty cool on that. Um, what other, so let's talk about the Makuna. You kind of went there. I remember you had your class in 07. I went on Makuna for the first time. I remember I was in, I was in LA and I was dosing it up and I, I took it and I literally got up.
And there was a Sunday morning and I felt drunk and I had to do this. And I'm like, I'm not drinking. What the hell happened? And I, I had to sit there and think I'm like, did someone drug me? Like, did I drink a roofie last night? And then I was just, I was thinking back to you and I'm like. Oh, I overdosed on Makuna.
Crap. This is what it feels like.
Dr. Dan Kalish: Yeah, I mean, I guess it's for good or evil Makuna, you know, I think a couple things about it. You got to have that tyrosine base in place for it to work right. And most people don't do that properly. And then it's got to be graduated. You can't just get on it. You can't just start taking Makuna one day, you got to start with Tyrosine and ramp yourself up, and then you got to figure out, like, how much 5 ATP do you need to make the Makuna work?
And most people don't even think about that, so they just hit the dopamine side so hard, and eventually you start to deplete the other neurotransmitters, and then you end up with an even bigger problem than you had when you started. But if you can get all those things dialed in, it works, you know. Dr.
Justin
Dr. Justin Marchegiani: Marchegiani That aromatic decarboxylase enzyme, that enzyme is the same one that metabolizes the dopamine, it's the same one that metabolizes the 5 HTP, right? So if you, if you upregulate the enzyme, but then you're not putting some of that serotonin in over time, then you're gonna deplete the serotonin, right?
That's the thinking on it.
Dr. Dan Kalish: Dr. David Jockers Yeah, exactly. And that is most obviously exemplified in Parkinson's patients, who, you know, in order to survive, have to take L DOPA, and they end up with very low B6 levels and very low B6 Serotonin levels at the end of the day.
Dr. Justin Marchegiani: And like with the cinnamon or, you know, the, the levodopa, right?
They're Yeah. They're at, they're lowering that serotonin. Plus you mentioned the B6. Now I always started out with like three to six grams of tyrosine, you know, over the course of the day. And if I could get someone on that level, then we bring in the Makuna. And I think, I remember your sentiment is, if you feel nothing, that means you need it.
If you feel great, you definitely need it. And if you feel loopy, you're drunk, then you went too far. Yeah. Yeah. That was kind of my
Dr. Dan Kalish: Yeah. That's a good summary, though. And then we start and you can test, too. You know, you should see the catecholamine markers and all that, so at least you have a clue when you're getting started.
Um, it's also just part of the stress response to become depleted in the catecholamine, so I don't know. It's pretty common, right? You're gonna have that. Dr. Justin Marchegiani
Dr. Justin Marchegiani: And so the other co factors are gonna be what? B6, are you putting in vitamin C, calcium, uh, like the folate, B12, what are the other big ones that you find are needed for that to work?
Dr. Dan Kalish: Yeah, what you just listed out and then the the sulfur containing stuff like cysteine or methionine.
Dr. Justin Marchegiani: Talk about that because that was um, what's his name out of University of Minnesota? Hintz, Marty Hintz. Remember him? Yeah. You used to work with
Dr. Dan Kalish: him? No, no, I haven't talked to him in years. Yeah,
Dr. Justin Marchegiani: but he was always about like Cysteine, cysteine, cysteine.
I use N acetylcysteine now because that gets converted to that anyway. Are you doing NAC over cysteine?
Dr. Dan Kalish: Yeah, you can do either NAC or methionine.
Dr. Justin Marchegiani: Methionine?
Dr. Dan Kalish: Yeah.
Dr. Justin Marchegiani: Or SAMe, that's a little more expensive though.
Dr. Dan Kalish: Or SAMe, yeah. SAMe sometimes works really well, but it is extremely pricey. Sometimes SAMe can work by itself, and then that kind of drags you into the whole methylation thing, which is another can of worms, you know?
But um, I don't know, if you look at any Brain program, virtually, I would say any immune program, any gut program, they all, you know, need NAC, right? NAC for biodisruption of, you know, biofilm disruption or whatever. NAC is a precursor to glutathione for any kind of detox. NAC just, it just shows up in every protocol.
I give it to, I give it to almost everybody for different reasons, you know, but.
Dr. Justin Marchegiani: Oh, I take, I recommend it for one, antiviral. So when there was that virus hanging out years back, wonderful on that. Uh, any pneumonia issues, break some eucalyptic, they've been using, they've been using NAC. For, uh, pneumonia for a while.
Also, it's first line therapy with cystic fibrosis when they don't have the, the lung mucus going on. They've been using NAC since the sixties for, for liver failure due to too much Tylenol.
Dr. Dan Kalish: Right, right.
Dr. Justin Marchegiani: So if you're a parent and you're put in a position where you have to give your kid Tylenol, guess what?
Tylenol just depletes glutathione. So if you have to take it with an NAC glutathione to protect the liver.
Dr. Dan Kalish: Yeah, it ends up, and then, yeah, anyone who's exposed to environmental toxins, which is all of us, you need the NAC.
Dr. Justin Marchegiani: They did a phase, uh, three clinical trial two years ago comparing NAC to minoxidil for hair loss and hair growth, and it outperformed minoxidil.
Dr. Dan Kalish: Did it really? Oh, nice. So, there you go. There's a whole other reason.
Dr. Justin Marchegiani: Oh, so many good benefits, though. But so, going back to Hins, right? Hins always used to say that NAC or cysteine was really important for the catecholamine synthesis. I couldn't find a lot of mechanisms on that, per se, outside of the oxidative stress mechanism.
Did you have any more insight on why that was so important with dopamine? You always used to harp on that.
Dr. Dan Kalish: Yeah, so there's, if you look at, um, the methylation cycle, I can just see the diagram in my head, but I don't have it. I'll pull it up,
Dr. Justin Marchegiani: I'll pull it up. Yeah,
Dr. Dan Kalish: um, and it, and how, um, methylation, if you, maybe you have an image that has methylation and glutathione production together.
Dr. Justin Marchegiani: Mm hmm.
Dr. Dan Kalish: And there's a whole transulforation pathway that's kind of connecting them. Um, so there's certain Nutrients you need to methylate, and then there's certain nutrients that you need to make glutathione. And then they're kind of yoked together, those two processes so that when the body's under oxidative stress, we're going to be forced to make more, your cells are forced to make more glutathione.
And that comes at the expense of being able to methylate. And so I think the idea is if you have any kind of a brain issue and you want enough glutathione in the system. Yeah, there we go. See, you want enough glutathione in the system to cover off on everything. Then you need the, let's see, do you see the neck there?
Oh yeah. I see it up there. I see the cysteine at the top there.
Dr. Justin Marchegiani: Yeah. Cysteine.
Dr. Dan Kalish: Yeah. Yeah. So that, that ends up that cysteine or. Or if we're talking about in the supplement form, you could do N acetylcysteine ends up being one of the key connectors between, because that gets your glutathione levels up. And that allows you then to methylate properly because it's reducing your oxidative stress.
Otherwise you end up in a situation where you've got some oxidative stress, you're cranking out glutathione, but you're depleting. Yeah. Yeah, there you go. That's a perfect one. You see that.
Dr. Justin Marchegiani: So your protein up here, there's your methionine, right? And this is where folate and B12 kind of interact over here on the methylation cycle.
And then essentially, we're taking methionine and we're converting it down to cysteine. And if it gets stuck at homocysteine, that's where, you know, the Kilmer McCulley heart inflammation thing comes into effect there, right?
Dr. Dan Kalish: Dr. And then you can see the cysteine below there, so you get that pathway down to glutathione gets dramatically accelerated if you've got oxidative stress, which is going to deplete your ability to methylate.
And then what's not on here, but you kind of imagine it, is that in order to make, uh, In order to, I should say, in order to break down the catecholamines, you have to be able to methylate, right? Because it's COMPT is the enzyme that's doing that, so that's catechol o methyltransferase is the actual enzyme.
It's a methylation process, right? And so if you can't methylate, then your whole metabolism of the norepinephrine gets screwed up. And what's a weird factoid of the day, I have no idea why this is set up like this by the design team, but the other human product that's controlled by that same enzyme, CompT, is estrogen.
Isn't that weird? Really? Estrogen is broken down by CompT. It's the estrogen and the, and the catecholamines. I know there's a lot of biochemistry behind it, but it just seems a little odd that your body's set up, that you break down your estrogen and your catecholamines with the exact same enzyme. It's a little weird.
Dr. Justin Marchegiani: So, so what does that mean clinically? So that just means what? The more stressed we are, The more we're gonna have a hard time breaking down our estrogen, which means it could go back into circulation and create more estrogen dominance.
Dr. Dan Kalish: Uh, yeah, kind of. Is that, well, that is true. That's definitely true for a lot of different reasons.
One, because when you're stressed, your progesterone levels drop, and then that creates estrogen dominance right off the bat from that.
Dr. Justin Marchegiani: Yeah.
Dr. Dan Kalish: But I think that the comp T in relation to estrogen, not so much thinking people think about it as stress related, but more like breast cancer prevention related, right?
Because if you're, if you're not metabolizing your estrogens well, and they act as a growth hormone and they can trigger problems like breast cancer. So you really want the comp for on the estrogen side, separate from the stress issue. with the catecholamines. You really want that enzyme working right because it's one of the things that helps protect you against breast cancer.
If that enzyme is screwed up, then your estrogens can build up. And then there are these different estrogen metabolites, some of which can be uh, cancer causing and some of which are cancer protective. So you want to make sure if you're, and the short version of that story is that if you're methylating well, then it all works out.
But if you can't methylate well, then you run the risk of generating these cancer causing estrogen metabolites. So, you're right back to the same nutrients that we just looked at, but for, in the house, under breast cancer prevention versus under, you know, your brain health. Dr. Justin Marchegiani
Dr. Justin Marchegiani: And for COMT, the big nutrients, they are gonna be, yeah, we're gonna still be in that methylation cycle, the B6, B9, B12, but also the magnesium also plays a big role in that, too.
Dr. Dan Kalish: Dr. David Jockers Yeah, I know. It's just, it comes back to these same nutrients, and then NAC is in the middle of that every time. Right? Because of that diagram you just showed, you can see where the cysteine is. Because it's the glutathione production that creates this whole cascade, right? So the exposure to oxidative stress, now you have to, your body's forced to make all this glutathione, so your cysteine gets chewed up, and then that screws up your methylation that's right above it, right?
Dr. Justin Marchegiani: And also people forget too, people kind of been jumping on board with glutathione, but what you'll find when you look at the literature, glutathione's too big to cross the blood brain barrier. But cysteine can, and then also convert to Glutathione in the brain once it crosses the blood brain. We kind of knew this in neurotransmitter world 15 years ago.
You always would say, hey, we can't just give serotonin. It's too big. It won't cross the blood brain. We can give 5 HTP. It'll cross and then we can get serotonin, melatonin in the brain via that way.
Dr. Dan Kalish: Yeah. Yeah. That's pretty basic. And it turns out to often be better to let your body take that raw ingredient and make it at its own pace, you know, plus it can do other things with it.
If you don't need the extra glutathione support, there's a gazillion other things you can do with NAC.
Dr. Justin Marchegiani: And then hence we get back to the working theory of why pregnenolone was always so good. Because it's cholesterol, pregnenolone, and then pregnenolone goes out to. Dr. Justin Marchegiani I
Dr. Dan Kalish: know that's why, you know, the, I've gotten pushback over the years from doctors saying they don't use pregnenolone because, well it's because they never tried it, because anyone who tries it, like you, will use it.
But they say, Oh, because it's at such an early stage of the pathway, I don't know where it's going to convert, you know, but it turns out that it. The wisdom of the body. Now, the wisdom of the body is not always the best thing, but in this case, the wisdom of the body, it really does take care of things. And the preg seems to go where it needs to be.
Um, yeah, I know. It's pretty amazing.
Dr. Justin Marchegiani: And what do you see? I'm seeing lots of guys, lots of young guys. I mean, I'm talking like thirties, even early forties, they're just getting put on testosterone replacement really, really early. And I'm seeing a lot of these because the wisdom of what you always did with your hormonal support, you always microdosed it and your teachings would always be the more you microdose it, you prevent.
aromatization, if it's a testosterone, or you can do the opposite with a female with certain enzymes. Um, also, if you go too high, you can disrupt the feedback loop. Because you're thinking, and I'm, I want to put words in your mouth, but you're thinking was, let's re establish HPA access function. There's natural diurnal rhythms to how these hormones work.
Let's do it multiple times a day versus once a day or once a week. We're in testosterone once a week. And let's try to do small amounts where your body can do with it what it needs. And we're just replacing. What's missing, not giving a, you know, a physiological amount, just giving a physiological bump.
Does that sound right?
Dr. Dan Kalish: Yeah. That's exactly right. Yep. Mimicking internal production as much as possible.
Dr. Justin Marchegiani: So I see these guys coming in on 100, 120, 150 milligrams of testosterone injection. And a lot of these MDs I'm seeing, they're getting lazy. They're putting like arimidex, so they're compounding estrogen blockers in the testosterone because it's just, it's going downstream to estrogen.
Dr. Dan Kalish: Yeah, it gets, it's very, yeah, it's very difficult to work with males with just using testosterone when there's underlying upstream problems. Even if you could get the testosterone dialed in, you still have left a whole series of problems upstream that you never addressed. So, and it's pretty hard, as you've seen, I'm sure, you know, to get the testosterone working right, because there's so many other things that end up happening.
Yeah, it's sort of a nightmare. And there's ways you can boost testosterone naturally. I mean, you get the adrenals working like we're talking about with PrEG and DHEA. And then there's plenty of plants in. other products and nutrients like boron that can get your testosterone either freed up from sex hormone binding globulin so you can use it more or, or just produced more.
I've had really good results with that and you rarely need to use actual testosterone if you're doing it right.
Dr. Justin Marchegiani: Dr. Justin Marchegiani I agree like I've, I've had patients that have had low T. I've been able to double most guys testosterone. We do it first off is sleep. That's really good. Uh, we can use cold exposure, whether it's a cold plunge or cold showers.
Uh, we can do red light therapy. Um, ashwagandha studies on that increase free testosterone 20%. We can add sapamato, increase free testosterone 20%. Um, make sure the foundational micronutrients like zinc and selenium are in there. Make sure you're eating grass fed meats. Um, and magnesium, uh, is another big one.
And then there's different glandular, there's different glandular products that have a lot of nutrition in that glandular tissue that our systems can use as well that I've been able to double most guys T if it's necessary. On that level.
Dr. Dan Kalish: Yeah. The only thing I would add to that is, uh, Boron can work really well.
Dr. Justin Marchegiani: S H G B, right? That helps with S H G B.
Dr. Dan Kalish: And then cold plunging. Like, you just sound like you're insane when you talk about what it really does, unless you've done it, you know? Because it's so effective for so many things. Do
Dr. Justin Marchegiani: you have one?
Dr. Dan Kalish: Absolutely. Yeah.
Dr. Justin Marchegiani: Mine's right over there.
Dr. Dan Kalish: Every, every day, you know, every, not every day, almost every day, um, and it's just, it's the most, it's probably the single most life changing thing you could ever do, and you gotta combine it with Sonnet, obviously, and be kind of smart about how you do it, but it's, it's so much more effective than I could ever have imagined.
I'm probably on year four of it now, maybe? Which one are you using? The plunge? I like the Renew. R E N E W. Oh, it's great. It's super expensive, but, you know, my, I, I, I have a longevity teacher that's training me in longevity practices. Uh, it was like 10 grand.
Dr. Justin Marchegiani: Yes. This is the one that the celebrities use. I see them endorsing on Instagram.
Dr. Dan Kalish: Yeah, Mark Wahlberg has it, but you know what, my, my, my longevity teacher told me to get one and I was like, okay, it's expensive. I got it. It was the best money I've ever spent the thing. It's super clean. It cleans itself with all kinds of non toxic stuff.
Dr. Justin Marchegiani: Yeah.
Dr. Dan Kalish: Yeah. It's got ozonator and the filters and it's really nicely built and it's nice.
Dr. Justin Marchegiani: It's pretty
Dr. Dan Kalish: super clean water. Yeah, it's it's worth the extra money. I think, um, and I've had mine for maybe four years now. It's just flawless. It works. The only thing is that the top wooden deck, it needs a little tuning up. The woods getting a little old, but you know, I could probably just stand it or something, but the motor is impeccable and the, you can take it down as, as cold as you want to get.
It's easy to get in and out of. And and the main thing though is that the water stays super clean. I don't care that much about it But you know, uh, my wife is pretty clean and she would never get in something that had anything but the most pristine water so
Dr. Justin Marchegiani: totally I I use the box plunge where it retrofixed these chest freezers And they like put vinyl inside they make it all clean and then they use a um a filter over there That's the one i've been using because they're a couple grand.
They're not as expensive, but they're nice. They work good I mean a chest freezer is um, it's a hundred percent waterproof and it, it doesn't take more than like 20 or 30 bucks a month to kind of keep it running. So it's not too bad. Here's my theory on cold plunge. So number one, I always shower before I get in.
So I do you, I got an infrared sauna, jump on the sauna or hot tub, get my body temperature up, get sweating, shower off, jump in the cold plunge. And then I'll, I'll use my little filter to filter it out. And I use about three, four ounces every two weeks or so of. Dr. Justin Marchegiani Oh, yeah. That'll work.
Dr. Justin ppm level that will clean everything out, oxidize it, dissipate it in 12 hours, and then I use the, um, the O3, um, the Marchegiani
Dr. Dan Kalish: But yeah, yeah. Cold therapy combined with heat, it's just really, so. Many changes. Yeah. Testosterone, uh, every hormone you can imagine, your blood sugar gets affected. I mean, everything, all the inflammation, everything in our bodies, inflammation generated in terms of all the bad stuff.
Dr. Justin Marchegiani: But if you want to change your state, like if you're ever having a bad day and you want to change your state, just jump in. It's true. If you drink water for three minutes, you will, your whole physiological state will totally change.
Dr. Dan Kalish: So true, isn't it? I know. Like, and there's no exception to that. It's like, that's just what's going to happen.
And it's, it's like, it's honestly, it's like a powerful drug. I haven't done drugs since I was a teenager, but. It's like the most powerful drug you could ever get. And it's really, really good for you. You know what I mean? But it changes your mental state as much as it impacts anything.
Dr. Justin Marchegiani: And there's a mindset too.
I heard someone say this and it's kind of true. Cause you know, we're in America. We kind of are very blessed for all that we have in our country. I mean, like air conditioning, you have like Instacart where you can get your food dropped off in like an hour. Like we live in a really cushy country compared to like a hundred years ago.
Like. You wouldn't have indoor plumbing. You wouldn't have, you'd have to go out and have a farm to get all your food. And so, it's like kids today have it really easy. Like, we have it really easy in regards to like, just life being easier. So, kind of getting in cold water really makes things hard and kind of painful for a little bit.
We're, we're used to things being easy. I have, uh, two boys that are five and seven and we put them in the cold plunge just to get them used to like, Hey, all right, you guys want a gluten free graham cracker tonight in the cold plunge for one minute and you get a treat and they're like, all right, all right, dad, I'll do it.
Dr. Dan Kalish: That is great. That's the greatest thing you could do. You kind of trained. They also have studies that trains resilience. It trains the ability to adapt to stress. Yes. It trains a lot of emotional development skills for people. Uh, adversity. I just, you know, dealing with adversity without. What without your cortisol going up in the, this one study I saw, it's like growth hormone is surging testosterone, 500 percent up and then cortisol flat.
It doesn't stress you out.
Dr. Justin Marchegiani: It
Dr. Dan Kalish: completely changes all your hormones, but it does not create an HPA access crisis. So somehow your body knows. Okay. I'm just like super cold here and your catecholamines are surging, but your cortisol is just like, whew, it doesn't screw you up. And then another is just positive mentally.
Not bad.
Dr. Justin Marchegiani: Yeah. I remember when I first jumped in it, I was like, I'm going to probably have a heart attack. I'm probably going to die. I'm 10 seconds in, I got three minutes left. I can't do it. And then you just say, I'm going to do it. I'm going to do it. And then you just push through it. Um, but some of the data on it, right?
Because I was kind of writing my book and I'm like adding a whole part on cold plunge. I'm like, well, if you think about what the nervous system does when you're stressed to your blood flow, it typically goes away from the core to your hands and feet to fight and flight, but it goes again away from the digestion, which then cause low HCL, low enzyme.
So when you think about what, where does the blood flow go when you get cold? Right? It goes to the core. That's the same place it goes when we're parasympathetic, right? To the core. Right? So, it's kind of mimicking that blood flow response based on the parasympathetic response, right? Dr.
Dr. Dan Kalish: Justin Marchegiani Oh, that makes total sense.
Yeah. That's so cool. It's pretty, it's pretty life changing. It really is. And then the extreme heat, you know, so I have a sauna, I have an infrared sauna, and I have a regular dry sauna also. And, um, yeah, being able to survive sustained heat, 10 minutes, 20 minutes at a pretty high temperature, that's a character developer too.
You know, the most interesting thing about this is that when, you know, I do a rowing machine once, not, I don't know, like a couple of times a week, I do my rowing machine. And when I first got my sauna and cold plunge set up, maybe four years ago, I was doing it for like a few days or, you know, three or four sessions.
And then I got back on the rowing machine and. I could row like it was like maybe 10 seconds faster on the rowing machine, which is a lot, you know, like a whole life,
Dr. Justin Marchegiani: right?
Dr. Dan Kalish: Yeah. And all I was like, what the hell is going on? Like, I've never been able to row this fast and it, and it was effortless. It was effortless.
And I was like, Whoa. And then it took me a while to realize, Holy moly. It was the cold and heat exposure. It's not a joke. It really does change your cardiovascular system in a dramatic way that you can see just in your physical fitness on a, on a rowing machine. That really blew my mind. So you read about like, I think in, uh, Scandinavian countries, they have like a 50 percent reduction in death from a heart attack.
by using a sauna. 50%. That's a lot. And you're thinking, okay, in an abstract way, you kind of think that's cool. But to see that you can do a rowing machine exercise, that's easy that used to be struggling. It makes you realize, Oh my gosh, like my heart is just working better now. Like fundamentally changing the functioning of your heart.
You know, it's pretty cool. Dr.
Dr. Justin Marchegiani: Justin Marchegiani That is really cool. Definitely changing the mitochondria. That makes sense. So what else is new for you and in the functional medicine world that you're really excited about right now?
Dr. Dan Kalish: Let's see. Well, Oh, should we talk about business stuff?
Dr. Justin Marchegiani: We could talk about a little bit of that, sure.
Dr. Dan Kalish: Um, you know here, and this is like, I'm trying to do this. I'm trying to do this. I'm old. I'm trying to do this. But I don't really have a big practice anymore. I think where the world is really heading is with membership.
Dr. Justin Marchegiani: Hmm.
Dr. Dan Kalish: I think that we should all have a functional medicine doctor that we pay. A fixed monthly fee to to keep us healthy,
Dr. Justin Marchegiani: you
Dr. Dan Kalish: know, cause I've always been fee for service.
Like you pay an X dollar amount per month or, you know, per session and now you're better. Now you don't come anymore. But I think the bigger service that we could provide is, is to keep. Get people, people, get people healthy and then keep them healthy. It's like when you, you don't drop your gym membership when you get in shape, you know what I mean?
You like, like keep paying that monthly fee. So you go to the gym and you work out. And so I think that somehow as a model, we need to be more as functional medicine practitioners, more able to get people healthy and then keep them healthy and to change the financial incentive because in the. Like, my practice as it exists now, I mean, it's a big disincentive to talk to me, because it's expensive.
But it should be just, you talk to your doctor when you're sick, you talk to your doctor when you're healthy, to keep you healthy. You know, and you know this too, right? Like, you get someone to a certain level of health, and then they drop out of your practice, because they feel better. But you may have only gotten them 20%.
To where they could be. You didn't get to the cold therapy. You didn't get to the exercise. You didn't really get to dial in their diet at the highest level or even their supplements at the highest level. So I feel like most of my patients have dropped out of my practice when they felt better, but I didn't really get them healthy, you know, right?
And so, and then, but, but nobody wants to keep paying for, healthcare when they're healthy. So I think kind of shifting our mindset to more of a, um, like a coaching relationship and long term relationship with practitioners. That's beyond just not being sick. You know, like, how do we, how do we facilitate that?
How do we make it so that people want to see us once a year, even when they're healthy so we can get on healthier and healthier and healthier? No.
Dr. Justin Marchegiani: Yeah. Maybe it's access to a live call where they can ask questions. Maybe it's just like, Hey, use a voxer app where you can ask a 30 second audio question and you can just Give them an answer back.
Something like that, I think, is a good value add for patients.
Dr. Dan Kalish: You could do a group. Yeah, you could do groups. So it doesn't cost a lot, you know. Um, but that I think is the next level. Like, okay, getting people healthy, we've proven we can do that. But how do we keep people engaged and keep them healthy in the longer run?
Dr. Justin Marchegiani: With the phones and how everything is now, the audio, it's, it's so much easier to connect. So I've been, yeah, you could do it with an app, huh? You could do it with an app. I mean, like the Voxer one. I mean, see, I listen to things at like two X, right? So, and so some of the apps where you can take the person's text and have it talk back to you at two to three X, the speed you can, you can be more efficient and you can help more people that way.
And you have these short little simple responses back and be good too. Yeah. I like that. Dr. Justin Marchegiani I like that. That's good. Where's your approach on the neurotransmitter still? You love the Makuna, so you're working that into your protocol. We already talked about a lot of the cofactors. Are you doing testing for that?
Are you just looking at the um, the organic acids and really looking at the VMA? The HVA, really looking at those organic acid neurotransmitters.
Dr. Dan Kalish: Yeah. You know, in fact, I had a patient today, I don't see patients much, but I happened to have someone this morning and hi, his whole neurochemical, his whole brain chemical portion of organic acids was perfect.
Dr. Justin Marchegiani: Wow.
Dr. Dan Kalish: Just out in and perfect. And those tests are so accurate. You know, I mean, they really are. So, I, I, I, I more and more rely on organic acids for at least. You know, uh, a survey of how the brain's doing. And if there's a lot of neuroinflammation on that part of the test, the quinolinic is high and that kind of stuff, and if the metabolites are all over the place, then you know the person's stressed, you know.
And um, I think that you, and, and then also I think, You can, when you see enough people that have a perfectly healthy brain and their lab matches that, then you realize, oh, okay, this is like the goal, like everybody should have this, um, ability to sleep easily and well, not be depressed, not be anxious, you know, not be like stressed out of your mind with every little thing that happens, you know, people have a certain amount of equanimity and balance, you know, when their brain is in good shape.
I think that's just kind of missing from our culture now. In fact, kind of normalized a screwed up brain. Like it's, it seems like. The way things are, but it doesn't have to be like that.
Dr. Justin Marchegiani: What are the big stressors? Is it just too much on the phone? Is it too much of the pesticides and the various chemicals in our environment?
Is it not enough protein not digesting enough? Is it everything? What is it?
Dr. Dan Kalish: Yeah, if I was gonna order it, you know, I would say Uh, physical conditioning is the most important thing, like being in, in ridiculously good physical condition gives you a lot of immunity against other stuff.
Dr. Justin Marchegiani: And
Dr. Dan Kalish: then I would probably put, uh, like emotional, spiritual health, either before or after that, you know, and then food, you know.
But you know, I have plenty of patients that eat impeccably and are totally screwed up because their body's not in good physical shape. They just can't use the nutrients because they don't have enough muscle mass and their vo2 max is like crappy and You know and and in the reverse I have lots of Patients over these years who have very, very top physical conditioning with crappy diets.
And they look a lot better on the labs than the, than the opposite. So in other words, like you could dial in your nutrition perfectly, but if you're not exercising, it's almost a complete waste.
Dr. Justin Marchegiani: Or if you have parasites and you can't absorb things and your stomach acid's low, that's a big one.
Dr. Dan Kalish: Oh, yeah. If there's any kind of gut infection, no matter what you're eating.
Yeah, you're screwed. Yeah. Dr. Justin
Dr. Justin Marchegiani: Marchegiani Yeah. No, that makes sense. What's your diet looking like these days? I remember you started off kind of gluten free, soy free, kind of, uh, you know, dairy free kind of guy. And you would adjust your macros. You always seem to be a little bit higher carb. You were kind of more of a, you know, you could handle more carbohydrates.
I know you were paleo, then you were a little bit more plant based a little bit and you were kind of restricting meat.
Dr. Dan Kalish: Marchegiani I've been all over the map. Dr. Justin Marchegiani Yeah, you have. You know, don't do what I do. Oh, and also, real quick
Dr. Justin Marchegiani: for the listeners, you were also a Buddhist monk for a handful of years, so you had that kind of background, right?
Dr. Dan Kalish: Yeah, I'm kind of back to that, you know, so I lived in, as you said, in a monastery in Thailand for three years, and Um, one of the monasteries we ate once a day and the other one twice a day. So I'm back to that. I eat one meal a day, a couple of days a week, and I eat two meals a day, most days of the week, and then we were on vacation at the beach this weekend.
And okay, so did I have like. I didn't have the pastries, but I definitely had, like, bread and eggs. So I'm back eating gluten again, if it's really good quality grain. Um, and that doesn't seem to bother my system at all. In fact, I really like it quite a bit. I generally don't eat until 12 or 1 or 2. And I find the longer that I don't eat, closer to 4 p.
You just, my lifestyle doesn't work for that morning meal. So, um, one meal a day, a couple of days a week and then two meals a day all the time. Never really eating before 12 noon. Uh, I drink a fair amount of water and then in terms of the actual foods I'm eating, I'm on probably what most people would consider a pretty high protein diet.
Um, so I do a lot of eggs, meat. So you're doing more of
Dr. Justin Marchegiani: that now. Cause you were like, trying to do more lentils and beans for a bit, right?
Dr. Dan Kalish: Yeah, my body just doesn't do well on the vegan thing, man. I just can't live on the vegan thing. I don't know what's wrong with me metabolically, but I just can't do it.
So I'm pretty high on the meat. There's a lot
Dr. Justin Marchegiani: of anti nutrients in those foods.
Dr. Dan Kalish: Yeah. And, um, A lot of veggies, a little bit of fruit. Um, I, you know, pretty much my solid bowl full of vegetables twice a day. Uh, and then berries. I do berries on that. And then I went through a phase last year where I did a lot of protein shakes.
It's all these people now talking about how much protein we need, you know, and it's like double what everyone used to say.
Dr. Justin Marchegiani: And
Dr. Dan Kalish: you can't really eat enough protein for what some people say you need. Some people, meaning some researchers say you need.
Dr. Justin Marchegiani: Yeah.
Dr. Dan Kalish: Um, you know, it used to be like a guy my size would need like 70 grams a day.
Now they think like maybe it's more like 150. So I mean, how much meat can you eat really? So I tried that for a while. I did the protein shakes. I got really strong. I got stronger in the gym. I started deadlifting 200 pounds and I definitely put on some muscle with that, but I don't know that I felt that much better.
I don't know if I need to deadlift 200 pounds every day. Like, what the hell? So I'm kind of back to like deadlifting 165 now. And not doing any protein shakes. I don't know. How much muscle mass do you really need? It's kind of a tough call. But my goal is to be able to, I always want to deadlift my body weight.
That seems reasonable. You know, I should be able to do five reps, three, three or four sets of my body weight in a deadlift. Um, And China, you know, I don't know how much, but definitely is the case that when I was doing the protein shakes, I did get stronger, but I don't know how much we need to do that. Um, yeah.
And then I think the thing that I, the thing that has to happen every day, which is the hardest, and I really try to focus on, it's just getting enough vegetables in, you know, no matter what, no matter what I'm doing with the carbs and protein.
Dr. Justin Marchegiani: Excellent polyphenols for the gut, right?
Dr. Dan Kalish: Yeah, I do berries every day.
I do cranberries or blueberries every day. Um, the more you read about polyphenols, the more you want to eat berries. And they don't screw your blood sugar up much either, right? No. You know.
Dr. Justin Marchegiani: No, they're pretty good. I mean, you got a glycemic index, a low 30s, and if you, you know, have it after you have some protein, then it's gonna, the glycemic load just kind of comes down pretty low.
Dr. Dan Kalish: And I just read this the other day that raspberries have all kinds of fiber in them. Did you know that? I didn't know that.
Dr. Justin Marchegiani: Yeah.
Dr. Dan Kalish: Full of fiber. Like, they don't look like they have a lot of fiber.
Dr. Justin Marchegiani: Yeah. You wouldn't think that. Plus, they're lower FODMAP. So. So, if someone's got a lot of bloating or gas, you know, you can do pretty good on raspberries.
Usually it's the blackberries or blueberries that are more problematic, but yeah, raspberries are good. Dr. Justin Marchegiani
Dr. Dan Kalish: Well, then the other thing I kind of discovered, I'm a little late in the game on this, but eventually my students, like yourself, just wear me down, is the whole histamine thing, you know, um, so I used to, I just was avoiding low histamine diets for patients, but I've got a couple people a year now where it really does seem like their main problem is histamine in their foods.
So, I've kind of. open my, I've gotten open to doing low histamine diets now. And I had one, a patient like that about a month ago. Um, in fact, that was his whole problem was histamine. Surprising. You wouldn't think it'd be the case, but
Dr. Justin Marchegiani: then the question is, where is the histamine coming from? It's like, okay, the food, you can definitely cut out like aged meats or like, you know, bacon, or maybe some of the citrus stuff, or if they're doing nuts and seeds.
But then people don't realize like if you get like Klebsiella or Citrobacter or SIBO overgrowth, that bacteria can be making a ton of histamine. So you get this bucket, And then the back, they can take the histamine that's already full, or they got a bunch of mold in their home, and then, then the food is what that little bit that overflows the bucket.
Dr. Justin Marchegiani
Dr. Dan Kalish: That's why I think I got away with avoiding low histamine diet. Because I did so much dysbiosis treatment, you know? Dr. Justin Marchegiani
Dr. Justin Marchegiani: Yes. And just a good anti inflammatory diet just tends to avoid a lot of histamine in general. Dr. Justin Marchegiani
Dr. Dan Kalish: Yeah. Yeah. So that's
Dr. Justin Marchegiani: why it's like, I mean, you kind of said it like if you really work from the top, right?
I think you always said like system based approach versus a symptom based approach. Systems are always way upstream. Symptoms are downstream. And when you, when you do so many things upstream, you're gonna, because you do, I don't know, let's say because you eat these nutrient dense foods, right? You may be getting someone more zinc or more selenium and you didn't know there was a zinc deficiency but because you got them eating more of this thing you fix that even though that wasn't even on your radar and there's so many of those examples that you could give anywhere from you improve this biosis by getting them to eat some fermented foods or you got them to sleep better which increased their growth hormone but when you do the first principles upstream so much of that trickles downstream you may miss it but you get it by default.
Dr. Dan Kalish: Yeah, that's so true. That's so true. That's why, you know, so many times you just do these basic things and you're fixing complex problems that you actually maybe never even knew were there. That happens a lot.
Dr. Justin Marchegiani: And this is where functional medicine, I want to hear too, because you did like, I mean, you did the Mayo Clinic study like this is probably over 10 years ago on functional medicine.
And I always told people it's so hard to do a like double blind placebo control study on functional medicine because of the fact that medicine is always about controlling for a variable. Take this drug, take a water pill. Now we can control the difference. The patient won't know the doctor won't know.
That's like, you know, gold standard medicine, but the problem is in functional medicine world, it's like, all right. We're going to get you drinking more water. We're going to get you sleeping better. Here's some vitamin D. Go for a walk. Get some cold therapy. Uh, let's take some omega 3s. Let's cut out gluten.
Let's cut out dairy. I just changed 10 variables. Like, conventional medicine would hate that study because they would be like, you control too many variables. We don't know what the hell controls what now. That make sense?
Dr. Dan Kalish: Yeah, yeah, and I think I'm not against medicine in any way, but you gotta look at what, you know, it's not
Dr. Justin Marchegiani: neat, though.
It's not neat. We don't know what out of those ten things was the needle mover, but with this one to one drug thing, we can know.
Dr. Dan Kalish: Yeah, I mean, the placebo controlled double blind studies were basically just set up for pharma, and they worked for that, but outside of that, And of course we all know that maybe some of the ramifications are not so great because many of these medications have other effects that aren't known and originally, you know, but um, but yeah, you can't really, it's not that science doesn't apply to the functional medicine principles.
It's just that you know, the scientific study paradigm that's pharma based doesn't work at all.
Dr. Justin Marchegiani: No.
Dr. Dan Kalish: But yeah, we still know all of us who practice this can see the effect of it, you know, quite powerfully. That's pretty undeniable. And that's been going on for centuries, really. You think about it, maybe thousands of years.
It's not like we're the first round of healers that ever thought about changing someone's diet, you know, this has been going on for, yeah, probably. 10, 000 years, somewhere in that range, pretty long time, right? It's not, you were the first,
Dr. Justin Marchegiani: you were the first functional medicine person to really get a, a major study.
You did the one at Mayo. What was the final outcome and verdict of that?
Dr. Dan Kalish: Yeah, it came out pretty positive, actually, you know, uh, we did 25. Uh, women, we did adrenal and GI protocols only six months protocols and uh, most people got better. It was pretty impressive actually. I was surprised how well it came together.
What journal was it in
Dr. Justin Marchegiani: by the way? What journal was it in?
Dr. Dan Kalish: Uh, you can, if you Google it, can you find it? Let's see, uh, Are you the author of it? Yeah. Yeah. I'm the primary guy, print Kalish and Mayo Clinic Study. Let's see if it shows up. Uh,
Dr. Justin Marchegiani: I see what year was it?
Dr. Dan Kalish: Oh, there it is. Look national institute of health. Yeah, it's on pub med. Look at me It was a complimentary. Yeah, if you google it, uh, Uh kalish and mayo clinic study pops right up on pub med. That's a beautiful thing I never even tried that all these years. That's so I
Dr. Justin Marchegiani: got I got I got to pull this out.
Hold on I got to pull this up.
Dr. Dan Kalish: Yeah, try it try doing Kalish and mayo clinic study And then it went right to a PubMed citation.
Dr. Justin Marchegiani: Let's see here. What's it called? What's the actual study called?
Dr. Dan Kalish: Evaluation of a Functional Medicine Approach to Treating Fatigue. Sue Cuttsall, Larry Bergstrom, Daniel Kalish.
That's pretty funny. That's so funny I never even looked that up. What a joke.
Dr. Justin Marchegiani: This is great though, I mean. At the
Dr. Dan Kalish: time, at the time, it was the only functional medicine clinic study that Mayo had been involved with.
And the Sue Cutts Halls at Mayo Clinic in Minnesota, Larry Birdstrom is an interesting guy. Larry Birdstrom was the director of Mayo Clinic's internal medicine department in Minnesota for a decade. How did you
Dr. Justin Marchegiani: ever get connected with that? Because I mean, there wasn't really a big functional medicine kind of thing going in the peer review literature like this.
Dr. Dan Kalish: No, and in fact, so what happened was, um, Brent, Brent Bauer, who is the director of integrative medicine at Mayo, took my training program and then he told Larry about it. And Larry took my training program twice. I think he's the only doctor that ever took it twice. So they were really into this whole thing.
And then, and then Larry and Brent were like, Hey, we should do a study. And we pulled together a bunch of money and just did it. Um, that was pretty cool. It was a whole year of my life to do that. Oh yeah, look at that. There we are. Wow. So Larry, Larry was the head of integrative medicine. Yeah. Larry was the head.
When I met Larry, he was the head of integrative medicine at Mayo and Scottsdale, but before that, for a decade, he was the director of their internal medicine department, which is arguably the most powerful academic department in the world, right? It's the internal medicine at Mayo Clinic. It's like a hundred doctors under him.
And they only let you do that job for 10 years and you have to leave. So he did his 10 years running that. And then I think he was tired of Minnesota and moved out to Arizona where there's some sunshine and and set up a new integrative department out there. So Larry anyways was at the highest levels of academic medicine for a decade.
He's a pretty intense guy. And then he got interested in integrative medicine after that. Um, I need to get in touch with him. I haven't talked to him in a while.
Dr. Justin Marchegiani: And look, they even mentioned your three body system approach, which I think it's just, it's a great way to simplify stuff.
Dr. Dan Kalish: Yeah. Basically, we studied the Kalish method, which is kind of funny.
Dr. Justin Marchegiani: Wow. This is the whole thing. Wow. Yeah. Dr. Brent Bauer. Yeah. Very cool. Wow. That's amazing, Dan.
Dr. Dan Kalish: I know. You never know what, what the world's going to throw you. And one of my graduates, I won't mention his name, but, um, he graduated from the Kalish Method Mentorship in July, June of one year. And in July, he was the first doctor that Cleveland Clinic hired to do functional medicine.
Wow. So we've had, yeah, we've had, uh, A bunch of interactions with academic people, um, which is good. I mean, and hopefully there'd be more of that, more acceptance, you know, what we're doing here. Dr. Justin Marchegiani
Dr. Justin Marchegiani: Well, very cool. And I have a book coming out in just the next month here that you wrote the forward to on the thyroid reboot.
So I appreciate that. And uh, it's a great way to kind of, to pay it forward to the next generation of, uh, functional medicine docs.
Dr. Dan Kalish: Yeah, I'm excited about that. And you're, you're ventures in here as I'm kind of slowing down and stopping, you seem to be going full steam. So it's super important.
Dr. Justin Marchegiani: Yeah, it's like handing it off to the next generation, right?
Dr. Dan Kalish: Yeah, that's awesome.
Dr. Justin Marchegiani: Yeah. I mean, it's like the thing is you stand upon the giants that came before you, right? That that's really the.
Dr. Dan Kalish: Yeah,
Dr. Justin Marchegiani: anyone that's good. That's kind of the general motif, right?
Dr. Dan Kalish: Yeah, exactly.
Dr. Justin Marchegiani: Well, anyone listening here, whereas we're getting kind of close to the end, anyone listening that wants functional medicine training, whether you're on the patient side or definitely on the doctor clinician side as a functional medicine doc of 15 years, I could say Dr.
Dan is probably the most. important person in that, in that career in regards to education and not just education, but philosophy. Because if you don't have the right philosophy, philosophy is the bookshelf, right? It allows you to organize all the information in the right order and then you can recall it and be able to use it in the right way.
And so Dr. Dan would probably be the best resource for that out of, and I have. I've seen all the programs that are out there and so that's my shining recommendation for Dr. Kalish. Kalishinstitute. com. I'll put the link down below. Dr. Dan, anything else you want to highlight or kind of share to the listeners here?
Dr. Dan Kalish: Uh, no, I think I'm good for now, but I appreciate your time and getting this whole thing set up very much.
Dr. Justin Marchegiani: Yeah, we're coming to the end of 2024. Let's chat again sometime in 25 and just see what else is going on with you. I appreciate you sharing all the cool things. I didn't know you were so into the cold therapy.
That's so cool.
Dr. Dan Kalish: Yeah, yeah. It's my life. For better or
Dr. Justin Marchegiani: worse. Awesome. All right, Dan. Hey, great chatting with you. Have a good one. Take care. Bye.
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