Dr. Daniel Kalish on Aging, Mitochondria, Hormones, and Longevity

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Katie: Hello, and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com and wellnesse.com. That’s wellness with an E on the end. And this episode is all about mitochondria, which may be affecting your health more than you have ever realized. I certainly actually learned a lot in this episode and am curious to keep delving into this world as well.

I’m here with Dr. Daniel Kalish, who is the founder of Kalish Wellness, which is a telemedicine functional medicine practice, and he helps patients understand their lab data from an advanced functional medicine perspective. He has been in practice and very popular for 30 years, and has worked with tens of thousands of patients on a variety of concerns. He’s also the founder of the Kalish Institute, which is a physician training program in functional medicine. And he has now trained over 5,000 practitioners. Graduates include practitioners ranging from Dr. Mercola’s medical staff to Mayo Clinic and Cleveland Clinic physicians, so he knows what he’s talking about.

In this episode, we start off by hearing a really cool story about his monastic training early in life, and then really going deep on the subject of mitochondria and basically what happens when someone dies of “old age,” the one variable that everyone agrees can extend lifespan and how to take advantage of it, why your level of muscle mass is one of the most clear determinants of how long you’ll live, his tips on improving both of those things, and then really, really going deep on mitochondrial function, everything from how we can measure it, what symptoms of low mitochondrial function include, why excess weight gain and trouble losing weight might be connected to the mitochondria specifically, the mitochondria-thyroid connection, steps we can all take to improve mitochondrial function, some less-known things that may be decreasing your mitochondrial function in a really negative way, how to know if you have a damaged metabolism and what to do about it, how environmental toxins, breath work, and a lot of other things come into play. And he provides some really practical advice in this episode. Like I said, I learned a lot. I think you will too. So let’s join Dr. Kalish. Dr. Kalish, welcome to the podcast.

Dr. Kalish: Yeah, glad to be here, excited to be talking with you all.

Katie: Before we jump into that, I have to ask because I have a note in my show notes that you spent two years in formal monastic training, setting at a Zen monastery in Japan, and then also in Thailand. And those are probably the two top places on my bucket list. So I would love to hear just briefly about your experience there and what you learned.

Dr. Kalish: Yeah, so when I was 18 years old, I went to Japan. And I studied under a man named Harada R?shi, who’s one of the, you know, generally agreed upon enlightened Zen masters of his time. This is 19…woo, 19-something, 1980, you know, early 1980s, 1982. And so, I learned a lot there about Zen meditation and Buddhism, in general. I learned a lot about pain because you have to sit in a full lotus for 12-plus hours a day, which really hurts your knees. I learned a lot. As a young man, teenager, it was a good experience.

And then I graduated from college and then I was like, “Oh, I should do this again.” So I went back to Asia and this time, I went to Thailand, to southern Thailand and studied with a master named Ajahn Buddhadasa, who was quite a trip. And it was a large monastery, it’s like 80 monks. And I spent a year-and-a-half, maybe two years there. I never ordained but I lived with the monks. And it was sort of like a…I don’t know how to…Looking back on it now, we were all just so young. There was men in their 20s being, you know, spiritually oriented, and trying really hard to get all this done.

And they did have a section in that monastery for women only also. But the women were more rational about it, you know. We were…I mean, I would wake up at 2 or 3 in the morning and go to the meditation hall because I wanted to get a good cushion before the crowd showed up at 4 a.m. And we would sit, or I would sit from 2 or 3 in the morning until 10, 11 that evening. I don’t know that it was the best thing, but for me at that time it was a good experience, you know. But what it taught me was that you can’t get enlightened by forcing things.

So I ended up coming back to the U.S. and deciding to have a more normal life, although many of my close friends ordained and they’re still in these monastic settings today, you know. But it was a good experience. And I learned a lot about the spiritual practices that are widespread in Asia, and they don’t really appear in the United States in the same form. You know, they get translated over here, but it’s not quite the same.

Katie: Yeah, it does seem like that meditation in that world is becoming more popular in the U.S. now. But it seems like you were very ahead of that curve. And is that a practice of…meditation, is that a practice that stayed with you throughout your life?

Dr. Kalish: Yeah, currently, for the last 10 or 12 years, I’ve been setting with a Taoist Master, who’s actually Australian but lives in the United States. And so I meditate now, maybe two, three hours a day doing these Taoist practices, which I like a lot. And then this is actually my favorite thing I’ve ever done on the spiritual life side. It’s, sort of, what I was made for. So I’m very, very interested in Taoism and the Taoist practices, you know, and they’re health-oriented, you know, like, I mean, they were vegan before vegan was cool. They were vegan 5,000 years ago. They’re, you know, really interested in mitochondria and energy and breathing exercises. And the nice thing about Taoism is that it’s health-centered and longevity-centered.

And, you know, at least what I learned from the Buddhists in Asia, it was more like a torture camp for pain and suffering. You know, I mean, it’s kind of enlightenment through pain and suffering, okay, I get that, or enlightenment through health and vitality. So I’m really drawn to the Taoist thing. Anyone who’s a Buddhist is probably going to be assassinating me for saying it but that’s how I interpreted Buddhism in Asia anyways, we suffered a lot. There’s a lot of pain involved and the Taoists really have it the opposite viewpoint.

Katie: And it seems like, yeah, we’re now using science to understand what they’ve known for a long time and that…I always find it funny when I see studies about meditation, and they’re like, “Oh, it increases your HRV. And we’re finding out that your mindset can impact your physical body.” And I feel like these people have known that for a really long time.

Dr. Kalish: Yeah, there’s a very big component of the Taoist stuff that I study that’s healing-oriented, huge component. You know kind of like acupuncture, but in a different way, you know, along those same lines of energy healing for the physical body. Yeah, but I’ve seen my teacher do things that I’m like, “Whoa, I can’t believe that this happened.” If you get really good at this, you can help people heal rather instantaneously. It’s pretty profound, you know.

Katie: That’s incredible. I’ve studied some of the martial arts that come from places like Japan. And they always talk about how the 12th level, the highest level of any of those is actually to heal people. That like the fighting is the baby steps in the beginning, but that like the true mastery is when you’re actually able to impact someone in a positive way. So what a cool, amazing life story. That’s incredible. Thank you for sharing that.

Dr. Kalish: Absolutely. Yeah, that’s probably the most important thing about my life. I guess in public I’m known as a functional medicine teacher and practitioner, but yeah, the spiritual world is of more interest to me, to be honest.

Katie: Well, it seems like there’s crossover there that we’re identifying more and more in that people finding other spiritual practices, meditation, etc. have a direct crossover into how the body feels and works and functions. And I know science is only barely beginning to start to understand that, but I feel like it’s very relevant, actually, to the functional medicine world as well.

Dr. Kalish: Yeah, and sometimes the functional medicine doctors talk about this, sometimes they don’t. But the 3 doctors that trained me, the ones that I spent 5 to 10 years with, were all intensely spiritually-oriented people, but also a little private about it, you know. But if you would talk to them, if you would bring it up, they would talk about it. But you know, they saw the world of healing as being the world of spiritual growth. And then they practiced functional medicine, you know, it’s interesting.

And all from different backgrounds. Like, Glenn Frieder is Jewish. My big teacher, Dr. Timmins, is a Catholic, Irish Catholic guy. And my current teacher, Dr. Richard Lord, is Baptist, Southern Baptist. But all tensely aware of how the spiritual world guides the healing process, and then experts at doing labs and experts in prescribing supplements, and that other layer too, you know. So it’s interesting to see that historically, this area of functional medicine has attracted people who have that split view, science plus the spiritual world coming together, I think.

Katie: That’s so fascinating. Well, I guess that actually is a good lead-in point to talking about what we’re going to talk about today because I’m a big believer that things like meditation can be very helpful in some of these things we’re about to start diving into. But the first thing I want to touch a little bit broadly on aging because that is a topic I hear a lot about from my audience. And it’s something that’s more top of mind for me now as I get older as well. So what are some of the current scientific theories surrounding aging, and especially looking older? Because ironically, I think people are more concerned with how they look as they age than the cellular level. Obviously, there’s a connection there. But for instance, like skin quality, energy levels, those are big topics I hear from a lot of people about.

Dr. Kalish: Yeah, I mean, people don’t wake up in the morning and think, “I hope I don’t have a heart attack today.” But people do wake up in the morning and look and see, “I wonder how my skin looks,” you know. So there’s definitely this level of superficiality to all of us. But I think it’s kind of important, you know, that we want to feel that we’re looking good and we feel like we’re presenting our best selves, you know, on a physical plane, as well as spiritual plane and those sort of things.

And so it turns out that there’s a huge area of study now in understanding why cells age and die. Cell senescence, they call it, you know, what makes that happen. And so if you look at the human lifespan, a lot of people die…a big chunk of people die in their 50s and 60s, and they get cancer, they have a heart attack, they get taken out by something like that. But if you get a little bit past that window, in your 70s, then people die of “old age.” Old age, meaning that they just gradually slow down and wear out, sometime in their 90s they just expire. And so I think there’s two aspects to this. One is that, what causes people to age? What causes people to die of “old age?” And why are the cells wearing out in the first place? Is there a way you can change that programming so you could have 20-year-old quality cells in a 90-year-old body?

And a lot of that research centers around mitochondrial function. It also looks a lot at oxidative stress. And there’s one variable that everybody agrees on, it’s hard to get people to agree on things in the scientific community that extends lifespan, which is calorie restriction, or intermittent fasting as is known nowadays. And interestingly, if you go back and look at the monasteries I lived at in Thailand, several of them, the two I lived at, this has been going on for 5,000 years. The monks eat one meal a day. They wake up in the morning, they go beg for food, they take the food back to the monastery that the people in the village gave them, they eat that one meal and that’s it. One meal a day, so they’ve been doing intermittent fasting since the time of Buddha, and there’s a reason for it, you know, it extends lifespan. And it’s, kind of, a profound thing to do. We don’t usually do one meal a day with patients because that’s not realistic, we try to make it may be a short eating window with two meals. That’s kind of a modern version of what we’re talking about.

And so that’s the lifestyle change you can do, and obviously staying physically fit and keeping your muscle mass. So sarcopenia is the medical term for the loss of muscle mass. And the level of your muscle mass is one of the most clear determinants of how long you’re going to live, which is surprising. So if you look at, like, mortality and what are the ways that you can predict when someone’s going to die, muscle mass is right at the very top of the list. And so you want to keep good muscle tone, you want to not eat too much, on the lifestyle side. And both of those things, it turns out, are all driven by mitochondria, which is fascinating, you know.

And then the next thing that you’re looking at as well, what do we think about the mitochondria themselves, like, could we actually test and correct any problems with them? And that’s the area that I’m most interested in, in terms of the lab work, in terms of preventing aging. And I guess the superficial versions of that, okay, your skin looks better, you have more pep in your step, you have more energy, you feel like working out more, you feel like having sex more, you just feel more vibrant and alive, you know. And it’s a key way to help prevent diabetes, cardiovascular disease, cancer, etc. is to keep the mitochondria healthy. So it has health implications and, sort of, you know, personal beauty implications as well.

Katie: It makes sense that those are all so related. On the note of calorie restriction, I agree, this is one of the few areas it does seem like everyone is on the same page. I would say that and sleep. I’m yet to see any health experts say you benefit from poor quality sleep. What do you feel like personally is the best way for the average person to do that? I feel like there’s a lot of misinformation out there when it comes to calorie restriction and what eating window should look like. And especially I’ve heard of women being told that women should not ever have a restricted eating window, which I don’t personally agree with, but I’m curious to get your take.

Dr. Kalish: Well, I guess the biggest picture view of it is that if you’re sick and your hormones are unstable, you need to regulate your blood sugar. And it may be hard or impossible to do calorie restriction or intermittent fasting. And the sicker you are, the more repair you need. In general, the more you need to eat protein and eat fat because we need proteins and fat for healthy…you know, to get healthy. So I think there’s a different set of diets that we use when people are sick to get them healthy. But that’s assuming you are healthy, and you’re in good shape, and you’re not worried about blood sugar regulation, you’re not worried about all these other things. So you’re starting with a pretty high level now, whatever autoimmune illnesses are gone, or whatever chronic thyroid problem you had is gone, you’re healthy.

So the healthy person then, well, the best way to do it, the way that I think is the most convenient because it’s just the most realistic with our culture is you have your dinner around, you know, 5, or 6, or maybe 7 p.m. And then you don’t eat the next day until the earliest would be like noon, then you have a lunch meal that’s kind of light around noon-ish. And then you have your next meal again around 5, 6, 7 p.m., somewhere in that window. That seems to work the best, and it’s realistic for most people. And you’ll find that you also want to exercise when you’re fasted, in the fasting state, because that’s going to stimulate something we call beta-oxidation, which is burning of fat for energy or fat for fuel. And if you want to mix into that, you know, periodic complete fasts where you skip a whole day of food, that’s not a bad thing. But most people don’t want to do that on a regular basis.

And women, if you’re sick and you have a hormone problem, man or woman, then intermittent fasting can go bad on you quickly. But if you’re a healthy and fit person, then it’s a wonderful thing. In fact, my partner, she’s way better faster than I ever could be. She’s on a week-long juice fast right now. You know, we had dinner last night, it was like the first meal she had in a week. And she’s going to do a second week. So women, I mean, personally, my experience, women do a better job at this than men. You wouldn’t want to do it if you’re trying to get pregnant or something, obviously, right? I mean, there’s some rules around that. Or if you’re breastfeeding, you wouldn’t want to do it, but outside of that…

Katie: Got it, that’s helpful to understand more in-depth. And you’ve mentioned mitochondria already a couple of times. And I feel like maybe people have at least heard this term in high school biology, but maybe don’t clearly understand it in a holistic sense, or especially in an aging capacity. So can you give us an overview of what mitochondria do and how they work?

Dr. Kalish: Yeah, so the mitochondria regulate your metabolism. I think that’s the best way to think about it. So what is metabolism? Metabolism is the reality that the human body needs energy, needs to get energy from food, generally, right, and the ability to eat protein, fat, and carbs coming into our system, and then how do those foods get converted into energy that your cells can use? So the mitochondria, their role is to take the energy from your food and convert that into something that every cell in your body can use. And there’s certain parts of your body that use a ton of energy. Like, obviously, your brain sucks up, I think, something like 20%-something of the total energy for the whole body. Your heart, constantly pumping 24 hours a day, takes another 20% something. And I think your liver takes 20% something. So there’s certain areas like heart, liver, and brain that are just huge energy hogs, you know, they’re just burning through tons of energy. And then, of course, every cell in your body needs some amount of energy as well.

And then mitochondria, they’re tiny little things, you know, they’re called organelles. And they’re inside the cells of the body. Some cells have thousands of them, like muscle cells have thousands of them because muscle cells, obviously, are really active. Heart cells, you know, cardio system, they have tons of mitochondria because a heart has a lot of work to do. And they’re kind of the critical component in the functioning of all this.

And it turns out that as mitochondria become more and more dysfunctional, they don’t work quite as crisply and cleanly, and that exchange and production of energy gets dirtier and less functional. That’s what causes cells to age, this process we call oxidative stress or free radical damage that takes its toll on people as they get older. And so that’s kind of the Holy Grail, if we can figure out how to prevent oxidative stress or free radicals from damaging mitochondria, then, you know, we could potentially live to be, I don’t know, 140, 150, whatever.

Katie: Do you think that that’s something feasible we might actually see during her lifetime?

Dr. Kalish: I don’t know. You know, think about it like, already, you know, my mom is 83 and most of her friends are well into their 90s. And, you know, we joke about her because we can’t even keep track of her. She goes to baseball games, they went to…I mean, every time there’s like a show somewhere, they’re all on the road. I mean, these people are active. If you think about 50 years ago, you know, what did doctors think about, would there be tons of active people in their 90s running around? Probably not, you know, so that we’ve, I think, even in the last 100 years seen this expansion of people in their 90s who are quite healthy and fit and active and doing things.

So I don’t see why they couldn’t go up another 10 years and another 50 years, you know, why they couldn’t gradually expand because I don’t think we’ve even begun to crack the code on how the mitochondria work and how they can be improved. I think a lot of the longevity that we’re seeing now is just more public health-related issues, or, you know, lack of infections, and people maybe having a little bit, you know, better control over things in terms of lifestyle than we have in the past. But yeah, I think there’s definitely the potential for that.

Katie: And you mentioned you’re excited about the ability to have lab testing for mitochondrial function. Talk about that, what types of lab tests are available now? What is current research and potential future research look like in that?

Dr. Kalish: Yeah. So there’s like two separate tracks. There’s the track that I’m on, which is we measure mitochondrial function using a test called organic acids. And this technology has been around since the 1960s, but the integrative and functional medicine doctors started to apply it to mitochondrial function maybe in the ’80s. And we can measure every step with which the mitochondria makes energy. It’s kind of like when…this just happened to me recently with my car. I has this Audi Allroad, and it started to throw an engine light, you know, and I don’t know what that means. It could be like 300 different things. So I brought it into the shop and they ran this little machine computer thing for me, “Oh, it’s your oxygen sensor,” you know.

So there’s all kinds of different things that can go wrong with a car. I mean, it’s like that with mitochondria. So we’re literally measuring each little step in mitochondrial function just like a computer at your car mechanic place measures what could be potentially going wrong with the engine of your car. And then we can get super-specific. If you’re wondering, the oxygen sensor’s, like, 124 bucks. They take two hours to install, so it’s not a huge bill, it’s like a $300 car bill. But what I do, like, oh, you know, it’s not the oxygen sensor, it’s the citrate, you know, marker is super high and that means you need this, or your lactate marker is super high and that means you need B1 and B3. So we’re getting…it’s like running a computer diagnostic, but it’s on the mitochondria. And then we can target lipoic acid, or CoQ10, or magnesium, exactly where things are wrong, and get those aspects of dysfunctional mitochondria working. So that’s how we deal with it in clinical nutrition.

There’s a whole separate track. And interestingly, my son is on this track. He’s in graduate school now in biophysics, and they measure mitochondrial function too at UCSF. This huge…I just went to see his lab the other day, I mean, these people are getting hundreds of millions of dollars in research money to look at this stuff because everyone wants to figure out this aging problem. And so in the more conventional scientific perspective, they’re taking pictures of mitochondria, they’re seeing…this is what Asa does in his lab. And they’re giving mitochondria amino acids and seeing if they grow, or if they shrink, or how can we get these things to work better. There’s obviously a pharmaceutical application team, they’re trying to figure out drugs that might work as well.

But everyone’s on this track, both in the more conventional scientific groups as well as the integrative medicine groups to try to figure out how to make these little guys work better and more efficiently. And the labs where you can look at each biochemical step in the pathway, to me, are the most precise. There’s also DNA testing that’s done. But again, I think the organic acids labs give you the deepest insight most instantaneously to how they’re functioning and give you the punchline about what you should do to try to fix that aspect of the mitochondria that aren’t working properly.

Katie: That’s really, really fascinating. And I would guess that also, like, most people aren’t able to look at their mitochondria or their organic acids at home. But it would seem like if it was something that’s going to have a whole widespread body effect, there would probably be some common symptoms or noticeable external things that someone might see if they had a poor mitochondrial function. Are there ways that this shows up that are noticeable to a human?

Dr. Kalish: Oh, absolutely. So you know, cellular energy. So number one, you get tired, you don’t have the energy that you used to have. Brain function I mentioned earlier, right. So you get a little brain fog, a little memory problem, just not that crisp brain capacity that you’re used to having, that would be another sign. Any kind of hint of cardiovascular problems. So that could be high cholesterol, high blood pressure, high triglycerides, metabolic syndrome/diabetes type things. So high glucose levels, anything along those lines, by definition, means that mitochondria are working well.

And obesity, you know, so weight gain, because they’re burning fat, they should be burning fat. And in fact, the preferred fuel source for mitochondria is your body fat. And if you’re not burning that body fat effectively, then it’s going to accumulate, and then you’re going to get fat, right? So that’s another sign that the mitochondria aren’t working as they should. Or maybe they’re being overloaded with too much food or it’s a variety of different things. Some of this is lifestyle-driven, too. So all based on the labs.

Katie: That’s interesting. So basically, weight gain can be a potential symptom of low mitochondrial function. Does that work in reverse as well, that improving mitochondrial function can also help people with stubborn weight?

Dr. Kalish: Absolutely, because it’s your metabolism, basically. So when you say, you know, well, everyone knows the term metabolism, it means the burning up of protein, fat, and carbs, you know, for fuel, for energy, but where that’s actually happening is in the mitochondria. And so if they’re not working very well, then that process gets, kind of, gummed up and you can end up…if your mitochondria aren’t working well, your cholesterol goes high, your blood sugar can get wonky. And as that process starts to happen, you can end up with what we call insulin resistance, and then you can end up with a fatty liver, and then you end up with a lot of body fat because your body is just storing all these excess calories, it can’t burn them very well.

And ironically, many people are walking around with plenty of fat to burn in their body, they have the body fat, but they can’t do it very effectively. So they’re also tired, or they get kind of depressed or anxious. We have actually a really great case last week, it was one of the doctors in my training program talking about herself. And she had lifelong anxiety. And this is her, you know, speaking in class, it’s maybe 20 doctors listening, we’re talking about cases, you know, but she presented herself as her own case. And lifelong anxiety and within a few hours of studying her mitochondrial program that she put herself on, her anxiety disappeared. And she realized that she had been anxious all this time because she’s so low energy, she felt like she could never get everything that she needed to get done.

Can you imagine this professional woman, doctor, a couple of young kids, running a household, dealing with life and finances and everything? You know, people are under a lot of pressure. And if your mitochondria are poorly performing, you just don’t have that physical energy to get everything done. And you can end up with some level of depression or anxiety. Or just, sort of, generalized fear that you’re not going to get through your day because you don’t have that spring in your step like you should, you know.

Katie: That makes sense. And it makes me also think that there is a hormone connection here. How does mitochondrial function relate to hormones? And especially for a lot of people listening, there’s a pretty high percentage of people listening who have thyroid-related hormone issues.

Dr. Kalish: Yeah, so this is my question I always ask when I do public speaking to groups of doctors. And no one’s ever gotten this right. I’ve asked the same question for like at least five or six years. Hundreds of doctors, no one ever gets this one right. So the question is…well, you got to set it up a little bit. So like, we know hormones, like estrogen causes things to grow in the female body. Insulin everybody knows helps you regulate your glucose or your blood sugar. Testosterone can change, you know, your muscle density and strength and everything, you work out really hard to boost up your testosterone.

So each hormone that we think about has an association. So when you say thyroid, I’ll say, and this is a doctor question, “Okay, doctors, when I say thyroid, what do you think about?” I say insulin, you think blood sugar. I say thyroid, everyone always says the same thing 100% of the time because it’s in every medical textbook. They’ll say basal metabolic rate, or they’ll say metabolism, or metabolic rate. And then I’ll say, “Okay, well, how does the thyroid regulate metabolism?” And then there’s always dead silence. I mean, you can have 500 doctors in a room. It’s too easy a question for people to get right and also reveals the thinking process that we have that’s dysfunctional. So thyroid regulates metabolism, how? The answer is because it directs and controls what sets your metabolism, which is your mitochondria.

And whenever I ask that question, you can just see people’s lights go on, like, “Oh, I never thought about it that way.” So if you have mitochondrial problems, even a normal thyroid hormone output will not regulate your metabolism sufficiently because the thyroid is trying to manipulate mitochondria and if they’re not working right, then it’s really hard. You can also have situations where there’s a thyroid problem, and the person is put on thyroid medications, and they get a little bit better, you know, maybe half better, 80% better, but not 100% because the thyroid hormone levels are now normal, but the mitochondrial function is still lagging behind. So in order to have your metabolism working, you need hormonal control with the thyroid, and you need the mitochondria present and functioning so that everything can work.

Katie: That does make a lot more sense and probably is very relevant to a lot of the people listening. And it makes me wonder, what are some of the ways we can improve, like tangibly improve, mitochondrial function? And is this the same for everyone, or is there a very personalized aspect of this?

Dr. Kalish: Yeah, so I guess there’s two answers to that. One answer is that there are preset things that anyone can do to improve their mitochondria. And then there are what we call personalized, sort of, prescriptions, right, personalized recommendations, personalized medicine, which is like per person, you know, individual to that person based on their genetics often. And so for the general recommendations, you want to have your good lean muscle mass and your super clean food, especially with a ton of antioxidants. Because it’s oxidative stress that damages mitochondrion. So that’s your vegetables and your fruit, all that kind of stuff. And then you want to have enough lean muscle mass because that’s, you know, sort of a reservoir of mitochondria, so to speak, is the actual muscle tissue itself. So physical activity, and then a super clean diet with lots of antioxidants are, sort of, the general recommendations for everybody.

And then, when you get into the labs, that’s when you can see a whole variety of genetic problems that allow us to design personalized programs. So, for example, sometimes people don’t…There’s this scientific, like, biochemical process called beta-oxidation which describes how we burn fat for energy. Sometimes people have problems with beta-oxidation, so it doesn’t matter how they eat or what they eat, they just can’t burn fat effectively. And for that, you need a nutrient called carnitine. Does everybody need carnitine? No, not at all. But if you need it, you know, you need it.

And the same thing can happen with carbs. Some people don’t, you know, process carbs very well and then these markers are called lactate and pyruvate that go super high. And to get those enzymes working properly, so you can handle carbs well, you need a lot of niacin and thiamine, lipoic acid, pantothenic acid, there’s a whole bunch of B vitamins basically that you need. And so does everybody need those? No, but if lactate and pyruvate are super high, then it’s a carb problem. You know, if adipate and suberate are super high, it’s a beta-oxidation and fat-burning problem.

So that’s where you get to the personalized part. And if you just generically give everybody a ton of thiamine and niacin or a ton of carnitine, it won’t work, right, because it only helps if you need it and maybe it’s even a little risky or dangerous to take a ton of supplements that you don’t actually need. But when there’s an enzyme or an enzyme system in your body that’s sluggish that’s regulating metabolism, you can normalize that enzyme or enzyme system with really simple things like carnitine, you know, niacin, thiamine, that’s the vitamins B1, B3, B5.

And that’s what the labs show you is that window. And not just a little bit, you know, like, if you have a problem with the carb metabolism, you know, 20 milligrams of niacin or thiamine may not be enough, you may need 100 or 200 milligrams. So when you can target it and you know that that person needs the…problem to fix their enzyme, you can get the dosage to what I would call a therapeutic level so it actually makes a difference. And that is, kind of, the heart and soul of, to me, what functional medicine really is, is these personalized lab-based programs.

Katie: And I know you have resources for this, I’ll make sure we include some of those in the show notes for people listening. I’m guessing many people will want to know a lot more about this. You also mentioned the term fatty liver. And I’ve seen some research that this is on the rise right now. And this is becoming a pretty widespread problem. For anybody who’s not familiar, can you explain what fatty liver is and what’s going on in the body when that happens?

Dr. Kalish: Okay, so what you really don’t want to have happen is to have fat deposited in and around your abdominal organs because that’s a very dangerous kind of fat and it leads to problems like heart attacks, you know, and diabetes and stuff like that. And so, if you’re eating and your metabolism is working right, your thyroid’s dialed in, your mitochondria are working right, then your body takes carbohydrate and it converts it into energy or fuel and we burn it up. If your mitochondria are sluggish and not working well, then that carbohydrate hits the mitochondria and it almost gets pushed away, and you can’t make energy from the carbs. And unfortunately, when people are in this position, they start to crave carbohydrates, they crave sugar because they’re not getting a sustained balanced sense of energy from the mitochondria making energy properly, right. So ironically, people that have this problem crave carbs, but carbs cause the problem to get worse.

And so if you get all this extra carbohydrate, the mitochondria are broken and they can’t burn it, then your body has to do something with it and it converts it into fat, and it does that primarily in the liver. And some of these fats are really dangerous, right? There’s, you know, bad kinds of cholesterol they call LDL cholesterol, it can also just get converted into triglycerides, which would just be more like body fat, and that’s why you can end up with some pretty serious problems. And once the fat starts to build up, then you’re going to…fat in a sense, kind of, gums up the workings of the cells. And then you become more and more what we call insulin-resistant, meaning that your body processes insulin or carbohydrates worse and worse and worse. So it becomes a negative spiral with the one thing leading to the next.

Yeah, I mean, honestly, I was in the airport in Phoenix…not to pick on Phoenix, it’s a great town. But I was in the airport, I got there kind of early, I had an extra hour to kill the airport a couple of weeks ago. And walking around the airport in Phoenix, I’d say 80% of people in that airport had some pretty serious fatty liver problems, just looking at the body fat on those folks, you know. I mean, and it was like 10-year-old kids, 80-year-old men and women, whole families of people carrying 30, 40, 50, 60 extra pounds of body fat. And that’s basically, if you’ve got that much body fat on you, there’s almost certainly going to be some of it that’s just, you know, accumulated in your liver. And then your liver can’t work as well, right? This becomes a problem for your organs, you don’t have normal organ function at this point.

Katie: Is there a general process for improving fatty liver? Or what are some things to do?

Dr. Kalish: Yeah, just getting your…I mean, you don’t even have to do all the fancy labs and supplements. You know, people start to eat properly, get a little bit of exercise, even just like walking for an hour a day and eating properly, you can, you know, drop the body fat and drop the fat from the liver. It’s about getting metabolically realigned in this sense, you know. And you can do it with all kinds of different diets. You know, if you really have gone to an extreme and you’re not doing well, you know, you can do it with a vegan diet, then it goes really quickly if you do it right. Most of the time people I work with don’t want to…they do want to eat meat still, their meat products, you know, or dairy or whatever. So we usually, kind of, adjust for that. But there’s a lot of research on being able to flip this around. Your body is quite resilient, it can change these things if you give it half a chance, you know.

Katie: And it sounds like a lot of these things you’ve, kind of, touched on that they can damage the metabolism and make it hard to lose weight for people. I had this experience in the past as well where it was hard to lose weight even though I felt like diet was very dialed in and I was exercising and trying to maintain muscle mass. I’m guessing mitochondria come into play here. What are some steps people can do in that situation?

Dr. Kalish: Yeah, so if your calories in and calories out aren’t working, then by definition, you have what we call a damaged metabolism. And so, I think of that as almost like a flowchart in my brain for that. So first thing I always think about is hormones, there’s a hormone called cortisol, which is made by the adrenal glands. And if you have high levels of cortisol, that’ll cause a damaged metabolism. Because high cortisol interferes with normal blood sugar regulation. High cortisol causes thyroid hormone problems. High cortisol makes your metabolism pretty phooey, you know, and you’ll start to become what we call catabolic, breaking down your own tissues, and it’s a pretty negative state. And that goes back to what you were saying earlier about sleep, right. So you get your cortisol under control, you meditate, you sleep, you do…I don’t know, take some hot baths, or you do something to relaxing and, you know, start to reduce the stress, hopefully, a little bit.

Then the other ways metabolism can get damaged is if there’s enough oxidative stress or enough tissue damage and inflammation happening in the body. And for that, in functional medicine, usually we look at two huge categories outside of stress and hormones, which would be the microbiome and gut function as a potential major source for problems, and then environmental toxins and your liver. And there’s a very famous naturopath named Dr. Joe Pizzorno who’s done a lot of research on this whole environmental toxin issue. And one of the more impactful things he said at this lecture I was out a couple of years ago was that his team of researchers looked at the studies that were done when scientists were proving that cigarettes caused lung cancer. And it’s a causative thing, right? I mean, some people smoked their whole lives but never get lung cancer, some people get lung cancer but never smoke.

But you know, they prove, through these mathematical formulas, that the more you smoke, the more likely you are to die of lung cancer. And, you know, this was actually something, it was a scientific argument that had to be proved. Now we, kind of, take it for granted. I think almost everybody on the planet would say, “Yeah, you’re going to be more likely to die from lung cancer if you smoke.” And so the correlation, the math between that relationship and the toxin and metabolic damage relationship is like a factor of three, meaning that if you believe that cigarette smoking increases your likelihood of getting lung cancer, there’s three or four times more scientific evidence to show that environmental toxin exposure damages metabolism. That’s just a nice way of looking at it.

And environmental toxins are in all of our bodies. You know, this has been pretty well documented for decades now. The CDC tracks this, in fact, each year looking at the total environmental toxin load of all Americans. There’s literally a couple hundred environmental toxins in almost every human being’s body on this entire planet right now. And so, many of those are endocrine disruptors, and many of those can mess around with your thyroid, and many of these end up attacking various enzymes that are regulating your metabolism in your mitochondria. And we see mitochondrial enzymes are very susceptible to damage from environmental toxins. And so Pizzorno, in his latest article I just read a few weeks ago, he really went out on a limb to say this, it’s pretty gutsy, and he said that, “Of course diet and exercise are key, but mitochondrial damage from environmental toxin exposure is a bigger variable in our obesity epidemic than diet and exercise are.”

That was pretty bold, and he has the science to prove it too. So people are interested can look him up, Dr. Joe Pizzorno, P-I-Z-Z-O-R-N-O. He’s written tons of books. And his more recent book is on toxins, and he’s all over YouTube, and he gives speeches all the time everywhere. But that is pretty profound that someone of that stature who’s been in this industry for, you know, 50, 60 years now sees environmental toxins as a major cause of weight gain, even more so than what we eat and how much or how little we exercise. That’s pretty deep. That’s a big problem.

Katie: That’s a big statement, especially considering, I mean, we see the statistics about all these things being on the rise, and it often is blamed strictly on diet and lifestyle. But to me, that makes sense that environmental toxins could be a big component. And for me, this was why I started years ago making a lot of my own products at home, and then now actually making them for other people. Because I realized, you know, we tend to feel more of an effect when we eat food and feel bad or we can notice that relationship. But I think the environmental toxin one is a little tougher for people to, kind of, pinpoint. But yet, like you said, we’re all exposed to hundreds of thousands of these chemicals on a daily basis, many of which have not been studied for safety. Are there any that really stand out as ones we especially should be careful to avoid or to start with?

Dr. Kalish: Well, the one that everyone in my field agrees is just the absolute shredder killer of human cells is glyphosate, Roundup. And you can’t really control your exposure that because that’s gonna be, you know, sprayed on crops generally. Most people aren’t walking around spraying Roundup on their food at home. But you know, there’s a good…I can’t remember who said this, maybe it was Paul Chek, somebody I talked to years ago, I think it was Paul. And he was giving a talk and I was listening, and he was standing up front and he’s really kind of an outgoing guy. He’s like, “Would you take an apple, take an apple, spray a can of Raid on it, you know, the ant spray, and then hand it to your child?” And everyone in the audience is going, “No, I wouldn’t do that.” And then he’s like, “If you did take a can of Raid and spray it on apple and hand it to someone else’s child, you might even go to jail.”

How’s it any different? You guys aren’t seeing the spraying happening but that’s what’s happening. All these crops are being sprayed, and then we’re consuming them, you know, that’s a problem. So there’s environmental toxins from the food supply. What most of the experts that I work with say is that the majority of the environmental toxin exposure is from air. So get a decent air filter, you know, try to keep the air in your house clean. Can’t really filter the whole planet outside, you know, the inside air you can control.

And then there’s two groupings of environmental toxins, one is water-soluble, one is fat-soluble. So water-soluble toxins will get flushed out of your body if you simply hydrate. And almost every patient that I work with is profoundly dehydrated. You may have seen me drinking water this whole time. If you’re listening, you don’t know, but you have to just trust me, I’ve been drinking a glass of water this whole time. I’m going to take another sip right now. So that’s the way to get the water-soluble toxins out, just, you know, drink enough water. And then the fat-soluble ones we’re, kind of, stuck with because they’re in our fat tissue. For that, we need to get the whole mitochondrial thing working and do a little more sophisticated detox.

Katie: Any specific hydration tips? I know I’ve done my own reading about this. A lot of people aren’t drinking enough just pure water to begin with, but also, it seems like a lot of people are low on some electrolytes that also really help with hydration.

Dr. Kalish: Yeah, I mean, it’s pretty simple. Like, I have, I don’t know…again, you guys are listening, you can’t hear. But I have these big Mason jar thingies here, you know, I don’t even know what size they are, but like, they’re really big ones. I drink, like, two of these a day. I just fill them up in the morning and then I drink them and it’s done. So it’s not like I measure it but I know if they’re sitting on my desk at the end of the day, I didn’t do it. And then I take a pinch of Himalayan sea salt into each one. So I get some electrolytes that way. You can buy electrolytes too, I guess, but Himalayan sea salt works pretty well. It’s not very expensive.

And that’s enough. You know, I mean, the general rule, you don’t want to drink too much water. But it’s rare that people drink too much water. I mean, once in a while that happens, but it’s pretty hard to drink too much water. You have to be a little psycho, I think, to get that into it. You know, if you’re obsessive-compulsive, you know, be careful. So the general rule of thumb is that you want at least one completely clear urination a day. That’s the general rule of thumb. So if your urine is coming out yellow all the time, then you’re way dehydrated. You want one completely clear urination a day, that shows that your kidneys have filtered everything and you’ve gotten everything out. But for most people, it’s going to be, you know, at least three quarts of water, somewhere in that ballpark.

Katie: What are some other lifestyle factors to pay attention to when it comes to mitochondrial function, especially, I would guess sleep, mentioned in passing a couple of times, is going to be a big one. I’ve also read some things about the mitochondrial function being at least responsive to certain types of light. And that we, because of artificial light, aren’t getting enough light, especially outdoor light in modern times, and that this might have effect as well. Any other lifestyle factors that you would name?

Dr. Kalish: Yeah, so I know this seems so silly but this works really well is that if you go outside…as soon as you wake up, when it’s light out, you go outside and get at least two or three minutes of real daylight. If it’s cloudy, it doesn’t matter, the rays come through the clouds. So sometime in the early morning as soon as the sun’s up, and then repeat that somewhere between noon and 4 p.m. Two minutes, three minutes, more is better but, you know, two or three minutes is enough. And we had this doctor in class a couple of months ago, in the training program, he was so excited, so great to see these other doctors, and he was like, “I can’t believe it. I told this woman…” This was his idea, not my idea, right? “I got this patient to go outside first thing in the morning for two or three minutes and her whole insomnia problems just got resolved.”

And it’s just like, you can see this young doctor getting it. it’s like, for the rest of his career, he’s gonna be saying this, you know, is just so cool. So yeah, natural light helps a lot. Oh, and then breathing. Breathing is the key. So why do we breathe and how important is it that we breathe? Well, I don’t know, when is the last time you tried to hold your breath? You know, how long can you survive without breathing? I don’t know, I mean, I can hold my breath for two minutes, that’s the farthest I’ve ever gotten. Some people can hold their breath for five minutes or more, you know, underwater sea diver people and stuff.

But anyways, the reason we breathe, and what the oxygen does is 90% of that oxygen goes right to your mitochondria so you can run your metabolism. So if you’re…The three, kind of, killers of the mitochondria are lack of CoQ10, lack of magnesium, and lack of oxygen. So CoQ10 is complicated, we don’t want to get into that, that’s like hours of talking. But basically, if you eat enough vegetables and fruit, hopefully, your CoQ10 will work out. Magnesium comes from, you know, green leafy veggies, anything that’s dark and green, like arugula, or kale, or collard greens, not really spinach, but any dark leafy green. So if you’re worried about your mitochondria, just have dark leafy greens three times a day, a serving of them with each meal. You can steam ’em, cook ’em, you know, eat them raw, it doesn’t really matter. So that’s one easy one to get the magnesium.

And then oxygen, if you just doing some breathing exercises, you know, and making sure that you’re staying really well oxygenated. And a lot of us end up sitting on a couch, in a desk in front of a computer, kind of hunched over, and we’re not really getting our maximum airflow through our lungs very well. And there’s an easy one you can do called, you know, four-square breathing, where you just take a deep breath in, hold it for four seconds. Take four seconds to breathe out, hold it out for four seconds, take a deep breath in, you know, so it’s like counting to four each time.

And then if you really wanna get into it, you can go online. Just watching these videos this morning. There’s a Dr. Eric Goodman, Eric Goodman. And he does a thing called Foundation Training, which is great for relieving low back pain. It’s like the best thing for relieving low back pain. But if you look at some of his other videos, he talks about decompression breathing, and how you can just fill your lungs. And he uses that as part of his physical therapy, kind of, rehab for people in pain. But it’s just a great way of thinking about breathing, decompression breathing. He’s got a ton of free stuff on YouTube you can read about, or listen to, you know. And then if you do have back pain or any kind of chronic hip pain, his exercises called Foundation Training are really good as well. He’s a great resource. He’s a really good guy too.

So yeah, oxygen, magnesium, CoQ10, those are, kind of, key things you can do. It sounds a little crazy to eat greens every day, three times a day. But hey, if you’re really tired all the time, you know, try it for five or six weeks and see what the effect is, these things kick in pretty quickly.

Katie: I will link to some of that breathing training in the show notes for you guys listening at wellnessmama.fm. And ironically, that brings us pretty full circle to meditation and breathwork and being intentional about those things and how they are also related.

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For anybody listening who maybe for the first time is realizing that mitochondrial dysfunction could be part of their problem, where would you recommend as jumping-in points to keep learning from you, to keep learning in general, to maybe get organic acid tests? Where do you recommend people start?

Dr. Kalish: Yeah, so my website, if you wanna get in touch with me to do some lab work, is kalishwellness.com. And then we have a ton of videos that I’ve done, mostly they’re doctor training videos, but they’re posted on YouTube. And I would say every new patient I work with now says the same thing. How did you find out about us? “Oh, I found your video on YouTube.” So basically, patients are listening to these videos that I produce to train doctors. And, you know, I speak pretty simply. So I guess they’re pretty easy to understand. So there’s tons of stuff on mitochondria, on ion panels, on all these different subjects that are just right there on YouTube. People can listen and see if it resonates with them, you know, as a resource.

Katie: Wonderful. I’ll make sure that’s linked as well so people can find you. And lastly, I’m curious if there is a book or a number of books that have had a profound impact on your life, and if so, what they are and why?

Dr. Kalish: Well, I read the “Tao Te Ching” every day. And it’s, you know, 81 verses long, I can read it probably in an hour. And there’s a lot of different translations of it, you know, and there’s one that I’m pretty attached to. It’s just the best, basically, it’s really, really, really good. So it’s the “Tao Te Ching.” This is Lao Tzu. Lao Tzu was, sort of, the founder of Taoism. And you know, some of the translations are really academic and really, kind of, hard to understand and, you know, just honestly don’t make any sense. But the one by Jonathan Star, S-T-A-R, Jonathan Star, “Tao Te Ching,” and Tao is spelled T-A-O. T-A-O. “Tao Te Ching” is T-A-O T-E C-H-I-N-G, so “Tao Te Ching.”

So it’s the words of Lao Tzu. And it’s 81 verses, but man, it’s pretty good. I literally read it every day. And it’s one of these books. I don’t know how you can read something every day, and every day it seems different, but it’s quite a little miracle. So Jonathan Star, that’s a really good resource. And then, I don’t know, I guess with what we’re talking about, and your audience is…describe your audience a little bit, like who’s listening to this? Is it mostly women?

Katie: Mostly women, 20s to 40s, a lot of them with kids. And typically things like autoimmunity and thyroid are the more recurring conditions.

Dr. Kalish: Well, you know, there’s Izabella Wentz. You know her?

Katie: Yeah, she’s a dear friend. Yeah.

Dr. Kalish: Oh, yeah. So she’s, like, so smart about thyroid, you know, so I always recommend people read her books. And then…for thyroid stuff. And then there’s a book that’s really good by this medical doctor named Uzzi Reiss. U-Z-Z-I is his first name, last name is Reiss, R-E-I-S-S. And he’s long-term medical doc, been doing, you know, female hormones forever. I mean, he was old, like, 25 years ago. So he’s just been doing this for a long time. And he wrote this book a long time ago, you know, and I never really hear anybody talk about it.

But when I read it initially, I thought, “Oh, he’s writing…who’s he writing this for?” You know, because it was written…or it is written, like, for doctors, basically, because he’s telling you in each chapter how to treat. So I’m just mentioning this as a book because either you’re going to see someone like me as a patient, or if you can’t afford to do that, you don’t want to do that for some reason, then Uzzi Reiss’s book is a good resource, you know, if you’re going to try to tinker with things on your own a little bit. And it’s called “Natural Hormone Balance.” I’m sure you can buy it from Amazon for 10 bucks or something. It’s been around for a long time, “Natural Hormone Balance” by Uzzi Reiss.

But I like that one because he wrote it, I think…my feeling on it, if I remember right, is he had tons and tons of patients who were always asking tons of questions. And so he wrote this book to say, “Hey, I’m working with you. I’m your doctor. But here’s how you can do some self-guided stuff, you know, so you don’t always have to pay for consults with me.” And I just find his information…as I was reading each chapter, I was like, “Whoa, he’s right about that, he’s right about that.” He just nailed it so well. Just a wealth of information and quite accurate treatment options for women. So I like that one a lot.

Katie: That’s a new recommendation. I’ll make sure all of those are linked in the show notes for you guys listening at wellnessmama.fm along with the notes I’ve been taking while we have been chatting and all of the resources you’ve mentioned. But Dr. Kalish, I know that you are a very busy person, and very grateful for your time and your wisdom today.

Dr. Kalish: Thank you so much. Appreciate it.

Katie: And thanks as always to all of you for listening, for sharing your most valuable resources, your time, your energy, and your attention with us today. We’re so grateful that you did and I hope that you will join me again on the next episode of the “Wellness Mama” podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.