CITV 36: Case Review – 38 yo Presents with Dizziness

– Hello, my name’s Dr. Freddys Garcia, and today we’re gonna be joined by Dr. David Clark. Dr. Clark remains one of our highest rated faculty members. And today, we’re gonna be doing a video case review. Dr. Clark, thank you for joining us.

– Hey, thanks for having me. Let’s jump into it. So, this is gonna be a 38-year-old man with dizziness. Now, you’ll notice that we call these little walkthroughs we do clinical neurochemistry and nutrition in action, so we’re not doing theory. I’m not really gonna do a lot of pathways. I’m gonna show you how we apply all of this information to a real patient, so let’s get going. So, here’s my goals for us today. I want us to understand some physiology because you’ve got to understand physiology, otherwise you can’t decipher the patient’s symptoms that can start pointing you in the direction that you need to go. We wanna understand physiology so we know what tests to order if any for this patient. Why would we do those tests? What are those tests gonna tell us? Secondly, my goal is I want us to learn how to think. So, we wanna understand clinical decision making. How do we learn how to think? Which may seem, I don’t know, it may seem silly to say that, but you’d be surprised how many people that do this kind of stuff don’t really think. They just kinda do this for that, and they don’t know how to prioritize things, so the patient’s taking 50 supplements, and they don’t know what to do next. That’s what I want us to learn how to do today. If even just a little bit, I want us to learn that. Now, the third goal is I want us to not memorize protocols, right? Now, we’ll use the word protocols sometime, but this is not something we memorize that we do for people. We take every case on its base. So, we’re not doing this supplement for that symptom, okay? We’re not gonna do that. We are not gonna make ourselves little robots, okay? Where we just go patient has headaches, this is what they take. We don’t do that, okay? We are not gonna be robots, we’re gonna learn how to think. So, let’s get going with this guy. So, where’s it start? Well, it always starts with the chief complaints. Let’s analyze those. So, this guy has transient dizziness. Well, that doesn’t really mean much. I don’t know what he means by dizziness. And this is the thing, you always, always, always dig deep and find out what is it that they mean? Because people use words like dizziness to mean 45 different things. Some people say dizzy when they mean egocentric vertigo. Some people say dizziness when they just mean a little, ah, kinda feel off. So, you can’t take that at face value. So, that’s what we ask them. It is not rotational. So, the fact that this guy’s dizziness is not rotational should, if we know our neurology, should kinda rule out a few things pretty well for us, meaning it should rule out probably a peripheral vestibular lesion. And now if you don’t know that that’s the case, you don’t know why I say that, then we’ve some great vestibular classes you can take that’ll explain that.

– And specifically more, specifically more a unilateral peripheral disorder, right?

– Right, exactly, right. Unilateral, right, exactly, unilateral. Now, this guy has more of what he calls it a lightheadedness feeling. All right, cool. That points us more towards maybe autonomic, right? Because lightheaded people usually are lightheaded because they’re not getting blood to their head. He also says he can feel his brain. Now, I don’t know what that means, feel his brain, but I do think I know what this next sentence means. He says if he hugs someone, he feels like his brain’s slapping around in his head. Now, what I think he’s describing is is when he hugs someone or kinda gets jostled, he has a momentary problem with his VOR and perhaps even his COR, his cervical ocular reflex and he gets a little disturbance in his vision and he gets a little blurry. That’s what I think he’s probably saying. For example, he notes if he turns too quickly, he gets a swimming sort of feeling in his head. If he text messages too quickly, like if he texts, texts, texts, and is doing something with his head pulled down, the same thing happens. He also says, we’ll look at this in a second, so if he turns his head too quickly, what does that mean? Well, it means that he’s probably getting a slip of his visual scene on his retina. He’s not able to keep it fovealized. And so that little slip that he’s getting is blurring his vision for a second, and it gives him that little slight weird feeling that he’s describing as lightheadedness as dizziness. We’re gonna find out if that’s the case. So, here’s our radar screen for this guy. What is on the radar just from his chief complaints? Well, vestibular, right? I mean, he could have a vestibular problem because look, if you turn too quickly, is it his VOR that’s slow, the gain is low? Is it something else where there’s visual slip, he’s too visually motion sensitive? That could be the case, it could be a V5 problem. Metabolically speaking, yeah, I mean, there’s some metabolic things that can go into this. But none of this says strictly metabolic, except maybe if we think the lightheadedness is more of a autonomic issue. That could certainly be metabolic and we’ll dig into that. Dysautonomia, those are the things that are kind of on the radar at the moment. So, let’s see what else we learn. So, from his history, so now, we’ve just analyzed his chief complaint. So, if we understand his chief complaints, and don’t just blow by them. What does that mean? What are the chief complaints telling us? We have a few things on the radar. Now, let’s see if the history helps us bring more things onto the radar, or help push some things off of the radar. So, he claims to be healthy until he had head injury when he was doing some hand-to-hand combat sparring. He says he was working with someone, and he rolled over them and hit his head on the mat. He’s pretty sure he had a concussion. The problem is, he didn’t go see anyone, and get really assessed, so I’m taking his word for it. But it definitely wasn’t just like a little tap. It’s something that he remembers was pretty forceful. Now, Wednesday through Friday after that injury, he didn’t go to work. He works as a bartender. And then for the week after that, he did kind of his own kind of self-retreat, where he spent some time on the beach drinking tea and eating watermelon and just kind of chilling out. Kind of doing that total rest paradigm that people still want you to do when you have a concussion. And he was doing that for about five or six days. Now, if you didn’t know this guy was from California, sitting on the beach and drinking tea and watermelon should tell you that the guy’s from California. He did that for about five or six days. Now, somewhere in the last day of this, things just kind of went off the rails. The tea he was drinking, he said just acutely didn’t taste good, and he began feeling overheated, and was getting very symptomatic and very dizzy. Now, that to me, maybe the guy had hyperthermia. Maybe he had, it provoked a dysautonomic event. Hard to know for sure, but something acutely kinda went wrong. Now, he says that when he has a quote-unquote “true dizzy spell”, he feels after it, similar to how he would feel after a migraine. Well, that’s interesting ’cause what is a migraine? A migraine’s a big old autonomic event. And so he feels like the same post-migraine feeling after he has a real bad dizzy spell. That’s very interesting for us. Now, by the way, it doesn’t mean that he still doesn’t have a vestibular problem. ‘Cause obviously, vestibular integration integrates all into the autonomic system, but it does help us more understand that yeah, there’s a big dysautonomic component here perhaps. He cannot run or jostle his head very much, although he would really like to be able to run again. He is able to do some non-running exercises, such as calisthenics and kettlebell. So, what happens when you run? You’re running, you get these short high-frequency perturbations. He can’t do that. That’s telling us again, there’s probably an issue with that VOR, or visual slip on his retina, right? It’s like, which one is it or it could be both? Now, being able to do calisthenics and kettlebell, I mean, his head’s relatively still. There’s not a jostle. It’s a very kind of a smooth motion. So, that tells us that when he gets that little jostle, he’s not able to process that correctly. Now, this is a weird thing. He says that if he has more than a few minutes of sunlight on his skin, that seems to induce dizziness. It’s not the light, but the sun on his skin. And I’ve kind of grilled him on this, and I don’t know about that. I can’t think of a reason why that would be. I’m open to anyone else’s ideas, but that are really kind of science-based. That’s just what he thinks. So, I just wanted to throw that in there because sometimes you get something and you go, “Hm, I don’t know what that means.” Not everything means something useful. He does note that caffeine in any amount seems to bring on a dizziness episode. That’s actually very common in people that have chronic vestibular type complaints, caffeine usually worsens them, why? Well, caffeine can disturb the kind of ionic balance that you have in your inner ear fluid. It can dehydrate you, it’s also a stimulant. There’s a bunch of different reasons why it could do that. But typically, if someone has a vestibular problem that’s chronic, caffeine almost always worsens it. And it’s probably from an integrational aspect in the brainstem. All right, now, he’s been following a detox protocol, not this tea on the beach and watermelon thing. He’s just kind of looking for something to make himself feel better and so he’s been taking some herbal formulas. And the list of ingredient’s huge but categorically what they are are antimicrobial, antiparasitics, adaptogens, hepatic biotransformation kind of stuff. And he’s been feeling a little bit better. I wouldn’t have expected any of that stuff to help him anyway just kind of based on what he told me. I mean, there’s no reason to think the guy’s got a parasite or a microbial infection. There’s no reason to think he’s got one of those just based on his symptoms but anyway, I mean, that’s what he was taking. He says in general since the injury, he’s been feeling gradually better over a few months, but still bad enough to come see me. Now, here’s a big thing. He’s been vegan for a decade, and does not tell me that he takes supplements of any kind. Now, let me just tell you, that puts him at big-time risk for iron deficiency, B12 deficiency, vitamin D deficiency, a folic acid deficiency. Yeah, I mean, it’s very, very likely he’s gonna have a problem with one or more of those. And let me just tell you, as you guys will find out, if he’s got iron deficiency, B12 deficiency, folic acid deficiency, that could be sabotaging his ability to actually normally kinda get better. It could do that. It could absolutely do that, and I’ll explain why in a moment. No real family history, except he’s got a mom who took an SSRI. And he’s got a younger sister with some kind of mental illness for about 20 years, okay? Does that mean he’s gonna have mental illness? No, but I can tell you this, if you are B12 deficient and folic acid deficient, and you have a strong family history of mental illness, you’ve just upped your odds a lot. I mean, you really have. All right, so system review, just kinda running through some other things he reports. He says that eating relieves fatigue. He has afternoon headaches. Well, what does those mean? Well, those are pretty specific indicators for a problem with his HPA axis tone. Eating should not relieve your fatigue, right? Eating should just make you not feel hungry anymore. Afternoon headaches is pretty indicative of a problem with someone’s cortisol release being lower than it’s supposed to be ’cause, guys, remember, and I had a whole three-day class on these hormone things and adrenal stuff. But cortisol is very high in the morning, and then by afternoon, it’s way lower than it is in the morning, but you still need it. And so, if your cortisol levels are still lower than they’re supposed to be, you classically are gonna get afternoon symptoms. Others include, from one to five, I start crashing with my energy. From one to five, I crave salt, I crave sugar. Those are people whose HPA axis tone is not correct. Now, notice, I’m not using the phrase adrenal fatigue because that, you’re never gonna hear me use that phrase because that really doesn’t exist. That was a term that was thought up maybe 10 or 12 years ago by a chiropractor. And it kinda hung on, kinda like the, what is it? The bone on nerve metaphor. That’s not really how it works, right? And I don’t wanna go any further with that, but that’s why we’re not using the phrase adrenal fatigue ’cause that doesn’t really describe what it is. So, what’s our impression of this guy so far? Well, what could possibly be going on reasonably? There might be a peripheral vestibulopathy. I mean, maybe because he does have a little bit of VOR. So, yeah, that’s a possibility. He could have a centrally maintained vestibulopathy. Absolutely, he could. It could be a vestibular problem. It could be a cerebellar problem. It could be a cortical problem. Is there dysautonomia? Well, yeah, I mean because look, HPA axis problems, that is an autonomic, there’s gonna be autonomic consequences from that and he does describe symptoms that are like lightheadedness and like having a migraine. Could there be a metabolic issue? Well, yeah, he’s at risk for these for sure because he’s been a vegan for 10 years and hasn’t taken anything to get what he’s missing in that diet. So, where do we start? I mean, we’ve said all this stuff, where in the heck do we start? I mean, what do we do? Well, there’s a lot of places you could start. We could start simply by looking at the metabolic and neurochemical factors with this patient. Because look, he’s probably gonna have them. If anybody’s predisposed to having metabolic issues, this guy is it just based on his veganism. And by the way, I’m not against veganism as a rule. I mean, I was a vegetarian for about 10 or 12 years. I mean, I don’t have a problem with it as long as you do it right. Now, could you just start and lunch in, and start looking for rehab stuff to do? Sure, you could. But with this guy, I’m gonna recommend we probably don’t do that. Now, you could do it and here’s the thing, if you started with receptor based rehab, you just gotta be honest with yourself. You just gotta say look, if this is gonna work, it should work, right? It if doesn’t work, it’s not working, there’s gotta be something else I need to be doing. Maybe I should look at this guy’s metabolic stuff, right? You don’t just pretend that it worked, right? Well, you’ll get better, right? Or just do these rehab exercises for four months. If it’s gonna work, it’s gonna work. Could you just go ahead and adjust this guy, find subluxations or join aberrations? Sure, you could do that but the same standard holds. Did he get better? Did he stay better? If he didn’t, you gotta look at some of these other things. Could you do something else like I don’t know, you could do acupuncture, you could energy work or whatever. You still gotta hold yourself to the same standard. If it’s gonna work, it’s gonna work, and it’s gonna stay working. Well, here is why we’re starting with the neurochemical stuff with this guy, particularly. And this is the same neurochemical priorities for every patient I see, I don’t care what they have. Number four is GI and liver function. Okay, well, why? Why is that a priority? Well, your GI tract is where you absorb everything, right? So, if you don’t absorb something, you’re gonna have a problem, be it a macromolecules or micronutrients. You’ve got to have a GI tract that is functioning. You’ve gotta eliminate waste. Plus, the GI tract is a major source of inflammation. That’s something we talk about at length in the classes. But look, any inflammation you get in your GI tract, it’s not staying in your GI tract. I mean, your immune system is not confined to one area. Through cytokines and circulating cytokines, and chemokines and all these other things, that inflammation’s going other places. It’s how your brain will know that your GI tract is inflamed. So, GI function is a very big priority for us, why liver? Well, the liver has multiple functions, not just biotransformation, but also protein synthesis. So, if your liver is not working, and if your liver’s not working and it’s very bad, you get encephalopathies. So, that is number four, that’s what I use. Number three. Now, we don’t know if this guy has this, right? There were no symptoms he gave us that tell us that he has particular GI function. I have to put out a fire real fast, give me one second. And there we go. What about number three? Well, number three is what I call cellular energy part one, which is his HPA axis and glucose handling. Now, we already know, I just told you a second ago, he’s got an HPA problem, right? Why is it a priority? Well, if you just go back to plain regular neuroscience, what do neurons need? They need fuel and they need activation. Fuel is gonna be delivered via blood. And that fuel is gonna be oxygen and glucose in its most basic form. Now, obviously, there’s all the micronutrients, but in its most basic sense. So, if someone has a problem with how their HPA axis is working, they’re gonna have problems with the glucose. They just are. And I can go into that in more detail some other time. Yep, he’s got that, right? So, I’m gonna put a big red check mark right there. What about cellular energy part two? Well, this is looking at how we deliver that fuel, looking at his red blood cells, the size and shape of them, how many does he have? What about the micronutrients involved in that like B12 and iron and folic acid? What about mitochondrial health? And the name of the game here, guys, is ATP, right? That’s what every cell’s gotta make. It’s what every neuron’s gotta have. You’ve gotta have ATP. So, do we know that this guy has a problem with that? No, he’s not telling us anything that would clue us into that, so we’re gonna have to do some labs and see if he does. What about the last one? Well, number one is what I call clinically significant autoimmunity. Now, this is what I think is the most significant most important priority with all the patients that I see and here’s why. Having an autoimmune condition is like having an octopus stuck on your back. But it’s an octopus with 500 legs. And all those tentacles, okay, these are cytokines and chemokines and all kinds of… These things are circulating throughout the body, and they’re messing with things. A clinically significant autoimmune problem can create problems two, three and four. And if that’s happening, and you don’t go after the autoimmune problem, and deal with that, you’re gonna waste a bunch of time and money spinning your wheels kind of chasing the smoke, right? So, in my experience, that is the most important thing you gotta rule in or rule out as quick as you can. Now, does he have that? We don’t know, so let’s find out how we’re gonna get this. What tests can we do for this patient? What tests are appropriate? Okay, so it depends on a couple of factors, and you guys have probably heard me talk about these before. It depends on number one, what is the clinical yield? What am I gonna get out of this, right? If I do this test, is it gonna tell me something that’s really gonna be a game-changer that’s really gonna guide me? Is it gonna answer these four questions for me? Number two, logistics. I mean, do I need to wait two or three weeks to get back this test or could I just go ahead and treat the guy presumptively, right? And then of course, in the real world, it’s the patient’s budget because look, a lot of people just don’t have $5,000 to spend on your non-insurance covered tests. They just don’t. So, I would much rather just from a treatment standpoint, have them spend money on treatment, not blow all their budget on testing. And it’s pretty, I mean, it’s at best arrogant to think that you can just order whatever you want, and the patient’s just gonna have to get it. That’s just not, that’s not the real world, you know? And the truth is, people that don’t really know how to do this stuff order the most tests, right? And that’s pretty much it, right?

– It’s so true. If I could chime in on that.

– Yeah, go ahead.

– Because when I first started doing clinical nutrition work and you start learning about all these tests, and you just wanna see if it applies to your patient, you literally order the smorgasbord.

– Oh, everything.

– And then as you learn more, you start being more judicious with your choices and you go, “Okay, well, this is what matters and this is what matters,” based off what they said, and presented with and all that stuff. So, I was guilty of that. I really, really was.

– Oh, yeah. I did it too, sure, absolutely. But the thing is is when you get better, you realize, I don’t have to do that. Do I ever do salivary testing? No, do I ever do urinary adrenal testing? Almost never because in my experience, if you understand their symptoms, and ask them enough questions, you’ve got your answer. You don’t really need to do that test, right? I’ll tell you the other people that order lots and lots of tests are people that are kind of, well, I probably shouldn’t say this, but sometimes famous people like famous practitioners that like to just order everything. But you don’t have to do that. ‘Cause the other thing I’ll tell you, the other thing I’ll tell you, if you order enough tests, you’re gonna find something wrong, right? I mean, you’re gonna find something wrong, but you may make the mistake of thinking that abnormality has anything to do with their chief complaint. So, you gotta be careful what you order. I mean, I have to make sure that I’m just not, if I see, oh, person’s got thyroid antibodies that means… Well you don’t know that. You don’t know anything until you treat them. When you treat them, that’s when you start finding out, is any of the stuff I saw really relevant to what’s going on with them? All right. So, he’s got some chronic vestibular symptoms. Are there metabolic factors associated with that? Yes, I’ll tell you that people with a chronic vestibular problem that make it to me, almost always have some immune system component, whether it’s outright autoimmunity, or a chronic inflammatory problem. I’m always gonna look for that because I’ve treated enough of these people that it’s stupid for me not to consider that and look for it. Now, what about the lightheadedness and the presyncope? Well, metabolically, if he’s hypotensive, which is kind of what that sounds like, he could be hypertensive too for that matter. Anemias can do that, iron deficiencies can do that. A poor HPA tone can do that as well, right? Those can all make you feel lightheaded. So, what testing would we do? Okay, blood chemistry, you bet. I’m gonna do a CBC, comp metabolic, LDH, lipid panel, a full thyroid panel and antibodies, vitamin D, B12, folate, ferritin, homocysteine. I probably left something out, why? Because that’s gonna answer a lot of my top four questions, right? That’s gonna answer a lot of my things. Now, just so you guys know, when we do the big neurochemistry classes, we go through every one of these tests so you understand what is this thing actually testing? Why would you do this test? How would you interpret that test? How would you interpret it in context with other tests, right? I just don’t have time to do all that right now. Would I do adrenal testing since I said the guy had an HPA problem? No, ’cause I’ve done hundreds and hundreds of urine tests and saliva tests and I’m telling you, there are some pretty specific indicators that will tell you pretty reliably what flavor of problem they have. You don’t necessarily have to do those tests. Stool testing? There’s no indication the guy needs any stool testing at all. Could I do it? Sure, I could do it but I mean, at best, I might pick up something that really has nothing to do with anything or at worst, I’ve just wasted a couple hundred bucks and a couple of weeks waiting for the test to come back. I just don’t see any reason to do it. Immune system challenge. Well, what is that? Well, this is how we’re gonna find out if this guy’s immune system really has anything to do with his chief complaints, right? Now, let me go through his labs. Let me go through his… I’ll explain the challenge in a second. So, here’s what the lab results showed. His creatinine, right? Lab low, it’s more concerning if that’s lab high because that’s more of a renal problem. Creatinine being lab low can be associated with low protein intake, okay? His BUN, which is blood urea nitrogen is a nine, that’s on the low end. His chloride is 95, that’s low. His magnesium’s 1.9, that’s low by my standard. That’s why I say functionally low. His protein’s 6.7, that’s functionally low. So, what do we got here? We got a creatinine, we got a BUN, we got a protein. That’s all looking like either a stomach acid issue where he’s not able to break things down and absorb protein, or he’s just not eating protein, right? And knowing that the guy’s vegan, that’s a possibility. So, his LDH is 138, just quickly, what is that? LDH is lactate dehydrogenase and we use that as a surrogate marker for telling us how much glucose is getting out of the bloodstream and into the tissues. ‘Cause we can look at his fasting glucose. We can look at his hemoglobin A1C. But what about what’s actually getting into the tissues? LDH is a reasonable proxy for that. Now, my cutoff is 140 so if it’s less than 140, we’re probably dealing with someone that may have an issue with glucose transport or maybe he’s not eating, right? Or maybe he’s not making enough cortisol to liberate glycogen, okay? So, I call that functionally low. His ferritin is 45, this is bad. This is definitely functionally low because the lab range, if you look at it, it’s like 10 to 500, which is a really ridiculous range. And it’s a example of how lab ranges are often just statistical creations. They’re not really, see, we shouldn’t call these things normal in my opinion. It says reference range, it doesn’t say normal range on the lab. If you look at it, it doesn’t say normal. It’s says to reference it, right? You’re referencing that. You’re not saying that if it’s within that range, it’s absolutely fine, right? I think we need to retrain everybody that does blood work to understand it says reference range. It doesn’t say totally completely 100% normal range. It doesn’t say that. So, in a guy, a ferritin less than 100 is pretty, that’s cause for concern. Why would this guy’s ferritin be that low? Remember, ferritin is your best iron marker, not serum iron, which is only 1%. It really reflects only 1%. Ferritin reflects 22%, that’s what you should be looking at. Well, I can tell you why this guy’s ferritin is so low, he’s been vegan forever. That’s why his iron’s so low. T3 uptake, we’re not gonna worry about that. His D is 53, that’s pretty good. I can live with that. This, I do not like, his B12 is 269. That is not very far away from being actually quote-unquote, “B12 deficient.” True, the B12 test is not the greatest test but look, if your B12 is less than 550, the literature says you’re probably gonna benefit from taking B12, okay? Now, this guy’s got an iron issue already. He’s got a B12 issue. His folic acid’s greater than 20, great. I wasn’t really expecting that but is what it is. So, let’s just kinda break these down. So, in relation to our four priorities, is there anything on here that says, yeah, there might be a GI problem? Yes, that kinda protein stomach acid thing. That could be a GI issue. Now, again, it could be poor intake, right? So, either he’s not taking this stuff in, or he’s not absorbing the stuff that he’s taking in. There’s no liver enzyme elevation, so we think his liver function is probably pretty good. All right, I don’t know why it did that. Number three, what about cellular energy, and looking at his HPA axis and glucose handling? Well, his fasting glucose is not abnormal. It’s not too low. His A1C was not abnormal, although it was never put on here. But what is the problem is that LDH because that’s giving us an indication that there’s probably not very much glucose, we need more glucose getting into his tissues. And either A, he’s not eating it. Or B, he’s having poor cortisol release due to low HP axis tone and therefore not probably getting glycogen out of storage to help him recover from hypoglycemia. Hints, if you remember, his afternoon headaches, right? And his eating relieves fatigue. Number two, what about these RBCs and that? Well, his red blood cells were fine. He’s not anemic, right? ‘Cause that’s not the same thing. Saying someone’s iron is too low is not the same thing as anemic. What about the B12? Well, that’s a problem. Folic acid was okay. What about mitochondria? Well, we didn’t do any specific mitochondria tests, but I can tell you if his B12 is low and his iron is low, he’s probably gonna have at least compromised ability to make ATP. What about clinically significant autoimmunity? Well, we don’t know about that. So, how are we gonna figure that out? Well, we’re gonna do this immune system challenge. Now, if you’re trying to find out if someone has an autoimmune problem, there’s basically a couple things you could do. Number one, you could try to figure out a specific antibody that relates to the person’s condition. Or you could just know if there’s some autoimmune problem. Like it’s an autoimmune problem, but I don’t know the name of it. That’s also acceptable based on the kind of stuff that I’m gonna show you. So, you can do antibody testing and it’s very specific, but also very expensive. I mean, it’s just the way that it is, you know? And you could spend all the money you wanna spend on antibody tests, you could do that so don’t. Don’t do that. But antibody testing is not, it’s not encyclopedic. Like if you do, I use Cyrex Labs a lot. I don’t have any financial interest in them or anything. They have an Array 5, right? It looks for 24 different kinds of antibodies. That’s cool, I mean, that’s a pretty efficient economical way to look at antibodies, but that’s not all the antibodies a person could have. So, it’s a mistake to do that test and think, “Oh, they didn’t have any of these. They don’t have any autoimmune problem.” That is totally incorrect, so don’t ever do that. Now, the thing I’m gonna talk about now is doing a clinical challenge, meaning it’s cheap, it’s cheap, but it’s not very specific. It’s about 25 bucks to do this on someone. And basically, what they’re gonna do, and do not just start trying to do this on your own, here’s my word of caution. You do not go out and start doing this. I’m not gonna give you enough information to know how to do it, so just don’t. Basically, what we have people do is ingest T helper 1 cytokine stimulators for a couple of days and just see what’s it make them feel like, right? Then we have them ingest T helper 2 cytokine stimulators and just see what that does. Now, look, there’s a lot more T helpers than one and two. I know that. But from just a practical standpoint, we’re trying to find out, is this person’s immune system involved? Well, this is what we can do. We can basically just kinda rattle their immune system. It’s kinda like, it’s the metabolic equivalent of putting him in a Romberg position, and hitting him on the shoulder, right? It’s the metabolic equivalent of that. So, here’s the results of this guy’s clinical challenge. And I’m just gonna say this anyway because some of you are probably gonna be creative, and try to go do it. You would never do this kind of procedure on someone that you know has a demyelinating condition. That would be incredibly stupid to do that, right? You would never do this on someone who you think might have a demyelinating condition, right? You would never do this on someone who you think probably couldn’t stand feeling worse for a few hours. You wouldn’t do that, okay? That’s just my general rule to you, just so you understand. So, here’s his clinical challenge. He felt good after ingesting the T helper 1 cytokine stimulators. Well, there’s his treatment, we’re just gonna give him that, right? No, no, we’re not doing that. And he had no response to the T helper 2 cytokine stimulators. Well, that’s cool. So, here’s the thing. He probably does not have a significant autoimmune problem, probably, right? Because he didn’t have… ‘Cause what I’m really looking for on this challenge, guys, is does one of these things or both of them make him feel temporarily worse? And since neither one of them did, probably not an autoimmune issue, probably. All right, so, just gonna resummarize kind of his metabolic stuff, right? Got a need for iron, a need for B12, a need for magnesium, low HP axis tone, protein malabsorption or low intake. I didn’t tell you this but his cholesterol was kind of low. I think it was like 130 or something. So, what’s our treatment plan gonna be for this guy? So, remember, we’re gonna prioritize. We’re gonna prioritize. We have our four priorities, right? What are we gonna do? Well, based on what we know, we need him to start having some more protein, and he has no problem with it, right? He doesn’t have any issue with it, he’s like, “No, I’m fine, I’ll do it.” Okay, great, I need you to start having some. He’s like, “Well, I’ll try maybe some eggs and fish.” Fantastic, let’s do that. What about supplement-wise? Well, listen, I could give him, there’s 30 things I could think of I could give this guy, right? But we’re not gonna do that. We’re gonna try to keep it manageable, keep it targeted. We’re not gonna go nuts. So, the first thing I’m gonna do is I’m gonna give him iron. And I’m gonna give him something called Iron Bisglycinate. And then I’m gonna give him a form of B12 that’s called hydroxocobalamin. And I’m gonna give him to it sublingual because people that have been vegan and vegetarian for a long time, sometimes they’ve down regulated those intestinal transport mechanisms for some of these things. So, I’m gonna try to short circuit that if you will, in a good way and go through sublingual. I’m gonna let him have some magnesium citrate. I’m gonna use an adaptogen. And if you don’t know what those are, adaptogens are basically plant compounds that allow your HPA axis to move back to normal. So, whether your HPA axis is too low or is too high, it’s like the ultimate BLT right? It keeps the hot side hot and the cold side cold, do you guys remember that? It moves it back to the middle. And then we’re gonna use something for this kind of glucose issue. We’re gonna give him something that’s a multi-nutrient formula that’s got some vitamins, minerals and glandulars in it that are designed to number one, help him transport glucose into his cells. And number two, try to give his adrenal glands the raw materials they need to make the hormone cortisol. Truth is, we don’t really know if that works or not, I’m gonna be honest with you but that’s what we do. Yeah?

– So, Dr. Clark, what I’m finding interesting about this is because of the clinical challenge you did before, you know you can get away with that adaptogen formula ’cause some of those formulas have some things that are disruptive to people with autoimmunity.

– Oh, absolutely, yeah, yeah. So, what Freddy’s referring to is that for example, like your classic adaptogen is licorice root, right? Well, licorice root is a T helper 1 booster for sure, right? A lot of adaptogens fall into that category. So, I feel pretty confident I can get away with that because he had no problem with that. So, it’s exactly right. So, not only did that challenge help me determine is his immune system probably involved in this or not? It also helped me say, okay, what’s in my toolbox now that I can probably use with this guy? And that means you’ve gotta understand the physiology of what you’re using. You’ve gotta understand what does this adaptogen thing do and how does it do it? You can’t just learn this for that. You’ve gotta understand why does it do that? Why would I wanna do that?

– And that’s why it’s not memorizing protocol.

– Yes, no robots.

– Perfect.

– All right, we’re not doing robots. And we’re gonna give him some omega fatty acids ’cause he’s gonna have a problem with… He’s definitely, I didn’t have to test for that. I mean, you can do all that kind of testing if you want but look, the guy hasn’t eaten fish in 10 years. He’s probably got an omega 3 fatty acid issue. All right, here we go. So, 30 days later, okay? He can’t remember the last time he was dizzy. Well, that’s good, right? That’s very good, we like that. And here’s the thing, why is it 30 days later? Well because that’s how I do my treatment plans. I do them in 30 day chunks ’cause 30 days is plenty of time to find out if you’re on the right path or not with most people based on their symptom frequency and what they’re experiencing. It doesn’t take six months of doing metabolic work to find out if it’s gonna help. It just doesn’t do that. You have to set a bar for yourself, like same thing with rehab, right? If I’m doing rehab on someone, if they’re not getting better significantly after two days, then I need to reevaluate what I’m doing. That’s how I do it. Same thing with this, right? So, 30 days is good. But this is the thing, I’m not gonna congratulate myself too much and light a cigar. He has to stay better, right? He’s gotta stay better. So, the transient dizziness, all that seems to be good. He’s eating fish and eggs. Well, what now? We just cut him loose? We did our job, everything’s great? No, we’re gonna have him continue this same protocol for a little bit longer. We’re gonna recheck his select lab like the iron and the B12, the Vitamin D which was okay. And we’re gonna recheck those things in 30 days. So, 60 days after starting treatment, still no dizziness. Awesome, we’re getting very happy now. We’re getting very happy. Now, we rechecked his blood chemistry, and here’s what it showed. B12’s 799, that’s way better, right? His ferritin, not any better at all. That sucks. His magnesium is 2.2. So, we know that he can absorb B12 sublingually. We know he can absorb magnesium gastrointestinally, orally. It doesn’t look like he’s able to absorb iron very well. His LDH, we like that, that’s almost 30 points higher, right? So, there’s gotta be some change in his glucose handling and his HP axis tone. Now, he was wanting to, when he did this, he didn’t have hormonal problems to begin with, but he wanted to check his hormones, right? A lot of guys in their 30s and 40s wanna do that. So, his luteinizing hormone’s 5.3. That’s kinda middle of the road. But his total testosterone was 360. Now, that’s low I think for a guy who’s 38. I mean, I think, I’m not making a mountain out of a molehill. I think it definitely should not be that low. His free testosterone is actually low. 3.5 is very low, you guys. I mean, that’s very, very low. Now, did he have overt erectile dysfunction? No, but could that cause problems in basically every cell? Sure, now, I don’t always put hormones on my, I don’t put those on my priority list, right? ‘Cause usually, hormone problems are secondary to one of those other four things that I mentioned. So, this guy’s got a hormone issue. Now, what do we do now?

– Dr. Clark, the guy didn’t have ED, but he did watch the Lifetime channel and cried during every movie.

– Yes, right. The Hallmark Channel.

– All of those, yeah. The dog food commercials, he’s crying. I mean, it’s everything, right? Watching “The Secret Life of a Dog” or that thing is “The Purpose of a Dog,” he’s just a sobbing snot bubble mess, right?

– That is a tearjerker of a movie.

– Oh, yeah. You put a dog on the screen, I’m just on a sack of nothing. Anyway, so what’s his diet? What are you gonna do, right? Well, keep that same diet, my friend. We’re gonna keep the same protocol, except I’m gonna switch him to a liquid iron because perhaps, he just can’t get that capsule absorbed, so we’re gonna switch to a different delivery format. I’m gonna keep the other stuff the same. Now, here’s a little detour though. That’s why the slide’s kinda went funky. We’re gonna have to go on a small cholesterol and mycotoxin detour for this patient, why? Because we checked his labs, they were low for the testosterone. 11 days, 10 days later, I checked his cholesterol. Initially and I forgot to put this on there for you guys, initially his cholesterol was 110. That’s too low.

– Yeah, very low. Below 150, you’re probably gonna have some hormone problems. And that’s probably where this guy’s hormone problem is coming from. He just has no substrate, he has no precursor. I mean, cholesterol is what all these hormones are made from, right? So, on January 20th, he discovers mold in his house. A significant enough mold problem that he’s gotta get out. And he says, “Man, for like a month before this, this depression kinda came over me.” well, that’s not uncommon because mycotoxins are no joke. I don’t have time to launch into it, but let me just say that they are no joke. And the big treatment is to get away from them. There’s other things you can do. But the primary treatment is if you’ve got them, where are they coming from? They’re usually coming from where you live. So, you’ve gotta get your house inspected, you gotta get it remediated. You gotta get it away from your environment. So, he moved out of the house, started feeling better. So, what testing could we do now? Well, I’m gonna do his lipid panel because I wanna follow up on this cholesterol thing, right? I wanna follow up on that and the connection between his testosterone, right? ‘Cause that’s a very possible tantalizing connection. We need to find out if that’s really the case. And then I wanna check his ferritin ’cause I changed him to liquid iron. ‘Cause that’s… This is what no one ever teaches you how to do when you take other types of education in this field, I feel, is they never tell you what to do when this happens . It’s like, well, what do I do now, right? Well, what if I give him the iron and it doesn’t work? Ah, just take it at double the dose, take it anyway, right? That’s my favorite thing for people that don’t know what they’re doing, they just tell them take double. Come on, come on.

– Especially when the educational program is also the provider of the supplements. They’re like, “Oh, the actual answer is to buy more of the same supplements.”

– Just take double. Just take double. That kinda serves both purposes, right? Anyway, so what the treatment plan? Well, we added some turmeric and resveratrol to help with this what I assume, and I think I can safely assume this, is gonna be some problems with biotransformation and some inflammatory consequences from having mycotoxins. And there’s plenty of stuff you could add. That’s what I chose to do. All right, so we’re still on the detour. So, on February, his cholesterol had gone down. Remember, so his cholesterol was pretty good. It went up with diet change. It went down with the mycotoxins and the depression. But his serum testosterone’s better and his free testosterone is better but still low. It’s double basically what it was but it’s still low. His ferritin’s gone up, great. We like that so that’s pretty cool. So, we like the fact that his ferritin’s gone up. Still rarely dizzy. Sometimes, in the afternoon if he moves his eyes too quickly when he’s texting, he’ll get a little dizzy. So, that’s probably telling us that there’s a visual motion sensitivity issue, right? Because if he’s moving his eyes and not his head, there’s no VOR involved with that, right? So, what he may have is he’s too visually motion sensitive. And I’ll just tell you guys, people that have that, usually have some sort of proprioceptive deficit, which could be cerebellar mediated. It could be deconditioning. But that’s usually something that’s at play in there. So, treatment plan. Same diet, same protocol. We added the turmeric, resveratrol. But now I’m gonna add some medical grade cholesterol. You can buy this, there’s medical grade cholesterol. Because I need to get his cholesterol level up and keep it up and see if it has a big impact on his hormones and everything else or not.

– Hey, Dr. Clark, on a medical grade cholesterol, that’s actually new to me. What’s the format of that, is it a capsule? How does that work?

– Yeah, just a capsule. And you just take it with meals, yep. I mean, I can tell you guys the name. I mean, I don’t have a… It’s called Sonic Cholesterol is the name of it. I don’t have any kind of interest in it, no disclosures or anything. So, 30 days later, Bruce is like, “Look, I wanna come into the office. We wanna see if you can do rehab on me.” Because he wasn’t 100% dizzy-free. He had been and then this cholesterol and mycotoxin thing happened. And so now, we gotta bring something else to bear, right? Because look, he’s gotta have something that we can work on circuit-wise. There just has to be based on what he’s telling me. So, just to remember, running is problematic and provocative. Unexpected perturbation of his body and head is provocative. Moving the head quickly in yaw is provocative. Moving it like this and shifting his gaze is provocative. And he has, on exam, he has significant hypertonicity of his suboccipital triangle muscles on the right side. And just so you know, that is super common in people that have vestibular problems. Because and I’ll give you the quick run-through, you’ve got this little pyramid I like to show people, the three-dimensional balanced pyramid, right? And at the bottom of the pyramid are three corners. On one corner is your vision. Another corner is vestibular. And the other corner is your neck, right? Basically the proprioception from your neck, mainly your upper neck. And at the top of the pyramid, the big integrator for all that stuff is your cerebellum. So, what you’ll see is if one of these corners goes south or the gain goes down, the the gain of one of the other ones has gotta turn up to try to help the system re-weight. And what you’ll see very frequently is people will get neck pain with vestibular complaints. And if you see that, then you know that’s probably what it is. Now, does that mean you wanna go in and adjust that right away? No, because that may screw them up. Because that neck pain may be what’s keeping him functional. It’s not comfortable. That may be what’s keeping him comfortable. That’s a compensation, so to speak. And you go in there and decompensate him, even with your awesome adjusting technique, you’re probably gonna make him worse. And that is what happens most of the time with these people if you do this without correcting the other problems. He’s got some decreased cervical range of motion, and he’s got head forward posture. Now, the reason I talk about that is that… I look at that stuff, I don’t just look at his blood work. I mean, I still integrate all that other stuff when it’s appropriate. And I still look at that postural musculoskeletal stuff because if you know how it fits in with everything, it’s very, very important. All right, so this guy, this is not 30 days later, this is all the office. So, upper extremity cerebellar testing was good. That’s cool. Now, his head-still pursuits with his head still and his eyes tracking, they were pretty good, except he had a little bit of sway when we did up to the right, down to the left, which is integrated via the right half of the cerebellum. Saccades at bedside, doing this, doing that, those were pretty good in terms of their latency, velocity and accuracy. There’s a lot you learn, I’m skipping over that, but that’s ruling out a lot of stuff, I might add. If I’m selling you that, there’s a lot of things that went woosh, okay, that’s probably not an issue. In terms of his cervical function, there’s that tightness. And he has that restricted motion, et cetera. Now, we did a one-leg stand perturbation test, which I don’t have time to show you guys, but basically the person stands on one leg, and you can have them lean against you, and then you have them move out of the way. Then you move out of the way and find out, can they keep their balance or not? But essentially, here’s the thing, he was unstable back and to his right, okay? So, back and to his right, which makes your eyes go down, okay? Which is right posterior canal, integrated through the right half of the cerebellum. Then we did the Cervical Joint Position Error test. And what that is, you have a little head-mounted laser, you have a target on the wall or a grid or something and they look at it and they get it lined up and then they close their eyes, they turn their head. And they come back with their eyes closed and try to remember where the target was and they open their eyes. And this guy sucked. I mean, he was really bad. When we rotated his head to the right and back and tried to bring him back to neutral, he’s off by like five feet. So, there is an integration problem on this right side for sure. All right, so what’d we do? So, nutshell, okay, I’m not going through day by day because you guys have been hanging with me so far. I wanna kinda get to the punch line of all this. We began by working on that joint position error. And you can do that a couple of ways. You can do that by just having them use his vision to correct. So, meaning, if here’s the target, and here’s the laser, right? And they start like this and he turns his head with his eyes closed and he comes back, oop, and he falls short and then he opens his eyes. That little correction, sometimes that’s enough to kinda get the maps to correct and calibrate. But that doesn’t work for him. So, we had to do collicular remapping, which means we had to start bringing in small amplitude saccades and small amplitude pursuits, mainly up to the right and down to the left to try to reestablish a normal visual map upon which other proprioceptive and somatosensory maps could then be built, okay? If that’s way over your head, we’ve got all kinds of classes at the Carrick Institute that can help you learn how to do that. I also mixed in some right arm non-linear complex movements, plus a right one-leg stand, why? Because this type of movement, this non-linear thing, is gonna increase cerebellar output on the right side. The right one-leg stand’s gonna increase drive from the right side. And keeping in mind, I’m not just doing that blindly, right? We’re doing those tests, and then rechecking his performance, right? Doing the treatment and then rechecking his performance. Then we also did a lot of adjustments ’cause this guy’s system loved to be adjusted. I mean, it really just, it was crazy. You could basically see his joint position error stuff just totally normalize out when you adjusted him. It was very, very cool. So, I adjusted his hands, his fingers, his radial head, his shoulder, his costovertebral joints. I think I adjusted his neck maybe once. Maybe once I adjusted his neck. So, I was able to target that bullseye with the joint position error test. And then we also used, and you guys can’t see it, but we also use this thing called an ATM2 to really try to change his upper torso juxtaposition with his head to change his posture for good, right? To reset the gain of the cerebellum in the particular slices of the cerebellum related to controlling this head forward posture. That’s really the best way I can put that. So, what happens? Well, after four days of doing this stuff with him, he can run. He ran around and around and around the parking lot, no problem. I mean, he broke a sweat, he was really going for it. He could do burpees up and down, jumping jacks, no problem. So, we’re moving that head, right? We’re getting the visual scene to move on his eyes. He could text head down with no provocation, although I told him not to do that ’cause this is not a good biomechanical position. You shouldn’t be doing that. The joint position error test was normal. We rechecked some labs. ‘Cause remember, we were gonna see what happened. So, his cholesterol, 118, not great, not great. It went up a tiny bit, really a statistically unsignificant amount. But his serum testosterone keeps going up, right? That’s good. And his free testosterone was now normal at 9.9. Okay, so even though his serum cholesterol total was not normal, the downstream metabolites of that, if you will, were normalizing and that is good, we like that. We like that. And the ferritin, eh. So, here’s what I told him, I said, “Look, can you just eat liver?” Because that’s actually the best source of iron you can get. That’s 100% heme iron, right, yeah?

– And maybe this is not the way it works, but as you tried giving that cholesterol, especially that medical-grade cholesterol, could it be a factor of utilization? I mean, his hormones are improving, right? So, does he even need more? Is it too simplistic to think of it that way?

– Well, it’s hard but I can tell you this, what he’s probably doing is sucking all of that in and using it, you know what I mean? He’s just probably really, really utilizing it to the point that he could probably use more, right? So, guess what? He’s still taking it, right? And I don’t remember if I have this in here or not, ’cause I can’t remember if I put it in here. But it’s back up to like 130-something now, if I remember correctly. So, yeah, he could still use more. So, what’s the treatment plan now, right? We did the metabolic stuff, did okay. We had the detour, we did some rehab. That’s doing pretty well. Well I said, “Hey, man, maybe add some liver.” He said, “I’ll do it. Whatever you tell me to do, I’m gonna do.” And I said, “Okay, fantastic.” Supplement protocol, I’m not changing anything. That’s actually incorrect. It’s not Iron Bisglycinate. Take the iron off of there because we’re not doing that. The hydroxocobalamin and the adaptogen and all that stuff, the turmeric, resveratrol, the cholesterol, we’re still doing that, right? Because we’re not out of the woods yet with this guy, okay? We’re not out of the woods. So, two weeks after rehab, we follow up, why? Okay, here we go. Here’s why we do this. Here’s the numbers I use when I do rehab. We’re getting to the very end of this case. I use a two-day rule, which means if I do two days of treatment with this patient and they’re not significantly better, they are not significantly feeling better, then I’m probably gonna stop, okay? Now, yes, I should see saccades and pursuits and whatever objective markers I’m using, those should get better. But if the patient’s not reporting to me that they are feeling better, I’m stopping, okay? I do four or five days of rehab, depending on what I think they need, and what their budget is and that kinda stuff. And then we follow up two weeks after that, here’s why. So, we often hear about immediate early gene responses. We taught those in the 800 series in the neuroscience classes. Immediate early gene responses really aren’t that immediate or early. That’s a term that was taken from virology, viruses, virology. In neuroscience, those immediate early changes take about a couple of days. That’s how long they take. Medium-term changes take about four or five days. And longterm plastic changes take about two weeks to set in. So that’s why we do the timings like we talked about. Yes, we should see some changes right away, with someone like if someone’s got a bad Romberg’s and I adjust them and they get better, that’s not an immediate early gene response. That’s not what that is. That is not an immediate early gene response. If you adjusted them and that’s the only thing you did, and two days later, their Romberg was still good, that’s probably an immediate early gene response that you saw happen. If their Romberg stayed good after five days, well that’s a medium-term change that’s happening. And then if two weeks later, their Romberg was totally fine, and they haven’t been doing anything else, and the only intervention was that adjustment, well, then that’s it, man. That was the changes. So that’s why we follow up two weeks after rehab, and we don’t get excited, and we don’t clap ourselves on the back and we don’t post on Facebook about how good we are when we’ve treated someone for four days. We don’t do that. They need to stay that way. They need to stay that way. So, after two weeks, no significant dizziness since the rehab. Okay, cool. The only times he gets a second or two is in the afternoon, still metabolic, if he’s looking down, texting on his phone. So, I still have him doing some rehab stuff. And then of course, COVID hit, right? But he’s still doing well. Just so you guys know, he’s still doing well. He still says he’s essentially 99% better. He occasionally has like a second. I mean, how long is a second? One thousand one, he has that much of symptom occasionally. But he can run, he can exercise. He can do activities of daily living he couldn’t do so that is good. We like that. So, what’s the treatment plan? Well, I’m still working with him, right? ‘Cause I’m not gonna take him off this stuff during the middle of a pandemic. I’m not gonna do that. So, we’re still… I still messed up the iron thing here, that should be gone. But we’re still gonna check his ferritin. We’re still gonna monitor his hormones ’cause we’re not out of the woods with that. So, he didn’t come to me because of the hormones, you understand? He came to me because of this vestibular problem. And because I am well-trained and I know a lot of stuff, I was able to help him with these other things as well. Now, the hormones may have nothing to do with the dizziness, but it’s still a problem that needs to be addressed. And because I know how to do that, I’m the guy that can help him with that, all right? All right, so what’s our takeaways from all this stuff we’ve just been doing for the last long time? Well, you have to know and own relevant physiology in order to be efficient and effective with this guy, right? Otherwise, you’re gonna waste time, you’re gonna waste money and you’re not gonna fulfill your role, which is to help him get better and stay better. You need to do testing that makes sense based on that case, okay? Please don’t have a standard new patient lab package that every new patient does. I would encourage you not to do that, and I understand why you would do it because it just makes you not have to think. I understand that, but I just don’t think you should do that. Use those four priorities once you understand them and own them to prioritize the treatment like we did here with this guy, right? We said, hm, this is what it looks like it could be. Here’s what the testing shows it could be. Which things am I gonna go after, right? And then we went after them and then you follow up . Then you know how to monitor them and find out is that working? Always think of what’s next? What if the iron doesn’t go up, what do I do? What if the B12 doesn’t go up, what am I gonna do? What if none of this works, what am I gonna do? You’ve gotta know the physiology of the nutrients and the herbs and whatever. You have to know what those things do in order to achieve the desired changes you want and avoid the non-desirable changes that you don’t want. And you definitely wanna integrate brain-based treatment receptor. You wanna integrate that when it’s appropriate and when it’s indicated, right? That’s what you wanna do because look, I couldn’t have got this guy completely better if I didn’t know how to do brain-based rehab. I couldn’t have, couldn’t have done it, right? And by the same token, if I didn’t know any metabolic stuff, there’s a real good chance I wouldn’t have gotten him better doing the rehab stuff by itself because of the metabolic issues he’s had. But it’s okay, you don’t have to pick one or the other, you can do both. You can do in whatever order you wanna do. You just have to have a standard in place where you say is this working? If it’s not working, what’s next, right? That’s okay, you can do either one. Yeah, you understand that. So, that brings me to this, which is we’re relaunching the series starting in October. And I’ll let Freddys say a lot about this in a second. But again, this, how to do what we just did, that’s what I’m gonna show you guys. I’m not gonna show you how to do rehab ’cause that’s way too much to put in one program. But I am gonna show you how to analyze people’s symptoms, how to do lab work, how to interpret the lab work, how to develop a treatment plan, how to follow up on that treatment plan, what physiology you should know. You’re gonna be extremely confident and I’m super excited because they’ve made some changes on their end to how we’re running the program. I’ve made some big changes in how I’m doing the program. So, with that said, I’ll let Freddys say what you wanna say about the program.

– Yeah, and Dr. Clark, when did we first launch this program? This is the second time you’re teaching it. Remember how many years ago?

– 2016. I think it was 2016 if I remember correctly.

– So, listen, so, Dr. Clark, since 2016 we’ve had an incredible amount of scholars go through this program and it’s highly recommended. I mean, they absolutely love it. I mean, they tell all their doctors to go through it. This really was a big help to their practice. And all those doctors for this program now are invited to go to it, included in the tuition. So, the way the programs now work with the Carrick Institute is when you buy a piece of education like this, you get the updates. Not only do you get the digital recording, so if you were to do the live stream or go to Cape Canaveral and watch the education with you in the room, which is my favorite way to do it, ’cause I always have a good time learning with you, but if you can’t do that, you do it live stream. You’re gonna get the digital recordings and guess what happens? Whenever we teach the course again three years later or four years later ’cause there’s gonna be updated material just like you mentioned a moment ago, they’re gonna have access to that material, so they can keep evolving and growing as the science changes. Because just as neuroscience is evolving, so is the clinical nutrition, and that science is changing and evolving. So what you’re gonna be recommending and teaching, what you did four years ago is gonna be different than you’re gonna teach this year, which is gonna be different three years from now. And I think that’s a big boon to these doctors ’cause we want to create lifelong learners. The Carrick Institute’s really committed to creating the best scholars and doctors in the world. And we wanted to find a model that would allow them to continuously grow and fortunately, we have professors like you who are evolving as well. I mean, you’re just not teaching the same things over and over and over again. And some things, you’re improving and some things, you say hey you know what that was wrong.

– That didn’t work, right.

– Yeah, let me do it better. So, we really applaud you for that, and we’re really excited about the Carrick Institute finding this model that’ll work for.

– To translate for everyone, what’s he saying is when you invest for the class now, and it gets done again in the future, you get to go to that class at no extra charge. Am I right, that’s how you’re doing it?

– Correct, yeah, that’s how we’re doing it.

– Now, the other thing is, we’re doing these modules about every three months, I think. And the cool thing is is you’re gonna get, the turnaround time on the digital recordings, you’re gonna get those before we even do the next module in the sequence. So you’ll be able to have time to review all of this stuff. So, you’re not gonna get lost. We’ve picked a pace that makes it very digestible.

– Yeah, I gotta tell you something about the digital recordings as well. We’ve actually evolved that system. It used to be before that you would just watch the recordings of you teaching, and we do a really good job with high definition cameras and audios and integrative PowerPoints. But now we’ve gone towards interactive video. So, let’s say you teach them a concept on Th1 and Th2 stimulators and what they do. And maybe you teach them that licorice root is a Th1 stimulator.

– Right.

– Right after you teach that point, the interactive video will pop up and say, hey, licorice root, is it a Th1 or Th2 stimulator? And what we’re finding ’cause we already launched a couple classes with this, what we’re finding is that that interactivity pulls your attention back in.

– Absolutely.

– You suddenly can’t sit there and watch. Oh, I just watched 40 minute of a video, I mean, what did I learn?

– What it’s gonna do. See, what it’s gonna do, when I teach live, that’s how I do it too. I’m always mixing in little mini quizzes, if you will. But what it allows you to do with the online thing is basically replicate that and say… ‘Cause if you grapple with the material as you’re going, and you make decisions and you make calls, you’re gonna learn it.

– You have to be challenged.

– You have to be challenged, absolutely.

– So, we would do the quizzes, but we very closely watch the data on the quizzes and we go, “Well, hold on one second. How many times did they have to do these quizzes before they get it right?” We don’t want it to be like, oh, got it wrong, got it wrong, okay, this time I got it right. There was only four answers.

– Right, right, right.

– All right, we’re gonna check them and really engage them during the videos.

– Right.

– And so, just the changes that we’re making, and the changes that you’re making, I think just elevates the quality of the education that we’re doing, which is gonna elevate the quality of the clinician we’re creating, which is why it’s freaking exciting. And it’s a good time to have this stuff available to us.

– That’s gonna be awesome.

– It’s always awesome with you, Dr. Clark, always awesome.

– Yeah, I’ll see you all there.

– Well, speaking of that, Dr. Clark, what I loved about this particular case review, two things, one, I really get a kick out of the clinical challenge. I think that that is so brilliant. What I love about it is there’s some people that would be thrown off by the red herring of autoimmunity. There’s some people that would be thrown off by the expense of autoimmune testing. There’s some people… I mean, the fact that you know what to not focus on is powerful and the fact it actually guides your treatment plan in the future is also powerful, and that takes a lot of wisdom. But my second other favorite part was the way you have formed your reassessments and how you actually gauge your success. And how you base that off creating actual neuroplasticity and longterm potentiation in this patient. Did I really change their nervous system? Am I supporting them biochemically? Did it actually change their brain? And you are not being like, “Oh, I hope I did it, and let’s see if they call me.”

– Right .

– You’re creating the model and saying.

– But people do that. But there are practitioners that do that. They go, “Ooh, I hope the person doesn’t call me and say they’re worse.” I mean, come on, you’re a doctor.

– You’re designing it for being like, well, actually I’m gonna check at all the appropriate times to make sure I did the thing. And I mean, Dr. Clark, I admire you so much for the way you work with your patients. The way you judiciously use your tools, whether you’re gonna use clinical nutrition or use neurology and the most beautiful is when you bring them both like in this example. And that’s why a lot of doctors like these case reviews. I mean, we actually get a ridiculous amount of views on them om YouTube and stuff. It’s pretty neat that people love this stuff. Every month, we get an email that says how many hours that people watch these case reviews.

– Oh, right.

– Yeah, it’s thousands of hours.

– Cool, good, maybe they’ll learn something.

– Yeah, so, we’re gonna keep putting them out, Dr. Clark.

– Absolutely.

– Thank you so much for your time.

– Oh, you’re welcome.

– I know you’re scheduled to do another one in a little bit. And everybody, we hope to see you at the clinical neurochemistry and nutrition program coming later this year in 2020. If you missed the first module, catch it on video. And again, thank you very much, Dr. Clark.

– Thank you all, see you.