79: The Disease That Looks Like Everything – The Hidden Cause Behind Fatigue, Weight Gain, and Inflammation with Dr. Christian Jenski

And we have cell senescence our whole lives. When we're young, our immune system identifies it and clears it out. As the immune system ages, and there's more emerging literature on your true biological age is most closely linked to the age of your immune system. As your immune system is aging, you're less equipped to clear out senescent cells, so you have more of them, therefore, infecting or affecting adjacent cells. And that just becomes this cascade of events that now you're starting to have organ dysfunction and damage. And so to me, that's kind of just a different way of saying metabolic dysfunction foreign.

I am super excited to be with everybody once again to talk with my friend and colleague, Dr. Christian Jensky, about all things functional medicine. And today we're going to take a deep dive into metabolic syndrome. And we were talking before we started recording here about metabolic syndrome, what it is. And I think people are hearing about energy, you know, having adequate energy, having good energy, hearing about mitochondria, a bunch of things that I don't think they understand. The scope of metabolic syndrome, which is primarily an issue of energy production. And it looks like a lot of different things. So what we're gonna be doing over the next three sessions is talking about metabolic syndrome, like just listing off what are some of the things you see in metabolic syndrome, then taking a deeper dive into individual ones. What are some lab tests you can look at, and then at the end, talk about mitochondria, what they do. Like, how can you actually address some of these things? Cause ultimately, you know, we talk about diet, we talk about lifestyle, we talk about toxins, a lot of things that play into this. But ultimately, taking get to the root cause, you really need to kind of know what's causing your energy production issues. And if you don't have an idea of what could be going on, it makes it hard to kind of get to the root cause. So I don't know if you have any introductory remarks before we start diving into some of this.

No, I think that was good. I think you kind of hit the nail on the head, which is to say that metabolic syndrome, I think, falls into this general bucket that most people have some semblance of an idea about. Like, okay, it's an issue with your metabolism. So maybe for that person, it means I'm gaining weight, or I feel tired, or, you know, my brain's not working as well, but the layers are so deep. And the problem list gets bigger and bigger and bigger the more we understand this. And I think there are things that people don't really realize are still classified within that confine of metabolic syndrome. So the whole point of all this is to kind of uncover that and delineate what some of these things are, because I think it'll then resonate with more people to see just how ubiquitous this is and how much like when you talk about things like inflammation as the root cause of all evil, so to speak, or mitochondrial dysfunction, this is that playing a role. And it can kind of be that common thread to all these different parameters of health or disease that tie it together.

And like in going on like thinking that like the reason we talk about metabolic syndrome is because we have a research based criteria. And so when someone says metabolic syndrome, you know, this is according to the ncpt. So this is a national guideline that cardiologists and endocrinologists and family practitioner, internal medicine people use. And we're just going to go through these really briefly and this is how we define metabolic syndrome. And I want to start with the definition and the concept of how lacking the definition is, especially when you dive into what diseases are in that. So, you know, first thing is obesity. If you're central obesity, particularly you hear the weight around the spare tire, which, which correlates with fat around your internal organs. Visceral fat is the term for that. Essentially how some ethnic groups will hold more visceral fat than others. Asians, for example, will hold more fat around their organs than their skin. So you can see someone who looks skinny and be metabolically obese, versus on the other side, African Americans will actually hold body fat more on their skin so they can look overweight but not have as much fat. Mediterraneans, Middle Easterns and northern European descent individuals are between these two spectrums. But just realizing that can help you understand how you can have someone who's from India, for example, or Bangladesh, which I've had patients from all these areas who look to be healthy and they're diabetic, pre diabetic. So it's particularly for men, your waist is greater than 40 centimeters, women greater than 35. Talk about the next one, which is triglycerides over 1:50. How about that? A little too. Yeah.

And interestingly enough, like this condition, this didn't exist when we were in medical school, kind of came to pass while we were coming up like it was metabolic syndrome. It's something that's developed over time, secondary to all the trends that we've seen in, you know, lack of exercise and sedentary lifestyle, poor diet, not managing stress, not managing other hormones, not Sleeping appropriately. Metabolic syndrome. I think the reason there's confusion or lacking in clarity is because it's kind of relatively newer. Triglycerides greater than 150. So triglycerides are part of the lipid profile that we look at when we're trying to risk, stratify somebody for cardiovascular disease. And there's cholesterol, there's triglycerides, there's hdl, and there's ldl. That's the good and the bad. Cholesterol, total cholesterol, and then the triglycerides. Triglycerides greater than 150. For us, greater than 70 is deemed to be too much. I mean, really, this is the difference between normal and optimization. If you have triglycerides less than 150, you don't meet diagnostic criteria for metabolic syndrome. In my practice, it's not optimal. We want those less than 70. So there's even these hallmarks as part of the criteria that, again, like many things in conventional medicine, the range is too big because it's predicated on the general population, which is overweight and obese, overweight and diabetic and metabolically inflexible. And so that's a problem. But there's many factors within triglycerides. The next one, like things like diet, lack of activity, you know, genetics, these are all things that are playing a role. And then the next one being hdl, which I just alluded to, which is good, seem to be good cholesterol, but that even has layers. And so if your HDL is low in men less than 40 and in women less than 50, that's part of the criteria.

Blood pressure greater than 130 or 85, and fasting glucose over a hundred. So if you have, you know, at least three of these, you have metabolic syndrome. But then, yeah, taking a little bit of a deep dive into, you know, blood pressure. If you're, you know, blood pressure 130 or 85, again, not optimal. You want your diastolic probably, you know, a little bit less than 80. You're systolic in the 120s. Fasting glucose is interesting because we know if you're fasting glucose, I believe it's 86. If it's over 86, any for every point it goes up over 86, you have a 6% increased chance developing diabetes.

In the next year.

So all of a sudden, when you hear metabolic syndrome, you have to realize it's a very limited view. So, which goes into the next section? I want to. I'm just going to Read through the list first of. Of illnesses, it'll be, yeah, so these are the associated diseases.

Yeah.

And when I mentioned these diseases, you have to think about, okay, where does that fall into this diagnostic criteria he just mentioned before? And the answer is, many of them do not. Okay. Obesity, of course, type 2 diabetes, cardiovascular disease. And when you realize half the people who go to the ER with the first heart attack have normal cholesterol. Huh. What's the market for that non alcoholic fatty liver disease, which now is called Medbock Medlock Associated fatty liver disease. Basically, the concept is with some of the triglyceride issues, your body can't appropriately store and move around fat. And so let's just put in the liver and see what happens. Yeah.

And it's interesting how many g acid does that. Which we'll talk acid does that too.

One thing that's interesting about fatty liver is that, you know, early in my career I would see patients, we do it, you know, liver pain, whatever comes in. They don't have diabetes or pre diabetes. And you do an ultrasound as part of the workup in the year, how many people would you see that comes back with, you know, heterogeneous liver consistent with fatty liver disease? And they're like, okay, well you're, you're okay because we see this all the time.

Yeah. Drives me crazy because it's dismissed and I think less so now, but still not aggressively managed in a way that I think is appropriate. And having a parent that passed away from liver disease like this is one of the things that I focus on a lot with my patients. The way I'd explain it to patients is there's a continuum for everything. Like, the best way to understand medicine is to just look at it in simplistic terms. And so if you look at fatty liver disease, or liver disease in general, as a continuum all the way to the left, no liver problems, no risk, liver's functional. Everything architecturally looks okay. And then you start to have a little bit of liver injury patterns. So you start to see elevation in liver enzymes. It's called transaminitis. Those hepatocytes, the cells themselves, as they start or break open, they'll spill these enzymes into your bloodstream. You measure that. So we see an injury pattern. Then there's fat deposition that gets put down. So we start to say fatty liver disease. Then you start to see a little bit of early scar tissue we call fibrosis. Then, then mid stage, then late stage. And then you're cirrhotic where your liver's failed and it's completely scarred down and it's irreversible, as are the later stages of fibrosis, even pre cirrhosis. And so when someone says, oh, you got some fatty liver disease, you're ready all the way here on the continuum, like that should be a flare gun going off saying, hey, we gotta do something about this. Now, in that individual, is there a lot of low hanging fruit? Do we need to lose some weight? Do we need to get exercising? Do we gotta clean up the diet? Usually yes to all of those things.

But.

But what if they're doing all that already? Then where do you go? And that's where this gets complicated and layered. But you gotta do something about that because the next step is the beginning of that burgeoning irreversible process. Right? We used to call these things incidental lomas. Right. Somebody would come to the ER and their reason for whatever imaging you're getting is unrelated to what you find in the imaging. An example would be someone has right lower quadrant abdominal pain.

Okay?

I push on it, they wince, there's rebound, their white counts up. I suspect appendicitis. Get a CT scan. No appendicitis. Great, you don't have appendicitis. Urine's clear. I don't see anything concerning. You can go home. Oh, by the way, we saw incidentally that you have fatty liver disease on your CT scan. Follow up with your primary care doctor. And they may or may not. And if they do, that, primary care doctor might just be like, yeah, try to lose some weight. But that's it. So you see it over and over and over again. It's, it's common and it's everywhere.

We'll talk about, in part two, about specific, each specific third, because I've had patients have their fatty liver disease go away, have the fibrosis score, the elastography normalize.

So, yeah, my fatty liver went away. I mean, I had fatty liver disease.

So there are things we can do about this, you know, gout. Well, let's also talk about pcos, and you talk about gout. Pcos. Polycystic ovarian syndrome is interesting because I don't want to talk too much about here, but part of that is insulin resistance. When you develop insulin resistance, which is a part of Mailbach syndrome, you get it in every organ in your body except for two. One of them is your ovaries and one's your kidneys. So what happens is when the insulin goes up, you retain fluid, you can get blood pressure issues, and you get Overstimulation of your ovaries, which can result in excessive amounts of testosterone. But as well, you get these cysts and it's a big cause of infertility. It's a part of this metabolic syndrome thing. Talk about gout a little bit, because I don't think people really think about gout. And then the excessive amount of oxalates, uric acids, and how that correlates with.

Yeah, so I think even I would say gout, slash elevated uric acid. Because you can have elevated uric acid and not have a gouty arthritis presentation. And that's still a metabolic disease as far as I'm concerned. It's a harbinger of things to come. Like, we weren't paying attention to uric acid as much as we should have. Unless that person had gout. Right. Pain is a motivator. Someone has a, a red hot inflamed big toe that's called podogra. That's usually the initial presentation of gout. And so they go to their doctor, they get put on some NSAIDs, some non steroidal anti inflammatories, maybe some steroids, maybe a gout specific drug like colchicine. And then they're like, all right, clean up your diet, eat a lower purine diet, don't eat a lot of, you know, red meat, don't drink beer, that kind of stuff. But what they don't ever get counseled on is don't eat a lot of fructose, don't eat high fructose corn syrup syrup, don't eat sugar, even fruit that has fructose in it. The things that are gonna drive fructose up in your body are gonna drive up uric acid, which is gonna drive up metaflammation. It's gonna hurt the liver deposit fat. So uric acid, again, much like everything else that we measure, is within a normal range, but we have a range that's optimal. It needs to be below a certain number. And so when your uric acid starts to trend up and it was previously normal, that might be an early indicator that you need to clean up your lifestyle or do something different about your metabolism because it may be going in the wrong direction. So I see uric acids that are too high and that person does not have gout. I see uric acid going along with gout. I see people with a gout flare that have a completely normal uric acid in the flare setting. That's often the case. So you really have to look at it through the lens of what Is this trying to tell me? And how does it fit the bigger clinical picture of that patient? But this is one that I think is really, really important as kind of an upstream clinical indicator of what else might be going on. And so I get a uric acid on every single patient. I'm pretty sure you do, too.

And if uric acid level is greater than 6, you're still accumulating in your tissues, whether or not you have flares. We'll talk about that a little later on.

Yeah, the gout, it basically causes these crystals to essentially deposit into the joint space and cause an acute inflammatory arthritis. Right. That's essentially what you see it in the toe, see it in the elbow, see it in the knees. Those are most common presentations. But, I mean, that then kind of lends itself to, in my opinion, also a harbinger of cardiovascular risk. Part of Dr. Mark Houston's protocols for reversing cardiovascular disease and decreasing plaque burden is that he puts patients on allopurinol or colchicine if three levels are high and their lifestyle is not managing it. So there's utility for these medications. But this is stuff that can be correctable with other things. Right. What about kidney stones is another one. You want to talk about that? And sleep apnea. I know you have lots of thoughts.

Well, with kidney stones, you know, it can be from too much oxalates in your diet. Sometimes, you know, we actually do it to ourselves by eating too much kale or doing green smoothies, which are high in oxalates. And in nature, what's supposed to happen is when you eat these foods, you actually eat calcium with them, and the calcium binds to oxalates in your diet, and you just poop them out and you don't absorb them. The other source of oxalates can actually be yeast in your GI tract. And so when you see people with elevate oxalates, and I've had patients who've had that and have their gut testing shows your yeast levels are high. But all of a sudden, in order to get the oxalates, now, it's not just, you know, taking some calcium citrate or magnesium citrate with a meal to minimize absorption. It's also dealing with your gut to actually minimize yeast and other bacteria that can. There's actually certain bacteria that actually break down oxalates. And so we do it on the gut gut testing. So gut microbiome, yeast overgrowth. But ultimately, and we'll talk about this a little bit later, your gut microbiome is a big part of this. But the point is, like, this is not oxalate levels, uric acid levels, sleep apnea screening aren't any part of the current diagnosis criteria. PCOS or for diagnosing metabolic syndrome. And when I. We'll finish the list and go back. But one of my things about if, if someone has anything on this list, all of a sudden I'm looking for all the buddies. I'm looking for the crowd. I'm looking for the gang that comes with them. It's amazing. You'll find, ooh, you do organic acid testing. Your oxalates are elevated, all your uric acid level, 7.7. Oh, you snore a little bit at night, and all of a sudden it's like, I'm treating all this, you know.

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Foreign sleep apnea is one of my pet peeves because I feel like it's very common and frequently diagnosed because the definition of, you know, when you do this thing, I'm called an Aries evaluation. You look how thick the neck is. You look at their bmi, their weight. Do you snore? Does someone see you awake in a night? And if you check enough boxes, you can get a sleep apnea evaluation. When I see my patients, I'm looking at facial structure, looking at how big their tongue is. If they're hypermobile, you know, when someone goes, ah, ah, ah, ah, ah, ah, can actually see the backs down, Is their tongue too big? They can't see this, you know, but as a part of metabolic syndrome, and there's a close association with sleep apnea and low testosterone Especially in men. And we know low testosterone and men can be associated with cognitive decline, strangely enough, in diabetic. And we've known this for 15 years. I mean, this was. The drug reps, when they used to come around my office would sell me on giving testosterone to my diabetic patients. Because the literature is out there that if you're diabetic, check low T and your T load, that affects your, your progression of diabetes. But we're not gonna deal with the metabolic stuff. Right. And so it's interesting how I. It's one of those strange things that the drug reps come into the office to sell me a testosterone product after an article came out, because there's a product to go with the article. But when you talk about gut microbiome stuff to go on these, no one's coming by to send me probiotics or to have me sell patients, you know, probiotics or whatever. So which.

And it's also downstream. I mean, giving someone tea then shuts down their supply doesn't get to the root as to why the T's low to begin with. You may be short term helping them.

That's one of the things. In one of the groups I'm in, I'm in a, like a high net, a business networking group, and you hear people talking about low T a bunch and never do you ever hear them talk about metabolic syndrome. They're getting on T therapy, they're getting peptides, they're getting a testosterone, they feel great. And it's like, well, who looked for metabolic syndrome? Who looked for all these other things? Were you screen for sleep apnea and sometimes like, oh, yeah, last year I got checked for that. I don't treat it. I'm like, no one told you that's probably one of the reasons why your testosterone is low.

Yeah, it doesn't make any sense. I mean, we didn't know and I don't know that it even matters whether low T was the result of metabolic dysfunction and syndrome or the harbinger of metabolic dysfunction to come, because you can push your T down in a variety of different ways. Chronic stress and cortisol elevation, biotoxin injury. So it's not always the direct result of metabolic dysfunction or whatever to come. But that being said, like, which is emerging as this new thing shouldn't exist. And we're seeing it all the time. Like evolutionarily, men should be able to make testosterone for the duration of their lives. And now we're seeing guys in their 20s and 30s with low T and it's like this epidemic, and it's insane. Clearly, this is a problem and it's related to all this. Going back to the sleep apnea thing. Like their mountain potty score, their oral architecture, their Aries score. All that aside, if any of my patients have any of these and they've never had a sleep study, I order a sleep study. It doesn't matter if they have a thick neck or what their mouth looks like. I'm doing that as part of my full metabolic.

I feel like if you're 50 or over, you should get a sleep. A sleep apnea at least. Yeah. It's like if you get 50 or over, we should get calcium. Coronary calcium score.

Right. And a colonoscopy.

45 for the colonoscopy. Because cancer's coming earlier now.

Well, I just turned 50 and I'm getting my.

I got my 51. So I was a little. But it was clean. It was clean.

I did cologuard when the new guidelines came out. I was 46 and a half when the guidelines dropped it to 45. So I did cologuard. It was negative. Now I'm newly 50 and I'm going to go ahead and get my scope, and then hopefully they'll say see it.

And then you don't have to worry about it. Yeah. Yeah. My recommendation would be this, the sutap. Because suprap is what I said. Suprap, unfortunately has sucralose in it. The sweetener in it is the Splenda. You know who told me that? My wife. I got it from mine. I'm like, I did it. And she. With her. She has these eyes that see things in my. I'm. I'm kind of rushing around. She's like, what's this thing right here? I'm like. And I was in the process of doing my prep, so I couldn't reverse it. But the sutap is just potassium sulfate.

Osmotic.

Yeah, it's potassium, sodium, magnesium sulfate. And magnesium sulfate is Epsom salt. So it's kind of like a prescription fancy version of Epsom salts that are. Yeah. And you basically drink a lot of water.

It's a liver flesh.

If you're old. If you have parts of Dysautonomia. Because if you don't drink enough water, you will get dehydrated and then you won't get it done. So it's. Yeah. That's one of the reasons why some of the GI doctors don't like it, because if you don't drink enough water or you're elderly or chronically dehydrated, that could cause some problems. That's the little. Yeah. Anyway, moving on.

What about dementia?

Alzheimer's disease is now being referred to as type 3 diabetes. Yeah, well, why is that? Because the insulin resistance stuff, and when I did my protocol training, you know, there's like type 1 through 5 Alzheimer's, but type 1.5 was glycotoxic. So there's a correlation with mitochondrial dysfunction with insulin resistance, with metabolic syndrome and with Alzheimer's. So if someone's having cognitive decline, look for all these things in metabolic syndrome, you know.

Right. Not to mention the fact that neurons, your brain cells, can utilize ketones as fuel. But the supporting cast, the glial cells and the astrocytes, what do they like? Glucose. If you have insulin resistance, they're not getting their glucose, and that's a problem. What are they doing? Housekeeping. You're not getting housekeeping. You develop senescent cells, you develop amyloid plaque buildup. You start to get neurofibrillary tangles. Next thing you know, you have cognitive decline, or that usually precedes it, but you know what I mean? And then what about chronic fatigue? And what about mood disorders? Like, how would mood disorders fall into.

The realm of the thing about mood disorder? Well, so chronic fatigue will say we talk about. I feel like we talk about this so much. I don't want to belabor the point, but that's.

It's just.

It's a metabolic.

We'll probably hit that when we do the mitochondrial part.

But, you know, I wanted my. You know what. How is the way in which you interpret the data, the labs, your science, you know, ethics, the world around you? What's your worldview is the term for that. You know, and my. One of my worldview glasses I put on when I look at literature and look at labs is what were people doing a thousand, two thousand, three thousand years ago? Maybe I don't understand Ayurvedic medicine or traditional Chinese medicine, but people saw patterns. They. They noticed nuances. And it's interesting. How has that changed over time, you know, and so that's like the traditional thing. It's been around for thousands of years. And then you have the modern things. And in our, you know, in the ER and family medicine and even in functional medicine, what are we doing now that we've done for more than three or five years? I mean, I manage migraines radically different than I did 10 years ago. I manage chronic fatigue and fibro different than I did five Years ago. So the first question I have in traditional medicine, what are we doing now? The exact same thing, exact same way as we were doing in the 1950s. And the answer is mental health. The neurotransmitter theory of mental health disease came out in the 50s and we've been basing all of our therapies on it since then. And we have not had breakthroughs in mental health. Well, come to find out, you know, we learned when we did our mold training, there was a subset of people with bipolar schizophrenia that actually took the neurotoxicity for mold and the associated people with mitochondrial dysfunction. It can affect, obviously affects everything else, but can affect your brain function, which in some people can look like anxiety, depression, mood, lability.

Well, it also affects neurotransmitters.

So clearly it affects all these things. And so if someone comes in and they have stability, anxiety, depression, ocd, adhd, schizophrenia, bipolar. Yeah, there are, there is in schizophrenia and bipolar is a genetic component, but that is the vast minority of individuals. You have a mitochondrial metabolic kind of thing, inflammatory. And a lot of the treatments are very similar. But there's for great example, there's a drug called Deplin that is FDA approved to treat severe recalcitrant depression.

Very high dose of folic acid, methylfolate. It's a B vitamin. B, vitamin B9, like, but it's pre methylated. I have a patient who has an MTHFR SNP who was severely depressed and anxious, saw someone was put on Deplin and immediately was normal.

Not to say they're all, it's all the case, having symptoms, not say it's all the case, but a lot of these are symptoms. You get this symptom, cluster your depression, this symptom cluster your anxiety, this one your adhd. And finding out is there a metabolic component is huge because many of them do have a metabolic mitochondrial component. And the last one we talk about is cancer being a.

This is the one that no one really talks about as much as they.

Should actually interview Dr. Seyfried, who wrote the whole textbook on this, you know, and back to, you know, it was interesting when back in the 20s and 30s, they were having research showing that cancer actually was an issue with energy production. The cells stopped using oxygen and would actually start using glucose for energy and create acids, lactic acid. Which one of the biomarkers I use, my integrative cancer patients is looking at ldh. Is that elevated? You know, you know, it's called the Warburg. Yeah, Warburg. Correct. And so but what happened Was is we discovered genes, and all of a sudden we forgot about the metabolic aspect of cancer. Yeah. And how, you know, you look at cancer. You know, cancers have disappeared in the last seven years. We've cured them all, and they're all gone away. Our treatments are perfect. No, it's more common. Getting younger and younger and younger, and we're realizing there's definitely a metabolic component to it. You know, when you hear about cases of a glioblastoma, which is like the most aggressive brain tumor, um, they were actually treating those at Hopkins in the twenties with ketogenic diets. And, you know, what's a ketogenic diet? Going back to what you're talking about with energy, you know.

Yeah. So basically eating a higher fat, high protein, really low carb sugar diet, so that you're into a state of ketosis where your body is essentially using ketones as fuel. More efficient, more sustainable, and it's going to turn over cells better. So you're getting better autophagy, you're getting better apoptosis, not defective apoptosis that we can sometimes see. Um, you're having less senescent cells. You have less inflammation, you can detox. You tend to be feeding the good cells like your brain and not cancer cells. You tend to starve cancer when you're in a ketogenic diet.

One thing that popped in my head when you were saying that, and I don't know the answer to this question, so I'm gonna ask you this right now, what you're saying. It makes sense that metabolic syndrome might also be a senescent cell issue, because senescent cells are dysfunctional mitochondria. Are you familiar with literature in the metabolic syndrome world specifically referring to senescent cells? Cause there are therapies for that as well. Are you familiar with that?

With a tie between the two? Not any. Not any specific study, but I. I can almost guarantee if we did a PubMed search right now, we would find a link. I mean, it's one of those things where these are the common threads that we see over and over again. Do I know of a case report that's out there that proves those two or links those two? No, but I'm sure that there are. I mean, like, senescent cells are zombie cells. What are they doing? They're dysfunctional cells that are infecting adjacent healthy cells. And. And we have cell senescence our whole lives. When we're young, our immune system identifies it and clears it out as the immune system ages. And there's More emerging literature on your true biological age is most closely linked to the age of your immune system. As your immune system is aging, you're less equipped to clear out senescent cells, so you have more of them, and they are therefore infecting or affecting adjacent cells. And that just becomes this cascade of events. And now you're starting to have organ dysfunction and damage. And so to me, that's kind of just a different way of saying metabolic dysfunction. I think they're tied together.

So I want to close things out with this. The point of this is metabolic syndrome. Energy production issues, not creating enough energy, not having enough good energy, includes a lot of diseases. And just checking your sugar, this actually didn't even mention A1Cs and vitamin D levels. And we'll go to that later. Right. But you really need to take a deep dive and looking at these other associated issues, if you have energy production issues, if you have metabolic syndrome, you need to look at the bigger picture. Do you have markers for any of these other things? And we'll dive into that a little later. But that's my takeaway, is that you have to look at this whole group of metabolic illnesses. If someone has one of them, I'm looking for the buddies. If there's smoke, I look for the fire. And then we start addressing those. And lo and behold, people feel better.

If you have one of the conditions or suspect you have one of the conditions on this list and your doctor hasn't done a deeper dive on your metabolic dysfunction, you need to see somebody else. You need to see somebody that will, because there are more answers to be uncovered that can help you maybe resolve those problems, bare minimum, manage them better, and determine if there's something else that's on the horizon that you're not expecting. Why not get ahead of it? Why not be proactive and preemptive?

We'll talk the next one. I want to talk about some easy treatments for each one of these that can be super helpful. But if you have fatty liver disease, for example, and you're not on TCA or your S dial, like, that's where all the literature is going right now. Like at the highest levels of nih. And it's like most people are like, huh, secondary bio. I can use that. I know. Yeah, yeah.

Or vitamin E or milk thistle or a hostess, right? You have some fatty liver disease.

Walk, lose some weight. And actually, I remember early in my career, patients were getting for gastric bypass to treat this because weight loss was the optimal thing, and you don't lose weight for your fatty liver disease. So let's do bypass surgery.

I mean, that's like the opposite end of the spectrum versus doing nothing. I think there's a middle ground.

Agreed, my friend. Agreed. So let's stop there. Hopefully this information was helpful. Talking about Energy Metabolic Syndrome if you have questions, please post them in social media where you're looking at this. And next time around we're going to dive into these individually to give you some more information about energy production, metabolic syndrome and all things related to that. Take care and we'll talk to you soon.