Was wäre, wenn Laborwerte keine Aussagekraft hätten? | Kolloquium Medicine | QS24

Are you already on Wikisana? Welcome, dear viewers, to our special round of interviews in the format of a colloquium. Today we are talking to Professors König, Schubert and Wieneke about the theoretical question, what would happen if blood values had no power of expression at all? And I am very happy that we are getting into this topic together today. Stay tuned. Hello, nice to meet you. Good, otherwise I would have been working for free for the last decades. Brigitte, very good. Yes, we are happy to get involved. You are in the field of research. Mitochondria is your pet horse. Yes, but also microbiology. And we actually do a lot of laboratory values, even if they are not the classic ones that you may know. But we have a lot to do with validation, that they say something. And that has actually been the business of diagnostics for the last decades. What are your important values, where you say, okay, especially in relation to mitochondria, ATP, energy gain, performance in the body? So if we now concentrate or limit it to mitochondria in analytics, because otherwise this show would certainly blow up, then we measure the ability of mitochondria to perform their performance at all. And you can see that in general. Do they manage to produce energy at all, i.e. in the form of ATP? But mitochondria also have completely different functions. They regulate cell function, they communicate with the cell nucleus. And we can also analyze this very well in further analysis. And then, if it is not as it should be, then we look more closely at what it may be. Is there any protein missing? Are the cell complexes or the respiratory complexes not in order? Is the cell membrane perhaps to blame for not being properly put together? Or is the mitochondrial DNA, i.e. the genetic substance of the mitochondria, which is still partly in the mitochondria, so damaged that they can no longer perform proper protein functions? If this is the case, then we can of course continue to look whether we can regenerate them again. With mitochondria, of course, we are lucky that they can rebuild themselves again independently or that we can induce this. And that then, if it is not too late, the healthy mitochondria multiply again and the cell function is functional again. Does it also make sense with laboratory values to take blood three times, send it in and have it checked independently to see if there are error sources? This is part of the validation of these assays or analyzes. We did that, of course. And if someone has run a marathon in between, then we can already see changes. Then we know that this will then be adjusted again. But otherwise, the analysis is such that today the same result is as tomorrow and the day after tomorrow. As I said, since he has now run a marathon in between. You work in the field of micronutrients, in micronutrient diagnostics, because we are really much in favor of that and now with the 60,000 data that we have found. And that's why it's very important to say that the question is exciting, the one you asked. The decisive factor is the laboratory center. You are, Brigitte, we have been working closely with you for a long time. You do this micronutrient diagnostics. But the decisive factor is also, Brigitte will agree with me, the laboratories do not get information from patients. They get the information age, weight and size. These are the information that the laboratories get. What about the framework conditions? That means, as a laboratory center, which has been criticized for years, that's why I spent a lot of money on my foundation to finally get a micronutrient database worldwide. Even in America there was none. There was no micronutrient database anywhere. The decisive factor is the following. I can only assess or the laboratories measure, and even if they measure intra-etroceter, measure in the cells, and the question you asked now, if I do an analysis on the serum level in terms of nutrition today, tomorrow, the day after tomorrow, I have different values every day. And I have different values every day, if I do it on a full-fledged level. Because the blood underlies nutritional physiological influences. That means it fluctuates. The erythrocyte, the red blood cell, we did 5,000 analyzes in the morning, in the afternoon, in the evening. Every day it is measured again and again. It is a long-term parameter for many micronutrients. For magnesium, zinc, selenium, for B1, B2, B6, B9, it is definitely a long-term parameter that is not short-term nutritionally influenced. That means it also has a certain constancy. So it does not underlie these nutritional physiological foundations. But a decisive factor in all these considerations is the assignment to the individual person. And then I can, if the reference is so large, let's say a 20-year-old patient has this and that and that, then you have a reference set from there to there. Then the lab says, we did that once, we sent it to 15 different labs in Germany. It is completely in the reference area. Then I say, okay, how many comparable patients have you examined? No answer, 150. That is why it is important that the whole thing is group-specific, that you have the cluster, that you can basically do disease-related things. What does diabetes look like at 20 years old? Where are the comparable data? They didn't exist at all until now. It was always intended to do that. Therefore, laboratory values ​​are absolutely necessary. They have to be done correctly. And I have always said, it is very important, due to the compartment system that we have, that the body attacks a structural protein. And this attack of the body on a structural protein requires that it can attack bones, bones, organ systems in a short time to cover the energy system. If it doesn't have that, it goes to its substance. You can see that in the blood at some point. And that is why it is absolutely necessary to do these blood-accompanying things. But maybe, Brigitte, you have an idea, maybe there is a possibility in the future that maybe the labs will get more information. And we also had a fantastic discussion with you yesterday. As you can see, there are laboratory values, but it also comes in such an analysis conversation. A whole other spectrum is added. The whole psychosomatic component is added. It is completely left out. Yes, I would also find that exciting to hear from you, Christian. Which laboratory values ​​play a role for you? And where do you say, that's nonsense, that doesn't work for me at all? What would be nonsense and doesn't work for me? Well, if you make a classic blood picture, for example. The standard patient is missing something now. The surgeon has depression or inflammation and goes to the GP, who makes a large blood picture. And then he comes to you and says, everything is fine in the blood vessel. So first of all, we do something different in Innsbruck. I am in research, I am a psychoneuroanologist. So I combine psychosocial relationships, everyday life, with laboratory values. And these laboratory values ​​are cortisol, for example. Or this is neopterin. This is a cellular immune marker. Interleukin 6 is analyzed by us. And what we do is, we ask our patients to collect their entire hair over a relatively long period of time. And in 12-hour intervals. From 8 o'clock in the morning to 8 o'clock in the evening. 8 o'clock in the evening to 8 o'clock in the morning. In a canister. And that is then pipetted by the patients themselves in their everyday life on small tubes, frozen. And in parallel to this biochemical level, we also capture the psychological level, by distributing questionnaires, which are then always filled out at 8 o'clock in the morning, 8 o'clock in the evening, 8 o'clock in the morning, 8 o'clock in the evening. Now we already have two time series, i.e. both the biochemical and the psychological, throughout everyday life. And then we only see our patients once a week. Then they come to us in the clinic, bring their frozen hair samples to the clinic and fill out their questionnaires. And then we interview them. And we look very closely at what happened last week. We can rate it in a variety of ways, whether it is burdening or relieving. And in the end, we now have three time series structures from biochemistry, from psychology and, in the end, even from the social spectrum. And they are connected with time series analyses. This is a very complex statistic. And there we see, first of all, that on the biochemical level, as you have just indicated, there are clearly more fluctuations than one would normally expect. And you can't tell from three samples that have been measured one after the other. Because these samples are part of a large process. And even the smallest fluctuations, which one would normally say, oh, that's similar to the day before, make a difference in the overall context. And we see massively that these fluctuations in the everyday life of samples are connected with what people experience in everyday life. You also indicated that earlier. If the nutritional situation is different, then our samples are also different and our measurement data are different. I go one step further and say, it's not just the nutrition or the movement, but it's what people experience in their everyday life that has a fundamental influence on what happens down there in biochemistry in terms of variability. Sometimes more, sometimes less, depending on how everyday life behaves. And that's something where I say, yes, we have a huge problem, for my terms, in research, which only, in quotation marks, looks at laboratory values. Because from the laboratory value, in my opinion, we take cortisol. If we were to measure cortisol now, then you would say, oh, that's the stress hormone. And when the stress hormone is high, then it has a lot of stress. So from the bottom up. I look at a value and then I conclude how people are doing. That's very dangerous. Because we can't measure how the person is doing from a cortisol value. Because a cortisol value can be increased in stressed people, but we have traumatized people. And with the traumatized people, it's exactly the other way around. We have cortisol reductions in stress. They can't measure anything. That's the so-called adrenal insufficiency, which is actually obsolete. You can forget about it. That's hypocortisolism, and that's stress disease. That means we have diametrically different statements. In both we have to do with stress. In one is cortisol up, in the other down. That means, in principle, we can't tell from the pure analysis I go into a conversation with a person and ask them and try to find out in the conversation, in the relationship, how they are doing. And then I measure. I do a top-down analysis. But in practice, of course, it's super hard to implement. It's a new medicine, a relationship medicine, which we need. Everything else is machine medicine. A reductionism from the bottom up I also had, Birgitte, we talked in the introduction, also my appeal to you, you really do excellent analysis. But I had suggested it would be best if you do a conversation basis with the doctors who send things to you and really not only explain the values, but what effect it has. Because many of the doctors orient themselves to these blood values and they don't even see the other thing. And that doesn't work. Exactly, that's why we don't just have these simple blood values. We also say that only ATP measurement doesn't help at all. Only a metabolism from the citric acid cycle doesn't help us either. We really have to see the dynamics. And that's why we focused on analyzing the resistance function. How can they react when stress comes or can they not react at all? Because they have receptors for all possible neurotransmitters. How are they set up? How flexible are they? Of course, sometimes we also ask what the value means when it is high. It can be good, it can also be bad. I can't judge that alone at the moment. I can say, can this be, can that be? Birgitte, you hit the nail on the head. A hypocortisolism, many people don't know that. Why is it happening? If I don't know now, the picture has no stress. Exactly the statement comes, that doesn't work. Complete misinterpretation. Exactly, that fits together so well that I don't know what it is. Is it good or is it bad? Do I need certain additional parameters? Either I have to go even more into analysis, i.e. go even more specifically into the dynamics of the cell, for example from your area, or you have to communicate together and say, I have this value, but now I need to sit down as a therapist and say, if this and that is the case, or the analytics, the statistical evaluation, to say, if this and that is the case, then how does it work? Do I see that in this and that parameter? Or do I always have to take the two or three puzzle pieces together and do a bioinformatics evaluation? We are also going here even more into the smaller and smaller. And on the other hand, I just see a woman who has a thyroid problem, goes to the thyroid doctor, he sends in the laboratory values, then she has Hashimoto, then she goes to the gynecologist because of the inferiority complex, then she has endometriosis, but that's all connected, but no one checks that. So even the labs don't even get the body and the inflammation herds matched together. Then you really need a different structure. Then you need the laboratories or therapists, so either therapists are trained by different laboratories, who also know, of course, interdisciplinary, and say, if this and that comes together, then please pay attention to that, or how is this and that? So do a real training, which is also demanding. What you also do in universities is that you meet up and just discuss a case from different areas, i.e. internal medicine, orthopedics, whatever fits together, that you really bring that together and then discuss the case from the various directions. That's why I admire that very much, and that's also the future you mentioned, that it has to go more in this direction. A laboratory value, to be fair, can't be the end goal. That's not the case for us either. But it really is, because we know much more about the individual. But it is also very important that you discuss it like that, because otherwise it goes in the completely wrong direction. Yes, yes. In the previous conversation, Brigitte also mentioned that the values are standardized and validated. So if I now have a value, a blood value, that the leukocytes, for example, have a value, then that's also true. So it's not a utopian number, the value is valid. So it's a methodical validation. Clinical validation is something else. What does it tell me for the clinic or for the function? Let's go to the standard values. The body compensates incredibly well. So if they don't feel right anymore, a lot has already gone wrong in advance. That's how I see it from the values. So you can be happy if they still feel right, but still say, if you feel bad, you have to look for where it is before the blood value gets bad. What gets bad first? Is it the blood or the feeling of the body? I would say the feeling. I have to give the question to the expert. Yesterday I had an interesting discussion on the question of depression and inflammation. So we know quite well that inflammation causes so-called sickness behavior, i.e. a feeling of illness in the brain. Cytokines are ejected from the cellular immune system per inflammatory cytokine and they are transferred to the brain. The information of this cytokine is transferred to the brain and you feel sick. This makes a lot of sense in evolution, because if we have an infection or a wound, we have to protect ourselves. And the immune system feels exhausted. We are tired, we don't eat anymore, we go to bed, and we limit social relations. We spend a lot of energy. And to save this energy for the defense process, nature has set it up. Now the question is, and we know, that this interaction between inflammation and sickness behavior is also the basis for depression. There is even depression. If you go very far, you would say that depression is an immunological disease. But this is only a small section of the whole picture. This is the mechanistic mediator how depression can be explained mechanistically. If it goes wrong, the industry starts to treat depression with anti-inflammatory substances. That can't be. Anti-inflammatory substances that inhibit inflammation can't solve a problem with the wife. Depression is something biographical. Depression is something significant. Depression is something completely different from the cause. Mediation is inflammation, depression, that's right. But where does the inflammation come from? And it, in turn, comes from stress situations that a person experiences, which then makes him depressed due to inflammation. But if we only take this small section out, and unfortunately this happens far too often, then we even have the idea that by changing the microbiome or by changing the micronutrient situation or by anti-inflammatory medication, because we are basically in the same boat. We don't need to attack the pharmaceutical industry. If we assume that we can fight depression with anti-inflammatory changes, that's not possible. You might be able to do it in a supportive way, but in the end it's about solving the relationship problem of this person with psychotherapy and thus changing depression via inflammation reduction. If you ignore that your body is looking for this channel as inflammation. Yes, that's right. But that's the problem with medicine, that it has nothing to do with relationship medicine. It's not preventive medicine. In the end, it's the machine that looks at the person and the machine has no psyche, no social relationship, no relationship. If you look at hyperactivity in children, there's the expert. I can only say that we did a study with 160 parents. We found that, first of all, you have a vegetative dysregulation, which is always the cause of it. But if you, we did that, specifically to children who lack micronutrients, especially phenylalanine. Phenylalanine is an exorbitantly important amino acid. It is never measured because no one knows what phenylalanine is. In medical education, I have to honestly criticize that a bit. I had doctors in my master's program, they never heard of phenylalanine. It's an amino acid that has a very important biochemical prerequisite. If the biochemical prerequisite is not there, then you basically can't build up any corresponding substances. These children were really, after 8, 9 or 10 weeks, we did that with 24-hour HF measurements, we did cortisol daily profiles, they were really almost like alternated. That means biochemical deficits that have nutritional physiological causes are stronger than ever today. Which problem did they come to you with? We have a basic master's student, he was a doctor himself, and he really had a massive, twin brother, he had a massive ADS component. And then he said, I want to now, give me our data. So growth deficits. So with aggression, running around. So really massive. And here he picked up the data. A lot is, for example, that was also new to me in this situation, these children were often ferritin underfed. Ferritin is iron. Iron brings oxygen into the tissue and also to the brain. That means if these children are tired, sluggish, go to class in the morning and they don't have ferritin, no iron, then they shouldn't be surprised. I can't work in the psychosomatic area, I have to give them what's missing. Of course I have to accompany them, I have to work on this level. And then really, and that's what I'm saying right now, what you've already said, that's why such programs like today, that you push the whole synergetically, that you encourage thinking, and that you bring many things together. But who tells you that your attention that you gave to this child has caused change in the metabolism? If this child with ADHS, Attention Deficit Syndrome, very funny, that especially in the diagnosis the problem is probably already in it. For me it's a psychosomatic story. The trigger is a problem probably transmitted to the child by the parents. And we see changes in metabolism, that's psychology. We have top-down from the psyche the effect on metabolism. If you start now to change something in metabolism, you don't do it as a machine and as a robot, but you approach this child, you give him something, you say, let's see what we can do with you, and I'll give you this substance. And now my provocative question is, who says that the relationship that you gave to this child as a nice person and this attention that you gave him within these study designs ultimately top-down has changed the metabolism? You're right. I can't do that. At the end of the day, if it's better for the child, then it's a path that is at least walkable, that leads to success. But be careful, because the conclusions may not be because of the ferritin that I shot, the child is doing better now, but I would like to have the message I have given this person attention and that's why his metabolism has changed. The problem is that we accept two fundamentally different causalities. One is reductionist, from bottom to top. I feed him with ferritin and he's doing better and his ADS is getting lower. And the other is a top-down idea. I managed to help this child through relationships. And if it's symbiosis between both? That's not the idea of psychosomatics. You have effects from bottom to top. That's right. You have them. Let's take our own example. I don't eat well, I smoke, I drink, then I don't have a good mood. You're a bit sluggish. Now let's do a fasting cure. I don't change anything in my psychological environment. I just fast. And I already have a brightened mood, I'm clearer, I see things, I can present myself better. Absolutely right. I can accept that. And this child with ADS, would I be in doubt if it's a sustainable intervention? I can only say that the two-year support documented sustainability. No question. But I understand... You don't even know. That's important. That's a completely different approach in medicine and medical research. I understand that too. I don't want to say that one is right and the other is wrong. I just wanted to ask what you think about that. No, I follow that. Inflammation, I come from infectious immunology. Inflammation has a cause. Not necessarily interpersonal relationship problems, but a bacterium, a parasite, a virus or whatever. Now maybe from me a stupid or provocative question. A lot of people have the same relationship problem. Why do some develop depression and others don't? Is it because their body can compensate better because they have functional metatarsals and the regulation is much better? Then developing depression would be cheaper and they wouldn't get into this situation if their body, mineral substances, movement, fasting, whatever. Provocative answer. Ferritin is ferritin, but depression is not depression. And if I have a person in front of me, then he is completely different from the other. But I think on a material level we have substances that are simply substances. That's why you can measure them so well because they are the same. But as soon as we go higher in the hierarchy, it becomes super complex and completely different and there is no same relationship disorder. Oh, that screams continuation. There is still a bit of power behind it. Thank you very much for being here today. It was a nice insight, and yes, mainly people are helped and somewhere they will find their pot lid. Therapists, yes, find their own way. But it's nice that so many people like you are there who support the site of the viewers. I hope you could take a lot with you and of course I am always happy when you switch on. Under Wikisana you will find more videos and yes, have a good time. See you soon and bye.