Latest / Resiliency Radio with Dr. Jill Carnahan, MD / 335: Resiliency Radio with Dr. Jill: The Cell Membrane: Your Body's Power Grid with Bob Miller

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335: Resiliency Radio with Dr. Jill: The Cell Membrane: Your Body's Power Grid with Bob Miller · Resiliency Radio with Dr. Jill Carnahan, MD

• 0:04
  Dr. Jill Carnahan: Hey guys, welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine.
• 0:12
  Dr. Jill Carnahan: I'm your host, Dr. Jill and with each episode we dive into the heart of healing and personal transformation.
• 0:18
  Dr. Jill Carnahan: Join me as I interview medical experts, world leaders, innovators of all types helping you on your journey to optimal performance and healing.
• 0:27
  Dr. Jill Carnahan: Today you're going to hear from one of my most repeat guests, some of the top episodes, Dr. Bob Miller, who goes into the genetics and different pathways.
• 0:36
  Dr. Jill Carnahan: Today we're going to be talking about a protein you may or may not know on the lipid bilayer.
• 0:40
  Dr. Jill Carnahan: It's called Cardiolipin, so stay tuned and if you haven't yet heard Dr. Bob, you will enjoy this episode.
• 0:47
  Dr. Jill Carnahan: Before we do, I just want to remind you we are accepting new patients at Flatiron Functional medicine in Louisville, Colorado.
• 0:53
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• 1:06
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• 1:14
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• 1:24
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• 1:25
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• 1:27
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• 1:34
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• 1:37
  Dr. Jill Carnahan: One of the most common feedback I've heard from the readers is I sat down and read it in one sitting.
• 1:43
  Dr. Jill Carnahan: So it tells my own story of overcoming Crohn's disease, cancer and mold related illness and all of the battles and difficulties that I overcame, but also the things that I learned in the process, the really practical tips including things like how deal with our old trauma and relationships and things that you might not expect.
• 2:03
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• 2:05
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• 2:11
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• 2:18
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• 2:21
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• 2:27
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• 2:29
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• 2:30
  Dr. Jill Carnahan: They make me smile.
• 2:31
  Dr. Jill Carnahan: So hopefully they'll do the same for you.
• 2:34
  Dr. Jill Carnahan: Okay, let me introduce Bob Miller, a traditional naturopath specializing in the field of genetic specific nutrition.
• 2:40
  Dr. Jill Carnahan: In 1983, he opened Tree of Life, a practice and served as a traditional naturopath for 27 years.
• 2:46
  Dr. Jill Carnahan: He lectures nationally and internationally at seminars to educate healthcare practitioners about genetic variants.
• 2:51
  Dr. Jill Carnahan: If you've been on this channel, you have heard him before.
• 2:53
  Dr. Jill Carnahan: But let's dive right in with Cardiolipin with Bob Miller.
• 2:58
  Dr. Jill Carnahan: Bob, we're back again.
• 2:59
  Dr. Jill Carnahan: I don't know how many this is.
• 3:01
  Dr. Jill Carnahan: Now, you probably have the numbers of what we've done, but this is always such a fun episode, kind of different from our normal episode, but we're diving deep and you've got some really profound discoveries about the cell membrane that we're going to dive into.
• 3:15
  Dr. Jill Carnahan: So I'm just going to hand it right over to you.
• 3:18
  Dr. Jill Carnahan: And as always, we're like the talk show host, you know, back and forth.
• 3:22
  Dr. Jill Carnahan: I'm going to let you kind of go with it and then I will comment clinically as I see interesting things that you're sharing with us today.
• 3:30
  Bob Miller: Absolutely.
• 3:31
  Bob Miller: And this is number 14.
• 3:32
  Dr. Jill Carnahan: Amazing.
• 3:33
  Dr. Jill Carnahan: That's pretty.
• 3:34
  Dr. Jill Carnahan: Pretty amazing.
• 3:36
  Bob Miller: Yes.
• 3:37
  Bob Miller: So while you're seeing the screen.
• 3:39
  Dr. Jill Carnahan: I am, yes.
• 3:40
  Dr. Jill Carnahan: Looks great.
• 3:41
  Bob Miller: Yeah.
• 3:41
  Bob Miller: We're going to be talking about the cell membrane, your body's power grid.
• 3:46
  Bob Miller: Now, what's absolutely fascinating, Dr. Jill, is that, you know, we have been doing this, as I said, for a long time.
• 3:53
  Dr. Jill Carnahan: Yeah.
• 3:54
  Bob Miller: We started all the way back in 2020.
• 3:56
  Dr. Jill Carnahan: Wow.
• 3:56
  Bob Miller: Episode number 16.
• 3:59
  Bob Miller: And what's interesting is we've talked about, you know, things like the peroxy nitrite, the overstimulation of NOx IL6, upregulation of INOS that we call the carnage reaction, the heat oxygenase pathway, superoxide.
• 4:13
  Bob Miller: What's interesting, we're tying those all together now into one piece.
• 4:18
  Bob Miller: And I think everybody's going to be very surprised how we've taking all those things and tied them together.
• 4:27
  Bob Miller: So what we're going to learn, we're going to talk about the cell membrane.
• 4:30
  Bob Miller: We're going to talk about ATP, adenosine triphosphate, and we're going to learn how that's made in the electron transport chain.
• 4:38
  Bob Miller: And we're going to look at all the things you need for that.
• 4:41
  Bob Miller: The major focus today is going to be on an interesting membrane called cardiolipin, possibly people never even heard of this and by the time you're finished, you're going to understand why this cardiolipin is more important than we ever realized.
• 4:57
  Bob Miller: Then you also have what's called the lipid bilayer and how they get damaged by what's called lipid peroxidation, by peroxynitrite and hydroxyl radicals, things that we spoke about in previous webinars.
• 5:10
  Bob Miller: Then we're going to talk about that lipid peroxidation and calcium dysfunction, how it messes with how your calcium is used and then also how it changes your sodium potassium pump and the consequences that is.
• 5:22
  Bob Miller: And then we're going to tie that into glutamate and anxiety.
• 5:26
  Bob Miller: So put your seatbelt on folks, because here we go.
• 5:31
  Bob Miller: So I'm going to burn through these pretty quickly.
• 5:34
  Bob Miller: I'm not going to read them all.
• 5:36
  Bob Miller: So the cell membrane is a thin flexible barrier that surrounds every cell in your body.
• 5:41
  Bob Miller: It's made of a phospholipid bilayer.
• 5:43
  Bob Miller: Those are fats with water loving head and tails.
• 5:46
  Bob Miller: It keeps the cell safe and stable.
• 5:48
  Bob Miller: If you didn't have that, the cell would not be functioning.
• 5:51
  Bob Miller: It controls what enters and leaves.
• 5:53
  Bob Miller: It helps with communication, it supports the cell structure, enables specialized functions.
• 6:01
  Bob Miller: So obviously without cell membranes, cell couldn't keep their contents, exchange materials or communicate with each other.
• 6:08
  Bob Miller: We call it the foundation of life at the cellular level, keeping your body cells healthy, organized and able to work together.
• 6:19
  Bob Miller: Now the first step in making a cell membrane is the formation of a phospholipid bilayer.
• 6:24
  Bob Miller: As we said, we've got the heads and the tails and this creates a stable flexible barrier that makes life possible.
• 6:34
  Bob Miller: Now this bilayer serves as the scaffold for embedding proteins, carbohydrates and other molecules.
• 6:40
  Bob Miller: The functional plasma membrane that controls what enters and leaves the cell.
• 6:45
  Bob Miller: Proteins need to go in and out, controls fluidity with cholesterol, the glycoproteins.
• 6:50
  Bob Miller: And this chart to the right here shows what it actually looks like.
• 6:54
  Bob Miller: Where there's places where the nutrients go in and out based upon what's called the change in the gradient.
• 7:03
  Bob Miller: The your cell membrane is your life gate.
• 7:05
  Bob Miller: That's what we call it, that it lets in glucose, amino acids, your sodium, potassium and calcium, keeps out toxins, maintains membrane potential, houses receptors for your hormones, cytokines, neurotransmitters.
• 7:20
  Bob Miller: And if this gate fails, here's what happens.
• 7:23
  Bob Miller: Dr. Jill There goes your energy, your communication and your structural integrity.
• 7:30
  Bob Miller: The cell membrane is your life gate because it controls energy flow, information flow, the ion Balance inflammatory signaling.
• 7:40
  Bob Miller: If it's healthy, the cell adapts, repairs and survives.
• 7:44
  Bob Miller: If it's damaged, the cell becomes inflamed, dysregulated and eventually dies.
• 7:49
  Bob Miller: And that is the dying process when the cells start falling apart.
• 7:54
  Bob Miller: All right, I knew I burned through that pretty quickly, but I want to talk about.
• 7:59
  Dr. Jill Carnahan: Well, that's so important, Bob.
• 8:00
  Dr. Jill Carnahan: I just want to just.
• 8:01
  Dr. Jill Carnahan: We've talked before about these things, but this is at such a core level of every cell in the body.
• 8:07
  Dr. Jill Carnahan: How it communicates, how it acts in conjunction.
• 8:11
  Dr. Jill Carnahan: And we've known for many years as well that all.
• 8:14
  Dr. Jill Carnahan: I'm sure you're going to go into all the things that damage these membranes, but this is really a core concept, so I want people listening to realize that this is at the core of so, so many complex chronic diseases.
• 8:24
  Dr. Jill Carnahan: Go on.
• 8:25
  Bob Miller: Absolutely.
• 8:26
  Bob Miller: Well, we want to talk about ATP, adenosine triphosphate.
• 8:29
  Bob Miller: People have probably heard that.
• 8:30
  Bob Miller: I mean, they learned that in high school biology.
• 8:33
  Bob Miller: But it's good to review your brain, your lungs, your kidneys, your digestive system, your immune system, reproductive, all your cells, the nervous system, the skin, the skeletal system, the muscles, the liver, the heart, the.
• 8:47
  Bob Miller: They all need ATP.
• 8:50
  Bob Miller: And if we theoretically had an ATP switch, which we don't have, obviously, but if we switch that to off, everything would just stop because everything depends upon that ATP.
• 9:02
  Bob Miller: And that's what we're going to be talking about in this webinar.
• 9:05
  Bob Miller: All right, now, we just spoke about how ATP is so important.
• 9:08
  Bob Miller: Now, I know many times if we talked about ATP in the past, we said, oh, yeah, that's responsible for your muscle energy.
• 9:14
  Bob Miller: But look at this list.
• 9:15
  Bob Miller: Not only energy.
• 9:17
  Bob Miller: If the low ATP, you're going to have increased inflammation, lowered repair, lowered resistance, fatigue, your sodium, potassium balance goes off, your calcium regulation goes off, you're going to become anxious, and we're going to talk about that a little bit.
• 9:32
  Bob Miller: There's something called glial cells that'll give persistent inflammation.
• 9:36
  Dr. Jill Carnahan: So, Bob, pause right there really quickly.
• 9:38
  Dr. Jill Carnahan: ATP.
• 9:38
  Dr. Jill Carnahan: We know about energy.
• 9:39
  Dr. Jill Carnahan: You've got these incredible lists, but you just said something that I think you're going to talk more about later.
• 9:44
  Dr. Jill Carnahan: Problems with ATP could actually cause anxiety.
• 9:46
  Dr. Jill Carnahan: Is that true?
• 9:47
  Bob Miller: Yes.
• 9:49
  Dr. Jill Carnahan: Brilliant.
• 9:52
  Bob Miller: So we're going to get into this.
• 9:53
  Bob Miller: Impaired neurotransmitter balance in neurons creates anxiety, impaired glial cell function, impaired protein synthesis, reduced antioxidants, cell loss and organ dysfunction.
• 10:05
  Bob Miller: Decreased immune function, reduced muscle function, impaired digestion.
• 10:11
  Bob Miller: Restore ATP and you restore life.
• 10:15
  Bob Miller: I'm going to tie this into why the Three major things that we're seeing today is mold getting stronger, Lyme disease, spike protein.
• 10:23
  Bob Miller: And I'm going to tie that all together as to why that's attacking our ATP.
• 10:29
  Bob Miller: Now, we're going to talk now about how you make ATP.
• 10:34
  Bob Miller: There's something called the electronic transport chain, and we'll try to make this simple.
• 10:40
  Bob Miller: They're called complexes, and there's five of them.
• 10:45
  Bob Miller: And what happens is electrons that come from something called NADH flow through what's called an iron sulfur cluster.
• 10:55
  Bob Miller: We're going to talk about that.
• 10:57
  Bob Miller: It also needs heme.
• 10:59
  Bob Miller: And then what happens is these protons get pushed into the inner cell membrane and each one pushes a little bit out and then they come back in number five and make your ATP.
• 11:12
  Bob Miller: So what we're going to be talking about today, Dr. Jill, is what can go wrong here?
• 11:17
  Bob Miller: And there's a heck of a lot that can go wrong.
• 11:20
  Bob Miller: So nadh.
• 11:21
  Bob Miller: Now, I would encourage people to go back and look at one of our, the last webinar we did, and that was on the importance of nadph.
• 11:30
  Bob Miller: So your NADH is what provides that electron that pushes it.
• 11:37
  Bob Miller: So that's how it's made.
• 11:40
  Bob Miller: Now look what happens if we have low nadh, which many people do.
• 11:44
  Bob Miller: We in our clinic, we measure the nadph.
• 11:49
  Bob Miller: And if you got low nadh, you're not going to be pushing those protons up and you're going to have low energy.
• 11:58
  Bob Miller: So it's episode number 270.
• 12:00
  Bob Miller: I encourage people to go back and watch that one.
• 12:03
  Bob Miller: We really dig in deeply into nadph.
• 12:08
  Bob Miller: We don't have time for it today, but encourage you to watch episode number 270.
• 12:13
  Bob Miller: So that's if we have low NADH.
• 12:16
  Bob Miller: Now, on the other hand, in episode number 270, we talked about that you can have too much NADH if it doesn't get turned back to nad.
• 12:26
  Bob Miller: That can be just as bad because the electrons back up and then they'll actually come back to a complex one.
• 12:34
  Bob Miller: And we'll talk about this later.
• 12:36
  Bob Miller: The electron leaks off and makes a free radical called superoxide.
• 12:42
  Dr. Jill Carnahan: Yes.
• 12:42
  Bob Miller: Now, again, I would encourage everybody go back and watch our video.
• 12:46
  Bob Miller: I think we spoke like for an hour and 15 minutes on superoxide.
• 12:50
  Bob Miller: So you see how this is all tying together.
• 12:53
  Bob Miller: So if we have balanced nadh, sort of like Goldilocks and the three bears, not too much, not too little, then the protons fly out, they come back in, and we have plenty of ATP.
• 13:09
  Bob Miller: So it's really critical that we have this Nedh balanced again, episode 270.
• 13:16
  Bob Miller: Watch that to learn all the complexities of that.
• 13:21
  Bob Miller: Now, Coq10, I'm sure most people have heard about Coq10.
• 13:25
  Bob Miller: Coq10 is part of the shuttle that takes that electron.
• 13:29
  Bob Miller: So you can see one and two here.
• 13:31
  Bob Miller: Start donating, they hand it over to three.
• 13:34
  Bob Miller: And we could probably do a whole episode on Coq 10.
• 13:38
  Bob Miller: But just briefly, it's in two forms and between reduced and oxidized.
• 13:43
  Bob Miller: So we have to have enough CoQ10.
• 13:46
  Bob Miller: Well, guess what?
• 13:47
  Bob Miller: You can have genetic SNP single nucleotide polymorphisms that impair the efficient creation and utilization of CoQ10.
• 13:56
  Bob Miller: So if you don't have enough CoQ10 here, you're not getting the whole way down here and you're going to be tired.
• 14:04
  Bob Miller: Now, also, heme.
• 14:07
  Bob Miller: Now what's interesting, episode number 119, we spoke about heme and heme plays a lot of roles, but I'm just referring to it right here.
• 14:17
  Bob Miller: You can see it's in complex two, complex three, complex four.
• 14:24
  Bob Miller: So if you don't have enough heme, then you're also not going to have those protons go up and make your ATP.
• 14:32
  Bob Miller: So here we say inadequate heme can therefore impair electron flow, lower ATP production and increase electron leakage and oxidative stress.
• 14:42
  Bob Miller: And guess what?
• 14:43
  Bob Miller: You can have genetic weakness in the heme cycle.
• 14:46
  Bob Miller: And we talk about that in episode number 119.
• 14:51
  Bob Miller: Now here's what we spoke about in that episode.
• 14:53
  Bob Miller: I'm not going to go through it here, but this is the pathway in which you make that hemet.
• 15:00
  Bob Miller: And for example, you can have lead exposure which will impair this.
• 15:05
  Bob Miller: You can have genetic SNPs, mutations.
• 15:07
  Bob Miller: All of that will impact your body's production of heme.
• 15:12
  Bob Miller: So here's another way that your ATP can be lowered.
• 15:16
  Bob Miller: Now this is one that I'm absolutely fascinated.
• 15:19
  Dr. Jill Carnahan: Now, Bob, I'm going to ask really a quick question about heme.
• 15:22
  Dr. Jill Carnahan: And this may be a silly question, but I bet if those people listening might have the same question.
• 15:27
  Dr. Jill Carnahan: Heme, how is that related to iron and ferritin directly?
• 15:29
  Dr. Jill Carnahan: If you're measuring that in the blood, a different particle or is it actually believe.
• 15:34
  Bob Miller: Yeah, I do believe it's.
• 15:35
  Bob Miller: It's different than your iron or ferritin.
• 15:37
  Bob Miller: Yes.
• 15:38
  Bob Miller: Well, I want to go back to that episode and watch that.
• 15:40
  Bob Miller: I think we perfect in there.
• 15:42
  Bob Miller: Yeah.
• 15:43
  Bob Miller: Now this one I'm absolutely excited about.
• 15:47
  Bob Miller: Nobody's talking about the iron sulfur cluster.
• 15:52
  Bob Miller: And what that means is that iron and Sulfur.
• 15:57
  Bob Miller: Combine together four irons, four sulfurs, and make an iron sulfur cluster.
• 16:03
  Bob Miller: And you can see here it is in complex 1, 2, and 3.
• 16:10
  Bob Miller: And if we don't have the iron sulfur cluster, this is what helps those electrons flow.
• 16:17
  Bob Miller: And if you don't have that, this isn't going to flow.
• 16:20
  Bob Miller: So I'm sure, Dr. Jill, one of the most, you know, biggest complaints you hear from some of your patients is they're tired.
• 16:26
  Dr. Jill Carnahan: Yes.
• 16:27
  Bob Miller: They're fatigued.
• 16:28
  Bob Miller: Well, you can see there's a lot that can go wrong here.
• 16:32
  Bob Miller: So here it says when iron sulfur clusters are deficient, electron transfer becomes less efficient, increasing the leakage and superoxide formation while reducing the proton gradient needed to make ATP.
• 16:48
  Bob Miller: Yeah.
• 16:48
  Bob Miller: So again, you don't have these protons going up to come down here to make ATP.
• 16:53
  Bob Miller: Then on top of that, the electron leaks off.
• 16:56
  Bob Miller: And I'm going to show that later, making superoxide.
• 16:59
  Bob Miller: And again, please go back and watch our episode on superoxide.
• 17:02
  Bob Miller: So you understand the significance of that?
• 17:04
  Dr. Jill Carnahan: Yes.
• 17:05
  Bob Miller: Now, here is how we make the iron sulfur cluster.
• 17:09
  Bob Miller: This is complex, Dr. Dill.
• 17:12
  Bob Miller: So you'll see up here we have iron import, and these are what are called solute carriers that create the mitochondrial iron pool.
• 17:21
  Bob Miller: Then there's an enzyme called FXN Fertaxin, which you can also have genetic SNPs on, that provides the iron.
• 17:32
  Bob Miller: Then you need cysteine.
• 17:35
  Bob Miller: And through the enzyme NFS1, you can have SNPs here, provides the sulfur.
• 17:42
  Bob Miller: But you also need an electron and a dph.
• 17:47
  Bob Miller: So if you're having trouble with your nad, and you're low in nadph, you're not donating the electron.
• 17:54
  Dr. Jill Carnahan: Yeah, it's like a little recipe equation.
• 17:58
  Bob Miller: So then these are the genes we won't get into this, but these are the ones that actually assemble.
• 18:03
  Bob Miller: And when it comes out of here, it's two FES, two Ss, two sulfurs.
• 18:09
  Bob Miller: And then through this process, we get it into the four FE4s.
• 18:16
  Bob Miller: But look who's here.
• 18:18
  Bob Miller: Glutathione redoxase number five.
• 18:22
  Bob Miller: So if we don't have enough glutathione, we don't get from 2 to 4.
• 18:29
  Bob Miller: And then through these enzymes right here.
• 18:33
  Bob Miller: And if you want, and you can have genetic SNPs here, it hands it over to complex one.
• 18:43
  Bob Miller: Now, what we've been seeing is we're looking at this.
• 18:46
  Bob Miller: I am stunned for how many people.
• 18:48
  Bob Miller: This is their issue.
• 18:51
  Bob Miller: And when we're at the end, we're going to.
• 18:53
  Bob Miller: You're so brave.
• 18:54
  Bob Miller: We're going to look at your genome, and I'm going to show you why this might be something you need to look at.
• 18:58
  Bob Miller: Dr. Jill.
• 18:59
  Dr. Jill Carnahan: Oh, excellent.
• 19:01
  Bob Miller: Now, here's what we need.
• 19:03
  Bob Miller: If we have iron that's too high and cysteine too low, you're going to have not enough clusters, and you're going to be making what are called hydroxyl radicals.
• 19:15
  Bob Miller: We spoke about that in our very first webinar.
• 19:18
  Bob Miller: If ideally, they're balanced, everything's good, you're going to have adequate ATP, low inflammation, everything's going good.
• 19:27
  Bob Miller: If you would have low iron and high cysteine for your sulfur, again, you're going to have a problem.
• 19:33
  Bob Miller: And if they're both low, you're going to have a problem.
• 19:37
  Dr. Jill Carnahan: Okay, this is fascinating.
• 19:38
  Dr. Jill Carnahan: Again, it's so clear, and I want to just mention people out there might not know cysteine.
• 19:42
  Dr. Jill Carnahan: NAC is a form of cysteine that we take as a supplement.
• 19:46
  Dr. Jill Carnahan: And this is why I've always known in clinical practice, and you and I have talked about other scenarios, Bob, where it's Goldilocks.
• 19:52
  Dr. Jill Carnahan: Sometimes you just think, oh, I need NAC because it's a precursor of glutathione, and everybody takes it, or they take a lot of it.
• 19:58
  Dr. Jill Carnahan: And in this scenario, for example, number three, if you took two too much and you had low iron, it may be a problem.
• 20:05
  Bob Miller: You're right, Goldilocks.
• 20:07
  Bob Miller: Not too hot, not too cold.
• 20:10
  Bob Miller: All right, now, here's what can happen.
• 20:13
  Bob Miller: We're living in a different world.
• 20:14
  Bob Miller: I often tell people that I was born in a different world.
• 20:18
  Bob Miller: In 1954, we didn't have so many of the things that we have now.
• 20:22
  Bob Miller: Today we have the spike protein.
• 20:25
  Bob Miller: This very well may have changed things dramatically.
• 20:29
  Bob Miller: Yes, there's a lot of people that do believe mycotoxins are getting stronger.
• 20:34
  Bob Miller: And then Lyme disease seems to be rampant.
• 20:37
  Bob Miller: Now, there's many things that'll trigger this, but these, I think, are the big three.
• 20:41
  Dr. Jill Carnahan: Yeah.
• 20:42
  Bob Miller: And that stimulates tumor necrosis factor, which is an enzyme that's inflammatory part of your immune system.
• 20:49
  Bob Miller: But again, Goldilocks, if it's too active, we have a problem.
• 20:52
  Bob Miller: Then it stimulates NF kappa B.
• 20:54
  Bob Miller: This is the core enzyme that starts putting off inflammation.
• 20:59
  Bob Miller: It stimulates NOx.
• 21:00
  Bob Miller: Again, this is one of our.
• 21:03
  Bob Miller: This is one of our webinars.
• 21:04
  Bob Miller: Early on, it stimulates inos.
• 21:06
  Bob Miller: This is Carnahan reaction that we where too much nos 2.
• 21:14
  Bob Miller: So if you get superoxide nitric oxide, we get peroxy nitrite.
• 21:20
  Bob Miller: Ironically.
• 21:21
  Bob Miller: Oh, no, it's the.
• 21:23
  Bob Miller: Is the symbol for it that will then start destroying the iron sulfur cluster.
• 21:29
  Bob Miller: That isn't the end of it.
• 21:30
  Bob Miller: That iron gets released and iron is your best friend, unless it's your worst enemy.
• 21:36
  Bob Miller: Because if it's floating around on its own, it can be very inflammatory and it will come back and stimulate tnfa.
• 21:44
  Bob Miller: Then through the Fenton reaction, hydroxyl radicals combine and make hydroxyl radicals.
• 21:51
  Bob Miller: That does more damage to the lipid bilayer.
• 21:57
  Bob Miller: So here you can see if you've got plenty of iron sulfur clusters.
• 22:02
  Bob Miller: Everything's going good.
• 22:04
  Bob Miller: If you don't.
• 22:06
  Bob Miller: Impaired electron transfer, proton leak, loss of gradients, reduced ATP, increased reactive oxygen species.
• 22:15
  Bob Miller: And when those electrons leak off, rather than make energy, I'm going to show you later how that can create quite the problem.
• 22:23
  Bob Miller: And then you're going to have loss of that membrane integrity.
• 22:27
  Bob Miller: And remember, we said that membrane integrity is one of the most important things we need to have.
• 22:33
  Bob Miller: Now, if you wouldn't think that's enough, there's.
• 22:36
  Bob Miller: There's more.
• 22:37
  Bob Miller: There's something called the Krebs cycle, and this is really important because this is part of our energy production.
• 22:44
  Bob Miller: It makes many of the things that your electron transport chain needs.
• 22:49
  Bob Miller: But interestingly, there's an enzyme called ACO2, and it needs the iron sulfur cluster to turn what's called cisactinate into isocitrate.
• 23:02
  Bob Miller: And if that happens, you're going to have adequate NADH production.
• 23:07
  Bob Miller: You're going to support your ATP.
• 23:09
  Bob Miller: Everything is going good.
• 23:11
  Bob Miller: But look what happens if your iron sulfur cluster is damaged.
• 23:16
  Bob Miller: It doesn't happen.
• 23:18
  Bob Miller: There's going to be citrate buildup, reduced Krebs cycle flux, less nadh, lowered ATP, more oxidative stress.
• 23:28
  Bob Miller: When we came across that one was like, that's a big deal.
• 23:33
  Bob Miller: If your Krebs cycle is not spinning, you're going to be tired.
• 23:37
  Dr. Jill Carnahan: Yes.
• 23:37
  Bob Miller: We'll try to take all kinds of stimulants and other things and either they don't work or they backfire.
• 23:43
  Dr. Jill Carnahan: Yes.
• 23:44
  Bob Miller: Because you're.
• 23:44
  Bob Miller: I'm sure you've heard that many times.
• 23:46
  Bob Miller: Oh, I took.
• 23:46
  Bob Miller: I can't take vitamins because they react to them.
• 23:50
  Bob Miller: Yeah, there's many reasons, but this could be one of them.
• 23:52
  Bob Miller: When you start pushing this and you're stuck here.
• 23:56
  Dr. Jill Carnahan: Right, Exactly.
• 23:59
  Bob Miller: It's not going to go now.
• 24:00
  Bob Miller: I'm not going to read each of these, but I'm going to burn through them very quickly.
• 24:04
  Bob Miller: But it just shows all the body systems that are impacted by the iron sulfur cluster.
• 24:11
  Bob Miller: We're going to start with the lungs.
• 24:13
  Bob Miller: If it's damaged, we're going to have electron leaks, ATP declines, lung stress and dysfunction, fatigue or exercise intolerance, airway irritation, pulmonary stress, the brain, same thing.
• 24:29
  Bob Miller: Brain fog, neurotransmitters, excitability imbalance, neuroinflammation risk, neurodegenerative stress.
• 24:38
  Bob Miller: All that happens if you don't have enough iron sulfur clusters, that affects the brain.
• 24:43
  Bob Miller: Here's the kidneys, where reabsorption, electrolyte imbalance, fluid dysregulation, kidney injury and risk.
• 24:52
  Bob Miller: Then here we have the liver fatigue or detoxification, fatty liver risk, metabolic stress, all if you don't have that iron sulfur cluster delivering those electrons.
• 25:06
  Bob Miller: Now this is probably going to be the most important thing we're going to talk about in this podcast.
• 25:11
  Bob Miller: Yes, cardiolipin.
• 25:15
  Bob Miller: It's a specialized phospholipid found mainly in the inner mitochondrial membrane where the electron transport is located.
• 25:22
  Bob Miller: Now, I'm not going to read all these enzymes.
• 25:24
  Bob Miller: These are the ones that make, helps organize.
• 25:27
  Bob Miller: This is key points.
• 25:28
  Bob Miller: This may be the most important thing we're saying in this whole webinar.
• 25:32
  Bob Miller: Helps organize and stabilize the electron transport chain complexes.
• 25:37
  Bob Miller: And we'll talk a little bit about super complexes.
• 25:40
  Bob Miller: Supports efficient electron transfer and proton pumping and helps maintain the membrane structure needed to generate ATP.
• 25:49
  Bob Miller: So now I'm beginning to believe that having adequate manufacturing of cardiolipin and not destroying it might be one of the most important things we should put to the top of our list when we're dealing with dysfunction.
• 26:05
  Dr. Jill Carnahan: Hey guys, just a reminder, you can find products and services@drjillhealth.com Things like the detox bundle, the Epstein Barr bundle and many other things for your gut, for your brain, or for whatever might ail you.
• 26:17
  Dr. Jill Carnahan: Go to Dr. Jill health.com get 15% off your first order.
• 26:21
  Dr. Jill Carnahan: And let's get back to the show with Dr. Bob.
• 26:25
  Dr. Jill Carnahan: Yes, and Bob, in clinical experience, I'm sure you're going to go to this, but what I see since Spikes since Molten's that I am actually regularly testing every patient for anticardiolipin antibodies because as you have this damaged membrane, the body's like, whoa, what's going on with that?
• 26:39
  Dr. Jill Carnahan: And again, I'm sure you'll explain more about this then often you get autoantibodies to that and to me that's a sign not of lupus, although that can be, but more of damage to these membranes and I have to actually intervene and think about what needs to be done.
• 26:56
  Dr. Jill Carnahan: So there are tests that can measure some of these processes to the cardiolipin.
• 27:01
  Bob Miller: Mm.
• 27:02
  Bob Miller: Yeah.
• 27:02
  Bob Miller: You can't measure cardiolipin itself, but as you said, you can measure the cardiolipin antibodies.
• 27:07
  Dr. Jill Carnahan: Yeah.
• 27:07
  Bob Miller: So if the cardiolipin falls out of the membrane immune system says who the heck are you?
• 27:12
  Dr. Jill Carnahan: What's going on?
• 27:12
  Dr. Jill Carnahan: Exactly.
• 27:13
  Dr. Jill Carnahan: Exactly.
• 27:14
  Dr. Jill Carnahan: And well.
• 27:15
  Dr. Jill Carnahan: Sorry, go ahead, Bob.
• 27:16
  Bob Miller: Oh, and then you start attacking what one of the most important molecules might be in the body.
• 27:21
  Dr. Jill Carnahan: Yes.
• 27:21
  Dr. Jill Carnahan: And again, you can speak to this later.
• 27:23
  Dr. Jill Carnahan: When you talk about my genetics, I always share to you guys listening out here who haven't heard of Bob and I episode, I always put my genetics right out there for the public to see.
• 27:31
  Dr. Jill Carnahan: Really transparent.
• 27:32
  Dr. Jill Carnahan: But what I was going to say is after my first significant COVID infection, I developed anticardiolipin antibodies.
• 27:38
  Dr. Jill Carnahan: Surprise, surprise, fries.
• 27:41
  Bob Miller: Well, that's interesting.
• 27:42
  Dr. Jill Carnahan: Yeah.
• 27:44
  Bob Miller: So here we go.
• 27:45
  Bob Miller: Neurological disorders, neuropsychiatric disorders, mitochondrial issues, cardiovascular issues, metabolic disorders, skeletal muscle disorders, immune disorders, autoimmune, gastrointestinal liver, kidney, endocrine, fertility, aging.
• 28:01
  Dr. Jill Carnahan: Wow.
• 28:02
  Bob Miller: Aging is cumulative.
• 28:03
  Bob Miller: Cardiolipin oxidation.
• 28:05
  Bob Miller: Even cardiolipin abnormalities can have a complex relationship with cancer.
• 28:10
  Bob Miller: And vision disorders.
• 28:12
  Dr. Jill Carnahan: Wow.
• 28:12
  Bob Miller: Hearing disorders, pulmonary disorders, blood disorders, rare genetic disorders, all of that can be related.
• 28:19
  Bob Miller: Now, cardiolipin isn't the only piece, but it's likely a contributing factor to all of those conditions.
• 28:26
  Bob Miller: So that's why our research team is saying, you know what, we need to really make sure we are making and taking care of our cardiolipin.
• 28:35
  Dr. Jill Carnahan: Yeah.
• 28:37
  Bob Miller: Because when it's exposed, it can even directly talk to NLRP 3.
• 28:41
  Bob Miller: We spoke about that in another webinar, helping recruit and activate the inflammasomes and trigger more inflammatory signaling.
• 28:50
  Bob Miller: That's why we have our little yikes over here.
• 28:53
  Dr. Jill Carnahan: Yeah.
• 28:54
  Bob Miller: So you can see how this thing just keeps spinning.
• 28:57
  Bob Miller: So mitochondrial stress leads to the NLRP3 recruitment inflammasome activation.
• 29:05
  Bob Miller: So look at all cardiolipin helps to do.
• 29:07
  Bob Miller: Organizes the inner mitochondrial membrane, anchors the electron transport complexes, stabilizes the super complexes.
• 29:16
  Bob Miller: So let's talk about that a little bit.
• 29:18
  Bob Miller: As I showed you before, there's a little space between the complexes and that's where electrons can leak off.
• 29:27
  Bob Miller: When there's adequate cardiolipin, they get closer together and there's less chance for leakage.
• 29:34
  Bob Miller: So you're going to have more ATP.
• 29:36
  Bob Miller: It's believed that people who are naturally athletic have that going on, that their complexes are close to each other and there's plenty of ATP.
• 29:46
  Bob Miller: And not having the.
• 29:48
  Bob Miller: And not having the leakage.
• 29:51
  Bob Miller: So improved electron transfer efficiency.
• 29:54
  Bob Miller: Leakage decreasing your superoxide production, maximizing your ATP, supporting the proton retention, regulating aptosis, the death of the cells, supporting autophagy of the recycling and maintaining the structure of the membrane.
• 30:10
  Bob Miller: All of that's related to cardiolipin.
• 30:13
  Bob Miller: Now we could probably do a whole webinar on just cardiolipin, but there's something called cytochrome C, which is also part of the electron transfer.
• 30:28
  Bob Miller: And if there's not enough cardiolipin, cytochrome C falls out of the inner membrane and then that is really making apoptosis where mitochondria are actually damaged.
• 30:41
  Bob Miller: Interestingly, this is where red light therapy is shining.
• 30:44
  Bob Miller: no pun intended, right?
• 30:46
  Bob Miller: Yes, yes, the red light helps keep that cytochrome C into place.
• 30:51
  Bob Miller: That's why red light therapy has become so popular.
• 30:56
  Bob Miller: Now again, we could spend a whole webinar on talking about this, but this is how your cardiolipin gets made.
• 31:08
  Bob Miller: The final step being here.
• 31:10
  Bob Miller: But you also need some of your essential fatty acids and they're controlled by FADS two and FADS one.
• 31:18
  Bob Miller: One of the things we are finding is that people who are really struggling have genetic snips in FADS two and FADS one.
• 31:26
  Bob Miller: Therefore they're not getting the polyunsaturated fatty acids over here.
• 31:31
  Bob Miller: So this final step, they call this tas, it combines these two together to make your mature cardiolipin.
• 31:40
  Bob Miller: So we oftentimes see people that.
• 31:43
  Bob Miller: I just spoke to a 40 some year old woman today who, her sister died of a heart attack at 44.
• 31:49
  Bob Miller: She's having heart problems.
• 31:51
  Dr. Jill Carnahan: Wow.
• 31:51
  Bob Miller: She was homozygous on just about every fads, so she was not making cardinalipin and creating all kinds of problems.
• 32:03
  Bob Miller: So now lipid peroxidation.
• 32:05
  Bob Miller: Again, this is probably the key thing we need to focus on today.
• 32:10
  Bob Miller: That's where reactive oxygen species.
• 32:12
  Bob Miller: Here we go back to what we spoke about six years ago.
• 32:16
  Dr. Jill Carnahan: Yes.
• 32:16
  Bob Miller: Hydroxyl radicals, superoxide and peroxy nitrite attack the fatty acids within the cell and mitochondrial membranes.
• 32:25
  Bob Miller: This, Dr. Jill, might be the most important things we've said today.
• 32:30
  Bob Miller: When that cardiolipin gets damaged, it destabilizes the membrane proteins and ion transport impairs the electron transport chain, lowers ATP, increases electron leakage and superoxide generation.
• 32:46
  Bob Miller: Then it makes aldehydes such as 4HNe and MDA, which can further damage proteins, enzymes, DNA and mitochondrial structures, contributing to calcium dysregulation that we're going to get to next, inflammation, oxidative stress, and progressive cellular dysfunction.
• 33:02
  Bob Miller: See how this is all tying together here, Dr. Jill?
• 33:06
  Bob Miller: This might be one of the more important slides we're going to show as well.
• 33:10
  Bob Miller: So here's your cell membrane, your lipid bilayer.
• 33:15
  Bob Miller: Here's your cardiolipin.
• 33:17
  Bob Miller: And when we make superoxide from Nox, I think this is our second webinar we did.
• 33:25
  Bob Miller: When the electrons leak, when we combine to make peroxy nitrite, or if we get iron combining with hydrogen peroxide, we make hydroxyl radicals.
• 33:35
  Bob Miller: There's another one called alox that we won't get into today.
• 33:38
  Bob Miller: They will start damaging the bilayer by grabbing a hydrogen.
• 33:43
  Bob Miller: We call that the spark.
• 33:45
  Bob Miller: By the way, this is Mr. Sparky over here.
• 33:47
  Dr. Jill Carnahan: yes.
• 33:48
  Bob Miller: Then the propagation, where it just keeps feeding on itself until we bring out the firefighters.
• 33:57
  Bob Miller: And that includes things like vitamin E. I particularly like Delta Gold, K2, Astaxanthin, CoQ10 and Glutathione.
• 34:06
  Bob Miller: They're the firefighters, particularly astaxanthin.
• 34:09
  Bob Miller: It actually protects the entire cell membrane where a vitamin E just protects part of it.
• 34:15
  Bob Miller: So we've been finding pretty nice improvements.
• 34:18
  Bob Miller: When you turn off the blowtorch and you bring out the firefighters, this very well may be step number one.
• 34:28
  Bob Miller: So I know a lot of folks are like, oh, you've got mold.
• 34:30
  Bob Miller: We've got a detox mold.
• 34:31
  Bob Miller: Oh, you've got Candida.
• 34:32
  Bob Miller: Oh, you've got heavy metals.
• 34:34
  Bob Miller: Well, if this is malfunctioning and the eliminating organs aren't getting the power, it can be very difficult to do.
• 34:41
  Dr. Jill Carnahan: Yes, that makes sense.
• 34:42
  Bob Miller: I'm putting out that hypothesis that maybe this is step number one.
• 34:48
  Dr. Jill Carnahan: Yeah.
• 34:48
  Bob Miller: Before you try to do anything else too heroic.
• 34:51
  Dr. Jill Carnahan: And I think this is why Patricia Kane's work on cell membrane restoration has been so powerful in all of these years of any practitioner doing these kind of mold or Lyme or Long Covid.
• 35:01
  Dr. Jill Carnahan: Because it focuses on this very topic, which is cell membrane restoration.
• 35:07
  Bob Miller: Yes.
• 35:07
  Bob Miller: I've been posting this on my.
• 35:09
  Bob Miller: My Facebook page, and she's actually been jumping in and giving.
• 35:11
  Dr. Jill Carnahan: Yay.
• 35:12
  Dr. Jill Carnahan: She's probably like, yes, Bob, you're bringing evidence to what I've been doing for years.
• 35:16
  Dr. Jill Carnahan: It's amazing.
• 35:16
  Dr. Jill Carnahan: But I mean, you've got the.
• 35:17
  Dr. Jill Carnahan: She.
• 35:18
  Dr. Jill Carnahan: She obviously knew it worked, but you're bringing a whole new level of understanding to the topic.
• 35:23
  Bob Miller: Yeah.
• 35:24
  Bob Miller: And I believe when.
• 35:25
  Bob Miller: When co came along, that's stimulating this.
• 35:28
  Bob Miller: The mycotoxin stimulate this.
• 35:30
  Bob Miller: Lyme stimulates this epic storm.
• 35:32
  Bob Miller: So I believe that's why we might be in a new world here that things that maybe worked in the past aren't going to work quite as well until we address this.
• 35:43
  Bob Miller: Step number one here, Dr. Jill.
• 35:46
  Bob Miller: All right, now here's another.
• 35:48
  Bob Miller: This is one of my favorite pictures.
• 35:51
  Bob Miller: When.
• 35:51
  Bob Miller: Here's the complexes again.
• 35:53
  Bob Miller: Here's the protons, here's the electrons flowing.
• 35:56
  Bob Miller: Here's CoQ10, your cytochrome C making the ATP.
• 36:02
  Bob Miller: This represents your cardiolipin.
• 36:06
  Bob Miller: If cardiolipin gets damaged, these electrons don't make ATP, they leak off.
• 36:15
  Bob Miller: This is important.
• 36:16
  Bob Miller: Combined with oxygen to make superoxide, then combined with nitric oxide to make peroxy nitrite.
• 36:23
  Bob Miller: By the way, nitric oxide isn't a bad guy.
• 36:24
  Bob Miller: It's very good for us.
• 36:26
  Dr. Jill Carnahan: Right?
• 36:26
  Bob Miller: Except that when it combines with superoxide, then it becomes.
• 36:30
  Bob Miller: Oh, no, Peroxy nitrite.
• 36:32
  Bob Miller: And there was some thought that peroxinitrite wasn't as dangerous, but we're now finding it.
• 36:37
  Bob Miller: It really is, with new scientific research.
• 36:40
  Bob Miller: Then oxidizes your cardiolipin, damages the cardiolipin.
• 36:45
  Bob Miller: And what do you have here, Dr. Jill?
• 36:47
  Bob Miller: A feedback loop.
• 36:49
  Bob Miller: A vicious feedback loop that as you damage the cardiolipin, there's more leakage.
• 36:56
  Bob Miller: More leakage leads to more cardiolipin, and around we go.
• 37:01
  Bob Miller: This may be the key point of this podcast.
• 37:05
  Bob Miller: Wow.
• 37:06
  Bob Miller: If this is going on, you gotta stop it.
• 37:11
  Bob Miller: Because if you don't, many things that you're going to try may not work.
• 37:16
  Dr. Jill Carnahan: Correct.
• 37:17
  Bob Miller: So stopping this is critical.
• 37:21
  Bob Miller: Isn't that absolutely fascinating, Dr. Jill?
• 37:23
  Dr. Jill Carnahan: It makes so much sense, Bob.
• 37:25
  Dr. Jill Carnahan: I love how we keep going.
• 37:26
  Dr. Jill Carnahan: It's like the Russian dolls.
• 37:28
  Dr. Jill Carnahan: You said we keep going, you know, lower into you open one, and they're like, oh, there's more.
• 37:33
  Dr. Jill Carnahan: Open one, there's more.
• 37:34
  Dr. Jill Carnahan: And as you get to the depth of this, and this is such an essential cell membrane, even the cell danger response by Navio was all around when cell membranes get damaged and ATP leaks outside the cell, it triggers this response, which this is at the core if we can prevent this cardio damaged.
• 37:52
  Dr. Jill Carnahan: So tell us more.
• 37:53
  Dr. Jill Carnahan: How do we.
• 37:54
  Dr. Jill Carnahan: How do we deal with this?
• 37:55
  Bob Miller: Okay, here we go.
• 37:58
  Bob Miller: So this is just a little drawing on how the cardiolipin gets damaged from peroxinitrite.
• 38:03
  Bob Miller: Here again, spikes mycotoxins.
• 38:06
  Bob Miller: Lyme stimulates microglia M1, TNFA, NF, Kappa B.
• 38:12
  Bob Miller: Here's your inflammasomes.
• 38:14
  Bob Miller: Stimulates NOX and Inos.
• 38:16
  Bob Miller: Then peroxinitrite.
• 38:18
  Bob Miller: Oh, no.
• 38:19
  Bob Miller: Damages the cardiolipin, lipid peroxidation and again, genetic SNPs.
• 38:24
  Bob Miller: If you got gain of function on TNFA, gain a function in F kappa B, gain a function NLRP 3, gain a function IL 6, gain a function here.
• 38:34
  Bob Miller: Two people could be exposed to the same thing.
• 38:37
  Bob Miller: But if one person has genetic gain of functions here, they're going to be more impacted.
• 38:42
  Bob Miller: That's why two people can live in a moldy house.
• 38:45
  Bob Miller: One person is sick and the other one says, but I don't feel anything.
• 38:49
  Bob Miller: There's the difference.
• 38:52
  Bob Miller: Then here comes your hydroxyl radicals again.
• 38:54
  Bob Miller: I think this is our first.
• 38:56
  Bob Miller: Our first podcast.
• 38:57
  Bob Miller: Six years ago, we spoke about how hydrogen peroxide combines with iron in the Fenton reaction and makes these hydroxyl radicals.
• 39:09
  Bob Miller: Now, if we're able to have enough catalase thyrodoxin or glutathione peroxidase 4, we can burn that off.
• 39:17
  Bob Miller: But again, you can have genetic snips in these guys that you don't clear the hydrogen peroxide, you're going to be more prone for this.
• 39:25
  Bob Miller: And what do you have?
• 39:26
  Bob Miller: Cardiolipin oxidation.
• 39:28
  Bob Miller: Then impaired electron transport efficiency.
• 39:31
  Bob Miller: More electron leaks, weaker proton gradients, less ATP.
• 39:38
  Bob Miller: And around we go.
• 39:41
  Bob Miller: Now, what happens next is fascinating.
• 39:45
  Bob Miller: We all know that calcium is, you know, critical for the body.
• 39:49
  Bob Miller: It builds the teeth and the bones, but it's also a signaling molecule.
• 39:54
  Bob Miller: It'll signal things.
• 39:55
  Bob Miller: So when you move your hand or your heartbeats, the calcium is the one that signals it to do that.
• 40:04
  Bob Miller: But anything can be excessive.
• 40:06
  Bob Miller: Back to our Goldilocks.
• 40:08
  Bob Miller: And there's an enzyme called RYR1 that takes calcium from something called the endoplasmic reticulum, which does a lot of things, but one of the things, it's the storehouse for calcium.
• 40:21
  Bob Miller: And when stimulated here it says when it's excessively stimulated, the cytosolic calcium rises, creating a stronger calcium signal near the mitochondria.
• 40:31
  Bob Miller: The mitochondria then take out more calcium through this enzyme increasing.
• 40:36
  Bob Miller: And then they're saying, excessive matric calcium can promote oxidative stress, impair the electron transport chain, and reduce efficient ATP production.
• 40:46
  Bob Miller: So calcium can be your best friend or your worst enemy, like everything can be.
• 40:52
  Bob Miller: So this RYR one can be stimulated by lipid peroxidation.
• 40:59
  Bob Miller: Whoa.
• 41:01
  Dr. Jill Carnahan: Yes.
• 41:01
  Bob Miller: So lipid peroxidation will tell this guy, dump out calcium.
• 41:06
  Bob Miller: Well, then what does it do?
• 41:09
  Bob Miller: So it says,.
• 41:11
  Dr. Jill Carnahan: And, Bob, will we actually see hypercalcemia in the serum, or is this just a process that's intracellular that we couldn't measure?
• 41:18
  Dr. Jill Carnahan: Do we know?
• 41:19
  Bob Miller: I'm not sure.
• 41:20
  Bob Miller: But just interestingly now, this is just.
• 41:23
  Bob Miller: Yeah, clinical observation.
• 41:24
  Bob Miller: This is all it is when I point this out.
• 41:27
  Bob Miller: These people do have high calcium in the blood.
• 41:30
  Dr. Jill Carnahan: Well, we already know, like, cancer situations and we call them metaneoplastic syndromes, which are things that go alongside, not that always means there's cancer, but when there's damage and growth in the body, often this hypercalcemia is one of the things that can happen again, among other things.
• 41:46
  Dr. Jill Carnahan: So that makes sense.
• 41:49
  Bob Miller: So here we go.
• 41:50
  Bob Miller: Lipid peroxidation generates reactive oxidants and aldehydes that can modify that RYR one.
• 41:58
  Bob Miller: Oh, my goodness.
• 41:59
  Bob Miller: Let me say that again.
• 42:00
  Bob Miller: Lipid peroxidation modifies ryr1, making the channel more prone to calcium leakage from the endoplasmic reticulum.
• 42:09
  Bob Miller: The resulting rise increases mitochondrial calcium uptake, primarily through that mcu, and that increases more reactive oxygen species, promotes mitochondrial permeability changes, disrupts electron flow through the electron transport chain.
• 42:25
  Bob Miller: And here we go.
• 42:26
  Bob Miller: Decreases your ATP production while increasing leakage and oxidative stress.
• 42:33
  Bob Miller: You see how we've got a couple of feedback loops going on here, Dr. Jill?
• 42:37
  Dr. Jill Carnahan: Yes.
• 42:40
  Bob Miller: All right, then here's what happens when we get that calcium overload.
• 42:45
  Bob Miller: Here's your endoplasmic reticulum.
• 42:48
  Bob Miller: Ryr1 becomes overactive, puts too much calcium in the cytosolic area, goes into the mitochondria, and then that creates mitochondrial dysfunction, oxidative stress, er, stress.
• 43:04
  Bob Miller: There's something called calpain that we can get into later.
• 43:07
  Bob Miller: Inflammation, excitability problems, muscle dysfunction, cardiac stress, cell injury and apoptosis, all that can occur when this guy is pumping out too much calcium.
• 43:22
  Dr. Jill Carnahan: Wow.
• 43:22
  Bob Miller: And then we'll talk later.
• 43:23
  Bob Miller: There's an enzyme called ncx, which helps take the calcium out, but that will be weakened if there's not enough ATP.
• 43:32
  Bob Miller: That's.
• 43:32
  Bob Miller: We're going to go here next.
• 43:35
  Bob Miller: So now we're going to move over to the sodium potassium pump.
• 43:39
  Bob Miller: And quite simply, what that does, it keeps the balance of sodium and potassium.
• 43:44
  Bob Miller: So you need potassium inside the cell and not too much sodium.
• 43:51
  Bob Miller: And this pump is an ATP dependent membrane that moves three sodium ions out of the cell, two potassiums into the cell, maintaining the electrical and chemical gradients needed for normal cellular function.
• 44:04
  Bob Miller: Look what it does.
• 44:05
  Bob Miller: Nerve signaling, muscle contraction, nutrient transport, cell volume control, secondary transport systems such as calcium and neurotransmitter handling.
• 44:14
  Bob Miller: Talk about that stress a little bit later.
• 44:17
  Bob Miller: Yeah.
• 44:17
  Bob Miller: When the pump is impaired, sodium can accumulate inside the cell.
• 44:21
  Bob Miller: Potassium gradients, weakened calcium regulations become disrupted and neurons and muscles may become electrically unstable, contributing to impaired signaling, weakness, excitability and further cellular stress.
• 44:35
  Bob Miller: And guess who this guy runs on ATP.
• 44:41
  Bob Miller: So we're not going to read all of this here, but here's the.
• 44:44
  Bob Miller: Here's the sodium potassium pump.
• 44:48
  Bob Miller: Taking out sodium, bringing in potassium, running off ATP consequences, brain and nerves, heart, muscles, kidneys, intestines, all of those can be impacted if we don't have this guy doing its job.
• 45:04
  Bob Miller: Now over here, you see the enzymes that are part of that and genetic SNPs here can further impact how the sodium potassium pump does its job.
• 45:15
  Bob Miller: So one of the easiest ways to see that is when people have edema, the swelling of the ankles, they're getting that sodium potassium out of balance.
• 45:24
  Bob Miller: Now here's how we take care of the calcium.
• 45:28
  Bob Miller: There's an enzyme called circa that puts the calcium back into the endoplasmic reticulum.
• 45:36
  Bob Miller: But look who it's dependent upon.
• 45:38
  Dr. Jill Carnahan: ATP seems like a common theme here, Bob, we need that ATP.
• 45:43
  Dr. Jill Carnahan: We sure do.
• 45:46
  Bob Miller: So then if your sodium potassium pump doesn't work, it doesn't create the right gradient so NCX can take the calcium out.
• 45:56
  Bob Miller: And then you're going to have all this cellular stress, impaired relaxation, mitochondrial strain, dysfunctional injury if circa is not doing its job and the sodium potassium pump was weak, all depended upon ATP.
• 46:15
  Bob Miller: So this is just another drawing of the circa that if you got adequate ATP, you're going to put this calcium back into the endoplasmic reticulum.
• 46:25
  Bob Miller: If it's not doing its job, it stays in the cytosol, creating all the problems that it creates.
• 46:33
  Bob Miller: Now listen to this.
• 46:34
  Bob Miller: It makes neurons more excitable and that's going to make you stressed.
• 46:41
  Bob Miller: So you can see how this just becomes a chain of events that keeps impacting.
• 46:46
  Bob Miller: So the brain and nervous system, the lungs, the muscles, the intestines, the heart, they're all impacted if that's not working properly.
• 46:56
  Bob Miller: So here's.
• 46:57
  Bob Miller: And again, I'm not going to read all this.
• 46:59
  Bob Miller: We could spend a whole webinar on this one.
• 47:01
  Bob Miller: But it just shows how the sodium potassium pump's going to affect the neurons homeostasis and enabling every thought, signal and movement in the brain.
• 47:12
  Bob Miller: It's the foundation for stable neurons, healthy signaling and brain resilience.
• 47:19
  Bob Miller: For the heart, it's the foundation for healthy rhythm, contraction and cardiac resilience.
• 47:29
  Bob Miller: Then also for the lungs, supports healthy airway function, cellular stability and lung resilience.
• 47:37
  Bob Miller: For the muscles supporting strength, relaxation and muscle resilience.
• 47:41
  Bob Miller: As people get older, that's one of their Biggest concerns that they don't have the strength to stay stable, to walk properly, to fall.
• 47:48
  Bob Miller: Because you know, one fall at a certain age can really be serious if you break a hip.
• 47:53
  Bob Miller: So if you want those muscles to be working, you got to make sure they have enough ATP.
• 47:58
  Bob Miller: And this sodium potassium pump is doing its job.
• 48:03
  Bob Miller: And finally the intestines supports motility, absorption and intestinal resilience.
• 48:08
  Bob Miller: And finally the kidneys, Healthy kidney cells, balanced electrolytes, stable blood pressure, long term kidney protection, all of that is dependent upon that.
• 48:19
  Bob Miller: So when that's inadequate loss of membrane stability, calcium may be cleared less effectively, cells may swell.
• 48:26
  Bob Miller: I'm sure you see a lot of people, they've got swollen ankles.
• 48:30
  Bob Miller: Nerves, muscles, heart tissue and other high energy organs may function less efficiently.
• 48:34
  Bob Miller: And as the ATP falls, lump function slows.
• 48:39
  Bob Miller: All right, now you had said earlier you were excited about stress.
• 48:42
  Dr. Jill Carnahan: Yeah.
• 48:43
  Bob Miller: Okay, so there's something called an astrocyte.
• 48:48
  Bob Miller: And astrocytes take glutamate.
• 48:51
  Bob Miller: Now glutamate makes you intelligent, highly motivated, go getter.
• 48:55
  Bob Miller: But in excess creates anxiety, neuroinflammation.
• 49:00
  Bob Miller: Can't sleep, it's a mess.
• 49:02
  Bob Miller: If the glutamate is too high.
• 49:04
  Bob Miller: Again, Goldilocks, yes.
• 49:07
  Bob Miller: Not too much, not too little.
• 49:11
  Bob Miller: So if we have adequate ATP, you see that up top here, it actually creates a gradient where what happens is that sodium grabs the glutamate and brings it in if there's low sodium inside here.
• 49:25
  Bob Miller: And then this enzyme the takes the glutamate, turns it into glutamine, which is an amino acid that actually helps make glutathione and it goes back out as glutamine.
• 49:41
  Bob Miller: So the excitatory glutamate turns into the helpful glutamine through the astrocyte.
• 49:48
  Bob Miller: That's contingent upon the sodium potassium pump keeping that sodium and potassium balanced so that it will flow in.
• 50:00
  Bob Miller: So what happens if we don't have it?
• 50:04
  Bob Miller: Oh, and by the way, I forgot to mention that it's not just glutamate, it's ammonia.
• 50:11
  Bob Miller: So there's some researchers that believe this is why autistic children do flapping, because of the ammonia and the glutamate together.
• 50:20
  Bob Miller: So wouldn't that be something if autism was actually an ATP problem?
• 50:25
  Bob Miller: So now here is the astrocyte where we don't have enough potassium and we have too much sodium, the glutamate remains outside, doesn't come in here, very little goes out as glutamine.
• 50:44
  Bob Miller: And then you're going to have pulling less glutamate in and Then the glutamate remains high and you're going to be stressed.
• 50:53
  Bob Miller: That's the astrocyte.
• 50:55
  Bob Miller: Now here's the neuron, so the neurons.
• 51:00
  Bob Miller: I'm sure everybody's heard of gaba.
• 51:02
  Bob Miller: GABA is the don't worry, relax, be happy.
• 51:05
  Bob Miller: And some people take GABA and they're relaxed.
• 51:08
  Bob Miller: And some people take GABA and say, it made me worse.
• 51:11
  Bob Miller: Did you ever hear that?
• 51:13
  Dr. Jill Carnahan: Oh, yes, because I know this pathway well, I do have patients that can't take gaba.
• 51:18
  Bob Miller: So what happens?
• 51:19
  Bob Miller: GABA has one job and one job only.
• 51:22
  Bob Miller: It opens up the GABA receptor, so chloride can flow in.
• 51:29
  Bob Miller: But for the chloride to flow in, you have to have low chloride inside.
• 51:35
  Bob Miller: And guess who does that?
• 51:36
  Bob Miller: There's enzymes called KCC2 and NKCC1.
• 51:40
  Bob Miller: So KCC2 keeps the intracellular calcium low.
• 51:45
  Bob Miller: NKCC1 brings it in.
• 51:49
  Bob Miller: Guess who controls it?
• 51:51
  Bob Miller: The sodium potassium pump that needs ATP.
• 51:56
  Bob Miller: So if everything's working fine, GABA hits chloride, moves in.
• 52:03
  Bob Miller: relaxing.
• 52:05
  Bob Miller: However, if we don't have enough ATP and the sodium potassium balance gets off, there's high chloride inside.
• 52:16
  Bob Miller: GABA hits chloride, rather than going in, moves out.
• 52:21
  Bob Miller: And that's excitatory.
• 52:24
  Bob Miller: And we want to do some research on this, but this very well may be happening with a lot of anxiety disorders and even autism.
• 52:32
  Bob Miller: Not saying that yet, but that needs to be researched.
• 52:34
  Dr. Jill Carnahan: That makes a lot of sense because I find glutamate being high in this GABA issue in patients who have, like you said, it's sometimes on the spectrum or other things.
• 52:44
  Dr. Jill Carnahan: And this glutamate, GABA thing are all about mood disorders and sleep.
• 52:51
  Bob Miller: Absolutely.
• 52:52
  Bob Miller: So as we said, that's why people can take gaba.
• 52:54
  Bob Miller: Somebody tells them, oh, you're stressed, take gaba.
• 52:56
  Bob Miller: And it's like it made me worse because it did what it's supposed to do.
• 53:00
  Bob Miller: GABA has one job.
• 53:02
  Bob Miller: Open up this channel.
• 53:04
  Bob Miller: Yes.
• 53:04
  Bob Miller: And if the chloride is low inside, it flows in.
• 53:09
  Bob Miller: It's relaxing.
• 53:10
  Bob Miller: If it's high inside, it goes the other direction and it's excitatory.
• 53:15
  Bob Miller: Yeah.
• 53:17
  Bob Miller: So ATP doesn't just power the cell, it determines which systems fail first.
• 53:25
  Bob Miller: So we need to start asking which ATP dependent systems are failing.
• 53:29
  Bob Miller: So here's the cardiolipin story.
• 53:31
  Bob Miller: Cardiolipin organizes the electron transport chain.
• 53:35
  Bob Miller: Then it produces the ATP, powers nearly every biological process.
• 53:40
  Bob Miller: When cardiolipin is damaged, they fail in predictable patterns all the way to clinical manifestations physicians see every day.
• 53:49
  Bob Miller: It's a compelling system biology narrative that ties together mitochondrial function, inflammation, organ dysfunction in a Single network.
• 53:59
  Bob Miller: So when you got low ATP, it forces cells to reduce non essential functions, preserve membrane integrity, maintain ion gradients, limit biosynthesis.
• 54:09
  Bob Miller: Physicians often see the downstream effects.
• 54:12
  Bob Miller: Fatigue, organ dysfunction, metabolic influx, inflexibility, sometimes without recognizing the mitochondrial origin.
• 54:23
  Bob Miller: So, ATP deficiency, we talked about the electrical failure, neurological, muscular, immune failure, genetic failure, structural failure, recycling failure, detoxification failure, organ failure.
• 54:36
  Bob Miller: Now, this is a chart that I just literally finished last night.
• 54:40
  Dr. Jill Carnahan: Wow.
• 54:41
  Bob Miller: Maybe I'm being a little brave here, but I'm saying redefining functional medicine.
• 54:46
  Bob Miller: So here's your infections, your Lyme, your mycotoxins, your spike protein, your EMF, your pollutants, chronic stress, they stimulate microglia, M1, tumor necrosis factor NF, kappa B.
• 55:00
  Bob Miller: Here's Carnahan reaction.
• 55:03
  Bob Miller: Peroxonitrite damages the cardiolipin lipid bilayer, mitochondrial damage, electron leak, superoxide that then combines with hydrogen peroxide, hydroxyl radicals, lipid peroxidation.
• 55:19
  Bob Miller: Okay.
• 55:21
  Bob Miller: And feedback loop, Then iron, sulfur clusters.
• 55:25
  Bob Miller: If they're not doing their job, more iron may participate in the Fenton reaction.
• 55:31
  Bob Miller: Then again, electron transport, chain activity goes down, all of it pointing to low ATP production.
• 55:40
  Bob Miller: That's going to affect the sodium potassium pump.
• 55:43
  Bob Miller: Then we get a problem there.
• 55:45
  Bob Miller: And then comes the calcium.
• 55:47
  Bob Miller: And then here's your impaired astrocytes and neurons.
• 55:51
  Bob Miller: Anxiety and hyperbility, hyperexcitability and anxiety.
• 55:56
  Bob Miller: And then that glutamate dysregulation causes more cellular damage.
• 56:00
  Bob Miller: And around we go.
• 56:02
  Bob Miller: So I literally just had this.
• 56:05
  Dr. Jill Carnahan: Fascinating.
• 56:06
  Dr. Jill Carnahan: I love it so much.
• 56:08
  Dr. Jill Carnahan: Makes so much sense.
• 56:09
  Dr. Jill Carnahan: Bob.
• 56:09
  Dr. Jill Carnahan: Yeah.
• 56:10
  Bob Miller: I'll probably be redefining this a little bit over time, but I think this captures the bulk of it.
• 56:14
  Dr. Jill Carnahan: I was gonna say this is so much that I think we should have a part two and kind of go over like in a few months of what has changed, if there's been any little.
• 56:21
  Dr. Jill Carnahan: Because this is just fascinating.
• 56:22
  Dr. Jill Carnahan: I think the cell membrane concept, ATP at the core is really where we should be at, really.
• 56:27
  Dr. Jill Carnahan: Molecular medicine, but personalized precision.
• 56:30
  Dr. Jill Carnahan: This is where it's at.
• 56:32
  Bob Miller: Absolutely.
• 56:33
  Dr. Jill Carnahan: Now, I don't know if you want to share.
• 56:35
  Dr. Jill Carnahan: We've got about five minutes left.
• 56:36
  Dr. Jill Carnahan: So you can decide what's most priority.
• 56:38
  Bob Miller: But what we'll do, we'll go through action steps very quickly.
• 56:42
  Dr. Jill Carnahan: You got it.
• 56:43
  Bob Miller: A quick peek at you.
• 56:44
  Dr. Jill Carnahan: Okay, sounds good.
• 56:46
  Bob Miller: Inflammatory triggers the tnfa, restore calcium homeostasis, protect the cardiolipin, the support cardiolipin synthesis, limit hydrogen peroxide, support the electron transport cofactors.
• 57:01
  Bob Miller: And we could probably do a whole webinar on that.
• 57:03
  Bob Miller: Just Very quickly, if anyone wants to take a peek at the genetic side, that's what we do.
• 57:08
  Bob Miller: We do functional genetic testing.
• 57:10
  Bob Miller: And if somebody wants to get our clinic here we are Tree of Life Health to l health.com we can measure your genetics, do a consult, find out where your weakness is.
• 57:20
  Bob Miller: And then for practitioners, if they would like to do this, here's where a practitioner can go ahead and do this.
• 57:27
  Bob Miller: Functionalgenomicanalysis.com now let's take a really quick peek at you, Dr. Jill.
• 57:32
  Dr. Jill Carnahan: Sounds good.
• 57:33
  Dr. Jill Carnahan: And I just want to say, Bob, your work here in training physicians and helping patients has been so profound.
• 57:39
  Dr. Jill Carnahan: So I'm really glad to share this information.
• 57:41
  Dr. Jill Carnahan: Every single episode that we do because it's the going to this level often gives an insight or aha.
• 57:47
  Dr. Jill Carnahan: Into these small.
• 57:48
  Dr. Jill Carnahan: Like the Carnahan reaction.
• 57:49
  Dr. Jill Carnahan: Right, One of these things that.
• 57:51
  Dr. Jill Carnahan: Exactly.
• 57:52
  Bob Miller: Okay, now this is Dr. Jill and this is on our functional genomic analysis.
• 57:59
  Bob Miller: So what triggers it is if we absorb extra iron.
• 58:03
  Bob Miller: And if you remember your heterozygous for the hemochromatosis gene.
• 58:07
  Dr. Jill Carnahan: Yes.
• 58:08
  Bob Miller: Then you also have SLC 40 a one that could give us more iron.
• 58:13
  Bob Miller: This would be a topic all itself.
• 58:15
  Bob Miller: But there's an enzyme called hepherd.
• 58:17
  Bob Miller: It helps take the Fe2 into the Fe3.
• 58:19
  Bob Miller: And you can see you got a couple snips there that stimulates TNFA, NF, Kappa B, Interleukin 6.
• 58:29
  Bob Miller: And here's Carnahan reaction 2 right here.
• 58:33
  Bob Miller: Increase excess super ox nitric oxide.
• 58:36
  Bob Miller: Again, nitric oxide is not bad.
• 58:38
  Bob Miller: People get very upset that you're saying nitric oxide's bad.
• 58:41
  Bob Miller: Not at all.
• 58:42
  Bob Miller: But when it combines with superoxide, that's when it makes the peroxy nitrite that damages the cell membranes.
• 58:50
  Bob Miller: Then over here, if we don't clear hydrogen peroxide.
• 58:55
  Bob Miller: And you can see here you've got one homozygous on catalase.
• 58:58
  Bob Miller: You'll get hydroxyl radicals.
• 59:00
  Bob Miller: That makes lipid peroxidation.
• 59:02
  Bob Miller: And you're in one feedback loop here.
• 59:06
  Bob Miller: Now remember we said that stimulates the RYR1 enzyme to push calcium in to the mitochondria.
• 59:18
  Bob Miller: So this is your complexes here.
• 59:20
  Bob Miller: So no matter what's going on with the ingredients that are needed for this, if that calcium comes rushing in, it shuts it down.
• 59:28
  Bob Miller: Okay, then here you can see, these are the enzymes that make the cardiolipin.
• 59:33
  Bob Miller: But you also, if you remember I told you need the long chain polyunsaturated fatty acids.
• 59:37
  Dr. Jill Carnahan: Yes.
• 59:39
  Bob Miller: And you can see it's not real bad, but you have some snips here on Fads 2.
• 59:44
  Bob Miller: Your Fads 1 is looking fine.
• 59:46
  Bob Miller: So you really don't have any trouble I don't believe getting the nutrients there to make the cardiolipin.
• 59:53
  Bob Miller: But your challenge might be that because of the lipid peroxidation the calcium is coming in.
• 1:00:00
  Bob Miller: Now I'm really excited about the iron sulfur cluster.
• 1:00:05
  Dr. Jill Carnahan: huh.
• 1:00:06
  Bob Miller: So here you can see the making of the iron sulfur cluster.
• 1:00:10
  Bob Miller: Okay.
• 1:00:10
  Bob Miller: Now we've not identified which of these are evidence based yet.
• 1:00:14
  Bob Miller: So we don't know.
• 1:00:15
  Bob Miller: But you can see here you've got two little snips on the guy that delivers the NADPH to make the iron sulfur cluster.
• 1:00:26
  Bob Miller: But remember I said once you make it, you can oxidize it.
• 1:00:31
  Bob Miller: And again not a diagnosis but a predisposition here Dr. Joe, that because you're a little weakness on nerf on nrf2 and you've got a little weakness on HMOX and little extra push on NF Kappa B.
• 1:00:47
  Bob Miller: But here's the one, the Nos 2, yes.
• 1:00:49
  Bob Miller: If you're making any superoxide that's going to make peroxonitrite which is going to damage your iron sulfur cluster, then this guy right here, you can see you've got a homozygous on all three of them.
• 1:01:03
  Bob Miller: That's the one that takes the iron sulfur cluster and delivers it to complex number one.
• 1:01:09
  Bob Miller: Wow.
• 1:01:11
  Bob Miller: So yeah, you can see there's a second component here to the.
• 1:01:18
  Bob Miller: Yeah to that Nos 2.
• 1:01:20
  Bob Miller: That again not a diagnosis but a potential that you might be damaging those iron sulfur clusters just a little bit.
• 1:01:29
  Bob Miller: Wow.
• 1:01:30
  Dr. Jill Carnahan: Makes sense.
• 1:01:30
  Dr. Jill Carnahan: We just, like we said, we just keep getting deeper and more layers and this is fascinating.
• 1:01:37
  Dr. Jill Carnahan: So if you're out there listening, like I said, Bob started in the beginning, please go back.
• 1:01:40
  Dr. Jill Carnahan: It's almost like we've created a whole course of episodes.
• 1:01:44
  Dr. Jill Carnahan: Go back to the episode that he first mentioned and listen to that.
• 1:01:48
  Dr. Jill Carnahan: He has them all listed in earlier in this, you can just rewind if you're listening audio or video.
• 1:01:53
  Dr. Jill Carnahan: And then this to me though is the cherry on the top.
• 1:01:57
  Dr. Jill Carnahan: Right.
• 1:01:57
  Dr. Jill Carnahan: Like this is one of those things that you told me beforehand would be profound.
• 1:02:01
  Dr. Jill Carnahan: And because I'm also seeing this in clinical practice with more anticardiolipin antibodies and more inflammation and just lipid membranes in general being the core of how we often reverse some of this complex chronic issues.
• 1:02:15
  Dr. Jill Carnahan: I really love going to that level versus being up here and the infections and toxins.
• 1:02:19
  Bob Miller: Right, Yeah, I think that's the whole point of this, we perhaps we're just going too far down.
• 1:02:25
  Bob Miller: And I wouldn't be surprised that Covid has made it happen.
• 1:02:29
  Dr. Jill Carnahan: Yes.
• 1:02:31
  Bob Miller: That's what's driving it now.
• 1:02:32
  Bob Miller: And then mold getting stronger, Lyme getting stronger.
• 1:02:35
  Bob Miller: And we're just doing.
• 1:02:37
  Bob Miller: I help doctors many times go through the genetics, and they keep telling me things that used to work in the past don't work as well.
• 1:02:43
  Dr. Jill Carnahan: Yes, that's exactly.
• 1:02:44
  Dr. Jill Carnahan: I often say, you know, I'd have these very simple patients in three months, they'd be, well, 20 plus years ago.
• 1:02:49
  Dr. Jill Carnahan: And now it doesn't happen that way.
• 1:02:51
  Dr. Jill Carnahan: It's way more complex and more layers.
• 1:02:53
  Dr. Jill Carnahan: So, Bob, as always, I am so grateful for you, for our friendship.
• 1:02:58
  Dr. Jill Carnahan: I'm so grateful for the brilliance that you bring to this.
• 1:03:00
  Dr. Jill Carnahan: And I love these very special episodes because they really dive deep.
• 1:03:03
  Dr. Jill Carnahan: And those people who want that are watching and listening.
• 1:03:06
  Dr. Jill Carnahan: And if you guys have enjoyed this or find it helpful, please share it with a friend or your physician, please.
• 1:03:12
  Dr. Jill Carnahan: Pretty please.
• 1:03:13
  Dr. Jill Carnahan: Bob, as always, we're going to do another.
• 1:03:14
  Dr. Jill Carnahan: We're going to do round two around three, around 27.
• 1:03:18
  Bob Miller: So couple rounds on every.
• 1:03:20
  Bob Miller: Because we really just touched the surf.
• 1:03:21
  Bob Miller: We could do.
• 1:03:22
  Dr. Jill Carnahan: Exactly.
• 1:03:22
  Dr. Jill Carnahan: I'm like, this is so good and it's so deep.
• 1:03:24
  Dr. Jill Carnahan: Like, I'm going to have to go and watch it again.
• 1:03:26
  Dr. Jill Carnahan: So if you're out there listening, you may want to rewind and listen again.
• 1:03:28
  Dr. Jill Carnahan: But as always, thank you for your brilliant research.
• 1:03:31
  Dr. Jill Carnahan: Thank you for bringing this to the field, and I hope to see you upcoming in person at one of the conferences.
• 1:03:36
  Bob Miller: Absolutely.
• 1:03:37
  Bob Miller: All right, well, take care, my friend, and we'll.
• 1:03:38
  Bob Miller: We'll talk again soon.
• 1:03:40
  Dr. Jill Carnahan: Thank you, Bob.