110 | Why I Don't Work with Functional Labs

0:00 Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman. I'm an herbalist and nutritionist, and in this podcast, I share tips, tidbits, and resources that might be helpful for other practitioners. I'm going to share one of my most controversial opinions when it comes to integrative health, which is that I do not work with functional lab tests. I use that as an umbrella term to talk about things like microbiome testing, Dutch testing, GI map, organic acid testing, and so forth. I'm not going to list out every single lab that fits under that category, but I think most of you will understand the type of thing that I am talking about. I want to explain why I don't work with these, but before I do, I want to just say that if you are working with these labs, I'm not judging you.

0:44 I still think you can be an excellent practitioner. We all have different pathways to the work that we do, and I'm hoping that whether you do or don't work with these functional labs that you can hear what I'm saying with an open heart and an open mind, just as I continue to keep an open mind about these labs. And maybe in the future, as more data comes in, as we get more clinical evidence and so forth, maybe I'll change my mind. Maybe I will start to work with these. But for right now, based on my understanding of what's out there and my assessment of the literature, the pros and cons for my clients and for myself, I've chosen not to work with them. So I want to explain this decision. I'm not trying to say that you should make the same decision or that if you've made a different decision than me, there's something wrong with the way that you're doing it.

1:28 So with all those caveats in place, let me talk about why at this time I am not working with these types of labs. The first and probably biggest reason that I don't work with them is that I don't think I need them. I really strongly believe in only ordering tests if I think that I need that test, the results of that test, in order to inform the work that I'm going to do with a client. So if I need something, for example, a test that I might feel that is really important to me in order to move forward with the client might be looking at iron testing. So that would be things like ferritin, hemoglobin, hematocrit, and so forth. If a client is having extreme fatigue and other things that seem like they might be related to low iron, either iron deficiency, iron deficiency anemia, or similar, to me it feels really important to have some lab studies done to investigate whether they do have low ferritin, what their iron levels look like.

2:25 Because if they do have low iron, all of the adaptogens and nervines and resting and stress management in the world is not really going to help them feel all the way better unless they got to do something about the iron. So that to me feels like a very important test to order. Some of these functional labs, I'm like, I don't really see the need to order them because they're not going to inform the work that I'm doing. I have strategies that I can use to help people feel better without understanding or knowing what their microbiome, the specifics of what their microbiome is. Knowing that they have more or less of a certain microbe in the vagina, in the small intestine, the large intestine, etc.

3:06 Is not generally going to change my approach versus what I would do based on symptoms and what they're telling me in their health history and so on and so forth. So that's one of my biggest reasons. I don't see a need for somebody to pay hundreds of dollars if it is not going to clearly inform the work that I'm doing. Would there be a scenario if, let's say, we had covered all the bases, we had gotten to where we have ensured that the client is sleeping really well, and they are managing their stress to the best that's possible given their circumstances, and they're eating a varied and generally balanced diet with plenty of micro and macronutrients represented. And they have community and they're moving their body and all these foundational pieces are in place. They are drinking plenty of fluids.

3:51 All of that's in place and we're still stuck. And it seems like, hmm, there's something there. Would I consider one of these labs? Personally, no, not right now. But maybe there's a scenario in the future where there might be additional information coming through. So that's probably the number one reason. I'll get into some additional reasons, though. Number two, the data that I have seen does not show that these tests are particularly valid, meaning are the results repeatable and do they reflect, do we have good reason to think that they reflect what's actually going on within that particular client in a meaningful way? I don't think that that's true of all of these labs necessarily. That's one of the reasons that they are not widely accepted in the larger medical world. So that's one piece of the puzzle.

4:38 And as an example, there are some previous studies showing that if you take the same fecal sample and send it off to a number of different microbiome testing labs, you get vastly different results. And that is questionable to me. You know, we need to have a way to feel confident that the results that we're getting are actually accurate and they do represent what's going on in the client's body. Even if, let's just say that is true. Let's say these labs, which are generally, you know, for-profit types of situations, let's say they are accurate. And these tests are finding, you know, they're accurately reflecting what's going on in the person's body. Amazing. I think that's really cool from a physiological perspective. Perspective as a science nerd, the chance to kind of peek inside your body and get a feel for what's going on under the hood, I think is amazing.

5:25 I love that. I love science. I love progress. I think it's really neat. However, that's going to move us into point number three, which is the data about what that means and what we should do about it is basically not there for many of these tests. So even if we do know, oh, somebody, so-and-so has high levels of acromantia, or, you know, their estrogen metabolism is pushing down this pathway versus that pathway, whatever it is. Amazing. Okay, we've identified that. Let's just presume that the results are accurate, which we don't always have solid data in that direction. The what do you do about it part, most of the time, A, the what-do-you-do-about-it part is being provided by the same labs.

6:10 Oftentimes, they're recommending supplements, which they potentially are making money off of, or the clinician who ordered it is making money off of. And they're just saying, like, oh, because of this pathway, you might want to take quercetin, or this particular strain of probiotic, or, you know, XYZ, whatever thing that they're recommending. Usually, if you actually look at the data there, and you say, hey, how do we know that? What data shows us that if this, you know, estradiol is being metabolized by this pathway, that then the person should take this green tea extract or whatever it is? Ask for the data. Ask for, like, what's the citation? What's the reference? When you look at those, you will find that they are pretty much exclusively theoretical.

6:53 There's not good clinical data saying oh when we measure this metabolic factor and then we give some of those people green tea and other people control we see a positive result in the green tea group and that's how we know these people might want to take green tea or whatever it is that data doesn't exist most of the time it's hypothetical it's like well in a lab environment in an in vitro study in this one particular scenario we measured that this pathway was upregulated by green tea. And therefore, why would we not do it here as well? It's several steps away from having solid evidence. I'm not saying it doesn't help or it doesn't work, but I am saying it's not as solid as you would be led to believe in most cases.

7:37 And I think it's misleading because when people get these labs back, it looks very official. It's like, oh, it's kind of like what happens when you get a lipid panel back. Your cholesterol, this one's high, this one's low, then you should take a statin. It feels very similar to that type of thing. So it seems like it's written in black and white. This is what I should do. But when you go looking at the data, It just isn't there most of the time, or it's theoretical, or it's not that different than what you would do already. It's not that big of a stretch. If somebody is having some hormone issues. Green tea is not out of the realm of possibility that you would recommend without $300 worth of lab testing. It's a reasonable thing for some people to do. It's a drink green tea, even if they're not taking a specialized metabolic extract that, you know, blah, blah, blah.

8:20 So you can see why I have some skepticism about running these labs. It's like, well, they're expensive, they're being paid out of pocket, they're often promoting specific supplements. The data for a lot of these interventions, whether they're supplements, foods, lifestyle things, whatever, is often pretty scant. And certainly, usually, it's not long term. It's like, well, we did this three-week study, we did this 10-day study, we did maybe three months if you're lucky. But again, most of it doesn't apply to these specific labs. All right. So to me, the reasons to do them are, I mean, they're just not there. They're just not there. I think it can cause people to think like, oh, this one pathway might be the problem.

9:00 And therefore, if we just target this pathway by doing these things, then everything will get better. I'm like, I, you know, the body is complex. The body is complex. Pathways don't exist in isolation. There's upstream, there's downstream. Again, if all the basics aren't in place, like eating plenty of fiber, lots of different micronutrients, all these things. I just, I don't know that it makes sense to try to be like, well, we're going to take inulin and see if we can affect this one little pathway, and therefore it's going to shift everything and the person's going to feel better, or their numbers are going to drop, or whatever. To me, that just doesn't pan out, and it's not the way that I want to practice. I want to practice with the person sitting in front of me. I don't want to feel that I'm reliant on these numbers going through a lab where somebody needs to pay hundreds of dollars on top of the hundreds of dollars. They're already paying.

9:49 The other thing I will just point out is that if you are a practitioner and you're ordering these labs because you're like, oh, well, you know, it just tells me what to do. I ordered a lab. It says on there, you know, they're low in this, high in this, and therefore I know I should give them, you know, vitamin E and EGCG and blah, blah, blah, whatever else. Why are they paying you? Like, they can read as well. They could look at that and say, oh, it says here I should take, you know, 200 milligrams of DHA or whatever it is. They can read that. Why do they need to pay you? I guess I'm making a little plug to think about your training. What were you trained to do? Are you using your own clinical assessment, your judgment, the things that you learned how to do in school that involve understanding the person sitting in front of you?

10:35 And coming up with a plan for that person based on what you're seeing in front of you. Okay, so there we go. Those are just some of the reasons that I choose not to use these functional labs in my practice. There may be a time down the road when we have more data and we have more of an understanding of how some of these things work that maybe I'll change my mind, like I said. But for right now, I feel that I have really great results without them and I'd rather my clients spend that money on going to the farmer's market, eating good food, getting a massage, you know, going on a vacation, do something else with that money. I think there's other ways that they can spend their money and that we can get so much done with just talking to the person in front of me, figuring out what is the next best step for that person and moving forward with that.

11:26 So there you go. It's a little bit of rationale as to why I practice the way that I do. I'd love to hear from you. If you have rebuttals, if you have thoughts, if you have questions, intheclinic.com is the best way to reach me. If you're not already getting my practitioner notes every Thursday, it's a newsletter I send out. It's relatively short. I send out resources, anything that's coming up in Bloom and Grow, and a little note to help make your work just a tiny bit easier, I hope. You can sign up for that at camillefreeman.com or intheclinic.com. All right. Hope to see you there. Have a lovely day, and thanks so much for the work that you do.