This might be my most controversial clinical opinion: I don't work with functional lab tests. Not DUTCH testing, not GI Map, not organic acids, not microbiome panels. In this episode, I walk through exactly why and some considerations for those who do work with these tests.
In this episode, we cover:
What I mean by "functional labs" and which tests fall under that umbrella.
Why I only order tests when the results will actually change what I do.
The validity problem, with fecal samples for microbiome testing as an example.
Why "accurate results" and "clinically actionable results" are two very different things.
The evidence problem: how recommendations attached to these labs are often theoretical rather than based on clinical data.
The conflict of interest issue.
A harder question for practitioners: if a lab is telling your client what to take, what exactly are they paying you for?
Timestamps:
0:00 - Introduction
0:10 - My most controversial clinical opinion
0:35 - Full disclosure: not judging practitioners who use these labs
1:38 - Reason 1: I don't think I need them
2:03 - When I think testing matters (iron as an example)
4:07 - Reason 2: Validity concerns
5:01 - Reason 3: The "what do we do about it" data is mostly theoretical
6:05 - The supplement recommendation problem
9:38 - A question for practitioners who rely on labs to guide recommendations
10:45 - What I'd rather clients spend that money on
Thanks for listening.
I'd love to hear from you. Leave me a voicemail with feedback or submit a question (click the pink "Send Camille a Message" button on the side of the page) 💚
Camille's Helpful Links for Practitioners
WEBVTT
00:00:00.017 --> 00:00:03.497
Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
00:00:03.697 --> 00:00:06.857
I'm an herbalist and nutritionist, and in this podcast, I share tips,
00:00:06.977 --> 00:00:09.417
tidbits, and resources that might be helpful for other practitioners.
00:00:10.017 --> 00:00:14.057
I'm going to share one of my most controversial opinions when it comes to integrative
00:00:14.057 --> 00:00:18.657
health, which is that I do not work with functional lab tests.
00:00:18.877 --> 00:00:23.837
I use that as an umbrella term to talk about things like microbiome testing,
00:00:24.177 --> 00:00:27.877
Dutch testing, GI map, organic acid testing, and so forth.
00:00:28.017 --> 00:00:31.637
I'm not going to list out every single lab that fits under that category,
00:00:31.657 --> 00:00:35.017
but I think most of you will understand the type of thing that I am talking about.
00:00:35.557 --> 00:00:39.457
I want to explain why I don't work with these, but before I do,
00:00:39.657 --> 00:00:44.177
I want to just say that if you are working with these labs, I'm not judging you.
00:00:44.557 --> 00:00:46.297
I still think you can be an excellent
00:00:46.297 --> 00:00:49.957
practitioner. We all have different pathways to the work that we do,
00:00:49.977 --> 00:00:53.897
and I'm hoping that whether you do or don't work with these functional labs
00:00:53.897 --> 00:00:57.277
that you can hear what I'm saying with an open heart and an open mind,
00:00:57.277 --> 00:01:00.837
just as I continue to keep an open mind about these labs.
00:01:01.157 --> 00:01:05.997
And maybe in the future, as more data comes in, as we get more clinical evidence
00:01:05.997 --> 00:01:07.477
and so forth, maybe I'll change my mind.
00:01:07.617 --> 00:01:11.577
Maybe I will start to work with these. But for right now, based on my understanding
00:01:11.577 --> 00:01:16.777
of what's out there and my assessment of the literature, the pros and cons for
00:01:16.777 --> 00:01:19.257
my clients and for myself, I've chosen not to work with them.
00:01:19.317 --> 00:01:20.537
So I want to explain this decision.
00:01:20.977 --> 00:01:25.057
I'm not trying to say that you should make the same decision or that if you've
00:01:25.057 --> 00:01:27.937
made a different decision than me, there's something wrong with the way that you're doing it.
00:01:28.037 --> 00:01:32.737
So with all those caveats in place, let me talk about why at this time I am
00:01:32.737 --> 00:01:34.077
not working with these types of labs.
00:01:34.617 --> 00:01:38.897
The first and probably biggest reason that I don't work with them is that I don't think I need them.
00:01:39.457 --> 00:01:46.237
I really strongly believe in only ordering tests if I think that I need that
00:01:46.237 --> 00:01:51.197
test, the results of that test, in order to inform the work that I'm going to do with a client.
00:01:51.946 --> 00:01:58.186
So if I need something, for example, a test that I might feel that is really
00:01:58.186 --> 00:02:03.386
important to me in order to move forward with the client might be looking at iron testing.
00:02:03.626 --> 00:02:06.366
So that would be things like ferritin, hemoglobin, hematocrit, and so forth.
00:02:06.546 --> 00:02:12.646
If a client is having extreme fatigue and other things that seem like they might be related to low iron,
00:02:12.946 --> 00:02:17.406
either iron deficiency, iron deficiency anemia, or similar, to me it feels really
00:02:17.406 --> 00:02:23.046
important to have some lab studies done to investigate whether they do have
00:02:23.046 --> 00:02:25.826
low ferritin, what their iron levels look like.
00:02:25.846 --> 00:02:32.826
Because if they do have low iron, all of the adaptogens and nervines and resting
00:02:32.826 --> 00:02:35.786
and stress management in the world is not really going to help them feel all
00:02:35.786 --> 00:02:38.966
the way better unless they got to do something about the iron.
00:02:39.146 --> 00:02:41.726
So that to me feels like a very important test to order.
00:02:42.026 --> 00:02:45.826
Some of these functional labs, I'm like, I don't really see the need to order
00:02:45.826 --> 00:02:48.446
them because they're not going to inform the work that I'm doing.
00:02:48.866 --> 00:02:54.646
I have strategies that I can use to help people feel better without understanding
00:02:54.646 --> 00:02:58.846
or knowing what their microbiome, the specifics of what their microbiome is.
00:02:59.306 --> 00:03:03.346
Knowing that they have more or less of a certain microbe in the vagina,
00:03:03.346 --> 00:03:06.026
in the small intestine, the large intestine, etc.
00:03:06.186 --> 00:03:11.046
Is not generally going to change my approach versus what I would do based on
00:03:11.046 --> 00:03:15.186
symptoms and what they're telling me in their health history and so on and so forth.
00:03:15.892 --> 00:03:19.092
So that's one of my biggest reasons. I don't see a need for somebody to pay
00:03:19.092 --> 00:03:23.792
hundreds of dollars if it is not going to clearly inform the work that I'm doing.
00:03:24.392 --> 00:03:29.012
Would there be a scenario if, let's say, we had covered all the bases,
00:03:29.012 --> 00:03:34.132
we had gotten to where we have ensured that the client is sleeping really well,
00:03:34.312 --> 00:03:38.592
and they are managing their stress to the best that's possible given their circumstances,
00:03:38.592 --> 00:03:42.872
and they're eating a varied and generally balanced diet with plenty of micro
00:03:42.872 --> 00:03:44.972
and macronutrients represented.
00:03:44.972 --> 00:03:49.072
And they have community and they're moving their body and all these foundational
00:03:49.072 --> 00:03:51.232
pieces are in place. They are drinking plenty of fluids.
00:03:51.452 --> 00:03:54.272
All of that's in place and we're still stuck. And it seems like,
00:03:54.352 --> 00:03:55.172
hmm, there's something there.
00:03:55.652 --> 00:03:58.372
Would I consider one of these labs? Personally, no, not right now.
00:03:58.632 --> 00:04:03.192
But maybe there's a scenario in the future where there might be additional information coming through.
00:04:03.372 --> 00:04:07.052
So that's probably the number one reason. I'll get into some additional reasons, though.
00:04:07.492 --> 00:04:14.012
Number two, the data that I have seen does not show that these tests are particularly valid,
00:04:14.292 --> 00:04:19.472
meaning are the results repeatable and do they reflect, do we have good reason
00:04:19.472 --> 00:04:21.212
to think that they reflect what's
00:04:21.212 --> 00:04:24.852
actually going on within that particular client in a meaningful way?
00:04:25.677 --> 00:04:29.337
I don't think that that's true of all of these labs necessarily.
00:04:29.917 --> 00:04:34.837
That's one of the reasons that they are not widely accepted in the larger medical
00:04:34.837 --> 00:04:37.717
world. So that's one piece of the puzzle.
00:04:38.297 --> 00:04:42.437
And as an example, there are some previous studies showing that if you take
00:04:42.437 --> 00:04:48.117
the same fecal sample and send it off to a number of different microbiome testing
00:04:48.117 --> 00:04:50.277
labs, you get vastly different results.
00:04:50.497 --> 00:04:55.697
And that is questionable to me. You know, we need to have a way to feel confident
00:04:55.697 --> 00:04:59.117
that the results that we're getting are actually accurate and they do represent
00:04:59.117 --> 00:05:00.437
what's going on in the client's body.
00:05:01.077 --> 00:05:04.837
Even if, let's just say that is true. Let's say these labs, which are generally,
00:05:04.837 --> 00:05:09.757
you know, for-profit types of situations, let's say they are accurate.
00:05:09.757 --> 00:05:13.397
And these tests are finding, you know, they're accurately reflecting what's
00:05:13.397 --> 00:05:14.737
going on in the person's body. Amazing.
00:05:14.997 --> 00:05:17.737
I think that's really cool from a physiological perspective.
00:05:17.797 --> 00:05:22.277
Perspective as a science nerd, the chance to kind of peek inside your body and
00:05:22.277 --> 00:05:25.417
get a feel for what's going on under the hood, I think is amazing.
00:05:25.997 --> 00:05:28.277
I love that. I love science. I love progress.
00:05:29.097 --> 00:05:33.197
I think it's really neat. However, that's going to move us into point number
00:05:33.197 --> 00:05:39.017
three, which is the data about what that means and what we should do about it
00:05:39.017 --> 00:05:42.457
is basically not there for many of these tests.
00:05:42.777 --> 00:05:48.477
So even if we do know, oh, somebody, so-and-so has high levels of acromantia,
00:05:48.737 --> 00:05:52.517
or, you know, their estrogen metabolism is pushing down this pathway versus
00:05:52.517 --> 00:05:54.397
that pathway, whatever it is.
00:05:54.817 --> 00:05:58.537
Amazing. Okay, we've identified that. Let's just presume that the results are
00:05:58.537 --> 00:06:01.757
accurate, which we don't always have solid data in that direction.
00:06:02.557 --> 00:06:05.857
The what do you do about it part, most of the time,
00:06:06.629 --> 00:06:09.989
A, the what-do-you-do-about-it part is being provided by the same labs.
00:06:10.469 --> 00:06:13.709
Oftentimes, they're recommending supplements, which they potentially are making
00:06:13.709 --> 00:06:16.649
money off of, or the clinician who ordered it is making money off of.
00:06:17.289 --> 00:06:20.269
And they're just saying, like, oh, because of this pathway, you might want to
00:06:20.269 --> 00:06:25.089
take quercetin, or this particular strain of probiotic, or, you know,
00:06:25.209 --> 00:06:27.369
XYZ, whatever thing that they're recommending.
00:06:28.309 --> 00:06:32.469
Usually, if you actually look at the data there, and you say, hey, how do we know that?
00:06:32.729 --> 00:06:37.229
What data shows us that if this, you know, estradiol is being metabolized by
00:06:37.229 --> 00:06:42.049
this pathway, that then the person should take this green tea extract or whatever it is?
00:06:42.529 --> 00:06:45.669
Ask for the data. Ask for, like, what's the citation?
00:06:45.909 --> 00:06:50.149
What's the reference? When you look at those, you will find that they are pretty
00:06:50.149 --> 00:06:52.109
much exclusively theoretical.
00:06:53.149 --> 00:06:56.549
There's not good clinical data saying oh when
00:06:56.549 --> 00:07:00.149
we measure this metabolic factor and then
00:07:00.149 --> 00:07:02.869
we give some of those people green tea and other
00:07:02.869 --> 00:07:06.409
people control we see a positive result in the green tea group and that's how
00:07:06.409 --> 00:07:10.229
we know these people might want to take green tea or whatever it is that data
00:07:10.229 --> 00:07:14.949
doesn't exist most of the time it's hypothetical it's like well in a lab environment
00:07:14.949 --> 00:07:21.349
in an in vitro study in this one particular scenario we measured that this pathway
00:07:21.349 --> 00:07:22.749
was upregulated by green tea.
00:07:22.889 --> 00:07:25.409
And therefore, why would we not do it here as well?
00:07:25.709 --> 00:07:29.129
It's several steps away from having solid evidence.
00:07:29.489 --> 00:07:33.589
I'm not saying it doesn't help or it doesn't work, but I am saying it's not
00:07:33.589 --> 00:07:37.009
as solid as you would be led to believe in most cases.
00:07:37.289 --> 00:07:41.689
And I think it's misleading because when people get these labs back, it looks very official.
00:07:41.849 --> 00:07:44.769
It's like, oh, it's kind of like what happens when you get a lipid panel back.
00:07:44.869 --> 00:07:48.489
Your cholesterol, this one's high, this one's low, then you should take a statin.
00:07:48.489 --> 00:07:52.309
It feels very similar to that type of thing. So it seems like it's written in black and white.
00:07:52.389 --> 00:07:55.209
This is what I should do. But when you go looking at the data,
00:07:55.961 --> 00:07:59.841
It just isn't there most of the time, or it's theoretical, or it's not that
00:07:59.841 --> 00:08:01.181
different than what you would do already.
00:08:01.861 --> 00:08:05.861
It's not that big of a stretch. If somebody is having some hormone issues.
00:08:06.621 --> 00:08:10.241
Green tea is not out of the realm of possibility that you would recommend without
00:08:10.241 --> 00:08:11.981
$300 worth of lab testing.
00:08:12.541 --> 00:08:15.721
It's a reasonable thing for some people to do. It's a drink green tea,
00:08:15.901 --> 00:08:18.341
even if they're not taking a specialized metabolic extract that,
00:08:18.501 --> 00:08:19.421
you know, blah, blah, blah.
00:08:20.021 --> 00:08:25.001
So you can see why I have some skepticism about running these labs.
00:08:25.141 --> 00:08:27.261
It's like, well, they're expensive, they're being paid out of pocket,
00:08:27.401 --> 00:08:29.241
they're often promoting specific supplements.
00:08:29.681 --> 00:08:32.641
The data for a lot of these interventions, whether they're supplements,
00:08:33.061 --> 00:08:36.841
foods, lifestyle things, whatever, is often pretty scant.
00:08:37.121 --> 00:08:39.821
And certainly, usually, it's not long term. It's like, well,
00:08:39.861 --> 00:08:44.381
we did this three-week study, we did this 10-day study, we did maybe three months if you're lucky.
00:08:44.601 --> 00:08:48.281
But again, most of it doesn't apply to these specific labs. All right.
00:08:48.421 --> 00:08:54.221
So to me, the reasons to do them are, I mean, they're just not there.
00:08:54.621 --> 00:08:57.661
They're just not there. I think it can cause people to think like,
00:08:57.781 --> 00:08:59.781
oh, this one pathway might be the problem.
00:09:00.101 --> 00:09:03.641
And therefore, if we just target this pathway by doing these things,
00:09:04.001 --> 00:09:05.461
then everything will get better.
00:09:05.881 --> 00:09:09.781
I'm like, I, you know, the body is complex. The body is complex.
00:09:09.981 --> 00:09:13.801
Pathways don't exist in isolation. There's upstream, there's downstream.
00:09:14.401 --> 00:09:18.401
Again, if all the basics aren't in place, like eating plenty of fiber,
00:09:18.761 --> 00:09:20.541
lots of different micronutrients, all these things.
00:09:21.541 --> 00:09:24.161
I just, I don't know that it makes sense to try to be like, well,
00:09:24.321 --> 00:09:28.161
we're going to take inulin and see if we can affect this one little pathway,
00:09:28.161 --> 00:09:31.081
and therefore it's going to shift everything and the person's going to feel
00:09:31.081 --> 00:09:33.181
better, or their numbers are going to drop, or whatever.
00:09:33.681 --> 00:09:37.401
To me, that just doesn't pan out, and it's not the way that I want to practice.
00:09:38.021 --> 00:09:41.761
I want to practice with the person sitting in front of me. I don't want to feel
00:09:41.761 --> 00:09:46.141
that I'm reliant on these numbers going through a lab where somebody needs to
00:09:46.141 --> 00:09:48.761
pay hundreds of dollars on top of the hundreds of dollars. They're already paying.
00:09:49.858 --> 00:09:53.598
The other thing I will just point out is that if you are a practitioner and
00:09:53.598 --> 00:09:56.518
you're ordering these labs because you're like, oh, well, you know,
00:09:56.578 --> 00:09:58.778
it just tells me what to do. I ordered a lab.
00:09:59.278 --> 00:10:02.078
It says on there, you know, they're low in this, high in this,
00:10:02.258 --> 00:10:08.558
and therefore I know I should give them, you know, vitamin E and EGCG and blah,
00:10:08.638 --> 00:10:09.778
blah, blah, whatever else.
00:10:10.358 --> 00:10:14.018
Why are they paying you? Like, they can read as well. They could look at that
00:10:14.018 --> 00:10:18.318
and say, oh, it says here I should take, you know, 200 milligrams of DHA or
00:10:18.318 --> 00:10:20.578
whatever it is. They can read that. Why do they need to pay you?
00:10:21.378 --> 00:10:24.198
I guess I'm making a little plug to think about your training.
00:10:24.398 --> 00:10:25.338
What were you trained to do?
00:10:25.478 --> 00:10:30.618
Are you using your own clinical assessment, your judgment, the things that you
00:10:30.618 --> 00:10:34.958
learned how to do in school that involve understanding the person sitting in front of you?
00:10:35.860 --> 00:10:41.180
And coming up with a plan for that person based on what you're seeing in front of you.
00:10:41.600 --> 00:10:46.360
Okay, so there we go. Those are just some of the reasons that I choose not to
00:10:46.360 --> 00:10:48.040
use these functional labs in my practice.
00:10:48.240 --> 00:10:53.520
There may be a time down the road when we have more data and we have more of
00:10:53.520 --> 00:10:57.480
an understanding of how some of these things work that maybe I'll change my mind, like I said.
00:10:57.580 --> 00:11:02.540
But for right now, I feel that I have really great results without them and
00:11:02.540 --> 00:11:06.760
I'd rather my clients spend that money on going to the farmer's market,
00:11:07.180 --> 00:11:09.500
eating good food, getting a massage,
00:11:10.180 --> 00:11:12.740
you know, going on a vacation, do something else with that money.
00:11:12.820 --> 00:11:16.020
I think there's other ways that they can spend their money and that we can get
00:11:16.020 --> 00:11:20.320
so much done with just talking to the person in front of me,
00:11:21.000 --> 00:11:25.700
figuring out what is the next best step for that person and moving forward with that.
00:11:26.260 --> 00:11:31.120
So there you go. It's a little bit of rationale as to why I practice the way that I do.
00:11:31.460 --> 00:11:34.220
I'd love to hear from you. If you have rebuttals, if you have thoughts,
00:11:34.320 --> 00:11:37.380
if you have questions, intheclinic.com is the best way to reach me.
00:11:37.660 --> 00:11:40.440
If you're not already getting my practitioner notes every Thursday,
00:11:40.620 --> 00:11:41.760
it's a newsletter I send out.
00:11:42.260 --> 00:11:46.160
It's relatively short. I send out resources, anything that's coming up in Bloom
00:11:46.160 --> 00:11:50.640
and Grow, and a little note to help make your work just a tiny bit easier, I hope.
00:11:50.800 --> 00:11:53.960
You can sign up for that at camillefreeman.com or intheclinic.com.
00:11:54.220 --> 00:11:58.380
All right. Hope to see you there. Have a lovely day, and thanks so much for the work that you do.
00:00:00.017 --> 00:00:03.497
Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
00:00:03.697 --> 00:00:06.857
I'm an herbalist and nutritionist, and in this podcast, I share tips,
00:00:06.977 --> 00:00:09.417
tidbits, and resources that might be helpful for other practitioners.
00:00:10.017 --> 00:00:14.057
I'm going to share one of my most controversial opinions when it comes to integrative
00:00:14.057 --> 00:00:18.657
health, which is that I do not work with functional lab tests.
00:00:18.877 --> 00:00:23.837
I use that as an umbrella term to talk about things like microbiome testing,
00:00:24.177 --> 00:00:27.877
Dutch testing, GI map, organic acid testing, and so forth.
00:00:28.017 --> 00:00:31.637
I'm not going to list out every single lab that fits under that category,
00:00:31.657 --> 00:00:35.017
but I think most of you will understand the type of thing that I am talking about.
00:00:35.557 --> 00:00:39.457
I want to explain why I don't work with these, but before I do,
00:00:39.657 --> 00:00:44.177
I want to just say that if you are working with these labs, I'm not judging you.
00:00:44.557 --> 00:00:46.297
I still think you can be an excellent
00:00:46.297 --> 00:00:49.957
practitioner. We all have different pathways to the work that we do,
00:00:49.977 --> 00:00:53.897
and I'm hoping that whether you do or don't work with these functional labs
00:00:53.897 --> 00:00:57.277
that you can hear what I'm saying with an open heart and an open mind,
00:00:57.277 --> 00:01:00.837
just as I continue to keep an open mind about these labs.
00:01:01.157 --> 00:01:05.997
And maybe in the future, as more data comes in, as we get more clinical evidence
00:01:05.997 --> 00:01:07.477
and so forth, maybe I'll change my mind.
00:01:07.617 --> 00:01:11.577
Maybe I will start to work with these. But for right now, based on my understanding
00:01:11.577 --> 00:01:16.777
of what's out there and my assessment of the literature, the pros and cons for
00:01:16.777 --> 00:01:19.257
my clients and for myself, I've chosen not to work with them.
00:01:19.317 --> 00:01:20.537
So I want to explain this decision.
00:01:20.977 --> 00:01:25.057
I'm not trying to say that you should make the same decision or that if you've
00:01:25.057 --> 00:01:27.937
made a different decision than me, there's something wrong with the way that you're doing it.
00:01:28.037 --> 00:01:32.737
So with all those caveats in place, let me talk about why at this time I am
00:01:32.737 --> 00:01:34.077
not working with these types of labs.
00:01:34.617 --> 00:01:38.897
The first and probably biggest reason that I don't work with them is that I don't think I need them.
00:01:39.457 --> 00:01:46.237
I really strongly believe in only ordering tests if I think that I need that
00:01:46.237 --> 00:01:51.197
test, the results of that test, in order to inform the work that I'm going to do with a client.
00:01:51.946 --> 00:01:58.186
So if I need something, for example, a test that I might feel that is really
00:01:58.186 --> 00:02:03.386
important to me in order to move forward with the client might be looking at iron testing.
00:02:03.626 --> 00:02:06.366
So that would be things like ferritin, hemoglobin, hematocrit, and so forth.
00:02:06.546 --> 00:02:12.646
If a client is having extreme fatigue and other things that seem like they might be related to low iron,
00:02:12.946 --> 00:02:17.406
either iron deficiency, iron deficiency anemia, or similar, to me it feels really
00:02:17.406 --> 00:02:23.046
important to have some lab studies done to investigate whether they do have
00:02:23.046 --> 00:02:25.826
low ferritin, what their iron levels look like.
00:02:25.846 --> 00:02:32.826
Because if they do have low iron, all of the adaptogens and nervines and resting
00:02:32.826 --> 00:02:35.786
and stress management in the world is not really going to help them feel all
00:02:35.786 --> 00:02:38.966
the way better unless they got to do something about the iron.
00:02:39.146 --> 00:02:41.726
So that to me feels like a very important test to order.
00:02:42.026 --> 00:02:45.826
Some of these functional labs, I'm like, I don't really see the need to order
00:02:45.826 --> 00:02:48.446
them because they're not going to inform the work that I'm doing.
00:02:48.866 --> 00:02:54.646
I have strategies that I can use to help people feel better without understanding
00:02:54.646 --> 00:02:58.846
or knowing what their microbiome, the specifics of what their microbiome is.
00:02:59.306 --> 00:03:03.346
Knowing that they have more or less of a certain microbe in the vagina,
00:03:03.346 --> 00:03:06.026
in the small intestine, the large intestine, etc.
00:03:06.186 --> 00:03:11.046
Is not generally going to change my approach versus what I would do based on
00:03:11.046 --> 00:03:15.186
symptoms and what they're telling me in their health history and so on and so forth.
00:03:15.892 --> 00:03:19.092
So that's one of my biggest reasons. I don't see a need for somebody to pay
00:03:19.092 --> 00:03:23.792
hundreds of dollars if it is not going to clearly inform the work that I'm doing.
00:03:24.392 --> 00:03:29.012
Would there be a scenario if, let's say, we had covered all the bases,
00:03:29.012 --> 00:03:34.132
we had gotten to where we have ensured that the client is sleeping really well,
00:03:34.312 --> 00:03:38.592
and they are managing their stress to the best that's possible given their circumstances,
00:03:38.592 --> 00:03:42.872
and they're eating a varied and generally balanced diet with plenty of micro
00:03:42.872 --> 00:03:44.972
and macronutrients represented.
00:03:44.972 --> 00:03:49.072
And they have community and they're moving their body and all these foundational
00:03:49.072 --> 00:03:51.232
pieces are in place. They are drinking plenty of fluids.
00:03:51.452 --> 00:03:54.272
All of that's in place and we're still stuck. And it seems like,
00:03:54.352 --> 00:03:55.172
hmm, there's something there.
00:03:55.652 --> 00:03:58.372
Would I consider one of these labs? Personally, no, not right now.
00:03:58.632 --> 00:04:03.192
But maybe there's a scenario in the future where there might be additional information coming through.
00:04:03.372 --> 00:04:07.052
So that's probably the number one reason. I'll get into some additional reasons, though.
00:04:07.492 --> 00:04:14.012
Number two, the data that I have seen does not show that these tests are particularly valid,
00:04:14.292 --> 00:04:19.472
meaning are the results repeatable and do they reflect, do we have good reason
00:04:19.472 --> 00:04:21.212
to think that they reflect what's
00:04:21.212 --> 00:04:24.852
actually going on within that particular client in a meaningful way?
00:04:25.677 --> 00:04:29.337
I don't think that that's true of all of these labs necessarily.
00:04:29.917 --> 00:04:34.837
That's one of the reasons that they are not widely accepted in the larger medical
00:04:34.837 --> 00:04:37.717
world. So that's one piece of the puzzle.
00:04:38.297 --> 00:04:42.437
And as an example, there are some previous studies showing that if you take
00:04:42.437 --> 00:04:48.117
the same fecal sample and send it off to a number of different microbiome testing
00:04:48.117 --> 00:04:50.277
labs, you get vastly different results.
00:04:50.497 --> 00:04:55.697
And that is questionable to me. You know, we need to have a way to feel confident
00:04:55.697 --> 00:04:59.117
that the results that we're getting are actually accurate and they do represent
00:04:59.117 --> 00:05:00.437
what's going on in the client's body.
00:05:01.077 --> 00:05:04.837
Even if, let's just say that is true. Let's say these labs, which are generally,
00:05:04.837 --> 00:05:09.757
you know, for-profit types of situations, let's say they are accurate.
00:05:09.757 --> 00:05:13.397
And these tests are finding, you know, they're accurately reflecting what's
00:05:13.397 --> 00:05:14.737
going on in the person's body. Amazing.
00:05:14.997 --> 00:05:17.737
I think that's really cool from a physiological perspective.
00:05:17.797 --> 00:05:22.277
Perspective as a science nerd, the chance to kind of peek inside your body and
00:05:22.277 --> 00:05:25.417
get a feel for what's going on under the hood, I think is amazing.
00:05:25.997 --> 00:05:28.277
I love that. I love science. I love progress.
00:05:29.097 --> 00:05:33.197
I think it's really neat. However, that's going to move us into point number
00:05:33.197 --> 00:05:39.017
three, which is the data about what that means and what we should do about it
00:05:39.017 --> 00:05:42.457
is basically not there for many of these tests.
00:05:42.777 --> 00:05:48.477
So even if we do know, oh, somebody, so-and-so has high levels of acromantia,
00:05:48.737 --> 00:05:52.517
or, you know, their estrogen metabolism is pushing down this pathway versus
00:05:52.517 --> 00:05:54.397
that pathway, whatever it is.
00:05:54.817 --> 00:05:58.537
Amazing. Okay, we've identified that. Let's just presume that the results are
00:05:58.537 --> 00:06:01.757
accurate, which we don't always have solid data in that direction.
00:06:02.557 --> 00:06:05.857
The what do you do about it part, most of the time,
00:06:06.629 --> 00:06:09.989
A, the what-do-you-do-about-it part is being provided by the same labs.
00:06:10.469 --> 00:06:13.709
Oftentimes, they're recommending supplements, which they potentially are making
00:06:13.709 --> 00:06:16.649
money off of, or the clinician who ordered it is making money off of.
00:06:17.289 --> 00:06:20.269
And they're just saying, like, oh, because of this pathway, you might want to
00:06:20.269 --> 00:06:25.089
take quercetin, or this particular strain of probiotic, or, you know,
00:06:25.209 --> 00:06:27.369
XYZ, whatever thing that they're recommending.
00:06:28.309 --> 00:06:32.469
Usually, if you actually look at the data there, and you say, hey, how do we know that?
00:06:32.729 --> 00:06:37.229
What data shows us that if this, you know, estradiol is being metabolized by
00:06:37.229 --> 00:06:42.049
this pathway, that then the person should take this green tea extract or whatever it is?
00:06:42.529 --> 00:06:45.669
Ask for the data. Ask for, like, what's the citation?
00:06:45.909 --> 00:06:50.149
What's the reference? When you look at those, you will find that they are pretty
00:06:50.149 --> 00:06:52.109
much exclusively theoretical.
00:06:53.149 --> 00:06:56.549
There's not good clinical data saying oh when
00:06:56.549 --> 00:07:00.149
we measure this metabolic factor and then
00:07:00.149 --> 00:07:02.869
we give some of those people green tea and other
00:07:02.869 --> 00:07:06.409
people control we see a positive result in the green tea group and that's how
00:07:06.409 --> 00:07:10.229
we know these people might want to take green tea or whatever it is that data
00:07:10.229 --> 00:07:14.949
doesn't exist most of the time it's hypothetical it's like well in a lab environment
00:07:14.949 --> 00:07:21.349
in an in vitro study in this one particular scenario we measured that this pathway
00:07:21.349 --> 00:07:22.749
was upregulated by green tea.
00:07:22.889 --> 00:07:25.409
And therefore, why would we not do it here as well?
00:07:25.709 --> 00:07:29.129
It's several steps away from having solid evidence.
00:07:29.489 --> 00:07:33.589
I'm not saying it doesn't help or it doesn't work, but I am saying it's not
00:07:33.589 --> 00:07:37.009
as solid as you would be led to believe in most cases.
00:07:37.289 --> 00:07:41.689
And I think it's misleading because when people get these labs back, it looks very official.
00:07:41.849 --> 00:07:44.769
It's like, oh, it's kind of like what happens when you get a lipid panel back.
00:07:44.869 --> 00:07:48.489
Your cholesterol, this one's high, this one's low, then you should take a statin.
00:07:48.489 --> 00:07:52.309
It feels very similar to that type of thing. So it seems like it's written in black and white.
00:07:52.389 --> 00:07:55.209
This is what I should do. But when you go looking at the data,
00:07:55.961 --> 00:07:59.841
It just isn't there most of the time, or it's theoretical, or it's not that
00:07:59.841 --> 00:08:01.181
different than what you would do already.
00:08:01.861 --> 00:08:05.861
It's not that big of a stretch. If somebody is having some hormone issues.
00:08:06.621 --> 00:08:10.241
Green tea is not out of the realm of possibility that you would recommend without
00:08:10.241 --> 00:08:11.981
$300 worth of lab testing.
00:08:12.541 --> 00:08:15.721
It's a reasonable thing for some people to do. It's a drink green tea,
00:08:15.901 --> 00:08:18.341
even if they're not taking a specialized metabolic extract that,
00:08:18.501 --> 00:08:19.421
you know, blah, blah, blah.
00:08:20.021 --> 00:08:25.001
So you can see why I have some skepticism about running these labs.
00:08:25.141 --> 00:08:27.261
It's like, well, they're expensive, they're being paid out of pocket,
00:08:27.401 --> 00:08:29.241
they're often promoting specific supplements.
00:08:29.681 --> 00:08:32.641
The data for a lot of these interventions, whether they're supplements,
00:08:33.061 --> 00:08:36.841
foods, lifestyle things, whatever, is often pretty scant.
00:08:37.121 --> 00:08:39.821
And certainly, usually, it's not long term. It's like, well,
00:08:39.861 --> 00:08:44.381
we did this three-week study, we did this 10-day study, we did maybe three months if you're lucky.
00:08:44.601 --> 00:08:48.281
But again, most of it doesn't apply to these specific labs. All right.
00:08:48.421 --> 00:08:54.221
So to me, the reasons to do them are, I mean, they're just not there.
00:08:54.621 --> 00:08:57.661
They're just not there. I think it can cause people to think like,
00:08:57.781 --> 00:08:59.781
oh, this one pathway might be the problem.
00:09:00.101 --> 00:09:03.641
And therefore, if we just target this pathway by doing these things,
00:09:04.001 --> 00:09:05.461
then everything will get better.
00:09:05.881 --> 00:09:09.781
I'm like, I, you know, the body is complex. The body is complex.
00:09:09.981 --> 00:09:13.801
Pathways don't exist in isolation. There's upstream, there's downstream.
00:09:14.401 --> 00:09:18.401
Again, if all the basics aren't in place, like eating plenty of fiber,
00:09:18.761 --> 00:09:20.541
lots of different micronutrients, all these things.
00:09:21.541 --> 00:09:24.161
I just, I don't know that it makes sense to try to be like, well,
00:09:24.321 --> 00:09:28.161
we're going to take inulin and see if we can affect this one little pathway,
00:09:28.161 --> 00:09:31.081
and therefore it's going to shift everything and the person's going to feel
00:09:31.081 --> 00:09:33.181
better, or their numbers are going to drop, or whatever.
00:09:33.681 --> 00:09:37.401
To me, that just doesn't pan out, and it's not the way that I want to practice.
00:09:38.021 --> 00:09:41.761
I want to practice with the person sitting in front of me. I don't want to feel
00:09:41.761 --> 00:09:46.141
that I'm reliant on these numbers going through a lab where somebody needs to
00:09:46.141 --> 00:09:48.761
pay hundreds of dollars on top of the hundreds of dollars. They're already paying.
00:09:49.858 --> 00:09:53.598
The other thing I will just point out is that if you are a practitioner and
00:09:53.598 --> 00:09:56.518
you're ordering these labs because you're like, oh, well, you know,
00:09:56.578 --> 00:09:58.778
it just tells me what to do. I ordered a lab.
00:09:59.278 --> 00:10:02.078
It says on there, you know, they're low in this, high in this,
00:10:02.258 --> 00:10:08.558
and therefore I know I should give them, you know, vitamin E and EGCG and blah,
00:10:08.638 --> 00:10:09.778
blah, blah, whatever else.
00:10:10.358 --> 00:10:14.018
Why are they paying you? Like, they can read as well. They could look at that
00:10:14.018 --> 00:10:18.318
and say, oh, it says here I should take, you know, 200 milligrams of DHA or
00:10:18.318 --> 00:10:20.578
whatever it is. They can read that. Why do they need to pay you?
00:10:21.378 --> 00:10:24.198
I guess I'm making a little plug to think about your training.
00:10:24.398 --> 00:10:25.338
What were you trained to do?
00:10:25.478 --> 00:10:30.618
Are you using your own clinical assessment, your judgment, the things that you
00:10:30.618 --> 00:10:34.958
learned how to do in school that involve understanding the person sitting in front of you?
00:10:35.860 --> 00:10:41.180
And coming up with a plan for that person based on what you're seeing in front of you.
00:10:41.600 --> 00:10:46.360
Okay, so there we go. Those are just some of the reasons that I choose not to
00:10:46.360 --> 00:10:48.040
use these functional labs in my practice.
00:10:48.240 --> 00:10:53.520
There may be a time down the road when we have more data and we have more of
00:10:53.520 --> 00:10:57.480
an understanding of how some of these things work that maybe I'll change my mind, like I said.
00:10:57.580 --> 00:11:02.540
But for right now, I feel that I have really great results without them and
00:11:02.540 --> 00:11:06.760
I'd rather my clients spend that money on going to the farmer's market,
00:11:07.180 --> 00:11:09.500
eating good food, getting a massage,
00:11:10.180 --> 00:11:12.740
you know, going on a vacation, do something else with that money.
00:11:12.820 --> 00:11:16.020
I think there's other ways that they can spend their money and that we can get
00:11:16.020 --> 00:11:20.320
so much done with just talking to the person in front of me,
00:11:21.000 --> 00:11:25.700
figuring out what is the next best step for that person and moving forward with that.
00:11:26.260 --> 00:11:31.120
So there you go. It's a little bit of rationale as to why I practice the way that I do.
00:11:31.460 --> 00:11:34.220
I'd love to hear from you. If you have rebuttals, if you have thoughts,
00:11:34.320 --> 00:11:37.380
if you have questions, intheclinic.com is the best way to reach me.
00:11:37.660 --> 00:11:40.440
If you're not already getting my practitioner notes every Thursday,
00:11:40.620 --> 00:11:41.760
it's a newsletter I send out.
00:11:42.260 --> 00:11:46.160
It's relatively short. I send out resources, anything that's coming up in Bloom
00:11:46.160 --> 00:11:50.640
and Grow, and a little note to help make your work just a tiny bit easier, I hope.
00:11:50.800 --> 00:11:53.960
You can sign up for that at camillefreeman.com or intheclinic.com.
00:11:54.220 --> 00:11:58.380
All right. Hope to see you there. Have a lovely day, and thanks so much for the work that you do.
