[Transcript] – Cutting Through The Confusion Of Blood, Urine & Stool Testing For Gut, Toxins, Amino Acids, Fatty Acids & Much More – With The Team From Genova Diagnostics.

Affiliate Disclosure


From podcast: https://bengreenfieldlife.com/podcast/gdx-podcast/

[00:00:00] Introduction

[00:01:38] Podcast Sponsors

[00:05:33] What is Genova Diagnostics and who are its leaders?

[00:12:32] What actually happens when you take your blood and urine to the lab

[00:16:30] Do you have to go through your doctor or do you need to call your doctor?

[00:19:19] What is Metabolomix?

[00:25:04] What are you looking at for oxidative stress? And for mitochondrial health?

[00:31:28] What does Genova Diagnostics Team recommend to Ben based on these results?

[00:35:48] What can you do even if you're living a clean lifestyle in this industrial era?

[00:40:02] What are the other areas of Metabolomix that you want to highlight from our results?

[00:44:58] Protocol or eradication system for toxins or metals that is effective?

[00:50:09] What is the GI effects panel and why is it three days?

[00:55:27] Would it be accurate to say that a genetic test for the gut is telling you what you are capable of doing or would have propensity for?

[01:01:39] Pancreatic enzyme insufficiencies in elite athletes

[01:07:14] Gut issues are common in chronic repetitive motion athletes and marathoners

[01:11:39] What's the actionable step that people can take from this page?

[01:14:01] Closing the Podcast

[01:14:44] End of Podcast

[01:15:16] Disclaimer

Ben:  My name is Ben Greenfield. And, on this episode of the Ben Greenfield Life Podcast.

Michael:  Under oxidative stress, there's a couple main things that we look at. And, for one, we look at signs of oxidative damage. Those are going to be the biggest drivers of a score of oxidative stress. And, oxidative damage means free radical damage. So, you're familiar with whether there's a toxin in our environment or things of that nature that might be driving oxidative stress from free radical exposure. But, we often don't think about how much oxidative stress might come from internal stress, whether that's in the form of exercise, for instance, or even some of the things that we're taking from a nutritional standpoint.

To get into some of the details, one of the markers that was high on your test, Ben, was lipid peroxides, which is a marker for fat damage, damage to fat molecules. And, this is actually a marker that's very commonly elevated in people who are doing a lot of physical exertion, a lot of exercises, because it makes sense. When you're exercising, you're turning over a lot of your internal cells, you're breaking down muscle tissue, which is all surrounded in fat, and those things are spilling out into the urine. So, for people who are heavily involved in exercise, that's not uncommon to see high levels of this marker lipid peroxides.

Ben:  Faith, family, fitness, health, performance, nutrition, longevity, ancestral living, biohacking, and a whole lot more. Welcome to the show.

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Ben:  Well, folks, this is going to be a fun episode because if you've listened to the podcast for a while, for a very long time I've recommended to folks who want to take a really deep dive into their blood work and their biomarkers in terms of what's going on inside your body to look into a couple of different tests, namely one called a Nutreval, and it turns out there's kind of an at-home version of this test, which my guest will fill us in on. But, it's basically an analysis of a whole bunch of key nutritional biomarkers that a typical blood test that your doctor might order might not give you. And then, I also recommend kind of this gold standard test for the gut, that test for yeast and parasites and fungus, gut inflammation and bacterial imbalances, et cetera. And, that one is called the GI Effects test.

Both of these tests are made by a company called Genova Diagnostics. And, Genova Diagnostics basically develops lab measurements and lab tests for a lot of things that, again, your doctor might not order in a typical panel. So, I like to do these tests not only with a lot of the clients that I work with, but I love to take a deep dive into my own biology. And so, I recently did my most updated test for the at-home version of Nutreval, which is called Metabolomix, and then also did the GI Effects test, which is wonderful because you get to poop and collect your stool in little tubes which everybody loves to do especially when I'm storing my poop for three days in the refrigerator much to the chagrin of my wife and children, but that's the best place to keep it. So, that's the way it goes down, folks.

So, anyways, I thought it would be super interesting for everybody if I took a deep dive into these tests for you and asked all the questions that everybody often asked me about this Metabolomix test and this GI Effects test; how you get them, how they're different from other test, what you should look for, what's important to pay attention to, et cetera.

Now, this is a pretty complicated podcast episode because I have three guests on the show. Now, if you're watching the video and both the video and the shownotes, you can find at BenGreenfieldLife.com/GDXpodcast. GDX is Genova Diagnostics. BenGreenfieldLife.com/GDXpodcast is where you can go for the shownotes.

And so, as you'll see if you're watching the video there, I've got three guests. The first is Jeff. Wave hello, Jeff.

Jeff:  How's it going?

Ben:  So, Jeff is the CEO of Genova Diagnostics and he oversees their entire operations and has a pretty significant history in business development. And, I'm working with a lot of these health companies. My second guest is Patricia. Wave hello, Patricia, who's a DO. She's the Chief Clinical Officer, board-certified internal medicine physician with a specialty in hospitalist medicine, and she, of course, speaks a lot of the medical language around these tests. And then, finally, I've got Michael Chapman. Say hello, Michael. And, Michael's an MD. He's the Director of Product Innovation at Genova Diagnostics. He has a doctorate in naturopathic medicine from the fantastic Bastyr University in Seattle, Washington.

So, I figure between the three of you, Jeff, Patricia, and Michael, we're going to be able to give a lot of interesting information to people with, of course, the complicated factor being I don't know who's going to be best equipped to answer each of my odd curveball questions here. So, I'll let you guys fight amongst that as we [00:09:19] _____.

Patricia:  We will.

Ben:  Alright, cool. And, by the way, also if you're watching the video and if you notice my mouth is blue, I have Smurf mouth this morning because I actually did take some methylene blue before my infrared sauna, which seems to really help my cytochrome oxidase enzymes in my cells produce a little bit more ATP and you feel fantastic on this stuff. But unfortunately, I didn't rinse out my mouth with baking soda as I'm used to doing, so my apologies to everybody. You have to put up with the Smurf mouth.

You guys ever use that stuff, by the way, methylene blue? Are you familiar with it?

Michael:  No, I haven't used it.

Patricia:  No. But, it looks adorable on you, Ben, just so you know.

Ben:  Okay, okay. And, that's a topic for another day but we can talk about that later. So, what is Genova Diagnostics exactly? What do you guys do? Explain it to people.

Jeff:  Sure, I think you did a great job covering it but if you look at it in a simple sense, we're a clinical laboratory. But, what we're different is we look at root cause, so we look at a more complex approach, full system approach, functional approach to healthcare, to laboratory testing with the primary goal of understanding not only management of chronic disease and understanding a patient complaint that comes in but looking at the full continuum of health care when you're looking at somebody from chronic disease all the way to fitness. And, I think that we have products that fit into all the different categories and help people understand basically how to meet their goals and how does somebody live their best life.

Ben:  How many tests do you guys actually have available at Genova?

Patricia:  Oh, my goodness.

Michael:  We've got us mattering. It kind of spans across several different product lines. Our biggest focuses are around GI and nutrition, so we have a couple key tests for each one of those. And then, it goes into a little bit of some endocrine testing, the unique part of that being. We can look at hormones, either in the saliva, in the serum, or in the blood depending on really what aspect of the hormone track you're trying to really understand. We also do a couple other things we call Specialty, some genomics or along there. I know you're familiar with a lot of genomics and run that on some of your clients as well.

Patricia:  And some toxin environmental exposure testing as well.

Michael:  Yeah.

Ben:  Okay, got it. Got it. So, it appears to me that two of kind of the gold standard tests that you run that seem to be most helpful for people are indeed this Metabolomix test and the GI Effects test. I'd love to tackle these one by one because they seem to be just super helpful for a lot of people. And, I've learned a lot about my body even though I've never had you guys actually walk through my lab results with me, which I think is going to be very eye-opening for a lot of people. But, just kind of opening the kimono here in terms of some inside baseball, this Metabolomix test, I took it 12 weeks ago and just you guys know, I get so many tests sent to my home. And, I'm always getting poked and prodded and I'm peeing and dripping saliva out of my mouth and pooping in the hot dog trays and all sorts of things. But, if I recall properly the Metabolomix test was both blood and urine. Is that correct?

Patricia:  Yup, it's a blood spot finger stick and the first-morning void urine. Yup.

Ben:  Okay, blood spot and first-morning void urine.

So, what I'm curious about is when I take that and I do the blood spot and the urine test and send it off to your lab, what actually happens next as far as how this is actually analyzed?

Jeff:  Right. So, if you're looking at either the panels that you're talking about, GI Effects or the Metabolomix panel, when they hit the laboratory, the interesting part about our approach to healthcare is you have a lot of different markers that are on this. When you look at Metabolomix, there are how many markers on there now?

Patricia:  135.

Jeff:  So, you're looking 135 markers. And so, as it hits the laboratory, we basically receive the test, split it into its appropriate aliquots or samples so it could be distributed throughout the laboratories. The nutritional test touch three of our laboratories, four if you do the genomic testing along with that. And, they're handled in their sample types but once they have been processed, you're really dealing with something that can be put on any analyzer whether they're GCMS mass spects, LCMS. The same things you'd hear on CSI if you're watching the TV on any of those episodes where they're talking science.

Ben:  Okay. So, you guys actually have a lab there that has these things like mass spec, gas chromatography, et cetera. You're feeding my blood and my urine into these different testing, what do you call them, like machines or how do you define it exactly?

Jeff:  Sure. Their machines, their platforms, I mean there's robotics involved. I mean, there's a lot of processing. If you look at, you're talking about micro when you're looking at bacterial and yeast. You're doing cultures, which is a methodology that's been around a very long time, but at the same time, we're deploying a technology called MALDI-TOF where time of flight–so you're actually putting your sample into a system and it basically blows it up into the machine. And, based on the interpretation from that platform, we're able to understand exactly what organisms are in that, in your stool. And so, you could look at the same thing for gas chromatography or liquid chromatography as you look at organic acids and amino acids. Those breakdown very predictable ways and these platforms allow us to be able to identify within those systems exactly what's going on to be able to not only quantify but define what it is that you have going on.

Ben:  Does a human person actually have to open those tubes with the stool in them? I've always wondered that. Is somebody actually having to put up with whatever nasty smell is coming out of these tubes?

Patricia:  Yes, they do. And, it's funny because we talk about how most people and clinicians, in fact, me included, didn't fully understand laboratory medicine until I started to work here and you think you send a sample, stick in a machine, bada-boom, bada-bing, there's your answer. But, the Genova products are so extensive and there's so many different departments that are being touched. A human person does open those samples and does–it's this beautiful choreography where it goes through different departments; parasitology, the chromatography part. So, all of this choreography is happening with real humans handling these samples and then in the end, it comes into this beautiful comprehensive report.

Ben:  So, does the intern in the mail room kind of have to take on this stinky job? Is that like a lower-ranking job for the stool tube opener?

Jeff:  And, we have lab support services they basically will open the box and put them in the order that they have appropriate label as they get into the laboratory. Processing itself can be handled by a lab assistant or a lab tech depending on what the role is. When you get into an industry like this and understand the value of a stool test to an individual and what that data can do makes it a lot easier to process and handle that here at work.

Ben:  Okay, got you. And, I'm sure that one of the perks of the job is you probably get a clothespin for your nose just to– 

Jeff:  Yeah, you can definitely get a clothespin or something of flavor that you can put under your nose to help out a little bit.

Ben:  Peppermint oil.

Patricia:  Jeff volunteers and goes down and actually helps them open the samples and that's truth, he does it. Yeah.

Ben:  Bless your heart Jeff.

Well, the other thing that I think sometimes people wonder is for tests like this, do you have to go through your doctor or how does it work in terms of the flow from you wanting–let's say somebody's listening and they're like, “Oh, I want to do a Metabolomix and a GI Effects,” and for those of you listening, we'll get into the details of these tests shortly. But, can they just go to a website and order these or do they need to call up their doctor or go to their doctor and say, “Hey, Doc, I need you to order these for me.”

Jeff:  So, there are two approaches. So, one, you can work with your practitioner to be able to order the test. And, that allows you to be able to interact and let the doctor know what it is that you're curious about which tests are most appropriate for you and they can order them directly from us. And then, in those cases, we can send a test. If it's a blood draw, we'll send it either to you where you can go get it drawn or drawn in the doctor's office. If it's a stool test or urine test or otherwise, we can drop ship that directly to your home based on that physician order.

If you don't want to work with or you're not working with a physician or you don't have a physician in your area that can work with us, we do have Genova Connect, which does allow you through a physician-in-the-loop model to be able to buy the product over the internet, which is www.gdx–

Patricia:  Connect.gdx.net. Yeah.

Ben:  Okay.

Jeff:  And, by ordering it there, you can order the test, have it delivered to your home. There is a physician that will review your results but you're not required to interact with them specific to interpretation. If you choose to do that for an additional fee with our physician partners, you can work directly with them as well.

Ben:  Okay. And, if you order it yourself, if you go to the Genova Connect website and order it yourself, are you able to build that to insurance or is this all out-of-pocket?

Jeff:  Specific to Geneva Connect, it's 100% out-of-pocket. It's a cash-pay approach from that. If you're going to want to work with insurance, you need to work with your practitioner to be able to do that.

Ben:  Okay. So, you could have your doctor order it for you and then bill that to your insurance that way.

Jeff:  You can or we can bill through our programs as well. So, as you register the test, you provide the insurance information. We'll actually bill insurance for you from here.

Ben:  Okay, okay, got it. And, does insurance typically cover these kind of fringe tests that might go above and beyond what a normal blood panel might? Is that pretty successful in terms of insurance being able to cover something like this?

Jeff:  Well, I mean, it first starts with clinical necessity. So, if you're looking at it from an optimal performance or wellness piece, probably not in those cases. If you're looking at it for some clinical condition that is appropriate for the test, we do find that insurance does reimburse the test. We are out of network for those, so you're going to see how to network reimbursement but it's always best to check with your insurance provider in advance of ordering the test if you're going to choose that process.

Ben:  Okay, okay, got it. That's clear.

Alright. So, I want to jump right into the good stuff here. So, this Metabolomix test, like I mentioned in the past, I've recommended Nutreval. From what I understand, Metabolomix gives a lot of the same insight as Nutreval but allows you to do it from your home rather than having to drive to a Quest or a LabCorp or a testing service like that to give your blood and your urine. But, walk me through what exactly Metabolomix is.

Michael:  Yeah. So, the Metabolomix is, as you said, Ben, very similar to the Nutreval test that you've mentioned before. One of the major differences being that we have swapped out the blood draw component for a finger stick component. I think we knew at a certain point and have known for a while that people having access to being able to do these labs at home and not necessarily having to do a blood draw was going to be important. So, we wanted to see as much as possible how could we get the most optimal complete nutritional evaluation while people are still at home and we got a lot of that through the finger stick. It's pretty much nearly identical to that Nutreval test you were mentioning before. And again, it's mostly a urine test and a finger stick test. And, it ultimately tells you what's going on first and foremost with nutritional health, and beyond that for all of your listeners and biohackers alike is giving a lot of information on what your cellular health is. And, that's talking about things like oxidative stress, mitochondrial dysfunction, a lot of these things that you talk about a lot on your podcast. We're actually getting a direct read. And, that's I think one of the major powers of a test like this.

Ben:  Okay, got it. So, if you were to go through and chunk each of the different categories that Metabolomix would be giving you insight on like you mentioned oxidative stress, for example, what would be kind of the list of different categories that this is going to test for? I realize it's kind of a complicated question, but I'm just curious about the details of what this is actually looking at.

Michael:  Yeah, it's a great question. So, I kind of look at it two different ways. What we're actually measuring on the test are things like organic acids, amino acids, fatty acids, toxics, and elements like magnesium, potassium. And, we're taking all of that data to then say, “Okay, what's the function?” What do we want to know out of that information? And, that's how we assess for mitochondrial function, oxidative stress, inflammation, toxic exposure, a lot of those things that we think about from how well the cell inside your body or the cells inside your body are doing.

So, we're actually measuring those things like organic acids and amino acids, fatty acids like your omega-3s but that's giving us the information around how your overall health and your optimization strategies are going.

Ben:  Okay, got you. And, I'm sure we'll get more clarity on this as we walk through my results for illustrative purposes for folks and kind of unpack what each of the different things you're looking at are. Potentially, you might have even maybe found some methylene blue in my urine. I don't know, but it's possible.

So, anyways, do you guys want to just walk through my results and we can use this as a way to point out to people the type of things that Metabolomix is testing and what they should look for?

Patricia:  Sure.

Michael:  Yeah. I think that sounds great. And, one of the things that I always think about with the test is because, like you're saying, Ben, there's a lot of information on a test like this, there's a lot of analytes. So, understanding what the take-home message is and where to focus is going to be a big part of the story. And so, kind of just in high level looking at the results of your Metabolomix test right on the front page of this report, we kind of have a scoring system that says, “Hey, here's some of the priorities that we see and maybe here's some things that are not showing up to be any sort of problem, whatsoever.”

Ben:  Okay. And, by the way, I'm going to interrupt you real quick, I should note that for people who want to go to BenGreenfieldLife.com/GDXpodcast, I will put a download of my results if you want to look at those and follow along as these guys kind of highlight some of the things to look at. So anyways, that's important in case people need a visual but go ahead.

Michael:  Yeah, absolutely. That'd be great.

Yeah. And so, right on the front page, I think we try to synthesize all the information so you really kind of know where to start. And, in looking at your results, Ben, on the Metabolomix aspect, not surprisingly a lot of it looks pretty darn awesome. And, I'm thinking about things like mitochondrial dysfunction, we have a score there of zero for your overall mitochondrial health, which I think given all the things that you're employing shouldn't really surprise very many listeners at this point.

Patricia:  Zero means zero need.

Michael:  That's right.

Patricia:  Right, right.

Ben:  Okay.

Michael:  And then, looking at things like inflammation and methylation function, these are another key areas for overall systemic health and cellular health. Those were looking really, really great on your results as well. The only thing where we found a little bit of question marks and maybe a little bit of a higher need for support was around this area of oxidative stress. And, we did find a little bit of evidence of some toxic exposure that I think we could maybe brainstorm and get into a little bit later as far as what might be driving that. And, that's kind of the summary from the high level. 

After that part of the report, if people are looking, what happens with the test result is, okay, now that we've found some evidence of needs for support in certain areas, in your case, maybe some oxidative stress support, what can we do from a nutritional standpoint? What are their additional B vitamins, antioxidants, things of that nature that might help to address some of these functional needs I guess I would say?

Ben:  Okay. So, for each of those categories, if you can walk me through what exactly is being tested, like what are you looking at for oxidative stress? What are you looking at from mitochondrial health, et cetera, if we can get into the details?

Michael:  For sure. So, under oxidative stress, there's a couple main things that we look at. And, for one, we look at signs of oxidative damage. Those are going to be the biggest drivers of a score of oxidative stress. And, oxidative damage means free radical damage, right? So, you're familiar with whether there's a toxin in our environment or things of that nature that might be driving oxidative stress from free radical exposure. But, we often don't think about how much oxidative stress might come from internal stress, whether that's in the form of exercise, for instance, or even some of the things that we're taking from a nutritional standpoint. So, to get into some of the details, one of the markers that was high on your test, Ben, was lipid peroxides, which is a marker for fat damage, damage to fat molecules. And, this is actually a marker that's very commonly elevated in people who are doing a lot of physical exertion, a lot of exercise because it makes sense, when you're exercising, you're turning over a lot of your internal cells, you're breaking down muscle tissue, which is all surrounded in fat. And, those things are spilling out into the urine. So, for people who are heavily involved in exercise, that's not uncommon to see high levels of this marker lipid peroxides.

Ben:  A lot of times you'll see, for example, in athletes or fit individuals also a high amount of, for example, endogenous antioxidant production. Well, I guess what I'm curious about is if you see a high level of lipid peroxides on something like Metabolomix, does that indicate that potentially that person is still not getting enough antioxidants or they could use more antioxidant support despite the fact that they're physically active, for example?

Michael:  No, that's great. That's exactly, yeah, where it's going. And so, the flip side of the oxidative stress is that redox balance to make sure you're mitigating the oxidative stress with enough antioxidants. And so, whether that's looking at something like glutathione, we know glutathione is a very powerful antioxidant in the body is that at an adequate level. On this test, it seemed some of the precursors to glutathione actually looked pretty good, maybe they were upregulated to help balance out that oxidative stress.

And, the other thing too is a lot of the things that we do for antioxidant support whether that's through our diet by taking polyphenols or taking exogenous antioxidants, those are a lot of times are actually really pro-oxidant at their core and their antioxidant function is based in how it's stimulating our endogenous antioxidant production. So, if you're doing a lot of plant flavonoids, phenols, those are actually creating to a degree oxidative stress that your body then compensates for. So, that redox balance is super important. And, given the fact that you're doing so much, having additional antioxidant support makes a lot of sense in this case.

Ben:  So, just to clarify on that, so let's say you're eating a plant, a high flavanol, high polyphenol plant or have any big salad with mixed greens, et cetera, for lunch, are you saying that the advantage of doing so is not necessarily the antioxidants that you're consuming from food sources but the antioxidant production that occurs endogenously in response to some of the mild stress that those food sources present?

Michael:  Right. That's what sometimes–yeah, go ahead.

Patricia:  Like hormesis. When we think about the concept of hormesis, a little bit of stress is good to kind of build that redox balance. And so, I think that's where you're going with that. Right, Michael?

Michael:  Yeah, absolutely.

Ben:  Okay.

Michael:  Absolutely. Yeah. And, a similar sort of effect, it's kind of no pain, no gain, right? It's a similar sort of concept with any sort of exercise, you're breaking something down to stimulate an additional growth or repair mechanism of that entire system.

Ben:  Okay, got it. So, if someone does test and they show a high level of lipid peroxide like you've indicated you see on my tests, what are some of the things that you recommend people do based on what the Metabolomix test is indicating is the cause of that lipid peroxide elevation?

Michael:  Yeah, this is where I think it gets into a little bit of the art and the biohacking because you always want to kind of align what the test result is with what you know about the person who did the test. In the similar way that you talk about, there's no one diet for every person. If this was any old patient walking into my office, I would want to know, “Hey, is this somebody that we have an explanation for why their lipid peroxides are so high or not? In your case, and I would have some presumptions that the lipid peroxides are so high because of all the pro-oxidants that you're taking to help your antioxidant systems, all the exercise that you're doing on a regular basis, I'd have a good explanation for it. 

But, in the absence of that, maybe in somebody who's totally different, then I would really be wanting to remove the causes of their oxidative stress and their free radicals and then support them with additional antioxidants to help rebalance that system.

Ben:  And, is the preciseness of the Metabolomix test, if I can spit that out I'm going to say that 20 times on today's show, does the preciseness of that give any indication as to, like you mentioned, glutathione, for example, which particular pro-oxidants or lipid peroxide mitigation strategies are from a specificity standpoint based on that person's results going to be best for them?

Michael:  Yeah, it does actually. Depending on what type of oxidative stress we're seeing, whether that's lipid peroxides or maybe some of the other markers that roll up into that evaluation, it's going to drive recommendations for either fat-soluble vitamins like our vitamins A and E or it might filter down into more recommendations around vitamin C plant-based antioxidants. Because we're measuring so many different forms of oxidative stress, it's going to help tailor what antioxidant strategy would be best for you.

Ben:  Okay. So, based on that, what would you recommend for me?

Michael:  Yeah. Essentially, it says a little bit about plant-based antioxidants on there and increasing plant-based antioxidants. I think that in your case because if I remember correctly, you're a little bit more carnivore nose-to-tail eater, I would also be making sure that your systems that upregulate endogenous production of antioxidants through some of the animal-based products would be helpful in that certain circumstance as well. So, you're doing some of that already with the methylene blue, but I would also at the end of the day, we want to make sure that we're balancing out some of the pro-oxidant strategies with the antioxidant strategies. And, I think that's where tailoring each recommendation to the person is a little bit of the skill there too.

Ben:  Yeah. Got you, guys. And, by the way, not that I want to sound like a methylene blue devotee, I typically will do a more hefty sauna session one or two times a week. So, it might be one to two times a week that I'd dose with something like that and have the Smurf mouth you guys have to put up with on today's show. 

But also, I should clarify that these days I eat a lot more wild-caught fish, a more Mediterranean type of approach work in some organ meats, but I do have a very plant-forward diet. I'm getting exposed to a wide range of plant matter especially in the beautiful spring here where wild plant foraging is in season and I can go out in the backyard for dandelion and mint and plantain and nettle and the like. And so, it's good to know these type of plants will be beneficial from a lipid peroxide standpoint and I think it's also beneficial probably for people listening in especially if they are very physically active individuals that something like the Metabolomix could reveal whether or not you could do a better job in the antioxidant department.

So, this definitely gives me something I can act on as far as prioritizing some of the control, the lipid peroxidation. What else did you see on the Metabolomix results that were interesting?

Michael:  Yeah, we always talk about kind of headlines and then things below the headlines. I think the other headline that I would have questions about with the test was around the area of toxic exposure. And interestingly, there was a couple things that fell into that that we picked up. There was a couple things that come from typically different petrochemicals and plastics, which as you can imagine in today's society with how ubiquitous plastics in our environment. And, that's not just plastic water bottles and things of that nature, Styrofoams, but also even some of our solvents and chemicals even how well we're off guessing say a new mattress or things like that. All the plastics maybe that we don't even think about, that was a little bit on the high normal side in your results. Again, we see this so commonly on test results that almost, I mean, Patty and I, we spend most of our day staring at these. And so, we become less and less surprised by a high level of that finding but it was there.

And then, another thing talking about water filtration that there's another marker that had a little bit of a higher value around water filtration. And, that can come from so many different sources not just your home water or the water you're showering in or things of that nature but things that can contaminate the water can also come in any sort of food substance. And, some of the sneaky ones is even our organic vegetables and things of that nature, we can't control necessarily what waters are being used to grow those ingredients in those crops or what water, some of our fishes that we consume are being raised in and things of that nature. So again, some of the trickiness around toxic exposure can actually just come from the fact that we live and honestly, Ben, a growing toxic environment that you've spoken to as well.

Ben:  Yeah, yeah. And, this may be disheartening for some people here because I actually live a very clean lifestyle. Not only do I have the best of the best water filtration strategies at my home, I drink out of only glass when I travel and even have portable water filtration systems that I travel with, I don't eat out of plastic or drink coffee out of Styrofoam. I mean, I'm even careful with excessive handling of receipts at the gas station, et cetera.

So, when people hear that and they know that a guy like me is already pretty careful from a toxin exposure standpoint yet still shows that I'm getting a decent load, I guess this probably raises the question for people who might be making some of the same efforts I am, what can you do even if you're living a clean lifestyle in this industrial era that we're living in to actually take care of the type of issues that you're seeing if we know that, despite our best efforts, we're still going to get exposed to some of this stuff? So, I guess it's kind of what do you do from a detoxification or a cleanup standpoint if you see these type of issues on your Metabolomix test and you're already aware of mitigating exposure.

Michael:  Yeah, it's a great question. And, it does kind of point to that aspect. I think the first thing to do is to try not to get disheartened because I had a professor actually from environmental medicine standpoint say that the system's really good at exposing us to toxins but it turns out that the body's really, really good, even better at getting rid of them. And so, taking that a little bit in stride and then kind of countering it with, as you're doing being very aware of what potential exposure sources might be and then following that up with, again, appropriate antioxidant support to making sure that you're actually mitigating it. The fact that these markers actually come out in the urine portion of the test does tell you that while these things were once in your system, they are no longer. This is coming out in the system. So, this is something that your body was exposed to, processed, and then dealt with. So, it doesn't necessarily mean that at that moment you were being damaged per se especially if your liver function and your antioxidant system were working optimally.

Ben:  Well, couldn't you say though then arguably if someone's urinary levels of some of these indications of toxins and microplastics were low that that would indicate that they're not detoxifying them properly? Does that make sense? And, in that case, how would you actually know what's in the tissue versus what's in the urine?

Michael:  Yeah, another great question. Spot on as always. So, when something is lower in the urine, then you could not know, you'd have a little bit of a blind eye to a potential body burden that's accumulating. I think the fact that the things that we're looking at are water-soluble elements, those do tend to have shorter half-lives and be processed in the body so we're more likely to pick them up. But, the exposure window even for some of the things that we're looking at whether that's lead, arsenic, mercury, if we're looking in the urine, we're really getting an idea of, “Hey, this came through the system.” And, we picked it up and we're seeing that.

Now, there's a lot of fat-soluble toxins out there coming from different animal sources and things of that nature which will likely stay in the body for a good amount of time. So, that's a little bit of a different perspective as well. And so, I think if something is showing up in the urine, it's telling us there was an exposure to it, we did see it, let's try and find out where that is. If you're not seeing it, if there's absence of a water-soluble item in the urine, probably less likely that you had that in your environment but maybe a different story with some of the more fat-soluble toxins.

Ben:  Okay, okay, got it. And, just as a reminder for people. If you're going to the doctor and getting a typical blood panel, you're seeing lipids, you're seeing sometimes your thyroid results, your metabolic count, your white blood cells, sometimes your hormones, sometimes a little bit of the minerals, et cetera, but it's not actually looking at some of these markers that we're talking about already, right?

Michael:  Yeah.

Patricia:  Correct.

Michael:  Yeah, that's right. You want to speak to that a little bit more?

Ben:  Oh, were you going to say something, Patty?

Patricia:  Oh, no, sorry. No, I was just going to echo Michael's sentiment and to say that oftentimes to your point if we're not picking these up on our lab tests, if you're not excreting them likely, we often see it play out some other place. Like mitochondrial dysfunction, we'll see that the toxin exposure has affected some other part of cellular health. So, we try to put that whole picture together. If, to your point, it's not showing up in the urine and we see a lot of mitochondrial dysfunction or some abnormalities within the cell that we can't explain, toxins are on the list for that as well.

Ben:  Okay, okay, got it.

Alright, so what else? What are the other areas that you look into with the Metabolomix that you want to highlight from my results?

Michael:  Yeah. Like I said, those were kind of the two major headlines was the toxic exposure part. I think one more interesting thing that would be worth evaluation on that toxic exposure front was from a urinary perspective. We did find kind of higher amount or high normal amount of arsenic compared to our reference ranges. And so, knowing that arsenic, again, is a little bit more ubiquitous in the environment, I would maybe be asking around that time that you took the test. We know that arsenic can be very high in certain sources of rice, fish, chicken, are very, very common sources of arsenic. And so, I would maybe be investigating the diet around the time of the test with that.

Ben:  That makes sense. And, by the way, I kind of looked into this after looking at my test results, a lot of bioremedians, nature's bioremedians so to speak, things like mushrooms, lettuce, actually another big one that I think a lot of people should be aware of is cannabis. Cannabis, I know, is very popular, a lot of people using CBD, THC, et cetera. That tends to be a bioremedian for arsenic. So, I kind of went through and audited my own diet, I really don't use any cannabis these days besides just a full-spectrum CBD oil that's from a pretty clean organic source. But, a lot of times when I travel, I'll swing in and I'll get a half-roasted chicken at a restaurant. I'll often get a big side of mushrooms. I'm probably having mushrooms and chicken on a pretty frequent basis. And, I'll also do things like lettuce wraps, greens, things that also tend to be bioremedians. So, it makes me think I'm probably getting it from a dietary standpoint during those times particularly when I travel and I don't have access to quite the cleanliness and the organic nature of some of the foods that I have at home. Do you think that's a reasonable hypothesis?

Michael:  I do. Yeah, Patty and I were actually just traveling and we were just talking about this recently just how much the travel experience really derails attempts on average whether that's maybe even during that time there was some exposure to some of these petrochemicals or even the water filtration elements they were talking about whether we're just grabbing something at the airport because it's really our only option. I think that makes a ton of sense that that would be where this is coming from. And, that's super interesting about the mushrooms and the bioremedian aspect as well. That makes a ton of sense.

And, another finding on your test that made me question a little bit or think about whether it was the mushroom consumption was actually there's a marker called 5-hydroxyindoleacetic acid. That's a big long word for what is a serotonin turnover marker. And, that one was a little bit on the higher side too. And so, it got Patty and I talking a little bit as to whether I was like, well, I imagine that maybe there's some type of neurotropic or something in the system that could be promoting the production of 5-HTP or even serotonin. And, that is probably leading to maybe a little bit of a higher production and therefore higher turnover. And so, maybe that's a good explanation for that as well.

Ben:  That's actually something I want to talk to you about because I saw that. Me and a lot of my listeners, we use nootropics, smart drugs, sleep compounds that contain 5-HTP or other serotonin precursors. I'm just curious, how big of an issue is that to have upregulated serotonin turnover pathways?

Michael:  I don't think it's an issue at all clinically. I think it's one of those things where when we find it on a test, if we have a good explanation for it, then that doesn't necessarily mean an intervention is required especially if that's helping you and your optimization and overall. Symptomatically, you're doing great. As long as we have an understanding why that's occurring, not every abnormal requires an intervention. But, in this case, that would be my suspicion. I think in somebody who maybe we don't have an explanation for that, there's actually some interesting reasons why somebody's serotonin pathway might be upregulated, some of them with related to brain production of serotonin but also gut production of serotonin. So, as a clinician, so much serotonins that produced in our gut if that marker were to be elevated, I might actually be asking about GI symptoms.

Ben:  Yeah. And, I know we're going to get into that with the GI Effects panel here shortly. But, I know that you guys have other panels that you run for toxins, metals, et cetera, in addition this Metabolomix test, so you must see these type of issues pop up repeatedly, and there are many, many off-marketed detoxification protocols out there from ayurvedic cleansing protocols to do your sauna and your niacin flush while jumping on a trampoline with a coffee enema to some fringe ayurvedic protocol, like panchakarma.

Have you guys ever come across some type of protocol or eradication system for toxins or metals that especially based on testing you've noted as something that seems to be pretty darn effective at doing things like removing arsenic or mercury or microplastics, et cetera, from the body?

Michael:  I'll be honest, I haven't come across one particular thing that I would hang my hat on other than the human body. And, maybe that's because I'm a naturopathic doctor and I tend to think a little bit like that. But, I mean, our system is so well-designed to encounter the majority of things that we're exposed to that it's built in these systems really, really ingeniously to help us mitigate that. So, as long as we're reducing the inflow of these things and then we're supporting the body's ability to produce endogenously like you do all the time, whether through your hyperbaric oxygen therapy, the glutathione production through dietary influences of antioxidants, saunas, all these things really are supporting the body in its own production of its endogenous antioxidants. That's the way to go.

I think outside of that, they might be elaborate but they might not be long-lasting, especially if the longer you're doing this and the more years you're doing it, the more your body is staying in a state of optimization.

Ben:  Yeah, that kind of makes sense. Lifestyle strategies, it's like exercise, I tell people, “Hey, if you're going to run, don't go do some marathon beat-down three-hour session on the weekend and not run the rest of the week.” Little microdoses of 2 to 4 miles each day is good. Hit the weights for a full body session a few times a week instead of just despairingly in January starting a 30-day intensive weight training protocol. 

Similar to detoxification, some people will wait until January, for example, and then do some kind of a juice cleanse or Panchakarma or niacin flush or whatever; whereas, I think that a lot of these daily or weekly detoxification strategies like sauna or hyperbaric or breathwork or paying attention to like you guys mentioned, your glutathione intake, et cetera. Just basically living your life in a manner in which your body every day gets a chance to sweat, breathe, urinate, pass bowels effectively, et cetera, in a way that supports the body's natural detoxification processes seems a pretty reasonable way to clean things up as you go along.

Michael:  Yeah, yeah. Absolutely agree. And honestly, the rest of the report not surprisingly look pretty darn good, Ben. Whether it relates to the amino acids and your overall protein intake, we can get a sense of that. That looked fantastic on your results. The fatty acid breakdown, omega-3s, omega-6s, omega-9s and how that might be producing inflammation in the body that look really, really good on your results as well. So, those are kind of the main takeaways that we hit but I also wanted to make sure we highlight all the awesomeness that's going on in the system too.

Ben:  Yeah. You mentioned, for example, organic amino acids, fatty acids, et cetera, do you find that when people do these Metabolomix protocols, there are issues that seem to repeatedly pop up that folks should be aware of whether it's a fatty acid imbalance that might indicate a fatty acid some people might not track as much with an omega-3 index like say omega-9 fatty acids or extreme amino acid deficiencies or things that you just think the general population should be more aware of that they might not be seeing on their typical blood panel?

Michael:  Yeah, I think there's things that we commonly see in a lot of people. One I would point out would be inability to digest and absorb or effectively utilize the amino acids that you're getting in the system. We have on this test an ability to track how much protein is seemingly coming in through the diet from animal sources things like chicken, turkey, fish. So, we can get a sense of people are eating a large amount of that but how well that's turning into and being broken down into its really important components the amino acids, that's a very common pattern and that's suggestive need for digestive support. 

But, I'll also say that the genetics play a big role, so oftentimes when people do testing and then repeat testing, we'll find that because of genetic variation of people that a person will have a particular sticking point or a couple sticking points that will repeat over and over again that will be their kind of susceptibilities. And, that's really important to know and that's going to be different person to person, which is what makes the test thing so great.

Some of these other things are kind of common in our environment needs for additional B vitamins or needs for omega-3 support and things of that nature. That's very common, but it's pretty amazing to see somebody's first, second, third, and fourth test where some of the things improved because we did some support where we're needed and then other things were a little bit tricky just because they have genetic variations that makes them different and those areas need even more support.

Ben:  Okay, got you. Well, let's put on our nose clips here, our clothespins, and dive into the stool piece. So, let's get ready to stir into the toilet a little bit.

What exactly is the GI Effects panel and why is it three days?

Patricia:  Great questions. Well, the concept of microbiome testing has evolved dramatically, and yet still we're in our infancy as it comes to understanding the microbiome, the bugs in our gut that make important byproducts that affect our systemic health, our skin, our mood, cardiovascular disease. So, the gut is really coming into the forefront and that technology is rapidly evolving. The GI Effects has rapidly evolved four decades to Jeff's point earlier, we've been doing this studying the microbiome since before the microbiome became cool. So, we've watched this evolve. So, the GI Effects has evolved. We feel here at Genova that it takes several different methodologies to fully capture the dynamics of what's happening in your microbiome. So, we're measuring biomarkers directly as it relates to digestion and absorption. We're using various methods to look at the commensal bacteria real-time/QPCR. We're doing parasitology looking under a microscope or culturing. So, there's a lot of methodologies that go into capturing what's happening on the GI Effects.

And, to your point, most people can do just a one-day stool test. But, in particular, if you have a patient who has traveled or you're suspicious that there might be parasites, it's often helpful to do a three-day collection of stool and keep it in your refrigerator like you did, Ben, because a lot of these smaller protozoan parasites, it's just intermittently shed and they're not always evident. So, to do it three times really increases your sensitivity of picking up a parasite.

Ben:  Okay, got it. Is it true when people say that they've done some kind of a cleanse and they can see parasites in their stool or in the toilet bowl? Is that true? I've always wondered if it's that or if it's just long shreds of mucus, for example, that people are interpreting visually as parasites?

Patricia:  You're a thousand percent right. That's a very common thing we get. We get patients sending us pictures of their stool saying you missed a parasite, 99% of the time it's exactly that. It's a fiber. It's mucous casings to your point. It's something else that has come in from their diet that's not digested. We have the head of the Microbiology Department actually is in charge of looking at all of these things. They send pictures. They send pieces of them and 99% of the time it's not a parasite though it can look that way to an untrained eye. So, we have the experts on checking out every single one.

Ben:  Right.

Jeff:  But, if there is a concern for that, we do provide microscopic exam. So, if they want to put it in a container, ship it to us again we'll take a look at it and let them know what we see.

Ben:  Right back and say this is a carrot or a coconut flake.

Patricia:  That's right.

Jeff:  Exactly.

Patricia:  That's exactly what happens, yeah.

Jeff:  For peace of mind.

Patricia:  Yes, of course.

Ben:  Yeah, exactly. Exactly. Okay. So, you mentioned PCR analysis and some of these other diagnostic tools that you're using to analyze the stool when it comes in, I think this is a real confusing point for a lot of people. It's really popped up in the past decade this concept of testing your biome, using from what I understand is more of a DNA analysis of what's going on in your gut. You see companies like uBiome or Viome or there's a few others, et cetera, who are giving you a complete genetic profile of what's going on in your gut. And, I think some people just think, “Okay, I'm pooping. I'm getting these results back. It's all the same.” What's the difference between something about the analysis that you're doing and something like a biome test?

Patricia:  Great question. And, to look at the microbiome, you can look at DNA, you can look at RNA. Some of those transcriptomics are done by some of those bigger companies like Viome. To look at DNA, you can get a probe and look at specific or targeted organisms or you can do whole genome sequencing which looks at your entire microbiome. And actually, Genova does have a whole genome sequencing microbiome profile called the Microbiomix. It's available by itself or as an add-on to GI Effects. And, it's a little bit different in the sense that it's giving you all of the genetic information within your microbiome, even our Microbiomix test does.

It also can look at your microbiome's potential to make certain important metabolites like methane gas, hydrogen sulfide, TMA, which could go to the liver become a cardiovascular risk factor. So, you're looking at the genetic potential to do all of those things in addition to that list of all of the bacteria and yeast that live there. But, when it comes to the GI Effects, we're actually measuring, did your microbiome make those metabolites? So, we're looking at very important biomarkers like calprotectin, which is an incredibly important inflammatory biomarker. We're looking directly at some of those byproducts that the bacteria make.

So, it's a little bit different because we do all of it, we do hold genome sequencing. We have the GI Effects. We're the only company doing both genotypic and phenotypic measurements which has been really exciting for us to watch how these things intertwine because we're basically the only company doing it. Again, we're still in our infancy to understand how this comes but because we've been around a very long time, we sit on hundreds and hundreds of thousands of data points. And, we use artificial intelligence to create scores, to create algorithms to Michael's point earlier to see if we can predict inflammation. If you're setting yourself up for inflammation in the future, we're looking at various different algorithms and perhaps even going across product lines to look at all of the data points for the GI Effects as it relates then to the Nutreval, as it relates to hormones to see how all of these combines. Because now that we have this whole genome sequencing, we're looking towards the future to push the entire field forward.

Ben:  So, would it be accurate then to say that in the same way that, A, genetic test that's going to tell your propensity for things like colon cancer, type 2 diabetes, coffee metabolizing rate, et cetera, is telling you what you are capable of doing or would have a propensity towards doing or experiencing but may not actually tell you if those are manifesting? Like, you could go get tested for colon cancer, you could go get tested for type 2 diabetes, or drink a cup of coffee and see whether it gives you the jitters or not. In the same way, a genetic test for the gut is telling you the complete genetic bacterial profile of what's in your gut and giving you hints at what that might be capable of producing or have a propensity to cause in your gut but then the GI Effects panel is actually telling you, “Well, here's what's actually taking place and what we've actually found via imaging to be present in your gut right now.”

Patricia:  Great question. And, we often talk, Michael and I speak to clinicians about SNP, single nucleotide polymorphisms. And, our line is always your genes are not your destiny, and here are the things that you can do to overcome this propensity. As it relates to the microbiome, some would argue that it's a little less complicated and complex that these are oftentimes expressed within your microbiome. But again, this is all just being studied to see how exactly true this is, the beauty of Genova is that we have all of that genetic information but we're also measuring these things to say, is that actually true? And so, that's kind of where we are now in our space. Some would argue that the microbiome is less complex, all of those genes are just about expressed but they don't know that Genova is the one that's going to figure this out because we're doing both.

Ben:  Okay, got it.

So, let's dig into some of these results here. What exactly do you see when you look at the summary of my panel or the summary of anyone else's panel as far as similar to the Metabolomix chunking things into mitochondria, oxidative stress, toxins, et cetera, what are the categories you're looking at for the GI Effects panel?

Patricia:  Yeah. And, to Michael's point, most of the Genova profiles are pretty complex. I mean, Jeff mentioned it earlier, these are pretty complex. So, what we try to do is synthesize as much as we can on the front page for a patient or a clinician to look at this and say, “Where do I need to focus my efforts? What's the headlines?” like we always say. And, we're looking at, what are your needs for digestive support? What are your needs to modulate inflammation in the gut? Or, what's the need to support your microbiome? Or, do you have a need for more prebiotics or a need for antimicrobials? Did something bad grow out in that stool? So, those are kind of the biggest categories.

And, not unsurprisingly, as we've been saying all along, your tests actually looked pretty darn good. It's really great because we don't often see–

Ben:  Thank you. How did it smell?

Patricia:  Jeff, do you have any answer to that?

Ben:  Jeff should know. He said he's down there helping out.

Patricia:  Jeff didn't open that one.

Ben:  Okay. Alright, sorry, go ahead.

Patricia:  Yeah. But, to see zeros for need, for things like microbiome support is impressive. So, there's no argument on how well you're doing as far as metabolic imbalance or no infection or no microbiome support. But, there were two headlines. As it relates to maldigestion and one of the inflammation immunology markers, and I just want to talk about, first, let's talk about that digestion and absorption because we're looking in this section on the GI Effects how well you digest and reabsorb things like proteins and fat because these things should be broken down and reabsorbed three or small intestine. We should not be seeing these things make their way to the stool. And, in fact yours did not, which is great. So, looks like you are breaking down and reabsorbing proteins and fats quite well. But, there was a marker in that section that caused some alarm or made us take a second look, and that is pancreatic elastase 1.

And, pancreatic elastase 1 is an enzyme and it's secreted by your pancreas. It's a good reflection of exocrine pancreatic function. The pancreas is needed to help digest fats and various macronutrients. And, it looks as if yours is drifting downward into this yellow moderate insufficiency phase, which big headline for me. I mean, you're a young super healthy guy, so I start working down logically the list of things that can do this. And, as I work down that list, it's things like advanced aging clearly not you, diabetes; type 1 and 2; cystic fibrosis, some of these rarer things; pancreatic disease, chronic alcoholism, various pancreatic autoimmune conditions, vegan diets, and vegetarian diets, which I don't believe is the case with you or maybe at the time of this test.

Ben:  No, it wasn't.

Patricia:  I don't know. Yeah. And, these are the things we think about. And so, finally, Michael and I sort of had to noodle on this because like he said we speak to doctors all day long. We see hundreds and thousands of these. And, some of these GI Effects that we see are in professional athletes, military special ops. And, anecdotally in our department, we start to see this pancreatic elastase start to drift downward in some of those superior athletes. Now, we've been in the literature, we've gone looking to see like what is it about putting stress on the body that causes this to fall.

Ben:  Physical stress, particularly, is what you're referring to.

Patricia:  Correct.

Ben:  Yeah, okay.

Patricia:  Correct, correct. And so, not a lot of literature out there. There are some rat studies out there, but I'll tell you anecdotally, we see this a lot in professional athletes and some of these special ops. But, the one last thing that comes up when we see this is any type of blunting of the villi in your small intestine, whether that's from some kind of destructive disease, celiac disease, or something like small intestinal bacterial overgrowth, which is where the bacteria from your colon make their way into the small intestine where they don't belong take up all the real estate, cause some problems. These patients are bloated, sometimes constipated. What happens is when there's damage in the villi of the small intestine, that's signaling back to the pancreas is often disrupted. So, we start to see that pancreatic elastase fall.

So, if I were reviewing this test with someone who wasn't you and a super athlete, I'd start asking questions around things like SIBO to see if that's a way we need to go down, to see if there's a problem happening with the blunting of the microvilli in your small intestine. And, that's the other place I would go. Even in talking to you, we know you're an elite athlete but could it be that you have a small intestinal bacterial liver growth that needs to be evaluated? So, that's also high on my list.

Ben:  Yeah, we'll give some color to this. Former elite athlete by the way. Mostly for me now it's walking and pickleball and a little bit of kettlebells. But, the interesting thing is for six years, although I've since eradicated it, I struggled with pretty horrific SIBO. And, as you could probably note, the GI Effects tests will give you clues about that but it's more of a breath test. I think the newer gold standard is the tri-test for SIBO. And yes, I had it for six years, managed it, and eventually eradicated it through a low FODMAP, low fermentation diet combined with a few select antimicrobials and herbals. But yeah, it was a big issue for me up until about two years ago.

Patricia:  That's excellent. Well, that could explain it because that signaling could take some time to regenerate. And, I would also say this, Ben, that to your point, on the stool test we can see some clues about SIBO, a really high abundance difficulty here in this digestion and absorption section. We have a methane dysbiosis score which sometimes can give us clues and tip to methane or intestinal methanogen overgrowth; not diagnostic, the breath test is the diagnostic way. But, if in fact that was true and it was years of this, that downregulation of the pancreatic signaling may it be what we're seeing here, and it's just starting to get on its way back up. So, it may in fact be what we're seeing.

Ben:  Yeah, it makes total sense. And, by the way, I feel fantastic if I have a shot of apple cider vinegar or digestive enzymes prior to any large meal. And, if I don't, I still get and I think this is pretty common especially as people age in their pancreatic enzyme production tends to naturally decrease a little bit. People a lot of times will feel a lot better when they do that. And, I look at a lot of these panels myself because I send a lot of clients over to do the Genova Diagnostics panels and I see the same thing anecdotally as you have. The most active fit heavily exercising people tend to, probably because of the combination of digestive distress from the high-calorie intake and physical stress driving blood away from the gut, tend to have the same type of enzyme insufficiencies. I see it quite often.

Patricia:  Yeah, yeah. And, there's some theories about perhaps the adaptability of the pancreas as it relates to insulin regulation and glycogen storage. So, there's a lot of theories out there, but like I said, not well-represented in literature but Michael and I can attest unless you have a different experience.

Michael:  No, I don't. This is one of the things that we've been going back and forth on around maybe we can put our heads together and come out with a paper, get enough of our evidence, or the three of our minds together and really put something together. So, we have more, more, and more evidence to support the pancreatic needs for some of our most elite athletes. Yeah.

Patricia:  Sure. But, I will also say looking at your products of protein breakdown in your fecal fat, it doesn't appear to be affecting how well you're digesting and absorbing at this time according to this test, so that's great, which leads me to think that it is on its way back up and re-regulating. And, in fact, you are supporting yourself with things like apple cider vinegar, which it's just not revealing itself as clinically important on this test.

Ben:  Since I've gotten rid of the SIBO, my gut feels better and better every month. So, that seems to align with the pattern I'm seeing.

What else did you see on this test?

Patricia:  Great. Well, the other headline that, like we say, there's main headlines and then there's other little nuances but another main headline for me was in that section called inflammation and immunology. And here, we're looking at really important inflammatory biomarkers, things like calprotectin which is FDA-cleared to differentiate between IBS and irritable bowel syndrome and inflammatory bowel disease. Yours was fine. We're looking at eosinophil protein x which can often give us insight into things like IGE-mediated reactions, food allergies or parasite. Those are fine on yours but there was this one marker called fecal secretory IGA. And, this is a class of antibodies that's made right in the mucosal lining of your GI tract. It's that first line of defense, that first barrier. And, it's basically telling us that there's an immune reaction happening right at the layer of the mucosa, the first barrier. And, yours is pretty high.

Now, the problem is that this is a pretty non-specific marker, you can't specifically tell what caused it. You have to put on your detective cap and go looking. And, it can be anything from a potential path that grew out on the test, a parasite that we're picking up, but it's also associated with things like intestinal permeability or leaky gut like the cells that line your intestine are usually pretty tightly closed. Physiologically, they open and close to improve your adaptive immunity within your GI tract. So, that opens and closes physiologically. But, sometimes there are things that keep those gaps open and that can cause a continued immune response. And, that's things like gluten but what we also see, again, in elite athletes and endurance runners, corticotropin-releasing hormone is released from your brain in a stress response that can directly affect the tight junctions in the epithelial layer here. So, it's not uncommon for endurance athletes or high-level athletes to start to develop some of this a little bit of leaky gut. And, we know that this sometimes can manifest sometimes at later stages can manifest with autoimmunity and sometimes it's just transient based on what you had been doing just prior to doing this test if it were a high level of exercise or not. So, we talk about recovery, we talk about supporting your GI health, we talk about gluten, we talk about specific herbs that can help to heal an intestinal permeability, things like aloe or marshmallow, or Michael you're the naturopath, there's a lot of–glutamine can also help.

Ben:  Colostrum, I think, can be helpful for sealing up the lining.

Patricia:  Colostrum, sure.

Michael:  You got it.

Patricia:  Yup, yup, yup. So, those are the things we'd be thinking about. And again, to your point whenever we see something like this elevated because it is so non-specific, we need to put our investigator caps on. And, in you, I suspect that it's more that because I'm not seeing any of those other things playing out in the culture result.

Ben:  Yeah. And look, I mean, we all know and I know many of my listeners know that intestinal permeability is quite common, not only in people who have a lot of mental and emotional stress, which is why a lot of times your gut goes south when you're going through a divorce or the home has a flood or you're having relationship issues, whatever, but it can also happen.

And, I'm glad you said endurance exercise because it's quite common in chronic repetitive motion athletes like triathletes and marathoners, et cetera, because you are usually moving for long periods of time often while simultaneously attempting to digest food. And, of course, that defined my life for many, many years. And, I would say that I still do a decent amount of exercise and have found that if I'm not cautious in terms of additional lifestyle stressors or not consumption or not consuming a lot of these things you mentioned like glutamine, colostrum, bone broth, aloe vera, et cetera, and to have issues and I think that it's one of those deals where you either have to care for your gut and attend to intestinal permeability and keep exercising or really step back on the exercise, particularly the higher intensity endurance exercise and opt for a better gut. Because of that, my problem is I just love adventures and cycling and did triathlons for so long and better I was just willing to put up with the gut issues and Band-Aid them, but increasingly and I think that's why my gut just feels better and better with time, I've really recognized that you can't have your cake and eat it too when it comes to physical stress and a pristine gut.

And so, I think this is also important for people particularly if you exercise a lot. And, correct me if I'm wrong, you guys, and you go to the bathroom and see undigested food particles, et cetera, which I found is the number one sign for me that I am pushing both my gut and my physical body to excess because I've noted that in more stressful times of training, especially when combined with travel. And, the stress from travel, I will tend to see, back to the carrot shreds and coconut flakes piece, undigested food particles in my stool. And, I think it's just important for people to be aware of this. And, from what I understand, and then I'll shut my yapper, two contributory factors to this that are even more concerning, especially in the endurance athlete community is heat, exercise in the heat, and the use of non-steroidal anti-inflammatory drugs in conjunction with that. And, I don't want to tell you how many people I know who are out going on runs at 90 degrees with a double dose of ibuprofen in their gut to manage the knee that's bugging them as they're training for their marathon.

Patricia:  Yeah, yeah. And, to piggyback on that, chronic NSAID use or all these people are continually using NSAIDs can cause something we call NSAID enteropathy. And, we can start to see some of those inflammatory biomarkers start to rise at lower levels just by use of chronic NSAIDs. So, to your point, putting Band-Aids on things, you're really just setting yourself up for badness.

Ben:  Yeah, yeah. Well, what else do you guys want to add if anything about the Metabolomix or the GI Effects? And again, I'll remind people if you go to BenGreenfieldLife.com/GDXpodcast. I'll put my results in there. I'll remove my personal privacy information so you don't show up at my front door. And, I'll also put links to these tests in there. But, anything else you guys want to throw in?

Michael:  Yeah. I mean one interesting thing, Patty and I were talking out right before we actually started recording here was on pages two and three of the GI Effects, we actually do a full analysis of the microbiome using some of the PCR results for the commensal bacteria and just kind of understanding it's not just about what bad bacteria or yeast or parasites might be there but actually what's the balance between the good bacteria. And, when we really kind of put all that information into the system, your microbiome look great. We have this area called the commensal balance, which is, I mean, as you can imagine, very common to see people with varying levels of dysbiosis. Your results on that front look really, really good.

Patricia:  We never see that.

Michael:  Yeah.

Patricia:  It's really just a chart to tell us how close you are to healthy comparing you to a healthy cohort, how far are you. And, I said, “Michael, I don't think I've ever seen anyone that in the green.” It's great.

Michael:  Yeah. So, I was going to say a lot of the things that you're doing from a prebiotic standpoint is probably really, really going a long way to assist the overall balance of your gut bacteria.

Ben:  Okay. That's good to know. I'm glad you brought up the ladder pages of the test because there actually was one thing at the back of my mind I wanted to ask you. I think on the last or close to the last page of these tests, there's a list of different herbs like uva ursi, oregano, berberine, et cetera, and a little printout that says “What foreign critters in your gut might be sensitive to such and such an herbal eradication protocol or herbal management protocol.” Where does that come from exactly like where it says you might rather take oil of oregano instead of berberine or uva ursi or something like that? Is that something that's based on research? What's the actionable step that people can take from seeing that page?

Patricia:  Actually, when something grows out in culture that is potentially pathogenic or a pathogen, the lab actually isolates that exact thing that grew out in your stool and tests it against those specific antimicrobials. So, it's not just this general like, “Oh, this usually works.” It's like, “No, the bug you grew in your stool, on your plate is sensitive to this and here's how sensitive it is.” Yeah.

Ben:  Wow.

Patricia:  There's a lot going on in microbiology. I mean, Jeff can attest. He was in charge of Lab Ops. There's a lot that goes on down the microbiology department.

Ben:  Yeah, that's fascinating. It just seems super specific. And, do you actually find that people if they choose the type of herbs that are shown to be beneficial for managing any bacteria that might be deleterious in their gut based on their results actually see good results from say choosing oil oregano because their Genova Diagnostics panel told them that that would be good for what's going on in their gut?

Michael:  Yeah. I mean, that's the power of personalized approaches to therapy I would say. And, I think a lot of people whether they're choosing one specific agent like oregano or maybe they're doing a formula, it can even help them guide what formula they might pick. They're seeing that oregano, these bad bacteria were sensitive to oregano so they're finding a formula that's really, really high in oregano oil and predominant. So, you can either do a single herb approach or maybe not, you don't want to go in with napalm and wipe everything out, you want to be a little bit more cautious sometimes. And, that's where something like a goldenseal is another herb that you might use to help treat some of these things might be a little bit more gentle and go a long way. So yeah, it can help you in the short-term and the long-term that way.

Ben:  It's interesting. I didn't know that about goldenseal. It's good to know.

You guys, this is really, really fascinating. And again, for folks listening in, go to BenGreenfieldLife.com/GDXpodcast to leave your questions, your comments, your feedback, to look over my results and to pipe in with any additions that you have. But, in the meantime, Michael and Patricia and Jeff, this has just been so good, it's so helpful and I really appreciate you coming on and sharing my results so we can hopefully help a lot of other people out.

Patricia:  Thank you.

Jeff:  No, thank you. We appreciate your time.

Ben:  Yeah, yeah, for sure. Alright, folks. Well, I'm Ben Greenfield along with the team from Genova Diagnostics signing out from BenGreenfieldLife.com. Have an amazing week and thank you so much for tuning in.

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For a very long time, the Metabolomix+ (an “at-home” version of the very popular Nutreval test) and GI Effects tests have been two of the “gold-standard” tests I recommend to most people who want to know a lot about their body that the average blood test doesn't measure, and are also tests I require of each of my VIP coaching clients .

The Metabolomix+ is a unique combination of nutritional tests that provides an analysis of key nutritional biomarkers. A first morning void (FMV) urine collection, with optional add-on bloodspot finger stick and buccal swab, the Metabolomix nutritional test is a non-invasive, patient-friendly way to assess the functional need for antioxidants, B-vitamins, minerals, digestive support, fatty acids, and amino acids. Insights gained from the Metabolomix+ nutritional test allows people to target nutritional therapies in a very precise and thorough way.
The GI Effects test is a comprehensive assessment of complete gut health, assessing the root cause of most GI complaints. It is a combination of PCR, culture, and microscopic testing methods that ensures any and all relevant organisms are identified, including yeast, parasites, along with gut inflammation, bacterial imbalances and much more.
Both of these tests are made by Genova Diagnostics, which is a leading clinical laboratory applying systems-based testing approaches to the diagnosis, treatment and prevention of complex chronic disease. Genova specializes in clinical laboratory services with actionable information. Testing service areas include gut health, nutritional status, immune function, hormonal health and specialty testing. Recently launched Genova Connect for athletes, high performers and exercise enthusiasts.

In this interview, which includes for your learning and educational enjoyment a comprehensive review of my Metabolomix+ and GI Effects results, broken down in an easy-to-understand way, I interview:

Jeffrey Ledford, the Chief Executive Officer of Genova Diagnostics since 1999. Jeff previously served as Vice President of Laboratory Operations. In this role he managed our high complexity large-volume laboratories in Asheville, North Carolina and Atlanta, Georgia. Jeff also directed our Project Management Office which oversees all large corporate initiatives, including new product introductions, acquisition integration activities, and corporate LEAN Six Sigma program. Jeff has been instrumental in developing new product configurations, resolving complex service issues, and addressing unique market needs. Previously, Jeff served as Vice President of Business Development, General Manager of our Atlanta facility, Managing Director of Genova Diagnostics Europe and Director of Product Development. Jeff holds an MBA from the Terry College of Business at the University of Georgia, and is a veteran of the U.S. Air Force.

Patricia Devers, DO, Chief Clinical Officer, who is a board-certified Internal Medicine physician with a specialty in Hospitalist Medicine. She holds a Bachelor of Science degree in Biology/Chemistry and a medical degree from the Philadelphia College of Osteopathic Medicine where she also completed a three-year Internal Medicine residency. Dr. Devers currently serves as the Chief Clinical Officer at Genova Diagnostics. After 20 years in clinical practice, she has been extensively trained in functional medicine and has lectured throughout the country and internationally. Dr. Devers is a Medical Affairs content writer, contributor to the latest edition of Dr. Joseph Pizzorno's Textbook of Natural Medicine, and cohost of the Genova Diagnostics podcast entitled The Lab Report.

Michael Chapman, ND, Director of Product Innovation, who has a doctorate in naturopathic medicine from Bastyr University in Seattle, Washington. Dr. Chapman is currently the Director of Product Innovation at Genova Diagnostics. Aside from educating and consulting with integrative and functional medicine practitioners, he is responsible for researching and developing new test profiles. In addition, he has delivered presentations nationwide at functional and integrative medicine conferences. Dr. Chapman is a writer and contributor to the latest edition of The Textbook of Natural Medicine by Joe Pizzorno & Michael Murray, authoring chapters on urinary organic acid testing and urinary porphyrin analysis. Also, he is cohost of the Genova Diagnostics podcast titled The Lab Report.

During our discussion, you'll discover:

-Genova Diagnostics…07:10

  • Nutreval is an analysis of a whole bunch of key nutritional biomarkers 
  • GI Effects test is the gold standard test for the gut – tests for
    • Yeast
    • Parasites and fungus
    • Gut inflammation
    • Bacterial imbalances
  • These tests are available in Genova Diagnostics 
  • Ben used Methylene blue before starting the podcast
  • Guests for this podcast:
    • Michael Chapman – Director of Products
    • Patricia Devers – Chief Clinical Officer
    • Jeff Ledford – CEO
  • What sets Genova Diagnostics apart from other clinical laboratories
  • Key tests are for GI effects and nutrition but also has what are call Specialty tests
  • The gold standard tests:

What actually happens when you take your blood and urine to the lab…13:56

  • The Metabolomix test is both blood and urine
  • Metabolomix looks at 135 markers
  • How the test is analyzed – machines, robotics involved
  • MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization – Time Of Flight) mass spectrometry
  • Lab techs handling samples 

-Do you have to go through your doctor or do you need to call your doctor?…18:06

  • Two approaches to ordering genetic testing
    • Work with your practitioner to bill to insurance
    • Work with us directly through Genova Connect – 100% out of pocket
  • Genova Connect is 100% out-of-pocket, and insurance typically covers some fringe tests
  • It's always best to check with your insurance provider in advance of ordering the test if you're going to choose that process

-What is Metabolomix?…23:46

  • Metabolomix is mostly a urine test and a finger stick test
  • Very similar to Neutreval
  • The most optimal complete at-home nutritional evaluation
  • Identifying your current cellular health
    • Oxidative stress
    • Mitochondrial dysfunction
    • Inflammation
    • Toxic exposure
  • Measuring organic acids and amino acids, fatty acids, like omega threes
  • Illustrating Metabolomix testing using Ben’s results 
  • Ben’s results look good, but would consider providing support for oxidative stress

-What are you looking at for oxidative stress? And for mitochondrial health?…26:42

  • Oxidative damage means free radical damage from toxins in our environment
  • Oxidative stress also comes from internal stress
  • One of the markers from Ben’s test – lipid peroxides, which is a marker for fat damage, damage to fat molecules
  • High levels of lipid peroxides is common in athletes and fit individuals
  • Does this indicate that potentially that person is still not getting enough antioxidants
  • Antioxidant support in the body 
    • Glutathione (use code BEN to save 5%)
    • Polyphenols
    • If you're doing a lot of plant flavonoids, phenols, those are actually creating a degree of oxidative stress that your body then compensates for so you know that redox balance is super important
  • No pain, no gain –  like with any exercise, breaking something down to stimulate an additional growth or repair mechanism of entire system
  • There's no one diet for every person

-What does the Genova Diagnostics Team recommend to Ben based on these results?…33:06 

  • Recommendation: increase plant-based antioxidants and upregulate endogenous production of antioxidants
  • Methylene blue detoxification
  • Ben’s current diet – plant based, wild caught fish, Mediterranean diet
  • Toxic exposure to petrochemicals and plastics
  • Water filtration and its role in toxic exposure

-What can you do even if you’re living a clean lifestyle in this industrial era?…37:00 

  • Living a clean lifestyle and avoiding toxins
    • Invest in water filtration system
    • Drink only from glass containers
    • Don’t drink coffee from styrofoam containers
    • Be careful when handling receipts (carbon printed)
  • Low urinary levels of toxins and microplastics – would that indicate that they're not detoxifying them properly?
  • With the results – water soluble elements tend to have shorter half-lives and be processed in the body so more likely to picked up
    • Lead
    • Arsenic
    • Mercury 
  • “If you're not excreting them, though, likely, we often see it play out some other place, like mitochondrial dysfunction, we'll see that the toxin exposure has affected some of the parts of cellular health”

-What are the other areas of Metabolomix that you want to highlight from our results?…41:39 

  • Toxic exposure as seen from high urinary arsenic levels
  • Some foods with high levels of arsenic content 
    • Rice
    • Fish
    • Chicken
  • Some bioremedians
    • Mushrooms
    • Lettuce
  • Cannabis is also a bioremedian for arsenic
  • Issues on travelling – we don’t have access to “clean” foods as we used to at home
  • From Ben's result, 5-hydroxyindoleacetic acid is seen as elevated
  • Overall symptomatically Ben is doing great, as long as we have a good explanation why that's occurring
  • Not every abnormal test result requires an intervention

-Are there protocols or eradication system for toxins or metals that is effective?…46:03

  • No specific detoxification protocol for toxins or metals
  • Daily or weekly detoxification strategies for toxins
  • Sweat, breathe, urinate, pass bowels effectively in way that supports the body's natural detoxification processes
  • Main takeaways from the Metabolomix report – amazing results, fatty acid breakdown, omega threes and inflammation
  • A lot of people have the inability to digest and absorb or effectively utilize the amino acids that you're getting in the system
  • Metabolomix has the ability to track how much protein is coming in through diet, from animal sources (chicken, turkey, fish)
    • Get a sense of what people are eating then identify how much is being broken down to amino acids 
  • Genetics plays a big role
    • Someone has a particular sticking point or a couple sticking points that repeats over and over again and that will be their kind of susceptibilities

-What is the GI Effects panel and why is it three days?…51:36 

  • The GI Effects panel and why it takes three days
  • Different methodologies to fully capture the dynamics of what's happening in the microbiome
    • Measuring biomarkers directly as it relates to digestion and absorption
    • Looking at the commensal bacteria real-time/QPCR
    • Parasitology looking under a microscope or culturing
  • How the GI-Effect panel works
    • Three-day collection of stool to increase sensitivity of picking up parasites
  • Genova is the only company doing both genotypic and phenotypic measurements
  • AI-powered algorithms

-Would it be accurate to say that a genetic test for the gut is telling you what you are capable of doing or would have a propensity for?…57:04

  • Genova vs genetic tests for the gut like Viome
    • The only company doing both genotypic and phenotypic measurements
  • Metabolix is also a whole genome sequencing microbiome profile
    • Available by itself or as an add-on to GI effects
  • Categories of results for the GI effects panel
    • Need for digestive support
    • Need for Inflammation modulation
    • Need for Microbiome support
    • Need for Prebiotic support
    • Need for Antimicrobial support
  • Ben does very well with digestion and reabsorption of proteins and fats
  • A marker that caused alarm is pancreatic elastase 1, an enzyme secreted by the pancreas
    • a good reflection of exocrine pancreatic function
  • Possible causes of pancreatic elastase 1 drifting downward
    • Advanced aging
    • Diabetes – type 1 and 2
    • Cystic fibrosis, some of these rarer things
    • Pancreatic disease
    • Chronic alcoholism
    • Various pancreatic autoimmune conditions
    • Vegan diet
    • Vegetarian diet

-Pancreatic enzyme insufficiencies in elite athletes…1:03:17 

  • See this a lot in professional athletes and military special operators
    • Any type of blunting of the villi in the small intestine caused by
      • Destructive disease
      • Celiac disease
      • SIBO
  • When there's damage in the villi of the small intestine, signaling back to the pancreas is often disrupted and pancreatic elastase 1 falls
  • Ben suffered from SIBO for six years when he was competing but has since managed to eventually eradicate it through
    • A low FODMAP
    • Low fermentation diet combined with a few select antimicrobials and herbals
  • Ben takes a shot of Apple cider vinegar and digestive enzymes before any large meal
  • High fecal secretory IGA
    • A non specific marker
    • A class of antibodies that's made right in the mucosal lining of your GI tract
    • It's that first line of defense, the first barrier telling us that there's an immune reaction happening right at the layer of the mucosa, the first barrier

-Gut issues are common in chronic repetitive motion athletes and marathoners…1:08:33

  • Intestinal permeability is common in chronic repetitive motion athletes
  • Indigested food particles in stool
  • Chronic NSAID use and Ibuprofen use
  • Colostrum can help

-Actionable steps that people can take…1:13:16 

  • The power of personalized approaches to therapy
  • When something grows out in culture that is potentially pathogenic or a pathogen, it is tested
  • The lab actually isolates that exact thing that grew out in your stool and tests it against those specific antimicrobials
  • It's not just like: “Oh, this usually works.” It's like: “No, the bug you grew in your stool, on your plate is sensitive to this and here's how sensitive it is.”

-And much more…

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Click here for the full written transcript of this podcast episode.

Resources from this episode:

– Genova Diagnostics:

– Articles:

– Other Resources:

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