EP130: The Challenges with Functional Medicine Testing with Dr. Bryan Walsh
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In this episode, Sachin interviews Dr. Bryan Walsh. Sachin bumped into Dr. Walsh at ECO, the CellCore Conference. After talking, Sachin invited Bryan to be a guest on Perfect Practice. Bryan is extremely passionate about functional medicine. He brings over 25 years of experience in helping us become better clinicians, looking at our patients through a slightly different lens and upgrading our paradigm so we can be of better value to the people we want to serve the most.
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Key Takeaways:
[2:12] Sachin welcomes Dr. Bryan Walsh and thanks him for joining the podcast today. Sachin speaks of producing evidence-based treatment driven by awareness. There are more tests coming onto the market and more supplements and more research being done every year.
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[3:10] Bryan started as a fitness specialist. He read much about nutrition. Before going to naturopathic school, Bryan went to a functional medicine weekend seminar produced by a lab. He was amazed by all the available tests. That hooked him on functional medicine.
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[4:06] Bryan then went to naturopathic school where he met his wife. He learned about many tests and did them all: organic acid test, salivary cortisol test, urinary hormone test, stool test, hair tissue mineral analysis test, you name the test, he did it. But he started hearing gurus say things he knew not to be true and he started questioning the supplements.
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[6:14] Bryan asked himself why he was running expensive tests if he didn\\u2019t know their scientific validity. The scientific literature is not friendly to these biomarkers and tests. He compares it to testing your home for radon with a bad test. Bryan is trying to raise the bar in the industry for better practitioners and healthier patients for less money, and being more evidence-based.
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[8:10] Bryan and his wife run their business while trying to raise the bar in the industry as much as they can. Sachin loves that they are holding the entire industry to a higher standard. You have to feel solid on the tests you order for people. The foundation of our business is the outcomes we produce.
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[9:24] Sachin asks, \\u201cHow do I create a program that is independent of the labs, that produces results every single time that has tons of evidence and ancient wisdom wrapped up into it, and common sense wrapped up into it, and develop a lifestyle-design program that isn\\u2019t dependent on lab testing?\\u201d Sachin includes Oura rings for his patients so they can measure their progress.
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[10:18] Bryan\\u2019s view is that a lab test should not give you any new insights into the person, it should just confirm what you already believe to be true. That means going back to your clinical skills, history-taking, symptom questionnaire, and physical exam. Bryan\\u2019s not opposed to any test that he knows of, but a test is not a fishing expedition, it\\u2019s confirmation of a suspected issue.
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[11:28] For example, if a patient has hypoglycemic symptoms, there\\u2019s probably something going on. Testing blood glucose and A1C gathers hard data and allows for interventions and tracking progress. If someone has hypothyroid symptoms, run a complete thyroid panel and see where the defect is.
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[12:35] Blood chemistry is one of Bryan\\u2019s passions. Standard blood chemistry is one of the most studied labs around the world. It\\u2019s been scientifically validated over and over. It\\u2019s inexpensive for what you get, if you know what you\\u2019re doing, have good reference markers, and are up to date on the modern literature on these markers.
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[14:02] When you look at the literature on Albumin, old markers have new reasons they might be high or low that have implications for us as practitioners. If you take old tests and combine them with updated research on the markers, they can tell you as a clinician far more than you were using them for in the past.
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[14:47] Bryan cites recent research linking high HDL with leaky gut. A high HDL may indicate testing for intestinal permeability of lipopolysaccharides to confirm. There is updated research on many old markers. Some inoculations are indicated from existing markers. There are new calculations for fatty liver. Some markers are useless and don\\u2019t need to be run.
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[17:55] Bryan notes that with too much data, it\\u2019s hard for practitioners to know what to work on first. Go back to the fundamentals and the basics that you have evidence that they improve people. People are suffering and practitioners are suffering with inaccurate tests. Patients are spending on tests unnecessarily. Some tests just give patients something new to worry about.
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[21:50] Bryan does not see people being plain honest about the industry. Practitioners do the best they can and show confidence about it but they don\\u2019t know if the second test will show improvement over the first test.
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[23:46] Bryan tells more about HDL. If triglycerides are low, HDL tends to be high, lymphocytes tend to be high and neutrophils in women tend to decrease. Potassium tends to high normal and sodium tends to low normal, because of low cortisol and aldosterone. Females with this pattern have autoimmunity and get dizzy when they stand up. Bryan looks hard at HDL.
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[24:51] Bryan found one paper years ago that included in the data tape but did not report, data that people that had a higher HDL also had a higher incidence of cancer. There is an HDL immunological component. Bryan has been seeing HDL higher than LDL in the past five years more than ever before.
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[24:45] Bryan talks about optimal functional ranges and shares a story. If you don\\u2019t have a reference, don\\u2019t speak of an optimal range. Bryan has stacks of references of ranges for various markers and he has the papers about them and how he came up with the ranges.
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[28:06] The literature on GGT very clearly says high normal levels, in the upper 20s or 30s, are more accurate as a pathophysiology marker than CRP, some metrics like blood pressure, or A1C. GGT is a robust marker of pathology, xenobiotic exposure, and hepatic glutathione deficiency. It\\u2019s a marker to justify your use of n-acetylcysteine.
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[29:51] Pyroglutamic acid is lower in autoimmune patients than in healthy patients. Low bilirubin is a marker of fat-soluble oxidative stress. Papers that Bryan read recently show a highly increased risk of mortality for bilirubin levels below .4. This points to fat-soluble oxidative stress and may call for support from fat-soluble anti-oxidants, Co-Q 10 and Vitamin E and/or GGT.
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[31:28] Bryan refers to water-soluble glutathione. N-acetylcysteine can lower High-normal GGT. These are old markers. Bryn mentions there are also loads of novel and new markers.
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[32:13] What about mold? Bryan waits for the bandwagon to turn around and come back before hopping on. He doesn\\u2019t want to give the newest supplement only to find it causes cancer. Mold is insidious. People are hyper-stressed about mold. A few years ago, people were stressed about candida and then heavy metals. Bryan doesn\\u2019t run a blood chemistry for mold.
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[35:41] High albumin is a dehydration marker. Low albumin is an inflammation marker. A1C and C-peptide are insulin markers. If fasting glucose is normal with high A1C, give a C-peptide test. Globulin is a marker of all globulins. IGG antibodies are the greatest contributor to serum globulin. To make globulin, tryptophan is required. High globulin is an autoimmunity marker.
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[38:32] If a woman is taking exogenous estrogen (birth control, hormone replacement) that will drive up sex hormone-binding globulin. These women may have mild depression because of a relative tryptophan deficiency. Try tryptophan. Bryan discusses protein electrophoresis, CBC, and other tests.
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[40:02] Iron fluctuates by within-person variability. Bryan talks about homocysteine. It is suggested to have a within-person variance of about 8% of 10 Mol/L. About 95% of people will have within +/- 2 standard deviations of that 8% variance. The results of a year\\u2019s worth of monthly homocysteine tests might be as high as 11.2 mol/L and as low as 8.4.
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[41:50] Iron has a 32% within-person variance. If iron is all over the place, so will serum iron. Don\\u2019t consider iron overload protocol unless a reading is high again in 30 days. A standard iron test would be, iron, ferritin, and TIBC. Some use transferrin instead of TIBC. Ferritin has a variance of around 20%. Iron has a variance of upwards of 32%. TIBC has a low variance.
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[43:19] When TIBC goes up, the body is looking for more iron. This may be because of a bacterial infection. TIBC is an important marker. The soluble transferrin receptor is a receptor for iron on transferrin. If there are no iron receptors on transferrin, the body is low on iron but doesn\\u2019t want any, because it\\u2019s fighting off a bacterial infection that thrives on iron. Clear it up.
[48:47] Bryan believes the bacteria appear first in a leaky gut situation. He describes how they wake up without proliferating into sepsis. That\\u2019s where the HDL test comes in. Bryan doesn\\u2019t differentiate between a gut protocol and a non-gut immune protocol. Any botanical gets absorbed in the gut. Fibers and most minerals don\\u2019t get absorbed.
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[53:46] Bryan lists classifications of tests he recommends not using, and he explains why: Organic acid tests, salivary cortisol tests (unless you run it serially a few times in a week for patterns), hair tissue mineral analysis tests, and stool tests (unless you suspect a raging infection). Bryan cites incorrect medical treatments of past decades.
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[1:04:45] Bryan started his career with more liberal and aggressive protocols. He is conservative now. He works with blood chemistry, evidence-based supplements, and the mental-emotional components and how they affect physiology. Not running all these labs and not going crazy about the best diet has been a huge stress reliever for Bryan.
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[1:05:58] About CGM. Sometimes more data can cause anxiety, especially when used by people without diabetes. Bryan is interested in what the counterregulatory hormones are doing. If someone has hyperglycemia, is it because they have no insulin, or too much insulin and it\\u2019s not working?
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[1:07:56] Why do you have high glucose? Is it because you\\u2019re not making enough insulin, insulin\\u2019s late to the party, or do you have hyperinsulinemia and insulin resistance? That\\u2019s two different patients and protocols.
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[1:08:23] There is also hyper insulin sensitivity. Bryan believes that is caused by too much GLP-1. These patients have totally normal glucose but they\\u2019re having a hyper insulin response with insulin receptors that are more sensitive. That is not normal physiology. The only thing CGMs focus on is the easy one, glucose. Bryan has never recommended one to a client.
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[1:08:38] Sleep trackers were part of a study. They put two groups of sleepers in a room with a clock showing the wrong time. Some people had a great night\\u2019s sleep but they thought they had a restricted sleep. They were asked to do math problems and they did poorly. They thought they were exhausted after eight hours of sleep.
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[1:10:12] The other sleep group was interrupted after four hours of sleep but the clock showed they had slept eight hours and they believed it. They reported feeling wonderful. They did well on the math problems. The problem with gadgets is that a little information is good but we can sometimes get taken too far. Use tools as they are defined and don\\u2019t take them too far.
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[1:11:39] Sachin commits to give up personal tech devices for a week and see the results. Bryan says one of the biggest issues we have right now is that we are hyper-focused on ourselves and no longer focused on life and our community. In the past, who you were was who you were to the community. It was your purpose in the community.
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[1:12:43] Now we look so much within ourselves, we don\\u2019t look out anymore. Nobody\\u2019s focused on anybody else anymore. Bryan thinks that one of the biggest health issues we have is people running around lacking purpose, lacking knowing who they are and lacking connections to other people. Bryan thinks it\\u2019s showing up in neurotransmitters and hormone issues.
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[1:13:54] Sachin is a student for life, like Bryan, willing to learn and adapt and experiment. He will let Bryan know in a week how the tech fast goes. The Oura ring will sit on his desk for a week.
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[1:14:37] What is Bryan\\u2019s take on AI in blood chemistry? He thinks it has fantastic potential. His fear is that people don\\u2019t like to think. Thinking is hormetic but we just want a protocol. The literature about AI in interpreting blood chemistry is good. It does what we are trying to do mentally and manually with the numbers. Bryan\\u2019s concern is we will forget how to observe.
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[1:16:05] Bryan has experience with AI and labs. He looks at the lab first and draws his conclusions without bias before looking at the AI interpretation. Sachin agrees. No one can do your pushups for you.
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[1:17:09] Bryan and his wife have their business at MetabolicFitnessPro.com. They are trying to raise the bar. They are Christian. In a world of dishonesty, they run with humility and integrity and they hope that everything they do emanates from there. They have a number of courses people can get to improve what they do in their practice, be successful, and feel good about it.
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[1:18:47] Bryan says he doesn\\u2019t think of himself as smart; when you\\u2019re dumb, you keep trying to be smart. He\\u2019s always trying to impress his wife, who doesn\\u2019t impress easily. They are working on creating a lab with some pretty cool markers that aren\\u2019t on standard labs but the evidence suggests they should be. They teach a course in blood chemistry analysis.
[1:20:04] Sachin thanks Dr. Bryan Walsh for this enlightening conversation. Sachin invites Bryan to return for further discussions, to speak at Sachin\\u2019s events, and to offer mentorships.
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Mentioned in this episode
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