Example of a Functional Workup Using a Lab Rat – Me
As we make inroads in this type of medicine called “Functional Medicine”, I would like to keep you abreast of my meanderings. I am personally walking this road with many of you so that when I make recommendations for certain interventions I can “speak from experience.” So I wanted to give you a brief history of Me, the guinea pig as I really can’t use any of you due to HIPAA privacy. I am allowing you into some of my medical issues in order to illustrate the process. It has been some time since I have done any bloodwork on myself, so I was seen at the doctor’s office and had a baseline set of labs done. Historically I have had issues with things like marginally high TSH (low functioning thyroid) based on family history. Then I have also had issues with greatly elevated triglycerides, also genetic. There is no cancer or things like Alzheimer in the family genetically but there is neuropathy, arthritis, histiocytosis (lots of very itchy spots on the skin). So, needless to say, I was interested in getting an update on where my own body was. After all, I am living a relatively clean life, eating cleanly, organic food, and all, etc. On the basic chemistry profile, I was found to have the following:
Low serum pH of 7.31 (nl 7.35-7.45), meaning I am mildly acidotic
Low serum Mg of 5 (nl 6-7)
Low Potassium of 3.7 (I like to see it between 4-4.5)
Elevated TSH of 11.5 (I like to see it less than 2), meaning I am a bit hypothyroid
Homocysteine of 17!!! (I like to see that between 7 and 11 for adults); BTW, markedly elevated homocysteine for prolonged periods is associated with premature mortality!! Yikes!
Eosinophils on the CBC was mildly elevated at 3% (really needs to be below 1-2%)
Copper was way low at 51 (like to see it around 100)
Triglycerides was 478!!! (its that darn familial hypertriglyceridemia); nl is <150
All the other stuff was normal (Vit D, CBC, chemistries, liver function, kidney function, food allergy profile, etc.
So, in summary, I am struggling with some acid buildup in my system, struggling to build up my Mg level even on 500 mg daily; struggling to keep my thyroid functioning robustly in spite of not having thyroid antibodies; have some evidence of eosinophils in my system (may be the cause of itchy skin due to elevated histamines, or food issues like gluten or dairy, or parasites); copper was low likely due to having taken lots of zinc over the previous 10 months without balancing it with copper. Triglycerides were still through the roof in spite of trying hard to limit sugar and carb intake. The homocysteine was markedly elevated and likely due to my genetic mutation in the MTHFR gene that converts dietary folic acid to folate. I also have other weaknesses throughout my methylation cycle, so in spite of taking 400 mcg of active folate daily for a year, that was obviously not going to be enough. And that potassium!! That is hard stuff to get enough of!! It is mostly intracellular and so small changes in the serum reflect on large changes inside the cell. Of course, much of this can be attributed to aging also. But I don’t want to age THIS rapidly! So, what to do?
In comes Nutreval, the test we are starting to do with some of you. It analyzes over 100 biomarkers and gives suggestions for the fixes of some of the unbalanced markers. Three weeks after my basic labwork the Nutreval report arrived and I dug through it with much interest. I then spent ½ an hour with one of Genova’s consultants reviewing the results. I will spend that same kind of time with each one of your reports in order to get the most information from them. So, in spite of being on my Restore Professional formula for almost a year, I found that my age still required some areas that required even MORE support!
I was marginal on Vit A, E, alpha Lipoic Acid, B1, B2, B3, folate, B12, and markedly deficient in Biotin. All of the B complex and lipoic acid are integrally involved in mitochondrial function and energy production. I was low in all but B6 and CoQ10!! So, was I just not absorbing? Or not getting enough? Or dealing with gut dysbiosis?
Then we looked at the Bioenergetics of the mitochondria. It was mostly OK but found that there were some possible heavy metals causing blockages in the energy producing cycle. Look at the photo in the right lower part of the Citric Acid Cycle where Isocitric Acid is a bit high and alpha-ketoglutaric acid is almost non-existent! Then look at the mineral that blocks that…Aluminum!! So where on earth is THAT coming from? Likely from all the shots I got over the years… use of aluminum cookware during backpacking over the years…who knows where else. Then look at how low Succinic acid is…not detectable! The metals that can be responsible for this are mercury (I have had a LOT of amalgam fillings over the decades), and arsenic (there is arsenic in our ground water here in the Treasure Valley). There is also a lack of adequate Mg and B1, B2, and B3. B12 and folate also play a part in this portion of the cycle. So why is all this important? The Fats, Carbohydrates, and Proteins in our diet come down through the metabolic funnel at the top to provide high energy electrons via the Citric Acid Cycle (Krebs Cycle) and NADH/FADH2 out the bottom of the cycle. These high energy electrons then pass into the electron transport chain (see my previous post yesterday on how that works) whose end product is ATP. That is the energy currency of all the cells in our bodies. If we don’t make adequate ATP due to heavy metals or other toxins or lack of adequate B complex vitamin supply, we tend to be weaker, lack energy, tend to have poor exercise tolerance, and can’t fight off stress and infection well. That is why it is important!
Then we took a look at malabsorption and dysbiosis markers which did, in fact show that I was having some trouble absorbing amino acids in spite of getting plenty of protein and some trouble with mild overgrowth of yeast. These may cause some of this malabsorption. Going down to Carbohydrate and energy metabolism, we found that my elevations in the early Citric acid metabolites were likely high due to acid buildup. They were trying to counter that acidity! Remember my pH was 7.31? Then we found that another reason for the nonexistent alpha-ketoglutaric acid and succinic acid was likely from my elevated triglycerides and B12 deficiency. I forgot to mention that in my genomics, most of my B12 assimilation and utilization genes were mutated so I can’t absorb B12 well. Then going down the Neurotransmitter and vitamin markers, the consequences of low B complex and low copper were manifest. It was also very clear that I needed a LOT more folate due to my MTHFR snp… more on the order of 2-3 mg rather than 400 mcg. In the Toxin Markers section, I found that I had markers for various solvents and gasoline additives that I have worked with many years ago. It appears that as I try and “detox” myself and eat more of a ketogenic diet, these toxins are starting to leave the storage fat and into the bloodstream!! Wow! My past is coming back to bite me! I remember scrubbing various surfaces with toluene, and not being careful about getting gasoline on my hands when pouring many decades ago!
Then we finished up with a look at actual amino acid levels and other markers like GABA and glutamic acid. Several of the amino acids were on the low side. Arginine was particularly low and is important in the ammonia elimination. So, maybe this is where some of acid buildup is coming from, ammonia buildup. But where is THAT coming from? The Lysine, which, BTW, needs copper, is used for structure building, e.g. collagen. You can’t rebuild tissue without adequate lysine. Tryptophan is also low in spite of adequate intake. This, if you remember, feeds into the calming neurotransmitters like Serotonin and Melatonin. Maybe I need more of this to be able to sleep better, no? Finally notice how high the excitotoxin glutamic acid is and how low the calming gama-aminobutyric acid (GABA) neurotransmitter is? I also know from my genomics that I cannot easily convert glutamate to GABA so I do not do well eating things with MSG (monosodium glutamate).
So...What to do? Several things:
Start a major detox effort to get rid of heavy metals, mercury, aluminum, arsenic. I have made an appointment to remove my last small amalgam filling.
Add specific nutrients above and beyond my Restore Professional for 2-3 months in order to bring some of these laggards into line. This will include The B complex vitamins, Biotin, extra Mg and copper, the amino acids Arginine, Tryptophan, GABA, alphaketoglutarate, some support for detox with selenium and manganese and N-acetyl cysteine (precursor to glutathione), etc.
Increase my enzyme intake to improve my protein digestion and absorption.
Continue my S boulardii probiotic at six caps daily and try increase if I can.
Continue my regular probiotic.
I started a week ago doing fresh green smoothies daily to alkalinize my body and reduce the acidity.
Continue a generally Paleo diet and move a bit more to ketogenic to try reduce that triglyceride metabolic load.
Continue daily brief periods of exercise for range of motion and increase the aerobic portion of that exercise.
So, how to add all these supplements for the short haul? Remember back a few months ago I told you I was working on a customized supplement company in Oregon that will make a custom supplement based on MD recommendations? Well, I will be my first guinea pig! Here is the top of the page where such a concoction is created. It will have 26 different nutrients based on the results of my labwork, Nutreval, and genomic testing. I will be on this for 3 months and do a repeat on my labwork to see how well this works in correcting imbalances.
How does all this apply to you and your kiddos? Well, As we study the reports as they come back on your kids, we find various imbalances and issues and try to address them. The more tools we have, the more refined our intervention. It is still very important to do the basics, e.g. eat cleanly, organic food, clean water, get exercise, limit sugar intake, avoid processed foods and chemicals. However, as you are mostly all aware, our modern life is not doing us well. Lots of toxins; poor nutrient quality of the food supply; poor water quality; gut destruction due to antibiotics, mercury, and glyphosate; and on and on it goes. This is all on top of our genomics! No wonder we struggle so! As I have worked hard to gain access to more tools in our workups, we now have in our grasp the ability to actually address the deficits in a precise and fully customizable way. I am also working, as I have told you, on a mitochondrial cocktail that should be soon available for trial for some of you who have kiddos with decreased muscle tone, delays in oral motor skills like speech, uncoordination, etc. Stay tuned.