Know Your Numbers: How Personalized Testing Can Optimize Your Health And Reverse Disease with Pranitha Patil

Coming up on this episode of the Doctor's Pharmacy, we're fundamentally shaking up what people think about how to manage their health. Not just manage it, but get on top of it. And again, for it to be the fabric of how you live your life.

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Your age are basically just putting their head down in the sand, doing their job and never go see the doctor? Absolutely. Thanks for having me, Mark. I could not, I mean, I couldn't even begin to start with, it seems as though on the outside that all is well. I'm healthy and I'm happy and I'm radiant. But that was not always the case. My journey with health actually started at a pretty young age. I was raised as a vegetarian. You know, the concept of food as medicine was prevalent was the fabric of my family. My dad has a PhD in horticulture. My parents harvested vegetables from their garden and still do. And so that idea was instilled in me at an early age. But to be honest, my health really took a turn in my young 20s when I was off on my own. I was diagnosed with PCOS. I was given metformin for being pre-diabetic, and I had genetically high cholesterol. I soon found out that this is pretty common with South Asians, but back then I had no clue. And I knew, like, I'm 25.

Why do I have this stuff, right?

Correct. Yeah, 20, 20. Yeah. They told me, actually, my physician told me when I got my cholesterol checked that I was too young to be given statins, but my cholesterol was that high that I should have been given statins. So it was it was kind of a whirlwind for me. And and I didn't really know what to do. I knew that the care and the oversight that I was receiving could have been better though, like fundamentally. So I began running experiments on myself, you know, testing my blood, tracking it in a spreadsheet, seeing how I improved by doing this thing for six months or didn't improve by doing something else. And also I was in my 20s, I was in college, I was living my life. So I had that juxtaposition of really trying to care for my health and also enjoy my young 20s. And so flash forward after those diagnoses, I became a healthcare consultant. And as you might know, consulting means you're traveling. And once again, I was not- Even.

The healthy life, right? Eating at airports and staying in hotels, right? Yeah.

Justifying takeout, you know, five times a week because you're in a hotel. working or you're in another state working. And I realized that if I continued this job, that my health was just going to continue down this trajectory. So I decided to actually go back to grad school and try to reset and think about how I wanted to work in healthcare. Because as a consultant, I did work in healthcare. I worked in hospital systems. I worked with payers. And I realized how much I wanted to work within healthcare. I just figured out that if I wanted to make a change, I think I needed to work a little bit outside of the system itself to start to enact some change.

You mean healthcare doesn't change on a dime and just revolutionize its practice overnight?

Exactly.

Take advantage of all the science that was discovered yesterday, today. You mean it doesn't do that?

No, shockingly, no. Exactly. So for me, it was a revolutionary time of taking a step back and saying, okay, what do I want to do? And I went to grad school thinking that was going to solve my problems and I was going to make a change there. And to some people, it really does that. But for me, I started grad school in the middle of COVID I actually met Jonathan, our co-founder, while I was on campus through a friend. You know, the idea of function, it was a seed. It was this idea of, hey, what about providing people with data about their health and what's going on inside instead of using symptoms when we go to the doctor's office?

-Yeah.

-And that was the origin story of not just Jonathan and I's relationship, but the start of function and how we got engaged with you and the rest of our co-founders. And you know what, frankly, I'm a function member. I am not a clinician. I'm still learning, even though I'm a co-founder, and I'm still learning in this conversation, which was what makes me so excited about being able to sit down with you and just chat, not just about my health, but the health of some of our members, the health of people I know in my life, and how these biomarkers can really fundamentally shift how we think about our biology and our ever-changing health.

Yeah, it's just great. It's great. You know, essentially, when you talk about the symptoms, most of medicine is amazing. Like, oh, you got this symptom, you got that symptom. Let's do this. And it's, it's not really taking a deep dive into what's happening underneath. And, I mean, up until now, we really haven't had the ability to do this really well. And, you know, doctors can order lab tests, but, you know, they typically are pre-stayed and people get a typical CBC chem screen and a cholesterol test, and they say, oh, you're fine. Everything's great. Well, those tests don't go abnormal until you're basically in the hospital. And, there's so much more to know about what's going on underneath. And now, with wearables and, you know, Oura rings and Apple Watch and a Garmin and this and that, Zoo Whoop and, you know, Fitbits, we actually are starting to get data about ourselves. It's fasting. People are tracking their sleep and they're tracking their heart rate variability and their exercise patterns, their VO2 max, their oxygen saturation, their body temperature on their devices. But, that's just the tip of the iceberg. What's really going on underneath the hood really matters, which is you're underlying biomarkers. And, you know, typically in medicine, you know, we're taught that we should only do testing when people have a problem. I think the truth is we need to start thinking about things proactively, preventatively, in a personalized way, understanding how we're all unique and different. And the only way to do that is to get our own data and to find out what's really going on underneath. And that's, that's what's so beautiful about function is we actually, for the first time, are giving people an opportunity to do that. And it's backed by science, it's backed by the evidence is out there, but often evidence that's not incorporated into medical practice. It takes about 17 years on average for time we discover something, a time it's in practice. You know, I was just, unfortunately, I was talking to this incredible scientist, Ronald Krauss, not that was unfortunate I was talking about what he was saying, which is so sad. He's like in his 70s, I don't know, he's 80 now. But, you know, about 40 years ago, he discovered that, you know, our typical cholesterol profile just is not doing the job. and that our way of thinking about it is wrong, and that we actually can look at a more sophisticated way of looking at cholesterol through LDL particle number, particle size, one of the important tests that we offer through Function Health. And so I said to him, so, Ron, you've been doing this for 40 years. What percentage of cholesterol tests done now by doctors use this Cardio IQ and this NMR test from LabCorp? He goes, well, I think it might be 1%. And I'm like, maybe less, you know, and I'm like, this is just criminal because there's really no other way to look at your cholesterol in the 21st century. You know, it's like, it's like, it's like trying to do, you know, like an x-ray from 1910 to know what's going on in your brain rather than a, you know, functional MRI. Like, we have the technology, we just don't use it. So that's really what function tries to do, is bring the Leading Edge research into an easy to access platform where you can take control of your health so you can not just know what your numbers are, what lifestyle changes you can make, what supplements may be helpful. You can be actually advocate for your health by knowing and being informed with the right information. It's really a very robust roadmap for people to own their own health because, you know, 80% of health does not happen in the doctor's office or maybe 90. It happens in the kitchen, in the grocery store, you know, when you're running with your running shoes and your bedroom and, you know, and all these really things that we have tremendous control over, which is our environment, our lifestyle, which drive most of our our health challenges today, which is chronic disease.

-Couldn'T agree more. And this idea of, you know, nobody actually wants to be in the doctor's office time and time again. We love our doctors and we respect them deeply. But, yeah, we want to be empowered to be at home and make these decisions on vacation and make the good decisions. You know, all of that is so critical to how we think about health. And if it can be less of this, Oh, I'm sick. I have to get health. It's not like, no, this is the fabric of every day. Your health can change your life. And that's what's so exciting about function is it gives you that information. Yeah.

You know, what's sort of interesting is that people think, oh, you know, I'm young. I'm not going to have any issues. Maybe when I'm 50 or 60 or whatever, I'll get serious and start going to the doctor. But, you know, it's been shocking to see that, you know, a lot of our customer base is the degree to which even in a very young apparently, quote, healthy population and people who are proactive about their health, the number of things we're finding that are way out of whack, whether it's their lipids or their nutrient levels or heavy metals or their hormones or their, you know, we're finding things like, you know, pituitary tumors and cancers and things that just people aren't looking for, but that are literally saving lives and, and are doing in a way that is empowering people and being proactive, that, that allows them to not actually have to suffer the consequences.

Of something that would have been ignored for decades. And don't get me wrong, it can be anxiety inducing, right? Like, I'd love to talk about that because I've had the same thing. I get back my function results and it's like 30 biomarkers are out of range. And, you know, you're like, oh my goodness, okay, let me dive in. So I'd love to actually to dive into how you would advise somebody if they're feeling anxious. or, you know, how can I shift all of these overnight? Because I know it's not an overnight solution.

No, I think that's right. And I want to answer that question first. And then second, I really want to explain like why, why this is so important to me.

Yeah, let's get back to that.

Yeah. Because, you know, I think, you know, people get the results and they go, ah, what am I going to do? But, but the beautiful thing about function is it provides really detailed explanations of what it means. And the reality is that most of the things that we're finding are things that are highly modifiable, like highly modifiable. If you're low, like, for example, we just did something the other day, his vitamin D was like 20 and they're constantly getting sick with the flu and colds and infections and, and covid. And you take a vitamin D pill every day and then you can recheck and see your level. Although some people might need, for example, 5 000, some might need 2 000. Some people might need 10 000 based on their genetics and vitamin D receptors and the genetics variation of absorption of vitamin D. So there's a lot of variability in the population. It's like one size fits all. So some of those things are super easy fixes. Other things might be a little more challenging. Maybe you have, for example, a genetic test for ApoE4, which puts you at risk for Alzheimer's. Doesn't mean you're going to get it, but it means you probably need a more rigorous evaluation to see what is going on with your biology that you can modify to reduce your risk. You know, what dietary changes do you need? How do you need to exercise differently? What about heavy metals? Should you be looking at that? How do you optimize your gut microbiome? You know, how do you make sure you take care of your mitochondria? How to reduce inflammation in your body? So sometimes it's a little more complicated, but they're not things that unachievable. They're things that each one of us can do. When you look at what happened at the turn of the century, I remember studying William Osler, who was one of the fathers of modern medicine, who was a Johns Hopkins physician, and he was a philosopher, an incredible physician, wrote the first textbook of physiology and internal medicine. And he would tell these stories of how there was a heart attack patient in 1910 on the ward, and everybody would come running, the residents, the medical students, the doctors, the attendings. This is this rare case. It was like if someone saw syphilis today or measles like, oh wow, I've never seen that. Let's go run and see those cases because it just didn't happen very much. So, I think a lot of what we're suffering today is just optional. And that's really what Function Health is about.

I think that's amazing. That's amazing. I would love to actually learn a little bit about your journey. And obviously there was a large life and journey in medicine prior to Function. So, when we met, You know, you were you were you're you're Dr. Mike Heinman, the director of functional medicine. But take us back to the beginning. What was it that sparked this interest in you that created this lifelong journey for you?

Well, to be honest with you, I've had this dream for function for the last 25 years. I mean, it just the technology wasn't there. The internet was barely there. AI wasn't there. Machine learning wasn't there. The low cost of biomarkers wasn't there. You know, you know, when I bought my first calculator, it was like $150 and all I did was add some and now I can get a supercomputer for $150. I think I just bought a five terabyte hard drive for like $170. And my first computer was $3,500 with four megabytes of hard drive. So I think the prices are coming down. And I've had this vision for years of democratizing healthcare, of decentralizing healthcare, of giving people agency over their own health, of ending needless suffering for millions of people through the power of functional medicine and the power of people owning their own health data and through the power of using the technology of machine learning and AI to make sense of so much information. There's like 9 million articles on PubMed, you know, so when your doctor says, well, there's no evidence for that, have you read all 9 million articles? You know, like, no.

So that's impossible to, right?

I mean, you can't. I'm up to about, you know, 5,300,472 articles, but no, I can't be report on this tomorrow. But no, it's a joke, right? It's a joke. And I think, you know, doctors are busy. They're, you know, seeing 30 patients a day. I mean, they don't have much time to read articles and read papers and look at this literature and keep up to date. And it's tough. And so my, my dream has always been to actually make, you know, what I do accessible to millions. You know, I've been able to be very lucky and had the opportunity to work at Canyon Ranch and through my own practice in a Cleveland clinic and to see literally millions and millions of biomarkers on thousands and thousands and thousands of people and learn so much about what's going on under the hood and what we should be looking at and we should be testing. You know, the things that are included in the function are not things that the doctors usually check for. You know, maybe some more checking more and more, but most doctors don't check lipoprotein fractionation. Most sectors don't check ApoB. Most doctors don't check homocysteine. Most doctors don't check vitamin D. Most doctors don't check the right type of hormone testing. There's so much else going on there that they haven't even paid attention to. So I think I'm just so excited to be part of Function Health because it's Fulfilling the dream I've had my whole life, which is how do we get people access to their own health data in ways that are actionable, that transform their health and take advantage of the latest science and do it in a way that's seamless, easy, fun, affordable, and accessible to everybody. Amazing.

And why do you think it is that doctors are not doing comprehensive testing generally?

Well, you know, my daughter's in medical school now. We just had a conversation about this because we get trained brainwashed. I wouldn't say trained. We get brainwashed. So, don't order any test unless there's a specific indication. You want to minimize that and you want to just only do testing when there's something you're going to try to confirm. You know, let's say you think someone's in heart failure, so you do a pro BNP level or you think someone's having a heart attack, so you do a troponin level or you think someone might be anemic based on their history, so you do a CBC, but you don't want to test anything unless there's a problem because, well, first of all, it's expensive. Second of all, who knows what you might find and you get on a wild goose chase that you don't want to be on. And it's kind of like a bit of an arrogant view in my view. I used to work with Human Longevity Institute, which is a great organization that created this deep testing for people. So they would get their genome sequence, their microbiome, they get all this imaging, they would get tons of lab work done. And then they would get this giant binder like this big and they would go like, what do I do with that? And they would try to help them there, but they just didn't have the expertise. And so they would send them to me and I would look through these thousands of pages of stuff and I would put it through my little, you know, I wouldn't call it supercomputer, but you know, whatever's in there between my ears and kind of see what's going on. And I would, you know, it was like, oh, this is the pattern. This is the story. This is the thing. And then I could tell the story based on that. But I'm just one guy and I just you know, have one level of expertise. I mean, it's a lot given I've been doing this for 30 years and I've been studying really hard and working hard and seen thousands, thousands of patients. But it's not what we need to be doing right now because we can access, you know, enormous amounts of scientific evidence and integrate it into a learning system that will give you information about your health in a ranked order priority with literally millions of bits of data. I mean, not just a hundred, or a thousand, but literally millions of bits of data. So that's coming down the pike. We're not quite there. We're building the foundation. We'll get there, everybody. But this is coming.

Exactly. And one big idea to add to that is we, Function, is looking to build a new approach to managing your health. We're fundamentally shaking up what people think about how to manage their health. not just manage it, but get on top of it. And again, for it to be the fabric of how you live your life. We're starting with diagnostic lab testing and our goal is to give people the access to these tests. That's an exciting space that we're heading into.

That's true. And to me, you know, Pranita, it's not just about managing your health and some things you have to manage, but it's actually about resolving the problems. You know, I don't want to manage chronic disease. I want to cure diabetes. I want to cure people's autoimmune disease. I want to cure their digestive problems. I want to get rid of their migraines. I want to get rid of their asthma. I want to get rid of their sinus. It's like, you know, We often do what we know how to do, you know, the old adage is if everything, if you only have a hammer, everything looks like a nail, right? And so doctors typically have their hammer and then everything looks like a nail. So if you're an expert in, let's say, endocrinology, but you know nothing about nutrition, you're gonna focus on, you know, using pharmacology rather than food, which is the best way to deal with endocrinological problems, right? Or, you know, if you, if you're, you know, the other, the other joke I often tell is, you know, like, it's knowing what to do, right? You know, this one doctor takes out this guy's appendix and he sends him a bill for $1,000 and the patient goes, wow, that's a lot of money for such a simple operation. The doctor goes, yeah, yeah, you're right, I'm gonna send you a new bill. So he sends him a new bill and the new bill says, taking out your appendix, $1. Knowing what needs to be taken out, $999. And so, you know, I think that's the key is how do we get to that place where we are actually getting the right instructions about what's going on with their biology rather than, oh, don't worry about it. For example, like if you go to like a, some conventional labs, their reference range for vitamin D may be as low as 20, right? 20. Sometimes it's 30. 30 is usually the cutoff for most, but 20, see? Now, if you look at the data on vitamin D, you know, the optimum levels are 45 or 50 or more. And, and so how does it come up with that? Well, you know, the way I explain is if you were, if you were a Martian, and you landed in America today, it would be normal to think that all humans are overweight because 75% of Americans are overweight, right? So it's like if you were to do the kind of normal, normal is just a statistical term, which means two standard deviations from the mean, right? So basically the outliers get cut off 2% on either side and then everybody else is normal. But that's ridiculous, right? If your level of a vitamin D is 20 and that's considered normal. It's because we all live and work inside. But if you were go to like go back, you know, 150 years and go to the Native Americans who are running around all day outside and lived and worked outside, their vitamin D levels are probably 60, 70 or 80. But that's because they had a very different life. Right. But we can say, well, it's normal to have a vitamin D of 20. That's ridiculous. So a lot of the reference ranges we share are, are what the conventional cutoffs are. But we go, well, that's That's okay. That's normal, but that's not optimal. So the question is how do you.

Optimize your health, not just manage your health? I love it. I love that clarification. Thank you. I couldn't agree more because we spend so much time comparing to reference ranges prior to, I mean, prior to me knowing about function, right? I was like, yeah, cool. I'm good. Check, check. And then you don't have to see me. Then, you know, the doctor says something like, you don't have to see me for the next one year or two years. But no way, look under the hood. There's definitely stuff going wrong. So, yeah.

Or like testosterone. That's another one. So, guys coming in with testosterone, like my testosterone, it was like 35-year-old with a testosterone of like 350. And it's in the normal range. My doctor said my testosterone is normal.

It's like, yeah, it's normal for an 80-year-old. But who's gonna tell you that, right? Who's gonna tell you that?

No one. Because for them, you're comparing it against a reference range. For the physician, I mean, that's what.

They have to go off of for now. Hey everyone, it's Dr. Mark.

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That's one and a zero. I love it. I'd love to continue with a few things here. Two questions for you, actually.

One is- well, you're going to have.

More than two questions, actually. It's fine. Well, I have definitely more than two questions. What do you say to those who are concerned that function is promoting over testing?

This might sound really arrogant, but I'm just going to quote Max Planck, who's a famous physicist. He said, Science does not advance by convincing your opponents and helping them see the light, but because they eventually die and a new generation grows up that's familiar with it. So essentially, science advances one funeral at a time. Oh, man.

Oh, man. That is pretty brutal.

I told you it was rough. But, but what I would say is this, you know, we're in a revolution in healthcare right now. And, you know, I just had a conversation with Leroy Hood, who founded the Institute for Systems Biology, who's, was one of the guys who helped design the technology that decoded the human genome. He's just like, he won the Lasker Prize. I mean, he's just like a, a giant in science. And, you know, he's painting a picture of a new vision of, of medicine. He, he wrote a book with my friend Nathan Price called the Art of Scientific Wellness. And it's about understanding what's really going on at a deep level and not just waiting till something goes wrong. and, and, and fixing it, right? I mean, we go take our car and get an oil change. We, we rotate our tires. We get new tires when we need to. We change the spark plugs. We get a tune-up like, we know we're supposed to do all that for our car if we want to keep it running. But for the human body, we go, oh, geez, wait till the, the engine falls out or wait till the radiator runs out of water. Wait, wait till your oil is zero. And then, you know, and then we'll do something. And so I would say, you know, there, there is, there is no time that's too soon to check what's going on with your health. You know, we, for example, in medicine, did a large trial called the Bogalusa Heart Study. And this was done in children in Louisiana, Bogalusa, Bogalusa, Bogalusa, Louisiana. It was a mouthful. Okay. And the Bogalusa Heart Study essentially found that they could track teenagers and their biomarkers, their cholesterol, their blood sugar, their weight, their blood pressure, and even they were able to look inside their arteries and they found that they had early plaque even as teenagers and that they could predict where they were going to end up and how soon they were going to die and what their death and complications and disease they were going to get by what was going on when they were teenagers. So from my perspective, you know, we are in a reactive form of medicine as opposed to a proactive form of medicine. and I have always been an advocate of actually understanding the disease is not just something that is an on or off switch, right? If your blood sugar is 120 and 126 is diabetes, it doesn't mean that that's okay, right? You might start being worried when it's 85 or 86 or 87, even though that's totally, quote, normal, right? Up to 100 is considered normal. It used to be 110. Blood sugar used to be like, you know, One 140 was diabetic, now it's 126. But basically, we are understanding that there's derangements in our biology that occur across a continuum of our life. And then if we wait till late stages to find out what's going on, it's often too late. Or often, as Benjamin Franklin said, it takes a pound of cure instead of an ounce of prevention. What you do early on makes a huge difference down the road. If you put in $10,000 in your retirement account when you're one year old, you know, it's going to be better than if you put it in when you're 30 or 40 or 50 years old, right? It's the compounding interest on your health is huge. So, you know, we need to understand that the earlier we intervene, the easier it's going to be. It's not that we can't help people when they get to a late stage of disease. It's just a lot more work, you know? Yeah.

And there's less time theoretically, right? It's the sooner you start, the more time you have to build this into your lifestyle. Exactly.

Yeah.

Okay. And then next question we talked about a little bit about it is what's your vision for that when you think about function and making sure that we're not creating a population of hypochondriacs with function testing?

Well, I think, look, first thing is, you know, just because you don't know what's going on doesn't mean it's not an issue, right? Exactly. You know, like if your vitamin needs 10 and you don't know it, it doesn't mean it's not hurting you, right? So it's important to find out so you can be proactive and fix it. But I also think that, that I think about it this way. Imagine having the smartest doctor in the world in your pocket, informing you about everything that's going on in your body. My friend Chris Garra had cancer when she was about 30, and it was a rare cancer, and she was about 30, and she was pretty freaked out about it. But then she got religion, and she basically started a new company, which was Save My Ass Technologies, Inc. And so I think we all need to form our own companies and Save Our Ass Technologies, Inc. so that we can be advocates for our health. And it doesn't mean we don't need to ask experts. It doesn't mean we don't need another opinion. I mean, I mean, we do say this is concerning. Go do these follow-up tests. Go see this conventional doctor because they're going to be able to do this kind of test. You know, I, I talked to someone yesterday who was like, Mercury was 30, which is insane. I mean, and she's like, well, I don't even tuna. I don't eat big fish. I know what's going on. I'm like, well, you probably have a few things. One, you genetically not be able to detoxify to you might be in things you don't realize or I had mercury and, you know, for you need to get further testing to look at a challenge to see what's really stored in your body. And five, you need a roadmap once you find out that information. And that's what function provides. So in a way, it's kind of a way to create less anxiety for people because they're actually getting a roadmap.

I think that's a fantastic, that's a fantastic take. And I couldn't agree with it more. and honestly, this conversation and the ones that we have with function leadership and how we're growing is, it's really creating the greatest way to understand your health that's ever existed. And that's why a conversation with you is so exciting to just start to get the word out that function is here and function is here to help you. So it's, it's really exciting to be in this moment. I would love to spend the rest of our conversation, and we started tapping into it for sure already, diving into the categories of biomarkers that function tests. You know, me and you and Jonathan and Mike spent a lot of time thinking about what tests to include for the function membership. We went back and forth. What are the most comprehensive set of tests so we can include for our membership that is also maintaining the fact that it's accessible. The big thing for us is how do we make this as accessible as possible? You know, folks have folks who have wealth have access to this testing, and we want to make sure that function can be used by the average individual. Ultimately, that's our goal. So would love to dive into this and cover by category what we test and why it's important. And I'll pepper in some questions and thoughts and dialogue along the way. So let's start with heart, because I think cardiovascular health is a big one, not only for our members, but for all of America. Can you talk about the importance of this test? We briefly touched on it and, and honestly, not just the importance of it, but what to do when you get a number that is astronomically high and you see that number, what do you do about it?

We touched on this a little bit when I mentioned Ron Krause, who was the discoverer of this phenomena of there being different types of lipid particles, not just LDL, HDL and so forth, triglycerides, but, like, subtypes. Is it large cholesterol LDL? Is it small? You know, what type of HDL? Is it large? Is it small? What type of triglycerides? Large or small? And, and it turns out that that's far more important and far better predictor of what's going on inside your body in terms of your cardiac risk. And, and it's not what most doctors test. As I mentioned, I think he said maybe 1% or less of doctors across the country, including cardiologists, are ordering this. And it's just shocking to me because it's like, well, this is available and it's, it's like, it's not that much different in price than just a regular cholesterol panel. It's like pretty much apples and oranges now. The prices come down so much. So, you know, what we're finding is that the most important biomarkers for heart disease are mostly ignored. There are things that I've been doing as a functional medicine doctor for 30 years, right? Because this was discovered 40 years ago and I heard about it. I'm like, this is the greatest thing. I'm gonna start doing it. You can get it through conventional labs before you couldn't. And one of the most important biomarkers is what we call lipoprotein fractionation. So essentially think about your cholesterol number that you get when you go to your regular doctor being the weight of your cholesterol. It's like milligrams per deciliter. How many milligrams of cholesterol is there in a tenth of a liter of your blood? Okay, fair enough. What does that mean though? Is it made up of a thousand little tiny BBs that are going to damage your arteries, these small cholesterol particles, or is it like a hundred big fluffy beach balls that bounce off and don't cause any problem? Well, there's no way to know that. looking at your regular cholesterol number. In fact, 75% of people who end up in the heart attack with an end up with a heart attack in an emergency room have normal, quote, normal total cholesterol.

Right.

So what is going on? Well, it's the quality of the cholesterol. You could have a cholesterol of 70 or 80, which are LDL of 70 or 80, or a cholesterol of 150, but have like a thousand or 2000 small LDL particles. And that's an enormous risk. So it's a better way of determining what's going on. And it determines also your metabolic health. so, you know, we always say, you know, people have poor metabolism or poor metabolic Health. What does that actually mean? It means you have trouble regulating your blood sugar, that you're on the spectrum of pre-diabetes to type two diabetes. And, and you think of cholesterol being related to fat and saturated fat, but actually most of your bad cholesterol is driven by sugar and starch, not fat. Now, saturated fat does raise LDL, but actually increases the light, fluffy ones. not the dangerous small ones. The dangerous small ones are caused by sugar and starch. So it's really important to get the right type of cholesterol panel, including this lipoprotein fractionation. And the second is a test called ApoB. ApoB is kind of a particle that collects all the bad cholesterol. So it's a reflection of how much of these small particles you have about a little bit about triglycerides. And so basically it gives you a sense of you know, what your kind of real risk is. So I think this is one of the most important tests to look at your cardiac risk is your ApoB high or low. What about your lipoprotein A? That's another one. And by the way, these are modifiable through lifestyle for the most part. You know, ApoB can be lowered by eating more walnuts, by tons of fish oil, by exercise, by getting enough sleep. If you're, if you're having six hours sleep or less, you're almost having twice the, the number of ApoB. that you would if you're getting eight hours of sleep. So there's a lot of things you can do to modify these things. There's another one called lipoprotein little A. It's a more of a genetic marker, but it's really important. If that's high, your risk is higher and it helps inform decisions about what to do. We also look at your triglycerides, your HDL, also HDL size, and also inflammation because inflammation turns out is one of the biggest risk factors for heart disease. If your cholesterol is abnormal, but you don't have inflammation, it's not as big of a risk. So I think we look at all these biomarkers and then even, I mean, look, I, I don't, I don't like separating out heart and metabolic. I call it cardiometabolic disease because it's one thing. Right. So we also, when you include that, there's a lot, even a lot more biomarkers. We look at insulin, we look at blood sugar, we look at A1C, we look at uric acid, we look at fatty liver test. We look at a lot of biomarkers that aren't typically looked at, including leptin and other things that are highly predictive of your cardiac risk. And that are one, are the things that in a pattern correlated with heart disease, you know, more than just your cholesterol alone. So it's really important to look at all these factors. What was really amazing is that, you know, many members, and again, you know, our subset is relatively young and healthy, right? So this is not people who are smokers and people who are overweight typically, or who are, you know, struggling with their health in, in many ways. These are people who are, you know, proactive and engaged and, you know, early adopters and yet 50% of them had really bad lipid particle size, which is really bad. Also, many had inflammation they didn't know about. So it's really important to look at all these factors and then come up with a roadmap. It's really not that hard to fix. A lot of it can be fixed through diet and lifestyle. For those who maybe have some genetic disorders, they may need some other kinds of things. You know, I had a patient the day who had a high ApoB, high LPA, high lipid particle number, small particles. but everything else about his health was ideal. And he might have some genetic weird thing that I don't even know we even know about, but his arteries were clean when they did a special follow-up scan. So based on those tests, I said, you need a. An imaging test that looks at not just a coronary angiogram with a CT scan, which we now do, but using AI to interpret it. And that allows us to look at soft plaque. And he had none, which is like, well, wait a minute. You know, if your arteries are clean, do you need a statin? Do you need a drug? Probably not. So there's lots of ways that this information informs. our decisions and then tells you what to do next.

Dr. Absolutely. And pairing that with metabolic, I think, is a great call out. You know, we could talk about metabolic and cardiovascular health for an hour and a half or five episodes at this point, just because of how important this one is. I did have a specific question thinking about folks who do have type 2 diabetes, you know, folks who do come into function with a chronic condition. How do you think about of putting type two diabetes into remission. I think a lot of folks come in and their doctor's like, Hey, this is a lifelong thing. Good luck. That's, you know, that's the average conversation around it. So I want to just dive in a little bit into type two just because we do have members who come in with existing chronic conditions and they're interested in a different opinion on how to take care of this.

Absolutely. You know, look, my training in medical school was that if you get type two diabetes is a one way street and you have to manage the disease, which means you need to take medications, maybe insulin, try a little diet and lifestyle. But basically, you know, there was no going back, right? Once you crossed that threshold, that was it. And what's really exciting about the scientific literature is it constantly challenges orthodoxy and particularly in terms of diabetes. And, for example, you know, we're seeing such a degree of poor metabolic health in this country that it's terrifying to me. You know, when I was born there, I think there were less than five percent of the population was, was obese. Now it's 42%. That's an eight-fold plus increase. And in just my lifetime, we, we, you know, had really unusually low rates of type two diabetes, you know, 50 years ago or 60 years ago. Now it's one in 10 Americans, one in four teenage boys have pre-diabetes or type two diabetes. Now, when I was in medical school, I know I'm old, but not that old. You know, like, I mean, then we didn't have a term for this. It was called juvenile diabetes and adult onset diabetes. So what did you call a 10 year old or a 12 year old or a 15 year old that got type 2 diabetes? We called it adult onset, but we had to change the name to type one and type two. That's what happened. Right. And, and now we're seeing kids as young as two or three, and we see now, now, depending on the criteria, I, I use a little bit broader criteria, but. 50%, conservatively 50% of Americans have either pre-diabetes or type 2 diabetes, meaning they are really in trouble. And then in addition to that, 93%, or actually 93.2 to be exact, percent of Americans are in poor metabolic health. What does that mean? It means they're somewhere in that continuum. They either have high cholesterol, high blood sugar, high blood pressure, which are all basically the same problem. They're overweight, or they've already had a heart attack or stroke. So if you've met those five criteria, you're in poor metabolic health and it's 93% of Americans. So they're basically everybody except a few of us out there have this problem. And, and what we were taught was that there's no way to actually fix this. You just have to manage it. I had one patient who came in and their blood sugar was like 118 or something. I'm like, hey, have you seen your doctor about this? And they're like, yeah. I said, what do they say? He says, well, you know, he said, wait till it gets to be like 126, and then I, I, he'll give me medication for diabetes. And I'm like, what? You know, and I, and I think, you know, we now have studies, for example, that have shown that a ketogenic diet in advanced type two diabetics can completely reverse type two diabetes by 60% of cases, can get a hundred percent of people off the main diabetes medication, can get over 90 plus percent of people off insulin. causes a drop in A1C more than any other intervention and leads to an average, an average weight loss of 12%, which is a massive result. I mean, you think, you know, that sounds, sounds like a lot, but actually, if you have a weight loss study with a 5% weight loss, that's like a miracle drug, right? So this is, this is really impressive stuff using, for example, a ketogenic diet or extremely low carbohydrate, higher fat diets. So these are completely reversible metabolic conditions for the most part. Now, some people may not be able to, but beta cells can recover, and I think we've seen this happen over and over when you get rid of the fatty infiltration by changing your diet. And basically the fatty infiltration of your liver and your pancreas, which is associated with poor metabolic health and pre-diabetes is almost entirely caused by starch and sugar, which we're eating a huge amount of, about 150 pounds of sugar and 130 pounds of flour per person every year. And, and 60 of our diet in America is Ultra processed foods. So we have such room to reverse these problems.

And I've done it over and over and over with my patients. Yeah, that's amazing. I mean, I'm one of those, right? Like, I have the full whammy. I have high cholesterol. I was pre-diabetic and given metformin. And so I know that it is possible to come down because I've done it myself. And I think it's a lot of like will and knowing that you have somebody and an advocate to say like, yes, yes, you actually can. It's possible. You're not stuck with this lifelong chronic condition and that motivating element is critical. And that's where I think function can be really, really helpful is you're getting detailed information on actionable steps you can take to address the problem.

And what's so beautiful about function health is it's a full deep dive on the conventional viewpoint of disease and health. And not just that, but you also get a different perspective based on the emerging science of systems biology, systems medicine, network medicine, functional medicine, whatever you want to call it. It's looking at the body as an ecosystem and reimagining our health in a very different way, in a proactive way. And in functional medicine, I would say, is the science of creating health as opposed to conventional medicine, which is the science of diagnosing and treating disease, which is important, but it's not the only picture here we need to be thinking about.

Yeah, absolutely. Okay, I'd love to continue the conversation moving to the thyroid. This one is an interesting one because I don't think it's measured as much until you have a problem and you go to an endocrinologist, right? so talk to me about all the thyroid tests and why somebody should be getting these tests done. Yes, super important topic.

And, you know, one in five women and one in 10 men have low thyroid function. And of those, half are not diagnosed. And of the ones who are diagnosed, I would say probably more than half are not properly treated. So that's like a lot of people suffering needlessly. And it's, you know, it's a lot of vague symptoms. You know, you may be a little tired, a little puffy, maybe you might get muscle cramps, maybe you're constipated, low sex drive. maybe a little depressed, maybe you don't sleep as well, maybe you have dry skin, maybe your nails are cracked, maybe your hair's falling out, like a lot of little things, right? And so it often gets missed. And so when you complain about these things, your doctor might say, okay, well maybe there's a thyroid problem. Let's check your thyroid and they'll check TSH, which means thyroid stimulating hormone. It's your pituitary hormone basically that goes up if your body is low in thyroid to make more. So it's telling your body to make more. And, and they go, well, if your thyroid is over five, your TSH is over five, maybe we'll consider treating you. The problem is so much gets missed because that is not the only number we should check. We need to check the other numbers that are really material to understanding what's going on with your thyroid. For example, T4, free T4, and free T3 are really important and almost never get checked. Sometimes free T4 will, but not that often until you actually have have a problem. Second is thyroid antibodies. Now, I actually started doing this probably 25 years ago because I went to a endocrinology conference at Harvard. Now, this was just conventional doctors. This was not any kind of alternative or functional medicine docs. And the endocrinologist saying, look, you know, people can have normal TSH, but if they have thyroid antibodies, it means they have this autoimmune disease and actually need to be treated. And I was like, wow, that's really interesting. So I started checking thyroid antibodies in everybody, and I was amazed to see how many people had quote normal thyroid, but had elevated thyroid antibodies, which means they had an autoimmune thyroid condition. And they're, they were in what we call subclinical hypothyroidism. Now, if you look at the literature, people with quote subclinical, meaning it's not really subclinical, they feel don't feel great. They may not have super full-blown low thyroid, but they're not feeling great. And that actually dramatically increases your risk of heart attacks, for example, if you don't have that treated. So even the American College of Endocrinology has reduced the, the threshold for TSH from five or five and a half to three and a half for being abnormal. And yet still most reference labs say five is the cutoff, which isn't actually even what the American College of Endocrinology says. My cutoff is one to two. Why? Because that's what's more optimal, right? That's what you get a better overall health profile. So I want to check all these variables and actually understand what to do about them. And it's not just say, well, I'm just going to take Synthroid. That's what doctors will typically recommend. but, you know, historically we used to use glandulars in medicine, which means this, meaning we use ground up adrenal glands or ground up thyroid from animals to actually provide as medicines. This was done, you know, in the 50s and the 30s and 40s, and, and they've kind of gone out of favor. But, but actually the best thyroid replacement is one that's a combination of your mimicking your body's own thyroid profile, which includes T3 and T4 and even something called T2. So armor thyroid, for example, or other forms. bioidentical thyroid is probably the preferred treatment. But there's also a lot of other things you need to know. What's causing it? Right? Well, God, if your thyroid's elevated, it's just like, oh, here's a thyroid pill. No, what's causing it? So if you have elevated antibodies in large percentage of those cases, it could be because of undiagnosed celiac or gluten sensitivity, non-celiac gluten sensitivity that you want to check. Or it could be because they have low selenium or low zinc or low vitamin D or low vitamin A. All of these things are important for regulating thyroid. You need to understand you need all these ingredients. You need iodine. So you should eat seaweed. You should eat Brazil nuts because they have selenium. You should have pumpkin seeds because they're high in zinc. You should actually have Omega-3 fats because they're important as well as vitamin D containing foods like porcini mushrooms, although you can't really find those that easy. Or, or herring or just take vitamin D. So it's really important to eat seaweed for iodine or fish. So there's ways to actually help your thyroid function better. and we just don't get that information. So, the beautiful thing about the platform of Function Health is that not only do you get the tests, but then you get a roadmap.

So, next up is autoimmunity. This one, I feel, is so underrated from the conversations usually with physicians. So, tell me about autoimmunity, how prevalent it is in the country, and why it's not something that so commonly tested traditionally because what we've seen even with our member base is actually a large majority of people who do come back with something in this test.

Yeah, I mean, it's shocking, Pranita, most people don't realize this, but autoimmune disease is more common than heart disease, diabetes, and cancer combined, right? There's over 80 million people walking around America with an autoimmune disease of some type. It could be Hashimoto's, a thyroid problem, it could be MS, it could be rheumatoid arthritis, could be lupus, could be inflammatory bowel disease. And, they haven't aren't thought of as one problem because each specialist takes care of their body part, right? If you've got a GI autoimmune disease, the GI doc takes care of it. If you've got a skin autoimmune disease like psoriasis, the dermatologist takes care of it, right? So, it's really gonna miss at how big of a problem this is. And, what's really important to understand is that this is not just like on and off. One day you're fine, the next day you get an autoimmune disease. There's a continuum. And just as we've identified things like pre-diabetes and pre-hypertension, now doctors, and this is conventional medicine, are recognizing there's something called pre-autoimmunity. And when you see a positive ANA or rheumatoid factor, even if you're not having a full-blown set of symptoms of rheumatoid arthritis or lupus or other things, it actually can be really revealing that you should be paying attention to something. Something is pissing off your immune system. And then you need to figure out why. Not, oh, I'm gonna take an anti-inflammatory or some kind of immune suppressant, but I'm gonna figure out why. And, and it's a short list in functional medicine, which is, it's something you're eating, right? It's bad food, processed food, something that's creating inflammation. It's potential allergies or things that are triggering a reaction in your body, like gluten, is one of the biggest ones. It could be environmental toxin, like heavy metals. and it could be also some microbes, imbalances in your gut flora, for example, leaky gut, another big factor, or Lyme disease or mold. So there's all sorts of ways to actually figure out what's causing it.

Yeah, exactly. I think that's amazing. I think it's really, really, it can be frustrating to have symptoms that don't have that label, right, of I have diabetes or I have something, and until you get the root cause of what's happening, it can be really frustrating and I feel like that's often what happens with folks who have autoimmune conditions. So this testing is looking to get under the hood and figure that out for people. Okay, so next up is a really important one to me and a lot of people that I've spoken with. It's female health, right? It's people who are going through life and they go through a few stages. women. And it's complicated, it's complex, it's emotional, and it's folks in premenopause, perimenopause, and postmenopause. And the baseline and what I've experienced is, you know, you don't really need to get anything tested until and if you want to get pregnant. And I was diagnosed with PCOS at a very early age. I had no clue what I was walking into. And, you know, was, was and have been on birth control for over 15 years now. And now I'm getting to this point where I'm interested in having conversations about fertility and of family planning. So so many folks that I've spoken with have a similar experience, right? They, they ask for these tests, they want to know more, and they get this response. Only if and when you're ready to get pregnant, this should be tested. And then There's the folks who are peri and post-menopause. And I want to talk about the stages that women go through and why this testing doesn't just stop at the reproductive fertility stage of life. It's important throughout life. And those conversations are starting and happening today, but I personally believe it's certainly not enough. And I want to be loud and take space about this one. yeah.

Well, I think that's great. I think your own experience is revealing why it's important to look at hormones throughout the life cycle. And like you mentioned, there, there's change that happens throughout the life cycle of a woman from puberty to, you know, early, you know, reproductive life in your 20s, 30s, 40s, 50s, 60s Beyond every decade, it changes. And, and it's, it's important to understand how to navigate that. And I, you know, I used to work at Canyon Ranch, and basically my entire population was, you know, mid-30s to like mid-50 patients. And so I got a real interesting perspective on women's health and really did a lot of this testing. And unfortunately, most doctors don't know really what to test for. They don't look for the right things and they're missing a lot. And so it's also matters when you test it and what you're testing. So we look at, you know, full spectrum hormone panel, including estradiol, which is estrogen, progesterone, as well as FSH and LH, which are the pituitary hormones that regulate your sex hormones. testosterone. And, and by the way, women have testosterone, too, and it affects your sex drive. We look at prolactin levels, which can, you know, be changing with life and have various impacts on your health and also pick up tumors. We picked up people with pituitary tumors from this. We also looked at something called DHA sulfate. DHEA is an adrenal hormone, but it can be high in PCOS and it can be low if you're chronically stressed and can tell you about your level of chronic stress. And also we look at something called anti-malarian hormone. which is something that's really important to look at for fertility. So the higher your number, for example, the more fertile you are. And it's an easy test to do. So I think, I think, Pranita, you know, my experience is important to track your numbers over time to do it properly and then to learn what to do about it. Because most, you know, most people don't know that your hormones are under the direction of what's going on in your life. Right. So your level of stress affects your hormones, your exposure to light and dark affects your your diet affects your hormones, high sugar processed food diets and starch screw up hormones horribly. I mean, men, for example, we talk about men in a minute, but men who eat a lot of sugar and starch end up getting big bellies, and that's because they're making more estrogen. For example, men have estrogen, women have testosterone. People don't realize that. And, and so we, we really can do so much to regulate our hormones. Exercise, you know, alcohol plays a huge role in screwing up women's hormones. It really increases estrogen and causes toxic estrogens. Also environmental toxins, there's a whole slew of things called xenoestrogens that are highly powerful and very minuscule doses have extremely potent effects and can cause all kinds of hormonal disruption. There's a beautiful book about this called Hormonal Chaos by Theo Colburn that was written years ago, but it talks about these endocrine disruptors that we have prevalent in our society. So we go through how to interpret these tests, what they mean, how do I identify what changes you can make in your lifestyle. So it really gives you a beautiful roadmap on how to do this.

Amazing. I think that's a great answer. And it's shifting gears to male health and the male hormones. Obviously, testosterone is spoken about a lot with male health. We do test for testosterone, but talk to me about the other ones and why it's important to get that holistic testing for men. because I think what I, and what I've heard not only from our members, but from, from conversations is, oh, they don't really get, they don't really know that they need to get these things tested, maybe until they're trying to do family planning or they're sensing something is off. Right. And, and that's where I think some of this testing is super important. And it also actually really links to our prior conversation around metabolic health and how your metabolic health impacts the male health hormones and how it's all connected. So yeah, I would love to hear about male health and, and how to think about these hormone testing for men.

Absolutely. It's so important. And I think, you know, most men are pretty oblivious to their health. They usually go to the doctor because their partner or their wife wants them to go, and they just kind of don't pay attention to much. But the truth is, you can tell us so much about what's going on with a man. I mean, for example, men can have very high levels of estrogen or estradiol if they're drinking too much alcohol. or if they're eating too much sugar and starch because fat tissue makes estrogen. They can actually be pre-diabetic and not know the effects on their hormones. I mean, one of the most frightening things is that this poor metabolic health is not just affecting women. And by the way, it's one of the biggest cause of infertility is poor metabolic health and pre-diabetes and insulin resistance. And PCOS is part of that. But for men too, we're seeing, you know, drops in testosterone. And when people are eating a diet that's high in starch and sugar and high in alcohol, and they get, you know, high estrogen, low testosterone, and it's kind of bad news. And their sex drive goes down. And I see this in men in their 30s and 40s. It's pretty, it's pretty concerning. So it's important to know what's going on. Also, we look at the same adrenal hormones, we look at the pituitary hormones, and it gives us a really good view of what's going on. We also looked at prolactin as well. So we get a pretty 360 view. And PSA is important, you know, as a predictor of cancer. And it's important to track your numbers, not, you know, all the time, but you want to get a baseline and you want to look at the change over time. And it's not, it's an imperfect test, but it actually, I think, is important.

A few other tests that we run are regarding stress and aging. So cortisol specifically. I would love to talk about how you, Mark Hyman, think about this because, I mean, I'm, I'm a co-founder I'm managing my stress and burnout and I just got my cortisol And it is really high. 35.

See, everybody, Pranita is working so hard to get everything for you guys.

And she's like, well, what's the irony, right? Like, I am not, I refuse to be building a healthcare startup and then impact, like negatively impacting my health. So talk to me about how you as an individual keep this at bay as a traveler, as a physician, and now a startup founder with function. How do you think about this and how do you manage this?

As an individual.

Well, thanks for asking.

I mean, I, I think it's really about learning a life skill of how to regulate and manage your stress, like anything else. Right. Cooking is a life skill. Driving a car is a life skill. Learning how to exercise is a life skill. Using a computer, your phone's a life skill. These are all life skills that we can learn. And most people have no clue that, like Dorothy, with the ruby red slippers, they have a way to access their autonomic nervous system. Now, we think stress as an automatic response in the body. And it is right. It's the fight or flight limbic system. reptile brain, and it gets activated whether we like it or not, if we're under any kind of psychological or physical stress. However, you actually can access it and change it by doing things that help to reduce that stress response, whether it's meditation or yoga or deep breathing or a hot bath or a sauna or a cold plunge or dancing to music or taking a walk in nature or making love. I mean, the list goes on and on. So you have to figure out what's your jam. I am. Like personally, you know, I love to do hot and cold therapy that just immediately changes my stress response. I make sure I get enough sleep. I meditate. I make sure I eat in a rhythmic way and I actually sleep in a rhythmic way as best I can. I mean, sometimes I can't we do that if I'm traveling, but you know, try to go to bed at the same time, wake at the same time. So get light exposure in the morning. There's all sorts of simple hacks.

When you see abnormal levels of cortisol that are too high or DHEA that's too low, Yeah, great. I gotta start them now. Okay, so moving on to immune regulation. I'm gonna go play tennis after this and hit a ball.

When I hit a yellow, when I really hit the little yellow ball really hard, my stress goes way down. Cause all I can think about is the yellow ball. Nothing else is going on. I'm running around chasing it.

It's like it's awesome. Couldn't agree more. I mean, that for me is boxing. Like when I hit box, it's like, yes, I'm like truly just punching away the stress. so it couldn't agree more. Sometimes it's good to just get out there, see the sun, you know.

Yeah.

Function members can test about nine biomarkers relating to immune regulation. How should one think about immunity and immune regulation when it comes to these tests?

Well, you know, there are very many tests to look at immune function, cytokine panels. You know, David Furman at Stanford created the 1000 Immune Project, looked at over 50 different cytokines. There's a lot of stuff that, you know, you know, we want to look at may not be available commercially yet. But, but the basic stuff you can look at your blood count, your white cells, the type of white cells all give you a sense of what's going on. So, for example, I can, I can tell if someone's, you know, potentially has a viral and chronic viral infection with a low white count or maybe has yeast overgrowth. Or if their neutrophils are low, but their lymphocytes are high, it tells me that could be viral yeast. Or if their neutrophils are high, it could be bacteria. If their eosinophils are high, they could have a parasite, or they could have, for example, allergy or so I basically got a really good robust view of what's going on. And it's a basic simple test, but most doctors don't properly know how to interpret it. So we filter it through the lens.

Of the future of medicine. And thinking about the pancreas, we test for two here, amylase and lipase. And really honestly, I've heard that nobody tests for this. Why do you think that is and.

How would you change that? I mean, I think it's good to see what's going on with your pancreatic function. A lot of people have sort of suboptimal pancreatic function and amylase and lipase are pancreatic enzymes. They typically go high in pancreatitis, and people can have low grade pancreatitis and not know it from a stone or from, you know, various kinds of, you know, inflammatory issues or autoimmune disease or potentially even cancer or from, you know, a, a, even a blackwood or spider bite can do it. Although people don't usually have that. Alcoholism, all of that can affect your, your pancreas. So I think it's, it's important to have a look at it. I think, you know, most times it's.

Going to be normal, but it's, it's a good test to and then nutrients. This is a big one. Folks want to know where they're at. Vitamin D is one that's spoken about a lot. I have a couple questions on this one is, you know, how do you think about getting these nutrients with food predominantly and then adding it on with supplements? Because I think folks are like, oh, no, I'm low in this. I have to take fistfuls of supplements. Yeah, yeah, yeah. So one, I want to get that take as well as why it's important to get all these tests for nutrients. Yeah.

I mean, first of all, most doctors do not test for nutrients. Only recently, doctors started thinking about checking vitamin D levels, and most probably don't, even though 80 of us are either, are either deficient or insufficient. And, and to me, I've been doing nutritional testing for decades, and it's one of the most fruitful areas because people find all kinds of stuff. And the most common deficiencies in America are omega-3 fatty acids over 90. folate probably over 50%, vitamin D 80%, magnesium 45%, zinc over 40%, iron probably 40%. So we see this huge amount of nutritional deficiencies even in a country that's so overweight and overfed, they're undernourished. And so we are looking at panels of tests that typically doctors don't look at. We look at essential fatty acid levels. I mean, when did you get your Omega-3 test checked recently? But over 90% of ours are deficient in this and it is the most important fat. It's in this, we call it an essential fatty acid. you don't need fats other than this particular fat. And it is involved in the cell membrane function, regulating inflammation, immunity, brain health, and so much. We look at methylation, one of the most important parts of health and longevity that affects heart disease, cancer, dementia, and DNA methylation and mood. And, I mean, the list goes on. We look at homocysteine and methionine acid, whereas most doctors will just take a folate or B12. These are much more sensitive tests. Look at what the right vitamin. I mean, I, I mean, I see people doing vitamin D levels, doctors, and they order the wrong test. There's like a 125 and a 25, and they know which one to order. And they order the wrong one. They check the box on the order slip, and it's not the right test. And you need 25 hydroxy vitamin D. Really critical zinc, magnesium. Really important. A lot of people are low in magnesium. It causes muscle cramps and all kinds of headaches, digestive issues, constipation, easy to effects, iron studies. Really important. Not just checking your your total blood count, but actually looking at your ferritin levels. If your blood count's normal, you can have a very low ferritin, which is your iron stores, but that leads to fatigue and insomnia, other kinds of issues, the immune dysregulation and many other things that you can easily treat. You can also add on tests, for example, looking at selenium and copper. So we get a really robust picture of your nutritional status. And in terms of food or supplements, look, I had a patient once who's like, I don't want to take any supplements. And she's like, I'm gonna eat five Brazil nuts a day because that'll give me my selenium I'm going to have 27 pumpkin seeds. I'm going to eat three cups of beans because I'm going to get enough magnesium from that. And, I'm going to eat a little bit crazy, but she did it. I think most people are not able to do that. And, our diet is also different. I mean, the nutritional density of our food, even the same broccoli today from 50 years ago is far less nutrient dense because of how we're growing the food and the depletion of our soils and the damage in the organic matter. So, I think some people do need supplements, but a lot of times you can just be guided on what are the best foods. For example, you can get, you know, methylating nutrients from having dark green leafy vegetables. You can get vitamin D from having fatty fish like mackerel and herring. You can get magnesium from beans and greens and nuts and seeds. You can get zinc from things like pumpkin seeds and oysters. You can get Omega-3s from mackerel and salmon and herring, and you can get iron from, you know, meat and so forth.

So there's a lot of ways to get these things. Selenium from Brazil nuts.

So we can guide you on what to do, but you may need supplements.

Yeah, that's great. I think that makes a ton of sense. It's refreshing to know that, yes, you can use food and you might need supplements. I'm a vegan, so for me, this one's a really important one. My omegas are low. I always have to take supplements for this stuff. So it's important to know that you can use food and you might need supplements if you're not perfect about the food that you're eating. to get this information and get this food into your body. All right, next up is liver and kidney. What should we know when it comes to our liver and kidney health on an ongoing basis? Great question.

So kidneys are, you know, important to check for. And I pick up a lot of people with marginal kidney function. And by the time your kidney function starts to go up, it's often, you know, you've already lost half your kidney function. So it's important to track this regularly and early. I had someone, for example, who didn't check it for a while and ended up having high uric acid from stones and it screwed up his kidney and he almost had kidney failure because of it. So, it's important to check, but it's not going to be typically abnormal that much. If you're dehydrated, it might show that. Liver function, on the other hand, is important because ALT, which is a really important one, and particularly GGT, these are really sensitive indicators of fatty liver. and when you look at the reference range, it's really wide, but it's up to 50. Maybe it's probably 25 should be optimal. So, when you get from 25 and 50, you're already starting to get fatty liver and you can actually do things about it. And fatty liver affects over 90 million Americans. It's one of the most prevalent conditions as part of the poor metabolic health thing we talked about, pre-diabetes, really important. And GGT is very important too, which most doctors don't check as part of a normal liver panel because it's I don't know why, but they don't. But it's a very sensitive indicator of exposure to environmental toxins, alcoholic liver disease, and also metabolic disease like fatty liver. So really important. And I think these are, these are critical. And kidneys tests also important, like looking at urine protein. A lot of people don't look at microalbumin, but people have high blood pressure, if they've had diabetes or other issues, you know, they might not have abnormal liver fun, kidney function tests, but they might have early protein in their urine. And that's huge clue that they got to get on the ball and and fix their kidneys. Then of course looking at electrolytes is important, making sure you're balanced there. So I think, I think, you know.

Keeping our liver and kidneys healthy is pretty important. I wanted to cover a few more tests here that we offer. These are add-ons on top of the standard function membership available for an additional cost. The first one is our multi-cancer detection test that we offer through our partner GRAIL. It's called the Gallery Test by GRAIL and it tests for cancer signals of over 50 types of cancers. And we have actually had, you know, a handful of people who have tested positive from this test, and some of them have been totally asymptomatic. So, this is one that we fundamentally believe that everybody deserves and has proven to be a important test. I'd love to hear your thoughts on getting this test. This is an add-on for our function membership.

Dr. Yeah, I mean, look, the cancer screening has been in the dark ages for a long time. I mean, you can do a test. You can do a mammogram, you can do a colonoscopy, you can get a PSA. Yeah, that's about it. I mean, you know, some doctors will maybe check cancer markers and something in the blood and. But it's basically pretty, pretty old school. New Technologies emerge where we can actually look at sort of little fragments of DNA from various cancers that show up in the blood. We call this a liquid. biopsy. And it's not perfect. The test is, the technology is still improving. But now we can look at over 50 cancers that are really common. We can pick them up at extremely early stage, 75 of the time. It covers about 60 of all cancers, but, but most of the most important common ones. And it's something you can do something about. So I, I, for example, had a, a great story, actually, of someone who did this. She'd had breast cancer. She treated. Her doctor said on her recent visit, after five years, she was clear. Everything was fine. But we said, why don't we just do this test? And she did it, and it showed positive. So she immediately got a PET scan, found out she had some lymph nodes in her chest. We got her early treatment, and now she's completely clear. So I think, you know, this saves lives in ways that, you know, we're just beginning to understand. Now, it's still imperfect, and some con colleges are not super fans of it, but I think if you understand what to do with it and how to interpret It's really important. There may be false negatives. In other words, you may have a cancer and may never pick it up, but it gets it about 75% of the time. But there are very few false positives. If it's positive, there's something going on. And it tells you not only that you have something, but where it's coming from and what type of cancer it is. So that's really good. Yeah.

Exactly. It's the source of the cancer. So it's not diagnosing that you have cancer. It is saying, Hey, there's something going on here. You need to follow up and it shows you the cancer signal. of origin with this test. So we really, we really do love this partnership and are excited about this test. Okay, a couple more add-ons here. Heavy metals. Why should people be thinking about heavy metals?

Well, I mean, I had mercury poisoning and it's a mess. If you can get mercury poisoning, it's not fun. And I, you know, ate tons of sushi, lived in China, had fillings, grew up on tuna fish sandwiches when I was a kid, and it screwed up my whole system. So, you know, we live in a toxic world and people like you know, look at the reference ranges for mercury and lead on the lab. And it's like, oh, it's up to 10 or 15. I'm like, wait a minute. Like, what's the biological requirement for mercury in the body? Is zero. The normal test for mercury is zero. The normal test for lead is zero. And what they found, for example, even in kids, you know, they say, okay, well, 40 was the cutoff, then 20, then 10. And they found even down to levels of one, they can. They can actually find. indications of neurological impact and declines in neurodevelopmental function in kids, even down to one, which is considered normal. So if your blood level of lead, for example, is over two, it's a higher risk factor. And by the way, that's, quote, normal, right, in lab tests. If it's over two, your risk of having a heart attack or stroke is greater than if you have a high cholesterol. So it's really, really a big impact. And I think most people don't check for it. And it's important to understand what to do about it, too. And that's where, you know, functional medicine comes in because traditional medicine doesn't know what to tell you. But with functional medicine, you can actually figure out a roadmap to detoxify your body from the metals.

Another one we have is growth hormone, IGF-1. It is being spoken about in different spaces, but for the average individual who has no clue what this one is, why is this important to purchase as an add-on for growth hormone?

Well, you know, I think, you know, I wrote a lot about this in my book. young forever. And, you know, one of the, the key Regulators of our biology is, is something called nutrient sensing, and often it gets screwed up, and it's one of the Hallmarks of Aging and deregulated nutrient sensing is critical. And one of the ways it does that is, is by increasing insulin levels and insulin like growth factor one. That's what IGF1 means. And it's a, it's a, it's an indicator of the level of, of growth factors in your blood. So, you know, growth is important, right? If you want to grow a baby, you need growth factors. if you want to grow strong bones, you need growth factors. If you want to repair tissues, you need growth factors. But too much also grows other things like cancer. And so insulin growth factor, if it's very elevated, has been linked to cancer and other age-related diseases and recently is an indicator of overall poor health. Now, if it's too low, if your IGF-1 is too low, it may mean you're aging more rapidly and may need a little support, which can be given in the form of lifestyle recommendations. lower body heavy weights can increase growth hormone, strength training can increase growth hormone, taking certain supplements can increase growth hormone. So there's ways that actually naturally do it, peptides. So there's a lot of ways to fix it, but it's really an important marker of your overall health and your risk both of too much or too little.

Amazing. Okay. And then Lyme disease, this one is important for those who have had, who have something going on and have been told that nothing's going on. I've heard that so many times here. What's the importance of Lyme testing for our function members?

Well, you know, we, we basically, you know, Lyme is, I think, is like the new syphilis, a great masquerader, you know, can be show up as anything, an autoimmune disease, you know, Chris Christopherson had Lyme disease, and they thought he had dementia and he had Alzheimer's, but it turned out he had Lyme disease and he needed antibiotics, you know, not a nursing home. So I, I think we, we actually have a huge epidemic of tick-borne illnesses, and Lyme is very prevalent. And that's why I think it's important.

People get checked because they can have no autoimmune disease or chronic fatigue or.

Joint issues or just brain fog or who knows what. And it can show up as all sorts of things. So I encourage people to really check it out.

Yep. All right. This one time test is APOE, APO lipoprotein E genotype. One is it can be pretty controversial of a test. We've done some digging into the information and the data behind it, but I'd love to hear from you, like, what should people consider when they get the APOE4 gene. We have had many members who have gotten this. So to let them know that they can do something about it and what the gene means.

I mean, Priti, this is something, it's a bigger conversation, right? It's genetics and what does it mean and how do we test for it? So, you know, most people don't really know much about genes and just a two-second primer on genetics. You have about 20, 25,000 genes, but there's maybe three to five million variations in those genes that are, you know, normal variations in the population. so think of it like a spelling change. For example, like in Europe, in England, they spell color C-L-O-U-R. Here we spell it C-O-L-O-R, right? Same meaning, same word, spelled differently, but it has a little different function. So these are called SNPs and ApoE is a very important gene that has broad implications across cardiovascular health, metabolic health, Alzheimer's risk. And a lot of people say, well, I don't want to know. if I got Alzheimer's risk, I don't want to know. Just don't tell me because there's nothing I can do about it. Well, that's true given the conventional paradigm, but there's a lot that can be done to prevent Alzheimer's. And we know the data on this from diet and lifestyle to the right supplements to fixing root causes. And so learning what's going on in your risk is really important. I had a 94 year old woman who was a dentist who was still working and she had two APOE4 genotypes. Now that person typically would have 75% of risk or even more at her age. of having Alzheimer's and she was sharp as a tack. Why? Because she was a health nut. She exercised every day. She ate all our fruits and vegetables. She took her supplements. She stayed her ideal weight. She stayed engaged and active. So it's not a death sentence. It just means you have to be more proactive. So you have to be more careful. So with those patients, I'm much more aggressive on lipid management, much more aggressive on metabolic management, much more aggressive about.

Getting rid of toxins, optimizing their nutrient levels, their microbiome, basically giving them, you know, aggressive you know, five star tune up.

Great.

Okay. This has been such a fascinating conversation. I cannot wait for there to be so many more.

There's gonna be more. Yeah.

So many more. Thank you for. For taking the time to. To go through this. It's going to be incredibly beneficial, and it has been beneficial for me and for. And it will be for our members. So want to just say thank you. This is the first of many to come. The function podcast. is live and we are here and we can't wait to dive into these biomarkers, how they affect people's health and how function can really change the game for folks when it comes to being empowered and understanding what's happening in their body.

So, thank you, Pranita. This has been fabulous. I just want to say, everybody, if you've been listening to this podcast and you loved it, please share it with everybody. Share with your friends and family across all your social media platforms. Leave a comment, what have you learned about your own blood tests and finding those? And you can actually sign up right now at functionhealth.com and join the wait list and we'll try to get you in as soon as we can and learn about your own biology. And I think you're gonna love the journey into your own health and being empowered to be the CEO of your health for the rest of your life. And we'll see you next week on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Hi everyone. I hope you enjoyed this week's episode.

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