How to Create Evidence-Based Lifestyle Programs without Lab Results?

How do I create a program that is independent of the labs, it produces results every single time, that has tons of evidence and ancient wisdom wrapped up into it and common sense wrapped up into it. And develop a lifestyle design program that isn't dependent on lab testing and. Or if nothing else, it's dependent on perhaps some sort of feedback loop, because that's what testing often is, is a feedback loop, such as wearable tech. So we started including oura rings for our patients so they could measure their progress in ways besides labs. Right. Irrefutable ways that their health and health is moving towards vitalism was easy for us to measure without using labs. So I love to learn where, where this kind of insight led you. Did you stop doing tests? Did you order. Stop ordering specific tests? Like, how did you, how did you approach that kind of internally?

Yeah, that's so, so to, to kind of piggyback on what you just said is my view is a lab test should not give you any new insights into the person. It should just confirm what you already believe to be true. And that means going back to your clinical skills, your history, taking your symptoms questionnaire. You're. If you're doing a physical exam, you know that, that we. We nowadays. And I've known some practitioners that I, I hate how they do this. They'll just. Every new patient gets like $3,000 of testing. It's just like this fishnet. You're gonna try to catch whatever and all you have. H. Pylori. Do you really. You sure about that? You know, do they have symptoms that suggest that? So any, like, I'm not opposed to certain tests, and I'll tell you the, hands down, I think the best test there is out there. I'm not opposed to certain tests that I know of that I, you know, we researched a bit, but it should, it's not a fishing expedition. It's. I think this is going on with you. I just want to confirm this. And so when you get the results back, you're like, yeah, that's just what it. Let's. We just prove this, essentially.

So like a spear instead of a net.

Yeah, absolutely. Yeah. So, I mean, okay, so here's a great example is like, let's say somebody has hyperglycemic symptoms, of which if some, if they're actually hyperglycemic, that's probably something going on. Now what my question is is how bad is this? Right? So because then you have some metrics, you're like, wow, your fasting glucose is, you know, 120, 130 you have A, A, 1, C and the sevens or eights or whatever. It might be cool. Now we have some hard data where we can do all the lifestyle interventions you're talking about and we can actually track your progress over time. So, you know, again, if somebody has all the hypothyroid symptoms in the book, let's run a complete thyroid panel and just see really where the defect is. So, you know, you should, you should know what the, what you're going to be testing and find it in the person. I do believe in metrics because that is, it helps with compliance. It helps know just again, how bad is it really? I mean, what are we really looking at? We're looking at a little berberine. Are we looking at like the full fledged, like, let's give you every, you know, hypoglycemic agent in the book. So hands down, and, and I have, I have studied this brother, like so much. This is, I have two passions in my life when it comes to your extra family activities in terms of what I study and blood chemistry is one of them. And I can tell you I have spent a good part of the past 15 years really looking into their whole story as to why that happened too. But hands down, standard blood chemistry is easily the most studied lab. Let's just say it's a bunch of biomarkers, but around the world it's internationally respected, it's been scientifically validated and proved over and over and over again. The reference ranges may have changed, but that's a consequence of, you know, people and health and demographics and those things. It's inexpensive, what you get. And there's no other test that will tell you as much information on a fairly standard couple hundred dollar blood chemistry than anything else out there, hands down. I will argue anybody to the grave about that. If you know what you're doing and you have a better reference range and you're up to date on the modern literature as to what these markers are. And I'll just give you a quick example. You know, I forget when, but it was years ago. I was sitting there, I kind of have a love affair with albumin that's been like my, my go to. I just, I, there's something about albumin that kind of got me into blood chemistry and, and then one day I was thinking about it, I'm like, I guarantee you there are researchers who are still researching albumin, right, as old as it is, that they're trying to find new inferences in it. Indeed, when you look at the literature, I'll just use air quotes. Old markers have new reasons that they might be high or low that absolutely have implications to us as practitioners. If you combine this old test and people like new stuff, right? That glittery but old test, not sexy, black and white serif font, two pages, not 20. Scientifically validated, internationally respected, inexpensive. And volumes of information about just about any system in the body that you're really looking at, combined with updated research on the markers can tell us as clinicians far more than, you know, we're using in the past. I'll just give you a quick example if you want, like hdl, there's some. There's a paper done just a handful of years ago. It was only on men. Unfortunately, it was a rather small cohort. But what they found was, is that that HDL was positively correlated with leaky gut. I'll just say that intestinal permeability, like lipopolysaccharides and fantastic, fantastic piece of information. So if you see a high normal hdl, one of the things that should make you think of is, hmm, I wonder if this person has intestinal permeability. In which case, if you wanted to run that test to confirm that, which is the reason why we should be running tests, go for it. Or maybe that's just good enough because their symptoms correlate with leaky gut, if you want to put it that way. And then you look into it, well, why would HDL be a marker of leaky gut? That's, you know, it's the good cholesterol. And then you read about it and you find out that it's actually one of its jobs, is mopping up lipopolysaccharides. That's what HDL does, is the janitor for lipopolysaccharide. So then all of a sudden it makes sense. And where was that when we were in school? That was a super helpful, cool marker. And you could take just about any marker, even the old ones. And there's updated information that researchers are doing. There's calculations that you can do using existing markers. You think about where researchers are. They're trying to find better ways for doctors in the middle of Arkansas to be able to evaluate their patients better, more effectively with all the fancy, expensive machines that are available only to some or in rural communities or areas, even around the world. And so you have these brilliant researchers who are like, you know, fatty liver is a problem. AST and ALT basically completely suck in terms of finding it. You'll find it way too late if you're Just waiting for those to go up. Let's put together some calculation using basic markers that are found on just about every or metric on a blood chemistry panel or anthropomot, anthropomorphic data. And they come up with these calculations to predict fatty liver. So there's so much out there. We don't need all these ridiculous, expensive, colorful, pathway driven tests that in many cases have no scientific validity. And I'll tell you, in some of them, some of the world's Experts, world's experts, 80 years old, been studying redox for 50 of their years of their life, say, you know, they'll name certain markers that shouldn't even be used in research. Guess what those markers are on some of the functional medicine labs. And they say that those are just completely worthless markers. They shouldn't even be run. And we're running them every day of the week.

I mean, I mean, first of all, tell me how you really feel.

Well, let me start it.

And I could, I 100% concur because, you know, one of the, one of the challenges, forget about everything you just said, but the other challenge is like, what does the marker lead to in terms of overwhelming the clinician? Right. And, and kind of them not having the certainty that what they're doing is actually going to work. And so I feel like there's, there's a whole can of worms that gets opened up when we start ordering labs. It could be really a slippery slope and a runaway train, I feel like.

And, and I know, you know, you talk with loads of practitioners, I've heard that all the time. You know, I, it's like you get too much data and then you don't know what to do with it. Do I work on their hormones or their brain or their liver or their thyroid or, you know, and then you get all the people that are like, well, you have to treat the thyroid before you treat the adrenals. And then you get the other people that say the opposite. And then the brain runs the show, or the liver runs the show, or the gut runs the show, or, you know, and then practitioners are as, they're more confused than ever. And I think that that's why if you take this, my wife hates the phrase, but just a back to basics approach, just go back to the absolute fundamentals that we, I don't want to say no because it's a more of a belief, but that we strongly believe and have some evidence empirically that improve people. Yeah. And you know, you said, you know, tell me how you really feel. The Thing. The thing that gets me though, is, is people are suffering. Practitioners are suffering through inaccurate tests and figuring out what to do, and then they'll run one, and something doesn't calculate. It doesn't compute. And we have to come up with, well, you know, you're excreting more than you did before. Whatever. You know, like, we make up stuff for what's a lack. In some of these tests, the patients are suffering because they're spending an obscene amount of money on things that might lead to undue stress that they didn't need to know in the first place, that these markers are out of range. And, oh, guess what? You have autoimmunity.

Great.

Wonderful. You know, I mean, in some cases, it's helpful, but in some. If the. If the test isn't accurate and it's leading to stress or fear in somebody's life, that. I'm sorry, deep down in my heart, I have a huge problem with that. It's not even the financial part. It's. You know, you do a hair tissue test, and your. Your lead is screaming high, you know, and then, oh, my gosh, I have lead. I'm gonna. I. I think, you know, my brain hasn't been working as much lately. I think I have lead toxicity, and it's making me stupid. Like, but before they walked into the office, they were fine, you know, And. And I. Listen, I even. This is a bigger conversation. I. I just. We could even talk about this with testosterone. I mean, like, a basic thing. So here. Here you are, like, 50 years old. You go into the office. The doctor's like, well, you never had your testosterone run. You're about the age where it's important because it's a cardiovascular protector. If you have it, you run it. Like, the dude was feeling fine when he came into his office. He loves his wife. He's passionate about her. He has mojo, you know, like, he. He's not huge and ripped anymore. Like, he was in his 20s, but he doesn't really care so much because he's more heady than he was. Like, body. And then it comes back. It's like, you got low testosterone. Like, well, I was good. Like, why did I need to know that piece of information? Now all of a sudden, I find out I have, like, castrate levels of testosterone. And, you know, I'm. Well, gosh, now I guess I'm depressed. Something new to worry about, you know? And I. I wonder. This is more, like, ethically and philosophically, but I wonder, like, are we doing more harm than good when we think that we're running these important markers on people and in fact it's actually causing that, you know, the person was good, they just came in for a checkup and they leave knowing that they have H. Pylori and you know, low testosterone and they're, you're, you know, the things that practitioners, you know, your body's actively breaking itself down right now. What a horrible thing to say to somebody. Anyhow.

No, you know, I think in the defense of most practitioners, including my younger self and perhaps even your younger self, we didn't know this, right? We're bright eyed and bushy tailed and we have this tool that we assume is going to be insightful and helpful and then you start running them and you're realizing, okay, this is great and this is helpful, but how do I action all of this and how do I know that I'm actioning all of it simultaneously? And sometimes you almost get nervous to run the second lab because you don't know if what you did worked right and what's going to happen next.

So you know what?

Totally agree with you.

I love that you said that because this, one of the things that I see not happening in the industry is people being plain honest about it. Like I distinctly remember, like, oh dang, here we go running that next test. Like, I sure hope that that was, that's, that absolutely is real. That is a real feeling that you shouldn't have. If you rely, if you trust these tests and you're doing stuff that, you know, has some, some level of evidence to it and it's not all this, you know, like frivolous sort of latest glittery stuff or you know, part of the latest functional medicine story. I love that you said that. That's, that's just an imposter syndrome. You know, all these things, these are so real for people. How many times did you, did you recommend something to somebody and you're like, in your head you're like, well, you know, here we're gonna, we're gonna support phase one and phase two because you seem like your pathological whatever it was, you know, at the time or like, you know, and you'd be like, man, I sure hope this works. When deep down, like, you know, it was a mindful recommendation and, and to your point, not even my younger self, I'm gonna look back at myself now and be like, gosh, the moron at my age now too. Which is just, that's just the journey of life. And if we don't know better, we just do the best we can. And, you know, that's. That's why, you know, yourself and myself, we're trying to educate practitioners so they don't have to suffer through so many things in the past and look back at themselves and be like, dang, that was stupid. You know, why the heck did I run these salivary cortisol tests? Completely inaccurate, or whatever it might be.