The Dr. Hyman Show - Your Lab Tests Are Normal But You Feel Sick: What Your Doctor Is Missing with Dr. Todd LePine

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. A diagnosis means nothing, right? It really, you know, it's just a label that we put on it. And you may label it as a tick disorder, but there can be, you know, 50 ways of getting a tick disorder. And the same thing with diabetes or brain fog or whatever. So the whole concept of disease is sort of thrown on its head because we look at it from an entirely different perspective. Hey, everyone, it's Dr. Mark. I'm always talking to people about their health, from patients to friends to people on social media and podcast listeners. And something that comes up pretty

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Starting point is 00:04:19 colleagues from the Ultra Wellness Center and talk about functional medicine approaches to all sorts of things. And today I'm joined by Dr. Todd Lepine, who's been one of my colleagues for over almost three decades now. Scary to say that, but it's true. And we are, in our group at the Ultra Wellness Center, I think the most experienced in functional medicine in the world. I think we've got docs there have been doing this for 20, 25 years, and we tackle really difficult problems, and we really do a good job at complex chronic conditions. And Todd is just such a great guy. He's an outstanding physician. He graduated from Dartmouth Medical School. He's board-certified in internal medicine, and he teaches all over the world. He's been with our practice for a long time,

Starting point is 00:04:59 and I worked with him at Canyon Ranch before that. He's talked at many, many conferences and has taught us as part of the ACAM group and the AMG group and all kinds of groups that are advancing the field of medicine and functional medicine. He just loves being in the Berkshires and hanging out with his family. So Todd, welcome to the special episode of The Doctor's Pharmacy. Thank you, Mark. I'm excited to talk today. It's going to be a fun time. Okay. So Todd, how many times have you had a patient say, you know, I went to my doctor and I had my checkup and they said, all my tests were perfect and I'm fine, I'm healthy. How many times have you heard that and then gone on to found all sorts of other problems that the doctor

Starting point is 00:05:39 completely missed? Exactly. That's happened more times than not thousands of thousands of times right and and you know the patient still doesn't feel great and the doctor goes oh your checkup's fine your exam's fine your labs are fine you must be fine and uh that really means one of two things in my mind one either uh the patient's crazy or the doctor's missing something and i i generally assume it's the doctor's missing something and in I generally assume it's the doctor's missing something. And in functional medicine, we approach diagnosis very differently. And we use a lot of the conventional lab testing. We also look under the hood and figure out what's going on underneath a lot of issues that are ignored in traditional medicine, whether it's the gut function or the immune system function or how we detox or our energy systems or our hormones and

Starting point is 00:06:27 metabolism, we tend to sort of miss a lot of the important areas where the problems really are. And so we have a false sense when we're traditional doctors, oh, we checked everything, it's fine, but the patient is not fine. And so we're going to talk today about some of these innovative tests that are really the future of medicine that help us figure out what's going on. And someone once said to me, you know, the way we diagnose people now in traditional medicine is sort of like listening to the noises a car makes and trying to figure out what's wrong with it by listening to the noises it makes instead of looking under the hood. So functional medicine is more about looking under the hood. And that's what we're going to talk about today. So Todd, tell me about how you think about the world of testing in traditional medicine and functional medicine, how they're different.

Starting point is 00:07:10 Yeah. I mean, the analogy that I give to patients is that, you know, you said the patients come in and all their tests are normal. And their doctor says, you know, everything's fine. And the patient doesn't feel well. And oftentimes patients are then, you know, given either antidepressants or anti-anxiety medications because the doctor thinks, okay, everything's, all the normal tests are normal. This patient's got to be, you know, a hypochondriac or whatever. The best analogy is, you know, if you're on a dark street and you lose your quarter on the right side of the street, but the lamp is on the left side of the street, you're never going to find the quarter on the

Starting point is 00:07:43 right side of the street unless you shine a flashlight over there. And that's really the best analogy of what we do. So conventional lab testing, we use a lot of conventional lab testing and the major lab companies, LabCorp, Quest Diagnostics are sort of a backbone of what we do. But that's not all that we do. As you said, I mean, we basically do a lot of deep dive into nutritional, metabolic, toxic, genomic testing, and really try to look at what other things might be going on with the patient. And another analogy that I try to get to patients to understand what we're doing is, you know, oftentimes the patients that we see have, you know, complex symptoms. They might be going on for 5, 10, 15 years. And it's like a big jigsaw puzzle. And in order to see the picture of a 1,000-piece jigsaw puzzle, you can't do that with five pieces.

Starting point is 00:08:32 You need 500 pieces. So the more that we do at testing to really look at all of the different systems in the body, what really allows us to get a better picture of what's going on, and then we work through the functional medicine matrix to really do a deep dive into that unique patient because every patient that we see is different. I've never, I don't think I've ever seen one IBS patient that's the same as another patient. I mean, I've never seen one migraine patient that's the same as another patient. Everyone, and that's sort of the fun part of medicine is the challenging part is the personal uniqueness of each patient and their personality.

Starting point is 00:09:04 Yeah, it's so true. And I was just thinking as you're talking about this patient that I had the other day who had a tick disorder since he's like eight years old and just got his facial ticks and it's just annoying to him and it's socially embarrassing and he's a struggle with it. And, you know, he's been offered various medication for it. And in traditional medicine, you go to the doctor, well, you have a tick disorder. I don't know what you have. Maybe you have Tourette's and we don't really know what it caused it, and just take this drug to suppress the symptoms. Like Klonopin, they wanted to give him benzodiazepines, and from my perspective, I'm like, well, he's got some kind of neurologic irritability. So, gee, what are the

Starting point is 00:09:37 causes of neurological irritability? So, I took his history, and I thought, oh, he took a lot of antibiotics when he was a baby, and as a young adult, a young toddler, because he took a lot of antibiotics when he was a baby and as a young adult, a young toddler, because he had a lot of ear infections. He had a lot of strep. He also was born by C-section. So I know his microbiome might be off. And we know that changes in the microbiome can cause all kinds of neurotoxic symptoms, right? So that's one thing I'm thinking of. I'm going to look at his stool test. But also maybe he's got dandruff too. So that's another clue. Maybe he's got yeast issues. I'm going to look for yeast in his urine, in his stool. Maybe he has PANDAS, which is a neurologic condition caused by strep because he got it when he was young and after a strep throat, maybe that's what caused it. So I'm looking for this latent strep infections that he has been ignored. It

Starting point is 00:10:19 might be because he loves sushi and a lot of heavy metal laden mercury tuna when he was younger. So I sort of start to think about how do I test for these things? How do I test for the gut? How do I test for toxins? How do I test for latent infections? And these are the kinds of things we start to think about. Maybe it's gluten. You know, there's, for example, the regular test for celiac, but we do a test that looks at 20 different antigens and how we create antibodies against those. It gives us a better sense of whether someone's really reacting to wheat or gluten or not. So we start to look at these things. And traditional medicine just doesn't look at any of this stuff. So often, we're left feeling like,

Starting point is 00:10:52 well, we have a diagnosis, but we don't really know what's wrong with me. Yeah. Well, and even, you know, Jeff Land wrote the book, The Disease Delusion, which is really, you know, a diagnosis means nothing, right? It really, you know, it's just a label that we put on it. And you may label it as a tick disorder, but there can be, you know, 50 ways of getting a tick disorder. And the same thing with diabetes or brain fog or whatever. So the whole concept of disease is sort of thrown on its head, because we look at it from an entirely different perspective. Yeah, so let's just take a case of let's's just sort of, maybe you want to pick a disease like an autoimmune disease or maybe depression and talk through how would we approach it differently

Starting point is 00:11:34 in terms of the diagnostics? Because we have a different checklist in our brain of what we're trying to look for that's based on what we call the functional medicine matrix, which is the idea that the body has these core networks of function that are all dynamically connected as one big network, right? One ecosystem. But when those networks get out of balance, you get disease. And when they're in balance, you stay healthy. And the key is to figure out what's disturbing those systems, whether it's too much of something or not enough of something. And whether you have like too much mercury or gluten or not enough magnesium or whatever, We kind of figure it out. And then we get to take out the bad stuff, put in the good stuff to restore the functioning of these systems.

Starting point is 00:12:09 So that's what we do. And we're looking really diagnostically in a different way at the body. We're looking at how do we assess these networks and are they working? Are they not working? And that's what our diagnostics help us do. And then we can kind of sort through where the issues are for a patient. Whereas traditional medicine is just like, well, you have this diagnosis is based on this part of your body. Like you have a, you know, reflux or you have, you know, whatever, aeroval or you have colitis or you have heart disease or whatever. And we get, we get sidetracked by thinking we know what's wrong with them once we made the diagnosis, but we really don't. Right. Yeah, exactly. The whole, the whole. The whole question of name it and claim it,

Starting point is 00:12:45 that kind of thing. Name it and blame it. Name it and blame it. Yeah, name it and blame it. Exactly. Yeah. Yeah. So say, for example, if we have a patient who has depression, right now, mainstream medicine looks at depression as more or less a serotonin deficiency. And then you, you know, take SSRIs or other drugs, which also have effects on the epinephrine, norepinephrine pathways. But neurotransmitters are only part of the issue when it comes to depression. I would say that a large part of depression is probably related to neuroinflammation. And neuroinflammation can be caused by a whole bunch of different reasons. I mean, I'll never forget when I had a patient at Canyon Ranch and the patient had been hospitalized for two months in a psych hospital. And not once did the patient have any nutritional testing. And when I saw the patient, a young girl, she was on about five different medications,

Starting point is 00:13:49 medications for depression, medications for anxiety, medications for sleep, medications for irritable bowel syndrome. And when I did nutritional metabolic, you know, toxic and genomic testing, you know, the patient was also a vegetarian. You know, she was deficient in amino acid. She was deficient in fatty acids. She was deficient in magnesium. She had a sensitivity to gluten. She had some gut dysbiosis. She had a whole host of a lot of different things that were all playing a role in why her brain was not feeling well and why she wasn't quote unquote happy. And they were trying to fix it with a pill and that just really wasn't going to, wasn't going to do it. And so, you know, when someone comes in with depression, you know, we say, oh, someone's hopeless and helpless and sad, and they have no interest in daily activities, and they

Starting point is 00:14:29 want to have sex, they can't sleep, they're either losing weight, or they're binging eating. And I know what's wrong with you, you have depression. But depression is just the name of those symptoms. It's not the cause. And so with traditional medicine, okay, you have depression, here's an antidepressant, right? We go, well, if you have depression, well, what's the cause, right? Is it low magnesium? Is it low vitamin D? Is it low omega-3 fats? Like you said, it's nutritional factors.

Starting point is 00:14:51 Or maybe it's something else. Maybe it's a gluten sensitivity that's causing inflammation in the brain. Or maybe a gluten sensitivity that's causing a low thyroid function through Hashimoto's antibodies. Or maybe it's because they've been taking a drug like an acid blocker for years and have B12 deficiency. Or maybe they've taken antibiotics and their microbiome is a mess and that causes a depression because it creates inflammation in the brain. Or maybe they eat too much mercury-laden tuna and have mercury poisoning. Or maybe they have insulin resistance and prediabetes and you need to do a glucose tolerance test or insulin measurements

Starting point is 00:15:23 to figure that out. And so that's what we do in functional medicine is we dig down and we have tests. How do you test for heavy metals? It's not just checking a blood test. I remember reading this article in JAMA not too long ago where they were like, well, we did this check on mercury levels and we measured the blood because that's what's easy to measure. I'm like, that's like looking under your lamppost for your keys. Well, when you dropped them down the street, it's because the light's better, but it doesn't actually the right place to look. Very rarely. I mean, occasionally you might see it. If you see it in the blood, then you really know it's a it's really a major issue.

Starting point is 00:15:57 There's usually an acute intoxication to a heavy metal. But if you see it in the blood, but you're right, it's actually stored in the body. And then you have to do some challenge testing to try to get it out of the body. That's oftentimes helpful. One of the other tests that we do is the mercury test for mercury speciation, which I find is a really good one because in that particular case, you don't check for all the heavy metals. You can only check for the organic and inorganic. You don't check for mercury or lead or aluminum. but the Quicksilver test for mercury, I find that to be a really good one when I'm checking for mercury, and that can

Starting point is 00:16:30 help to differentiate are you dealing more with a fish organic type mercury or amalgam mercury issues. And sometimes you find both. That's right. And a lot of the tests we do are really designed to do a couple of things. One, they're designed to find out what you're missing, right? Whether you're missing a nutrient or maybe a healthy bacteria in your gut or whatever it is. And what you have too much of that we need to get rid of, right? It could be toxins, allergens, microbes, poor diet stress that are disturbing the system. We look at genetics and we look at all the things your body needs to function, right? You look at your diet, you look at the nutrient levels, at the hormone levels, at lifestyle and so forth. And we find out what are the ingredients for health and we try to see what's missing.

Starting point is 00:17:09 We try to put those in. And when we do that, we can help to really figure out what's going on with each individual and help find the solution that's personalized for them. And so let's go through in the matrix, which is for those of you listening who don't know what The Matrix is, it's not the Keanu Reeves movie. It's really the framework that we think about when we assess people with functional medicine lenses on. And we look at their predisposing factors and their lifestyle factors or genetics and how those influence these biological networks. And there's really seven of them. And let's go through and how we sort of begin to think about them differently. Let's talk about the gut first, because that's a big topic. What are the tests available with traditional medicine to look at the gut and in general? And what are the things that we do

Starting point is 00:17:52 differently in functional medicine? I mean, the traditional tests, they might do a stool culture test on you. Occasionally, some of the more sophisticated hospitals might do, you know, testing for pathogens by PCR technology. But the way that we look at it is we look at the whole big, if you will, the rainforest of the gut. So there are hundreds of different microbes that are in the gut, and there are some key players that are in the gut. The Acromantium isinophilia, which I think you have a personal experience with, is that is a key player, and I've never seen that on a regular laboratory test. And this particular bacteria helps.

Starting point is 00:18:25 It's a good guy. They're just looking for bad guys, right? So it's a good guy. They're looking for bad guys. It's a good guy, exactly. Yeah, we know that the probiotics, the lactobacillus-type species and bifidobacterium species, but this particular one is actually now available in a probiotic form now. It's Pendulum Probiotics that has that now.

Starting point is 00:18:48 Really? You can see this. Yes, yes. And they're actually touting it to help control blood sugar. Because what we do know is that people who have low levels of this are oftentimes associated with obesity and diabetes. And you can also see low levels of this in patients with autoimmune disease, colitis and such. So that's a key player. And when we do diagnostic testing, one of the tests that I really like to do, I think it's a cutting edge test, is the GI map test that does quantitative PCR. So it's not only just checking for the organism presence, but it's also checking for the level of the organism. And so you can check for these, some of these key things, fecal bacterium, prowsnitzy. You can also check for pathogenic organisms, things that might be associated with Crohn's disease, like mycobacterium. Some of the pathogenic organisms that are associated with autoimmune disease, klebsiella, proteus, citrobacter. So there's a

Starting point is 00:19:42 whole bunch of, you know, actors out there, good actors and bad actors. And then in addition, the testing that we do for the gut also looks at the gut function. So it's looking at, do you have high levels of beta-glucuronidase? Now, people have probably never heard of that. Most GI doctors probably don't test for it. But we know that that bacteria in the gut, when they're out of balance, will produce this enzyme, which causes your body to inability to detoxify estrogen. And we oftentimes see this in women who have estrogen dominant states. So it's a, you know, there's a lot more that you can look at than just doing a regular, you know, old fashioned stool test. We also look for calprotectin, we look for signs of leaky gut with zonulin, we look for anti-gliadin antibodies. We look at digestive

Starting point is 00:20:27 enzyme function with things like elastase. There's a whole bunch of different things that we look so that we're getting a big picture of what's going on in the gut. I would venture to say that we are just in the very nascent stages of understanding the microbiome. And I've talked about this earlier. I've been doing this for 30 years. It's still new. Yeah. And it's totally new. It's totally new. And it's really quite fascinating. And the other thing that's really an interesting phenomenon is that our gut bugs also affect our behavior. And our gut microbiome also can have a tendency for us to be thin or a tendency for us to be fat. There have actually been studies where people have had stool transplants for things like clostridium difficile,

Starting point is 00:21:10 and the person gained weight after the stool transplant and vice versa, where the patient got a stool transplant and began to lose weight. So we don't fully understand that, but there's an incredible role that the gut microbiome plays in our metabolism. It plays in our circadian rhythms. It plays in our immune system. And it also affects our mood and our brain health. It's true. So we'll look at stool tests, like you said, very differently. Look at the entire ecosystem in the gut, like digestion, how your enzymes, how's the inflammation, how's your immune system in your gut, whether there's good bugs or bad bugs, whether there's the byproducts of good

Starting point is 00:21:43 bugs, like short-chain fatty acids. So we can really tell so much about what's going on that you wouldn't even pick up. We'll find parasites that people don't find and worms and all kinds of things that have a huge impact on people's well-being when you find them. And it's sort of a shame that, you know, the doctors go, oh, you have irritable bowel. Don't know. I'll see you later. But you're really caused by something. Then we look at other things that indicate what's going on with the gut, like bacterial overgrowth testing. And we get a lot of information from tests that you just wouldn't get when you're a doctor. And we can go more into the digestive system, but let's just look at how do we think differently about immune function? What are the kinds of things that we really look at

Starting point is 00:22:17 and focus with assessing the inflammation in the body and immunity? Well, we look at the immune system. I mean, there's a couple of really neat tests that I've been doing lately on some more complex patients looking at what are called IgG subclass deficiencies. So some patients come in, they tell you, you know, I get sick a lot or, you know, there's an issue going on with me. And the immunoglobulin G is typically measured in an immunoglobulin panel. So you measure IgG, IgA, IgM, and IgE. But there's also what we call IgG subclasses, and there's four of them. And there are some people who have these subclass deficiencies, and it's not picked up by regular testing, or at least not by

Starting point is 00:22:57 routine testing. Mainstream laboratories test for this. And when patients have this, they can be more prone towards chronic conditions that are inflammatory or autoimmune. And when patients have this, they can be more prone towards chronic conditions that are inflammatory or autoimmune. And replacing with immunoglobulins, either intravenous immunoglobulins or subcutaneous immunoglobulins can oftentimes help these patients. You sometimes will see this in patients with chronic Lyme disease or autoimmune conditions. And then we'll also check for things like the natural killer cells, the CD57 counts. That's a nice test that I use a lot in patients. It's not diagnostic of anything, but it's a general way of looking at your overall robustness of your immune system. So you can see low CD57 counts

Starting point is 00:23:35 in patients who have chronic reactivated Epstein-Barr virus. You can see it in patients who have chronic Lyme disease. You can also see it in patients who have cancer or HIV infection. So it doesn't really give you a diagnosis. It just tells you that the natural killer cells are not working well. And there are things that you can do to raise and boost natural killer cell function. I oftentimes will use that in patients who I'm suspicious for Epstein-Barr virus or chronic Lyme disease to use as a barometer of how healthy their immune system is. And then you can also not only measure the level of the CD27, but you can measure the function of it. In other words, you might have a lot of Marines, but the Marines don't have guns. They're not going to be able to fight the enemy. And one of the

Starting point is 00:24:15 tests we do is the natural killer cell function test. So there's all different kinds of tests that we do that are outside of the regular box that really help us to guide our therapy and diagnostics. And we look differently at infections. We look at, for example, at tick infections through different testing. We look at white blood cell function. We look at food sensitivities.

Starting point is 00:24:33 You're talking about IgG, but we look at not just your food allergies, but actual, whether you're reacting to gluten or dairy, and we look at different antibodies nobody really is looking at. So we can get a real sense of, there's even tests we do that look at your immune age. We can look at immune age, for example, DNA methylation of your white blood cells. We can get a sense of your immune age, or we can look at the biomarkers

Starting point is 00:24:52 at Stanford. They put through literally thousands of biomolecules into these computer models looking and tracking against conditions and diseases. And they found there's like maybe four or five different immune markers that nobody's looking at that are the most predictive of your long-term risk of chronic disease. So we look at all sorts of stuff. And even with the gut, we'll look at urine, for example, we didn't mention that. We'll look at the urine test, look at byproducts from the gut metabolism in the urine that tell us about what bugs are growing in there. So we have so much information about the body. When you think about it, you know, you go to the doctor, you get like 20 lab tests, you know, like your blood count, you get your chemstream, you get your urine, you get liver

Starting point is 00:25:28 tests, kidney tests, maybe iron tests, you know, cholesterol, you know, it's kind of a boring panel. And the truth is there's so much more underneath that. And it's just scratching the surface. And it's really only often abnormal when there's something really bad with your body and the doctor goes, you're fine. And really they're missing all these other things that are really relevant to your health. Absolutely. Yeah. And my, my motto is, is test, don't guess, you know, you know, it's very, very, I'm a sort of, I have a very strong science background, so I really help to use tests. Now, obviously, you know, when you see enough patients, you do have some clinical intuition. And oftentimes, guess what?

Starting point is 00:26:07 I think this might be going on. But, you know, I'll tell you, sometimes I'm wrong. I mean, sometimes I think this is what's going on and I do the testing and that's not what's going on. So I got to go down another pathway. So the testing can help to clarify, you know, what you think is going on or what you have suspicion for, or you may stumble upon something and say, okay, you know, this is now something that, you know, I was totally not aware of, totally not expecting. Completely. Yeah. So we're just scratching the surface.

Starting point is 00:26:36 But talk about, for example, how we look at things like energy, because a lot of people complain of fatigue and there's a lot of issues around fatigue. And energy is not something we typically learn how to look at in medical school. Yeah. Like how do you look at the mitochondria? Absolutely. Right. So what is energy? You know, I always ask patients, you know, when you say you're low in energy, is that mental energy?

Starting point is 00:26:59 Is that physical energy? Or is it a combination thereof? Right? So, you know, when I see somebody with low energy, you know, I think of the common things. I So when, you know, I see somebody with low energy, you know, I think of the common things I think of, you know, are they, do they have iron deficiency? Do they have B12 deficiency? Now, when you talk about B12 deficiency, the interesting thing about B12 is you can actually have a high B12 level and have B12 deficiency because the B12 is not actually getting into the cell. So we actually do a test called methylmalonic acid and methylmalonic

Starting point is 00:27:23 acid is a functional B12 marker. And it typically allows us to see before a person gets, you know, frank pernicious anemia, which is the end stage of B12 deficiency, to see whether or not that's part of their issue. Adrenal issues are another thing that can play a role with chronic fatigue. And then you talk about mitochondria. We can do organic acid testing. Now, this is something that I learned, you know, firsthand when I was working, first doing functional medicine, organic acid testing, and I had a patient who was literally poisoned by high-dose Zocor, and that he was taking in combination with amiodarone. And the cardiologists were giving him the amiodarone because he had problems with cardiac arrhythmias. And they maxed out his Zocor at like 80 milligrams.

Starting point is 00:28:12 And right now there's actually a warning for drug-drug interactions, but at the time there wasn't. And when I checked the organic acids on this, this guy's mitochondrial, all his intermediaries of mitochondrial metabolism were all elevated, telling that the whole system was backed up. And his regular doctors said, oh, you know, you're just getting older. You know, you're just getting tired. You're just getting all this. You

Starting point is 00:28:32 have to deal with it. But literally, the doctors were actually the ones who had actually poisoned him. So organic acids for mitochondrial testing is really good. Another test that I've been doing a lot lately is a mitochondrial test called mitoswab. It's a buccal mucosal test. So you can just do a cheek swab and it helps to check for mitochondrial issues with patients in terms of what are called the respiratory chains, the little proteins that are in the mitochondria. And this is a really interesting test. It's probably about 85% concordant with doing a muscle biopsy. Now, the old gold standard of checking for mitochondria problems used to be doing muscle biopsies. And this one is probably the next best thing to doing a muscle biopsy. So I oftentimes will do this type of testing in patients who I'm suspicious

Starting point is 00:29:19 about mitochondria problems. Wow, incredible. So we look at all sorts of different tests and looking at the energy metabolism. In autism, for example, these kids have a deficit of energy in their brain and they often do really well where you're pleading the nutrients that make your body make energy, the right nutrients and vitamins, whether it's CoQ10 or so forth. And so you actually can start to look at some of the urine tests and other things we do to help differentiate what's going on with these patients. And it's stuff that we're looking under the hood and seeing things that no one else is looking at. Yeah, absolutely. And you mentioned earlier about like testing for some of these, you know, hidden infections. One of the tests that I really find very helpful and maybe

Starting point is 00:29:58 because we live up in the Northeast is advanced testing for Lyme disease because chronic Lyme disease could be very difficult to diagnose and very difficult to treat. And I can't tell you the number of times that I've had patients come in and their traditional testing for Lyme disease was negative. So they didn't have any antibodies by testing. They didn't have a Western blot positivity. But when you actually do some more advanced testing, which is by EliSpot Technology, and this is a T-cell mediated testing. And this testing is FDA approved. And it first was used on a clinical basis for tuberculosis diagnosis. So we know that the technology works quite well.

Starting point is 00:30:40 And you can actually use this for not only Lyme disease, but you can use it for co-infection testing. You can use it for atypical bacteria, things like Epstein-Barr virus, et cetera. So this newer type of technology is a really useful tool when we're trying to find, you know, some kind of infections which are a little more difficult to determine. Yeah, for sure. And let's talk a little bit about toxins because, you know, you go to the doctor and they just are like blank, you know, unless you have an acute poisoning, there's no real thinking or approach to assessing the body level of toxins, which are a huge factor in many chronic diseases. And I certainly know about that firsthand from having mercury poisoning. So talk about how we assess detoxification and also, you know, what kinds of things you're

Starting point is 00:31:23 looking for and how it's different. All right. So, so I always say it's not a matter of, are you toxic? It's a question of how toxic are you? Because we're all, we're all exposed to toxins and I call it, you know, if you've got the George Burns genes where you can, you know, smoke cigars and drink martinis and still get away with it, then you're, you're fortunate. But if you don't have good detox systems, looking at the detox pathways in the body are really, really important. So you mentioned heavy metals. We'll check for heavy metals. You can also check for mycotoxins. So if some patients have potential exposure to mold, we can do mycotoxin testing. You can also check glyphosate, which is the active ingredient in Roundup, which is another toxin, it's a ubiquitous toxin. That's an important one to be checking on patients. And then you can do sort of a screening

Starting point is 00:32:10 panel. Great Plains Lab has one that checks for some of the hydrocarbons like benzene and styrene, MTBE, which is found in fuels, acrylamide, you know, all of these different compounds, which are sort of more ubiquitous in the environment, you know, we can check for them and sort of see the body burden level of patients that have these. Absolutely. And we also look at heavy metals differently. I think that's one of the biggest toxins that are often overlooked. People maybe look at a blood level of mercury, but they often don't look at the total body level. So explain to us, how do we sort of start to look at heavy metals? Yeah. So you can look at heavy metals. I would say, you know, I think the biggest clinical heavy

Starting point is 00:32:54 metals are mercury, lead, and then I would say cadmium, aluminum, arsenic are probably the top ones. Every now and then you might see something unusual. You might see some people with exposure to uranium. Usually that's when they live near granite. And typically what we do is we'll test for that by doing a chelation challenge. We'll use a chelating agent like DMSA. We used to use DMPS, but it's not available anymore. But DMSA basically acts like a magnet to draw the heavy metal out of the body. So we'll measure the urine and we'll see how much is coming out by baseline and then check it after the person takes the chelating agent to see how much the heavy metal arises after the chelation challenge.

Starting point is 00:33:37 Yeah, and then we find things like that. And these cases are so astounding. Like I had this one patient who could not lose weight and she was a fitness trainer, ate perfect, super healthy. And it turned out she had super high levels of mercury. And when we chelated the mercury out of her, she lost 40 pounds. I had another patient who, and there's literature on this. You know, when they look at heart failure that isn't caused by any obvious cause,

Starting point is 00:34:03 like high blood pressure or heart attack, when they did muscle biopsies, they found, you know, 22,000 times the level of mercury in the heart muscle and arsenic, like 12,000 times the amount of arsenic for idiopathic, you know, cardiomyopathy, which is this heart failure that you don't know why. And so I had a patient come in who was otherwise pretty healthy woman in her early 60s who was starting to experience heart failure. I'm like, well, gee, let's see what could be causing it. It's a mitochondrial issue. Toxins can cause mitochondrial issues. It's a different kind of thinking, and then we sort of go down that rabbit hole and go, oh, well, maybe it's heavy metals, and I read this article, so maybe I should check, and so we found she had extremely high levels of

Starting point is 00:34:40 mercury, and by chelating the mercury out and optimizing your mitochondria, we're able to literally reverse her heart failure. And you just can't do that with traditional medicine. Yeah. You just can't. And I think that's where we're so unique at the Center for Functional Medicine at Cleveland Clinic and at the Ultra Wellness Center, where we really dive deep into the such root causes and use this different test as a lens to understand what's going on in the workings of the body and how it functions. We're really interested in the functional test and that's what's so different about what we're doing. Yeah, it's interesting you say that because, you know, when you think of heavy metals, one of the other heavy metals that we don't think of

Starting point is 00:35:16 because we think of it as a good thing is iron. I just recently had a patient who had a diagnosis of hereditary hemochromatosis and it was a woman and she came to me and she was feeling, you know, aches and pains and she had fatigue symptoms. And in her, in her, in her history, I was not her primary care doctor, but I was doing a consult on her. I noted that she had a history of hemochromatosis. And I asked her, I said, well, when's the last time you had your iron levels checked? She goes, oh, it's been quite a while. And I said, aren't they following you for your iron levels?

Starting point is 00:35:49 Because for those who don't know, hemochromatosis is when you have problems with excreting iron in your body. Now, iron is a necessary chemical or necessary element to have in your body for the formation of hemoglobin. And what the body does is the body takes iron and wraps it in hemoglobin because iron is a very reactive species. If you expose iron to oxygen, what does it do? It rusts. So our body wraps iron with this, we call it a porphyrin ring. So it keeps it caged up. And when you have high levels of free iron, iron is a very reactive metal and it oxidizes. So basically, if you have this condition, and a lot of people from Northern Europe have this, people of the Celtic origin, will have excess amounts of iron. Iron gets stored in all of your tissues. It gets stored in the

Starting point is 00:36:36 brain, it gets stored in the heart, it gets stored in the liver, it gets stored in the pancreas. So essentially, if you have this condition, you slowly rush to death. So you can develop Alzheimer's, Parkinson's, heart failure, liver failure, diabetes. And it's probably one of the silent missed conditions. So, you know, you just you have to really sort of think outside of the box. And anyway, this woman, I said, you know, you need to get checked because I think I think you need to have a phlebotomy. And lo and behold, her doctor was sort of reluctant. So I actually pushed her. I said, I want you to go get, and not only that, I want you to get a full iron panel, your iron saturation and your ferritin. And I want you to get an MRI of your liver. And sure

Starting point is 00:37:14 enough, she was showing significant forms of iron storage in her liver. And now only now is her doctor going to start phlebotomizing her. Wow. That's great. So, Todd, what would you say to people who are listening to this and wondering, you know, what they should do? How do they get these tests? How do they begin to think about looking at their biology differently? And it's kind of a sense of biohacking. I think functional medicine was the original biohacking. Right.

Starting point is 00:37:41 We are biohacking, yeah. And we're constantly biohacking. I mean, we even do the genetic testing, which I think takes it to another level. I really find that we have thousands of different genetic variations in our body. And looking at some of the clinically relevant SNPs or single nucleotide polymorphisms really allows what I call a precision, precise medicine. So I oftentimes will use that. So you're absolutely right. We are biohackers. That's exactly what we're doing. We're trying to play medical detective. We're trying to listen to the patient, listen to their story, listen to their unique perspective, listen to their symptoms. Even if they come in and all their other laboratory tests are normal, they're not crazy. I'm listening to them. I am. I'm listening to them to say, well, what is it that I'm missing? What is it that anybody else missed that may be going on with them?

Starting point is 00:38:32 Are they having problems with detoxification? Are they having problems with hormone? Are they having problems with hormone detoxification? Are they having a genetic predispositions based upon their unique snips? Are they being exposed to a toxin? Is it mold? Is it heavy metals? So there's a whole variety of different things that we can look at to really unpeel the layers of the onion to see what's going on with that patient that's causing dysfunction. Yeah, it's so powerful. And I think for people listening, it's important to understand that

Starting point is 00:39:01 traditional medicine is just like the tip of the iceberg when it comes to really looking at this complex system that we are, this complex ecosystem. Our bodies are an integrated biological network that is infinitely complex. I mean, think about it. There's 37 billion, billion chemical reactions every second in the body. Your stem cells and your bone marrow alone make a million white blood cells every second, every second, a million blood cells every second. So the amount of information and communications and messaging is huge. You might do 20 tests on your lab or maybe 100 if you're lucky. There's thousands of molecules floating around your blood, all having impact on everything that's going on. And in functional medicine, we're not looking at all of them, but we're starting to

Starting point is 00:39:44 kind of dig down to a bunch of deeper layers. And we're doing it strategically to understand the function or dysfunction of each of these key systems. And the testing that's in functional medicine is designed to look at that. And the things that we find are often extraordinary. And we often are able to solve people's problems that they've been struggling with for decades by simply looking under the hood a little more carefully. And whether you're looking at, you know, someone with a complex chronic problem or someone looking to optimize their health, you know, it's across the spectrum that it works. Just something that's always off. I think, I don't know about you, Todd, but I think

Starting point is 00:40:17 I've had one patient in 30 years of doing this that I did everything, the testing, and it was like nothing was abnormal. I'm like, oh, okay, you're good. That was it. One woman, she was like maybe late 30s, 40-something, and really took care of herself. You know, she was good. I was like, all right, you're good, you're good. But usually there's always something. There's always something.

Starting point is 00:40:40 There's always something. Yeah. You know, I'm going to interject one thing because I think this is another thing that's another missing piece of the puzzle, and I would call this – Yeah. You know, I'm going to, I'm going to interject one thing because I think this is another thing. That's another missing piece of the puzzle. And I would call this, it's a test that you and I can't do Mark. You know what that is? No. Checking for EMF exposure and toxicity. Yeah.

Starting point is 00:40:56 And I'll tell you this, I'll tell you this interesting story. You can test for it. There's Geiger counters. I had one in my apartment. It's not safe to be in the apartment. Right, right. But it's not like, essentially, when you go to see, and this is on my radar now, because we are energetic beings. We are beings of electricity. So when we want to measure our heart, we measure the electrical activity of the heart called the EKG. We measure electrical activity of the brain called the EEG. And I had this patient and his main complaint was he said he was EMF sensitive. Now, if you go to a regular doctor and you tell the doctor I'm EMF sensitive, they think you're a wacko and you're going to put a tinfoil hat on and, you know, call you crazy.

Starting point is 00:41:39 Well, when I actually listened to this guy and I got his whole story, his symptoms started after he had some dental implants. So he had some titanium dental implants and he had about four or five titanium dental implants. And that was about the only thing that I could sort of correlate with when his symptoms started and what was going on. And I, you know, asked him about his, we did a podcast about the oral systemic health connection. And lo and behold, I did a little bit of research after speaking with him. And it's in the literature that when you put titanium implants in the mouth,

Starting point is 00:42:18 they act as like antennas and they can actually augment EMF activity. And you know this because if you take a fork and you put it in a microwave, what happens? It sparks, okay? Metals attract electrons. So it'll have resonant frequencies. So you've got to think about all of these different things. And it's not necessarily a metal allergy, but there are some people who, for whatever reason, tend to be more EMF sensitive.

Starting point is 00:42:44 And it's a real phenomenon. And I just bring that out because I'm seeing that and it's on my radar. And I, you know, we can't draw a blood test or urine test to check for that, but it's a real phenomenon. Yeah, incredible. So for those of you listening, you might be a little overwhelmed by this conversation. And the goal here is just to give you a sense of how we think differently in functional medicine, that there's a lot to look at besides just your conventional lab tests, and that seeing a good functional medicine doctor will help you get to the root of your problem. And certainly, we're happy to see you at the Ultra Wellness Center. We are booked a little bit out, and so you can try us. We're going to add more physicians and providers,

Starting point is 00:43:22 and you can also look up where to find a functional medicine doctor in your area at ifm.org. But I encourage you to really look deeply if you're having any concerns about your health or well-being, because there's so much more than meets the eye with traditional medicine about getting the root cause of your disease. Absolutely. So thank you so much all for listening to this special episode of The Doctor's Pharmacy called House Call. And we are so excited to share these ideas with you. If you want to share them with your friends and family, please share this episode on social media.

Starting point is 00:43:54 Leave a comment. We'd love to hear from you. What kind of things have you discovered through diagnostic testing? Subscribe wherever you get your podcasts. 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 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

Starting point is 00:44:21 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 do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics, 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.

Starting point is 00:45:03 I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical

Starting point is 00:45:18 or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - Your Lab Tests Are Normal But You Feel Sick: What Your Doctor Is Missing with Dr. Todd LePine

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