Bryan Walsh blood chem transcript

Written by Christopher Kelly

Dec. 29, 2017

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today I am delighted to be joined once again by Dr. Bryan Walsh. Hi, Bryan.

Bryan:    Hello.

Christopher:    I'm very excited to have you on to talk about blood chemistry.

Bryan:    It's kind of a passion of mine.

Christopher:    Of course. You were my gateway to all of this, I have to say, back when I wasn't feeling very good, I don't know, maybe five years ago. I was sitting at the back of the office of a hedge fund and I would spend a lot of time going to see a doctor and the doctor would order some blood. I would go and see the nice lady down the hall that would draw the blood. The results would come back, and I wouldn't know what they meant. I was completely reliant on this doctor who I was starting not to trust to interpret this new data. Working at hedge funds, interpreting data was what I did for my day job and so I became quite interested in understanding what all this data meant.

    I was bruising the Internet, and I stumbled across these videos with this very baby-faced, bright-eyed guy standing in front of a whiteboard, talking about all of the data that I had just tested in blood, and I love those videos. I love them so much. Those videos that you made for WellnessFX, they've still not been seen all that much. I look at them probably once a week, at least once a month and many of them still only have like a thousand views. I can't believe that.

Bryan:    I don't think I knew that story. As long as we've known each other, I didn't know that that's how you got started on that.

Christopher:    Yeah, that's how I got started with the blood. Of course later on I got into more and more sexy tests but you could argue or maybe I'd ask you that question. Why would anyone care about blood chemistry when we've got all these other fancy tests?

Bryan:    Listen, man, you’re preaching to the choir with that. Are you asking me that question? You want to jump right in with that one? I'll tell you what, I'm going to go back a little bit and tell you a little bit of my story with this to answer that question fully. So I graduated from naturopathic school. We had one course in blood chemistry interpretation. It was very conventional. I think our textbook was Fischbach or something like that. If you've even seen that, it's this really thick, little paperback book that has a page per marker, pretty much, reasons why it's high and low, with the reference range. The reasons why it's high and low, if you want a good giggle, it's always pathology, basically.

    So, I graduated in naturopathics school. We started seeing patients. I look at blood chemistry. I tell this story, I think it's true of a lot of practitioners, I would just stare at the blood chemistry with the patient in front of me like I knew what I was doing but in my head, I'm looking at a thing, I have no idea what this is. The patients that were seeing us, they were fairly healthy people so rarely was anything outside of the lab range and when it was, I went to the Fischbach book and I'd look up what it was, what kind of death-defying, chronic pathological condition that they may or may not have had, and that was it. So it didn't take long that I realized this was a major hole in my education. There had to have been something else out there.

    I went online knowing what I was looking for but no idea if it existed, and I found this weekend functional blood chemistry course. I thought, this is exactly what I'm looking for. My wife and I went, drove -- she was pregnant, I think, first kid -- drove down to North Carolina from Maryland, went to the seminar and, man, it blew my mind, changed my life, functional reference ranges, not the laboratory reference ranges. They gave us this huge manual or this binder. There were these patterns that these three markers were high and these three markers were low then this is what this meant. I was just so excited. We were so excited to get back and start implementing this, which is what we did.

    So we started seeing patients again. We got the blood chemistry. Then problem #1 was -- it was put on by a supplement company which is important too because then of course they had all these huge protocols for these patterns that you might see. So my problem was pretty much on Monday morning, looking at a blood chemistry, it didn't match any of the patterns. Instead of these three markers being high and these three markers being low; two were high, one was low, three were normal; and I was like, well what does this mean now? I was just as confused as I was before. The second problem was we were trying some of the protocols and weren't seeing really any movement with the markers that they were supposed to do. It was painted as this really quick and easy, this is what you do, this is going to work for you but then it didn't really pan out.

    So then I realized that I didn't know, and the first marker was albumin, I didn't know really what albumin was. It sounds like the white part of an egg, and that's about all I knew. So I was like, I've got to figure this out on my own. What is albumin? So I read everything there is possibly to know about albumin, where it's made, why it's made, under what circumstances, what amino acids go into it, why it's high, why it's low, and then this thing happened where I didn't need a manual to know if albumin was high or low, what it meant because I knew was albumin was and I knew where it came from and I knew under what conditions it was made, if that makes sense. So that was like the pill. I thought, man, I've got to do this with everything. I did that with bilirubin and MCV. I did it with everything, and I still continue to do that to this day, quite honestly. So that was the pill and from that point on, I had been more passionate probably about blood chemistry interpretation than anything else in this space.

[0:05:15]

    So to answer your question, in the process of looking into what the markers actually are, what they mean, teaching myself these things that aren't being taught anywhere else, which we can get into, like low bilirubin, for example, and then the bit about evidence-based ranges which, where do these ranges come from, that was a sticking point for me. Chris, there's so much information in the literature, how to use just a standard blood chemistry and extract tons of information from it. I don't even have enough time to go through all the amazing papers and studies out there.

    You went to that weekend seminar that I had put on. There's a paper out there that basically says, are we missing the low-hanging fruit by going after all these sexy, fancy, new genetic tests in the functional medicine? We do this with stool tests and dried urine tests and hair tests and all these things when we have at our hands the most internationally recognized, scientifically validated, used hundreds of thousands of times, really inexpensive when you consider all the information you can get from a test, and we have ADD, I think is the society, so you get a dried urine test come out, we're like, oh, well everybody has to run this test. They totally forget about -- we just talked about this with glucose on the last podcast -- we totally forget about this basic test that there are reams, reams of studies on, that you can extract so much information from more than any other test out there.

    Organic acid test can tell you a lot. It doesn't tell you thyroid function or glucose regulation or hydration, all these things. You can tell that with a basic, tried and true, incredibly inexpensive test. So, hopefully that answers your question. There is no better test out there. I don't care how fancy or sexy or how the printout looks, there's nothing that can, in my opinion, or possibly ever will top a blood chemistry in terms of just overall value and what it tells and the price and everything else.

Christopher:    Of course it was a leading question. I know exactly why. It has to be the first place that you go when you look inside. There are lots of things you can do --

Bryan:    It must be.

Chris:    -- before you start looking inside but when you do start looking inside, it has to be the first place that you go.

Bryan:    It has to be, and that's the problem that I see in functional medicine today is, we're humans, everybody does this, but you get your thing, I mean, the candida or adrenal fatigue or whatever it is, whatever it is and then that's the first test you run on a patient that comes in. Let's look to see your heavy metal levels. No, let's not look at your heavy metal levels. Let's just look to see if you have freaking anemia, for God's sake. That's going to trump -- who cares if you have metals if you can't even get oxygen in the cells of your body? So it must be the first test that's run and the beauty of it is, I keep saying, it's so inexpensive for just a basic blood chemistry that tells you more than any other test out there.

Chris:    Can you talk about the reference ranges? Where do they come from?

Bryan:    To be as clear as I can, it depends on the marker. Now the older ones like the ones that you just talked about, the ones that have been around for a really long time, first of all it's considered to be regional so if you're out in California, Maryland, there are people all over the world in different countries that they -- a laboratory takes the blood that they have essentially and figures out the bell-shaped curved. They get a Gaussian curve, they figure out the mean and all these things and then basically once they have that, they go down what's called standard deviations. It's usually plus or minus two standard deviations for the mean.

    So if we were to take 100 people all from where you live, just pull them out of the grocery store, draw their blood and just choose something like glucose; you'd have a high, you'd have a low, you'd have a bunch in the middle, and you could calculate the bell curve and you could calculate the mean. Once you have that mean, the average -- let's just say hypothetically the average glucose from a grocery store where you are, is 100. If you go up two standard deviations and down two standard deviations which there are some additional calculations that are needed, you might come up with something like 80 to 120, for example. Now you could also use one standard deviation in which case that might be 90 to 110, or you could use three standard deviations, and I'm totally making this up, but three standard deviations would be even further, a wider range and would be something like, I'm trying to think of my own math, 70 to 130, for example. That's basically it.

    Reference ranges have changed a little bit over time as people in certain regions have become healthy or more healthy. It is possible for somebody to get their lab work run in one state and a different state has a slightly different reference range even in the same lab like LabCorp. It's possible to have different reference ranges for the same marker with different labs. Quest might not always agree with LabCorp. Then you get some big institutions like the Mayo Clinic and George Washington, they have their own ranges that they use based on looking at the labs that they're evaluating, sometimes looking into the literature.

[0:10:15]

    The last one that I should say though is if it's a newer marker, let's take something like vitamin D, it's kind of a hot topic, so vitamin D. Let's say you and I were researchers in a lab and we discover this really cool way of looking at vitamin D that the other ones, they're not using. What we'll do is we'll come up with our own reference range. How are we going to do that? The first step is we're going to need to gather up a certain number of people to test their vitamin D, run the calculations and then come up with what we consider to be a good reference range. Problem #1, who do you choose for that? In this research lab, you probably want to choose healthy people but what is their definition of health? There's no universal definition of health. What you and I think are healthy may not be what other people think are healthy. You and I may eat McDonald's, we don't exercise very much, you smoke, I drink a 12-pack of beer every a couple of few days, and we don't have diabetes and we feel okay, so we're healthy. That's who were used.

    Now we sell this technology to a lab like LabCorp. Now LabCorp asks us, "What's your reference range?" We give them our reference range. Now they only have to validate it, and it's something like just using 20 healthy people in order to validate what we sent them just to make sure that it's accurate. Just with that little bit of information, there's a lot to be desired when it comes to the laboratory reference ranges, the ones that somebody will see at a blood chemistry in black and white.

Chris:    What's the problem with two standard deviations either side of the mean? That seems quite reasonable at first glance.

Bryan:    It is reasonable. I had someone in the seminar one time, I forget what industry he was from originally, but he said that they used three standard deviations, not for blood chemistry but, I forget for what it was. There are pros and cons to each one, quite honestly. If you use three standard deviations, barely anybody will be outside of the range. If you use plus or minus one standard deviation then you'll have more people outside of the range. So labs and the scientific community have basically landed on this plus or minus two standard deviations as what they use.

    I don't think that there's any inherent problems with that, but you have to speak about it it in context. The context is, if you're looking for a disease which is what -- honestly, blood chemistry is used by doctors to look for disease, period. They're not looking for health. They're looking for a disease. So by using plus or minus two standard deviations, if you're outside of the reference range on any particular marker and it's plus or minus two standard deviations then there's probably something fairly significant, physiologically, going on with you. That's out there at this point.

    On the other hand, if you're inside of that plus or minus two standard deviations, that doesn't mean you're healthy necessarily. The difference between totally healthy glucose metabolism and diabetes is kind of a long road and so you can be inside of all the glucose regulatory markers, inside the laboratory reference range but be on your way towards diabetes. So to use these phrases of standard deviation, you could be outside the plus or minus one standard deviation but still inside the plus or minus two standard deviation. You can't be diagnosed with anything. Like I said, I don't think there's an inherent problem but if you're outside of the laboratory reference range then your physiology has scooted pretty far to be outside that range.

 

Christopher:    When you went to that first weekend seminar, what justification was given for using a different reference range?

Bryan:    You use functional ranges and I know you've asked about it. What kind of answer have you gotten?

Christopher:    Yeah, it was the fixed mindset answer. They were defended. No evidence was given. When we use some software and it uses functional reference ranges, no evidence was given. When I asked, probe further, the guy took it as an insult to his status as a doctor and as the author of this software. So to be honest to you, I don't know. In most instances, they look like one standard deviation but, yeah, the answer is I really don't know.

Bryan:    So, yeah, I'm going to tell you two stories in order to answer that question. One of them I just told you recently, and you weren't aware of this, that I know of, but I think it's really important for the listeners. I'm not going to name any names. There's too much hatred and drama and hurt feelings around that. That's not an important part of the story. So there was this guy, a PhD researcher who supposedly around 1980, started collecting data and according to him, it has been over 10,000 patients and probably about two decades of collecting data from different doctors that agreed to participate in this thing. He considers himself the grandfather of functional blood chemistry analysis and came up with these functional reference ranges using, I guess over 10,000 patients and a couple of decades, and from what I understand, pretty good research, really used quite a lot of evaluation methods, both objective and subjective, in order to develop what are these functional blood chemistry reference ranges.

[0:15:01]

    So this guy now worked for a professional supplement company, and he taught a weekend seminar on how to use these functional, something along the lines of, they're not just numbers and how to use blood chemistry to tell what was going on more with the patients. So healthcare practitioners would go to the seminar. This was a while ago. I don't think he's doing it so much anymore. Two individuals in particular went to the seminar, saw the benefit of this, saw how awesome this information was, probably had a similar experience that I did. One of them decided to self-publish a book on functional blood chemistry interpretation, and has done other things with it. The other one worked for another supplement company and decided to create his own functional blood chemistry interpretation seminar, which is what I went to, and they did a little bit of tweaking.

    At the time, I haven't looked at this in a long time, at the time, man, if you looked at those two guys' reference ranges, they're identical. If you look at the original guy's reference ranges, they were identical. That's where they got them from in the first place. So having been in this industry and having been to a number of these seminars, I would see people ask, "Where do these reference ranges come from?" The problem was there was this tipping point where people started asking. Originally they didn't. There was like, "This is awesome. I don't care where the ranges came from. He just gave me these optimal ranges, and I'm going to run with it." But I think over time, people started really questioning this, and I saw them being asked. You did the same thing. The answer was always either crickets or mumbling through something really quickly or just brushing past the question really quickly because, technically, they took these reference ranges from this original researcher. Now I will say, those ranges are --

Christopher:    You can name the original researcher, can't you? Name the original researcher so I can link it in the show notes.

Bryan:    Yeah, Harry Eideneir, PhD. There's a Harry Eidenier III, might be his son, that works for the same company now. They're still doing a lot of the same things. I will say about his initial work, those optimal reference ranges, I think that they, by and large, work clinically. From what I understand, he did an amazing job collecting all those data to create what was really the first functional blood chemistry reference ranges. Anyhow, people can take a look at him. The ranges worked but my problem was, is that I was asked that from patients, I was asked that from engineering patients who were really interested in that. I had medical doctors saying there's no such thing as a functional reference range.

    I tell you that whole story to basically say that a piece of this is that we needed to go in and find evidence-based ranges to see what really was going on. It turns out, there's a lot of stuff in the literature that was not taught by these people. I call it the nutritional grapevine. He said, she said, they just pass it along from one person to the next, to the next, and nobody really questions it. It turns out there's a ton of information in the literature that looks at more evidence-based ranges and is not what's being taught out there. I think that both patients and practitioners deserve more.

Christopher:    Yeah, it's fine, just taking the reference range and running with it is fine until new evidence comes along that disagrees with it and then you go back to the original source and say, "Can you just send me the references for this reference range?" They don't have it, and they see this as a personal affront on them. That's when the problem starts.

    So one of the big ones, the initial chink and the damned is eventually coming down, was total cholesterol. This functional reference range for total cholesterol was in complete disagreement with everything everyone else I respected was saying and the evidence that I had seen. Then you get back to the original source and you say, "Hey, what's with this reference?" It's crickets. Then you're in trouble because you've got to explain it to your clients why you're in disagreement.

Bryan:    But you can't. They couldn't. Again, I'm not disparaging anybody. It's just the way that things happened. But they couldn't. There was no explanation. Again, it doesn't matter who these people are. They might modify a couple of the ranges based on the Endocrine Society or what Life Extension says about hormone levels or maybe they do research on one of the markers themselves. What happened for me and part of that story, again I graduated, didn't work, went to the blood chemistry thing, didn't know what the markers were, the patterns weren't matching up, and I learned the markers. The next thing that happened was the first marker that it happened for was bilirubin because -- you know what the bilirubin reference range is, the functional one?

Christopher:    Not off the top of my head. You better start by explaining what bilirubin is.

Bryan:    All right, well I will in a second. Here was my problem, so there's this marker called bilirubin which essentially is, since you asked, it is a metabolic breakdown byproduct of red blood cell destruction. Red blood cells last for about three months and then eventually if somebody still has their spleen. The spleen, this little -- it's awesome how this works, man. You get me on a tangent, dude. You can't do that, but it's cool. Red blood cells, when they're first formed, they come out of the bone marrow, they're really flexible and pliable. The proteins and their cell membrane work really well, and they can get through these really tiny, tiny places.

[0:20:00]

    It's funny because as we age, we get more not flexible, we get more rigid both with our thinking and our body. Well so too do red blood cells. They get really rigid. There are these, I kind of picture them as barrels, wooden barrels with some of the slats missing. What happens is these red blood cells go through the spleen and they get stuck in these barrels because they're not flexible anymore. The young ones can slip right through. They do red blood cell yoga. They get through. They go back out of the spleen and into the body. These old, decrepit ones get stuck in these barrels in the spleen and then there are these macrophages just hanging out there waiting to gobble them up. When they do, the body recycles everything. Hemoglobin gets broken down into heme and then heme gets broken down to iron and something called biliverdin and then biliverdin gets converted to bilirubin. Then it goes to the liver, gets converted or gets conjugated and you poop it out basically.

    So here's my question. There was no functional reference range for bilirubin versus conventional laboratory reference range. It was 0.0. It was the low end and then upper end was something like 1.1 or 1.2. That confused me. How can you have all these functional lab ranges for all these markers? Sodium and potassium and chloride and CO2, all these different things, but what about bilirubin? That really confused me. So I started looking into bilirubin and I found a couple of papers that basically said, #1, if bilirubin is 0.4 or below -- now remember, the conventional and functional reference range that has been taught was 0.0. There's no such thing as a low end of bilirubin. These papers that I found said bilirubin, 0.4 or below was a marker, first of all, of oxidative stress which was super awesome to have, but secondly it was an increased risk of mortality. That's not good. Holy cow, there are a couple of papers on this.

    So what you were just referring to about not having a reference to be able to send to somebody as to why you had a range, my next patient, if they have low bilirubin, do you know how confident I was in being able to say that this is a marker of oxidative stress? I don't tell them that there's an increased risk for mortality, but this is an increase in oxidative stress. I had so much confidence with that single marker that, again, that was my second pill. I have to find evidence-based ranges for all of these things because otherwise -- and you've been using functional ranges. You say, well this may mean this or this or this, but I could say, based on these studies, that this is what this marker means and here's a really definitive cutoff for a functional range. I had to find as many evidence-based ranges that I could after that.

Christopher:    Yeah, it's a really beautiful problem to have because it's what encourages you to learn about what bilirubin is in the first place. It's like, okay, so someone used to say the reference range is different from the standard reference range that a doctor would use. Why are they saying that? What evidence are they citing? When you read that evidence, oh, that's what bilirubin is, that's pretty cool.

Bryan:    You really touched upon something that hits a good chord in me, is that empowering feeling, the first one was albumin and knowing what it was and not needing a piece of paper or a book or a manual to tell me whether it was high or low because I knew what it was. That was so empowering. The second one is to have reference ranges and papers that tell you why something may be high or low and there's evidence behind it. The confidence that those two things bred in me is what makes me want to teach this to other people, to other -- I wish that I had someone that -- because, man, it would have saved me a lot of time and effort and energy, but to have someone teach me that stuff, that's what inspires me to teach this stuff to people, say, practitioners, "Listen, you could be doing more and better. It takes a while to figure this out but this is really, really awesome." It's that empowering feeling that you just talked about. It feels so good, I want that for everybody.

    Anyways, the one piece I didn't really answer is the plus or minus one standard deviation. After people had been asking about where the evidence was for this, I actually calculated my own -- this is going back to answering people's questions -- my own plus or minus one standard deviation because I wanted to have something that was more scientific than these arbitrary numbers that would have been talked about out in the field or the industry that was more scientific, but even more scientific than that is getting these evidence-based ranges.

Christoper:    Yeah, and we saw that with the software. The range for insulin was zero to something, right? Zero insulin, really? But then --

Bryan:    Yeah, you're dead.

Christopher:    You're dead. But then, see, peptide does have a low optimal range. When you ask the guy about this, like, I don't know, crickets. Before we leave the topic of bilirubin, can you explain why it's the marker of oxidative stress?

Bryan:    Oh, it's an antioxidant basically, that's why. It's the same thing. Uric acid, I'm telling you, man, the pill, I could take it and that's it. So then I was like, holy crap, you're telling me that I can evaluate oxidative stress on a blood chemistry? This is going back to what I said before. The way I was taught this blood chemistry even in a functional way, they didn't have cool stuff. It was thyroid and glucose and adrenal and gut which was wrong, and anemia, immune system, but I was like, wait a minute, the same blood chemistry marker that I've been looking at for all this time can tell me if somebody has oxidative stress? You're telling me I don't need to run another oxidative stress panel for hundreds of dollars that I can tell this?

[0:25:01]

    So then my next one was GGT. GGT is an enzyme, and it's involved with like glutathione, I would say glutathione transport across cell membrane. GGT, it turns out, this is what the paper said, is GGT in the high normal range. Now what that really means is, within the laboratory reference range, or another way you could put this is a functional reference range or an optimal reference range, that high GGT was also a marker of oxidative stress. Now uric acid is similar to bilirubin in that uric acid is the most abundant, extra cellular antioxidant in the body, so it's an antioxidant. If there's excess oxidative stress then it gets used up as an antioxidant and can show up as low which is the same as bilirubin.

Christopher:    This is very interesting. Just to connect the dots for the listeners, we had analytical chemist Mark Newman talk about him adding 8-hydroxy, 2-deoxyguanosine to the DUTCH test which is a very well-validated marker of oxidative stress, and we're very excited about having that additional data. But what you're telling me right now is that I may be able to get that same information by looking at the basic blood chemistry that probably everybody listening to this podcast has done at some point in their lives.

Bryan:    That's what I'm saying. That's a fine marker. There's no problem with that but when you start with the blood chemistry, if you see a lowish bilirubin, a lowish uric acid and a highish GGT, especially if you have all three, that's a pretty strong indicator of oxidative stress. Then what do you do? You can do additional labs if you need to, based on that, if you want. What's interesting, without going into all the details about it now, but they actually may look at, I would say, different oxidative stress but one may be like GGT, for example, if that's a little bit elevated, that suggests possibly low glutathione in the liver because it's being used up with oxidative stress, which is glutathione is such a hot supplement right now. Who needs glutathione? Everybody needs glutathione but not really. It would be nice to know who may actually be a little bit low in glutathione, and something like a mildly elevated GGT might point to that which, again, this goes back to the awesomeness of a blood chemistry.

    There are things that a blood chemistry can't tell you, but there are far more things that it can tell you to justify it as a first test that anybody should invest. You know how it goes. The more money you put in, the more markers you get. That's fine, but invest in a blood -- forget about the hair test and the pee test and the poop test. These are all valid. There's a place for all those things but for God's sake, start with a blood chemistry because if you get somebody who knows how to interpret it, including some of these cool calculations that have been validated out there, there's so much information out there.

Christopher:    You're talking about the very basic blood chemistry then, the one I mentioned earlier. The thing about blood chemistry is there are lots and lots of markers you could run but as you get further and further away from the things that are being run a lot, it gets exponentially more expensive. So last time we were on, you talked about GlycoMark is a good example. GlycoMark costs, as a single marker, as much as a pretty decent basic blood chemistry, right?

Bryan:    Yeah, and Adiponectin is -- I forget how much that is. It has got to be expensive. The more doctors run a marker, the less expensive it is. You get something like GlycoMark, not many doctors are running it so it tends to be more expensive.

Christopher:    Yeah, you're saying there's so much information that could be had just from this basic, maybe it's only a $40 dollar blood chemistry.

Bryan:    Oh, yeah, no, no, it's a place to start, man, yeah, absolutely. I'll add to that urine analysis. Urine analysis is super inexpensive and that can help corroborate some of the information on a blood chemistry. Anyhow, go ahead.

Christopher:    Right. So I was going to ask you about some of the other markers on a blood chemistry because I think you've had some really interesting insight into some of these. Let's talk about HDL cholesterol. That's the good cholesterol and more is better, right?

Bryan:    I was just talking to somebody, a patient actually. You'd like her. She's been following a ketogenic diet for probably a couple of years now. Her HDL, it's in international units, but her HDL, if I'm remembering correctly, is 2.65 and then her LDL was 2.56 incidentally. So her HDL is actually a little bit higher than her LDL which is a pattern that I've been seeing more and more. I engaged [0:29:00] [Indiscernible] podcast topic. I will tell you, I do not have all the answers to HDL, but I definitely know a few interesting tidbits, enough to be concerned with elevated HDL. Historically it's considered the good cholesterol. It's made peripherally. As it head backs toward the liver, it picks up cholesterol and stuff to be metabolized. So it's supposedly good because it's collecting fat and bringing it to the liver to be gobbled up. That's where it got its definition as good. However, HDL is an antioxidant, for sure, but it's also a pro-oxidant which means that it could be good or it could be bad and just simply looking at a blood chemistry, you have no way of knowing.

    HDL, you could probably comment on this yourself, when it's elevated, that, to me, is a marker of, I don't say of bad things but not great things. For example, why would HDL be elevated and LDL be a little bit low? Could be liver dysfunction, that's classic liver dysfunction. That is a pattern that is very often seen in cancer. It's very often seen in elevated HDL, low LDL in autoimmune conditions. I mentioned this on the Keto Summit podcast that that happens on a ketogenic diet. I don't know why. Why is HDL high? Is it acting as an antioxidant because there's more oxidative stress? Is it acting as a pro-oxidant for some reason? Is the body trying to protect itself so it's making more HDL? In the case of liver dysfunction, the liver makes LDL so that would be why LDL is low and HDL is high is the periphery makes the HDL.

[0:30:32]

    The point is when it's high, it's hard to peg a specific number, but when it starts creeping up above 70, 75 is a bit my cutoff, but when it starts creeping up about 70, 75, 80, that's not good. I think that's a marker of probably some kind of dysfunction going on in the body. I can't say inflammation because it doesn't corroborate with inflammatory markers. I can't say oxidative stress because it also doesn't corroborate with oxidative stress markers. It's the marker of things, I don't have a better way of saying it, but there's something going on. I will just add, think about those things I just listed out, autoimmune conditions, cancer, liver dysfunction, there's something significant going on usually with the immune system but something significant going on with those things. It's hard to find literature that suggests that because everybody thinks it's so great. A high HDL is definitely not desirable.

Christopher:    It seems that's often the case with blood chemistry that it's not giving you a definitive answer on what you should do but instead is acting as a navigator saying, I think you should go this way and just have a look at this, check it out.

Bryan:    It's a really good point. There are some markers on a blood chemistry that say fairly definitively that something is going on. There's a bunch actually. I'd say more than that, that say something is wrong, I can't tell you specifically what it is, but I'm going to use this metric or all of these metrics as we modify your diet and lifestyle and various different things to see if we're making progress. So that HDL, if you see that come down over a three to six-month period because you're doing really great stuff with people, it's a marker, I don't say of health, but it's a marker of progress. So even if it doesn't say specifically why, you just need a lot of the markers on there to track progress.

Christopher:    Talk about triglycerides, is there a similar story there?

Bryan:    Yeah. So HDL, supposedly there's no upper end. I'll tell you, I've seen people's HDLs, rarely you see it above 100 but in the 80s and the 90s. The patient will come in and be like, wow, my cardiologist said he has never seen a better HDL so whatever I'm doing, I'm doing well." I hate to burst your bubble but, no, and the same is true for triglycerides. Everybody knows that high triglycerides are bad but there's no low end. The lower the triglycerides, the better, according to cardiologists, more HDL, the better. That's just simply not true either. We need a certain amount of triglycerides and there's, again, not a lot of evidence. When looking, it's so hard to find some of these things.

    I'll just give you some other examples like bilirubin. Bilirubin, GGT, AST, ALT, those are pretty easy to find some pretty cool studies on, but the amount of studies done on things like vitamin D and the lipids that finding that diamond in the rough, that one really awesome study is quite challenging because of just how much little research has been done on these things. So there was at least -- I think it was about 2003, 2009, anyhow, there was a paper that basically said low triglycerides are seen in just about every single autoimmune condition. That's a really good paper. There are indications that -- and they don't know why. It's only speculation, but I will tell you, I have seen that low triglycerides in people with autoimmunity so often that low triglycerides, if it comes in at 30s, 40s, 50s and the rest of their lipids are fine, they seem to have pretty good fat digestion and they're eating an adequate calorie diet, that's a tip-off to run auto antibodies on somebody. It's that common in autoimmunity.

    So there's something going on when there's inflammation or immune system dysregulation that -- and I don't know why. I don't know if they're being burned up or if they're not being made as much or if the liver is not releasing. I have no idea why but, no, there's absolutely a low end to -- it's like you said with insulin. How could you have zero insulin? How can you have zero triglycerides and how could that be a good thing? So, no, there's a low end to triglyceride levels as well.

Christopher:    We see a lot in the athletes that we work with. It could be part of this signature of a low energy state, maybe under-eating, malnutrition, that side of things as well. I wonder whether that, for our particular group of people, is more common than autoimmunity. But honestly, I don't know.

Bryan:    Well something that I would pose, and I'm just making this up, I wonder if the immune system of, I'm not going to say an extreme athlete but you know what I mean, somebody that is more than your average weekend warrior, if their immune system matches that of somebody with an autoimmune condition and therefore you might see low triglycerides. I'm not saying that they have an autoimmune condition but saying that the things that one sees with immune system and an autoimmune condition, can you train yourself into that same immune system pattern and then with that dysregulation, cause a decrease in triglyceride? It could be energy and calories and fat consumption and a number of things. That was just me thinking out loud, I suppose.

[0:35:05]

Christopher:    Let's talk about the complete blood count because that was the thing that got me into this with real gusto. I knew the hemoglobin was a major determiner of endurance exercise performance, and I could see that mine was low so that was another thing. I've always talked about C-reactive protein being my thing, but this was another thing I'm like, okay, if can just raise this by two points, I'm going to kick ass in mountain bike races. How can I do that? You talk to your primary care doctor and say, "Hey, how can I raise the C hemoglobin thing by a couple of points without breaking any rules?" He's like, "I don't know." He just doesn't know, not interested. He doesn't care. It's not his problem. Get out of my face. Talk about the complete blood count and what we can learn from it.

Bryan:    I would argue, anybody can argue with me about it if they want, but I would argue that that might be one of the most important parts of blood chemistry. Cash price for a complete blood count is, what, five bucks, ten bucks? It is such a valuable part. So there's a complete blood count or CBC and then there's CBC with differential. The CBC, there are three cell types in blood. There's red blood cells, white blood cells and platelets. It does what it says, it counts how many of those cells you have, how many red blood cells, white blood cells and platelets do you have but then in addition to that, it tells you what are called the red blood cell indices.

    So basically it tells you how many red blood cells, white blood cells and platelets you have and then tells you the health, like how the red blood cells look, so it tells you how much hemoglobin is on the inside. Hematocrit is known as the packed cell volume. If you take a vial of blood and you spin it around really fast, all the heavy stuff goes to the bottom. That's the hematocrit. Then it has these calculations that tell you, yeah, how the red blood cells look, the mean corpuscular volume, how big they are, the mean corpuscular hemoglobin concentration, and that's telling you their color so, how red are they, how colorful are they, how big are they, then the RDW is what's the variance in size of all the different red blood cells. That's a CBC. The CBC with differential, the only difference is it tells you the different types of white blood cells so, neutrophils, lymphocytes, monocytes, eosinophils and basophils. So there's not a lot of difference although if you're going to get one, just get the differential because the white blood cells are valuable.

    Man, you can tell so much from just a CBC. I don't know how much detail you want me to go into, but a CBC will essentially, first and foremost, will tell you if you are making or have enough capacity -- I don't want to make it sound like enough red blood cells because you can have enough red blood cells that don't have very much hemoglobin in them and you all have the same problem as somebody that doesn't have a whole lot of red blood cells. It tells you that your capacity to carry oxygen around your body and deliver to all the cells of the body, which we talked about biochemistry before, but oxygen, it's the key thing in the electron transport chain as an electron acceptor in order to be able to make ATPs. So without oxygen -- if nobody believes this, just try holding your breath for a few minutes and see how you do.

    So it tells you your ability to carry oxygen around the body. The beauty of it is, with some of the other indices in the CBC, you can see why, and it looks for -- you've seen all this. Just with the CBC alone, you can get great inferences into a number of different things that are going on in the body like nutrient deficiencies. It can point to an iron deficiency or possibly a copper deficiency or a zinc deficiency. It can cause abnormalities in the red blood cells, or B6 deficiency or B12 or folate or, vitamin C is a little funky, but vitamin C deficiency. You could tell if they're breaking down too early for some reason or they're not being made well. That's all in the CBC which is incredibly valuable.

    The RDW which is a marker -- this is, again, this is my own story, man. I was taught that the RDW looks at the variance of red blood cells, so if somebody makes a bunch of little ones and a bunch of big ones simultaneously, you'd have a high RDW versus, let's say all of yours are uniform-sized, you'd have a low RDW. I wasn't told anything about other than that. Well it turns out it's an incredible marker in helping to identify if you can't carry oxygen in your body due to a nutrient deficiency or some other reason, and by itself RDW is considered to be a marker that if elevated, you have an increased risk for mortality, increased inflammation that seems to correspond with CRP. You mentioned the thing about CRP.

    So just with that little itty-bitty, incredibly inexpensive CBC with differential, you can tell loads of things about the body. Again I would argue, if someone's anemic or has glucose dysregulation, the anemia, because you can't deliver oxygen to the cells of the body, you have no chance of the other cells of the body being healthy because they're lacking the thing that makes ATP to make every cell do what cell does.

Christopher:    Right. So just to summarize then, the red cell distribution width, when it's elevated, it's telling you there are lots of different sizes of red blood cells. The reason for that might be because you lack certain nutrients that require to make red blood cells. On some days you had enough, some days you had not enough of a particular nutrient that allows the cell to get bigger and so you ended up with a smaller cell. That variability is generally a bad thing.

[0:40:02]

Bryan:    Yeah, well the body wants uniformity when it comes to red blood cell size so it can get through capillaries and do gas exchange. Yeah, so just to give you a good point about -- you really hit it on the head. So red blood cells, they're in circulation for about three months. The ones that you were making three months ago are still hanging around probably, as are the new ones. So let's say a month ago, for whatever reason, you went vegetarian, you went vegan. You're a vegan and you weren't eating any greens, so you weren't getting any iron at all, but the other two months, you were. So during that month where you may have been a little bit iron-deficient, you make some small red blood cells. During the other two months where you were iron-sufficient, you might have made normal red blood cells. So there will be a little bit of variance. You have some that were made for that month that are small, a couple of months where you made normal and so there's a variance. Now on the other hand, if somebody is severely iron-deficient, now this is possible, if somebody is severely iron-deficient for a long period of time, they may have smaller than normal cells but because they've been chronically iron-deficient, they would have a normal RDW because they are the same size, they just happen to be small, if that makes sense.

Christopher:    It does. We've effectually named this the Three Stooges Syndrome, right? You've got one thing causing a problem in one direction and another thing causing a problem in the other direction and then the two things cancel out, and it looks completely normal.

Bryan:    Yeah, well it's like vitamin B12 deficiency and iron deficiency, one will make a big red blood cell, another will make a small red blood cell. If you have them both simultaneously then you may have a normal-looking-sized blood cell.

Christopher:    Talk about production, destruction and loss. That's something I think about that and learn from you every single time I look at blood chemistry. Talk about production, destruction and loss.

Bryan:    Well I like that because it rolls off the tongue and it's easy to remember, is production, destruction or loss, so it makes it easy. If somebody comes back with low red blood cells or low hematocrit or low hemoglobin then that means that they don't have enough red blood cells. There are only really three reasons for it. There's production issue. Maybe they're not making it, they're not making enough, there are a few reasons for that, maybe they're not making them well; could be destruction, so let's say they're making them just fine, they're dumping them into the bloodstream from the bone marrow, there's plenty of them, but they're being broken down before their time, before that three-month window; or loss.

    So let's say in the third person, they're making them just fine, they're not being broken down, but it's a female that has really heavy menstrual cycles and loses so much blood during her period that she doesn't really make up for it during the rest of the month, could be menopausal, or male, could be some kind of gastrointestinal bleed, could be a bleeding ulcer, could be colon cancer, God forbid, or some kind of bleed going on in the GI tract. That's it. I make it sound easy but that part is. That's the only reason why you can have low red blood cells is you're not making them, they're being destroyed early or they're being lost or a combination, but that's where the rest of the blood chemistry -- a little bit of history -- and just the CBC itself can tell you a little bit more information about which one to go for.

Christopher:    Yes, tell me about how you differentiate between the three problems. Well I'd mentioned the RDW. None of these are black and white. If somebody has low red blood cells, hemoglobin and hematocrit -- I mean, I guess I can walk you through this. The first thing that I do is look at the MCV, and I should just say this. Hemoglobin is the only of the first three that I just mentioned that's really important. You can have normal red blood cell count, normal hematocrit, which I won't get into, but low hemoglobin, that's the oxygen-carrying molecule. There are like 280 million hemoglobin molecules in one red blood cell which is just mind-boggling. It's just stuff like that. You and I have talked about this. Then you step back, like, you really think you know what you're doing in functional medicine? 280 million hemoglobin molecules in one single microscopic red blood cell. That's amazing.

    So if hemoglobin, the oxygen-carrying component of red blood cells is low then it doesn't matter how many red blood cells you have or what your hematocrit is, you'll have a hard time carrying and delivering oxygen around the body. So then the first place I look is the MCV. Of the next three, the MCV, MCH and MCHC, the MCV is the most valuable, just like the hemoglobin is the most valuable of the first three. MCV tells you the cell size. So if the cell is big then what you might be looking at is a B12 or folic acid deficiency is most common. If it's too small, low MCV, could be iron-deficiency, copper-deficiency, B6 deficiency, and then if the RDW is high, just to follow on everything that we just said, if the MCV is either large or small and the RDW is a little bit on the high side, indicates there's some variance in the size, that's probably production, that you're not making enough. It's not that you're making enough, but you're not making them well. If you're iron-deficient, you can't use the hemoglobin. You can't make hemoglobin well so you have low hemoglobin and small red blood cells because there's not enough hemoglobin on the inside, for example. So it's probably production, that you're probably not making them well.

[0:45:00]

    If everything I said was true but then the MCV is normal then what you're looking at possibly is normal red blood cells but you don't have enough of them for some reason. So then it's probably destruction or loss. If the RDW is normal then that is a good indication that it's either destruction or loss. Then at that point, honestly, if it's a menstruating female, ask about how heavy her cycle is because then you may just figure out the loss right there. If it's a male or a menopausal female, getting a stool occult test to see if they're bleeding out of their GI tracts could be helpful. In terms of destruction, the RDW will likely be normal.

    There's another marker that is not found on a standard blood chemistry I think is valuable enough to actually keep on every blood chemistry is the reticulocyte count. That's a whole topic and there's a little bit of calculating that one needs to do with that as well but that tells you how well production is actually going, how many they're making. Just to be super clear, production actually refers to how many are being made and how well they're being made. So if you're iron-deficient, it could be pumping them out but they're malformed. They don't have enough hemoglobin so they're on the small side. Production can also be just lack of production that there's not enough stimulus so there's inflammation going on, different amounts of cytokines or various things that's actually suppressing production, so you're making them just fine, everything is fine except you're not making enough. Kidney dysfunction would be involved in this too because it makes the hormone, erythropoietin which stimulates the other poiesis which is red blood cell production.

    So look at the MCV first, if it's big or if it's small then it's probably nutrient-related. If RDW is high then it's more likely nutrient-related. If the MCV is normal then it's usually, not always, not always, there's more to this, it's destruction or loss. If it's loss and you're menstruating, ask about the cycle. You can look at GI bleeds in the stool occult test. Destruction, really at that point, running a reticulocyte is the best thing because that will help differentiate between if it's destruction or loss.

Christopher:    Talk about reticulocytes and hemoglobin A1C. Sorry to send you off on another tangent here but this may be important because reticulocytes, as you said, is a very underrated marker.

Bryan:    It is. You mentioned before, there's no shortage of markers. You could put on thousands of dollars of blood chemistry markers. You'd probably pass out because of lack of blood of all the vials they needed, and be $3,000 in the whole. But there are some that aren't run routinely and I think that should be because of the utility, because of the value of them, and one of them is the reticulocytes. So within the red bone marrow, there are stem cells quite honestly, and they can become a bunch of different things. One of the things they become is the red blood cell. So inside the red bone marrow, we get what's called differentiation and then there's maturation. It starts out of the red bone marrow as these fairly large cells and the nucleus starts to make globin and then heme comes along and it gets attached to globin and then it gets smaller and more red.

    Then you have this thing called a reticulocyte, and a reticulocyte exists in the bone marrow and then gets spit out of the bone marrow into the bloodstream still as a reticulocyte, and it contains still a little bit of cellular fragments like the residual nucleus that really is no longer hardly acting as a nucleus. It dumps those out after a few days in circulation to become a fully formed, mature erythrocyte or red blood cell. So because reticulocyte is such a cool marker, because reticulocytes exist inside the bone marrow and the blood, they are a marker of blood cell production.

    So if you have, let's say, if people can follow this, I could quiz you if you wanted, let's say you had low red blood cells, hemoglobin and hematocrit. You don't have enough red blood cells. Let's say you and I, let's put it that way, you and I both have the exact same red blood cell, hemoglobin and hematocrit. My reticulocytes are low and yours are normal or high. In me, my red blood cells are low because my reticulocytes were low and I'm not making it. There's some problem with the production in the first place. I don't have enough because I'm not making them. You, you're losing them or destroying them, probably losing them but could be destroying them because with the high reticulocytes, what the body is saying is, listen, I know that I don't have enough and I'm sure trying to replace all these things but I can't keep up, if that makes sense. So that's the value of reticulocyte. It's such a cool marker and there are other things you can use as well.

    The problem with A1C which we've talked about before, and I don't know how often this happens. I think it's, I don't want to say extreme cases, but people with really good glucose regulation tend to have slightly longer-lived red blood cells. People with poor glucose, and this is based on published research, people that have poor glucose regulation tend to have shorter-lived red blood cells. Now the problem is, with hemoglobin A1C is it's glycated hemoglobin. They're looking at the globin portion of hemoglobin which is a protein, and how much glycation takes place with it, and because red blood cells last for about three months, it's considered to be about a three-month marker of blood sugar management. Well that's fine but what happens in somebody that has longer-lived red blood cells, they may have, say, more time for the hemoglobin to get glycated because it's existing longer in the bloodstream than would normally occur, they would show up with a false positive A1C, a higher A1C than you would expect in that individual, ironically, they have really excellent glucose regulation.

[0:50:28]

    I've seen those patients that everything is perfect, their glucose is -- everything is good, and their A1C is a little bit high, like, what the heck. It turns out that that might be part of it. On the other hand, and this is where the bigger of the two problems occur, is in somebody's really poor glucose regulation have shorter-lived red blood cells, less time for hemoglobin to get glycated and therefore a false negative, a lower than normal hemoglobin A1C and somebody that otherwise should be higher. So you may get somebody who has Type 2 diabetes, their A1C should actually be higher to reflect their glucose level but because they may have shorter-lived red blood cells and less time for hemoglobin to glycate that they may show up, the doctors are like, well you're doing a good job eating your McDonald's and Taco Bell and drinking your soda pop all day.

    The reticulocytes can be used along with hematocrit to calculate somebody's red blood cell life span which is super cool, and so in someone who has Type 2 diabetes or exceptional glucose control and a mildly high, slightly higher than one would expect A1C, you can just simply calculate this red blood cell life span using reticulocytes and that can be the answer which is pretty awesome.

Christopher:    It is awesome. I'll link to the formula that's in the papers that describe this formula, so I'll link to those in the show notes. Now just looking at the reticulocytes on my catalogue here, it's $5.95 to measure reticulocytes. How cool is that?

Bryan:    There's no reason not to. Listen, and that's the thing. I still don't get excited about vitamin D to the point that if someone didn't have vitamin D in their blood chemistry, I wouldn't care. On the other hand, reticulocytes, again for the price but also what it's telling you, I mean, you can chase down an anemia forever. If you don't run reticulocytes, you may be missing it and just to have it on the standard blood -- there are other things that you can do with some of these things, but it's so cheap and it tells you the health of your bone marrow and the production of your red blood cells, it's kind of an important thing, and for the cost, why not, and that you can do these additional calculations with it.

Christopher:    Yeah, it's amazing, amazing. Well I tell you what I need at this point, Bryan, is you in a box, Bryan in a box. How about this, so I go and get my basic blood chemistry done and then you're inside of this kiosk and there's a slot in front of the kiosk. I feed in my blood chemistry. You write down what you see, and you tell me what I should do. You push the paper back out and then I run with it. That's my thing. That's my diagnosis. That's my plan, my road map. Wouldn't that be awesome?

Bryan:    You know.

Christopher:    I could say what would be even more awesome, if Tommy was in there with you. That will be --

Bryan:    Oh, my God, see, now you're talking, yeah. First I was like, that's ridiculous, but if -- write me down for that.

Christopher:    Okay, so tell me what's the problem with my idea.

Bryan:    Being stuck in a black box, totally isolated? Well and here's the thing, I get excited about -- I will look at any blood chemistry really quickly just because there's a story. There's a biochemical, physiological story that's being told and by looking around and using an optimal reference range, you get the story. Then there are calculations. There are validated calculations for viscosity and fatty liver and atherogenic index, all these different validated calculations that, again, I was never taught. That's my frustration, man. I wasn't taught this stuff. I go on the literature and I read this all the time.

    I know that your listeners don't care about this, but last night when I jumped back on Slack after having been off for a few hours and chatting with you guys, I was laying down with my girls trying to put them to bed. The ages, what are they now, one of them is going to be five tomorrow and the other one is three. I was laying down with them while I was doing that. You know what I usually do when I'm laying down to put them to bed which takes way too long every single night, is I'm looking at research papers on this stuff. I cannot get enough of this stuff. This stuff is so exciting. It tells a story. Like I said, I will be in there laying down, trying to get them to bed, and I'll find on my phone, a fatty liver index, a calculation or something. Why the heck was I not taught this? The entire world needs to know calculations for viscosity because the importance of blood viscosity with all sorts of different conditions, but it's not being taught which is why I like this venue for being able to chat to get some of this stuff out there.

    But I don't think a kiosk would be good. I think what would be more ideal, which is something I've wanted for a really long time, is a really sleek awesome software program where somebody could essentially do the same thing, plug in their blood chemistry and get an output and then I don't have to sit in a kiosk.

Christopher:    Exactly, we just need to get whatever is inside your brain into software would be, I think, truly phenomenal. But in the absence of that software being available right now, say I want to learn more about blood chemistry, where is the first place you should go?

[0:55:02]

Bryan:    Well that was my problem. I went a couple of places and it was helpful initially but now that I look back, I wouldn't recommend that book quite honestly. I think it creates more confusion. Well actually, here's a funny story. I was in Ireland speaking a few months back. This one guy asked a question and, man, I'm trying to remember what it was now, but he said just two basic markers like, now I forget, is it CO2? He mentioned two basic blood chemistry markers and the guy's PSA was normal. I was like, why are you looking at the guy's PSA based on those things? Then he named the book. He was like, well it was So-and-So's book. I was like, oh, say no more. Listen, dude, you're barking up the wrong tree. That's not how that works. I think it creates more confusion than anything, honestly.

    I hate to say it, I don't know, my plan is to create my Metabolic Fitness level two physiology then my biochemistry and physiology level three which is blood chemistry interpretation. It's going to have all this stuff, man. It's going to have what albumin is, why it is, why it's made, bilirubin calculations. You went into an abbreviated version of that with that weekend seminar. I'm not trying to say that I have all the answers but this stuff that I wish I had access to when I was starting out, 10, 12, 15 years ago.

Christopher:    Well that's what I was going to say is I wouldn't have gotten nearly as much out of the weekend seminar on blood chemistry had I not done the basic Metabolic Fitness Pro, the level one biochemistry.

Bryan:    You have to. That's the whole reason why I'm doing it that way. The problem with these seminars is they're just jumping right in and saying, here's bilirubin. When it's high, it means this. Well if you don't know what the hell bilirubin is then you're going to have no idea what that actually means which was my problem. I didn't know what these markers were and when it didn't match a pattern then I didn't know what was going on. When you know that stuff, you don't need a manual. You don't need that stuff. You can figure out and when things come back crazy, you can -- you've done that -- you can figure it out yourself. You can walk yourself through it.

Christopher:    It's really hard. When you're starting from the beginning, the best way to learn is through solving a problem. You have your own personal problem. Why the heck is my hemoglobin so low? Let's learn about blood chemistry interpretation and then you go learn about that, and you realize you have no idea what anyone is saying. So then you have to swallow your pride and go back to level one basic biochemistry and then build your way back up to the thing that's going to solve your initial problem.

Bryan:    That's what I did. I'm teaching information that helped me to get where I am. You said that it has helped you get where you are, and that's how learning happens. You have to learn the basics to study the advanced stuff. The functional medicine world jumps to the advanced stuff without having the basics and that's why so many people are lost. That's why there are these protocols. Do this protocol when you see this lab result. It doesn't always work. If you don't know the physiology then you can't go troubleshoot.

    Anyhow, to answer your question, I forget about them, but those WellnessFX videos on YouTube, I don't think would be a bad place for some people just to get their feet wet with some of the blood chemistry markers. They're old. Those are old and I probably would do them differently now, but we get good feedback so I guess that's a good place to start.

Christopher:    Yeah, absolutely. I will link those in the show notes for this episode and of course I'll link Metabolic Fitness Pro as well and then your website, drwalsh.com. Is there anything else you'd want people to know about, Bryan?

Bryan:    You tell me. I don't know. Nothing that comes off the top of my head. I mean, glucose program, detox program, they can find all that stuff elsewhere .

Christopher:    Yeah. So that's just a reminder that Bryan also does the glucose regulation course, which I found incredibly helpful, and then also the detox course. I made a time map for your interview with Tommy which was excellent, but I came out of it thinking, oh, is this just a protocol? Yes, it is a protocol, but it's also Bryan in front of the whiteboard teaching you about the phase zero through four detox pathways, all the way down to the biochemical level which, if you're a practitioner or a health coach, that's really good stuff. I want to know how all that stuff works. That wasn't immediately obvious to me when I listened to that interview. Everything is linked from the same Metabolic Fitness Pro website, correct?

Bryan:    Yeah, you can get all there.

Christopher:    Excellent. Well this has been fantastic, Bryan. We'll have to get you back on to talk some more good stuff about blood chemistry in the near future, if that's okay with you.

Bryan:    Oh, there's some good stuff coming for sure.

Christopher:    Excellent. Okay, thanks a lot, Bryan.

Bryan: Thank you.

[0:59:22]    End of Audio

 
Biomarker   Latest Test Result
Jul 06 2017
Glucose   84.00
5.00
Insulin - Fasting   2.00
Fructosamine    
C-Peptide    
BUN   19.00
Creatinine   0.88
BUN/Creatinine Ratio   21.59
eGFR Non-Afr. American   99.00
eGFR African American   114.00
Sodium   139.00
Potassium   3.80
Sodium/Potassium Ratio   36.57
Chloride   106.00
CO2   24.00
Anion gap   12.80
Uric Acid, Male   5.70
Protein, total   6.00
Albumin   4.30
Globulin, total   1.70
Albumin/Globulin Ratio   2.50
Calcium   9.00
Calcium/Albumin Ratio   2.09
Phosphorus    
Calcium/Phosphorus Ratio    
Magnesium    
Alk Phos   46.00
LDH    
AST (SGOT)   25.00
ALT (SGPT)   18.00
GGT   12.00
Bilirubin - Total   0.70
Bilirubin - Direct   0.10
Bilirubin - Indirect   0.60
Iron - Serum   131.00
Ferritin   95.00
TIBC   238.00
% Transferrin saturation   55.00
Cholesterol - Total   184.00
Triglycerides   34.00
HDL Cholesterol   67.00
LDL Cholesterol   110.00
VLDL Cholesterol    
Cholesterol/HDL Ratio   2.70
Triglyceride/HDL Ratio   0.50
Leptin, Male    
TSH   1.50
Total T4   6.30
Total T3   75.00
Free T4   1.00
Free T3   2.70
T3 Uptake   34.00
Free Thyroxine Index (T7)   2.10
Thyroid Peroxidase (TPO) Abs   5.00
Thyroid Peroxidase (TPO) Abs LABCORP    
Thyroglobulin Abs LABCORP    
Thyroglobulin Abs   <1.00
Reverse T3   13.00
Hs CRP, Male   0.20
C-Reactive Protein    
ESR, Male    
Homocysteine   7.30
Fibrinogen    
Creatine Kinase    
Vitamin D (25-OH)   53.00
Vitamin B12    
Folate    
DHEA-S, Male    
Testosterone, Free Male    
Testosterone - Bioavailable Male    
Testosterone, Total Male    
Sex Hormone Binding Globulin, Male    
Testosterone, Free Male LABCORP    
Estradiol, Male    
Progesterone, Male    
PSA    
Collagen Cross-Linked NTx    
Creatinine Clearance    
Cortisol - AM    
Cortisol - PM    
Gastrin    
Total WBCs   3.70
RBC, Male   4.51
Reticulocyte count   0.40
Hemoglobin, Male   14.20
Hematocrit, Male   40.90
MCV   90.70
MCH   31.50
MCHC   34.70
Platelets   189.00
RDW   13.00
Neutrophils   47.60
Bands    
Lymphocytes   38.80
Monocytes   10.90
Basophils   1.10
Eosinophils   1.60
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