This week’s podcast: “James Maskell Exposed: Lab Testing Functional Style” features our good friend Dr. Jeff Gladd MD Medical Director at kNew Health, interpreting our co-founder James Maskell’s functional lab results on-air.
Not everyone would agree to have their health markers broadcast for the world to hear, but James has done this before in “The Genetics Summit” and is back for more. The goal of this expose´ is two-fold:
For practitioners: to demonstrate the power of functional lab work has to improve patient outcomes and super-charge your practice
For patients: To help demystify the world of functional medicine and inspire listeners to get out there and get these life-changing functional labs done.
Tune in to watch James get exposed and learn:
- How functional lab work transformed Dr. Gladd’s practice and improved patient outcomes
- What types of labs he recommends…and why he typically doesn’t recommend a full pricey workup for each patient
- How he gets these labs done for his patients at a super affordable rate
- What James’ actual lab marker ranges mean according to functional lab interpretation, and what Dr. Gladd recommends he do to get them back to optimal ranges
- How Dr. Gladd and James’ new venture: “kNew Health” works to help members save big on lab work, health coaching and self-health creation
Plus, we will air James’ re-test results, after he’s had a few months to follow Dr. Gladd’s advice to improve his markers, so stay tuned for that!
And be sure to check out Dr. Gladd and James’ newest venture kNew Health, a membership-based program aimed to provide functional medicine at an accessible and affordable rate.
Resources mentioned in this podcast:
James Maskell: Hello and welcome to a special podcast. This is your host, James Maskell. I am here with Dr. Jeffery Gladd. Welcome Doc. How are you doing?
Dr. Gladd: I’m doing great, man. It’s good to hang out with you again.
James Maskell: This is a special series of podcasts. Last year, I did a complete interpretation of my genetic profile and people seemed to like it. I think not many people had ever seen a empowering genetic consultation happening live. In that realm, in wanted to take a moment today to really just talk about lab testing in medical practice because this is an area where I think that different people are doing a lot of different things in the functional and integrated medicine space.
For those who are not familiar with Dr. Gladd, he and I met six years ago as faculty at the Heal Thy Practice Conference that we were together for four years. If you heard the announcement last week, he is now the chief medical officer of our new project, Knew Health.
One of the reasons why I decided to work with Jeff on this project was actually because of the way that he practices and the model that he’s created. Now, if you’ve read my book, you know that Jeff is one of the heroes of that book because he’s been able to deliver root cause resolution medicine, integrated medicine, functional medicine in Fort Wayne, Indiana to a much wider group of the population than most practices that we see.
Part of that strategy has been about creating a structure where you’re really making it easy for patients to interact with the lab and the supplements and that part of the practice.
Jeff, maybe as a starting point, you could just share a little bit with the audience what your learning process was and how you ended up coming up with the lab model that you currently have in your practice.
Dr. Gladd: Yeah, for sure.
As I got started, now going back 10 years when I was with the hospital, it always started with a big lab panel. Lots of data and two different focuses from what happens traditionally. Number one, a variety of different markers, deeper markers, more information, but also the reference range and the interpretation was vastly different. Just being in the normal ranges isn’t a health strategy.
As I started doing that and using labs, realized the power that that information had for people to impact their health and want to make changes and just want to come back and review the labs. For all kinds of reasons. It’s great for them. It’s great for your practice. It keeps them accountable, but it also keeps them coming back into your office.
A couple years in, I started catching wind of patients canceling appointments because the labs were too expensive. It was just as these, the deductibles just started creeping up and sometimes shockingly so, patients were getting this giant sticker shock of labs. They weren’t going to pay $2,000 or $3,000 to get labs done. I don’t blame them. Out of that became the necessity of, “Is there a better way to figure this out?”
We had a patient who was actually a midwife tell us about a lab company that was doing Lab Core labs at cash rates and it was incredibly less expensive. We immediately just implemented that policy and just went out and reached out to all our patients. We now have cash labs. The discount is incredible. Come connect with us.
Even to this day, matter of fact my staff was just telling me yesterday, we had a patient who said, turned down the cash labs, “No, my insurance does a good job of covering Lab Core. I’m just going to go there.”, calls 15 minutes later and says, “No, no. You guys are hundreds of dollars cheaper. Let me just do the cash labs.”
We’ve been able to continue, and now we work directly with Lab Core on our own account, but $3,000 to $6,000 is the panels that we’ve seen when people take a chance and use their insurance and get hammered by an out of pocket cost. We do those same lab tests for anywhere from $200 to $400.
We’re seeing more patients come in more regularly and be more engaged in their labs. We have some people do markers every month because it only costs them $10 or $15 as opposed to a couple hundred dollars every time you do it.
We’ve just enjoyed it from, mostly from the patient care perspective. Obviously, as a practice, you can now say, “Listen, your giant lab panel and the extensive interpretation that you’re not going to get anywhere else is goin to be less expensive than just doing the labs or just showing up at an urgent care and having a seven minute office appointment”.
James Maskell: Yeah, absolutely.
It was back at the March Functional Forum where you shared that, in the evolution of cardiology, this is, on that Functional Forum, that was the moment that I realized, “Okay, this has to be the model”, because the numbers are shockingly different.
If you just, the combination of giving your insurance card over in an environment where you have a high deductible plan, it’s almost like when you give the insurance card, you’re kind of saying, “You have permission to charge me full price”, right?
Dr. Gladd: Yeah. No, without a doubt.
You also, and another thing that attracts some patients, not all, but when you hand that insurance card over, you’re essentially making that data public. Labs have it. Hospitals have it. People can acquire that information. If you want truly private medicine, you pay cash and it doesn’t go through channels. It lives just between Lab Core and the patient and they’ve obviously invited me into that relationship, but I don’t share that with any other entity.
The insurance game, it’s very, it changes things quite a bit. Again, it’s great for the catastrophic thing, but when you’re just trying to optimize your health and do it in the best way possible, it doesn’t make sense to pay that much money for something that’s exact same data, dramatically less expensive, because again, you’ll do it more often, you’ll do it more regularly, you’ll let it inspire you to make the changes necessary.
James Maskell: Absolutely.
Yeah, I know. I think this is something that everyone in the space needs to really understand because I know a lot of people are doing different types of labs. If we can make it ultimately as cheap as possible, like this era of medicine that we’re in right now where single payer is not coming any time soon. Under Trump, we’re only moving towards more self payment, more health saving account, more people being responsible. We have to teach our patients to be responsible with their healthcare dollars.
That’s, I guess, I wanted to talk about, the role that you’ve played in your practice as sort of like a fiduciary almost for the patient to be able to say, “Hey, this is the practicalities of how the system works. I understand how the system works. Let me just take a few minutes to help you understand how it is.” Because I really fell like ultimately what you’re doing there is developing trust with the patient because you’re helping them to understand something that no one else is helping them to understand.
Dr. Gladd: Yeah, yeah. For sure.
Finance is one of the, it’s at the top of the list of stresses for people. If you can help in that department, you’re also aiding their stress management.
All the time, we continue to gather the information necessary to help people save money. If you need a colonoscopy, we’re sending you two hours south because it’s only $1,000, to teach them the difference between, yes, your insurance pays for a screening colonoscopy, but the minute they do a biopsy, it’s now a diagnostic colonoscopy. It’s not screening. Your insurance doesn’t cover that. Now, it’s a $6,000 bill. You go to somebody who is operating in a cash market, it’s $1,000 either way because he’s doing the same procedure.
It’s those kinds of things that, it’s just, it’s unfortunate that no one is a champion for the patient from this fiduciary perspective, which is obviously what our mission is at Knew. It’s what my mission is here in the office. It’s a necessary mission. It’s just how do you save money for the exact same stuff instead of getting buried in all kinds of bills that you really shouldn’t have anyway.
James Maskell: Absolutely.
Let’s just talk about what labs you run, because ultimately in the functional integrated space, one of the selling points of these kinds of these kind of practices is, “We offer labs that no one offers” and that kind of thing, but ultimately you’ve been building your practice in Fort Wayne for a very wide kind of population. People who are chronically ill who need help of your kind of care to get better. What’s been your take on traditional labs, different interpretations of traditional labs and then the more functional labs?
Dr. Gladd: Yeah, I know.
I usually only start with basic blood work. A lot of it is going to be the stuff we’re going to talk about that you had done. I usually go a little bit deeper than that in terms of some of the blood markers. We can talk about some of those that we don’t get, but because we believe this core panel now that we’re doing gives us that information, but to me this is the best assessment to just understand what the lay of the land is. I always describe it to patients as, “Let’s just figure out what’s going on at the State of the Union internally”.
There’s some nutrient markers that help us in that understanding. There’s certainly the classic lipid panel that we’re going to look at very, very differently. Also, blood sugar and inflammation.
It gives us a nice overview of what’s happening inside. That basic set of blood gives us then other things that we may want to investigate, either down the road or right away. You’re going to see as we walk through this, there’s so much information that can be gleaned from this. Way more than the medical assistant calling you and leaving a message on your answering machine saying your labs were fine. That doesn’t exist and that just can’t cut it anymore.
Somebody, you’ve got to understand, even if the markers are great, someone should understand why they’re great, what’s great about them. Just because they’re in the normal range doesn’t, absolutely doesn’t make them great. It’s this explanation and this understanding. People finally start to get it and then now they’re engaged. “How can I change that? Last time you said this was going to go down. It didn’t. What might be going on?”
To me, the expensive deep labs are important and still necessary, but not as necessary for all comers. I just could never get to the point where I charged somebody five grand and did gigantic workups, most of which just is unnecessary because if you have a few key markers, you can kind of figure out the story.
It still goes back to, in medical school on day one, it’s all about history. If you just take a good history, you’ll figure out most of it. That’s still absolutely true. The lab data then, doesn’t necessarily give you the answer as much as it supports your feelings of what’s going on, but also gives you this great opportunity to inspire the patient to become engaged and get more and more involved with what’s going on.
James Maskell: Yeah, absolutely.
It rings to me of this idea of the therapeutic order that we’ve spoken a lot about before, where you start with the least costly least invasive interventions first. You might start with diet and exercise and lifestyle. Then, you might move up to supplements if necessary. Then, only at the very, at the end, if nothing else works, would you consider drugs or surgery? I think that’s an idea the time’s come.
In the same way, look at this for lab testing. Do an extensive history. It’s basically just the physician’s time. It doesn’t cost anything. Do the very basic blood markers and get them at the cheapest possible cost for the patient. Then, and then if and only if you’re not making progress towards the patient goals with just that, then you could start to look at a wider panel of those markers. Then, you can start to look at the functional tests.
I totally agree with you because what is the value of a test if it A, doesn’t increase action on behalf of the patient and if you don’t test again? I know for a fact, that in most practices around the country, because I sit in the Facebook groups and I can see what people are saying. “The people didn’t come back for the labs. What shall I do? They’re only getting it once. They’re canceling their appointments in doing it.” But if you’re not having this kind of conversation with them, how would you expect them not to do that?
If they’re not intelligent as to understand how the system works or how to save money, they see you as part of the scam, because part of this is a scam. Paying 20 times over the base cost for a lab panel, in some of these things I’ve seen, it’s $5 versus $100. That is, in any other country, that would be called a scam. In this country, maybe they call it ‘Capitalism’ or whatever, but that seems like scam.
Now, if you’re inadvertently being seen as being part of that system, that is the quickest way to lose trust. I think the biggest opportunity for functional integrated medicine at this exact moment is the development of trust as quickly as possible and therefore being able to separate yourself from the rest of the system and say, “Hey, I’ve worked out the system. I’m going to communicate to you how to navigate it. I’m going to help you navigate it.” Wow, people can relax. People can say, “Wow, this guy has got my back”.
I think in the same way that Tony Robbins outed a few years ago, the fact that you’re financial advisor, if they’re not getting paid by you might secretly be getting paid by the mutual fund whose thing you’re selling, in the same way, doctors are sort of in that position. I love the positioning of, “Hey, I’m on your side.”
Dr. Gladd: Yeah, without a doubt.
I think it also gets into that, I’m starting to get really uncomfortable when I go to these conferences and the exhibit halls are lots of tests and lots of supplements. Again, I’ll be the first to tell you, these specialty tests are super valuable in plenty of cases and the supplements are incredibly valuable for getting people back on track, but we can’t miss the main point, which is the functional medicine lifestyle. That’s the key that has to happen for there to be any sustained health benefit.
Are your labs cultivating an improvement in the functional medicine lifestyle, an inspiration toward the lifestyle or are they giving you longer and longer lists of supplements?
It goes back to all things, but it really is relationship. The patient, you have to understand where they’re coming from and they have to understand where you’re coming from. That’s why we have this money talk all the time. “Hey, what’s your budget for this look like?”
“I only have a couple hundred dollars.”
“Then, let’s just do $50 worth of testing, because I’d rather have you spend $150 on really good food and working on some stress management stuff.”
What happens is, even we’re getting cost blind in the functional medicine space too where it’s a $500 test every time they come in. Of course, they’re going to make less and less appointments because they see that as a big payment every time they have to show up.
James Maskell: Absolutely, yeah.
This is sort of an inadvertent commercial for Knew Health here because ultimately what we’re doing at Knew Health is helping patients implement the functional medicine lifestyle and to navigate the health system. Functional medicine doctors and practitioners, we need you guys to be able to do the deep diagnosis, to be able to work with the chronically ill, but ultimately what we’ve seen and what I’ve seen in practices across the country and what you’ve told me too, Jeff, is that if you get this part right, a lot of other things go away. If you get this part wrong, you can’t make sustainable changes. This is why we’re diving deep into a new paradigm of healthcare, which is the new evolved primary care network, is implementing the functional medicine lifestyle, helping people to navigate the system as it is right now.
If you want to find out more about it, knewhealth.com. If you want to talk about getting your patients onto it, the people that need this kind of help and you’re not delivering it in your practice, let’s have a conversation, we’ll do it, but I want to get into now the blood panel themselves that you’ve chosen for Knew. I know that we’re going to develop this over time as the prices come down and down, but why don’t you just share with our audience now, what are things that you chose to put into an initial panel, baring in mind we wanted to keep the cost below $200 for the initial panel so that people would retake several times a year?
Dr. Gladd: Yeah, no. For sure.
There’s lots of hurdles just in the cash environment too. The labs are a little bit spooked by telemedicine. The labs are a little bit spooked by patients ordering their own labs. We’re still trying to navigate all that. I think as it comes to bare, we’ll be able to do a more extensive panel at a lower cost, but we chose the high level things that are going to get us the best value and the best conversations.
That would be your standard fasting lipid panel, which is your cholesterol markers. As we walk through that, it isn’t just looking at LDL and deciding whether you need a statin or not. That’s not why we measure that marker.
We’re going to measure inflammation, which is the high sensitivity C reactive protein, which to me, is just a great overall marker, not just of risk of heart attack and stroke, but status of the immune system and where things are.
We take a look at ferritin. Ferritin is a storage of iron, but it also has an inflammatory component. Usually people that are inflamed have a higher ferritin level. It doesn’t necessarily mean iron. It means inflammation. Low levels can also be issues of absorption, digestive health. We know that low ferritin contributes to a decreased thyroid hormone sensitivity.
I actually think this is the game that we’ve got to do a better job of figuring out, is not your thyroid levels. We’re all great in the functional medicine space at taking thyroid levels and giving a dose that gets you normal, but what we often realize and certainly the patient doesn’t realize is, if their body doesn’t respond to a normal level of thyroid hormone, they’re always going to have an issue. We know now that that’s stress. Ferritin is one of those markers, other vitamin and minerals. It gets back to the lifestyle. If your lifestyle is poor, then your thyroid hormone sensitivity is probably not great either.
We measure a fasting insulin, which is sort of the pre-pre diabetes measurement to help people understand where they stand. Even though their fasting glucose in their job health fair was normal, they still may be walking right into Type Two Diabetes and have no idea about it.
Then we look at thyroid markers as a thyroid screen, the overall TSH marker. Then, the active thyroid T3. We chose those two to give us the best window into what’s going on with the thyroid.
We do a B12 level and a Vitamin D level. Nutrients related to mood, related to absorption from the B12 perspective. Vitamin D, we all know what impact that has. Really important to look at that.
Then, we look at that average blood sugar, the hemoglobin A1C, which I think is really just the greatest insight into where we’re heading with risk. Now, I’ve pulled the research, the charts of, as soon as your A1C gets above six, your risk of heart attack skyrockets, your risk of stroke skyrockets, risk of cancer goes straight up too. That’s eye opening for patients, to say that this number … Again, it may be a really positive thing for them. “You know what? You think you eat too many carbs. Your A1C is really, really good. Let’s focus on some other things or maybe some of the other effects of sugar that might be negative for you.”
Again, those are the markers that we’ve boiled down to look at. Eventually, we’d like to grow this and look at the ANA, the antinuclear antibody, a couple other nutrient markers, but to me, this is 85% of the core of what’s really going to give us the best information.
James Maskell: Yeah.
One of those markers, that’s really … I’m glad you shared that out. Just on a practice management tip for everyone who is listening there, when a new patient comes into Knew, we talk in the language that we’d been talking to you for two years. Jeff is not explaining all of these markers to every patient. Jeff has made a series of videos that explains each one of these markers so that you could go through and understand what’s a good range, what’s a normal range, what’s an optimal range. That is just an automated system that people who start to take the labs get.
I just want to talk to everyone here who is building their own practice. We’d been talking about this in the practice accelerator and our trainings for years. As we go about building Knew Health, we’re showcasing the strategies that we’ve seen. Those videos are really well put together, professional. Anyone who is watching them can get a good understanding of how to interpret their labs.
Now, we’re going to do a tour. We announced the tour a couple days ago. We’re going to do a tour later this year where we’re going to go city to city and inspire the functional medicine movement and the group there.
A few months ago when were start talking about doing these kind of events, Jeff you thought that the hemoglobin A1C marker was one marker that we could do for a couple reasons. One, because of exactly what you just shared there. It’s the number one marker for chronic disease risk, but also that we could do a lot of tests very quickly. You can do commercial testing very quickly. What is it about … If someone had never interacted in a preventive with their health, in an integrated way, in a functional way with their health, how important do you see that marker in being able to change behavior and wake up, especially dudes like me to an idea that there is something that they need to be getting on with now because they’re, if we’re going to talk about predictive medicine, this is a pretty strong predictive marker?
Dr. Gladd: No, no. For sure.
Type Two Diabetes is rampant and climbing. The risks keep going up and up. Again, I think as we keep looking at this more and more, heart attack risk, stroke risk, cancer risk very heavily tied to excess blood sugar. That’s a three fold issue for people, as you think about the functional medicine lifestyle.
One, it’s sugar and carbohydrate intake, which continues to go up, particularly in kids, but really in all of us. It’s a lack of quality exercise, the kind of exercise where you challenge the muscles, because it’s the muscles that will increase your insulin sensitivity and put glucose away and it’s stress. It’s the three pillars of any lifestyle talk all tied to your blood sugar levels. That, in and of itself, is huge.
It’s risk in terms of connecting those dots, but then think about that hemoglobin A1C marker. What are you measuring? First of all, the way I explain this is, why do we even care about diabetes? The only reason we care about diabetes is because sugar corrodes tissues. We don’t care about diabetes as a name. We care about the complications of diabetes. Heart attack, kidney issues, nerve issues or you lose your vision and you have amputation. All that happens because sugar corrodes tissues. What a great window into that problem by looking at an A1C, which is basically sugar deposition on your blood cells. You can see how much corrosion or prevention of corrosion is going on right away.
You can do a finger stick, which is what we’re going to do in the tour. Lots and lots of people can do this. It’s not perfect. There are gaps, but at least it’s going to highlight people to understand they may need to really focus on that. If their A1C is awesome, let’s go focus on some other things to get optimal and prevent that from happening. It’s really that really key marker that we look at a lot.
Right now, I’m wearing a continuous glucose monitor that’s a sticker on the back of my arm. I’m tracking my glucose all day long, 24 hours a day now. It’s just fascinating information and it’s been really empowering for me to figure out what my breakfast routine is and how I can do better to keep those numbers down. To me, knowing that blood sugar number, the A1C is just the start. If we can now hand out continuous blood sugar monitors because they’re pretty convenient at this point, we’ve got to get the cost down some, but this is just truly empowering information. Eventually, they’re already talking about putting it on the Apple watch. Before you had to put a needle in. You just wear the watch and be able to monitor things there.
James Maskell: Yeah, super exciting.
Yeah, thanks for sharing that. I’m really excited to … Let’s deliver hemoglobin A1C readings to tens of thousands or hundreds of thousands more people. I think it’s a really inspiring moment. The way you just shared it is perfect.
This is the moment where I’m, if our goal as a doctor, as I said earlier, is to build trust with the patient as quickly as possible, my goal with Knew Health and what I’ve been doing all this time is to build trust with you, the practitioner and everyone who is listening to this. I’ve decided again, in classic Maskell style, is to just have Jeff do an interpretation of my blood labs right now so you can see what this actually looked like. What does it look like to get a functional interpretation of a typical lab count?
I have seen these results. When I did my other one before, when I did my genetics, I had never seen it and I wasn’t knowing what I was getting into. I have seen these numbers so I know kind of what’s going on, but we can pull them up on the screen and let’s just get into it. For the people who are listening, Jeff, maybe you could just shout out the numbers so you know what’s going on?
Dr. Gladd: Yeah, I know. For sure.
Again, we’ll start with that lipid panel. You look at the numbers, for those who can’t see the screen, the total cholesterol was 190. Goal is to be less than 200. The good cholesterol number is your HDL. That was 56. It seems that it’s protective when it’s above 59, so just a touch shy of that. Triglycerides at 110. The reference range is to be less than 150, but ideally, we’d really like to see that under 100. Then, your LDL, which is the number everybody points to, it’s flagged as high. Now, everybody is worried about taking a statin or you would be in the conventional setting.
If we just take those numbers and talk about them a bit, the way I break this down is I’m looking at, more importantly I’m looking at the triglycerides and the HDL because the triglycerides tell me, from a carbohydrate perspective, how are we doing. Are we over-consuming them or are we handling them okay? There’s a liver component to that. Most people think of triglycerides as fat, and it is fat, but it really, it comes as excess sugar that the liver has to convert into fat. Yours at 100 says, “We probably want to tweak down our carbohydrate intake some, particularly in the fructose food department”. That’s sugar, that’s fruit juice, that’s dried fruits. Those would be your high level things. We may, and we’re going to talk a lot about omega three fatty acids here in a moment, but you may increase your omega three fatty acid intake to also help drive that triglyceride marker down.
To me, it’s important to do that because as you look at that LDL cholesterol, and again as we talked about that LDL being a little bit higher than we want it to be at 112, to me that’s not a concern. Stress elevates this. Doing this more regularly is probably better to understand whether we’re at a familial genetic risk of making too much cholesterol, but 112 is fine. It’s even better if we can see the triglycerides come down lower because the triglycerides dictate the size of your LDL. Lower triglycerides, larger LDL, less concern about plaque and heart disease risk. To me, your numbers here with an LDL of 112, a triglyceride of 110 and an HDL, I’d put you in the ‘Good’ category. Usually talk about ‘Great’ being optimal, ‘Good’ being at not at high risk, could be better. Then you’ve got the ‘Warning’ and high concern level.
I’d say overall, this is good. Again, a small tweak toward lowering refined carbohydrate in your diet. Increasing the healthy fats, particularly the omega three fats, which not only will help lower your triglycerides, but also increase the HDL because the healthy fats will do that. Exercise, again, challenging those muscles basically accelerates this whole process, increases the HDL, brings down the triglycerides.
From a standard lipid panel, again looking at this very, very differently than your conventional doctor is doing, where they’re going to look at total and LDL and the MA is going to call you and say, “Your cholesterol is high. Go on a low fat diet.”
James Maskell: Yeah.
Just so I’m clear, one of the cool things is I’m going to do this again in like three or four months before we start the tour and everyone is going to see the changes there, so that’s pretty cool. I guess I just want to say, to ask you, if I’m in a situation now where I’m just at my primary care doctor and I’ve taken those labs, first of all I’ve paid way too much for the labs because I’ve got the high deductible plan, but now am I being put on a statin with those numbers?
Dr. Gladd: Probably not. I really hope not with your age. I think even today most doctors are not going to go there at the levels you’re at. You’re at maybe 150, 160, which to me, is still lifestyle convertible. Maybe then, the recommendation is there. I highly doubt most practitioners would be going that step at this point. They’ve gotten a little bit more in tune with saying, “Hey, you know what? Give this a chance lifestyle wise. Let’s see it again.” Certainly if it’s rising I think the recommendation comes in, but yeah, I don’t think we’re going there yet. Although, if you look at the next marker, it might actually justify that a bit.
You look at this high sensitivity C reactive protein number. This is inflammation. This is inflammation of the lining of your blood vessels. It speaks to, then, your risk of heart attack and stroke. As you see in the chart, less than one is ideal. That’s low relative risk of heart attack and stroke. One to three is average risk. Again, I say less than one is great. Less than three is good. Above three is a high risk. You’re at 3.8. That’s certainly the most concerning in this lab panel. If we’re calling this a very, very important marker for predicting risk, it’s high.
This would be your main focus would be, how does James lower inflammation? That’s an assessment that a coach or nutritionist needs to walk through. Where are the inflammatory foods for you? That would be the omega six foods. Are there any fried foods? Where’s the processed and refined? Are you getting omega three fatty acids in your diet? Wild caught fish, salmon, halibut. Nuts and seeds and flax have some, not nearly as potent as fish. Then, going probably, almost certainly adding fish oil as a supplement to your regimen to really help drive down the inflammation.
To me, this is your number one priority is driving down inflammation. Again, all ties into the lifestyle. We talked about the nutrition piece of this. This is probably where the statin shines, is statins have an impact on lowering inflammation. I still don’t think anybody is taking you there, even in the conventional world, but that would potentially justify it if someone had a very high cardiovascular risk, a history of heart attack and had this high inflammation level, but for you it’s really, you’re just really need to tune in your focus toward inflammation and driving it down.
James Maskell: If you saw better exercise, better stress management, more fatty, the fish oils and so forth, would you expect that to come down into the good range or even the optimal range?
Dr. Gladd: Yeah, for sure. Even within two or three months you can see this drive down into the optimal range.
Another thing that really highlights for some people is the whole concept of gluten sensitivity. Gluten is very inflaming food, can have a direct impact on irritating that immune system. That’s despite Celiac Disease, but I tend to also see people who cut grains out of their diet, at least early on aggressively, also get an advantage to driving this down. Then, once you get this down, if that lifestyle is too restrictive for you, play around with it a little bit. Find a little balance. Maybe a 90-10, 80-20 balance. As long as we can continue to see that CRP stay under one, then you know you’re maximally keeping inflammation down.
Again, that’s part of that whole balance story of moving … I’m trying to move away from long term restriction because if it doesn’t have to happen, let’s not have it happen. Let people enjoy some of the delicacies of life as long as it doesn’t negatively impact their health. That would be a marker that you’re going to follow long term. See how changes in your lifestyle, changes in stress levels, changes in sleep, how that impacts that inflammation marker because starting at square one, you’re on fire, so to speak.
James Maskell: That’s great. Look, definitely work to do there. Let’s get into the rest of the panel and look what else we’ve got here.
Dr. Gladd: Sure. I’ll bring this up here real quick. We’ve got that ferritin marker that we talked about, which is that storage of iron and also an inflammatory number. I like somewhere between 50 and 150 as the sweet spot. You’re at 189. Again, I don’t think that’s a bad thing. I don’t think that’s a … It might be a slight inflammation thing. I suspect if your C reactive protein comes down into the one range, I bet ferritin comes down as well, but it’s certainly not a high risk marker for you at this time.
James Maskell: Cool.
Dr. Gladd: Next would be that fasting insulin level. Again, this is the pre-pre diabetes level. As we talk about someone’s blood sugar may be perfectly normal, and as we’re talking about blood sugar, let’s just skip down to look at that. Your hemoglobin A1C is really quite optimal. Less than 5.4 I think is fantastic. Lower is always better. You’re at 5.2. That’s really, really good. What that tells us is that you don’t have an elevated sugar issue. Then, you look back and say, “I realize I don’t have Type Two Diabetes or persistently that elevated blood sugar. Am I set up for that?” That’s where the insulin comes in.
You look at a fasting insulin in the morning. I would say good is less than ten. Great is less than four, particularly in a fasted specimen. You’re at 6.2. Again, really good, not great, could use improvement. I think anything you do to impact those triglyceride levels that we talked about early on, tweaking down your carbohydrates, focusing on the omega three intake, I think you see that insulin level come down even lower and be in that optimal range, but I certainly would not call you ‘Pre-pre diabetic’ as we call it. People who have normal blood sugar, but are starting to see a little bit of insulin resistance. Not seeing it there.
Next would be a little bit of an insight into what your thyroid is doing. We look at TSH. TSH is Thyroid Stimulating Hormone. This is a hormone from your brain to tell your thyroid how much hormone to make. A low level is really what we’re aiming for. That would be your brain happy with your thyroid levels.
The lab reference range, really this is probably the most contentious part of functional medicine. The lab says 4.5 and under is good. Most functional practitioners would want to drive that below 2. You’re at 2.1. It’s a little bit above where we want to be. I don’t think nearly high enough to justify being aggressive. If we look at your active thyroid hormone, the T3, you’re well in the middle of normal at 3.1. From a thyroid perspective, I’d say good, not great.
Again, some of the nutrients involved in thyroid production may be helpful. Is that a little bit of L-tyrosine, a little bit of Iodine, a little bit of Zinc and Selenium? You can get those from foods. A health coach, a nutritionist would walk you through what are the anti-inflammatory whole foods that help lower inflammation, help bring down the triglycerides, up with the HDL and support your thyroid.
That’s it. What’s the lifestyle for you that’s really very good for everyone, but pointing out and highlighting the foods most important for your unique panel? Again, I wouldn’t really even aggressively do much here. Thyroid does relate to metabolism. Being able to burn off inflammation and hum along would be helpful, but I don’t think it’s in need of any type of hormone supplementation. A pretty good range from that perspective.
Next would be Vitamin D. If we look at that number, obviously this is an important one, but also very personal because it’s based on the season and your sun exposure and likely has some genetic components in terms of how well you convert sun exposure into Vitamin D. Most of us, at this point, feel the optimal zone is 40 to 60. You’re at 31. It’s January. You do get some sun exposure in your location and where you’re at, but maybe you need a little bit of Vitamin D supplementation and/or sensible sun exposure would be the key for getting your Vitamin D up into that 45, 50 window. Vitamin D is an anti-inflammatory. You need that help. Why not drive the Vitamin D up higher? Again, some sensible sun without getting sunburn or supplementing a little bit of D3 would be the key. It’d be a nice one to track, particularly through the winter and then probably able to ease off of the supplementation.
Most of the time you see somebody who is in the 30s in the winter. They probably have no need for Vitamin D supplementation in the summer months. It’s just come down a little bit outside of the optimal based on the season.
James Maskell: Yeah. That seems reasonable.
I would also say I do spend a lot of time inside. Trying to spend more time outside. Obviously it makes sense to me that, if we go back to the concept of the therapeutic order, if you can improve it through being outside more and taking more time in that way, it’s a good way. I feel sorry for all the people right now in Indiana where you are and New York, because as we’re recording this it’s like minus ten everywhere, but I live in Los Angeles so I will do better on that one for sure.
Dr. Gladd: Yeah.
We’ve already looked at that last marker that I had on the list here, was the hemoglobin A1C at 5.2, which was really good. Again, we’re going away from this saying, “Gosh, this is pretty darn good for not knowing what this information was and having no clue”. You’ve heard of all these markers, but you didn’t know what your personal numbers were. The inflammation one is, should be inspiring for you to implement change because that one is in the high risk zone and you don’t want to be there.
As we talked about, now the focus goes to the nutrition information, to the health coach to really figure out, “What are James’ goals? What are James’ habits? How are we going to bring those into focus under that lens or through that lens of the inflammation so that we can drive this down?” Now, that number is a great one for you to be following and monitoring and lining up with, “This is the status of where my health is”. It’s kind of based on this CRP number.
James Maskell: Absolutely.
Look Doc, I really appreciate you taking me through this. This has been a new experience for me. Obviously, I’ve been in this space for 12 years and certainly heard a lot of this done together, but as someone who was 24 and now 37, it hasn’t been, and generally healthy, it hasn’t been something that I think about, but at the same time I do realize, if we realize that I have a history of Alzheimer’s in the family and that’s connected to inflammation and I probably need to start thinking about that now or maybe even a few years ago in order to start to think, “Am I going to be one of the X percentage of people that’s getting that by the time I’m 80?” That’s something to start to thinking about now.
Also, I’m very interested in what does it take to get men, particularly men, to start to take action on this earlier in life? I hope that this has been informative for those of you who are listening. If you’re a patient, to get a really good idea of how to save money on your labs and also how to do a different type of interpretation on the standard lab panels. If you’re a doctor or practitioner, understanding why it’s important to be able to create trust by cutting out the middle man and being a fiduciary for your patients, I think is a really shift in the business model, and then …
Dr. Gladd: Hey James, I forgot … I’m going to stop your momentum here, but I forgot one marker.
James Maskell: Okay, go.
Dr. Gladd: I realized it was squeezed in between thyroid. I didn’t want you to wrap up and have us miss it. That was the B12 level. Vitamin B12, part of the story in the same way. It’s part of optimal function. It’s part of energy. It’s part of brain function. This huge range of normal is really pretty classic of vitamin and mineral levels in the conventional lab report. 200 to 1100 is a crazy wide range, but you have to realize that the reference range is really determining malnutrition and true deficiency versus being okay. We don’t just want to be okay. I’m always shooting for being above 700. I usually say 700 to 1,000. You’re at 434. That does highlight a potential need for you to support that level. That might be supplementation after chatting with, somebody dive into your lifestyle and dive into nutrition. Increasing your B12 foods.
Another really interesting way that this connects to lifestyle is the ability to digest and process your meals. That gets back to the habits of how we eat. I’ve had a few meals with you, James. I know you go fast.
James Maskell: I do.
Dr. Gladd: Taking your time in eating, letting the acid increase, letting the enzymes increase will be valuable for you for increasing your nutrient intake. That’ll be showing up in the Vitamin B12 level, but it also shows up in those thyroid levels because the thyroid, the ideal function and sensitivity relies on the nutrient level.
I didn’t want to skip that one. If anyone was paying attention would’ve noticed that, but yeah, that also would be something to be working on and keeping and eye on.
James Maskell: If you’re interested in seeing what it looks like to have a consultation with a health coach who can really dive deep and get into some of these numbers and make recommendations, you’re in luck, because in February we will be doing that with Tracy Harrison, who is the director of coaching for Knew Health. Stay tuned for that. We’re going to be sharing that with everyone, but yeah, between the different supplementation and the lifestyle, I really appreciate the time here.
I’m also, I’ve never been, wanted to be the guy in any way saying, “Hey, this is how I am healthy. Follow me. I’ll show you how to do pushups or whatever.”, but because this is something that I do want to do, I am going to be sharing on this journey and then into the tour, just my insights on what it’s like to be just a normal guy trying to make lifestyle change on Instagram and Instagram Stories. If you use Instagram, you can check me out @mrjamesmaskell. Follow me on Instagram Stories.
I’m going to be talking about, once this podcast comes out, I’m committing to, over the next few months really sharing my journey with you. I hope that, if anything else, it’s inspiring for other men, but also that, as a practitioner if you’re watching this, health is happening in the 167 hours a week where they’re not in your office. I think what we’ve spoken about a lot in the evolution of medicine for the last four years is, how do we actually facilitate the transformation for patients? I think data has a lot to do with it.
I’m really excited to be going through this process. One, so that everyone else can see what this looks like. Hopefully, this builds trust in our organization and what Jeff and I and Tracy and the rest of the Knew team are trying to do here. We’re really excited to be also working with some insurance companies and some employers in delivering this, because ultimately the majority of Americans are getting their healthcare via insurance, via employers even with what we spoke about earlier.
We’re excited to be offering that and looking for new ways to expand out functional medicine to a much wider population, but I hope this video is useful. I really appreciate your time. If you want to find out more about Knew Health, you go to knewhealth.com. It’s Knew Health with a ‘K’.
Yeah Jeff, thanks so much for being with us. I know that we’re going to be eating together soon. You’ll be able to see how slow I’m going.
Dr. Gladd: That’s right. It’s good to hang out. Yeah, for sure. Happy to help.
James Maskell: Great.
This has been a special session for Evolution of Medicine and for Knew Health. This has been, I’m your host, James Maskell. Been with Dr. Jeffrey Gladd. Thanks so much for watching and we’ll see you next time.
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