Episode 306: Lab Interpretation Case Study: OAT, HTMA & DUTCH Test
Listen on Apple Podcasts | Listen on Spotify
We’ve spoken about the importance of clinical mentorship, but we’ve never given a sneak peek of what that looks like within the Funk’tional Nutrition Academy until today!
In this lab review session, Rachel Mistry, our Lead Practitioner at Team FN, supports an FNA student through analyzing functional lab tests whilst also taking into consideration the experiences and lifestyle of the patient. This case study reiterates our belief that treatment requires a whole body approach and is not one-size-fits-all.
Are you a practitioner interested in gaining more confidence and experience with functional lab testing? Enrollment into the Funk’tional Nutrition Academy spring cohort is open. There are limited seats available, so apply today!
In this episode:
How FNA supports students & grads through clinical mentorship [2:44]
Chief complaints & diagnosis of the patient: Hashimotos, unexplained weight gain, histamine reactions, and mold toxicity [11:10]
The importance of taking into consideration her life experience with the lab test results [13:27]
How to support detoxification through lifestyle changes [22:48]
The nuances of functional lab interpretation [25:04]
How toxicity from mold or other environmental factors can inhibit treatment [30:02]
Resources mentioned:
Funk’tional Nutrition Academy™
Qualia Mind (get $100 off and an extra 15% off your first purchase with code FUNK)
LMNT Electrolyte Replenishing powder (Use code FUNK get a free sample pack with any purchase!)
Ned Natural Remedies (get 15% off your order with code FUNK)
Organifi supplement powder (save 20% on your order with code FUNK)
Learn more about Gut Health & Functional Nutrition
Related episodes:
305: Functional Lab Testing: Do’s & Don’ts
-
Erin Holt [00:00:02]:
I'm Erin Holt, and this is the Funk'tional Nutrition Podcast, where we lean into intuitive, functional medicine. We look at how diet, our environment, our emotions, and our beliefs all affect our physical health. This podcast is your full bodied, well rounded resource.
Erin Holt [00:00:18]:
I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet, culture, and the healthcare model. They're both failing so many of us. But functional medicine isn't the panacea that it’s made out to be, either.
Erin Holt [00:00:32]:
We've got some work to do, and that's why creating a new model is my life's work. I believe in the ripple effect. So I founded the Funk'tional Nutrition Academy, a school in mentorship for practitioners who want to do the same. This show is for you if you're looking for new ways of thinking about your health and you're ready to be an active participant in your own healing. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. I would love for you to follow the show, rate, review, and share because you never know whose life you might change.
Erin Holt [00:01:06]:
And, of course, keep coming back for more.
Erin Holt [00:01:13]:
Hey, friends, we're back with another episode. This is take three.
Erin Holt [00:01:17]:
Because I keep stuttering over my words. It's a unique episode. Today we have Rachel with us. Rachel is the lead practitioner here at TFN. She's also the lead clinical mentor of FNA. And today you're going to hear one of her lab review sessions with one of our FNA grads. Now, I polled you all on Instagram, whoever's there on Instagram recently, and I said, what do you want more of on the podcast? And a lot of you guys actually said, case studies. So this is a case study.
Erin Holt [00:01:48]:
I'll let Rachel kind of explain what was going on with the client. So let us know if you're into this sort of thing. If you learn well in this way, you can dm my team or email my team, whatever works best for you. But if this kind of thing is helpful, we will keep on keeping on with it. But, Rachel, why don't you explain what was going on with this case?
Rachel Mistry [00:02:10]:
Awesome.
Rachel Mistry [00:02:10]:
So, for this patient and in this office hour session, we reviewed through a case for a gal who was experiencing some new symptoms after moving into a new home, including weight gain, a lot of histamine, and allergy like symptoms, a stuffy nose that was interfering with her sleep, and there was some concern for autoimmunity based on lab work. So the clinician and I spoke about just some of the findings on the Organic Acids Testing and thoughts on next steps.
Erin Holt [00:02:44]:
Cool.
Erin Holt [00:02:44]:
And so this is, like we said, a lab review session that we offer all students and our graduates in the graduate membership of the Funk'tional Nutrition Academy. Now, FNA is open for enrollment right now. That is our 14 month practitioner training and mentorship. And we really talk about this as four programs in one. So, of course, it's the advanced clinical education, the continuing education, where you learn about lab testing and building out protocols and how to help your clients and your patients. But it's also clinical mentorship. So we talk about that often and the importance of mentorship, but we've never actually given you insight into what one of those sessions are. So when you're a student or a grad with us, you can schedule these calls with Rachel and actually go over labs of your clients or your patients.
Erin Holt [00:03:35]:
You can go over clinical case studies. And one of the primary reasons we love to do this is that it can keep you from feeling like you're punching above your weight. So when I say that a lot of newer clients, or, excuse me, newer practitioners or practitioners who are starting to implement new tools, like new lab tests, new tools in their arsenal, they can start to attract a more complex client caseload where clients are coming to them with more complex issues. And sometimes you can feel like you are swimming around without a life vest. And so we're essentially your life vest, so you're not taking on things that you're ill equipped to take on. We give you that safety net so you can run your ideas and run your cases by Rachel. Why else do you think these lab review sessions are beneficial?
Rachel Mistry [00:04:35]:
I love the lab review sessions because from my perspective, I'm really able to see how the clinicians and the students in the program are able to grow, especially their clinical confidence. Some of the feedback that I've gotten from students as well is it's really nice to be able to have a second set of eyes on your lab and also just to highlight any areas that they might have been missing in a treatment plan. I think it just gives them a lot of peace of mind to let them know, okay, I've got you as a backup if needed.
Erin Holt [00:05:07]:
And that's something that you and I will talk about kind of privately when discussing our students is like, hey, this person, you always go out of your way to be like, this person is doing so much, learned so much, is growing so much. It's really exciting for us as the mentors to be able to see our students' growth, because clinical confidence is, like, one of the things, the biggest things that holds us back as practitioners. We think we can't do it. And how do you know your blind spots if you don't have somebody there illuminating them for you? That's like one of the beauties of mentorship is Rachel gets to kind of highlight, like, oh, this is something that you could be thinking about that you're not currently thinking about, or like, oh, I wouldn't necessarily do it that way, and here's why. And so with know, with somebody kind of shining a light on some of those spots, you get to really grow faster. You get to expedite your clinical confidence, your clinical skill set, and your growth. And so it's just really beautiful to be able to witness that throughout the 14 months of the program. Anything else you want to add to any students who may be considering FNA or have any typical questions that you get from people considering FNA?
Rachel Mistry [00:06:20]:
I would say people, well, circling back, I guess, to the office hours piece as well. What I really love to see, too, is a lot of the newbies in the fresh cohorts. They will come to me, they'll submit labs to the office hours, and they'll say, this is my first time running this lab. Help me put together a treatment plan, which I'm happy to do. And then what's really cool is, I think our cohort that started five or six months ago at this point in time, I'm getting to the point in the semester, in the school year where the students are now like, oh, hey, I ran this lab. Here's this treatment plan. Can you give me a second set of eyes on it? And so that's really exciting for them as their clinical confidence grows. And you're absolutely right.
Rachel Mistry [00:07:06]:
People are able to start taking on more complex cases because they know what to do with them. And if they don't totally know what to do with them, then again, they know that they have us as a support system, too, which I love.
Erin Holt [00:07:18]:
And do you feel like, just in general, with where things are headed and the world and people's health and functional medicine, is that at least I know that we at TFN are definitely attracting more of the quote unquote complex cases. Do you feel like that's just going to be a trend based on what you're seeing?
Rachel Mistry [00:07:37]:
I think so. And I do also think that the world needs more people in the functional medicine and functional nutrition space chatting with people about their nutrition and their lifestyle and how they live their lives and then also more clinicians to help people do that deeper dive work if necessary, as well. So, yeah, we are definitely seeing more autoimmunity in practice and more complex hormonal issues. And I think that's part of a bigger conversation. But absolutely, I feel like we see the students being able to tackle those cases as well in FNA.
Erin Holt [00:08:11]:
Yeah, we need more people that can really feel prepared to do that. Okay, cool. So I don't think there's really much left to be said. So if you're interested in FNA. Well, I was going to say get your applications in because we're recording this a few weeks ahead. So by the time this airs, there might not be spots out, but get yourself applied. The sooner you apply, the sooner we can approve you and start the process. And we would love to see you in a future FNA cohort.
Erin Holt [00:08:44]:
So thanks, Rachel.
Rachel Mistry [00:08:45]:
Yeah, thanks for having me.
Rachel Mistry [00:11:10]:
This is your patient. 35 years old, weight gain, inflammation, low ferritin, poor thyroid function, fatigue. Diagnosed with graves in 2020. Unofficial hashimoto's, but antibodies have been present. Weight has been going up to, like, 190 from a stable weight of 150 to 160s. It sounds like her thyroid is up and down. Like, the autoimmunity is kind of up and down. She had shingles with a COVID vaccine.
Rachel Mistry [00:11:43]:
She's training for triathlons. She used to work with another functional medicine practitioner, did micronutrient testing, got zoomers, went gluten free. Feeling better on that. So IBS symptoms are on and off?
FNA Student [00:12:03]:
Yeah, they had mostly resolved. It seems like bloating is the number one kind of IBS symptom. I did run a GI map on her, and it was like, her akkermansia. I can pull it up. I didn't include it because it was kind of straightforward. If I'm being super honest.
Rachel Mistry [00:12:20]:
That's fine.
FNA Student [00:12:21]:
Akkermansia was DL, so working on that did have a little bit of H. Pylori present. It wasn't flagged, but I am still moving forward with the treatment protocol for that. Just given, like, bloating, low zinc or low iron. I think that it could be more of a picture than sort of notable, not much like overgrowth. Elastase one was 117, and her secretory IgA was low. That's what I'm doing on the calprotectin was like 26, so some inflammation going on, but not terrible.
Rachel Mistry [00:13:02]:
Okay, so big picture. Chief concerns weight gain, thyroid issues, low ferritin. She's not sleeping well. She's tired. She has a stuffy nose and allergies at home. And these symptoms started since recently moving. And so given her antibodies, you wanted to rule out mold and also her intense exercise schedule. You wanted to look at some oxidative stress, so you ran this OAT, and I would agree with you.
Rachel Mistry [00:13:27]:
You shared, like, the mycotoxin doesn't seem to be playing a role, but you kind of wanted to talk through this. You ruled out histamine producing bacteria in the gut. You were saying, like, you're having her test her home via some mold dishes, because perhaps mold is present, that maybe micotoxins aren't in the body yet. I love that. So the way that I'll explain Organic Acid Tests to patients is I feel like Organic Acids Tests can be really good when we're like, where do we want to explore next for this patient? Or we've completed a big treatment plan, and we want to kind of fine tune, like, maybe check in on some nutrient statuses, maybe do a follow up on what's kind of going on in the gut. And so markers one through nine are the yeast and fungal moldy markers. So for mold, I'm looking at markers 2-4-5-6 and 9. And again, I know you know this, but none of these are really elevated.
Rachel Mistry [00:14:26]:
Like the arabinose says, maybe there's a little bit of yeast present, but based on this test alone, I wouldn't be thinking, oh, my gosh, she's moldy, right?
FNA Student [00:14:36]:
Yeah.
Rachel Mistry [00:14:37]:
However, did anything else happen around the time that she moved? Or is it like, she moved into this new place and now she's, like, stuffy?
FNA Student [00:14:44]:
Yeah, she moved into the new place, and she's stuffy. Okay. And then it was, like, her immune system, even though that was, like, previous to moving. Yeah, the immune system. The hashimoto's picture, the fluctuation in the antibodies, the shingles. I just was like, maybe there's mold here because it's, like, a pretty common kind of mold picture.
Rachel Mistry [00:15:22]:
Oh, I agree.
FNA Student [00:15:24]:
Obviously not given this. That's why I was like, those kind of mold dishes are, like, $60 or something like that. And I was like, you're not, like, the most scientific thing, but maybe we'll just kind of double check. This client is an environmental toxicologist.
Rachel Mistry [00:15:44]:
Oh, cool. They're an expert.
FNA Student [00:15:47]:
Yeah, she is.
Rachel Mistry [00:15:49]:
Well, okay, so I do want to throw this out there, and I'm not discrediting this Organic Acids Test. We'll go through the test too, because I know you also want to rule out sources of inflammation, or how can we better support this patient? And you submitted the DUTCH test, too, just from, like, an adrenal dysfunction type of a picture. But I can tell you I have seen patients, so maybe it's not mold. Maybe it is mold. It sounds moldy to me, but maybe it's environmental toxins. Like, maybe it has something to do with her water. Maybe it has something to do with one of the case studies in the curriculum. Actually, I saw a patient where she moved to New Mexico in, like, oil country, and it was MTBE.
Rachel Mistry [00:16:26]:
It wasn't the mold. It was the MTBE. It's a little bit different for everyone. But what I'm also getting at is I've run OATs on patients, and their MycoTOX markers have all been clear. And then we run a MycoTOX test, and they are lit up. And it's pretty significant. And I know that's not what you want to hear because you just had her do this test, but I will say this is a good screening tool. But I wouldn't say that this is, like, gold standard in my eyes for mold because of the experiences that I've had and her lived experience also, we want to treat the patient in front of us and not just the test results.
Rachel Mistry [00:17:04]:
Right. And her lived experience, she moved to this home. She got worse, especially sinuses. I do agree with you. So I'm going to jump around a little bit because there are a handful of markers that I like to look at and think about. Do we maybe think more of a moldy picture? I'm happy with her oxalate levels. I know you know this, but whenever we see any type of mitochondrial dysfunction, toxicity can influence the mitochondria. Mitochondria impact energy.
Rachel Mistry [00:17:40]:
So the disclaimer here is that we need our mitochondria functioning well and functioning optimally in order to detoxify. And we start to enter that chicken or the egg type of a scenario. When you're toxic, your mitochondria don't work well. Then you can't detoxify, and then you're tired. And so what came first, the chicken or the egg?
FNA Student [00:18:01]:
I see that.
Rachel Mistry [00:18:02]:
High succinct acid, the marker number 28. When this is low, this is, like, not so much clinically significant. It's more clinically significant when it's high. Oh, sorry. Go ahead.
FNA Student [00:18:14]:
Yeah. Okay. Yeah, I think that that's right. Maybe there's some sort of toxin in the home that not mold, too.
Rachel Mistry [00:18:23]:
And, yeah, maybe it's mold. Maybe it's not. Mold with the HVA is kind of below the mean. I wouldn't say that it's completely tanked, but her VMA is kind of trending lower than where we'd ideally like to see. This is. This kind of aligns with that adrenal depletion adrenal fatigue type of a picture I can share with you. When we see like normalish HVA and not as robust VMAs, sometimes I start to think about methylation issues. Sometimes I start to think about methylation issues when that ratio is trending high or that HVA DOPAC ratio.
Rachel Mistry [00:19:01]:
I'm not trying to oversimplify this. I like to look for those patterns.
FNA Student [00:19:05]:
Yeah, and isn't that copper too? Because I do have HTMA and her copper on the hair test was low. So I am working on copper. Good for iron transportation.
Rachel Mistry [00:19:24]:
Perfect. And that will help with detoxification as well, like copper and clearing yeast fungus mold from the body. It plays a really integral role in that as well and the health of the interocytes and just like clearing that from the body. So I think that's perfect.
Rachel Mistry [00:22:04]:
When some more trends. Again, I'm always just looking for trends. I'm looking for patterns. Her vitamin C is, like, extremely low. And I can share with you. I never want to say, like, always, that this is always the case, but I have a tendency to see low NAC and or low vitamin C in patients who are struggling with oxidative stress, but specifically, like, some form of toxin. If she is eating fruits and vegetables, she should have some vitamin C in her body. It's not about what dose of vitamin C do we supplement her with.
Rachel Mistry [00:22:41]:
I mean, she could feel better, some antioxidant therapy, but it's more about why is she burning through this.
FNA Student [00:22:48]:
Yeah.
Rachel Mistry [00:22:48]:
And then I always like to come and look at this last page, too. I mean, her glutathione looks decent. These markers look decent, and I respect that, and I'm not trying to be dismissive of that. But her lived experience, she moved to this new environment. She started to get sicker. There's concern for autoimmunity, histamine like reactions, and this weight loss resistance. Weight gain, like, not where we want it to be. Have you done anything detoxifying for her yet?
FNA Student [00:23:23]:
No, I'm working on a lot of the basics and a lot of stress reduction. I sort of assumed that the adrenals were depleted. So it's a lot of taking exercise down, adding in meditation, working really on light exposure, all of that. So reorganizing her diet, I actually think it was, like, way too high in protein, and I've never said that to a client before. And not enough carbohydrates. Yeah, it was very protein dominant. So it's been a lot of kind of the basics with that so far.
Rachel Mistry [00:24:10]:
Okay. I love that because I know you know this. We don't want to go into a detoxification treatment plan until the foundations are in a better space. Until the adrenals are in a better space. We do have some attention and some concern that, based on her DUTCH test as well, I think there's some form of mitochondrial dysfunction, too. And so starting with adrenal work, addressing the gut with her, all of that good stuff is going to make any detoxification treatment plan more effective as well.
FNA Student [00:24:41]:
Yeah. What does her glutathione look like on the DUTCH? I just don't have it up. I had like, just gotten this stuff in before I submit it. Okay, interesting.
Rachel Mistry [00:24:52]:
So I'm happy with this. The biotin was above range and I don't think I saw that on here. It's like totally the opposite. But I think it's also looking at different markers too.
FNA Student [00:25:04]:
Okay. Is there anything else on that OAT? I'm not the most skilled with OATs. I'm going to just call myself out there. I just ran it because I was like, I feel like this client really actually needs an OAT. Is there anything else that you think is very noticeable on here? I think she's got some amino acid. Some of the amino acids were trending low, which I thought was really interesting given, like, really high protein intake.
Rachel Mistry [00:25:42]:
I've seen this a lot on these organic acids types of tests. And so when we see that these markers are trending high, the different markers, if they're elevated, they're more so associated with various B vitamin deficiencies. Whereas when they're like, low, low, then we start to think about, oh, does the body need more protein? And maybe not eating more protein, but is she burning through her protein? Is it because she's inflamed that she is just like, depleting those amino acid stores and those resources? That's a very real possibility. So my thoughts are you are working with her on mineral support, you're working with her on blood sugar balance, you're working with her on some adrenal support. Based on what we're seeing on this Organic Acids Test, I would be thinking, even though this methylation toxic exposure marker is in that more optimal range, kind of around the average, I would be thinking about why are some of her antioxidants depleted? Why is her B6 status not looking super hot or great? The interpretation of an Organic Acids Test, I rarely take a single value and I'm like, oh, my gosh, this is your root cause. We look for those trends and we look for those patterns. And so I would say for her, what I'm seeing is mitochondrial dysfunction. I'm seeing signs of adrenal dysfunction more than anything, kind of trending more towards depletion.
Rachel Mistry [00:27:17]:
I'm seeing that she has some deficiencies in certain antioxidants. This makes sense given oxidative stress and then respecting the fact that her yeast marker, the arabinose, is that above average. I know that it's not flagged as elevated per the lab, but this is above average. So do you need to get her on like a super intense antifungal treatment plan? I don't think so. But by addressing her gut, you're going to be treating an environment or creating an environment that doesn't love yeast to survive. And I can share with you in a lot of my mold patients, a lot of them do have yeast overgrowth. They kind of exist concurrently because they're both like, the mold suppresses the immune system and then yeast. It creates an environment where yeast can overgrow.
Rachel Mistry [00:28:09]:
I want to clarify. I'm not saying that this gal definitely has mold, but I feel like you're onto something here.
FNA Student [00:28:16]:
Okay. I think it makes sense to, like, I assume that stomach acid is probably playing a role here too, with those amino acids given, like elastase one is like 100, basically. Yeah. So supporting her with antioxidants like polyphenols. I'm just kind of talking out loud to myself too.
Rachel Mistry [00:28:47]:
Yeah.
FNA Student [00:28:51]:
Obviously supporting the mitochondria and continued adrenal work. And I think her progesterone was low as well on the DUTCH. I have to really look at that. It wasn't low, but it was like, I think she's still. Yeah, I think she's a little estrogen dominant when you look at the metabolism too. Okay. I think maybe on the mold. I mean, I can talk to her.
FNA Student [00:29:19]:
She's in my membership, so the labs are out of pocket. So if she wants to go forth with mold testing, she certainly can. But maybe the next step is like those mold plates. I always forget what they're called.
Rachel Mistry [00:29:33]:
Oh, there's the ERMI from Mycrometrics. And then there's a new plate that one of my patients just used. I can get back to you regarding that. I just heard of it a few months ago.
FNA Student [00:29:45]:
The Mosaic gave me the name of someplace that they actually really like too. I forget. So maybe we'll see what those plates come back as. And it's worth exploring, exploring more. I'm seeing a lot of this mold immune stuff right now. Like, a lot. They're coming to me for GI issues and I'm like, not getting better. It's not Gi.
Rachel Mistry [00:30:15]:
Yeah, well, and that's Gi, but it's not really. And the concept is you're going to have a hard time clearing gut infections if there's this immunocompromisation from something like a mold or environmental toxin. I'm seeing a lot more environmental toxicity, a lot more mold. Sometimes it's like, oh, we're thinking about it. We're looking for it, so we're going to see it. But some of these treatment resistant patients, we need to think outside the box. It's less about what gut killing treatment plan do we put you on? And more of why are things not clearing?
FNA Student [00:30:49]:
Yeah, I mean, this is unrelated, but I have a client who I just saw whose practitioner ran an OAT, and all of her mold markers are elevated. And she's like, we didn't really do anything with the mold. She was very concerned about my gluten allergy and food sensitivity, and I was like, that, too. Yeah, that's important. I mean, her antigliotin levels were, like, over 400, so that was significant. But I was like, you're not getting better because you're moldy.
Rachel Mistry [00:31:20]:
Yeah, exactly.
FNA Student [00:31:23]:
Anyway.
Rachel Mistry [00:31:23]:
Okay, awesome.
FNA Student [00:31:25]:
All right. This is really helpful.
Rachel Mistry [00:31:27]:
Good. Well, it was great to see you, as always. I'll stop my screen share. I'll get back to you about the mold plate.
FNA Student [00:31:34]:
Oh, yeah, I'll circle back. I'm curious on that, too, so thank you. It's just helpful to talk this out.
Rachel Mistry [00:31:40]:
Yeah, of course. Happy Friday. Have a great week.
FNA Student [00:31:42]:
You too. Thanks. Bye.
Erin Holt [00:31:50]:
Thanks for joining me for this episode of the Funk'tional Nutrition podcast. If you got something from today's show, don't forget to subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.
