James B. LaValle, RPh, CCN, MT, ND, is an internationally recognized clinical pharmacist, author, board certified clinical nutritionist and naturopathic doctorate with more than 35 years of clinical experience. In addition to his LaValle Metabolix Practice, he works with players and teams from the NFL, NBA, MLB, MLS, NHL and is the clinical director of the Hall of Fame Performance Health Program. He is best known for his expertise in metabolic and integrative medicine, with an extensive background in natural products, lifestyle drug/nutrient depletion and uncovering the underlying metabolic issues that keep people from feeling healthy and vital. Dr. LaValle is an appointed faculty member and course educator for the Integrative Medicine postgraduate program at George Washington University School of Health Sciences. He is the author of more than 22 books including, Your Blood Never Lies, and serves as a scientific adviser for probiotics.com. His cloud-based laboratory assessment system can be reviewed at metaboliccode.com.
Q: What was your motivation behind writing Your Blood Never Lies?
A: I constantly had patients coming in who told me that their doctor said their labs were “fine,” yet I would see disturbing trends that were not being addressed, like blood glucose levels that were nearly in or already in the prediabetic ranges. I wanted to write the book to help consumers take more responsibility in understanding their labs so they could see what they could get more proactive on to correct the trends and hopefully prevent getting a diagnosis, such as diabetes.
Q: Please discuss the different types of blood tests/panels that are available.
A: There are panels that are for looking at a person’s general health, like a CMP (comprehensive metabolic profile) and a CBC (complete blood count), which along with a lipid profile are typically done when you go for an annual physical. CMP’s give an overview on liver and kidney function, electrolytes, glucose, as well as an idea of general nutritional status. CBCs look at haemoglobin, red blood cell size and count, and white blood cell counts for the status of the immune system. For example, percent monocytes, eosinophils and basophils can give insight into immune function in the gut. A health care provider will often add other panels onto this, depending on any complaints you may be having at the time. For example, if you say you have been really tired and gaining weight, it might trigger them to order thyroid hormone levels.
Q: In your opinion, which optional blood test is most overlooked? Why?
A: Cortisol levels are most overlooked because they are an indicator of stress response. I think this is so critical today, knowing that so many people experience a lot of chronic stress with jobs, finances, family situations and the all too common overly packed schedule. We know more today than ever about the far-reaching impact of an out of control stress hormone cascade on our metabolism. Cortisol impacts thyroid hormones, sleep, our immune system and gut health. It can even have an effect on our short-term memory, so it’s super important. Looking at an advanced lipid panel is important because it gives us terrific insight into the metabolic inflammation that may be silently playing out in our chemistry. There are several others like galectin-3, adiponectin, leptin, mmp-9, zonulin, diamine oxidase, 8 OH deoxyguanosine, food allergy and sensitivity tests along with specific stool tests that give added insight into a person’s global metabolic health as well.
Q: In the book, you offer a number of lifestyle changes. What is the most effective lifestyle change that people can make to optimize their health?
A: The No. 1 area I think people need to monitor is their blood sugar level. When fasting blood sugar levels start elevating, it is a sign we are becoming insulin resistant. Insulin resistance is the underlying physiology that leads to our most common chronic diseases and conditions—diabetes, heart disease, high blood pressure and weight gain. We currently have an epidemic of people who are either prediabetic or diabetic. Two-thirds of our population today has blood glucose levels that are not in the optimal range. Diabetes is one of the most expensive diseases to manage over time because it can lead to so many other conditions and diseases. Diabetes contributes to heart disease, increases risk of cancer and Alzheimer’s, and causes damage to organs like our kidneys and tissue (e.g. the retina of the eye). This is how diabetes can lead to kidney failure that requires dialysis and blindness. It is very common for the fasting blood glucose levels to climb as people get older, gain a few pounds and become less active. So, I am a huge advocate for monitoring the level so you can prevent becoming another statistic. It also helps people better manage high blood pressure and cholesterol levels.
Q: Do you recommend dietary supplements? If so, which ones and why?
A: Yes, I use dietary supplements to help people manage their health. Dietary supplements can make up for long-term nutritional deficits that have been impacting people’s health unbeknownst to them and help manage things that diet, and nutrition can’t. For example, studies show that inadequate intake of magnesium significantly increases a person’s risk for diabetes, cardiovascular disease, high blood pressure and osteoporosis. The statistics show that about 50 percent of the population has inadequate intake. Our richest sources of it are things like green leafy vegetables, beans, nuts and seeds. But I find that it’s a challenge for people to make sure they are consistently eating enough of these nutrient-dense foods. So, I recommend supplements until people can get a healthier dietary intake going or, sometimes based on their chemistry or situation, they may need to stay on certain supplementation.
Another example is when people are under a lot of stress. Many times, there are extremely stressful situations that people can’t snap their fingers and change, like when they are doing double duty caring for their children and caring for an elderly parent. In addition, the demanding schedules that double duty causes can make it very challenging to get in things like regular yoga classes or meditation that can help manage that stress, whereas a daily supplement that contains herbs like rhodiola and ashwaganda can be easily incorporated into the schedule. It’s as quick as swallowing the supplement, and studies show these adaptogenic herbs are very good at helping to manage cortisol levels. If someone is already feeling anxious or nervous from chronic stress, I will suggest theanine or relora. If it is starting to affect blood pressure, I recommend Kyolic (Aged Garlic Extract) because of the multiple human studies specific to improving blood pressure. For people that are experiencing gut health issues, probiotics are a significant help along with allergy elimination diets. If I am sending someone to the health food store to pick one up, I recommend the Kyo-Dophilus Probiotic brand, once again because there are proven results through studies. It goes without saying that given the COVID-19 pandemic, I am recommending vitamin D, zinc and Moducare, especially if we know that vitamin D status is low.
Q: What advice would you give to practitioners when it comes to ordering blood tests/panels for their patients?
A: Well, there are a couple of panels people could request better information for different complaints or information on your disease risk. For example, heart disease is one of the biggest killers today. Typically, a lipid panel is ordered to assess risk for cardiovascular disease, but when a lipid panel is ordered, it is a conventional panel that just looks at the total cholesterol, with breakdown between HDL (high-density lipoprotein) and LDL (low-density lipoprotein). There are newer panels called NMR (nuclear magnetic resonance) lipid profiles, that look at the LDL particle size. This gives us very good insights as to whether the person is likely to actually develop cardiovascular disease or plaque in their arteries. An NMR lipid profile measures the particle sizes of our LDL and also includes an apolipoprotein B level (ApoB), which is a component of the most atherogenic types of lipids like VLDL (very low-denisty lipoprotein) and IDL (intermediate-density lipoprotein). Larger LDL particles are low risk. Smaller LDL particle sizes are the ones that can damage the linings of our arteries and increase our risk for plaque buildup on the arteries, known as atherosclerotic plaque. Other labs, such as oxidized LDL, are also important because they show the rate of damage to LDL cholesterol. You can think of this as the LDL cholesterol that has rusted.
Q: Is there anything else you would like to add?
A: Traditionally, labs have been used to diagnose disease. Biomarkers can be used to look at trends in your blood that can be predictive of future illness or conditions. We can begin to look at labs as a way to optimize our chemistry and determine how far away we are from our best health. From this, you can devise strategies and interventions to correct the metabolic roadblocks of an individual. Last thought is the current focus on clustering lab values together to look at networks of dysfunction. We have developed a cloud-based assessment that groups labs into organizational networks to look at where a person has the highest metabolic inflammation, which results in a loss of resiliency. We call this metabotyping in order to characterize where their metabolic weaknesses are most critical.