Elizma Lambert is a complex-case detective who enjoys identifying patterns in her patients' signs and symptoms, genetics, environment and functional testing.
In today's interview she shares with us how she selects the screening tools she uses to guide her clinical decisions. Elizma discusses, with some great clinical examples, why she chooses organic acid testing, genetic SNP testing, microbiological testing and heavy metal screening in her complex cases to help her uncover the blocks in a person's healing journey.
Covered in this episode
[00:42] Introducing Elizma Lambert
[01:18] Diving deeper into complex cases
[05:08] Becoming the "O.A.T Whisperer"?
[07:28] What is measured in Organic Acid Tests?
[11:34] Going beyond methylation
[12:38] Taking a personalised medicine approach
[18:48] Is testing a necessity?
[22:26] What can microbiological testing tell us?
[22:59] Accessing upskilling
[29:06] What are the emerging areas in genetics now?
[31:08] Genetic testing: opening Pandora's box?
[35:17] Elizma's clientele
[36:57] Autism: Genes and heavy metals
[44:44] Don't underestimate Candida
[46:34] Managing stressors in children and their carers?
[51:19] What does the future hold for personalised medicine?
Mark: It's my pleasure today to welcome the OAT Whisperer we'll tell you more about that soon, Elizma Lambert. She's had 15 years of clinical experience as a naturopath, nutritionist, homeopath, and GAPS practitioner, and has a passion for nutrigenomics.
Elizma brings skills drawn from nutrigenomics, genetics, and biochemistry together in a kind of a ‘join the dots’ approach to patient diagnostic and therapeutics, and I love that approach. It's something that I really have to spend the time for. But when you see all the dots before you and you can join them up, there's no greater joy. Welcome, Elizma.
Elizma: Thank you so much, Mark. Thank you.
Mark: You seem to have fun as a practitioner doing the things you love in the areas of your expertise and putting that picture together. Tell me what started you down this complex and torturous path. It is not an easy path to choose.
Elizma: You are absolutely right there, Mark. And, you know, I think that's why not a lot of practitioners go down this route because it's much easier to follow a protocol and to do the standard stuff and to try and put the pieces together and dig a little bit more deeper into someone's complex health cases. Because you end up treating everyone differently.
Elizma: So, I guess what started me on this track is I'm sort of like one of those people who has to understand everything. And so, I started the re-teaching myself biochemistry because I didn't pay enough attention when I was studying 15 years ago.
Mark: I think none of us did at the beginnings, did we? We paid no attention. It seemed irrelevant and then we wished later that we pay more attention.
Elizma: Absolutely. I had to reteach myself the Krebs cycle and all that stuff. But then I started realising that...and it was actually the Organic Acid Test that got me on to this pathway first. Because as I was studying the markers and the biochemical process, I realised it's all one big biochemistry map. And so that really showed me how a lot of these things are just interconnected and how, you know, we can't really sort of segment everything. It's not about the markers, it's about looking at the body almost in a three-dimensional view, so to speak.
And I just love that kind of stuff because the more you understand the biochemistry, the more you can actually understand why people get certain reactions. And I guess that was like another reason why I went down this pathway. Because I treat very chronically ill people, you know, sometimes you do what you think is the right thing and people get a reaction to something as simple as magnesium or something that you think, "Well, why are they getting a reaction?" And I found that by understanding the biochemistry, I started realising why people were possibly getting reactions to certain things. And so, it helped me navigate those kinds of things better. Which in the end, resulted in, you know, getting less and less adverse reactions with treatments, so better treatment outcomes, all of those kinds of things.
And so, for me, it's like when someone tells me about their signs and their symptoms, you know, I can immediately see it where it fits into the biochemical pathway and why they may be experiencing that. And I just think it makes you a better practitioner, better able to navigate difficult situations or especially in chronically ill patients. So, yeah, I guess I'm just a little bit of a geek. I love doing that stuff. So that's sort of what got me into it.
Mark: So, it wasn't so much from personal health issues for yourself. It was inquisitiveness and taking that out into the practitioner area, paying attention to all aspects. I know what you're saying when you say you hear the story. It happens to me sometimes. You can picture the biochemistry as the person is telling the story.
Mark: And you think, "I know why that happens." It's a kind of a moment where you start to realise, "Oh, the person's experience of illness and their biology and their genetics, they all line up. They have to." Don't they?
Elizma: Absolutely, absolutely. And you're right. It wasn't a personal health experience. I'm lucky that I've got very good health. It's more really that inquisitiveness that got me down into this.
But you're absolutely right. Everything is connected. You know, genetics, epigenetics, signs, symptoms. And then you start looking at functional test result. It all starts to make sense. And you just start connecting the concepts, and, you know, you know better how to treat that person.
Mark: Tell us what The OAT Whisperer means? I'm fascinated that what you've come back to is the organic acids as the kind of the whispering, the method of understanding how the biochemistry is playing out. How did that happen?
Elizma: Well, that's actually an interesting story. It was a couple of years ago and I was invited to London to go speak there and teach on the organic acids. And so I went there, did a two-day workshop there for practitioners in London,and one of the ladies said, "My goodness, you know, you are the organic acid whisperer." And it sort of like, just stuck.
So, I'm careful not to mention it too often because I don't want to be typecast so to speak. But I thought, "Well, you know, that's a compliment."
Elizma: And so that's pretty much how it came about. So purely by accident.
Mark: But it does seem as though like you can focus on many different aspects, test results, histories and things to come to the best summary of the person in front of you. It does seem like you've taken that to a new level with the Organic Acid Test to deliver personalised medicine by understanding the outcomes of the biochemistry. Is that a rough approximation of how you work with the OAT?
Elizma: Yeah. That's actually a really good description, Mark. Like, you know, you start off with the Organic Acid Test, but I'm now starting to get known here in Australia as a kind of as a diagnostic expert, I guess? Because, you know, it's, you have your blood tests, you have so many different kinds of tests, you know, all tell you a story, they all give you indicators.
Elizma: And I guess I'm lucky enough that the kind of clients that I see, they've had already multiple tests done to other practitioners. And so, by going to all these test results, you start seeing patterns, and you start making connections between even a different test result and even in the symptoms. And so next time you see it, it's sort of like, you know, rings a bell.
But I'm also very, very careful to not ever treat the test, but also always to treat the person. Because it's very easy to get stuck and look for tests as the only answer. And it really is just a snapshot. It doesn't matter what it is. It's a snapshot and you have to take it as that. But if it connects with their signs and symptoms, then you know, it can give you very valuable information.
Mark: What's mentioned in the test? I mean, I've had to look at the organic acids that are measured. What's measured and why? Is it because these represent the metabolic pathways? I'll be honest, the OAT test or the Organic Acid Test is so wide that it leaves me wondering how you can interpret any individual agents in there. How do you tie all those factors together to come to a sensible conclusion?
Elizma: For me these days, it's quite easy. I can, you know, it doesn't take me that long.
Mark: It doesn’t? Okay.
Elizma: I had to study the individual markers first and then understand where they fit in. Now that I know where it fits in, if you look at the Organic Acid Test, it's a little bit like a biochemistry snapshot in the body. Which is why I like it so much because it really gives you information of about four different or separate tests.
So, you can measure what goes on in the gut in terms of infections, like it measures these, like your Candida markers, Clostridia markers, etc. But it also gives you information on your neurotransmitter markers, such as your serotonin and dopamine. And that's actually a really useful bunch of markers when it comes to genetic expression. Because you can sort of like look at that in context with genetics and see how do those markers correlate with COMT activity, MAO activity, etc. So this is where you can actually measure genetic expression on a functional test.
And it also, you know, measures...there's quite a few markers involved in methylation there, like your folate markers, again, a genetic expression kind of scenario there. And also, many of your mitochondrial markers, so, you know, your whole Krebs cycle, glycolysis, all of those markers are in there as well.
Elizma: Fatty acid oxidation. So, it's interesting because it's a test that you can use in something like fibromyalgia, ADHD. But then I also have these days a lot of athletes and fitness fanatic people who’ll get the test done because they want to see how well are they burning fats, you know, how well is their mitochondria functioning in terms of fat adaption, things like that.
So it's such a versatile test, not just for chronically ill people, but also just for health, longevity, you know, improvement in sports performance, and all those kinds of things. So, I think it's about 70 to 80 different markers depending on which laboratory you use.
Mark: And the laboratories seem to segment them into functional groups as well. So it's not just a report comes back of 70, 80 markers. They're in functional groups. And I'm guessing, after a bit of experience, you get to see the patterns emerging of groupings of types of, say, methylation with, say, COMT-type problems. Can you see those? Do they start to become visible to you just with the experience of using the test?
Elizma: Yeah, definitely. Like, I, you know, have even, you know, found patterns within thyroid patterns, oestrogen patterns…
Mark: Oh, right.
Elizma: Which are not even tested for on the test. But when you start recognising the patterns, you can start seeing insulin resistance patterns, all of these things that are not a direct measurement on the test.
And so, I guess that's something that I found was a little bit lacking at the time when I was doing this, yeah, you know, the laboratories come out with a report and they tell you, "This marker means this, this marker means this, this marker means this." But there wasn't really any clinical information, you know? No one was, you know, if you look at it from a clinical point of view, you need probably a little bit more depth, otherwise, you just end up prescribing a whole bunch of supplements to a person, and you may still not really understand what's going on in their body. And so, I guess, for me, it was like I really wanted to bring out the clinical relevance of the test.
Elizma: That it's not just a whole bunch of markers, but let's look at association, let's look at patterns, and now we can understand, you know, what are the hormones doing? What are the neurotransmitters doing? And how is this, you know, relatable to the clients, you know, signs and symptoms? So that's what I really enjoy doing and you just become better and better at it the more you do it.
Mark: Right. And this is part of the beyond of the MTHFR and beyond. It's that's the, that you don't just come back to... I mean, everyone's favourite thing was methylation and then it expands out from that, and this seems to be the way of observing the biochemistry that spreads out from the potential of the genetics and the expression of the genes.
Elizma: Absolutely. Because it's not all about methylation. I mean, methylation is such a tiny bit in our whole biochemical chain, you know? So, I think, you know, if practitioners are not doing it already, they really need to look beyond it. And that's one of the reasons why that's what my website name. I wanted to sort of show that there's a world beyond MTHFR.
Elizma: There's a world beyond methylation. So let's not get too stuck in one biochemical cycle.
Mark: It's still an important cycle. I suppose that the one carbon metabolism, that whole idea of just shifting carbon and three hydrogens around, it seems so trivial, but it underpins so, so many different things. Viral deactivation, gene expression, hormones.
Mark: You can run the risk of thinking that the only thing is methylation. And I see doctors and naturopaths moving into the field thinking, "Oh, that is the answer," rather than that is a component of a process that expresses itself as the patient in front of you, or the person in front of you and their symptoms. So how do you make that link? You know, the person comes in, they’re before you, they're telling you about feeling depressed, they're low in energy, they've got muscle pain. What's your first move with those type of people? So, fibromyalgia fatigue, low grade, nonspecific symptoms that ruin the quality of life. Where do you start?
Elizma: So obviously, I always look at signs and symptoms. Then what I usually will do is I will start at something like an Organic Acid Test if they can afford it. If they can't, you know, I've got enough experience to sort of like know where to go. But what I'm looking for is I'm looking for a root cause here.
Elizma: So, you know, I'm looking for what is...you know, we can look at the genetics, but something would have had to trigger those genetics or cause them to express. And so, I'm looking for is there infections, is there heavy metals, is there environmental toxins, is it stress?
Elizma: You know, sometimes, the interesting thing is, is we find that stress, and things like PTSD can actually have the same biochemical effect as mercury on your cellular biochemistry. So, we sometimes underestimate the effects of chronic ongoing stress.
So, I start looking at, okay, well, what is the main trigger for all of this? Ultimately, that's what I want to treat. Now, we will probably support the body symptomatically in the meantime to get them to feel a little bit better. But I feel like this is sometimes lacking. Because even if you should look at the methylation cycle, a very important cycle, if you look at the enzymes and the genes involved there, many of them are influenced by environmental triggers.
Elizma: Bacteria, viruses, heavy metals. And so if you just focus on giving someone methylfolate for an MTHFR gene mutation and you ignore the triggers that got that system dysregulated in the first place, then I don't think you're really treating that person properly or you're not really moving them towards getting out of that chronic state. You're really is just supporting the body, which is okay, but you really want to get that person better.
So, for me it's always about looking at the root cause. That's the main focus. And sometimes I'll do that by doing Organic Acid Tests because that can give me information on the root cause. Or maybe I'll do like a mould panel if I think that mould biotoxins maybe an issue. Or a CDSA if I want to look a little bit further into the gut. So, that I will determine based on their signs and symptoms or where will I start to dig first?
Elizma: To find out what the trigger is for that person because, you know, Mark, you know, you can ask 10 people with fibromyalgia chronic fatigue and you'll probably treat them all slightly differently. Because they may have different triggers that got them there in the first place.
Mark: Yeah, I absolutely agree that learning from one person, this idea of personalised medicine is so critical. Medicine likes to aggregate things statistically and say, "Oh, you suffer depression. You suffer heart disease. You suffer..." And it's a macro-description that just over...it aggregates people who have different origins and pays no attention to those origins. So personalised medicine by its nature has to delve into what's different, even though two people look the same. I see this with CFS and fibromyalgia. I can't pick the difference from their, symptoms but the history is wildly different, the family history is wildly different and the test results show entirely different means of getting into that state of poor health.
So that side, it seems like you have the tools that kind of separate that out into, "Here's your particular journey into that condition," rather than, "Here's the name of your condition and here's the pills that I use for that."
Elizma: Absolutely. And I'm so glad you said that because for me, this is sort of what's starting to emerge in some health circles. Is that we're not looking at disease anymore or the word disease anymore. You know, in fact, you could almost argue that there is no such thing as disease. It's just cellular dysfunction. So disease is a name, you give it a label, makes it maybe easier to prescribe a drug, but that's not really what it is, it's a cellular dysfunction.
And when you start looking at from a cellular dysfunction point of view, it sort of opens yourself up to be able to really treat anything. If you understand the cellular biochemistry you can really treat anything.
Elizma: I'm not proclaiming that I can treat everything, I still have a lot of learning to do just like all practitioners. But I think we need to be careful of just diagnosing something and giving it a name because that's not really what it is. You know, there's an underlying biochemical dysregulation, that's what needs to be the focus.
Mark: Yeah. In a funny sense...well, it's not a funny sense. Medicine is really the profession of disease treatment and there, we own the names of the diseases. Well, the job is really not to give the disease a name but to understand a process, work at the basis of that process, and prevent the person getting the disease or pull them out of that disease state without being too radical.
So, I think that we are kind of dealing with two things. One, you fall over the end and you've got trauma, injury, stroke. Medical intervention is incredibly important. It's very, very powerful. But it is not powerful in the way of doing the real job of prevention, understanding the person's path, and getting them not to have that catastrophe in the first place.
So, there's a whole business of finding people's predispositions, catching them early and then guiding them out of a trajectory that would otherwise lead to real disease. And I think that's the most powerful form of medicine that we've got at the moment.
Elizma: Absolutely. I couldn’t agree more. Definitely.
Mark: We're at the very beginnings of this area of personalised medicine, of understanding of biochemistry, the expression of genes. There's huge data gaps everywhere. How do we as practitioners move from, if you like, good data on genes, on expression, on biochemistry? How do we take that into the patient care? What do we use for feedback about treatments, interventions, diet, lifestyle, stress management? How do we do that? Is it measure and re-measure it? You know, take your data, have a look at how you'll modify it and retest? Is it testing over and over, or do you just do the Organic Acids Test once, get a trajectory and then say, "Okay, here's our plan for the future?"
Elizma: Well, I'd probably say, you know, data is a really important tool and it's a very powerful tool because it can sort of like measure whether you're on the right track or not.
Elizma: So I think early on for any practitioner, I think data collection is great as long as you don't over-order tests because that's another thing that people just have to be aware of, you know, people are not made of money. You want to be very careful in not ordering too many tests and getting focused on it. So, for me, if you're going to order a test you need to already know what you want to do with the data.
Mark: Right, yep.
Elizma: The information in there needs to guide your treatment. If not, then there's no point in doing the test, you know?
So, for me it's like in the beginning, I would do the Organic Acid Test, and then I would usually retest about four months or so later. And I've done that enough times now that I started getting patterns, and now I have a good idea of how long does it take to change this marker at this level, this marker at this level. So, I don't really feel a need to retest anymore because I learned from that experience.
But a lot of people do like to do that because they're very interested in their biochemistry. They want to see where they're at. But ultimately, like I said previously, very, very careful not to treat the test. I mean, the person has to be getting better. You know, if their symptoms are improving and they're feeling better and they're able to engage in activities that they previously couldn't, you're on the right track.
But I do find that people find it very interesting and they do want to see what's going on in their biochemistry. And they get very excited when they see, you know, a lot of things shift in a more positive direction as well. And that keeps them very motivated. It's like, "Okay, I'm going to keep on with these dietary changes,” or what-have-you.
And also then enables them to get off a lot of supplements as well. Like, the interesting thing is that through my testing, what I found, is that you actually have to use very, very little nutrients, in terms of treatment. If you sort of like focus on the root cause areas, a lot of their nutritional markers, they just correct by themselves.
Elizma: Which I found really, really interesting. So, it enables people to take a lot less supplements than they normally would which, you know, gives a lot of people relief just in terms of, you know, not having to swallow a lot of tablets, also not having to spend a lot of money on it as well.
So, retesting is a great tool in the beginning and as we as practitioners get, you know, more comfortable, they don't necessarily have to do that. But I usually just like to keep it to maybe one or two tests. It'll have to be something very specific if I have to ask for more than two tests.
Mark: Hey, you do the microbiological testing as well. So, you're doing the metabolic products of the various microorganisms, so not just the body's organic acids but the microbial organic acids as well. Is that right?
Elizma: That is correct, yeah. And that's why, in my opinion, and everyone might not necessarily agree with me, but that's why I feel it's a more accurate test. Because when you do like stool analysis for microbes, there's a lot of false positives, false negatives.
Elizma: It depends on the laboratories. It depends on their testing methods. If you're actually measuring the metabolic by-products of these organisms, you're not measuring the organisms directly. So it doesn't matter if they die through transit or what-have-you. You're measuring byproducts that they have to produce, it doesn't matter where they are in the body, they produce these by-products. It gets dumped into the kidneys, into the urine and that's what you excrete out.
Elizma: So I feel it's probably a little bit better and more accurate in terms of organisms that maybe hiding and organisms that might not necessarily just be segregated to the gut. You know, maybe they've become systemic. And so I just feel like it's a more accurate way of testing for certain organisms.
I mean, the downside is it doesn't unfortunately measure parasites or anything like that. It's pretty much focused just on the Candida and the fungal organisms and your Clostridia and then a couple of generalised bacterial markers, and you still don't know which specific bacteria it may be. But in other respects, you know, you can catch probably a lot of positives in there where it can come back negative on a stool test.
Mark: It's a really difficult clinical problem, isn't it? This this whole issue of fungal organisms and the effect of fungi, especially in the kind of chronic inflammatory responses, this mould reactive group of people for whom fungi that colonise the gastrointestinal tract can play havoc with their health.
Elizma: Oh, yes.
Mark: And yet for other people, it's a trivial problem. That they don't even notice health problems associated.
Elizma: Absolutely. And I think this is where genetic variability comes in play again. You know, you can have two people with the same amount of yeast or fungal overgrowth. One person super sick, the other one not necessarily. And then that could be to do with genetic mutations and your acetaldehyde dehydrogenase genes or other genes. So this is where, you know, genetic variability can come into play.
Mark: Right. And that's how you unpick that. You use the organic acids both from the microbial side and from the host side to try and grab a picture of, "Is this affecting mitochondrial function? Is this affecting inflammation?" And so, you pick your targets from that kind of the OAT testing. Is that how you would do it?
Elizma: Yeah, absolutely. So, you know, that's exactly right. So you look at the Organic Acid Test as that snapshot of the biochemistry, you look at their symptoms and if they have other tests, like blood tests, you look at that as well and then you start seeing the patterns in there. And then it gives you sort of like an idea, "What's the most important aspect I have to focus on with this person?"
Elizma: It's, again, it's never about treating every single little marker that you see problematic on a test, it's trying to find the core issue that is influencing all of the other markers. And then you can create shifts in the biochemistry without necessarily treating every single little thing or putting them on a whole bunch of supplements.
Mark: Well, look, the secret ingredient with you is you've had 15 years' experience in this area. For those of us starting out in the area of organic acid assessments and of simple targets, things that we could reliably do this testing for, what would be an introduction to that? If we do the Organic Acid Testing, we see the markers in the different areas, the tendency for a neophyte is to rely on the test and to treat the test, and as you gain experience, you realise there's a person who you're treating and the test result is an aid to that. That transition is often very difficult.
There's a medical model of the test results will tell us when we are successful rather than the person will tell us when we're successful. So, do you have advice for a person who's starting out on the Organic Acid Testing? Is there a simple entry point where they can make sense of the complaint of the person?
Elizma: Well, okay. So, I guess I would probably say it's a little bit hard to sort of like explain because, it is like where do you start? It is a complex area.
Mark: There was a time where you didn't have that much clinical experience. So, you have been through this.
Elizma: That's right. So I guess, you know, if I can explain where I started, like my first start into genetics. So I think I did courses through Dr. Ben Lynch in around 2012, 2013 getting into the genetics.
Elizma: And got really fascinated about that. And then when I started with the organic acids, I mean, a lot of that was self-research as well. But in the meantime, in the last couple of years, you know, we've put out quite a few courses on Organic Acid Testing and how it works.
Elizma: So, I mean, there are webinars and educational material out there that people can certainly access whether it be mine or whether it be another practitioner. And, you know, then I would sort of like encourage them to really start looking for patterns within their own client populations. And that just takes time. So just looking for patterns.
So, there are like webinars for Organic Acid Testing out there and, like I said, Dr. Ben Lynch, he was a guy who got me into the whole nutrigenomics area very, very early on in those early years.
Elizma: And so I think...
Mark: He has been a major driver of this world-wide, I think, and I see that you have joined up with him in that progressing this information.
Mark: So getting from theory to practice is a very, very difficult thing to do. But I think the pair of you have done remarkable things to introduce that to practitioners.
Elizma: And you know, it's not stopping there. Dr. Ben Lynch is certainly evolving things more and more and so I think there will be more and more opportunities for practitioners to also learn in the near future as well. So there a lot of exciting things coming from his side and not just from a genetic perspective but also from functional testing and also in a sense connecting the dots.
Mark: I'm very keen to understand more. Methylation issues used to be purely MTHFR, going years back. It was almost like the genes that we could get were the two particular genes and we would interpret everything based on that. It's gone a long, long way since that. Hasn't it?
Elizma: Oh, yes.
Mark: And, I mean, I have a fascination with this COMT. It keeps on showing unrelated to neurological, neuropsychological processes, brain chemistry. There's way, way more than MTHFR. Could you tell us...give us a kind of overview of where it's moved to over the last five years?
Elizma: Yeah. Okay, so, you know, it's moved, you’re right, MTHFR where it started. Then everyone started looking at the B12 genes which is the MTR, MTRR and a couple of others. COMT has gotten a lot of attention. A lot of people are now looking at the histamine genes, the DAO genes. They're also looking at a lot of the glutathione genes. So, the GPX, GST and all of those glutathione genes.
Elizma: So, I'd say that that's probably where the focus is at the moment because they are more connected to the root cause of a lot of issues because it's your detoxification and it's histamine being produced by a lot of gut organisms, etc.
And so they're often the ones that they can create or can result in a lot of the other genes not working so well. So, when we talked about methylation and we said, well, a lot of those methylation genes, they stopped working or they don't work so well because of other influences, those other influences often come from the DAO and the glutathione genes.
Elizma: So, in my opinion, I think, they're probably more important because they can influence COMT, MTHFR, MTR, MTRR, all of those. So that is to me with the focus because at the moment, if you look at clinical practice.
Elizma: Of course, when we look at research, I mean, there's no limit to the amount of genes that they look at...
Elizma: It is.
Mark: Once you've opened it, there's no end to the goodies that come out of it. But on the other hand, too many goodies coming out of that testing, the heart-sink feeling of having a patient dump 200 pages of his biogenetics, "Now, what's wrong with me?" That link is not possible at the clinical practice level. There's limited time, not unlimited time, and the number of possible associations just seem to be out of control.
So, what do we as practitioners do to make sense of that? Is there a kind of starting point for taking the genetics, apart from the Organic Acid Testing, just even the genetics and making sensible discussions about that and nutritional choices about that? Is there a guideline for that or are we left in a kind of world of, there's so much happening that every week it changes? Where are we now?
Elizma: Yeah. That's a difficult one. Because I think at the moment we are probably left a little bit in the lurch. I mean, there's tons of guys, you know, putting out reports online where you can put your genetics through something and it pops out a report.
Elizma: But I guess what I found with a lot of those reports is they still just look at a gene and say, "This is what this gene means, and this is what this gene means."
Elizma: And if you actually, you know, the genetics work exactly the same as the Organic Acid Testing, everything else. It's about looking at clusters of genes in certain areas. And, again, understanding that these cluster of genes will influence this cluster of genes, will influence this cluster of genes.
Elizma: And so, it again, we come to whole connected kind of a thing. And, you know, how do we learn that? I guess, again, to experience, at this point in time, I'm not aware of a course or anything really that teaches that to practitioners.
Elizma: But I think that's actually so important and that's what we need. The best course thus far I would have to say is Dr. Ben Lynch's course, which looks at only a limited amount of genes because, again, you can jump down a rabbit hole like forever. But he probably explains it the best way in terms of how a lot of these genes connect with each other.
Elizma: Because that's how we need to look at genetics as practitioners as well. One gene SNP doesn't mean anything. It has to be looking at clusters of genes in a certain area and how that might potentially influence a certain organ system or systematic system. And then being able to look for markers on tests that may show us whether those genes are actually being expressed or not.
And so I guess this is a reason why not a lot of practitioners jumped down these rabbit holes because it's not easy. It's not a protocol approach, and it involves learning a lot of stuff over again, and really having to think outside the box.
Mark: And dealing with uncertainty as well? You know, these are patterns rather than, what doctors love to have, is a diagnostic marker that when my test comes back and says, "X, that's a disease that I can rely on and I can apply a drug therapy to."
This is more of pattern-matching to see what patterns match the person in front of us. And I think that's part of the reason that doctors get uncomfortable with it. Our idea is a test should be highly certain, highly directed, and because we think a person may have something, these tests are tendencies, movements, directions, but also brilliant opportunities to intervene before the disease becomes something in need of a drug.
So, it's softer but far, far more effective at changing the trajectory of the person heading down towards disease.
Elizma: Oh, absolutely, yeah. Because, I mean, there's a lot of genes that we can associate with, you know, where certain diets may be more beneficial for certain person.
Elizma: Or even they maybe more sensitive to certain chemicals and pesticides. And so, you can do a lot of lifestyle changes based on your genetics that could, you know, add years to your life and to your health further on.
Mark: The typical patient that you see, I would imagine, would be a fairly complex story. And do you see things like autism? Do you see chronic fatigue syndrome? Do you see complex illnesses, or have you got a more defined group of clients in your practice?
Elizma: No. You know, that's one of the things that I have very early on I sort of went against the whole industry grain and I did not want to practice or sort of specialise in a certain area. I was like, "I would be bored out of my mind if I had to specialise." I see myself as a generalist.
Elizma: And I feel like it's probably there's not enough generalists out there because it's, you know, when you become a generalist, you almost have to become an expert in everything. Because you're not just into thyroid or you're not just into hormones.
But that's what I like to do. And as a consequence, my clientele is varied. So, I see a lot of autism, I see a lot of CIRS, mould toxicity, a lot of chronic fatigue, fibromyalgia, a lot of people with chemical sensitivities. You know, even see depression, anxiety, bipolar disorder, you know, sometimes I'll even treat fertility, so preconception care. So, it's so varied. And in a sense, I love it because it's always interesting.
And, you know, because it's always about the cellular biochemistry, it doesn't really matter what they're there for. We look at the cellular biochemistry and that's what we focus on.
Elizma: Which is to why, you know, it doesn't really matter what disease or disorder they come in with, we can always work with it.
Mark: Okay. So if I gave you an example of a six-year-old autistic boy, severely on that spectrum. The parents have tried everything that they can and they've come to see you. Where do you start in something as complicated as a young person with that clear autistic tendency? What would you do first?
Elizma: Okay. So obviously I would look at what tests they have done and have not done. I would see if there's any gaps in treatment protocols that they've done. So, I guess, one of the big things in autism, if it hasn't been done yet, I would probably do something like an Organic Acid Test and I'd probably do something like a heavy metal panel. But I'll definitely be looking for organisms in the guts, and I'll be looking for toxicity. Because that's generally the kind of pattern that you would see in autism is usually there's something like a Clostridia overgrowth, yeast overgrowth, maybe something else. And usually these kids hold on to toxins and metals.
And that's quite interesting because, again, genetics come into play here. Because they may be exposed to exactly the same amount of toxins and heavy metals as everyone else is, but their bodies are not actually clearing it.
Elizma: So, their bodies are actually holding on to it and so it starts to accumulate. And then you have to look at, "Okay, well, why are the detoxification mechanisms not working?" You know, is it to do with genetic expression? Is to do with something else? But that's generally the two areas I would first look at because that's the most common areas where we do start these issues.
Mark: Right. The genetics and Organic Acid Tests and the microbial assessment, the gut assessment.
Elizma: Absolutely. And possibly like a heavy metal panel as well. And it is quite interesting, Mark. Like, I was recently treating a lot of autistic children in Poland. And, you know, these parents, they have done all the testing under the sun. They're very impressive, very proactive, the parents in Poland.
Elizma: What really struck me is when I looked at through the test results of these kids, having also, you know, treated autistic children here in Australia, I was really struck by the huge amount of heavy metals in these kids. I've never seen anything like it in my life. Like, all of the kids that I treated in Poland had the highest levels of heavy metals I have ever seen.
And sometimes it can depend on also the environment or the country that they live in, the area they live in, where something may be a bit more dominant than something else in another autism population. So, you know, this is where the functional testing can become quite useful because it helps you to focus your treatment a little bit better with them.
Mark: Yeah. The heavy metals and young children do not go together well at all, do they?
Mark: When that brain is developing, it is so critical not to disrupt the trajectory of a normal developing mind. And that, I didn't know. I found that almost heartbreaking because I have a doctor's approach, which is, "Wow, that's damage that you're never going to unravel." But that's actually not true, is it? There is still developing mind and developing brain, and action at that point is probably the optimal thing that you can do.
So, what would you do then? So you get the Organic Acid Test back and you get the toxicology back. Just take, for example, mercury. What's your next step? You're looking at detox pathways? How do you help? Is it diet? Supplements? Detox? What you do for a six-year-old?
Elizma: For a six-year-old? Well, the first thing you definitely have to do is you have to make sure that they are not actively exposed to something.
Elizma: So if it's just simply an accumulation of normal amounts that's everyone is exposed to or are they actually heavily exposed to something within their environment right now? So, if they are, that needs to be removed. Most cases, it's not. Most cases, it's just because mum had amalgams or, you know, their detox pathways are not working.
So for, you know, the general things I think for a six-year-old with autism still apply like going dairy free, gluten free, all of those standard dietary things. But if you’re looking at heavy metals, you know, it does become a little bit difficult in little kids because you have to be really careful with dosages and what you want to do. I generally would like...I like to get binders on board.
Elizma: Regardless of the age of the person. Because you can start, you know, giving them all of these detox supplements, but if there's not good binders, and a lot of these kids have bacterial overgrowth, their bacteria containing beta-glucurdonidase enzymes, etc., which essentially just reverses the whole detoxification process.
You can give these kids all of the supplements, essentially detoxing them but everything just gets reabsorbed back into the body unless they have binders that actually moves it out. Because some of these kids have constipation issues, bacterial issues. So, moving from the gut is definitely an important step before you even start to mobilise.
Mark: What do you use for your binders? Sorry, just, what do you use for binders in kids?
Elizma: Yes. So, for binders, sometimes we'll use Modified Citrus Pectin, sometimes I'll use the Clinoptilolite. They're probably my two favorites, if I had to be honest.
Elizma: There are certainly binders that I try and stay away from like Chlorella, I'm not a big fan of. But there's some binders that I probably do not like to use for various reasons.
Elizma: So those are probably my two favorite ones.
Mark: Well, a lot of the binders also run the risk of being able to disrupt nutrition as well. So you do have to be very careful about what you and what you don't. But that does sound like food-based rather than pharmacological binders.
Elizma: Yeah. I mean, you know, in the old days, I used to experiment, this is now, many, many years ago. This is when, you know, we could still get hold of things like EDTA and DMSA. I experimented on myself and made myself very, very sick. So, it was a good lesson that I learned and which is why, you know, I probably wouldn't...you know, I don't like to go that kind of pathway with my clients. So I feel like there's easier and probably less harmful ways to do these things.
Elizma: And so, yeah, definitely, binders is a good place to start. You know, then, of course, your liposomal gluthationes and things like that is another good one. So long as they don't have Sulphur issues because sometimes there can be issues with glutathione as well. So those are some of the basic things that I would probably put in there.
And then I think one of the most important things is...especially if you at look heavy metals, like heavy metals and bacterial organisms and fungal organisms, they go hand in hand.
Elizma: And you'd often have to get rid of the one to get rid of the other one. So sometimes it's a bit of a crossover with treatment. And another one that...another, I guess, variable that's very important in heavy metals is oxalates.
So, if a child has oxalates or a person has oxalates, which can be measured on the organic acid test.
Elizma: It'll be very hard for them to get rid of heavy metals unless you address the oxalate issue, because oxalates can actually bind as strong as EDTA to heavy metals and lock it in the body.
Elizma: It's a very, very strong chelating acidic molecule. And so sometimes you have to first get rid of the oxalate before you can actually get the metals to move out as well.
So sometimes, it's about the timing of things. It's not that something is the right treatment or the wrong treatment, but sometimes it's all about the timing. When do we do this? When do we do that? That's often get the best results.
Elizma: That's definitely part of where I will, especially with Candida. With Candida I definitely put a lot emphasis on Candida. I find that's a very... I don't think we take it as seriously as we should. You know, we sometimes get really sidetracked with a lot of these other organisms and I think Candida actually cause a lot more disruptions than some other organisms we sometimes pay attention to. Just because of the nature of how it manipulates our biochemistry and how it can really hijack the immune system and invade it, and it's what probably one of the organisms that is very strongly associated with mercury.
So, you know, with Candida, I always pay a lot of attention to, you know, looking at biofilm and all of those kinds of things. And I think, you know, sometimes you'll shift your treatment a little bit from this side to that side, and you use the client's feedback to see, "Well, where do we focus our attention on now?"
So sometimes it's not just about doing the same thing for six months, you sometimes have to just change things slightly from time to time based on what are they going to be doing.
Elizma: Because, I find that sometimes there will be a Candida dump, and then it's like, sometimes the body will then shift to a heavy metal dump.
Elizma: And so there seems to be like different priorities that the body goes through, depending on what it needs to do or wants to do at that point in time. You need to listen to signs and symptoms.
Mark: Yeah. Part of the experience in the field you have as a practitioner that the more time you spend, I suppose, the emphasis changes over time. Not to deal with that one at a time, but to deal within a pattern that the child in this circumstance can cope with and not become sickened by.
Elizma: Absolutely, absolutely.
Mark: How do you manage the broader stress? In these conditions, there's not only the inheritance, families carry the genetics and often the biochemistry of each other. So it's often as much a family issue as an individual issue. But always in these conditions, there are stresses of the expectations of the family, stresses of schooling, stresses...there are stresses everywhere.
Mark: And I've never figured out a way with children to diminish the stresses below that threshold that allows them to function at a better level and not to put too much of a load on their system. Do you have any thoughts about how we could do that as practitioners?
Elizma: Yeah. No, you're right. That is actually such a good point because the families are very stressed. The mothers are very stressed. You know, it doesn't matter if you tell them not to stress because they're children.
Mark: No, that's the worst thing to tell them.
Elizma: Yeah, exactly. And I find, and I say this with the most dearest and the most respect that it's actually really...it's probably the most emotional kind of environment to work in as we start to work in autism as opposed to some other chronic illness. Because there's a lot of emotion involved. And so I think it's very important for these parents to have a team of practitioners.
Elizma: In this case, it's not going to be the one practitioner treating everything. They need to have support systems whether it's to do with speech therapy, whether it's to do with occupational therapy, whether it's to do with behavioral therapy. There definitely needs to be other support systems in place for these parents so they address the child as a whole, you know, so there can be brain pattern changes and all kinds of other changes.
And, you know, I think sometimes, and this is going to sound...I don't really know if I'm going to express it correctly, but having gone through this to some degree myself with my son, I think it's very important for parents to step away from being the physician.
Elizma: Because that is a common thing with parents when they have autistic children is that they, obviously, don't have a lot of money. They're trying to do a lot of these things themselves, a lot of research themselves because they don't feel like they're getting the help from the medical community or from practitioners that they feel they need so they take things in their own hands and they become their children's practitioners, and not their parents anymore. And what happens there, is a very subtle shift, in that, it creates a lot of stress and resentment because parents feel like they're losing out on spending time with their children because they're busy trying to fix them.
And so I feel like this is actually something that's very important to discuss at some point with these families. And in my experience, you know, when we discuss these things, the mothers usually break down and cry.
Elizma: Because that's exactly how they feel. And that's not what they want to be. They don't want to be the child's practitioner, they want to be the mother. And I think as soon as you can sort of like if they have a good support network where they can move away from that and actually just be their child's mother, I think that'll really takes a lot of stress off of the family, and, hopefully, off the children as well.
Mark: Yeah. I agree with you so totally that getting the fear out as well because a parent can't be a practitioner, can't be separated enough and their fears and their doubts percolate through. They can love, they can love non-possessively and as their children, and they can deliver their children all the care that they can but they cannot be their doctor or they cannot be their practitioner, even if they're trained to do it.
So I agree with you, even in my own family, the tendency is even for us as practitioners to want to treat their own family. It's a poor idea every single time.
Mark: And allowing other, you know, professionals to work in these areas of personalised health care of looking after their child, taking that stress off, I think is so critically important. It's always good, you know, when the child is getting a step or two forward that allows the parent to release often. And so as you unpick these complex components, the organic acids, the metabolic products, the genetics, as it becomes clearer, often the parents do back off. And I think it's one of the best outcomes of this personalised metabolic type of medicine that you practice. That you see results, you see them relatively quickly. And as long as we're all prepared to back off and allow each individual to do their part for that sick person, then we get really good personalised outcomes. Maybe not a protocol, but really good outcomes that develop over time.
Elizma: Absolutely. Yep. I couldn't agree with you more.
Mark: So that brings me to the question; What is the future of this? I mean, one aspect of personalised medicine of methylation, genetics, of organic acids is it's an evolving field right now. We're in the middle of it and it is developing. How do you see this becoming a part of ordinary, everyday practice for healthcare practitioners? From here, what's the next steps? Do we have to simplify it? Do we need to deliver better science or what's the next step?
Elizma: I think we need to simplify it. I think we get lost a little bit in the complexities of things and sometimes think more information is better, but you can actually end up being like in a loop of just never really getting to a point. And so it's very easy to sort of like fall into that trap as well.
Elizma: So I think we really need to simplify it. For me and for other practitioners, it's really the whole lifestyle, diet, that kind of stuff and environment is, so, so important. Because, you know, genetics is maybe 10%, 15%, environment is the other 90% or 85%. And so if we clean up the environment, we essentially clean up the genetics and improve genetic function.
But if I look at mainstream medicine, I think what's going to be definitely part of personalised medicine, and it's already happening as far as I'm aware, is I think we're going to start looking at genetics in terms of, you know, drug prescriptions. You know, a lot of the CYP enzymes that can give us ideas of how quickly does someone metabolise drugs, or how slowly. I think it's going to start influencing our prescriptions, the dosages of people. So I can see that becoming part of mainstream medicine, absolutely, as we become more personalised in that sense. So that definitely I can see happening in the future.
Elizma: And then I think, you know, there's going to be more and more and more information on genetics coming out. And it's always very interesting, but I think we always need to remember that it's environment and lifestyle that plays the biggest role.
Our genetics have been pretty much the same for the last, you know, for hundreds and hundreds and hundreds of years. We're seeing the changes now emerging with the expression because of the environment.
So I think we have to be careful and not becoming too fancy or too complicated, and forgetting about the foundations and the basics. Because our tendency is to look for the magic pills, the magic cure.
Elizma: Or a genetic reason for why we are sick. It's like, well, not really. You know, something had to happen, there had to be a trigger. So, let's look for the triggers.
Elizma: That's where I would like to see it going. It's going not where it's going to go because, like I said...
Mark: I don't know. There's a lot to be saved for simplification. Generally, when new technologies like this appear, it goes complex while all the research is done, and then it percolates down to a level that the practitioners need to understand. If it never percolates down to that level, it's not useful information. So, you know, I absolutely agree with you. Personalised medicine could be so complex that it's useless.
Elizma: Yep, yep.
Mark: But after you've done enough of this and you've got, say, your 15 years experience, you see that personalised medicine through different eyes. You see it as opportunities for intervention, recovery, diet change, the environment. That's very, very powerful medicine. Compared to what doctors often think of, "Oh, I know which drug to prescribe." That's not very complicated nor is it very useful. It just means we do less harm with the drugs that are inappropriate.
Your area, I think, I honestly do think, is the future of medicine. That until we get back to kind of Hippocratic, environmental or until we all have understandings of illness, we're limited to wait for the disease and then treat with a drug. But as soon as we understand these things, as soon as we have tools and education like you and Ben are doing. Then what, we have tools finally to not let that, say, autistic child become an autistic adult, or to let schizophrenia develop, or to let inflammatory and autoimmune diseases develop.
So I think the simplifying of it is great, but we're still in that kind of phase of the science becoming real science and then turning back on to useful information for a practitioner.
Elizma: Yes, I think you're right. I think we'll get there. You know, I think it's very exciting.
Mark: You are getting there and that vanguard there, that you represent among the practitioners of the pragmatic approach is, gather your data, don't forget the person, and then apply the useful information, learn from that. And then I think that does percolate down to really much, much more useful information as years go by.
So, you know, I thank you for your time today, but also thank you for bringing what I regard, as the new medicine which is really the old medicine through new eyes.
Elizma: It's right.
Mark: To bringing it back to what we can do, not to treat diseases more effectively, but to prevent them and to give people the best opportunity for healthy life.
So thank you for joining us today on FX Omics, and again, congratulations and thank you for the work that you're doing.
Elizma: Thank you so much Dr. Donohoe.