Episode 74: Sponsored | Innovations in Clinical Laboratory Testing with Dr. Michael Chapman

Genova Diagnostics

Address: 63 Zillicoa Street Asheville, NC 28801

• Phone: (800) 522-4762
• Email: info@gdx.net
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A workhorse laboratory in any functional medicine practice is stool testing. But really gleaning the best insight into our patient’s clinical picture can be tough. What do all of these commensal organisms really suggest? How do they correlate with the inflammatory findings? Of the bell-weather bugs (like akkermansia) how can we increase levels?

Is there ANY place for microscopy (O&P) and culture in today’s high throughput Omics world? You see where I’m headed. Even for the most seasoned FxMed clinician, a review of how to use these tests with an eye towards what to expect in new technology is essential. Disagreement with methods? Yes. Why? Zonulin Family Peptide – any utility?

A great conversation with Dr. Michael Chapman of Genova Diagnostics. Thrilled with their commitment to in-house “data mining” and peer-reviewed publication (IMO all of the Fx labs should be doing this).

Thank you!  ~DrKF

Genova Diagnostics is a leader in functional laboratory testing, offering innovative approaches to personalized medicine. Genova provides practitioners and patients with comprehensive clinical lab services for the prevention, diagnosis, and treatment of complex chronic diseases.

In today’s episode of New Frontiers, Michael Chapman, ND, a naturopathic physician at Genova, talks with Dr. Fitzgerald about the company’s innovations in clinical laboratory testing and how functional practitioners can use and interpret Genova’s comprehensive, cutting-edge tests.

Dr. Chapman earned his medical degree from Bastyr University and worked as a microbiologist, performing pharmaceutical research on cancer cell lines, before joining the Genova team. Dr. Chapman has a passion for learning and helping others understand the dynamic processes happening within the human body.

Michael Chapman, N.D., is a licensed naturopathic physician who graduated from Bastyr University in Seattle, Washington. Upon graduation, he spent three years in private practice before joining the team at Genova Diagnostics.

His areas of clinical focus are hormone regulation, gastrointestinal health, and autonomic balance.

Prior to medical school, Dr. Chapman earned his Bachelor of Science degree from Indiana University with a focus in neuropsychology. He later worked as a microbiologist performing pharmaceutical research on cancer cell lines. Dr. Chapman has a passion for learning and helping others come to a greater understanding of the vast and dynamic processes that exist and interact within the human body.

• Dr. Stubbe’s Webinar: Understanding the Clinical Significance of the Commensal Bacteria
• GI Effects Support Guide
• Chen et al. 2019 Digestive Diseases and Sciences, PDF

Co-Author/Contributor:

• Textbook of Natural Medicine, 5th Edition by Joseph E. Pizzorno (Chapters on Porphyrins and Organic Acids Testing)

Webinars:

• Clinical Application of the Methylation Panel
• Introducing Genova’s Methylation Panel
• The Lifestyle Factor

White Papers

• Methylation Status as an Indicator of Cellular Aging – 2019 A4M Spring and Winter Congress Publication

Lectures

• 2019 AIC – Clinical Application of Methylation
• 2019 A4M Spring Congress – Clinical Application of Methylation

Dr. Kara Fitzgerald: Hello and welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine and of course, today is no exception. I am really excited to be talking to Dr. Michael Chapman. He’s an ND over at Genova. Let me give you a little bit of his background and then, I’ll tell you why I’m so excited. He graduated from Bastyr in Seattle and upon graduation, he was in private practice there before he headed out to North Carolina and joined Genova Diagnostics. His areas of clinical focus are hormone regulation, gastrointestinal health and autonomic balance.

Prior to medical school, Dr. Chapman earned his Bachelor of Science degree from Indiana University with a focus in neuropsychology. He later worked as a microbiologist, performing pharmaceutical research on cancer cell lines. Dr. Chapman has a passion for learning and helping others come to a greater understanding of vast and dynamic processes that exist and interact within the human body. Welcome to New Frontiers, Dr. Chapman.

Dr. Michael Chapman: Thank you, thank you. Hello. How are you?

Dr. Kara Fitzgerald: It’s just really great to have you here and as you and I have been talking, as we kind of started to get to know each other here since you’ve been at Genova, that’s … you’re in my alma mater, that’s where I did my postdoc, when we were Metametrix and I was with Dr. Richard Lord and we’re just talking about sort of the rich firmament of … or the amazing colleagues that you get to work with and the fact that you’re always elevating each other with learning and then the other thing you get to do Michael is you’re consulting with these clinicians around the globe and really some top clinicians where you’re reviewing their laboratory data and helping them sort of puzzle out what it means and interventions and so forth and …

Dr. Michael Chapman: Yeah, it’s a nice gig. I mean, I get to communicate and consult and learn so much on a regular basis, the clinical consults, a lot of time, we think, we’re having conversations with new docs about going over functional lab reports but so much of it is also, having amazing conversations with some of the thought leaders in the space and you remember, just banging through, report after report after report and just hitting all these wonderful talking points, the ones with therapeutics. I mean, it’s an ongoing learning experience and that combined with … sorry go ahead.

Dr. Kara Fitzgerald: Well, I’m just going to say and you’re looking at thousands of data points in a given … I mean, you’re just looking at so much that you actually do encounter the zebras and you get to do a drill down into the literature not just in interpreting but creating the educational materials and all the …

Dr. Michael Chapman: Yeah, absolutely. Absolutely. It’s really fun and we get to see so many different cases and case reports and different patterns in the test results. You just really get to learn what these biomarkers mean, what these test mean, kind of inside and out. Yes, it’s nice, it’s …

Dr. Kara Fitzgerald: I felt when I was at the lab, I felt like I was … we were involved in actually cutting the edge, kind of shaping where medicine is heading, not just sitting at the cutting edge but really participating in that process and I think Genova … I think you guys are still kind of in that mix so just talk to me where you were, where you’re heading and then we’re going to focus on stool testing too so you can move into that as well.

Dr. Michael Chapman: Yeah, I mean, Genova has been around a long time, 33 years and for those of you who’ve been with Genova for a long time know that originally it was Great Smokies Diagnostic Lab, right, way back in the day. Changed its name around 2003 to Genova Diagnostics but for that many years, we’ve really been specializing in stool testing and functional GI testing. It’s really been our bread and butter and just been kind of pioneering the way ever since then and we’ve added on things like genomic testing, nutritional testing, immune testing, hormone testing. We have a wide range of things that we provide to the functional medicine community and of course, we integrated with Metametrix in 2012.

We have kind of combined knowledge of those particular, two wonderful brain sets. It’s just been a rich history and a lot of GI testing under our belt and we kind of … we, continuing to use that, that knowledge and expertise to help try to pioneer the way forward still with GI and everywhere else.

Dr. Kara Fitzgerald: That’s exciting.

Dr. Michael Chapman: Yeah.

Dr. Kara Fitzgerald: I kind of envy you being in the little … the think tank of the lab. Okay, so talk to me about … and you know again, Michael, as you and I were talking before, I hit record. As we move through talking about some of the updates to the GI Effects Test, I want you to kind of just weave in any clinical stuff that hits you or any interesting case examples or whatever and then I’ll just … I’ll ping you as well. You’ve recently added PCR on for parasites.

Dr. Michael Chapman: Yes.

Dr. Kara Fitzgerald: Then, just … and this is an in-house methodology that you guys have created. I mean, just talk to me about how you’re doing this, what you’re doing, what’s interesting and unique about it?

Dr. Michael Chapman: Well, I think one of the things about PCR testing for parasites, we’ve kind of been evaluating it for a long time and at the end of the day, we’re always trying to say, answer the question of, what’s going to make the most sense and provide the best utility for the clinician, right, that’s kind of what it’s about. Give them something that they can rely on and is actionable. We’ve been doing PCR testing for a long time for the commensal bacteria so we’re familiar with the methodology. When it comes to parasites, it gets a little tricky because for one, parasites in the GI tract are in much smaller quantity than your commensal bacteria.

That poses a little bit of a challenge and also, PCR can have its own limitations compared to O&P and I think the biggest limitation is that when you’re doing a microscopic O&P for parasites, you have the capacity to see anything and everything. It’s kind of unlimited, whereas with PCR, you’re kind of limited by the number of probes, you can only detect what you have a probe for, right? We knew that we didn’t want to abandon the O&P method because it really … it can catch just about anything. The PCR technology has certainly become a little bit more interesting, flashy, the new tech in the industry and we kind of wanted to go out and be prudent about what PCR probes we’re going to be using.

We selected kind of some of the more common parasites for these PCR … for these parasites and so, I think one of the things that was interesting and the question we wanted to answer was, okay, well, if we’re going to be the first lab test to offer both an O&P and a PCR for parasite evaluation, let’s test this commonly held belief that PCR is more sensitive, right, because you kind of hear that out there, that PCR is more sensitive so bottom line it’s better but no one has really done the side by side comparison studies from actual clinical cases. They’ve really done more of kind of the sensitivity with respect to in vitro comparison studies or maybe in particular patient populations but we’ve got a different population base.

We’re testing people with functional bowel disorders and everything across the spectrum so how does it relate and that was one of the things that personally, I was really excited that we can come out and actually demonstrate, the positives, negatives of all the technologies which is something that we’re kind of in the process of putting out there as well.

Dr. Kara Fitzgerald: You did an in-house data mining project comparing microscopy with PCR.

Dr. Michael Chapman: Yes.

Dr. Kara Fitzgerald: Okay, what can you share with us and you know …

Dr. Michael Chapman: Yeah, absolutely.

Dr. Kara Fitzgerald: Yeah.

Dr. Michael Chapman: Yeah, and this is where it gets really interesting, we have some unpublished data around that but I can just tell you that, when we started pulling the data and looking at it side by side, first we were struck by seeing over 90% correlation between the two methods, which made us feel really good, right, because there’s a little bit of this image out there like microscopic O&P’s kind of like the old school method, maybe the landline method for parasite testing.

Dr. Kara Fitzgerald: Landlines are good when it’s a storm, right?

Dr. Michael Chapman: That’s right.

Dr. Kara Fitzgerald: No way, actually that’s not true. Cellphones are better.

Dr. Michael Chapman: To find that correlation, we’re like, okay, that’s awesome and we know that our method and the way that we’re carrying it out is working really, really well. I think what’s more interesting is that when there was a discrepancy between the two methods and when we saw that in a patient who’s positive, there was a discrepancy, we’re actually catching more of the positives using microscopic O&P compared to PCR. For example, with Blastocystis infection, we found that when there was a discrepancy, a patient was positive for Blastocystis, 27% of the time, it was picked up by O&P and missed by PCR whereas 14% of the time, it was picked up by PCR and not O&P. That was a little bit of a surprise also because I think inherently, maybe based on the whole PCR is more sensitive therefore better, it was sort of a surprise.

Dr. Kara Fitzgerald: Yeah, for sure, so including both of them obviously is a good idea and you’re going to get broad coverage.

Dr. Michael Chapman: Yeah.

Dr. Kara Fitzgerald: Well, let me ask you also as far as this data mining project goes, were you considering O&P like two or three specimen or just one, like how did you …

Dr. Michael Chapman: Three specimen, yeah.

Dr. Kara Fitzgerald: You did three, okay, so three collection times increase the sensitivity, that’s towards PCR

Dr. Michael Chapman: Yeah, yeah, and we are seeing … yup and we are seeing an increase positivity rate with the addition overall. It’s minor but as far as clinical significance goes, right, you want to be … you want to be finding out all about this as you can.

Dr. Kara Fitzgerald: You want to see it. Yeah.

Dr. Michael Chapman: I think the thing that demonstrates to me too is just that there is no perfect method at least yet, right? There’s inherent limitations and inherent positives of different methodologies and that’s kind of what we’re seeing in the data.

Dr. Kara Fitzgerald: Perfect. That just makes a lot of sense and I appreciate it and I’m glad that you are using both and I know that you guys are good microscopists over there, your reputation is sort of …

Dr. Michael Chapman: Yeah, it’s definitely … I mean, it’s the area of the lab that we always say, this is probably the most tenured, most experienced and most heavily trained because it takes a really good microscopist to feel confident in what they’re looking at and identification so that takes a lot of training.

Dr. Kara Fitzgerald: Michael, will we see these findings, are you going to submit to any peer review, are we going to get a white paper out of this or are we just going to have to email you guys and find you?

Dr. Michael Chapman: No, we’re planning on doing all of the above and actually, we’ll just going to get to it in a little bit too, but we have already put out one published paper which maybe we can provide as part of this.

Dr. Kara Fitzgerald: Yes, please do.

Dr. Michael Chapman: That’s on a little bit of a different data analysis project but we’re in the process of putting a lot out there actually.

Dr. Kara Fitzgerald: Fabulous, okay so yes, what we can do on the show notes page is we’ll just collect your resources and we’ll link them there so if you want any publications, any appropriate white papers, we were talking about some of the educational guides earlier, any kind of information, you want to share with the listeners would be fabulous and yeah, of course we want to see a link to that paper that you’ve just mentioned and then we’ll talk about it when it’s appropriate but I want to just move you over to discussing the … sort of the perineal drama of evaluating for yeast.

Dr. Michael Chapman: Yeah, sure.

Dr. Kara Fitzgerald: We do … I mean, when you’re in a functional medicine community, yeast is … people are thinking about it, docs are thinking about it and yeah, go ahead talk …

Dr. Michael Chapman: It’s always a fun topic, right. It’s kind of strangely controversial in our area.

Dr. Kara Fitzgerald: Right.

Dr. Michael Chapman: It’s funny, it makes me … it reminds me, I went to Bastyr University as you mentioned and I remember so clearly in one of our classes, I think one of the first times the concept of yeast overgrowth came up and it was … Dr. Eric Yarnell was the teacher at the time who spoke at IFM and he’s just an incredible naturopath and herbalist.

Dr. Kara Fitzgerald: Yeah, he is.

Dr. Michael Chapman: I just remember him bringing the class to a screeching halt and saying, so what is yeast overgrowth, like what specifically are you talking about? Are you talking about GI candidiasis? Are you talking about systemic candidiasis and immune compromised because I’ve seen those conditions in the literature, what you are referring to and it’s sort of … you could hear sort of a pin drop in the room. I didn’t ask his permission to share this story so shout out to Dr. Yarnell. It’s kind of always been a bit of this controversial topic.

Dr. Kara Fitzgerald: Yeah.

Dr. Michael Chapman: The same applies with just GI yeast, right, and GI candidiasis. One thing that I always say right upfront is like, yeast live in the GI tract, right, we know this and there’s lots of them that live there. There’s plenty of research on not just about the microbiome but the mycobiome. We know this with our testing as well, when clinicians order a KOH prep on their stool test, we find yeast in about 90% of the samples, which is that makes sense. We’re eating yeast in our diet. Some of them are transient and then there’s the ones that are part of the mycobiome. To me the next question becomes well, which ones do we care about?

Which ones are the ones worth investigating thoroughly and we start talking about the candidas or the candias, depending on how you say it but … and some of the other opportunistic yeast and one thing that is also controversial and I hear this a lot out there is that you hear … you can’t grow yeast in culture and that’s a pretty common thing that is out there and in all honesty, I believe this to be a completely wrong sentiment. I’m not sure where this came from but if you think about it, we have yeast that can sit in a jar, on a shelf, in a supermarket for years and it still works.

Yeast are apparently, very hardy organisms and more often than not, the problem that we encounter about yeast and shipping samples around the country is not with yeast dying but rather yeast going crazy like we do more to prevent yeast overgrowing than we do trying to keep it alive. That’s not our concern honestly and so, if you’re worried about GI yeast and yeast overgrowth, then the culture will absolutely detect it. That being said, PCR technology is out there and we’ve continually been evaluating with should we bring that on board as well and we’re still evaluating it but I think one of the things about that is we kind of feel like we have an understanding of what we’re going to get because we see yeast on 90% of samples when they come in.

We do a KOH prep. You have something as sensitive as PCR, you’re probably going to see 90% positives on the PCR, at least you should and if you’re not, then I might be asking some questions about what’s going on there but if you’re doing a PCR then it’s the same kind of question like, okay, now, the research on yeast in the GI tract is shifting towards, what’s the balance, right? They’re talking about mycobiome relative abundance, just like they’re talking about microbiome relative abundance. If you’re doing a PCR test and you know you’re going to get all these positives what’s clinically relevant again, right?

Maybe you want to know there is candida albicans and then you have to define what’s normal. You have to set a reference range so what is a normal amount of candida albicans or saccharomyces cerevisiae, right? You have to establish a normal and I don’t think we’re quite there yet because the research is talking more about balance between the yeast again. It’s something that we’re continuing to evaluate but with respect to answering the clinical question, I think a lot of the docs out there are going for which is, is there a potential pathogen or an opportunistic yeast, we get that with culture. I think moving forward is going to be more, a matter of if we’re going to incorporate this additional level of sensitivity then we’re going to be doing a totally different type of analysis.

Dr. Kara Fitzgerald: I just want to summarize, you’re seeing yeast on everyone, it’s just …

Dr. Michael Chapman: About 90% of samples when you do a KOH prep, absolutely.

Dr. Kara Fitzgerald: Okay.

Dr. Michael Chapman: That’s the difference because KOH preps determine live and dead as compared to a culture which only determines what’s living and that’s the same as PCR. PCR is not going to be able to distinguish something that … a yeast that you ate or a yeast that you already took care of and came out so that’s the distinction when you’re thinking about, okay, a culture tells you what’s alive, what do I really need to concern myself with that’s growing and is viable and is actually doing what yeast do in the GI tract.

Dr. Kara Fitzgerald: You think that there’s sufficient … it’s sufficiently reflective, a culture of what is actually happening in the GI tract using like ..

Dr. Michael Chapman: Yeah, I mean to be honest with you, I think it’s probably more reflective because it’s not being contaminated with what you’re eating, what you’re encountering and what’s not viable anymore, right? When you’re thinking clinically about do I need to treat this person for a potential pathogen that’s a yeast, I’m concerned about what’s alive and causing problems. I’m not concerned about the yeast that are no longer living so I think it’s actually probably more reflective in a lot of ways.

Dr. Kara Fitzgerald: That’s interesting so for you, as a clinician, you would actually still continue with culture at this point.

Dr. Michael Chapman: Absolutely, yeah, absolutely.

Dr. Kara Fitzgerald: Okay, well, okay. All right, so let’s talk a little bit about pathogens, potential pathogens, I mean and now we’re back to bacteria and actually, just what you guys are doing there, what biomarkers you’re interested in and how you’re different from the myriad laboratories offering stool tests, comprehensive stool test and they’re using different methods and so if you wanted to touch on that at all, you can as well.

Dr. Michael Chapman: Yeah, sure. I mean, similar kind of story honestly with the bacterial potential pathogens, dysbiotic bacteria, the nice thing about culture, it’s got essentially the MALDI-TOF capability of identifying these bugs, and so you’re unlimited and the number of different bacteria that you can evaluate for and …

Dr. Kara Fitzgerald: Just give me a super quick thumbnail on MALDI-TOF and then jump back in.

Dr. Michael Chapman: MALDI-TOF is a particular … so what you have to do with MALDI-TOF is, it’s a step after culture. You isolate the particular bacteria from the culture so you always have to do a culture first if you’re going to use MALDI-TOF and then MALDI-TOF essentially is a method that identifies the specific bacteria because it has essentially a library and it’s a pretty cool machine, it actually sort of blast a laser at this bacteria and breaks it apart into its individual kind of protein structures and then it uses that to identify it compared to a library and the library has tens of thousands of different potential bacteria or yeast that it would identify. That way we have the capability to identify that many bacteria, yeast and other potential pathogens.

No matter what we are able to grow out in culture, we can identify it and that means that again, we’re not limited by a particular set. We don’t have like, just one, we have the set of 13 different potential pathogens that we can identify where it’s sort of unlimited, like just recently, we had Vibrio cholerae that we were able to identify as Vibrio cholerae 901 I believe it was called and we sent it off to the state department to sort of follow up and secondarily identify and confirm and those levels of details that you can only ascertain by having a live bug that you culture and identify, and the other awesome thing is …

Dr. Kara Fitzgerald: Right, unless you have the probe.

Dr. Michael Chapman: That specific probe, right, so then you would have to have thousands and thousands of different probes which becomes somewhat really challenging so … and the other thing is that, not only did we identify that particular bug, let that doc know, when you have a live bug then you can run a specific sensitivity on that organism that came from that sample, right? It’s not even just bug specific, it’s person specific. You can say, these antibiotics were sensitive, these were resistant, the same goes for the botanical agents where these were sensitive, it was resistant to these so now, you’ve got direct treatment, guidelines, information that will assist in treating that specific organism.

Dr. Kara Fitzgerald: All right. Yeah, that is very handy to have those sensitivities both pharma and as well as botanical. Gosh I’m, curious about the cholerae, how was the patient?

Dr. Michael Chapman: Yeah, I didn’t get to field that particular case so I don’t know but I do know that that, specific strain of cholera tends to be less symptomatic than the more severe acute hospital borne. Those are the vibrios that tend to put people in the hospital. This might be one of those that the patient and the doc might not have known that this person even had it because it tends to be less severe in its presentation so it’s pretty cool that … I think it’s pretty cool, the way we caught that one.

Dr. Kara Fitzgerald: That is interesting, are you … just out of curiosity on that note, are you seeing any of those multi-drug resistant candida species, have those been coming across culture for you, like … yeah.

Dr. Michael Chapman: We see that fairly commonly honestly. Honestly, before you mentioned it, I hadn’t even thought to look for that as a particular pattern just because it’s kind of common to see some of the candidas have some resistance here and there, so yeah. I mean, yes and no I guess is kind of my answer to that question. I hadn’t really been looking for that specifically just because it’s not sort of novel to me, I guess.

Dr. Kara Fitzgerald: Well, there was … I mean, there’s just some relatively scary ones that have been making around that aren’t responsive these days. Let me just ask you this, if you’ve observed whether or not drug resistant, anti-fungal resistant yeasts might be still sensitive to some of the botanicals that you’re testing for, have you noticed a pattern there at all or have you looked for a pattern?

Dr. Michael Chapman: I haven’t noticed a pattern, overall, I’ve noticed the botanicals work really well, just as a general rule and I think when you start to narrow down to specific constituents, I love Berberine but it’s still a specific constituent and I guess the inner naturopath in me tends to say, that the herb in its full spectrum has so many constituents, not just the one constituent and I think there’s some power to that so I tend to see some of the things like the multi-herbal formulas work very, very well, even when there’s resistance from a pharmaceutical perspective. I think some of these, especially some of the ones that are out now are super powerful.

Dr. Kara Fitzgerald: Okay, I appreciate that. Can you just give me some ideas like what you’re recommending, what you’re seeing as being really powerful?

Dr. Michael Chapman: I mean, I’ll say that a lot of clinicians that I speak with are using a lot of the Biocidin. They’re using a lot of Candibactin AR, BR but there’s a bunch out there and I think those are some of the ones that I hear the most about on the phone and even with respect to treating bacterial overgrowth, you hear those products a lot.

Dr. Kara Fitzgerald: Yeah, that’s right. Yeah, yeah. Yeah, we use combination here all the time as well. I mean, we do use a solo Berberine for certain applications but I think when we’re focused on gut stuff it is … yeah, a combination is where it’s at. All right, anything that you want to talk about in relation to how you’re comparing to other stool test out there?

Dr. Michael Chapman: Well, I think one thing that’s interesting is that we’ve been doing … and you’re familiar with all the origins of this, the commensal bacterial analysis and there’s a lot of people out there that are doing a lot of different ways, a lot of cool interesting, exciting ways to try to just figure out what’s going on with this microbiome picture as a whole and it’s funny, because I think one of the questions that we get a lot is I don’t know what to do with the 24 commensal bacteria and that’s one thing that we’ve been focused on for a long time, is really trying to provide clinical utility to that.

One of the things that we did on our end was kind of just go back to the data and say, okay, is there a way that we can take these 24 different commensal bacteria and distinguish different disease groups. We were able to create this commensal balance graphic which was a way that we … and it’s right there on the front page of the report but it’s a way that we were able to say, okay, this particular algorithm was able to separate the individuals for the most part from the healthy cohort compared to multiple disease cohorts. We look at people with mood disorder. We looked at people with metabolic syndrome, we looked at people with IBS, IBD, insulin resistance.

That was actually able to separate all those different disease groups compared to healthy individuals. That’s one layer of trying to figure out what is going on with the commensal bacteria. Of course, we also offer total overall abundance which is on there as well which can give you some insight into just the general microbiome deficiency or microbiome overgrowth or at least a predisposition or a consideration of microbiome overgrowth which might relate to SIBO signs and symptoms. Now, we’re even trying to go a step further and we’re starting to pluck out individual patterns.

This is I think where it gets really, really interesting and exciting because we were able to start doing data analysis on the different commensal bacteria and how they relate to other biomarkers, say for instance inflammatory biomarkers.

Dr. Kara Fitzgerald: Yeah, yeah. All right. Well, tell me.

Dr. Michael Chapman: Yeah, and so we were actually able to come up with a pattern of depicting a microbiome I guess grouping of bacteria that can … that is very, very closely associated with the inflammatory biomarkers and we’re calling it the inflammation-associated dysbiosis score, where actually this is a paper that we recently published and we can provide open access, so we can provide a copy of that as well but it’s really exciting because it’s the first set of being able to say, of these commensal bacteria, now, we can start to determine that these bugs are more associated with inflammation and here is your particular score with respect to that.

That may or may not be in the presence of actually true inflammation because when you think about it, we talk about the microbiome really kind of being maybe even the heart of all of this and if you can detect that pattern earlier, right, then you can prevent somebody from walking the path towards actual inflammation, Calprotectin levels going up and ETX going up. That’s just one particular pattern and there’s many more actually that we’re discovering too.

Dr. Kara Fitzgerald: What organisms are you looking at? Are you looking at all of them and just grouping them?

Dr. Michael Chapman: Yes.

Dr. Kara Fitzgerald: Okay. Okay.

Dr. Michael Chapman: Yes, yeah, absolutely. Absolutely.

Dr. Kara Fitzgerald: Okay. All right.

Dr. Michael Chapman: Yeah, and there’s other patterns that we’re starting to chunk out so it’s almost like we’re beginning to not only just talk about Dysbiosis with a capital D, but it’s like, well, what type?

Dr. Kara Fitzgerald: Yeah, that’s right. That’s amazing, yup. Good, good, good, good.

Dr. Michael Chapman: Yeah, so it’s super exciting.

Dr. Kara Fitzgerald: Yeah, that is very exciting. All right, well, what are some of the … let’s just spend a second on this because you’re absolutely right, like the biggest question on the GI effects forever is working through the commensal page and I appreciate all of your efforts and I’m thrilled that you just published that inflammation, so I look forward to reading that paper. Just what are some of the bellwethers, give me a super high level of how … what clinicians want to eyeball.

Dr. Michael Chapman: Yeah, that’s a good question so we know, right, there’s the superstars like the lactobacillus and the bifido that appear in all the multivitamins or the probiotics and there’s some of the other ones like Akkermansia, right? Akkermansia is starting to get more and more press, has pretty good PR agent and it’s starting to become more understood as having an integral part to the barrier function and the integrity of the mucosal layer and in most cases is associated with overall better clinical outcomes so that’s another one that I tend to spend a little bit more time on when I’m looking at a report.

Methanobrevibacter of course is another … it’s not really a bacteria. It’s archaea but that’s a blur detail. That is a methane producing bacteria and methane we know slows transit time and has its own associations with whether you want to call SIBO or not, it has a dissociation with general methane production in the GI tract which is associated with constipation and obviously, because it slows transit time but may also have other aspects such as impacting the overall immune function and this is some new data that we’re starting to uncover as well with the relationships between methane production and immune function which is really, really compelling so that’s …

Dr. Kara Fitzgerald: Well, what can you say about that, don’t just leave us hanging.

Dr. Michael Chapman: Well one of the things is that what we’re seeing is with higher methane production, you actually tend to have a little bit of a decrease in the biomarkers related to immune function and that can actually become perhaps a setup for poor response to other opportunistic-type infections.

Dr. Kara Fitzgerald: Are you talking specifically IGA. I mean, what do you guys notice?

Dr. Michael Chapman: All of them.

Dr. Kara Fitzgerald: Really.

Dr. Michael Chapman: Yeah, IGA, Eosinophil, Protinex, Calprotectin, yeah, absolutely. That is another bit of really, really cool exciting information that’s come out of our data. That’s another cool thing, is that, when you go to the published research, they’re using all different types of methodologies to evaluate these bugs, right so sometimes you’ll see, well, bifidobacteria was associated with decreased IBD risk but then in another study, you’ll see it’s associated with increased IBD risk because there’s a lot of variables, there’s different cohorts, they’re using different demographics of the research groups.

When you’re getting a patient result that goes through our data analysis, you know that you’re being compared to our data set, right? It’s not different so that’s why we went to our data because we know if the clinician is ordering our test, then they want to know how it stacks up against our … what we know about it.

Dr. Kara Fitzgerald: Absolutely. Yeah, it’s really difficult right now to weed through what’s in the literature and I know a lot of clinicians in functional medicine want to do that and then extrapolate those findings to the stool test that they’re using because yeah, the reference ranges are different, the methodology is different and perhaps the species, subspecies are all different and you’re right. I’m really thrilled that you’re doing due diligence with data mining. Honestly, that’s like a little bit of a soapbox thing. I think if you’re in the lab, you really need to be data mining and publishing, so I’m glad you’re doing it.

Dr. Michael Chapman: It’s almost our due diligence to provide the information back to … because we are on the cutting edge of medicine, right? It’s important to be able to take the information that we have and provide it in honestly, the most transparent fashion as we can and that’s … I think that’s tantamount and that’s really, it’s a core … it’s a core focus of Genova, is transparency first and that’s I think one of the reasons why I really love being here all the time.

Dr. Kara Fitzgerald: Good, that’s nice to hear. All right. Well listen, I just want to pick your brain since I’ve got you on the phone, just what are you seeing for Akkermansia. In your experience, what have you observed to be the most effective at bumping it up because it really is kind of … it’s definitely a darling, commensal at this point and everybody is working on it and thinking about it.

Dr. Michael Chapman: Yeah, you always have to throw in the caveat of every individual is a little bit different and a complete history and all that.

Dr. Kara Fitzgerald: Yeah, got it, with that in mind.

Dr. Michael Chapman: I mean Inulin is probably the thing that I would recommend first and foremost as far as bumping up Akkermansia and that, as a therapeutic for sure but we also know that commensal bacteria have a really hard time when the terrain is all tore up, when there’s a lot of inflammation going on or new response, permeability issues. That’s going to create an inhospitable environment and Akkermansia, it lives and thrives in the mucus layer and the first thing to go when you have these types of insults right, is the mucus layer and so, you have to foster that barrier function and that healthy lining of the GI tract as well so you’ve got to get your protocols going.

Inulin is … I think it’s pretty well-established to be a prebiotic that helps stimulate the growth of Akkermansia and that’s the one I go with, you know, one of the problems that we tend to encounter on the clinical consult is we get the call around, okay, what does this report mean for this particular patient? We get the history but then we never hear the follow up. Sometimes that part of it is lacking as far as saying like, yes, I’ve heard that this worked from clinician a million times. I mean, we do hear that that is the prebiotic of choice for Akkermansia but I can’t pull out a specific time when I actually had that doc call back in and say, yeah, that worked.

Dr. Kara Fitzgerald: Okay, all right. Okay. There was a paper, relatively recently, probably 2018 demonstrating in association with Akkermansia and Butyrate and so, I said, we order … we’re looking at GI effects a lot here and so I just eyeballed my patient’s results and I did not anecdotally see an association. Is that something that you’ve looked at in the large …

Dr. Michael Chapman: That part of it is hard too because we tend to see butyrate, and it’s so … we tend to see that fluctuate in response to diet so readily and it’s another thing that … we were talking a little bit before about this but with respect to people being on the ketogenic diet and this being such a common therapy for so many different patients for good reason, right? I mean, it is very, very effective and as far as metabolic syndrome and insulin resistance, when you use that particular therapy in the right clinical condition, it’s really, really good but the thing that is really lacking from that diet is the fiber intake, just across the board, complex carbohydrates.

Dr. Kara Fitzgerald: Right, well and speak to FODMAP, speak to a long-term FODMAP or something really hefty elimination diets but yeah, okay, so go ahead.

Dr. Michael Chapman: Yeah, and so, that’s just something that I always caution about with our patients that we are putting on this ketogenic diet is that where does the butyrate kind of come from because butyrate is made from the fermentation of starches and so, those might be the patients that I’m actually talking about supplementation with butyrate just while they’re going through this particular process to make sure that the … as you know, the colonocytes use butyrate as a fuel source. They absolutely need it and if you’re not getting it in the form of fiber, where are you getting it? That’s just something I also always bring to the table when it comes too.

I think, Datis Kharrazian mentioned this a couple of months ago when he was on your podcast talking about how often we see patients coming in who have their diets so restricted and it’s actually … it’s creating a deficiency and the diversity of the microbiome and I couldn’t agree with that more. I think we had to be very careful when we’re employing these therapies.

Dr. Kara Fitzgerald: If you guys are still collecting clinical data, that would be so interesting to look at that. It would be really interesting to see, because you’re fasting the microbiome.

Dr. Michael Chapman: Yeah.

Dr. Kara Fitzgerald: Honestly, we … I guess since Doctor Google is kind of oftentimes our patient’s first encounter with a physician and there are all of these diets at everybody’s fingertips, I would say more often now in my clinical practice, I see people coming in, like gone are the days that you’re removing just gluten and dairy or encountering somebody who’s not gluten free. Everybody has … they’re on the autoimmune paleo or they’ve put themselves on the keto or they’re doing an autoimmune paleo keto layering in low FODMAP. Things that are just really draconian and we absolutely see it reflected in the GI tract and there’s a challenge with expanding diet.

I know on that Datis podcast, he said the first thing he prescribe is going to the perimeter of the grocery store and just start eating and I’m trying to pin him down on what specifically and he just said everything.

Dr. Michael Chapman: Right, right.

Dr. Kara Fitzgerald: Just start eating vegetables.

Dr. Michael Chapman: Right, and it does sometimes feel almost maybe too common place that when the patient comes in the first time and they have GI problems just doing elimination diet and while I think that is effective in a lot of cases as far as identifying what might be just causing immune response, we also need to be diligent as far as making sure that we’re not to your points, and to Datis’s point, starving the microbiome in response to that and creating a challenge just overall in the patient’s complexity and diversity of their diet.

Dr. Kara Fitzgerald: Yeah, that’s just really great. All right.

Dr. Michael Chapman: That’s all so boxed. Sorry about that.

Dr. Kara Fitzgerald: Yeah, a little so I know, I know. It’s funny, because I’m just thinking we could talk for a long time today, Michael but I want to stay on task here so perineal question, since you’re doing culture and you’re doing PCR is the mismatch of PCR lactobacillus and bifido and culture, so what’s going on with that and how the heck do we make that clinically useful when we see that?

Dr. Michael Chapman: Yeah, I mean, it’s interesting because first and foremost these are bacteria and just like people bacteria are all different and for instance, lactobacillus, I’ve talked to our microbiologist gurus here and they’re often saying, lactobacillus is … it’s kind of a tricky bug. It’s a facultative anaerobe meaning that some strains like oxygen and some don’t so when you’re doing a culture, you’re going to be favoring more of the ones that are growing oxygen rather than the anaerobic species and because of that you might find discrepancies because PCR is not beholding to oxygen. It’s just testing DNA.

You might see some discrepancies because of that and that’s again, another power of having both of those methodologies in your tool belt and bifida tends to be tricky in a sense that it’s actually an anaerobe that we grow in an oxygen deprived environment to be able to grow it and so we don’t see nearly as many discrepancies but there’s all sorts of strains, these samples are coming from different areas. They’re perhaps being prepped in different ways. It’s not like we’re always going to get a completely … what we expect I guess is the right way to say that, because we’re talking about living organisms and that’s why, having the DNA on top of the culture is helpful.

Dr. Kara Fitzgerald: Well, I guess … I mean, I like the DNA. I mean, in this … I have to say in this case, I’m not … I don’t know that culture is as informative, it’s the argument you’ve just made on yeast which I thought was fabulous and I think probably you can make the same argument on the potential pathogen or the pathogenic bacteria. I mean, I think personally, I’m … I don’t think, I know that personally as a clinician, I’m leaning more on PCR for how to …

Dr. Michael Chapman: Well, and I think … yeah, and I think you should like before … and maybe not saying lean more heavily … personally, I don’t lean more heavily on one versus the other. I think one of the things that’s interesting, you know, I mentioned with respect to the parasitology but it’s actually uniform about PCR is that you might ask the question of, well, why are you picking up more on O&P compared to PCR that doesn’t make sense. How and why is that possible?

Dr. Kara Fitzgerald: Because you’re growing it but go ahead, why?

Dr. Michael Chapman: No, yeah, yeah. With respect to just the Blastocystis, the parasite infection, when we were finding that discrepancy between the microscope and the PCR technology and we’re seeing more under the microscope, what we went back to was we looked at some of the Luminex FDA summaries and found that PCR actually had this issue that we were noticing internally as well and is referred to as inhibition in the actual publications. PCR has … especially, when you’re talking about stool testing, it has this propensity to go through inhibition and what that means is that there’s something in the sample that’s preventing the reaction from taking place.

Whether it’s a metabolite of bacteria, it actually interrupts the replication and gives you an inhibition of the PCR from working correctly. It’s actually … it’s well-known and happens in about 15% of samples. There’s some workarounds so one workaround did not get that 15% inhibition is to dilute the sample which we do and that takes that inhibition down a little bit but whenever you dilute it, you lose some of the sensitivity as well, right, that makes sense and so sometimes you could try to overcompensate from that loss of sensitivity by, this is getting technical but ramping up the number of cycles that you’re running.

Then you run the opposite risk of increasing positives, but it’s well-known and established that there is this 15% inhibition and actually on the reports, we will denote, when we see that and we actually say, there was PCR inhibition, cannot report the particular findings. If you’re not seeing that on a PCR test, then that’s something that you should be seeing I guess I should say and is another reason why when it comes to trying to make this decision PCR versus culture, again, they both have their limitations.

Dr. Kara Fitzgerald: Right, well, that’s pretty interesting, okay. Thanks for that. All right, what else do I …

Dr. Michael Chapman: You can see where it can … it can definitely be a tricky balance and at the end of the day, that’s why we at Genova have been evaluating these different technologies for such a long time and then when it comes to bacteria, I mean, we know that there’s aerobic and the same thing goes with anaerobic bacteria that we tend to grow those out very, very well in culture and the benefit there is we know exactly which particular botanical, pharmaceutical agents to use to get that bacteria.

Dr. Kara Fitzgerald: No, I get it, I get it. I’ll hand it to you Dr. Chapman. Let’s make it a good argument. I’m impressed. I mean, you are. It’s just like … when Metametrix published the laboratory evaluations textbook, I think it came out in 2008 and my … I was working on just really doing a big drill down into how to evaluate minerals. What are the specimen we want to use and so forth. The conclusion I came to spending many, many, many months reading, many, many articles was that we want … the more specimen, the more variety, the ultimately the better, to really get a sense of what’s going on in your body and I mean, that’s basically what you’re saying and it just makes … it makes total sense. If we can look at this from other angles, we’re going to get a truer clinical picture.

Dr. Michael Chapman: Yeah, it’s a great analogy because we know that some minerals are more … circulate more readily in the red blood cells, some of them circulate more freely in the plasma and so there’s …

Dr. Kara Fitzgerald: Yeah, you can do urine for some, you can even arguably use hair for some. Yeah, that’s exactly right and so just having a kaleidoscope of ways to look at it. Anyway, good job on the argument there. It makes total sense to me. Okay, so let me think what I want to just … let me ask you now. I know you guys are working on other pretty exciting stuff so I want to hear about that and then we might just have a few more minutes to … anything that you’re thinking about you want to add and perhaps I’ll just ping you on a couple of questions. I feel like I could pick your brain a lot. What’s going on? What’s new in the lab?

Dr. Michael Chapman: Well, I mean … we talked a little bit about the PCR and we didn’t mention the Blastocystis sub-typing, we’re also doing next gen sequencing for Blastocystis sub-typing because that’s becoming more and more prevalent in the literature as far as knowing that particular sub types might be associated with the different clinical presentation and perhaps even different treatment outcomes and so that we felt like was a nice little addition to the test that we could provide and at least are culminating the knowledge on it. We know that it’s probably not fully … we know it’s not fully flushed out in the literature yet.

There again, we have a lot of information and we have all the other chemistry markers to be able to relate to those particular sub-types, so yeah, we’re only going to be able to push the boundary further on that particular information.

Dr. Kara Fitzgerald: It’s basically like for anybody who’s not aware, although I think most folks listening are, so blasto was once upon a time …

Dr. Michael Chapman: Debated.

Dr. Kara Fitzgerald: Yeah, as to whether it was clinically relevant but if you’re sitting in practice and somebody’s got blasto, you would absolutely see clinically relevant cases. There was no doubt about it. I’m glad that the literature is sort of catching up with clinical observation and I’m glad that you guys are kind of helping us in the decision making.

Dr. Michael Chapman: Yeah, and one of the layers underneath that, that we’re starting to ask questions around is, is there a pre-disposing type of bacterial pattern dysbiosis that might put someone more at risk for acquiring that in the first place and it might be why.

Dr. Kara Fitzgerald: Makes sense.

Dr. Michael Chapman: We see so much …

Dr. Kara Fitzgerald: Yeah, who’s vulnerable.

Dr. Michael Chapman: Who’s vulnerable and which ones are so difficult to treat clinically.

Dr. Kara Fitzgerald: Yes.

Dr. Michael Chapman: Sometimes you take the blasto, you throw oregano and it’s gone and then some people had it for years, like what is going on here?

Dr. Kara Fitzgerald: Yes. Yeah and I would say honestly as a rule in my experience clinically, it’s most … it’s pretty challenging.

Dr. Michael Chapman: A lot, yeah.

Dr. Kara Fitzgerald: I think so yeah. To that point, what are the interventions in your observation that might be good for blasto?

Dr. Michael Chapman: Well, I mean, this might be a little preemptive but I think what we’re learning is … it kind of goes back to what we’re talking about a little bit earlier, it’s like, yes, you want to use the anti-microbial to go after that particular bug directly but then what are you doing to address the rest of the microbiome and what are you doing to address barrier function and immune response? That’s where … I maybe before wouldn’t be thinking about your immunoglobulins that help stimulate some of the immune response but that might be something, I’m thinking about moving forward and then your prebiotic fibers to make sure that you’re increasing the mucus layer and the Akkermansia and those particular elements.

Dr. Kara Fitzgerald: Right.

Dr. Michael Chapman: I think that’s … that’s some of the stuff that, now, we’re talking about directly clinically actionable and something that’s different than we would have thought about before.

Dr. Kara Fitzgerald: Good.

Dr. Michael Chapman: Which is cool, right?

Dr. Kara Fitzgerald: Yeah, it’s really good.

Dr. Michael Chapman: There’s a layer too, where we’re starting to be able to tie that to some of the chemistry markers like we’re seeing variances in the short chain fatty acid production, in the distribution there. We’re seeing variances in the actual fecal fats, so like the amount of cholesterol compared to long chain fatty acids and if you’re not familiar on the test, we not only do a sort of a total fecal fat analysis which just tells you are they breaking down, absorbing fat but then we break it, we actually separate it into triglycerides as compared to long chain fatty acids and phospholipids, which are more about absorption of fat, rather than digestion.

There’s a lot of nuances there that we probably spend another half hour on but we’re being able to tie these chemistry patterns to the actual microbiome which is another layer, another thread that we’re weaving this picture of work, we see …

Dr. Kara Fitzgerald: When are we going to have a little … when are we going to have a cheat sheet to be able to look at all of this, sitting in front of us as we’re working with our patient, where is all of this knowledge, where is it?

Dr. Michael Chapman: Yeah, yeah, it’s a good plug. We’re doing a webinar with Dr. Christine Stubbe next month on sort of understanding a little bit of … another layer into the commensal bacteria, where we’re going to weave in some of this. Like I said, we have one publication out now with several more to follow and then I think from a clinical testing perspective, you can expect some pretty cool changes in the future.

Dr. Kara Fitzgerald: Let’s make sure we have a link to that webinar and the recording, I’m assuming is available as well, right, if people aren’t there at the live.

Dr. Michael Chapman: Yeah, absolutely.

Dr. Kara Fitzgerald: It’s obviously available. Okay, okay, cool. Listen, do we need to prep patients prior to collection to go low fat or alter their fat intake? I mean, what again, if somebody is on a keto diet, what are we going to see with their fecal fat?

Dr. Michael Chapman: Yeah, we get that question a lot and I’m always answering well, what do you want to see and we get that question with respect to probiotics, should I keep them on the probiotics or take them off and I’m always like, well, what do you care about? Do you care about seeing whether that probiotic is staying viable, then I would keep them on it and then we’re going to see it in the DNA, if it’s sustaining or vice versa, if you take them off, right, and then wait two weeks, has that made an effect? Same thing goes with the diet. It kind of depends, are you planning on keeping them on keto for a long period of time, then I would keep them on keto and there you know what’s their butyrate percent, what’s their short chain fatty acid total so that I know, I need to layer in some intervention to help support that even more.

Dr. Kara Fitzgerald: When you see high fecal fat beyond the short chains or like short chains aside because I know we’re risking those being well but if you see high fecal fat, are we … we’re just assuming that’s because they’ve just had a few tablespoons of olive oil followed by an avocado and coconut.

Dr. Michael Chapman: It’s possible. Yeah. It’s possible. I mean, that’s where you really have to layer in the clinical history and what you know about it, because the reference range is definitely not set on a patient population that is doing that. That being said, you still have the knowledge that what they are doing is exceeding their ability to break it down enough to work.

Dr. Kara Fitzgerald: Right, that’s right.

Dr. Michael Chapman: Regardless, so whether that’s expected or not or whether you even care from a clinical perspective, that’s a little bit of a decision that you can make.

Dr. Kara Fitzgerald: That we can make clinically. Okay, so yes, if they’re having a high … if they’re on a very high fat diet, you might see it in the stool specimen. However, you want to determine as the doctor whether or not you think that they’re absorbing adequately. All right, I got one more question for you and then we’ll just head to home stretch and you will … we just need corral a lot of these things we touched upon for the show notes so people can have access to all of it but so what’s up with zonulin family peptide?

Dr. Michael Chapman: That’s a great question. Okay. Zonulin, there’s essentially the zonulin that Dr. Fasano has been researching for a long period of time, right, which is the molecule that he has been studying and has been linking to the permeability aspect and there’s several kits that were made available that can test zonulin and what happened was, what was discovered … the main kit that’s actually used in the literature, most of the literature is actually not testing and using the exact molecule for zonulin. It’s using sort of a family relative of it, which is why we came out with the name zonulin. This was suggested actually by the kit manufacturer, zonulin family peptide.

Dr. Kara Fitzgerald: Okay.

Dr. Michael Chapman: The thing to know about it is it’s actually the kit that was used in all the literature, in studying zonulin, except for Dr. Fasano so there’s kind of … he’s measuring this one particular molecule and it turns out … this is not uncommon, honestly in the scientific community where new discoveries are happening all the time and a particular peptide gets misidentified or misnamed but that’s kind of what happened and when we learn about it, we said, we know that this is not the zonulin that Dr. Fasano is studying and so … but we know it’s relative so we’re going to go out and just inform everyone, hey, this is the kit that is used in the majority of the literature around what was previously known as zonulin, it’s just … it’s not same molecule and that’s where we’re at with it.

Dr. Kara Fitzgerald: Okay, all right, and has any comparison been done yet, at least in the future?

Dr. Michael Chapman: No, I haven’t seen any … I don’t think there is any comparison because essentially from my understanding of it and I certainly could be wrong on this is that the only available way to detect zonulin is actually within Dr. Fasano’s research. There’s no other kits that I’m aware of that can actually detect that particular molecule that he’s testing and I don’t believe he’s done a comparison study that I’ve seen yet.

Dr. Kara Fitzgerald: Okay, so he would have to do it in his lab.

Dr. Michael Chapman: Yeah, but the bottom line is that those research studies that were done on zonulin still apply because it’s actually why we’re using the same kit.

Dr. Kara Fitzgerald: Yeah, the other … the non-Fasano studies.

Dr. Michael Chapman: Correct.

Dr. Kara Fitzgerald: Yeah, got it, got it, got it. Okay, so you’re seeing … I mean, how do you use this? Do you use this as a screening? Is this a definitive diagnosis, how are you using this clinically?

Dr. Michael Chapman: Clinically, I think that most of the literature done on that is with respect to more GI inflammatory conditions and metabolic syndrome actually interestingly which when you think about it, makes a lot of sense because we tend to think about metabolic syndrome having such a huge relationship to the gut and inflammation as well. I tend to think of that as, when you see a positive then it’s telling me that there’s likely some sort of inflammation and more often than not, when there’s inflammation of the GI tract, we’re talking permeability issues anyway. One of the problems with it, I think is that when you see a negative, you can’t necessarily use that as a rule out.

You still need to go forward if you’re interested in permeability. You need to do something like a Lactulose mannitol test to … which is the gold standard. That’s kind of how I use it. It can help pinpoint the inflammation.

Dr. Kara Fitzgerald: It’s a screen and if it’s high then we’re thinking inflammation as well. Especially, I would imagine if you have corroborated chemistries.

Dr. Michael Chapman: Absolutely.

Dr. Kara Fitzgerald: Okay. All right. All right. Well, listen Dr. Chapman, it was great to talk to you. We could keep going here, there’s just a fountain of information but people can call in and schedule with you at the lab right so then you can kind of do a drill down on one of their test so they can mine your brain and schedule with you, okay.

Dr. Michael Chapman: Yeah. There’s lots of other naturopaths, physicians, chiropractors on this particular team, all amazing, amazing, so you feel free to call anytime, that’s what we’re here for.

Dr. Kara Fitzgerald: Perfect. All right. Well, thanks for joining me today on New Frontiers.

Dr. Michael Chapman: Awesome. Thank you. Thank you.