Streamlining Functional Medicine Starting With Data Consolidation – EP10: Jeremy Malecha (Biocanic)
In this tenth episode, Jeremy Malecha discusses his company plans to democratize and scale functional medicine by more effective data processing. He discusses the need to consolidate data across hundreds of lab test lab providers, structuring of that data and finally the ability to better leverage the data. He discusses his own personal health journey along the way.
Lee: Hello and welcome. On today’s show we have Jeremy Malecha, hopefully I pronounced that okay. It will be an ad lib conversation without any pre agreed structure or topics. We’ve agreed only to talk around the focus of Jeremy’s company, which is streamlining functional medicine starting with data consolidation.
Lee: Jeremy is the CEO and co-founder of Biocanic with over 20 years of medical and software related experience. Prior to Biocanic, he was the Vice President of M&A Strategy in ResMed’s SaaS Business. Across his 10+ year career at ResMed he also held senior leadership roles overseeing global product management across the product portfolio and was the lead person behind the conceptualization and launch of the AirSolutions digital health ecosystem. Prior to joining ResMed, he worked for CardioDynamics as a product manager focusing on EHR integrations. He holds a Bachelor of Engineering in Biomedical Engineering from Northwestern University in addition to six patents in non-linear signal processing for medical applications.
Jeremy: Thanks for having me Lee, I appreciate it.
Lee: So, it’s quite early where you are?
Lee: You feeling good?
Jeremy: Yeah. Feeling great.
Lee: Okay, I’ll jump straight in. So, I was… I don’t recall the precise details, maybe you do, I was interviewing Travis Christofferson, and I happened to mention that to you on LinkedIn. You said, “Take a look at my platform..” I looked at your website. I think I pronounced it correct. Biocanic?
Jeremy: Correct. Yeah.
Lee: I look at the website and I’m like, “I’m not so sure. It looks more like a template or something.” Then you said, “Hey, do you want to look at the dashboard?” I logged in, then I began noticing actually you’re working on something that ties into the whole data driven notion of health, and I think you’ve got some of the concepts right and you’re acting as the one of the stepping stones to the future.
Lee: So, do you want to introduce your company and what it’s doing?
Jeremy: Yeah. So, my company is Biocanic and the origin of the word is really biology mechanic. And the idea is, is that we’re building a platform for people to help really guide them and understand how to really feel what is going on with their individual metabolism from a, the term would be, multi-omic perspective. But then also, really track and follow the outcomes based upon the changes that their making within their lifestyle.
Jeremy: And then ultimately what we’re really trying to do is a build a personalized health engine, so that the next person who comes in with similar complaints, similar metabolic function or dysregulations, so things like gut dysbiosis, cortisol dysregulation, yeast overgrowths, or any types of other, what I would call, subclinical things that are driving symptomatic expression, helping them find the fastest possible way to resolving those issues based upon what has worked for other people like them before.
Lee: So you’re trying to create some kind of shortcut to diagnostics?
Jeremy: No. Not to diagnostics from the traditional medical diagnostic of a ICD-10 perspective. What we’re really focused on is the health and wellness side of the world. So, people who are seeing their personal health decline in ways that would sit outside of the diagnostics base. So, things like I’m noticing that I’m getting afternoon headaches. I get gas and pain and bloating after eating. I’m starting to see hair loss, or I’m starting to feel like I have, you know, feeling lethargic or rapid weight gain despite not doing anything different.
Jeremy: And so, we’re really focused on enabling people to better understand and make sense of all the data that’s available to really get a good view of where their personal health is at today, and lead them on the path to how they could get better and even optimize their health.
Lee: It was kind of amusing, literally as you said that I was swallowing an ashwagandha tablet. So, what you’re meaning is you’re not aiming at people who are symptomatic, so you’re aiming towards asymptomatic individuals.
Jeremy: So, if you think about it from, and hopefully the audience understands the idea of functional health and wellness-
Lee: No, please, cover it.
Jeremy: Yeah, yeah, yeah. So-
Lee: I want to give a brief introduction to functional medicine et cetera for those who don’t know.
Jeremy: Yeah. So, functional medicine is really looking at the body as an inter connected whole. So, rather than taking a medical view of things like the cardiovascular or the neurological system or internal medicine, functional medicine looks at the body as an interconnected whole. So, the idea is instead of saying, you know, there’s an expression of say, gas, pain, bloating after eating and giving a symptomatic suppression prescription for something like an IBS type of diagnosis, the idea of functional medicine is to understand why.
Jeremy: So, why are you having gas and pain and bloating after eating? Is it related to gut dysbiosis? Do you have an underlying infection? Is there stress within your life or environmental factors that are driving the issues that prevent you from effectively digesting food that manifests itself in terms of this gas and pain and bloating after eating.
Jeremy: So, really function medicine and where we sit in what we call functional health, is the idea of helping people understand their health from a holistic perspective. So, thinking about it from the overall interaction of everything related to how your health and wellness manifests itself in how you live every day.
Lee: Many years ago, once I had access to biomarkers, I just started testing everything and fairly frequently. For example I would go for liver tests, like AST, ALP, GGT, BR, and kidney, BUN, creatine. I had no reason to go for such tests, or be it hormones et cetera, or thyroid. I just kept going fairly often. And it was so that I could get a data snapshot of my physiology. Because I reckoned that even if I don’t know what these biomarkers even mean today, I will in the future. And even if these biomarkers, which I hope they are, even if these biomarkers as normal for the next 10 years that’s fine. But, I want to do is be able to notice change over time.
Lee: Because I figured that having the data… I can’t get the data in 10 years. So for example, how would I know in 10 years if someone says, “Hey, my testosterone is low.” Well, how do I know it wasn’t actually low 15 years ago? And hey, if we’re going to supplement it, what was optimal when I was optimal. So, there’s a huge value in data.
Lee: And so, do you want to introduce your platform from the data perspective?
Jeremy: Yeah. So, similar to you I’ve had my own personal health journey. And really, I’ve spent most of my career in the regulated medical space and going through different electronic medical records, companies, working with medical device cardiovascular. But, along the way I was having personal declining health. I was starting to get afternoon headaches, wasn’t sleeping well, and then was having slow progressive weight gain over time.
Jeremy: During that time, my wife was studying to become a functional diagnostic nutrition practitioner, and so I was lucky enough to be her guinea pig in going through the process. And so, through that process I was able to collect a lot of different data points along the way.
Jeremy: We did things like gut microbiome testing, we did salivary cortisol testing. Of course I had my standard CBC, CMP lipid panels through my general practice physician. And so, what I started creating was a snapshot of my overall health. So, I was able to see things such that I was cortisol dominant, meaning that my cortisol pattern was generally higher than a normal person.
Lee: Was that high… Do you mind me asking if that was higher in the morning or higher overall or higher at night?
Jeremy: So, if you look at the general cortisol trend where it’s low and then as you wake it goes to a peak mid-morning, and then it falls off overtime. All of my values were higher than the reference range, which was interesting. Right? But, the question really comes is, is that my normal? Or, is that actually causing problems? And we didn’t really know because that was the first snapshot.
Jeremy: What we then-
Lee: And did you do inflammation also at the same time and match that to cortisol?
Jeremy: My C reactive protein wasn’t necessarily off the chart.
Lee: Yeah. That’s what I wondered.
Jeremy: Getting snapshots and getting an understanding of a time doesn’t necessarily tell you what’s your normal versus what’s your abnormal versus what’s driving your declining health in a given scenario. So, for me one of the big indicators through, what’s it called, dried urine test or a DUTCH test, was the fact that I was actually estrogen dominant.
Jeremy: So, given my qualitative symptoms in the traditional medical space, especially with all of the emerging hormone replacement models, would have been perceived as low testosterone. The reality was I was actually estrogen dominant with normal testosterone. And so, now having fast forwarded two years and done that progressive DUTCH test, what I see is that my general genetics and metabolic potential is that I am generally an estrogen dominant individual with low methylation.
Jeremy: And so for me, I have to be very cognizant of how I’m managing both my diet, relative to carbohydrate driving an insulin response, but then ultimately looking at how am I supporting my methylation pathways, given the fact that I’m heterozygous for the MTHFR gene. Right? And so really, it’s back to your original point is, getting the information gives a snapshot in time. And then building that visibility of how my metabolism is working over the time allowed us to glean the insights of what was really driving my personal declining health, which was hyperinsulinemia.
Jeremy: And so, going through this process, starting with what would be a traditional keto diet, and moving to more of a modified paleo low carb diet, I’ve actually been able to drive down my estrogen dominance, increase my methylation through diet choices, things like adding choline, creatine, glutathione, which has actually resulted in a transformation of my health. I ended up losing almost 45 pounds and about 15% body fat over the course of two years.
Jeremy: And all along the way it was built upon understanding what the levers were that were important to my own physiology that drove the manifestation of what is my health and wellbeing.
Lee: What was causing your weight gain precisely? You’re saying it was estrogen dominance was driving weight gain?
Jeremy: Yeah. [crosstalk]
Lee: Or, are you saying it was hyperinsulinemia? Or are you saying it was low methylation?
Jeremy: It was all of that. So, really what my particular situation was, I was doing the right things in terms of not eating processed food, I was gluten free, avoiding inflammatory foods, doing things, reducing alcohol consumption, sober tober types of experiences. Yet, I wasn’t getting a response. And that was largely driven because over time I was still consuming a large number of carbohydrates, even the good kind.
Jeremy: And so, what had happened over a course of say, four or five years of doing that, is I started to become insulin resistant. That insulin resistant-
Lee: How did you measure insulin resistance?
Jeremy: Looking at my HbA1c and then also measuring my fasting blood sugar over time. The challenge was my fasting blood sugar was slightly over 100 mg/dl [5.55 mmol/l]. Which, is not in the traditional medical system cause for concern, yet as we look at the functional medicine approach and looking at more around functional ranges, it absolutely was. It was indicative of where my problem actually lied.
Jeremy: However, it wasn’t really fully uncovered until we recognized that my estrogen numbers weren’t changing over time, despite trying other approaches to resolve the issue. And then so, about two years in, the medical director from Precision Analytical highlighted the question around, have you considered hyperinsulinemia or insulin resistance as a means to why the estrogen numbers aren’t changing? And that really sent me down the path of going the low carb approach, and that was what was really transformative for me and my own physiology.
Lee: Is there a link between estrogen and insulin and glucose? I’m not aware of one. I’m not saying there isn’t one, I’m just wanting educated if you know of one.
Jeremy: Yeah. So, in hyperinsulinemia you’re maxing out your fat cell storage so you’re having to increase more insulin to store more fat cells, which is then driving the estrogen creation through that metabolic pathway.
Lee: What was your HbA1c?
Jeremy: So it was close… I think it was 5.8 [percent]. So, not quite-
Lee: This is still quite low. Both values are quite low.
Jeremy: Well, in general the number that people really drive toward today should be below five. Now, form a diagnostic standpoint in the traditional medical system, type diabetes would be HbA1c is over six and a half.
Lee: Do you know what your triglyceride over HDL ratio was?
Jeremy: At the time it was over two.
Lee: It was over two?
Lee: Do you know if it was excessively over two?
Jeremy: I believe it was a 2.3. So, I think, again, broad brush strokes, my triglycerides were on the order of 120 mg/dL [1.35 mmol/L]. And my HDL was on the order of 60ish mg/dL [1.55 mmol/L].
Lee: Did you do any lipid analysis, like high resolution? I think there you’ve got NMR.
Jeremy: Yeah. So, I didn’t do that until my… At the time, which was two to three years ago, the NMR was not really well understood from a usage standpoint. Of course now that has accelerated with the discussion related to the usefulness of LDL-C. So I did do an NMR, but only recently. But my HDL triglyceride ratio has actually inverted, so I’m less than one in terms of the ratio. So, my HDL is higher than my triglycerides.
Lee: Okay. So, you’re below one.
Lee: That’s fine. In terms of MTHFR, I’ll link the Dirty Genes book by Ben Lynch, people who don’t know what that is can look there, can you kindly just give a small introduction to what the dutch test is?
Jeremy: Yeah. So, the DUTCH test is a, it’s called a dried urine test. And it’s done four times, or there’s an option for a fifth one. Once upon waking, once two hours after waking, once in the middle afternoon, and then one time before bed. And what that does is that gives one, a cortisol metabolite snap shot of what your cortisol pattern looks like.
Jeremy: Cortisol is a critical hormone that drives basically your awakening response. So, it basically prepares you for the day and starts to get you energized, gets you into a metabolic function where you’re creating energy to go about your day. And then should be declining over time as your melatonin starts to get increased from the gut to prepare you for bed.
Jeremy: So, the DUTCH test gives you a snap shot as to how that cortisol is going. That’s an important indicator, because a lot of people who are… And, cortisol being a stress hormone. People that are under considerable stress or have diet dysregulation, end up having a cortisol pattern that doesn’t follow that trend.
Jeremy: Or, perhaps based upon stress at the end of the night, ends up with cortisol that’s higher before they go to bed. Which then ends up causing sleep problems for people.
Lee: For example, fibromyalgia patients suffer a rise in cortisol at night. It’s very unfortunate.
Jeremy: Right. And so, you think about that stress hormone, which is driving the activity right before you’re supposed to be resting, it becomes very very challenging to have a good night sleep, or even fall asleep at all. We’ve seen dysregulated patterns where people are waking up six, eight times a night.
Lee: You just said you had a higher pattern overall. Were you having difficulty with sleep?
Jeremy: So, I wasn’t having a difficulty with sleep because my melatonin was appropriate relative to my cortisol value at the end of the night. So although I was higher than the reference range before bed, it wasn’t completely out of whack.
Lee: Were you helping it with sleep hygiene, like blue-blocker?
Jeremy: Not at the time. At the time this was three years ago-
Lee: I’m just surprised you were counter acting the cortisol with melatonin naturally, I mean in a modern lifestyle.
Jeremy: Yeah. But that was a function of my particular gut health being able to still compensate for the higher cortisol by compensating by putting out more melatonin from my gut.
Lee: So, a lot of people may not be aware of the link between melatonin and gut health. Do you want to briefly mention that?
Jeremy: So, melatonin is obviously the sleep hormone that helps you become restful. And it’s always produced in the gut. And all of it’s produced in the gut. And the reality is that when people have gut dysbiosis, things like leaky gut or underlying gut issues. You know, yeast overgrowth, SIBO, or H. pylori or some kind of pathogen, that can be impaired.
Jeremy: And so, one of the manifestations of that is obviously reduced melatonin output, which then makes it much more challenging for somebody to go to sleep.
Lee: True. And I’ve always wondered if actually disrupted sleep causes in the reverse direction, gut dysbiosis. It exacerbates leaky gut. I’ve always wondered if the backward direction was also casual to some degree.
Jeremy: Right. And I think that’s exactly the point of the challenge of functional medicine. Right? Which one is the starting point? Which one is the reaction? Right? And then the fact of now I have poor gut health, which is driving poor sleep, which is driving cortisol dysregulation, because I didn’t get my accurate sleep, therefore my cortisol pattern is now not following how it should be, which then drive my inability to metabolic function appropriately, which then makes my gut health worse. Because now I haven’t slept, I’m tired, I’m stressed. Which is now adding additional stress on my gut to continually make it worse and worse over time.
Lee: Yeah. And then you notice with disrupted sleep higher insulin, et cetera. Which reminds me, did you actually go about checking your insulin?
Jeremy: No, I did not.
Lee: Because I’ve been looking at various charts with glucose against insulin. And there’s this whole 20 year diabetic journey, and the relationship between the two depends on where you’re at. And it is complicated, but it’s also shocking. Because the more I look at it the more I see it’s hard to infer what a glucose result means or an insulin result means without looking at the pair in tandem, and without looking at them over some time. And, knowing what they look like over a 20 year span of growing insulin resistance. Because eventually they invert.
Lee: Anyway, you mentioned glutathione. If you don’t mind mentioning what glutathione is. And also, if you said you were supplementing witsh glutathione.
Jeremy: Yeah. So being heterozygous for MTHFR. Meaning that I have a reduce capacity for methylation. Methylation being the primary detoxification function. Left me in more of a inflammatory state. One of the ways that you can increase methylation is by adding support foods or supplements to help with methylation by adding more methyl donors. Glutathione being one of them.
Jeremy: Now glutathione is available through different types of food choices. Through things like [inaudible] vegetables. And for me, vegetables are not something that I’m a super huge fan of. So, I really struggled to really increase that. So one of the things that I do take now is a liposomal glutathione. Which is just the easier way of adding glutathione to the system.
Jeremy: But again, because of my reduced methylation, I have no added other things like choline through increasing my egg consumption and adding creatine, which is another methyl donor, to support my detoxification function.
Lee: And the liposomal glutathione, is there a particular brand you’re using?
Jeremy: Yes, but I can’t remember it off hand.
Lee: Okay. I’m also taking a liposomal glutathione. And I have a, maybe it’s totally subjective, but I have this subjective experience that when I take liposomal glutathione I feel better. Do you think that’s possible?
Jeremy: Yeah, absolutely. I think one of the things and one of the reasons why we built the Biocanic platform was to track perceived outcomes. Right? Certainly you want to look at objective markers. But, objective markers aren’t important if you don’t actually feel better. So, if you start a process and you say, “Look, I feel inflamed or tired or headaches. And I rate it as a 10 out of 10.” And you’re not objectively tracking that information, you tend to lose sight of what happened in the rear view mirror. Right?
Jeremy: So, if your perception of the pain and inflammation was 10 out of 10, two weeks later you’ve been taking glutathione, and now it’s six out of 10. You feel great. But, you’re still a six out of 10. Right? And that’s really why it’s important to look at how we’re supplementing or changing our behavior, changing our diet, and objectively tracking it as well. And that-
Lee: Yeah. You’ve biases of the human mind. For example, you remember how you felt more recently than you did some time ago.
Jeremy: Exactly. And you think about it, an objective qualitative measurement is how your clothes fit. That’s something that people can feel every day and it is generally how people measure their health and wellbeing. But now more than ever, people are becoming more aware of the things that you can’t necessarily quantify in terms of something that simple. Exactly how is my sleep quality? Do I feel rested in the morning? How do you think about brain fog?
Jeremy: And thinking about what does brain fog mean to me today. Making a diet, lifestyle, supplement, or some sort of lifestyle change, how can I objectively look back to tell whether I’m getting better? And you can’t really do that from a biases’ perspective without actually documenting it.
Lee: Did you test for heavy metals? It’s just when you said unexpected weight gain I often think about heavy metals since your body tries to protect itself by wrapping them in fat, which is a danger of actually losing weight quickly without using correct protocols and supplements.
Jeremy: Yeah. We did. We did both the micronutrient and heavy metal toxicity. What was actually interesting is we actually had black mold in the house. The difference between what happened to myself and my wife is, I don’t appear to have systemic symptoms related to black mold. But, my wife ended up developing Hashimoto’s because of the mold within the house. She’s now worked through the AIP diet and reduced her inflammation to get her thyroid numbers back in line and her TPO antibodies down. But yeah, we absolutely looked at heavy metal toxicity. But really for me, it’s my metabolic function related to carbohydrates.
Lee: So you’re carbohydrate intolerant?
Lee: Have you always been that way, or did it develop over time?
Jeremy: You know, it’s interesting. Thinking about the discussion in the industry related to brain health, anxiety, and thinking back growing up, and I was definitely a carb addict as a child. And I also remember having quite a bit of emotional ups and downs and anxiety. And had I known what I know now then, it would have been interesting to see if that would have resoled over time. This idea where my carb intolerance was driving my emotional and anxiety issues at the time. Because I definitely was heavy on the carbs.
Lee: Anxiety also reminds me the whole omega-3, omega-6 index. Did you test for that?
Jeremy: No. So, we didn’t do that at the time. [crosstalk 00:27:17].
Lee: Okay. Just wondered if you were taking any DHA, [crosstalk 00:27:18].
Jeremy: So, I do I now.
Lee: As part of your… Oh, you do now.
Lee: So, I should get to your company. So, how did your company come about? Because obviously you’ve had a health issue.
Lee: You’ve went about fixing it. It sounds like you began in a spreadsheet, which is what I’m doing. More recently I began using Heads Up Health, which I’m sure you’ve heard of.
Lee: When I looked at your platform briefly, it looked like a B2B2C version of Heads up Health.
Jeremy: Yup. Yup. Very astute. So, where Biocanic came from, came from my own personal health journey and my experience in the regulated medical space. So, today if you’re going to start as a functional health practitioner and implement a health lifestyle change based upon lab testing or objective data along with qualitative inputs, it’s all over the place.
Jeremy: In order to really drive an experience and drive the right outcomes, it takes a lot of work and a lot of investment for both the practitioner and their client. Prior to Biocanic, there was what they called intake assessment forms for things like, they’re called assessments, like adrenal stress indicators where you’re measuring your perceived craving of salt, your sleep quality, do you wake up between 2:00 am and 3:00 am, on a scale of zero to five and it’s entered into an excel spreadsheet.
Jeremy: The lab data, and if anybody has followed the functional lab space, I would guess that there’s no less than 500 lab providers and 10,000 different function labs (sic: tests) out there. So, the practitioner has multiple PDF reports that they’re trying to correlate with the qualitative assessments from their client. Then they’re also making supplement recommendations through various different entities through the dispensaries or drop shipping their own products. And then all the while, trying to figure out whether the changes that they’re recommending are actually having the desired impact.
Jeremy: So, I was doing that as you were. Tracking my result, my key metrics in Excel. I had a Dropbox folder with all of my different lab tests. I had my Excel spreadsheets with my periodic assessments. And, all this was very disparate, and it took a lot of work and time to be able to do that.
Jeremy: And really, how we look at it is we want to be a tech enabler to really bring scale to functional health and wellness. If you think about how hard it is to implement a health program, and how many different things there are from both a practitioner who lives and trains in the industry, and bring that information into a meaningful usable way to a client who doesn’t study it, it’s very challenging. And so, we’re really about trying to solve that problem.
Lee: I was often surprised by how scripted it was. You’ve got people who are very expensive, these functional medicine doctors practitioners. They go on particular courses, it could be for the DUTCH test or blood chemistry analysis. It’s very algorithmic. You know, do this test, that, if this then that. These people are being replicated all up and down the country. I can’t remember how many functional practitioners there are. What, 60,000 in the US, something of this order?
Lee: So, what you’re wanting to do is be able to have all functional medicine practitioners pull in the data from all the labs that they use, because they tend to use the same labs like GI, like Quicksilver, and so on. Suck that data in and have a common interface onto that data, and then somehow is there some way of spotting patterns over time? Or is it just data consolidation interfaced to all these lab providers?
Jeremy: It’s both. So, the initial first step is one, from a functional health industry we have to get the data centralized. There isn’t the ability to correlate individual lab metrics across an individual today. And so, when you look at something like a DUTCH test, there’s an interpretation guide for that. When you look at a GI map, there’s an interpretation guide for that. And there are experience practitioners who, in their head, have the ability to interpret what a dysbiosis on a GI map means related to a hormone result within the DUTCH test.
Jeremy: That’s learned over experience and time. What we’re trying to do is speed that learning process and also become the tool to enable the practitioner to understand and process the data faster. So, I as a naturopathic physician may not see DUTCH tests six times a day every day for five days a week, I may see a dutch test a week. And when I see something that’s abnormal I have to spend time and go, “Wait, what does that mean, what is the context, and how do I think about that? And then I have to do that.
Jeremy: That can take up to three hours in preparing for an individual client session. And you multiply that over time that’s why it is so expensive, because practitioners aren’t able to scale because of the time investment and the learning curve it takes for them to be able to effectively know what to do when they see it. And so really, what we’re trying to do first is aggregate the data, two to implement the known rule, so to your point, there is known decisions based upon what an individual value means.
Jeremy: Then the next step is to correlate what the individual labs mean in context of each other. And that’s really where we’re looking next. And then the question becomes, “Okay, now that we’ve seen what the correlation between multiple labs on an individual is, what works and what doesn’t?” And that was one of my bug challenges coming from the regulated medical space, is the data-driven aspect. Right? Everything is done through a placebo control, double blind study and everything else.
Jeremy: In the functional health space, a lot of it is what I call tribal knowledge. People are learning through experience and communication, but it isn’t necessarily well documented. And if you think about it from the perspective of an unsuccessful health engagement, does that naturopath physician or health coach ever hear back from the person who hasn’t seen results? And does that miss, or that wrong path, ever get assimilated into their thinking as a means to, “Oh, wait. When I see the person like that, I shouldn’t go this pathway because it hasn’t been effective.”
Jeremy: Really, where we’re trying to go is bring data structure and objectiveness to all of these different healthcare approaches to really enable scale for the industry as a whole.
Lee: I think when you gave me a brief tour of the platform and I just had been interviewing Travis. I think that’s what shone threw to me, was this data structured approach, which is clearly missing. That’s why I said, “Hey, come on and let’s have a chat.” An unstructured chat, actually. Again, when it came to functional medicine I know that we’re following scripted rules. Quite basic algorithms actually.
Lee: And then I’d notice you’d have people who would shine through in a field like Bryan Walsh, when it came to certain blood chemistry interpretation. And you wonder why is this functional medicine practitioner so ahead in this domain? And why hasn’t it propagated to all the other functional medicine practitioners. And that made functional medicine often seem more of an art.
Lee: I’ll give you another example. Most functional medicine practitioners will offer food sensitivity testing and intolerance testing. And yet, when you get into these areas of IgG, IgE, et cetera, it is anything but what I would term a science. But, it gets close to it when you’ve got practitioners who are doing it all the time and have gotten very good at it.
Jeremy: Yup. And that’s exactly the challenge. I think food sensitivity relative to IeG is a perfect example. Because of molecular mimicry where molecules of certain foods look similar enough to the body that drives the IgG response, you can have a lot of confounding information from an IgG test. And, to your point, the art of it is people who have spent their careers looking at IgGs and seen responses from individuals in the wild, naturally become more astute at how they find the insights and recommendations.
Jeremy: They’re able to look at individual values and recognize that the IgG response to, say, grapefruit could also be confounded by another similar molecule, which may be the heart of the issue if the individual isn’t necessarily eating grapefruit. Where that becomes problematic again from the industry perspective is, that is an art. It isn’t necessarily documented in objective data.
Jeremy: And really, you take somebody like a Bryan Walsh, who is an expert in blood chemistry, how do you take his brain, his ability to process, synthesize the data, and really understand what the best possible path is, and actually pass that on to other practitioners so that the industry can actually scale to reach more people?
Lee: That’s really exciting.
Lee: So, you’ve got these three areas that you mentioned. One, let’s centralize the data. So your incoming lab results from different providers like SpectraCell, et cetera. I assume you have SpectraCell. Then you’re giving a meaning across lab results. So, instead of one lab giving you the reference values or functional values and you’re looking at them in isolation and then having the human act as an artist/scientist given interpretation over it, you’re trying to have machine help give meaning over multiple lab provider results. How do you do that? And how well developed is that?
Lee: Is that something that you’re just beginning?
Jeremy: Yeah. We’re very much in the early phases. Really from a data model development standpoint, one, we’re in the process of centralizing data first and foremost. Two, the known expert rules, which is just simple decision tree type of stuff, adds a lot of value. Because you aren’t necessarily having to jump out of the system to go find the interpretation guide to tell you what to do when you see a given value. We have bring that front and center. But ultimately what we’re going to get to is the ability to connect the dots between the two, and then make insights and recommendations for the practitioner.
Lee: Are there competitors then? Again, I think of blood calculator. Have you heard of that?
Jeremy: Yeah, absolutely. And blood calculator’s great. There’s also quite a few new applications of microbiome and looking at microbiome and making recommendations. Where we view it is, we can’t look at a single omic value. If you look at the gut you only know about the gut. Now, people would argue we can make inferences based upon other information out there. But at an individual basis it’s nearly impossible to predict from a single value what the holistic view of the person is.
Jeremy: So, it’s great that the industry is moving forwards, specifically around things like blood calculator, or even some of the Viomes of the world. However, it doesn’t take into account the full view of the individual’s metabolism. So, that’s really what we’re focused on, is being agnostic to the testing model. Meaning we’re looking for the values from the lab, not concerned about the specifics of an individual lab. Because, if you have, let’s say, a cortisol pattern in isolation, you don’t necessarily know how that’s, one, driving the output of other metabolites, or you have no idea of what’s going on, from say, the gut perspective. Right?
Lee: Can the client also have access to their own data? Is there some kind of dashboard that they can share in?
Jeremy: Yeah. So the way that we built the platform is the dashboard view for the client is nearlu identical to the dashboard view for the practitioner.
Lee: You mentioned supplements earlier I think. I know you mentioned supplement protocol, so it wasn’t just you had incoming lab results being consolidated on your platform, and hopefully normalized et cetera, but you mentioned you had links to dispensary. Can you explain?
Jeremy: So, obviously anybody who is in the functional health space knows the importance of supplements, but also recognizes that supplementation doesn’t have a lot of objective data behind it. So looking at both supplement quality, but also thinking about dosage, a lot of it is, “Look, try to titrate up to, say, three to six pills three times a day.”
Jeremy: Well, is it three or is it six that drive the output? So, one of the things that we wanted to do was really bring, again, this idea of objective data measurement and output by tracking supplementation. Through my own personal health journey being estrogen dominate, one of the common supplements that you would take DIM. And, DIM helps remove some of the estrogen metabolites to bring down the estrogen dominance.
Jeremy: I was taking two twice a day for a year and a half and I wasn’t seeing any change in my estrogen metabolites. The medical director then said, “Well, why don’t you go to four twice day?” We had never done four twice a day. So, really what we’re trying to do on the supplementation side is bring more of the science to it rather than the art. One of the big challenges from a supplementation standpoint, thinking about my father’s experience, is being on a fixed income. A $70 bottle of digestive enzymes is very challenging within a fixed income.
Jeremy: So, getting to the right dosage not only benefits the client from a perspective of, “I can get the bare minimum of supplementation I need to support the best outcome.” But I can also look at it as a cost savings. How can I avoid waiting money on supplements that I’m taking too much of, or even taking supplements that aren’t effective at driving the right outcomes.
Lee: Did you say you were adding DIM as a supplement?
Jeremy: Yes. We actually increased dosage based on the interpreting medical director’s recommendation, but it was something that had never been considered before. So again, going to this idea of how to speed of how to speed the path to resolution would be instead of waiting that year and a half of doing an under titrated dose of DIM, start from the get go with the appropriate dose.
Lee: Because DIM is found in cauliflower and broccoli and it acts like estrogen in the body, and I thought you had estrogen dominance. So, would that not-
Jeremy: It reduces estrogen. Yup.
Lee: So, in terms of dispensaries a lot of these functional medicine practitioners have their own dispensary. I mean, their own brand of supplements.
Jeremy: Yup. So, we’re not in the dispensary business. Again, we’re tracking the data. So, how we’ve built the platform is we allow the practitioner to decide where they want to have their client get their supplements from. And we do that through our supplement template builder. So, they just add their existing dispensary if they have a personal branded one or if they’re using a third party, like a Fullscript or a Wellevate. They just plug in the links for the individual supplements.
Jeremy: And then for the client experience, oftentimes particular supplements aren’t available, you know, all the supplements aren’t available in a single dispensary, and they’re having to bounce through different places where they’re ordering, even from Amazon. And what it does, by our platform leveraging integrations with those other dispensaries, we’re able to let the practitioner leverage all of the different approaches. But, it’s a single experience for the client.
Lee: You mentioned supplement protocols, but what about eating protocols and maybe even fasting protocols?
Jeremy: So, we haven’t done that today. So, the way it would be done through the function health engagement is the practitioner would make given recommendation based upon diet. There’s obviously a lot of great tools out there in terms of food logging. I know quite a few of the clients in the system are using things like MyFitnessPal to track food and macros. We don’t do that today. We would certainly look to integrate.
Jeremy: Part of our platform strategy is not necessarily trying to be all things to everybody, because there are so many good platforms that do things exceptionally well today, we would look to just integrate with those platforms.
Lee: Yeah. It would be nice if the practitioner could see that the client was following an eating and/or fasting protocol.
Jeremy: So, we do do that through our health tracker. So we allow… Our heath trackers are very flexible. We can do anything-
Lee: Please explain the heath tracker.
Jeremy: Yeah. So, from the health tracker’s perspective what we’re trying to do is create accountability between sessions. And we do that through tracking individual health metrics. So for example, if they’re working with a client and they’re worried about, in my case hyperinsulinemia, they want to do daily blood glucose tracking, they have the ability to have a health tracker for blood glucose.
Jeremy: But, if they’re doing things like, “Look, this week I want you to avoid gluten. Or I want you to avoid caffeine for the next two weeks.” The health tracker can say, “Look, did you avoid caffeine today, or how many coffees did you have today.” And tracking that over time.
Lee: Is that manual? Or is any of the actual API stuff from devices in the health tracker?
Jeremy: Yeah. so, we’re manual today. Most of our clients are all over the map in terms of which products their using to track. So things like, for ketones some people use a Prescision Xtra versus a Keto-Mojo. We can do the integrations. We’re built on a flexible integration structure, so we would do that. We just haven’t had the demand yet for the direct integration.
Lee: You mentioned Precision Analytical, I guess that’s a lab provider. What is it they do?
Jeremy: So they’re the lab provider for the DUTCH test. And the DUTCH test is probably the most popular hormone cortisol test that’s probably in the world today. There’s always quite a few different types of hormone testing. But, the dutch test based upon the number of metrics that it gives and the robustness of the data has been their primary bread and butter test out there. We see a ton of those tests coming through.
Lee: The Cyrex test I would love to do. Do you want to explain what that is?
Jeremy: The which test?
Lee: The Cyrex.
Jeremy: Oh yeah, the Cyrex. Yeah, so they have a food sensitivity panel, they have a range of different panels. So, I did the array 10, which I think is eight pages of different IgG food sensitivities. Which, is really insightful because it helps give your directional approaches to understanding what works for you. I think the challenge with things like the keto diet today is if you were to go research online and you read about the keto diet, it becomes very heavy dairy and a lot of beef protein. Right?
Jeremy: Which was good for me in the fact that I was able to cut out carbs, but it was bad for me because I’m reactive to beef and cows milk. So, I’m not reactive to cheese because it’s fermented, but cows milk in it’s form. So, heavy whipping cream in coffee, adding sour cream to salads just does not work for me and it was actually inflammatory.
Jeremy: And so, really those food sensitivity tests become the next level of insights. So, if you say, “Look, we need to make a diet and lifestyle change.” But if we make that change in what I could consider a dogmatic approach, without understanding the individual’s ability to digest and process those foods effectively without an inflammatory response, you end up not seeing any benefit. And that is one of the key reasons why it’s important to have test that really give a clear snapshot of the individual.
Lee: Do you also support the Alcat on your system? Which is like Cyrex. In fact, I know somebody who ordered Alcat and Cyrex, and they ended up with conflicting results.
Jeremy: So, the way that we work today is we support probably on the order of 30 different labs. If we haven’t seen a lab before, the practitioner will just select lab not listed. That alerts us that there’s a new lab type that we don’t support. Then we write the code to process the data, process the data for that practitioner, and then that code is now available to all other practitioners and clients in [crosstalk 00:48:46].
Lee: Oh, nice.
Jeremy: So, like I said earlier, there’s no less than 500 functional lab providers with 10,000 different tests. We didn’t want to go out and write 10,000 different interpreters if nobodies using the test. So, what we let our practitioners is grow our list based upon what they’re using today.
Lee: Is there any interesting labs that you are aware of? Any new labs lately? Just because you had so many in the drop down list you showed me. I’m sure there must be one or two that’s particularly novel interesting or useful. And also tried to that, do you see a large future of metabolite testing? You mentioned a multi-omic future. You seem very focused on metabolism, and I understand why.
Jeremy: So, a lot of… You know, I just read an article on Business Insider about a 2.6 billion VC investment in microbiome testing. I think there’s a lot of interesting stuff coming through on the microbiome side. But, there is… Obviously if you think about your own genetics and compare it to the genetics of your gut, it’s chalk and cheese difference. There’s way more things to be learned from the gut microbiome. And we still have a long way to go.
Jeremy: I think from a simplicity standpoint on the GI side we still look at the GI map, or some other stool sample tests as being more clear and actionable than some of the newer technologies that are coming out today. And that’s largely because the basis of what to do about the information exists. I think a lot of the new testing techniques in terms of gut microbiome testing are interesting, but they haven’t been prevalent enough to really understand what behavior change and to close the loop on how to actually action and make changes based upon that.
Jeremy: I think from a usefulness perspective, the DUTCH test or the hormone test is really insightful, but it also is contextual. Right? So, it gives you a lot of information, but doesn’t necessarily tell you exactly what to do. I think from a food sensitivity standpoint the Oxford Biomedical Mediator Release Test is the most interesting. Because they’re testing the blood… They basically take the five blood samples and they’re injecting the actual proteins and measuring the inflammatory response.
Jeremy: So, it gives you more of a direct assessment of food sensitivities than say an IgG where you can be confounded by molecular mimicry. The other ones that I think people look past that I think are critical, especially in this day and age, are the environmental and heavy metal toxicity tests. I think we look at things like hormone dysregulation, but if you’re living in a toxic environment with all of these endocrine disruptors, things like BPA bottles, unclean water, mold toxicity, home toxicity, Ben Lynch talks quite a bit about home toxicity, and not understanding whether your environment is actually driving your dysregulation is a big blind spot that I don’t think a lot of people consider today.
Lee: Also thyroid problems for the same reason.
Jeremy: Exactly. My wife’s Hashimoto’s came from black mold within the house. We were looking at changing thyroid markers, T4, T3, TPO antibodies, and we didn’t really understand why despite making the food and diets changes, and it happened to be environmental. Right?
Lee: Is there any question I’ve not asked you that you wish I had asked?
Jeremy: No. I mean, I think the really exciting part about the functional health and wellness space really is that the health costs are out of control globally. And that’s largely driven through our environmental mismatch that’s happening, our processed foods and sugars. And there’s no doubt about that. I think the exciting aspect of function health and wellness, but the question around this industry, is do consumers care enough in mass to really take ownership over their health, or are people in mass just unwilling to do the investment and work that it takes to be healthy and stay healthy for longer?
Lee: So, I do actually wonder how you plan to structure the data. How do you tag it? How do you put an order to it?
Jeremy: Quite a few different approaches from a machine learning perspective. There’s the structured or supervised and unsupervised approach. We’re just in the process of, look get as much data on everything from everybody as soon as possible. We’re going to do some modeling relative to what the data sets, what size do they have to be for us to glean insights. But, really the expectation is, is that there are going to be some pretty key signals that come out. Let’s say for the DUTCH test there’s 75 different biometric values, not all 75 matter.
Jeremy: What actually really matters to an individual based up on their individual state or metabolic health that they’re really wanting to hang of. That fundamental issue is going to come out in the data. The question is, how much data is it going to take? That’s the real question around the industry.
Lee: Does the lab keep a copy of everybody? So, if a lab has 10,000 practitioners, does the lab end up storing forever the results of all patients across all practitioners?
Jeremy: So in general they do. Right? Because they’re updating their reference ranges as the distribution of the populations increase. The problem is-
Lee: That’s a hell of a dataset that they don’t seem to be mining as far as I know.
Jeremy: Yeah. The frustrating part from our perspective, again, we think about it from an integration standpoint. So, Quest and LabCorp you can certainly integrate with and get the data in a way that makes sense. All of these other function lab companies have really great tests and have zero technical infrastructure. So, we’ve been working with a few of the lab testing companies we talk with, and they’re business does not allow them to invest in unlocking the data. Because they’re looking at it-
Lee: It may be even their legal contracts et cetera stop them.
Jeremy: Right. Right. And so, that’s really import… Well, it depends. Through HIPPA law they can do de-identified aggregated analysis, unless they were entered into an agreement where they’re explicitly not allowed to. But, the reality is they need to keep lights on, they need to keep labs coming through. It’s not a big margin business. And so, investing in infrastructure analysis doesn’t necessarily create value for them right now. And so, they can’t afford to invest in the ability if we’re doing that.
Jeremy: And so, really why we’re trying to solve that by being agnostic to the lab companies is to be able to solve that problem to be able to create the population level analysis to really understand what are the key signals in the individual labs.
Lee: Is Biocanic, are you able to store the data yourself across many practitioners?
Lee: And therefore many labs and therefore many patients across many practitioners.
Lee: Yeah. So, longer term you can start giving insights based upon that population level data back to the practitioners.
Jeremy: Exactly. And the idea is creating phenotypes. So for me, “Hey, Jeremy walks in the door, he’s looking for sleep/brain fog issues and body composition issues. And he’s got cryptosporidium, H. Pylori, estrogen dominance, and food sensitivities.” Taking that and what worked for me, being able to take that type of insight so the next 42 year old male with the same complaints to a different practitioner said, “Hey look, rather than starting on a gut protocol to worry about yeast overgrowth or SIBO overgrowth, you really should focus on carbohydrate restriction.”
Jeremy: And, it’s not necessarily saying this is what it will be. It would be, “Hey practitioner, we’ve seen for similar clients like your new client, that 70% respond positively by approaching with a low carb diet.” And so, we really become, AI gets thrown a lot, but it’s really an augmented intelligence platform so that they can make decisions quickly and efficiently based upon other information and what’s worked.
Jeremy: The idea, if you think about it, is if you go to, I’m sure you’ve been to them, if you look at the LiveWello community for people uploading their genetic data, or you look at some of the support groups like Healing Rosie on Facebook, people have this information and they just have no idea what to do with that. And if they knew, that said, “Hey look, if I shared my information and I was really able to understand what worked for somebody else like me, so I’m not constantly caught in this space of trial and error, I absolutely would want to do that. I would share my dad because I’m going to get benefit along with helping somebody else find a better health outcome quicker as well too.”
Lee: Your long term goal, you didn’t say it was long term but it’s clearly long term. That’s a highly valuable long term goal.
Lee: One thing we never discussed was the underlying root cause of the majority of disease, chronic disease certainly, is the environment in which we live.
Jeremy: Yes. And that-
Lee: And so, when you say, “Hey, what’s the root cause?” Well, the root cause is we’re not keeping circadian rhythm, we do have junk light, hey we do have endocrine disruptors, we can’t expel the volume of heavy metals, toxins, molds, et cetera. The list goes on and on. So, the cure to everything, this is one thing I found funny about functional medicine, because the cure is always the same. Have a more natural life style, a more ancestral lifestyle. It’s always the same cure for everybody.
Jeremy: Yeah. And this may sound a little weird, but the challenge… You know, we look into your point. We look at things like the paleo diet, ancestral evolution and everything else as what we should be doing based upon what worked for our ancestors. We are in the middle of evolution. Right? And our environment is accelerating faster than our genes can adapt through progressive generations.
Jeremy: So, the only way for somebody to stay health ahead of our environment mismatch and the speed at which our environment is changing, is to understand their genetic and metabolic potential, and what is going to find the way to select them out of the environment. Right? And to do that, it may not necessarily be for you the same thing that it is for me.
Jeremy: And without really having that understanding to really understand what is the environment toxin that’s driving my inflammatory trigger, that’s driving my systemic low grade inflammation that’s ultimately going to leave to diabetes and a heart attack, is going to be different between two people, even though we may have the same type two diabetes diagnosis. And that’s why it’s so critical to be able to get the objective lab data to really drive how can I stay ahead of my environment so that I don’t get selected out of human civilization.
Lee: I appreciate that answer. Where do you see us in 10 years? Do you ever think about that? The 10 year plan? Because that’s where I spend quite a lot of my time.
Jeremy: Yeah. Look, I’m obviously very US focused both in my previous career experience and just happen to live in it, but the thought experiment that I always go through in my mind, and I should probably sit down and write it out is, when Medicare fails, because it will because nobody is getting healthy fast enough, what happens? It’s too big to fail, so there will be a government bail out. Where do the costs come out of the system? Is it through pharmaceutical reimbursement cuts? Is it uncovered benefits?
Jeremy: And then, does that become the tipping point where payer policy reimbursement regulations actually fall behind, and people as a consumer take control of their health, or do they not? That is a thought experiment question that I don’t think anybody knows the answer to. What is that critical point and the crossover point where the industry changes from a complete disruption perspective. That I think is the big question on how this actually unfolds.
Lee: You want people to stay and then drop dead quickly?
Jeremy: Yeah. I mean, the reality of if you think about crossing the chasm in terms of functional medicine getting to the early and late majority, those people, those people is a terrible term, but the people that are in this space in many ways are making intentional decisions that are against their health. But they do it because of despair, or financial reasons, or time reasons, or stress reasons. And that is a larger societal challenge that will be a limiter on people saying, “Yes, I want to be healthy. Yes, I have the ability and understanding to be able to make changes that matter that are going to drive a different outcome than what I’ve been doing yesterday.”
Lee: It’s like the opioid crisis is largely driven by economic disparity.
When Medicare fails, because it will because no body is getting healthy fast enough, what happens?.Jeremy Malecha
Jeremy: Yeah. I mean, one of the things in my respiratory days is a lot of people are thinking about COPD patients because of the cost and the issues, and I always give the example of you can’t understand a COPD patient who’s on a fixed income living in public housing until you go sit outside of VA in a smoking tent. And a person will literally go into a hospital, get admitted for emphysema, pneumonia or whatever, get discharged and go my cigarettes. That is a mindset and a challenge issue that all the best functional medicine docs in the world aren’t going to be able to solve. And that is where a lot of the real cost challenges are going to come from, and how does that every change?
when Medicare fails, because it will because no body is getting healthy fast enough, what happens? It’s too big to fail, so there will be a government bail out. Where do the costs come out of the system?
Lee: That’s a much, I laugh, that’s a much broader discussion we would go into there, and it’s quite a tempting one. But, respecting the time we agreed, I’d like to thank your Jeremy. It was much appreciated to jump on and talk, ad lib with me. I really enjoyed that.
Jeremy: Yeah. Well, I appreciate it. Thanks, Lee.
Lee: Excellent. Thank you very much Jeremy, for your time.