Andrew: So take through the…

Sofia: Sorry, just wanted to say that I’m a practising naturopath as well. So I still am hands-on in the clinic.

Andrew: So take us through urinary metabolites. What, like what are they? What analytes are measured?

Sofia: So urinary metabolomics is a next step from the organic asset assessment. So it is including, so your classic organic acids that we see, it would be your KREB cycle, your fatty acid oxidation, but then it also combines the neurotransmitter testing and neurotransmitter metabolites, as well as a few unique markers, things like glucose, cortisol. We have some metabolites like equol that look at your gut bacterial metabolites related to hormone production. But then also it looks at a few very unique markers, such as KT ratio, for example, which is the, you know, they describe it as the marker of inflammaging. So inflammation is related to aging.

Andrew: Okay. So where do urinary metabolites fit into modern clinical practice? Where do they shine?

Sofia: I guess one of the main areas where they shine is to how we call it, assess the person’s metabolic signature. And by assessing their metabolic signature, we mean to basically identifying what in their metabolism can be causing a specific disease, issue or symptom. For example, if we look at the more of, you know, complex cases, let’s say the person comes in to see you, and usually as naturopaths, you know, we will see people that have seen many practitioners and kind of are hitting the wall. Urinary metabolite testing gives us an understanding on where to start to unravel because we are looking at it from, you know, the system approach.

It’s just in a very holistic manner. It helps us to understand, is it, you know, the micronutrient metabolism issue? Do we have any kind of nutritional deficiencies? Is the nervous system involved? Urinary metabolite testing also looks at the gut microbiome, and could there be any issues in, or, you know, any overproduction of the toxic metabolites? It looks at some of the environmental exposure. So, I guess it really shines as a great holistic assessment tool in that sense.

Andrew: Right. Okay. So I’ve gotta ask then, why aren’t they used more regularly? What’s the hold up with grasping this technology? Is it that we haven’t been educated very well in them? You know, I remember other people galloping ahead of where I was with regard to organic acid testing and things like that. So in that sense, I’m a bit of a stick in the mud. So is it because of a knowledge deficit? Is it a fear of potential expense to the patient? Where are we at? Why is there that deficit?

Sofia: I would say that there’s definitely a combination of few of these points that you mentioned, Andrew. We do as naturopaths know about organic acids, but many of us are scared because we think that we’re not educated enough, we don’t understand the biochemical pathways well enough to make sense out of it. And you know, this kind of tests, especially with metabolomics, it’s really evolved in the sense that it gives you a good understanding on what is wrong, and which pathway can be affected without you really need to understand the whole biochemistry, right?

So it’s really, for example, if we look at the report, the way it’s structured and the way the layout is done, you can see is it, as I mentioned before, you know, is it the toxicity involvement? Is it a massive utilization problem? Is it the KREB cycle?

Sofia: You don’t need to know these days each specific asset to make sense out of it. So it’s more of a pattern that we’re trying to pick up in there as holistic practitioners. With the cost thing, I guess, it’s always a bit of an issue when we’re looking at any kind of functional testing. But in my opinion, and the way we see it is utilized, if you would do one test, this would be the test to do because it gives you such a good and broad overview of the potential things that could be happening, of potential drivers of the issue.

Andrew: And you know what, I’m getting the feeling that it would be the perfect partner to genetic testing, because genetic testing gives you the imprint, the background imprint, but doesn’t tell you about the epigenetics or how it’s functioning, how a system is functioning. This will tell you how it’s functioning, and then hopefully direct you to where your therapy should be concentrated. Is that right?

Sofia: Yes. Correct. Because, you know, I’m a big fan of genetic testing myself in my clinical practice. But you are right, with the genetics we know that that’s like your baseline, right? That’s the backbone of things, but we don’t know how the genes are playing up. While for example, with the metabolomic testing, we can actually see, you know, for example, you have the MTHFR gene. With metabolomics, we can see whether it’s playing out or not because we look at your methionine and history of metabolism. We can see what methylation is affected in any way. We, for example, with genetic testing can see that you have glutathione issues.

We don’t know, are you actually affected by that or not? While we’re looking at the metabolites, we can see that, yes, there is increased demand for glutathione. And that’s probably one of the really exciting things that we can see with testing as this.

Andrew: You said earlier that you are in practice yourself. Can you take us through a case or two of where OMX testing, this urinary metabolite testing has directed your therapy or changed the choice of therapy that you might make for a specific patient to help them out?

Sofia: Because urinary metabolomic testing can be looked at as a truth machine, we really see what is exactly happening in person’s body. In my clinical practice, a few times, what I have seen is that it really helped to develop a conversation with the person in terms of their eating patterns, in terms of their stress levels. To give an example, I had a patient who had a real weight resistance despite a good diet, despite a really active lifestyle. And we couldn’t really get anywhere with her. We’ve done the OMX test. And the picture that I’ve seen was the picture of really severe malnourishment.

With the OMX, we can see that we can assess some amino acid intake. We can see whether there is a muscle breakdown. And the person on the test looked almost malnourished and anorexic. This developed a really good conversation and opened it up with the patient, which then at some point really unravelled more of a deep, underlying thing that was not uncovered before that. And this is just one example. And I had it with a few different patients around that. So basically it’s, yeah, you know, when you show to the person, to your client on paper, “Look, this is what we’ve seen in your results. Why do you think it is happening like that?” It then really kind of abrades the wall for them to open up in terms of some underlying, you know, contributing factors to this and often can be

Andrew: Well, I guess indeed in this case, it might have uncovered an eating disorder that would’ve otherwise gone uncovered, undiagnosed, unheeded, and potentially led to a drastic outcome for the patient, horrible outcome. So that’s very interesting how…The flip side of that is that it can also tell when your patients are telling you fibs, so non-adherence to therapy.

Sofia: Yes. And I guess a few other things would be more from, you know, like chemistry perspective, when testers as this can really help you to pinpoint some of the underlying biochemical blocks or deficiencies. For example, just recently looking at one of the OMX reports, I can pinpoint a B2 deficiency that was contributing to really the sorted fat metabolism that was then contributing to the lower energy. You know, not always do we think about B2, riboflavin as your main energy-supporting nutrient. I mean, yes, we may look at the B complex, but you know, with yeah, tests as this, we can really pick up the tiniest nuances in someone’s metabolism.

And then, as a clinician, I like that it really saves you time. It saves your patient money because then you don’t need to go with 10 different supplements. You can choose just two because they would be very personalized. And that’s, I think how it fits, you know, in the whole approach of very personalized medicine that we are doing with this patient centre care.

Andrew: Gotcha. Now, we are talking about OMX metabolomic testing today, and, you know, I don’t have an issue when we’re talking branding, if you like, of this test. I don’t usually, I usually refrain from mentioning branding, but in this instance, it is crucial to mention it because it’s quite different in a couple of ways from other tests that it might be similar, correct? There are a couple of ways in which it’s quite unique.

Sofia: Yes. It is quite unique and I would say it’s almost like a next step, an advancement, an expansion from your classic organic acid test, because it does include the organic acid. It also looks at your immune, so it’s a very complete amino acid metabolite profile. It looks at the neurotransmitters. And also OMX test has a few markers that are very unique, which are not to our knowledge assessed in any other tests. And some of the unique markers, probably one of the most exciting ones is the kynurenine/tryptophan ratio. It’s when we’re looking at the tryptophan metabolism, and this KT ratio really is assessing the level of the inflammation in the body, and is referred to also like inflammaging as you know, the inflammation that is contributing to aging.

Another unique to, I guess, from the organic asset perspective marker would be, we’re looking at cortisol. We’re looking at which are not normally included in them. And there are also a few unique kidney health markers, such as microalbumin, which can really help you pick up whether there’s any kidney issue. And another interesting marker is called equol. And equol is, it’s the product of the bacterial, gut bacterial metabolism that has a very good isogenic and antioxidant activities.

Andrew: So I’m really interested in this microalbumin. Is this going to have an effect…Like how do I ask that correctly? Is this gonna be sensitive enough to pick up pre-pre-prediabetes so we’re getting like microleakage of albumin out of the kidneys, so we can address kidney function way ahead of, you know, any drastic issues that might occur later with diabetes?

Sofia: Yes. So microalbumin is used as a really early-stage indicator of kidney health. And, you know, generally in OMX not just with the microalbumin, but with many other metabolites, it’s a really good prevention screening, because we will pick up things way before they become pathological. Even if we look at the metabolism, by looking at, you know, the function of the KREB cycle or the fatty acid metabolism, or some of the inflammatory markers, we can really pinpoint and kind of a catch upstream, some of the metabolic things, let’s say insulin resistance.

Andrew: With regards to the equol measuring that you spoke about, Sofia, is this an indication of liver metabolite function? For instance, the Cyp3A1, 3A2 metabolites urinary…Sorry, forgive me, estrogen metabolites? And/or is this an indication of perhaps excess beta-glucuronidase function by the microbes in the gut?

Sofia: So not really out of those. So what is equol? Equol is a byproduct of the bacterial metabolism of the isoflavones from soy. And some people would be naturally equol producers or non-producers, and that would be dependent on the gut microbiome, the gut microbiota, so to say it correctly. And basically, we would know that people, you know, on the vegetarian diet or people from more of the Northern European descent are equol producers, which is actually more protective, especially for if we’re looking later in life when we need that extra good estrogenic support. There’s been some research on equol producers and its correlation with, you know, protection from cardiovascular disease or from some bone hormonal, like basically the osteoporosis hormonally related.

Andrew: So, what I’m getting at there though is, with equol, if you are measuring this, obviously you’re gonna have to measure a baseline and then therapy equol. So I don’t know, you know, that sort of plays into the expense issue, but to measure that, you could actually measure how any beneficial bacteria or dietary intervention that you are recommending for your patients is actually affecting their estrogen metabolism. Not, are we gonna give this in the hope that it will, but you’re actually showing that it is.

Sofia: Yes. And that’s, you know, also where metabolomic testing can be used as initially to set the baseline and to see where you’re at and then continuously doing, you know, repeated tests to basically see how the intervention is working. So many practitioners start to use this kind of testing to really see the progress. And as we said correctly, to see whether the intervention is working after knowing your baseline.

Andrew: Gotcha. And just going back to that KT measurement, which I thought was funny because I’m thinking about vitamin K and D, and then I thought about the KT boundary with regards to the extinction of dinosaurs. But when we’re talking about inflammaging, does it correlate with things like, you know, age, rage, you know, the receptor for advanced location end products? Are we talking about linking in with sugar metabolism? Or are we linking in with genetic metabolism, like telomere length and things like that?

Sofia: In the case where of the KT ratio, which is your kynurenine/tryptophan ratio, we’re basically looking at the tryptophan metabolism, right? So we know that tryptophan can go mainly down two pathways. It can go down the serotonin/melatonin pathway, or it can go down to the kynurenine pathway. Going down to the kynurenine pathway is influenced by your IDO enzyme. And we know that IDO enzyme will be upregulated in case of inflammatory response in the body. So this measurement not necessarily gives us an understanding of where exactly information is coming from, but it gives us a marker to say, “There is an inflammatory response in the body.”

Andrew: Ah, right.

Sofia: And you know, that’s why with the OMX test, we will not just look at the specific marker and focus on that, we would look at again, we’ll do the step back and we’ll look at the big picture. And we’ll try to see, all right where that inflammation could be coming from, because we will be able to see, you know, is there a toxic impact because we can see what it is, exposure to some environmental toxins. We can see, is there a gut involvement and overproduction of some of the, you know, toxic metabolites, like LPS from the gut microbiota if there’s a dysbiosis? It can show us, if could it be related to low glutathione levels. Or it could be just related to things like malnourishment.

Andrew: Sofia, obviously, I’m just on the cusp of looking into this deep cup of urinary metabolite testing. I’m one of the old school, so there’s so much to learn and yet I can just see that there’s such usefulness in picking up things really early so that they don’t become a menace, and indeed in some instances don’t become unrecoverable like diabetes, you know, kidney damage. So where can we learn more about urinary metabolite testing so that we can get a handle on how to use it in practice?

Sofia: Yes. So at the Designs For Health website, we have created a specific learning portal where practitioners can go deeply into each specific metabolite, exploring its usefulness and basically how to interpret the test. So yeah, there are about 15 hours of education on the topic and it’s very conveniently structured for you to dive deeper into specific metabolic pathways or specific markers that you’d like to explore. We have also recorded a webinar with a great overview and with highlighting, you know, the usefulness of this test in practice.

The one thing that I wanted to say is that I really encourage practitioners not to be overwhelmed by tests like this because, you know, sometimes when you look at this report and it looks too much, right? There are so many metabolites, there are so many markers tested, and I remember myself first time looking at it feeling, “Oh my God, what do I do with this all?” But then, you know, the way it is structured and the way it’s broken down really helps you just to understand what area of a person’s health picture needs to be looked at and nourished. And, you know, as with any kind of other pathology testing, you can look at the blood test and just say, “Oh, everything’s within range and it’s fine.” But then as you develop your clinical skills and as you learn deeper, you learn to pick up smaller nuances. So basically what I’m trying to say here is that with the OMX as well, you can really start very kind of…

Andrew: Broadly.

Sofia: …you start slowly and broadly because it’ll already give you so many answers. Even if you just understand where to start to like, you know, untangling the knots, where to begin to look at the deeper underlying issue.

Andrew: You know, I’m picking up some very common sort of threads with regards to when I first looked at SNIP testing. And I remember I kept on going over in my mind, and I would go, “Yeah, yeah, that’s great.” But I’d go back to laboratory testing and then I’d go, “Yeah, yeah, yeah, that’s really good.” But I’d go back to laboratory testing. And finally, when I did it, that’s when I understood where it really shone and where you needed laboratory testing, like these urinary metabolites to have a confirmation of an actual issue rather than a supposed or a potential issue.

So I think it just ties in so well, but urinary metabolites have certainly got some legs to sort of open up to for the future so that we can learn more, and see how we can help patients. Sofia, thanks so much for taking us through it today. And thank you everyone for joining us. Remember, you can catch up on all the show notes of today’s podcast and the other podcasts on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”