Episode 12: Trust Your Gut: Functional Lab Testing for Optimal GI Health with Dr. Oscar Coetzee

Evelyne: Dr. Coetzee was born and raised in South Africa where he completed his bachelor’s degree with majors in criminology and psychology. He holds two master’s degrees in organizational psychology and in human nutrition. He’s a faculty member at the University of Bridgeport and is the Associate Director of the Nutrition Tract in the Doctor of Health Science Degree. He’s also an associate professor at Maryland University of Integrative Health and an adjunct associate professor at Georgetown Medical School. Courses he currently teaches include clinical nutrition, sports nutrition, pathophysiology, advanced nutritional biochemistry and assessment, functional lab assessment and organizational development. He’s a certified board supervisor for the CNS Certified Nutrition Specialists and is on the National Board Exam Committee for the National Association of Nutrition Professionals. He has been on Designs for Health’s scientific advisory board since 2016 and is the Senior Director of Clinical Education. Today we’re going to be talking about lab testing, specifically GI lab testing, and I’m so excited for you to hear Dr. Coetzee’s expertise and passion for functional lab testing. So Oscar, can you share with us how did you get so passionate about lab testing? Can you tell us more about your journey the last few years in developing more tools for lab testing for practitioners?

Dr. Oscar Coetzee: I’ve been in clinical practice for just a little over 20 years, and it originated in the field of psychology. And at that particular point I wanted to cross over into a PhD in psychology, but it turns out that at some point I was open to the idea of maybe understanding the integration of nutrition and mental health and that set this whole thing on a journey, finished my degrees in the nutritional area and then started a practice where I have a little bit of an overlap between psychology and nutrition still today. I work with professional athletes from a sports psychology standpoint and then all the chronic diseases around. And as it turns out, I was probably one of the first people in the field of nutrition 15, 18 years ago to really get into the functional testing. Found it very, very helpful because it helped me set myself apart in my practice and also kind of get down the road of being a little bit more precision oriented in the outcomes of my patients. And that just kind of exploded for me. I used various companies for these tests over time, and they all came and went and I felt that the outcomes that I got from most of these tests were quite astronomical for my patients. There were some tests that I used in the past that I felt didn’t give me as much information as I wanted. Like straight amino acid testing, I think it’s helpful, maybe in other medical paradigms, but not really for us to fine tune what we are looking at. And then one thing led to the next and started teaching at university level and then designed a course for advanced lab assessment and integrated all those years of clinical experience and what I’ve done with those tests and how I integrated them into coursework. And then ended up on the advisory board for Designs for Health. Dr. David Brady approached me on this queue of tests that we have at Designs for Health now, Spotlight. To help assist him in the evolvement, development, algorithmic assessment to get it to where it’s today.

Evelyne: That’s really cool. And I’d love to hear more about how you are now more focused on optimizing wellness rather than diagnosing disease. And I’d like to specifically talk more about this testing that you’re referring to. Who are these tests created for and why is there a need now for these tests?

Dr. Oscar Coetzee: I think there’s always been a need for these tests. I just don’t think they’ve been properly promoted and facilitated in our industry. The reason that I really want to look at optimization of health is because disease is almost like a full gas tank or an empty gas tank. So people are either full or they’re empty and there’s nobody looking at the in-between parameter to determine how do you lie on that scale of being filled up or completely empty. So how far towards the regression of a disease are you or the progression of a disease are you? And that’s where these tests are extremely helpful. And optimization of health is something we all need. None of us are a hundred percent healthy and nor would we be a hundred percent healthy. And I think the biggest thing for me was the fact that over a period of time I always heard, “Well, there’s nothing wrong with me. The doctors tested me and there’s nothing wrong with me.” There’s never nothing wrong with us. It’s just a matter of how balanced are we and proper simulation of our nutrients and utilization of those nutrients. So it’s really just kind of a measurement of where do you lie on completely preventing disease or preventing that gas tank to completely become empty? That’s what this is all about. It’s almost like the medical system is designed, “Well, you don’t have the disease yet. There’s nothing wrong with you. We’ll test you in a year or two, then you get the disease.” And that’s kind of crazy thinking, right? Because disease don’t happen overnight, so it progresses to that point. So functional tests to me is how is the progression coming along? And the beautiful thing about these tests is you will never ever be able to tell a patient or a client, there’s nothing wrong. There’s always something out of range. Now that might be genetically associated, that might be environmentally associated, but that’s the beauty of it. There’s always something that you can work on and optimize, and when you work on things that you can optimize, you’re always going to have good outcomes.

Evelyne: What are the top tests that you’re using right now with your clients?

Dr. Oscar Coetzee: After all the years of doing this, I kind of got myself into three categories. I like metabolomics, organic acids because it gives you a really, really wide spectrum on the health overall. So it’s a great test on a yearly basis. Gastrointestinal, we have to look at that. We’re also compromised in that area because of herbicides, pesticides, stress and all the things that we grow with. And then genomics, right? Genomics is great to look at because you kind of want to know your genes and understand how they are facilitating, expressing certain potential issues that you might have.

So those are the three major ones that I’ve used, in the past I’ve done many others. I’ve done a lot of testing. And DUTCH testing, we look at hormonal testing, but that is not an area of my specialization as a practitioner. Certain of my interns in my practice do that. My area of specialization is metabolic, gastrointestinal and sport. So that’s why I think I am directed more into these other three categories of tests. So again, GI, organic acid, metabolomics, and genomics.

Evelyne: Great. And today I’d love to focus more on the GI testing. So with this testing, the GI spotlight, the Spotlight testing, how are you using an AI-based and algorithm-based approach to help guide clinicians to improve outcomes? And how are we using this technology and do you see the future of AI application in this field or in our field?

Dr. Oscar Coetzee: So I think using the AI terminology might be a little strong because it’s not an adaptable measurement. It’s not like we’re leaving this program to itself to figure out which microbes are doing what. So the algorithm behind it is static, so the algorithm is figuring out things that we’ve programmed it to do, but it’s not accumulating information and adapting it as we go along. I think that would be a pretty scary thing because we don’t know everything about every microbe at this point and nobody does. So I don’t feel like I’m taking nothing away from artificial intelligence. I just don’t think that there’s enough information to draw to be able to direct that in that level. Maybe in the next 10, 15 years that would happen. So when we’re talking about the intelligence behind that, it is that we’ve looked at the scientific literature, we’ve picked five or six categories in these tests, looked at what’s consistent in the chronic disease out there in the world. And figured what best nutraceutical applications have been utilized to have good outcomes there. Designed an algorithm to simplify the process of assessment. So the process of assessment with these tests are extremely complicated. You have so many microbes and so many interactions. So what we wanted to do is, “Okay, let’s just simplify it to five categories, have algorithms to assess these categories or six categories, and then we can fine tune it from there.” And it’s a living, breathing organism from the time that we started it. I just had a meeting this morning, ironically with a team at the lab. As the results come in, there’s slight alterations, new nutraceuticals coming and slight alterations to the algorithm to get it more specific. So that would be the intelligence involvement at this particular point, it’s not automated intelligence involvement.

Evelyne: And can you talk about more who or what type of practitioner this is best suited for and some of the benefits of choosing this testing versus maybe other functional GI testing on the market?

Dr. Oscar Coetzee: Well, I think the main thing is it’s self interpretive. So these tests, we design them to the point with these algorithms that they can spit out certain recommendations in those six categories, and those six categories might have a recommendation in four of them. And then that practitioner can look at the patient’s symptomology and determine which ones of those recommendations they want to do first. Because it’s not the test’s job to tell you what you need to do first because we don’t know the symptoms of the patient. But what we do have is the analysis of what’s in their stool testing, for instance. So who is this for? As far as practitioners are concerned, anybody in the functional paradigm of nutritional medicine, functional medicine, integrative medicine, holistic medicine, whatever you want to call it, right? Anybody should be using these kinds of tests if they really want to dig into finding the answers. The patient population that this is best for that ties back into the practitioner is the patient, if we’re talking specifically GI. It will be the patient that walks into the office and tells you that they have had a GI problem for five to 10 years. They’ve been tested for everything. Everything comes back negative. But there’s symptoms that they consistently have, like bloating, diarrhea, but they’ve tested negative for Crohn’s or ulcerative colitis or diverticulitis. So they’re frustrated. And then the next step normally is, well, it’s in your head. And then the recommendation goes to a psychiatrist or whatever. Which is clearly kind of a crazy approach because you have to at some point believe the symptoms that your patients are telling you that they have. And these tests can find the causes of those symptoms because again, they’re not disease oriented findings. They’re findings of imperfections or imbalances or slight insufficiencies. I think medicine is more a focus of deficiency causes the disease. We are more about insufficiency to prevent the deficiency that causes the disease.

Evelyne: That makes sense. And can you review what the broad categories are that you are looking at in this test?

Dr. Oscar Coetzee: So we are looking at… Category one would be the commensal species. We want to clearly look what a lot of people would perceive as the good bacteria, how well they are established in the microbiome, and how are they utilizing each other and feeding each other. So that’s part one. Then the second category that we have, we have inflammatory indicators. So we are looking at lipopolysaccharides, which is an endotoxin produced by gram-negative bacteria that we also investigate. We are looking at digestive sufficiency. We want to look at are you breaking the foods down? Are you assimilating them? Do you have enough of those substrates to make that happen? We look at gut barrier integrity. Everybody’s talking about leaky guts, not my favorite term. I like intestinal permeability. We are looking at the parameters that are associated with that. And then we also have a specific section in inflammation, so inflammatory reactions to gluten or histamine producing bacteria that could lead to histamine intolerance and then fungal. Fungal is the final category that we have. So if you just run over them. You have the commensals, you have the inflammation, you have the immune, you have the fungal, you have the digestive, and then you have the gut barrier.

Evelyne: I’d love to dive deeper into some of those. And since you said you liked intestinal permeability, and I know that you’re passionate about talking about LPS, let’s dive into that a little bit. So can you review some of the markers that comprise that gut barrier integrity section? Then I’d love to talk about some supplements too, because obviously there are different ways that practitioners treat. I want to get into that with you.

Dr. Oscar Coetzee: If you’re looking at some of the key ones that are correlated to intestinal permeability. Now we don’t specifically test for pathogens on these tests, and I’ll explain in a couple of seconds why. But any pathogen, if a person has a pathogen, they’re going to have permeability, right? Because those pathogens cause massive disruption in the gut. So let’s say hypothetically speaking, this person had gone to a doctor and they had some sort of an overt pathogen like E. coli or C. diff or even high levels of potential H. Pylori. That could definitely cause an issue. Let’s avoid that because most of the time the people that we do these tests on test negative for all that stuff anyway, so then you need to look at lactobacillus. So lactobacillus, when it’s low, it’s a clear indicator potentially of permeability, Akkermansia, eosinophilia. That is a real strong indicator. And that also kind of goes a little bit with some of the other butyrate producing bacteria like Faecalibacterium prausnitzii and roseburia species and gliadin, Anti-gliadin, right? We want to look at the gluten alpha gliadin, how’s the body reacting to that? And zonulin. So zonulin is kind of a cool add onto this test because if you do most of the functional testing, that’s an add-on. That’s an extra expense that you have to incur to be able to look at zonulin. So zonulin is the tight junction and permeability regulator, that is the communication center to open and close the gates and we have to consistently open and close the gates. But it’s just the fact that you don’t want to keep them open too long because then you have those endotoxins. Those LPSs that could end up in the bloodstream and then that becomes a real problem. And let’s talk a little bit about LPS. So for those audiences that don’t exactly know what it is, LPS stands for lipopolysaccharides, which is an endotoxin produced by gram-negative bacteria. So in our test, we actually grouped all the gram-negative bacteria together, which is fantastic because all the other stool tests that I’ve ever looked at, I have to go look for the gram-negative bacteria. And here at least we have all grouped together. So these gram-negative bacteria are just naturally in the gut. Some of them are good, some of them are not so good, and they have a life cycle. So as they go and die off, they produce this endotoxin. So a gram-negative bacteria needs to be dead to produce LPS, but because they’re organisms, they die, they process. So these LPS molecules, again, when they can go through the gate, get into the bloodstream across the blood brain barrier, you can have associations to anxiety, inflammation. Probably systemically, some of the origins of a lot of chronic disease could be coming from there. Not just that. You could also have other things come into the bloodstream from that permeability phase. So one of the major triggers to actually cause permeability apart from pathogens or the imbalance of these things that I just mentioned would be alcohol. Excess alcohol intake has a real, real negative effect on time junction regulation. Certain medications could completely affect that as well. And then the major player is clearly alpha‐gliadin, right? Alpha‐gliadin is a protein in wheat that expresses something called a CXCR3 receptor on zonulin, and that opens the gate. So we can look at which one is connected to causing the tight junction dysregulation, address that. So the antimicrobials that we would use in nutraceutical implementation will help lower that allostatic load of those gram-negative bacteria that cause the problem. But we don’t only want to lower that load. We also want to make sure that when those LPSs that we are creating due to the die off of those microbes, we want to facilitate some sort of a binding action for it not to go through the tight junctions. So that’s why we use serum immunoglobulins. So these things can bind to these LPSs and that molecule is almost too big to get into the bloodstream and then it kind of gets transferred out through the bowel. So it’s a really fantastic combination and it’s very, very effective because most of the time when a person has long-term immunological and bacterial imbalances, like large amounts of bacterial overgrowth or LPS production. They’re going to start to affect the immune system in the gut. And we measure that by looking at something called secretory IgA, immunoglobulin IgA. So when you’re looking at that, you can see how long that person has been exposed to that negative imbalance. So when you start binding those things out, you start killing them off, pulling them out of the system. It’s a lot easier to get those tight junctions to do their normal job again.

Evelyne: I have a question for you. So traditionally when we are working with someone on fixing intestinal barrier function, we use things like L-glutamine, zinc carnosine, we use some of the soothing demulcent herbs. And I’m curious how you are now using… Because serum bovine immunoglobulins, even though they’ve been on the market for a little while, they are sort of newer. So how do you determine when you use some of those nutrients and herbs versus using something like the serum bovine immunoglobulins versus even something like colostrum? And have you seen changes in patients as you’ve maybe made those changes or do you combine them sometimes?

Dr. Oscar Coetzee: That’s a great question. I mean, it’s been trial and error for many years from all of us because what do we have to base that on, originally 15, 20 years ago. So yes, I’ve used colostrum, I’ve used glutamine. So here’s what I’ve seen. Sometimes I give glutamine to a patient and they have incredible results immediately. And then on the other hand, I give a similar patient glutamine and they have a massive reaction to it. They’re more inflamed, they’re more irritated by it. And I think it’s because at that particular point, it was all symptom-based intervention, and I didn’t really dig into the nuances of the testing. So with the testing, I can now determine if there is a large amount of LPS and a huge amount of permeability. What I want to do is I want to lower the allostatic load of what’s causing the problem first. So I want to get rid of the things that are irritating. And then once I’ve done that in phase one, then I go to glutamine, L-carnosine and all those kinds of things to facilitate the second phase of healing. So it’s almost like you have to go into the combat zone, get rid of the enemy, there’s going to be casualties, there’s going to be things going on and then go up there and clean up the mess that was created. But it’s not like it’s phase one going into phase two. There’s sometimes phase one with a little bit of an overlapping phase two. This is why it’s so important for the practitioners to understand the symptomology of their patients. So if you’re working with somebody and you’re giving them a protocol and they’re having great reaction, how would you know? Well, you’re going to see changes in their bowel function. They’re going to be less diarrhea based, they’re going to be less constipated, they’ll be less bloated. They might have more energy, they might have a headache.

There might be a period where they’re going through all that, the bowels might change when you’re dying all those things off. So the practitioner needs to communicate with the patient to figure that out. Look, the studies and the research on zinc carnosine and intestinal permeability is reasonably good. I mean, it’s indicating great success. If you’re looking at glutamine, I mean, that is what the enterocytes live of, it’s their energy source. So it is important, but I’ve seen the opposite happen sometimes if it’s a little bit too quick. So for me, it’s always if it’s a very severe case that is the, let’s call it phase 1.5 after I go in and kind of semi-nuke what’s going on there.

Evelyne: Since you mentioned the phasing, I’m sure that most of the practitioners listening are familiar with the 5R protocol, used to be the 4R protocol. We’ve seen both. And so one thing, especially for clinicians who are newer to functional testing, and I didn’t learn this in my nutrition program, I feel like I’ve had to acquire a lot of this knowledge after, but we don’t necessarily learn. Do you always follow that exactly? Especially when it comes to removing the pathogens and then kind of rebuilding the gut, do you feel like you use your intuition versus experience or do you let the lab testing guide that? And I’m specifically referring to say, a lot of practitioners are kind of confused because you almost feel like, well, maybe using antimicrobials with someone might be too harsh, so maybe we want to rebuild the gut first. What are your thoughts on this?

Dr. Oscar Coetzee: I think it’s a very valid concern, and I think that the argument has strengths on both sides. What I will say is that when you’re looking at the testing, it kind of helps a lot because you can look at the factor by which those microbes are overgrown. So let’s say it’s 10th to the seventh, that is the normal range and you are at 10th to the ninth. That is a huge disparity of growth. So when I look at these tests and that person in their lipopolysaccharide producing gram-negative bacteria is at 10 to the seventh, and the reference range is 10 to the seventh, and it’s just slightly out. I might go for the second phase. It’s when those numbers are really out of range. If you have a million versus a hundred thousand, if you can just use a basic example, we got to address the problem. So the power factor in the reference range is really, really helpful when you’re coming to determine whether you want to do R1 or R1. And sometimes you can just go to R 2 with maybe a very, very short period of intervention. Now what we do in our clinical support, we actually show the practitioners that. So we kind of suggest or recommend that those practitioners do maybe one or two tests with us as the clinical support team, and then I take them through the whole test and I’ll circle it to them and I say, “See that E4 to E2? That’s really prevalent. Tell me a little bit about the symptomology, how that works, and then you can get a really, really clear picture.” So I absolutely appreciate what you’re saying, no. You don’t always just want to look. You have LPS start with protocol one. Sometimes if those power factors aren’t that heavy duty and the symptoms aren’t indicating it, then I would say start with the second phase. So intuition plays a role, but you certainly also want to look at those factors. So if you look at three things, you have intuition, you actually have the power factors that are very indicative, and then you have the patient’s symptomology. So if that patient’s symptomology isn’t very severe, then you can go into the carnosine and the glutamine and maybe a short-term anti-microbial if you want, or a less aggressive anti-microbial maybe in the form of oil of oregano. I’m not going to use something strong like black walnut or wormwood or something to that effect. And then I would add in glutamine or maybe zinc carnosine at that particular point. But I think also what’s important to take out of that is at that point, it’s really important to have a person on the right diet. So everybody looks at FODMAPs dieting and specific carbohydrate dieting is the answer to fixing small intestinal bowel overgrowth. It does nothing. It’s legitimately a symptom improver. So if you can help the patient improve their symptomology while you’re doing the treatment, the real success would be what happens if you introduce those foods again, are they reacting? Because if you reintroduce some of those foods and those criteria and they’re not reacting, then you’ve done your job. If they’re still reacting, then there’s still work to be done.

Evelyne: I know with SIBO, since you mentioned it, you usually use breath testing, but are there markers on the testing that you’re using that would indicate that there could potentially be small intestinal bacterial overgrowth?

Dr. Oscar Coetzee: There are certain markers that could be more prone to producing methane and histamine. So there are, in the immunological section of our test, we have specific microbes that would produce certain byproducts that could indicate what protocol you should be on. That’s what we’ve designed in the algorithm as well. We could physically tell you if we see some of these markers. Histamine protocol is suggested. If you see certain markers, FODMAP protocol, they’re suggested or gluten-free or candida free because we can pick that up. Now, sometimes you might find a person that triggers two protocols, right? Because they have both some of those methane producing bacteria as well as fungal overgrowth. Then it comes to the clinician determining what’s more prevalent, what is better to utilize. Now in the testing, we could probably sit down with our practitioner and say on paper, not on symptoms. On paper, this is more prevalent. Your markers for fungi are kind of just over the threshold, but for those bacteria producing immunological response, it’s a lot higher. So the suggestion would be that one first, but the algorithm is going to spit them both out if there’s a need for that. And if you are a person that works on gut health over a period of time, which most of us should do. It shouldn’t be a one-month deal, it should be a three to six month deal. You can go through different phases of these protocols until you get that gas tank to be filled up again.

Evelyne: I want to dive a little more into that because that is one of the most questions that I get when I’m speaking with practitioners who are kind of newer to lab testing, is how long do I do each of these phases for? Is that something that you advise on? Is that something that the testing can tell you? How do you determine that?

Dr. Oscar Coetzee: I wouldn’t say that it’s written in a book. If you have this parameter, then it’s three months, and if you have this parameter, it’s six months. If it’s a pretty aggressive overgrowth at a high factor of, let’s say LPS or maybe there’s a lot of histamine producing things that could overlap with LPs, by the way, because some of the histamine producing bacteria are also gram-negative. I would generally, say three months, many months. And that’s clinically based experienced over time. I have never, although I can say that as well, I’ve also had patients where those numbers have been wacky and within a month there was improvement. But generally speaking for me, I would say proper intervention on two investigation, if it’s not in great shape, three months minimum, right, before you might see movement. Now from a retesting standpoint, I’ve made that mistake as well, and I hope that who was on the other side of this call would learn from this. You do not want to retest stool too quickly because it’s a very complicated symbiotic system of adaptation. So I don’t retest anything sooner than six months once I’ve done stool testing. I’ve done it as early as a month, which was completely crazy because that person had better indicators of symptoms, but the numbers were still scary to look at, and then all of a sudden the storm starts calming down. When I look at some of the other testing like metabolomics, I’m okay with a three-month review, but stool testing, because of all the intricacies and complications that go with it, I love the six-month objective. Now that is purely a clinically based Oscar thought process, but I can tell you this is what I do a lot and definitely successful at that duration. As far as what protocol comes first, how long each protocol is, I base that very much because I’m not retesting in that phase, so I don’t have those numbers now. I’m legitimately basing that on my client or patients reporting back to my team and saying, “Bloating is much improved. I’ve gone from diarrhea to full formed stools.” Great indicators when you have better motility or you’ve reduced the osmotic drag that’s created by diarrhea. So it’s really important at that point to look at the patient and their feedback. If you know that there’s compliancy, if you know that that person is highly small intestinal bell overgrowth and fungal overgrowth and they refuse to stay on a FODMAP diet just to bring that load down and they’re not truly following the intervention strategy, then it could be a lot longer.

Evelyne: That’s very helpful. Thank you. And once a program is complete, and I’m putting complete in quotes because our bodies are always in flux, things are always changing. We’re exposed to so many things. What are some of the things that you do with your patients to maintain some of those changes specifically pertaining to GI health?

Dr. Oscar Coetzee: I think the beautiful thing about most of the patients that come to us, they are fed up, so they’re tired of feeling sick and tired. And when they have success with something that you’ve given them, I have seen the compliancy on that quite extensive because you’ve changed the quality of life. It’s obvious. I can give you an example of a patient that came to me that had 17 bowel movements a day, 17. We figured out through testing what was going on, she went to three bowel movements a day in a week. We picked up something just pretty small and she came crying in my office, “You’ve given me my life back. I can actually go to the supermarket now. I can actually have a life.” So when you’ve had that reaction with a patient, they will do whatever they have to do not to go back to where they were. So a person that is really, really ill, they will follow some of those principles. So what I always say to them, “Look, the objective of proper gut healing is for you to be able at some point in your life, as much as I hate to say this, go out and eat something crappy McDonald’s without a massive reaction.” That means that you have proper stomach acid. It’s not a complete mess. I don’t instill that mode in all my patients, but I want you to be able to handle, and let’s just make it even a little bit more simplistic. I would like you to eat garlic. I would like you to eat something that you’ve always reacted to because then I know that the job is done properly. And if those symptoms, let’s say that you get them to the point where they are completely improved and those symptoms come back, then that patient is so educated in their process that got them there because it’s six months. It’s like going to your own private nutrition school on gastrointestinal health. You will know what to do in the initial phases. So what I normally would get is, “Listen, Oscar, I was on a trip in Greece and I did this, this, and the bloating started to come back. Should I go back on X, Y, Z?” And then I would normally say to them, but at this particular point, it’s not going to be as long-term and just follow that. So that’s really what I’m seeing. So I don’t really see a lot of patients at the level of frustration that they’ve been that come to us. And I think a lot of practitioners would vouch for this. That people are completely saying, “I’m going to fix my gut, but as soon as I feel better, I’m going to eat fast food burgers and pizzas and drink beer for a month.” I’ve not seen that because they feel so good, that their body is almost to the point that it’s starting to reject some of those not so good foods. And your body will rebel, right? I mean, if you go from a reasonably healthy fiber rich diet that helps you with a butyrate and all that kind of stuff. And then you go to fast processed food, your body’s like, “Whoa, wait a minute. This is not what we signed up for.” So that’s the beauty about the adaptation of the gut. As you adapt to what changes you made, the body likes those changes. So if you throw something wicked in there, it’s going to rebel short term as well.

Evelyne: Thank you for that. You mentioned Akkermansia earlier, and I do want to talk about it because it’s a trendy little microbe right now, and we know that low levels can be problematic, but so can high levels. So I would love to know what are some of the roles of Akkermansia? Why is it important? We also know that there’s some relationship with GLP-1, and should we all be boosting Akkermansia? Tell me more about that.

Dr. Oscar Coetzee: No, not at all. I think if your Akkermansia species in your test is at the levels that it’s supposed to be, then leave it be. So Akkermansia is interesting, but we also don’t want to leave out Roseburia and Faecalibacterium prausnitzii. I think they’re kind of like a little team, but Akkermansia is probably the one that we see lowest the most, and Akkermansia is a mucus degrader. So it actually lives in the mucus membrane and it feeds off that mucus. And then what it does is it actually produces propionate, and then that propionate can convert to butyrate. So it’s actually indirectly a butyrate producer. It’s butyrate that then has the effect on the GLP-1. And the GLP-1 is how we regulate metabolism and blood sugar regulations and satiety and weight control. So the indirect pathway of Akkermansia conversion to propionate, converting to butyrate, butyrate expressing the GLP-1. That’s how that whole interrelation happens. And it’s interesting because when I do two tests together and I look at Akkermansia being low, I can immediately go to beta-hydroxybutyrate acid on a metabolomics test and find blood sugar dysregulation. It’s really interesting. It’s nothing that’s been published in the literature yet because those two tests haven’t been… It’s just that I’m looking at so many of them because I’m reviewing so many of the practitioners that we are working with. That I’m starting to see patterns in that and at some point I might put together a hypothesis paper on that because you can certainly integrate that. But also with Akkermansia species being high, more serious things. Parkinson’s disease have been associated to really high Akkermansia. Some infant eczema, they can play a role with that. But I think that species starts overgrowing when there is maybe too much mucus because of something creating that mucus layer. So you can’t blame a bacteria for wanting to feast of what you provided. So if you’re providing the negative agent, then you clearly want to do that. So some of the symptoms with low Akkermansia, diarrhea, bloating, also skin conditions, constipation, it goes back and forth. And I think there’s something else with Akkermansia, it has an effect on toll-like receptor 2, which is very important for the immune system and inflammation. I don’t remember the exact connection to it. So it’s really a diverse little dude, so an indirect connection to GLP-1, and then also toll-like receptor 2. So it’s an inflammatory regulator, it’s a mucus degrader, it’s a butyrate producer. So something that comes up all the time also is how do we boost Akkermansia, right? What can we do to boost Akkermansia? So the number one thing would actually be to chew your food well. So that would be kind of a helpful thing. When we see low elastase on the testing as such, that could be problematic. So the recommendation of some digestive enzymes is sometimes helpful. Also, be careful with where your pH level lies. So Akkermansia likes low pH. It doesn’t like high pH, so it’s very important. And I actually feel that some of these medications with lower pH in the stomach actually is one of the triggers of why we have such a consistency of low Akkermansia species on the stool testing. It’s almost to a T that you can find that connection, complete hypothesis. And then finally, polyphenols, eat plantains, eat sweet potatoes, eat greens. Eat things that contain those polyphenols to help keep them happy. So they are not a very difficult species to entertain as long as you provide them with those foods. But you and I both know how few people are actually focusing on those foods, right? Pomegranate, strawberries, plantains, sweet potatoes. It’s not the common food intake of the United States of America.

Evelyne: And thank you for sharing that. That was actually my next question, how to boost Akkermansia. And it’s great that just chewing our food, which we sometimes, as we rush, just don’t devote any attention to.

Dr. Oscar Coetzee: And I left one out intermittent fasting.

Evelyne: Tell me more about that.

Dr. Oscar Coetzee: So somehow the intermittent fasting helps the body to, I guess, give the digestive system a break and recuperate. I’m also kind of investigating some literature that has come out with training and how that is affecting Akkermansia, I cannot give you the clear outlines on that yet. The literature isn’t totally clear, but maybe if we have another one in the future, I’ll go a little bit deeper into that one, at this point.

Evelyne: I love hearing your hypotheses and seeing those connections between different tests. At one point, you had told me that you have a hypothesis about LPS. Do you want to get into that one today?

Dr. Oscar Coetzee: Yes. I think it’s more of a hypothesis. It’s a little bit more sound now than just a hypothesis the more and more I look at the testing. So there’s something going on with lipopolysaccharide exposure in the body and anxiety and depression. So if you look at some of the early stage studies, reasonably anecdotal, it’s indicating that LPS has the potential to cross the blood-brain barrier, and somehow that has an effect on anxiety. Anxiety has always been something that’s been very intriguing to me and depression, because my background’s in psychology as well. So I’ve always wanted to connect what I call psycho nutrigenomics, right? So the psychology, the nutrition, and the genomic or the genetic components that overlap with each other. But the more I look into the literature, the whole idea of psychobiotics and the bacteria in our gut, like lactobacillus and bifidobacteria that assist us in aromatic amino acid production, tyrosine and tryptophan, that leads to serotonin and dopamine. There’s a lot going on there, but the reduction of LPS in the literature has shown improvement in anxiety and depression. So that’s the early stage of where it is at the moment. So we have found a way to bind the LPS in the gut to take it out of the system, but there’s not much that you can do for the LPS that’s in the blood that’s already been assimilated. However, if the body goes into more of a nutrient-dense, anti-inflammatory state, which is what LPS kind of induces, is inflammation. You can clearly improve the symptoms that have already been residual from the exposure to the LPS. So my whole hypothesis is the connection to the psychological model of imbalance that we have in our world at the moment.

Evelyne: I think that’s so interesting. I’ve always been fascinated by the gut brain connection, and I think when it’s talked about, we often just hear, “Oh, well, more serotonin is produced in your gut than in your brain,” but it’s so much more to that. We know we’ve known for years about the inflammation model of depression. Do you think it’s just multifactorial? I mean, obviously our bodies are so beautifully designed and we’ll probably never fully understand everything, but can you touch a little more on that?

Dr. Oscar Coetzee: I mean, when it comes to… If you’re specifically talking about the whole serotonin thing and the gut produces most of the serotonin, that is true, but there’s still the need for that serotonin to get into the bloodstream and in the blood brain barrier and convert. So when you analyze all that, the most important thing for us to have as a species is the way, like you said, our bodies were designed originally. We need to have proper villi for absorption. We need to have the proper pH in our bodies for all our bacteria to live cohesively and help us produce and give us the end product of those neurotransmitters and catecholamines. Furthermore, if you just look into the vitamins involved with improvement of anxiety and depression, vitamin B6 is such an important one, and that is a consistent issue that we’re seeing on metabolomics testing. There’s a lot of deficiency in vitamin B6 that help to convert serotonin from tryptophan and tyrosine to dopamine. Vitamin B6 plays an extremely important role with that. And B6 is also depleted due to excess inflammation, so now you can see how everything starts to tie in. So if you have a lot of inflammation that is indicated in the stool test, you go to an organic acid or a metabolomics test and you look at the B6, it starts to match up on a consistent level. The beautiful thing also about, and I know we’re talking GI, but the metabolomics test is clearly indicating to us some of that conversion and some of that potentiation of what we’re trying to achieve with these neurotransmitters and catecholamines.

Evelyne: Very interesting. And I’m sure we’ll do a follow-up show on metabolomics and organic acids because that’s super fascinating, and the psycho nutrigenomic part is also very interesting to me. So I’d love to talk more about that. With the less vitamin B production, have you seen patterns when you’re running both metabolomics and the GI Spotlight test where you see patterns in certain bacteria that are maybe lower and so therefore they’re not producing more B vitamins? Or is it just the inflammation?

Dr. Oscar Coetzee: I’ve not looked at that, but that’d be an interesting one to look at. You might have given me a thought here for some of the intern graduate students to go look into it. I mean, this has opened up a can of worms for me because I’ve never been exposed to this level of testing. I mean, as the facilitator of the clinical support team, I review a lot of these tests and I used to review only my patients’ tests. Now all of a sudden I’m reviewing all these tests. So there are patterns, there are certainly patterns that are starting to form like the B6 one, I can pick it up consistently. If you have low elastase, you’re going to have certain species that are kind of out of whack. To name them individually off the top of my head, would be hard for me to do at this point. But I think it is definitely something that we could probably start accumulating information on and actually building a sound theory or hypothesis around to do further investigative testing because these tests can actually clarify and quantify research. I mean, if you have a test done, you have an intervention protocol that improves it. You have a case study, now you can turn that into a case series trial, and that evolves then into more specific randomized control trials. So I just think that we are sitting on such an interesting amount of information, and if I have my dream, I would love to have a discussion board of clinicians on an open site where they pick these things up without obviously talking about individual patient information. But hey, I see this marker all the time. I see this marker all the time. And the more you have those clinicians involved with those discussions, the more interesting the research avenues can get.

Evelyne: Absolutely. That’s where I think it gets really fun. And then you can throw in genomics and look for associations and correlations there.

Dr. Oscar Coetzee: Right? Then you get some many, many, many variables, causative issues.

Evelyne: Maybe this is jumping ahead a little bit, but is there a goal in the future to combine the data between either two of the tests or three of the different tests?

Dr. Oscar Coetzee: I wouldn’t say officially at this particular point because we clearly try to fine tune these three tests. The problem with a test like that is that you would have to do three samples in one kit, right? Let’s say you wanted to do genomics and specifically only focus on the neurological component, like you want to look at a gene called TPH1 or TPH2, which has to do with serotonergic conversion or DCC, which is dopamine conversion. And then you want to only look at the commensals because they have a very, very strong interrelation with neurocognitive health. And then you look at the neurotransmitter markers on the metabolomics test and you put all those, that’d be phenomenal tests. Let me tell you it’d be a great test to look at. But the complications of putting that together and then putting that in an algorithmic system, I don’t know if that would be cost-effective. The solution to that is do all three and go look at those individual components, and then you can kind of figure it out. So I think that would be the next step for me on an education level is to start putting things like that. Do you want to look at the mental factors? Go look in genomics on these categories, go look in metabolomics on those categories and go look at stool in those categories. So you effectively have created that. I don’t think if we combine those three tests that it’s going to be less expensive than doing each one of them individually. But there’s always discussion and room for growth. And if we keep growing the interest and the excitement that we have on this, then without the doubt who knows what’s next.

Evelyne: I want to go back to something you mentioned when we were talking about Akkermansia specifically and the link with butyrate. Butyrate is something else that we’re hearing a lot about, and butyrate is the most abundant of the short chain fatty acids. Are we directly looking at butyrate on this testing? What are the markers you’re looking at that might indicate a need for more butyrate? And then can you also touch on when you would take more of a dietary approach versus actually giving supplemental butyrate?

Dr. Oscar Coetzee: That’s a good question. Butyrate supplementation is actually one of the recommendations when we have low secretory IgA, right? So it’ll actually recommend that as a recommendation because there’s a correlation between immunological gut suppression and low butyrate production. But butyrate could be affected by a lot of things. So the number one thing that everybody keeps forgetting about butyrate is fiber. You cannot have butyrate without proper fiber intake. So even people on these extensive ketogenic diets and paleolithic diets and carnivore diets, there is very good potential if you’re excessively into the optimization of that particular belief system that you can end up with low butyrate. And butyrate is anti-inflammatory. There’s indications in the literature that it helps with potential cancer protection. And even eradication is a very strong statement to make. Atherosclerotic disease is very involved with low butyrate. So I think the key components to that are some of those foods that we mentioned earlier, like plantain, sweet potatoes to feed the bacteria that produce the butyrate indirectly. But fiber is the most overlooked thing when it comes to butyrate. And then diversity. Diversity in the diet, it’s okay to have a keto approach, and it’s okay to have whatever the individual aspect is. But this is again my personal opinion from a gut standpoint. If you go back into ancestral understanding, people used to eat 600, 700 different kinds of foods. That’s not that long ago. Maybe a thousand years ago, 2000 years ago. The average Americans is eating 16 to 20. So that gut diversity that we don’t have is probably why we are ending up with the amount of chronic diseases. So if they say that diseases start in the bowel, I think it’s a very strong statement because of the lack of diversity. So when you then go into a very particular macronutrient, obsessive diet, you want to do keto, but you only want to do it with animal protein or you’re doing… And I’m not saying that there aren’t research documentation at this point to say that the carnivore diet has proper involvement in atherosclerotic disease, which is kind of the opposite of what you think. Look, being a professor looking at research, I can give you good and bad on everything. You can give me a topic, I can find you good and bad on everything. There’s nothing I can find good and bad on that is not available in the literature. So it’s the same thing when it comes to this discussion. But in conclusion, diversity, once you fix the gut, once you’ve determined what’s wrong, you’ve gone through your 5R, your 4R, you’ve kind of intermittently figured out what you want to do, how long you want to do each one of those categories. Once that GI tract is fixed, the only way, because you asked me earlier, what is the long-term objective? Diversity, eat seasonally, eat local, eat diverse, many colors, fiber, animal protein, not animal protein, lots of it, little of it, go back and forth and challenge the gut with diversity. The more diversity you have, the more gut learns to assimilate. A lot of people, “I can only eat four foods.” Because you’re only exposing your body to four foods. At some point, it’s like working out. If you’re only doing 20 pushups and you ask me, why can’t I not do an Iron Man? Because you need to be able to do a hundred or whatever the goal is to reach that objective. So I think the simplicity, once you’ve healed the gut and those numbers look better, once you’ve done a retest on the gut at six months. Diversify, legitimately diversify and you will not regress again.

Evelyne: Thank you for that. And where can practitioners learn more about all of these different markers and some of the research if they want to dive deeper?

Dr. Oscar Coetzee: So if you are a DFH practitioner and you go onto the website, you will have direct access to something called a teachable platform that we’ve designed specifically for the practitioners. Where we physically go into the biochemistry, pathophysiological interaction, every microbe, every analyte, every gene, every SNP that is discussed. So we have an education platform that, let’s say you want to learn more about 8-hydroxy-2′ -deoxyguanosine, there’s a little video on it, there’s a PDF on it. If you want to learn more about Faecalibacterium prausnitzii, there’s a video on it, there’s a link on it. We also have a quick reference guide. That is really easy for that practitioner when they’re looking at this test, if there’s just a one-liner of what Akkermansia does and what Roseburia does, and that’s really helpful. And also on these things is where we laid out, if you have these microbes, then permeability is a potential. If these microbes are low and high, then digestive insufficiency is a potential. That’s all on the teachable platform, all to your access 247.

Evelyne: And I think it’s great, especially that GI module is about just over four hours in total, but you don’t have to watch all of it. You can dive into specific sections. So very, very helpful. Oscar, I have a few more questions for you that we ask every guest on the show, and we could make our whole podcast just about gut health if we wanted to, so we could talk all day. We’ll definitely do follow-up conversations. So what is your favorite supplement, just in general, or your top three supplements?

Dr. Oscar Coetzee: Glutathione without a doubt. Big believer in B complex because of the energy pathway and the effects that it has on the body. And there’s so many things that rely on B complex vitamins. And I like the glutathione for the antioxidant part of it. And then I actually do intermittently do some probiotics, like sporebiotics and different strains of probiotics because I want to stimulate my immune system. So a lot of people don’t necessarily understand that, it’s not the consistency of taking a probiotic because they’re transient.

Evelyne: It’s more what they do for your immune system when they’re there and what they teach your body when they’re in there. So it’s almost like they’re educators going through your system and they’re over there to give your current biome a lecture on what they need to do and then they move on. So intermittent use of probiotics as well as Bs. I do Bs all the time because I’m pretty active, so I lose a lot of them. And then glutathione, I’m just a big believer in the whole antioxidant thing because I’ve done a lot of research on uric acid. And uric acid’s connection to glutathione is actually pretty interesting. So those are my three top ones.

Evelyne: All right. I might have to actually make this a little bit longer because you brought up the probiotics and you and I just had this discussion the other day, and I feel like you can’t just give us that little bit and not expand on this. So we know that probiotics, or at least if you’re using research strains that have been shown to actually colonize in the gut, they do. But then when you stop taking them at some point they are not present anymore. And so can you talk a little bit more… You shared a great analogy with me, I’d love for you to get a little bit more into that. But is it about the gene expression, all of the genes they’re turning on and off and how that sticks around?

Dr. Oscar Coetzee: We don’t really know everything that they express and do not express, right? So I think the best explanation I’ve ever had on explaining the benefit of probiotics, it’s not my own creation. It’s definitely something that I picked up in some presentation somewhere. So I don’t know who to give credit to, but whoever that is, I give you credit. So basically, if you’re looking at a probiotic, getting into your body, you’ve got to look at them as tourists visiting a famous tourist site. So these bacteria, these probiotics, they go into your body and they go to, let’s say Paris. Paris is part of your microbiome there. They hang out, they drink wine, they party along. They hang out with the locals, they connect, they make friends, and then they fly out. But that friendship has long term benefit. You might become a very good friend communicating, you might help each other out. You might stay in communication. So the expression of that connection is the long-term thing. But that’s why it’s important to kind of intermittently do that because you might lose that connection if you don’t reconnect. So if you don’t reach out via Zoom or email or connect or you actually go and see each other face to face because that’s what it’s all about. Then that friendship might go along, but it might be great if you see each other twice a year or three times a year or four times a year, because then that relationship becomes more and more cohesive. Also, again, competition, right? The microbiome is all about competition. It’s all about working together, symbiosis, but there is some tag games going on between these different species. I think sometimes when you diversify the intake of these probiotics, you kind of give them a benefit of having a little bit more of a pull compared to the other ones. So I am all for probiotics because the literature, and I can tell you right now, I’ve looked at with my research team on the literature of probiotics. Now, whether they’re transient and have short-term expression or not, the literature is not lying in the efficacy of their outcomes. So psychologically improvement, right? There’s depression, anxiety studies on it. There is oncological studies on them. There is digestive disease studies on them that are quality, randomized, controlled trials that you can hardly find a confounder or an inconsistency in the studies. So they work without a doubt what that connection is, how that exactly works, how they express genes. We might never know. There’s too many factors involved because you don’t just have bacteria, fungi, you have phages. You have all sorts of things in your body that we don’t understand. But I think the diversification of the diet when you’re taking a probiotic is very important. So if your diet is healthier and you’re taking a probiotic, you’re giving that environment a better ability to have a good time and connect. I don’t think it’s a great idea to only take probiotics when you’re eating junk food because there’s not enough diversification, because at the end of the day, what do we need? We need butyrate. We need these connected end products that makes everything work together. But the whole process is so involved because you have to have the proper amount of stomach acid and then the pH and the duodenum needs to be a specific way. And it’s just such a downstream effect that I think probiotics really help that.

Evelyne: And since we talked a lot about antimicrobials. When you are working with patients or when you’re advising practitioners, do you recommend that they use probiotics alongside? And I’m not talking literally at the same time, maybe a little bit apart, and we can even get into the nitty-gritty of that. But do you use it at the same time, or do you wait until you’ve completed those, whatever it is, four to six weeks, and then give probiotics?

Dr. Oscar Coetzee: Again, for me, that’s going to depend on the power factor of what’s out there. It probably wouldn’t hurt to add in probiotics to compensate for a little bit of what you’re creating. Because if you’re sending an anti-microbial in, they don’t know that they just have to go to streptococcus, right? They are a broad spectrum, so they are going to lower the load of a lot of things. So if you’re looking at a test and you see that there’s certain areas that is low, maybe you want to compensate for that allostatic suppression that might happen when you’re taking it. But we are not dealing here with… Even though we are talking about black, walnut, wormwood, garlic, all these different entities that could suppress that, it’s not going in there and legitimately nuking it, right? It’s trimming the edges when you’re going through this, and that’s why that process takes a little longer. So I think there is benefits in both arguments. Sometimes not, sometimes yes. And I hate to be this inconclusive, but I’m a research professor, so I need to have conclusive evidence before I’m completely sold.

Evelyne: Well, I love this. I think there’s so much that we don’t know yet. I think it’s better to not say things conclusively because it’s science. Things can always change, and we’re all just learning as we go along. When you do give a probiotic alongside an antimicrobial protocol, how far timing wise do you space them apart?

Dr. Oscar Coetzee: I don’t really over focus on that, but if I had to give an answer on that, I’d probably say eight hours. If that helps somebody, I just don’t see… Clearly you don’t want to take it exactly at the same time, because those things together might not be the best combination. So if I have to put a number on, I’d say eight hours, but there’s absolutely no science that backs that up.

Evelyne: And then you also mentioned spore based probiotics. So when you are rotating probiotics, do you switch every bottle every month? Do you switch between spore based and other probiotics? How do you do that?

Dr. Oscar Coetzee: Yes. Yes, I do. I like to go for the traditional strains acidophilus and the bifidobacterium, and then I like to do the spore probiotics. I like spore biotics. I mean, they’re interesting entities because they are so old. They’ve been on this planet forever. They’re not really affected by gastric acid, and they kind of have this amazing regulatory ability with some of the other microbes. So I actually take them more than I take the other ones. So I’m a big believer. Personally, I do fermented food. I do a lot of kombucha. I do those kinds of things as part of my probiotic intake. But spores are kind of unique. So if there’s a probiotic I take more than anything else, it’d probably be spore. But I don’t know if my personal opinion here really matters because it’s just an N of 1 study. So I would say that four times a year, I do aggressive manipulation of my probiotics in and out. So I’ll have a good month to six weeks of intervention, and then I just focus on the diet again, and then I reintroduce it. But there are patients, when you look at the stool testing, that would require consistent exposure because they’re so compromised. So I don’t want to… It’s almost like when you’re really healthy and your gut seems to be healthy, then it’s good to go in this intermittent state. But if you are ill and you are trying to reestablish that balance, then there’s a good argument to be made for consistent stimulation to have the proper outcome. So I don’t want the listeners to think, “Man, Oscar is only taken four times a year, so that’s going to work for every patient.” It’s not. It’s not, right? So there are periods of time that you’re going to have to do it consistently. There are patients that I’ve had consistently on probiotics for more than a year because they’re just that compromised. So that is a potential.

Evelyne: Thank you. Very helpful. Going back to the questions that we ask everyone, what are your top health practices for your own personal health and wellbeing?

Dr. Oscar Coetzee: I’m probably going to be giving you the craziest answer that anybody has ever given you.

Evelyne: I’m ready.

Dr. Oscar Coetzee: I love what I do, my job, my teaching, this. Super passionate, this isn’t work for me. I find solace in doing this. So that’s part of my health orientation. So I can’t ever stop working because then I’ll get sick. But I am also a person that loves cycling, so I love going on extensive cyc- I have stopped personally doing the gym thing, and I’m a very active person, so I play tennis. I cycle, I do a little bit of jogging. I just like to now do the exercise in an environment that I enjoy. I’ll take my mountain bike and ride it up through the mountains where I used to be… I’m going to go to the gym and do my 12 sets of this and X, Y, z. I have moved. Maybe it’s because I’m at a later phase in my life, in my career. My relaxation from an exercise standpoint has to come from enjoying the exercise. Legitimately there’s got to be an ulterior or an alternative pleasure center. Like riding a bicycle in the middle of the mountains isn’t exactly the worst thing to do. Fresh air, rivers, that kind of stuff. I’m not a great cook by any stretch of the imagination, but I like to eat a pretty diverse diet. So I like to experiment with different things. Thank goodness, my better half is qualified at cooking those things. So that’d be another thing that I find really enjoyable.

Evelyne: Awesome. Thank you. And what is something that you’ve changed your mind about through all of your years in practice?

Dr. Oscar Coetzee: Very easy answer to that one. Pharmaceuticals, used to be anti-pharmaceuticals, like a lot of people in our industry. I mean, vehemently defending the natural process. After being in practice for 20 years, sometimes medication is really needed to have something happen. I’ll give you a perfect example. I’ve had patients that were so down and out because of physiological imbalances, and there was an issue with thyroid conversion. I have seen life-changing things happen to people by just taking short-term Cytomel. Like, T3, like physically go from depression, anxiety, almost suicidal to happy within two to three days. So I’ve built a very, very strong connection with a lot of doctors, medical doctors that we have an extremely great relationship. And I am not anti the utilization or the recommendation by referring back to a physician saying, “Hey, you know what? I’ve tried everything that I can do. This process is going to take a little bit of time. Maybe short term, this will be helpful.” And then we address the obvious things like if there are nutrient depletions or drug nutrient interactions, we’ve covered that because we have a strong team in understanding all that. So I’d say that’s probably the thing where I have in the first 10 years of my life, I always felt, because maybe we were frowned upon as a profession like I had to defend myself all the time. I think I’ve really connected with a medical community. For goodness’ sake, I’m teaching at Georgetown Medical School. So I guess there’s got to be some benefits to what we’ve done. And the acceptance of the medical community in this area is pretty amazing. It’s not what it was 10 years ago. It’s not as aggressive, I’m not saying that some of the bigger companies aren’t still trying to push us to the side, but there’s great connection. So I hope that answers your question.

Evelyne: It does. Thank you so much for sharing that. Very, very impactful. Well, Oscar, thank you so much for your time today, for your expertise. This has been a really fun conversation, and I know we’ll continue this. So thank you.

Dr. Oscar Coetzee: Thanks. Be well.

Evelyne: Thank you for tuning into Conversations for Health. Check out the show notes for resources that we shared on today’s show. Please share this podcast with your colleagues. Follow, rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht. Dedicated to engaging discussions with industry experts exploring evidence-based, cutting edge research and practical tips.