Decoding Environmental Medicine Labs with Dr. Claire Zimmerman

by | Mar 19, 2024

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Synopsis

In this episode of The Modern Vital Podcast, host Dr. Ben Reebs, welcomes Dr. Claire Zimmerman, a naturopathic doctor and herbalist specializing in environmental medicine. Dr. Zimmerman provides insights into the foundational labs essential for diagnosing environmental illnesses. She emphasizes the importance of including basic heavy metal panels alongside routine labs, such as CBC and CMP, due to prevalent toxic exposure in modern society. Dr. Zimmerman highlights the significance of testing both blood and urine for heavy metals like lead, mercury, arsenic, and cadmium, elucidating the necessity for nuanced interpretation and proper understanding of each test’s implications.

Throughout the conversation, Dr. Zimmerman emphasizes the need to comprehend the underlying mechanisms behind lab results, advocating for a holistic approach to diagnosis. She discusses the interplay between environmental toxins, immune function, and liver health, emphasizing the importance of addressing root causes rather than merely treating symptoms. Dr. Zimmerman shares her perspective on interpreting lab reference ranges in light of increasing environmental toxicity, urging listeners to prioritize optimal health rather than settling for marginal results. The episode concludes with Dr. Zimmerman sharing where listeners can find her online, underscoring her commitment to empowering patients through naturopathic care at the Seattle Naturopathy and Acupuncture Center.

If you’re looking to dive deeper into understanding the intricacies of chronic disease and its impact on your overall well-being, consider checking out Dr. Reebs’ book, “The Serpent & The Butterfly: The Seven Laws of Healing.” In this book, he discusses the laws of healing essential to resolving chronic disease and much more to help you on your journey to optimal wellness. Click here to purchase your copy: https://modernvital.com/products/the-serpent-and-the-butterfly-the-seven-laws-of-healing

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Complete Transcript of Episode 14714799

Dr. Ben: So on today’s podcast, we’re going to talk a little bit about what to look for in basic labs, when it comes to environmental illness. And our special guest is Dr. Claire Zimmerman. Dr. Claire Zimmerman is a naturopathic doctor and herbalist practicing in Seattle, Washington at the Seattle Naturopathy and Acupuncture Center.

And she is adjunct faculty at Bastyr University and runs the Environmental Medicine Center specialty shift at Bastyr’s teaching clinic. Dr. Zimmerman holds an ND degree from Bastyr, as mentioned, a certificate in clinical herbalism from the North American Institute for Clinical Herbalism. And she completed a post grad clinical training from Environmental Medicine Education International.

Welcome to the show, Dr. Zimmerman. 

Dr. Zimmerman: Thank you for having me, Ben. Yeah. Thanks so much. I’ve been really excited about this topic.

Dr. Ben: So when it comes to basic labs, like routine labs and even comprehensive labs, where do you start when it comes to environmental medicine? 

Dr. Zimmerman: Yeah. Well, where I start is I like to have the foundational labs done.

Those will be kind of the standard labs the primary care doctor would run. And then with that, if we suspect that there’s some exposure to environmental toxicants, in or through someone’s history of, you know, living as a human in this modern society, which is highly likely, we may then add a basic heavy metal panel.

And that’s usually done in two ways, we would run just a blood test through whatever local lab, maybe Labcorps or something. We would test for lead and mercury through the blood. And then we would also run a urine test. And that can be done either through a specialty lab, or also through your local lab.

And what we’re really testing through that is just going to be probably, arsenic, cadmium, and also mercury again. So those four metals, lead, mercury, arsenic, and cadmium are the most likely and highest found heavy metals in the population. So we usually start there if we’re not sure of any other metals’ really specific exposure that somebody’s had. 

Dr. Ben: So you’re saying that you’ll add those four to everyone’s basic labs. Like, let’s say they need a CBC and a CMP and lipids and all the things. You’ll usually tack those four on, if it’s like an environmental medicine workup. 

Dr. Zimmerman: I would. Yeah, I would.

Dr. Ben: Awesome. Okay.

Dr. Zimmerman: But I would always include both the blood and the urine. It’s very important that they’re done in the correct way. Right. And particularly for mercury, because of the speciation. So mercury is very mercurial in its nature. Like it changes in the body. And so, for example, when we have been eating a lot of fish, especially higher on the food chain, tuna is a common one that we want to test that more specifically through blood.

And then especially if people have amalgam fillings and silver fillings, we’re thinking about it showing up in the urine. And so we usually run both of those. There’s a lot of other ways that you can be exposed, but those are the most common ways. So we run both of those. Lead can also be run both as urine and blood, but it’s going to be a little clearer through the blood because of, we don’t always know if the kidneys are functioning quite up to par.

And so we want to make sure. And we can run both, but we definitely want the blood for lead. 

Dr. Ben: So as far as like the, you know, comp metabolic panel, complete blood count, lipid panel, those kinds of basics. What are you looking for, when you look at those, like from an environmental medicine perspective?

Dr. Zimmerman: Well, you’re not going to see usually a lot of changes that are definitely going to show up in those. I do like to add one additional lab that’s been cut out of the CMP or the comprehensive metabolic panel.

And that’s an additional liver enzyme test, and that’s called GGT. I run that test on people. I add it to that kind of general panel we were talking about. And the GGT, the reference range for the GGT has actually been increasing over the years. So now it’s a quite large range. It says it’s normal up to 60.

But really that’s just showing that because the population has become more and more toxic over time. So what happens is if a person’s exposed to a lot of environmental toxicants, it can put a lot of burden on the liver as the liver is trying to process that and that can damage some of the liver cells and show some of those higher liver enzymes.

And so if we run a GGT, and it shows a change around as low as like 20, between 12 and 20 is where the research shows that. We really start to see a change in like health outcomes for people with a GGT of 12 to 25. So I like to look at that as well. And that can show it may not be from heavy metals, but it may be from heavy metals.

And so it just shows us that there’s some burden on the liver and that might not show up in the other CMP,  or liver enzyme lab. So that’s a helpful one to add.

Dr. Ben: Yeah. It’s amazing how, um, how many of these reference ranges just aren’t that valuable anymore. I mean, and like fasting insulin is another example.

I know that a lot of the research now shows that insulin resistance really begins around 10, when talking about the, you know, the fasting insulin, but then the, you know, it goes up to 25 or so. And so if somebody’s at a 12 or 15, they look completely normal, but they’re actually far from normal.

Dr. Zimmerman: Right. Yeah, I always like to tell my patients, you know, we want to look at the ranges where you feel are going to be vital as opposed to just not dead, you know, or not, you know, if it’s very sick. So we’re trying to help people feel as good as they can and do preventative medicine and find things early as well.

Dr. Ben: Yeah. As far as the GGT goes, um, I mean, I know that glutathione is getting kind of used up when the GGT is going up. And so in some ways it might even be more of a superior glutathione marker, right, than just glutathione in the blood or the red blood cells? Or do you test glutathione?

Dr. Zimmerman: I honestly don’t often test glutathione. There are ways to do it. And sometimes there’s urine tests, specialty urine tests that I do that will reflect that. But I tend to give it and then if needed, and then watch to see if people how they respond to it. But then our body also makes glutathione. So I like to just ensure that the person has all the building blocks needed for that unless they’ve been exposed to something that we really know is blocking the body’s ability to make glutathione.

And that’s something to consider, too. That comes up a lot with mold sickness and other environmental toxicants.

Dr. Ben: Yeah. I had recently seen you speak and you were, you were at an environmental conference as we were talking about, and you had really said over and over again. You said, “Know what you’re testing. Know why you’re doing what you’re doing.” And what exactly are you looking for? And you said that two or three times. It really stuck because I was like, that’s, that’s really wise to to really think this through, like, in my testing the immune system, what exactly am I testing when I run this GGT? Is it just an enzyme, protein enzyme from the liver or is it actually something deeper? Can you talk a little bit more about that?  About the know what you’re testing?

Dr. Zimmerman: Yeah. The broad strokes of that, so here’s kind of a bigger, broader example. So when, for example, when somebody’s sick with, let’s say they have a body burden from an environmental toxin, we may then find that they also show a viral load in their body. And how we run that viral load is we test the immune system, but in order to test the immune, you then need to understand I’m testing the immune system’s response to that viral load, and you need to then understand the only reason that viral load is showing high and what we mean by viral load is that the immune system is working harder against that, because there’s the larger body burden of environmental toxicicant. And so it’s kind of going stepwise into what, what is the thing that I’m testing? What is it showing me about the system? And what’s the deeper reason behind why the system is reacting that way? You may also just symptomatically see in somebody, let’s say they’re having allergic responses to things. You may see that in their symptoms. You could also measure that. So maybe they’re hyperactively allergic. They’re getting, you know, hives all the time. And so they may get a diagnosis code of something. Maybe they did get mast cell activation syndrome. And so hat may be true.

But to me, what that says is, Okay, you may have this syndrome, but at the same time, what it really says is that the immune system is overreactive, and this specific part of the immune system is overreactive. So the deeper question is, why is the immune system overreactive? And more than likely, it’s a deeper body burden, so people with heavy metal burdens, or with other environmental toxicants, we see that a lot, where it’s just, there’s a lot of toxic burden on the system, that has overloaded the system.

And now the immune system is kind of really just freaking out and over-responding. So we could treat at the top for the, you know, for that overreaction, but we really want to treat for the bottom and get rid of the kind of underlying toxic load and underlying agents to that part of the system.

So really tracking what you’re testing, but even more of the question is, What does that tell us about what the system is doing?

Dr. Ben: Right, right.  That’s profound. I mean, one that I love to run, which I know is sort of popular among some, is the natural killer cells panel looking like a natural killer cell function,  you know, and I know it’s not FDA or CDC approved, and it’s not used to diagnose anything, but it’s amazing to see how often there’s a correlation between low natural killer counts or antibodies to the natural killer cells and reduced viral capacity, you know, reduced capacity to fight viruses and ultimately reduced innate immunity, which then could point to something behind the scenes like a mold illness or a tick borne illness or a CERS. Do you run natural killer cells sometimes?

Dr. Zimmerman: You know, I haven’t been, but you bringing that up reminds me that that was one I was going to look into lately because every other day I’m learning about another way to kind of, you know, frame the picture more, right. And have a more deep understanding of the whole profile. Yeah, it’s kind of like even some of those liver enzymes.

We may find if one of them is low, we might think that that indicates a zinc deficiency. And so treat that, see if things resolve that way as well. Yeah. And everything’s an interplay with each other in the body at all times. 

Dr. Ben: So as far as the labs go, just kind of the routine ones, what are a couple of your favorites?

I mean, I know you mentioned GGT. Are we talking like a ferritin or a vitamin D or, or do you have a couple that you really find give you a lot of information? 

Dr. Zimmerman: So the common, yeah, the complete blood count, the CMP, or the comprehensive metabolic panel, the lipids. I mean, most people are coming in with fatigue, and that’s a big profile there, so we’re going to run ferritin as well, which is checking the iron status.

That’ll also show us if it’s really high that can, that can be like really elevated when there’s inflammation. And if that’s the case, or it’s really abnormal, either way, I’ll follow up with an iron panel. I’m often running B12 as well to see that. And I wanted to make sure people are not taking B vitamins or specifically B12, B complex B vitamins before that is tested.

I run that along with an MMA, which is a methylmalonic acid.  I look at that with those two along with the CBC. I want that B12 to be up at about 800, which again is like much higher than the low range. So I want to make sure that’s replete. It is a fluctuant lab though. So if I see it very elevated, it could just be that they took a bunch of B vitamins.

But if I see it low, I know that it’s truly low and the MMA or the methylmalonic acid will reveal that further. I do run the vitamin D for sure, and I want the vitamin D to be up at 50. These are all telling me, or that in particular is telling me a lot about their immune status also. And a lot of these patients, depending on what they’re showing up with for symptoms, I may also run some inflammation markers such as high sensitivity CRP or C reactive protein, possibly an ESR,  yeah, and then it kind of depends on what other symptoms they’d show up.

But I think that would be a good place to start. 

Dr. Ben: Well, thanks so much for joining us today, Dr. Zimmerman. I know you’ve got to run here to a clinic shift, but where can people find you online? 

Dr. Zimmerman: Yeah, so they can, I have my own website. It’s Zimmermannaturopathic.com. And then also the clinic where I work, Seattle Naturopathy and Acupuncture Center and our website is seattlenac.com

Dr. Ben: Awesome. Well, I’ll make sure to link to those in the show notes. Thanks so much for joining us.

So that concludes today’s episode of the Modern Vital Podcast. We’d love to hear from you. We value your feedback. If you have any questions or suggestions, please reach out to me at ben@modernvital.com. And please leave us a review. If you enjoyed this episode, we look forward to having you join us next week for another exciting episode of the Modern Vital Podcast.

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About Me

Dr. Ben Reebs, ND, is an award-winning, naturopathic physician with a focus in environmental medicine, which looks at how environmental factors can cause chronic disease. He specializes in chronic infections, autoimmune disease, and digestive health.

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