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Aug 7, 2022

Developing Your Lab Interpretation Skills

by Dr. Dan Kalish

The accuracy of your lab data determines the consistency of your patient outcomes.

This concept was drilled into me by my first lab interpretation mentor, Dr. Bill Timmins. Bill and I met in 1995, and formed a long-lasting relationship through the rest of his life. Dr. Timmins was my mentor, a father figure, and a leader in our field. Through him, I met lab directors, prominent practitioners of all stripes, and developed my first connections with many companies I still do business with today.

We spent seven years working together; I was his content creator, writing the original program guides and doctor / patient education books for his seminar series, I provided lab interpretation sessions for 500 of his physicians ordering adrenal and GI and metabolic tests. I spent every Thursday with him, watching him work with patients and more than anything, Bill taught me the value of integrity, honesty and respect.

Dr. Timmins was both a clinician (of the ND clan) and a lab developer, lab director and educator. His gentle but firm energy guided me through the most challenging times. The first five years of interpreting labs are stressful. Learning why things don’t work out and learning from your mistakes, learning how to sequence protocols and how to problem solve, taking the victories and the failures in stride, all of the jitters and uncertainty of your first five years of working with patients is manageable when you have a mentor who truly cares and devotes their time to helping you develop your clinical skills. 

When Bill died, I attended his funeral. The reception was in a bar, of course - he was Irish through and through. As we sat around and drank, I counted the other functional medicine practitioners in the room, many of whom I knew quite well. I realized that over his long teaching career, he had taught thousands of physicians, but he only really trained a dozen or two of us. 

Thousands attended his weekend workshops and ordered labs from his company, but most dabbled in his approach. There was a small core group that made his life’s work our life’s work. I set a goal right then that throughout my career as a teacher,  I would train 250 doctors in a clear and easy to implement clinical model, and to this end, I created the Kalish Method and my Mentorship Program. 

Now entering our 18th year, I have educated over 6,000 practitioners of all types, from the directors of Mayo Clinic’s Integrative Medicine Department to a range of acupuncturists, ND’s, DC’s, NP’s a bunch of pharmacists a few dentists, therapists and a few computer engineers who were just interested in learning the work for their own enlightenment. 

I have far exceeded my goal of 250 doctors that I set at Bill’s wake. I have learned so much over these years about how doctors learn, what they need to know, what their blocks are and how to remove them so we can accelerate the development of functional medicine practices. Our typical new student in my mentorship program has a full practice within 18-24 months of starting the program, which is quite an achievement for these folks, and many of them do it in half that time. 

All of this depends upon the development of your confidence in working with patients, which in turn is dependent on your confidence in your lab interpretation skills. Mixed in with all of our curriculum that teaches lab interpretation are the patient communication skills that must accompany the ability to understand the labs. If taught properly, one can master both of these skills in a year or so. 

By combining pre-recorded videos, live Q and A calls, and providing hundreds of real life example patients, one can learn the ins and outs of the work quickly. One of the keys to this is to order the same type of labs over and over! Believe it or not you’ll have far better patient outcomes if you become expert at a few things rather than trying to learn a bit of everything. Once you have your base education in place and are rolling in your own practice, you can then branch out and add more specialized skills one at a time as you master them in turn.

What you don’t want to do is learn a little bit about everything and order completely different sets of lab work ups on every new patient. That just leads to confusion, and never gives you the volume of testing to really get the basics down. The basics to me are adrenal, thyroid and sex hormone tests, GI work ups and organic acids. If you understand each of those categories well, and learn how to mix and match them, sequence them properly and combine them when needed, then you will have consistent clinical results and voila, your first practice is born. 

Lab interpretation skills are adequate when you have the confidence to look at a test and within a few minutes you can envision the health program the patient needs; mastery comes when you can look at multiple tests with complex data and understand how to sequence the multiple protocols that inevitably arise from a series of labs. Do you work on the h. pylori first, or the thyroid and then the adrenals, do you go over detoxing all that mercury first or do that last?

It’s complicated and the stakes are high. Making small mistakes is ok, but making large mistakes can make patients worse, and will tank your practice and ruin your self-esteem. Don’t do that!

As you learn how to interpret a given lab you need to simultaneously develop three different skill sets: 

(1) Develop plans for the patient communication part of the work (the part where you present the labs to a patient and enroll them in helping you develop a program)
(2) Create lifestyle change recommendations for the patient to follow (the lab that indicates how you should prioritize
(3) Create a supplement program that will impact the labs, change patient physiology and improve patient symptoms

So a high cortisol and low DHEA level on a lab test means you need to lower the cortisol with phos serine raise the DHEA with DHEA and add in some pregnenolone if there is ongoing stress, and include some adrenal adaptogens and plenty of B vitamins esp. B5 and minerals esp. magnesium and some antioxidants esp. vitamin C at 3,000 to 5,000 mg/day. This is just the supplement part. 

Then you need to be able to tell the patient what the lab means in a way that allows them to not only understand what you are saying but to use your explanation as a powerful motivator for the hard part which is generating behavioral changes, i.e. lifestyle medicine. Everybody on the planet knows they should eat healthy food, exercise daily, meditate and get enough sleep. The word is out that these lifestyle changes are how we make significant changes to our health and wellbeing. The problem is it’s hard to make these changes! 

The solution is laboratory data that clearly demonstrates the need to change. This pulls the patient out of the realm of personal opinion and elevates it to the level of “your lab shows you need to eat more … or your test results show you need to lower your cortisol.” Lab data drives patient motivation to make lifestyle changes. It also drives motivation to purchase and take rather complex and long-lasting supplement programs. It’s a whole different experience when a patient sees a GI overgrowth of yeast that will require cleaning up their diet and eliminating sugar than if you just tell them sugar is bad for you please stop. 

For a typical GI test, another common example would be low levels of butyrate, low commensal GI bacteria and a yeast overgrowth. Teaching the patient about how butyrate is made when we consume fiber containing foods and how they can begin to  improve low commensals in a matter of days by eating more fruit and vegetables and how yeast overgrowth will begin to die off if they eliminate sugar all of a sudden the lab data turns into a science-based and personalized program to eat healthier. We all grew up and had this model drilled into our unconscious minds early on. High cholesterol (a lab value whose meaning is validated by science) means we need to take a statin. High blood pressure (a test result) means we need to take blood pressure medications. On and on it goes. 

We are conditioned at a deep level to think this way. In contrast, how many times did your mother tell you to eat more vegetables, how do kids respond? They begrudgingly do so, if being monitored. However, there is an unconscious and powerful human instinct that disregards advice that seems like personal opinion but accepts advice that has strong scientific backing. Therefore, a high fiber, high fruit and vegetable diet that also eliminates all sources of sugar will make everyone feel better and help improve pretty much every health condition known to humankind. It’s exactly what your mom would say, but done through the language of authority – science-based laboratory results. 

I could go on and on about lab interpretation but for the sake of brevity I’ll take a pause here. Hopefully you can join us at our various lab interpretation sessions we offer from free webinars to bootcamps to our full mentorship course.

Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.