Organic Acid Testing with Dr. Jeff Moss: Rational Wellness Podcast 145

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Organic Acid Testing with Dr. Jeff Moss: Rational Wellness Podcast 145

Dr. Jeff Moss discusses Organic Acid Testing with Dr. Ben Weitz.

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Podcast Highlights

1:01  Organic acids are chemical compounds excreted in the urine that are products of metabolism. Organic Acid Testing has been validated by the medical community for many years to measure genetic inborn errors of metabolism, such as phenylketonuria, methylmalonic acidemia, and pyruvate dehydrogenase deficiency, among others. But today we are discussing the use of Organic Acid Testing by the Functional Medicine community to look for possible mold exposure, fungal or bacterial overgrowth, detoxification, oxalates, mitochondrial function, neurotransmitters, nutritional deficiencies, et cetera.

3:25  Organic Acid testing involves measuring acids that are metabolic intermediates.  In order to speed up these metabolic processes in the body, the body uses enzymes and most of these enzymes have vitamin or mineral co-factors. If the conversion of substance A to substance B is happening well, then you will have a normal amount of substance B. If you have a buildup of substance A, then that indicates the metabolic process is not working properly and it could indicate that there is a deficiency of a vitamin or mineral co-factor.  Or it could be that the enzyme is not working as well as it could because of chronic inflammation caused by a gut disorder or a chemical or metal toxin.  So organic acid testing is a way to test chronically ill patients to discover why they are feeling poorly and what we can do about it.

7:50  While organic acids is a nice test to run as a basic screen on chronically ill patients to help discover the cause of metabolic issues and chronic inflammation, it is fairly expensive and not covered by insurance, so it may be better used as a second line diagnostic after the usual diagnostic workup and treatment plan did not work.

9:58  Organic acids testing is a way to identify tissue levels rather than serum levels of nutrients, which is more relevant for assessing patients with chronic diseases, since these patients do not have gross malnutrition. Organic acids is a functional test, since it tells us how well the nutrient is helping the body to function.  Serum levels of many nutrients often do not indicate functional or tissue levels.

14:38   One of the organic acid markers is Formiminoglutamic acid, also known as FIGLU, which is a marker for intracellular folate.  You might have good levels of serum folic acid, but this doesn’t mean that your body can utilize it.  If FIGLU is elevated, it tells us that we need more folate, even if serum levels are normal.  We could be taking in folic acid from fortified foods, but this is not being absorbed and utilized.

17:39  Methylmalonic acid is a well validated functional marker for B12 status.  Serum B12 can be elevated if there’s chronic inflammation. And patients with SNPs like the C677T and A1298C mutations of MTHFR will have trouble absorbing forms of B12 like cyanocobalamin rather than methylcobalamin.

23:28  Organic acid testing for gut health.  While we do now have very accurate DNA stool tests now, like GI Map from Diagnostic Solutions, but the organic acids testing can be a screening tool, for example, that there might be a fungal overgrowth and this points out the need for such a stool test to target if there is fungal overgrowth and what type.  We have markers for fatty acid metabolism like adipate and suberate, which indicate impaired fat metabolism, and markers for impaired carbohydrate metabolism like lactate and beta hydroxybutyrate. The mitochondrial markers like citrate, succinate, fumarate, and malate are metabolites of amino acids. They are significant for mitochondrial dysfunction is they are elevated, but if they are too low they indicate that you are taking in too few amino acids or malabsorbing them.  You may need more protein in your diet or may not be properly absorbing protein, or a combination of the two.

30:24  Intermittent fasting and Beta Hydroxybutyrate.  Intermittent fasting may have some health benefits and too many folks are grazing or continually eating all day now. This results in insulin being secreted all day long, which is not that healthy and inhibits fat burning.  Chronic insulinemia is a factor in many chronic illnesses.  Beta hydroxybutyrate is a ketone body and if it is trending high, it indicates that you are getting good fat burning in a fasted state, which is a good thing. Also consider that this organic acid test is done in the morning after an overnight fast. 

35:06  HMG, Hydroxymethylglutarate, which is a precursor to cholesterol synthesis, can be very high for a patient on statins, which inhibit cholesterol synthesis.  or it could indicate inflammation.  If the HMG is low, it may indicate malabsorption or malnutrition, such as in the anorexic or the bulimic and the tendency for some older folks not to eat much or to skip meals, for a number of reasons. Dr. Moss finds that when possible he will ask the children of an older person if their mother or father is really eating well, since such patients may not be accurate at reporting their eating habits. If their HMG is low, they will also likely be low in CoQ10, since this is the same pathway that produces cholesterol. 

40:03  Neurotransmitters.  Organic acid testing includes markers for neurotransmitter status, such as homovanillic and Kynurenic acid.  These can indicate if patients are overly in sympathetic, stress mode, instead of in parasympathetic rest and relax state.  Neurotransmitters are derived from amino acids and organic acids are metabolites of amino acids like tryptophan such as Kynurenic Acid, Quinolinic Acid, Picolinic Acid, and 5-HIAA and the end points of some of these organic acids are the production of B vitamins. The 5-HIAA tells us how well are we converting tryptophan to serotonin.  But if people are chornically stressed, the tryptophan will be redirected to the kynurenine pathway.  If these organic acids are high, it is an indication of chronic inflammation and is also correlated with behavioral and neurodegneerative  disorders, like depression, bipolar disorder, anxiety, Parkinson’s disease, but most notably elevated kynurenine and the quinolinic acid have been highly correlated with Alzheimer’s and senile dementia profiles.  Another test that can be run to screen for the possibility of developing Alzheimer’s Disease the Alzheimer’s Linx Test from Cyrex Labs that looks for antibodies to see whether your immune system is starting to attack any of the tissues related to your brain function.

46:53  Toxins.  Organic acid testing can tell us about the pathways involved in toxin metabolism, though they are not a direct measure of any toxins. History can tell you a lot about exposure and then you can do direct testing for toxins. The hippurate pathway and the glycinate pathway are indicators of glutathione status and tell us how well we are metabolizing toxins.  If we are having problems making gutathione, this is usually related to not having enough sulfur, which is an underappreciated mineral. Sulfur is found in red meat eggs and if you follow a plant based diet, you may be deficient in sulfur. N-Acetylcysteine, Alpha Lipoic acid, and MSM can all be helpful for adding sulfur.



Dr. Jeff Moss is a former Dentist who became a certified nutrition expert and started and operates a professional line of nutritional supplements, Moss Nutrition Products. Dr. Moss speaks regularly around the world about various topics in Functional Medicine and clinical nutrition, including organic acids. He established the popular online course “Expanded Organic Acids & Amino Acids Testing”.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness Podcast listeners, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcasts and give us ratings and review. If you’d like to see a video version of this podcast, please go to my YouTube page, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today we have an interview with Dr. Jeff Moss on Organic Acid Testing. Organic acids are chemical compounds excreted in the urine that are products of metabolism. Organic Acid Testing has been medically validated for many years to measure specific genetic inborn errors of metabolism such as phenylketonuria, methylmalonic acidemia, and pyruvate dehydrogenase deficiency, among others.

But many in the Functional Medicine community have been using Organic Acid Testing to provide information for patients about possible mold exposure, fungal or bacterial overgrowth, detoxification, oxalates, mitochondrial function, neurotransmitters, nutritional deficiencies, et cetera.  Some use organic acids profiles on all new patients as an initial screening tool, so for example, I like to run on some of the patients Genova’s NutrEval as an initial screening tool to look for nutritional deficiencies and for metal toxicities, but this also includes organic acids as part of the profile.

There’s quite a bit of controversy about the validity of Organic Acid Testing for such uses, since at least some of these markers ranges as to what constitutes normal have not necessarily been sufficiently validated by scientific studies as some routine lab tests have been. To sort out the validity and benefits of Organic Acid Testing as well us to provide us with some interesting pearls about what some of these metabolites mean, and how they can help us manage patients, I’ve asked Dr. Jeff Moss to join us today.

Dr. Jeffrey Moss is a former Dentist who became a certified nutrition expert and started and operates a professional line of nutritional supplements, Moss Nutrition Products. Dr. Moss speaks regularly around the world about various topics in Functional Medicine, clinical nutrition, and including about organic acids.  Dr. Moss, thank you so much for joining me today.

Dr. Moss:             Thank you so much for having me.

Dr. Weitz:            Good. What are organic acids and how are these best measured?

Dr. Moss:             What are organic acids? Number one, they’re exactly what the word says, they’re acids. Many of the people you work with, we work with are familiar with the idea of… and measured in urine, the idea that you check the pH of the urine and for the most part, we’re trying to see if their urine is too acid.  Measuring urine acidity is a quantitative measurement, if you will. What organic acids tell us is, it’s qualitative. In other words, if your urine is too acid, what is it in the urine that made it acid? So you’re basically measuring the acids in the urine that made the acid urine acid. So that’s basically what it is, what an organic acid is.

As you mentioned beyond that, they are metabolic intermediates, if you will. Basically, what the body does in the course of everything it does, millions, maybe billions of times of the day, is convert substances, metabolism. You have substance A and it’s got to be converted to substance B, that’s basically it.  And if you just put substance A in the test tube and let it sit at room temperature, it happens real slow. And so the body to speed it up uses two things. Number one, with an enzyme, and most of these enzymes require a nutrient co-factor, a vitamin or mineral co-factor to speed it up.  So if the enzyme isn’t working properly or you’re lacking the co-factor, the nutrient co-factor or both, you won’t get enough for the A going to B, and so you get a buildup of A. That’s what you’re measuring, is there’s too much of A and not enough B. That’s basically what you’re doing with it.

Also with this ID, if you have too much of A for example, the assumption has been made by the designers of the Organic Acids Test and the profile that I use, is the one from Genova where actually came from Metametrix originally. This is back in the ’90s in the work of Richard Lord and Alexander Bralley, Andy Bralley. They came up with the initial profile, and as you said they basically extrapolated existing literature.  Now, traditional thinking was that you couldn’t convert A to B, it was due to a hardwired genetic defect of the enzyme called inborn errors of metabolism. And when you see this hardwired defect in the enzyme, a SNP, if you will, usually people get very sick at a very young age and sometimes die.

Is it a black and white issue? Can you have varying shades of gray? In other words, yes, the enzyme is working perfectly or no, it’s not working at all, like an inborn error of metabolism, you can have a situation where the enzyme may be working less perfectly, it working at 50, 60, 70% and that you may be lacking in the nutrient cofactor.  And so when they noticed that and the research on that, they said, “Well, there’s a lot of sick people, the enzyme is working, but it’s not working as well as it should–usually due to lifestyle issues and it may be lack of the nutrient cofactor.” But they also know that maybe it’s not working as well as it can because of maybe chronic inflammation caused by some type of a gut disorder, or maybe it’s a toxin, a chemical or metal toxin.  Maybe they’re not eating enough protein, or maybe it’s psychological stress. All of them can affect this enzyme activity.  And so what they devised is a test where we can measure these different acids, the As, if you will, and the Bs, and from that we can get some idea of really why people… mainly chronically old people, why they’re feeling poorly and what we can do about it.

Dr. Weitz:            Okay. Do you like the idea of using organic acids as a first-line test? Or do you think it’s better used as a test later on? Or can it be used as either depending upon what you’re looking for?

Dr. Moss:             From a strictly clinical academic point of view, you can use it for either, but there is a practical aspect to it, and that is that the test is fairly expensive and rarely if ever covered by insurance. So there are the practicalities, but dismissing the monetary issues, would it be ideal to run it on every single patient, particularly those who are suffering from chronic illness, they’ve gone from sometimes pharmaceutical type therapies and not getting results, basic nutritional therapies and not getting results.  Certainly, it would be great to do what on every patient to detect as you suggested, are there some nutrient deficiencies that were missed with your usual basic clinical workup that you may have instituted therapies, they didn’t work. So what did you miss from a nutritional standpoint. The NutrEval organic acid is excellent first-line test basically fine tune the nutritional program.

But beyond that it’s also very good for finding these other metabolic issues, chronic inflammation. But from practical standpoint, most of the clinicians that I work with do not do this as a routine test strictly because of the practical aspects. They’ll do their usual diagnostic workup and treatment plan, and then what doesn’t work, they’ll tend to use it as a second-line diagnostic to basically answer the question or the patient didn’t respond, what did we miss?  Was it a nutrient deficiency? Was there some toxin?  Was there a gut problem?  Maybe underappreciated psychological stress?  All that can be found out with the organic acids and used as a second-line test.  You can be use it either way.

Dr. Weitz:            So with respect to looking at nutritional deficiencies, what are some of the advantages of using an Organic Acids Test versus using serum test for vitamins and minerals?

Dr. Moss:             Basically we have to understand the people that we are dealing with is that they don’t have acute illness for the most part, they’re chronically ill and they’re not in a gross malnutrition type situation. We’re not dealing for the most part, although some practices maybe dealing with-

Dr. Weitz:            They don’t have scurvy or beri beri…

Dr. Moss:             Exactly right. And that’s the main value of serum testing is to tell you about gross deficiency. Most of the nutrients do not stay in the serum very long, and so even if they are nutrient replete, it’s very time sensitive in terms when you measure it. And to see gross deficiency, they’d have to be significantly undernourished, which we tend not to see.

Dr. Weitz:            I think the point you’re making right there is that there are a few nutrients like Vitamin D that you can measure serum levels and you get a pretty good idea of what the tissue levels are, but for a lot of other nutrients, serum levels really are not a good gauge of the amount of nutrients that are in your tissues and your real need for those nutrients. For example-

Dr. Moss:             Yeah.

Dr. Weitz:            … blood calcium levels are always going to stay in a very narrow range, even if the person-

Dr. Moss:             Exactly.

Dr. Weitz:            … is osteoporotic and definitely can use a lot more calcium. Ditto for serum of B Vitamins, a lot of times the serum levels are not really accurate of what the tissue levels are and what the real needs of the person are.

Dr. Moss:             But there’s another big X factor that is really underappreciated, and that is, as you know that most chronically ill people, what do they share in common? Chronic inflammation.

Dr. Weitz:            Right.

Dr. Moss:             And what we know, the literature is very clear that chronic inflammation will alter a serum levels of virtually every macro and macro nutrient. And so if you’re inflamed, the blood will never be a true indicator of dietary intake, either too much the right amount or too little. And that’s the beauty of organic acids, it’s what we call a functional test.  What we really want to know is… We basically can assume they’re not grossly deficient. What we want to know is are they taking any enough for the particular problem we’re trying to address, and maybe they are taking enough, but the question is, all right, they’ve eaten enough, we know it was absorbed, the question is, did it go where we want it to go?  And healthy people, that’s not really an important question, but in sick people it is an important question, did it go where we want it to go? So we want to know how was it metabolized? And that’s the beauty of organic acids. We call a functional test, it tells us how well the body is functioning to utilize the nutrient. Is it really going where we want it to go to solve the problem and organic acids superior over our blood?

Dr. Weitz:            And also for patients who are coming to us for anti-aging programs, we want to know, not just have they resolved a frank deficiency, but do they have optimal levels to function at their highest level? And this is one way to look at metabolic pathways to see if they’re functioning at that optimal level. Right?

Dr. Moss:             Precisely. Aging itself is going to make people more prone, for example, to inflammation. There’s going to be aging impact on renal function, all of which can have an impact. So just by the fact of aging, you’re going to utilize it, I won’t say not as well, but differently. Are you utilizing it well enough to accomplish what you want to accomplish?  Again, maybe it’s a chronic illness, maybe it is anti-aging, optimizing wellness, we still want to know how well is the body using anti-age organic acids is a superior tool for that.

Dr. Weitz:            When it comes to nutritional deficiencies, one of the markers that I see when we run the NutrEval is formimidoyl-glutamic acid, also known as FIGLU, right?

Dr. Moss:             It’s called FIGLU because nobody-

Dr. Weitz:            FIGLU.

Dr. Moss:             … can pronounce that. Just say FIGLU. We all say FIGLU.

Dr. Weitz:            So this is a marker for intracellular folate.

Dr. Moss:             Yes.

Dr. Weitz:            So how does this correlate with serum folate levels and what is this telling us?

Dr. Moss:             Serum folate is very good for gross deficiency or excess because folate is actually interesting because of food fortification, many people are getting excess intake of folic acid in their diet and there’s a whole body of literature on that excess intake of folic acid.

Dr. Weitz:            Which is different than folate.

Dr. Moss:             Exactly right. And that’s another common misconception, misunderstanding that food folate is what we find in our green leafy vegetables. What we find in processed food is a synthetic compounds called folic acid that happens to act very similar to food folate in small amounts. In large amounts, over 400 micrograms a day, the body can’t metabolize it. You get unmetabolized folic acid, which is considered to be, I guess for lack of better word, a toxin.

Dr. Weitz:            Yes.

Dr. Moss:             It is an enzyme inhibitor. And so a blood can fool us because of that, but what we want to know again, with the organic acids with FIGLU, it can tell us how well the body is utilizing what it’s taking in. And so if we see FIGLU elevated, it tells us, “Oh, it’s not metabolizing folate correctly.” Is it an issue of just the need to eat more?  Maybe there was a malabsorption issue, maybe they’re taking in the wrong kind. They’re taking in too much processed food and not enough whole foods and getting the whole folate. Organic acids can help us make these subtle distinctions on how to proceed.

Dr. Weitz:            And this can also help us with piece into may have problems with methylation issues since-

Dr. Moss:             Exactly.

Dr. Weitz:            … some of us are doing genetic testing and looking for MTHF SNPs, and COMT SNPs, and these can affect methylation and.

Dr. Moss:             Yeah, you bring up another good point. We’re bringing a whole issue of very common SNPs with methylation pathways. In these circumstances, the individual may need more than the usual RDA or whatever it is. And so if this is a functional measurement if we see this SNP, we may have to give larger doses.  Maybe the individual, the patient didn’t respond because we didn’t give enough because we didn’t understand their polymorphism and the SNPs, and organic acids can help us understand those subtleties.

Dr. Weitz:            Right. Another marker which I think has been pretty well validated even from medical perspectives is methylmalonic acid, which is a marker for B12 status.

Dr. Moss:             Yeah. When that’s elevated there is an enzyme that converts B12 to what is known as succinic acid and the enzyme is absolutely vitamin B12 dependent. And so if there’s not enough B12, and again, I emphasize enough, either because you didn’t take in enough, it wasn’t absorbed well enough or wasn’t metabolized correctly, the methylmalonic acid will tend to go up. That’s correct. So it’s a good functional indicator for B12 metabolism need issues,

Dr. Weitz:            And really a better marker than serum B12, which is often-

Dr. Moss:             Yes.

Dr. Weitz:            … run.

Dr. Moss:             There’s a lot of interesting research on serum B12 and that one of the risks is not when it’s too low, although that can be an issue, but there’s a lot of information. The serum can go too high mainly due to inflammation. High serum B12, which you see fairly often is a good indicator that there was a chronic inflammation that wasn’t fully appreciated.

Dr. Weitz:            It’s funny, one of the panels we’ll do sometimes include some serum markers and we often see B12 high-

Dr. Moss:             Yes.

Dr. Weitz:            … but even patients who have high homocysteine, meaning that they really need more B12.

Dr. Moss:             Yeah. In this case, they need B12, but there’s also an issue of metabolism of B12. Some of these people already taken large amounts of B12 and not getting results because there was some type of metabolic issue. It may be a SNP, as you mentioned.  There may be inflammatory issues that are going on.  It could be a toxin that can act as a major enzyme inhibitor.  So yeah, you can see even the elevations and stare at B12, even though they’re taking in a fair amount because there’s these metabolic issues.

Dr. Weitz:            Or they could be taking the wrong type of B12-

Dr. Moss:             Correct. Yes, absolutely.

Dr. Weitz:            They might be taking cyanocobalamin which is actually… includes a small amount of cyanide with their B12 in instead of a methylated form of B12, which is easier for people with certain SNPs to be able to absorb.

Dr. Moss:             Yeah, your point is a well made in that we now understand that the old thinking was the synthetic forms of many of these vitamins. They’re good enough, they’re cheap, readily available, and so folic acid, cyanocobalamin, it’s good enough. And maybe it is in healthy populations, but we get into chronically ill populations, aging populations, they really need a supplement that is more, if you will, bioidentical to what’s in the food.  And as you mentioned, a methylcobalamin is a bioidentical to B12.

Dr. Weitz:            Or people who have any of these SNPs that make it more difficult for them to absorb standard B12, and now we’re learning that a huge percentage of people have at least some of these genetic variations that make it difficult to absorb some of these B vitamins.

Dr. Moss:             Yeah, extremely common now. The MTHFR SNP is considered to be about 25% of the general population. In certain populations, there are some very interesting and controversial, research suggested may even higher. The autism spectrum community suggested that it’s even more prevalent, although that’s very controversial, but the research is certainly compelling, if you will.  So yes, very common and really needs to be taken into account for more and more people.

Dr. Weitz:            Yeah. I think it’s more common than 25% for them to have at least one of them.  And especially if you run a number of these MTHFR SNPs because there’s one or two that are typically offered, but there’s actually about 15 of them.

Dr. Moss:             Yeah, exactly right.  MTHFR is getting the most publicity, but certainly there can be a lot of different SNPs in these nutrient metabolism pathways. Absolutely, you’re right.  And so these profiles are really giving us a much better idea of what’s going on.



Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.



Dr. Weitz:            So let’s go to organic testing for gut health.

Dr. Moss:             Okay.

Dr. Weitz:            What do you think is some of the most significant things we can learn about gut health from organic acids?

Dr. Moss:             Organic acids right now with… we have to look at it in terms of the newest generation of DNA-based stool tests. The old type of stool testing, which was called culture testing-

Dr. Weitz:            Yes.

Dr. Moss:             … you basically take a stool sample and try to culture out the organisms was okay at best. On those days, what we saw on organic acids was probably the best out there. It was not good enough to help us determine specific organisms that may be overgrowing or in the wrong place, like ESBL, small intestinal bacterial overgrowth situation, but it could give us a good general idea that there may be dysfunction in the gut.  With a new generation of DNA tests, stool tests now, that is the preferred way to really determine the nature of a chronic GI dysfunction. The Organic Acids Test is good for gut, but would I recommend running organic acids for gut?  No, I just say, spend the money on the stool, the newer generation of DNA-based stools test.

Dr. Weitz:            Now on the other hand, if you do an Organic Acid Test as part of your screen and it indicates there might be some fungal overgrowth, for example, then you could do a stool test to really narrow that down.

Dr. Moss:             Precisely, yes. Your point is well made, it’s a good gross screening tool. Is it accurate enough and definitive enough to tell us specifically what needs to be done in terms of lifestyle or recommendations for specific supplementation? Really, no. Yeah. You’d run the stool analysis and that’ll give you a definitive idea of what you’re dealing with so you can be much more targeted on your therapies.

Dr. Weitz:            Right. Now, I know there’s certain markers for malabsorption. What do you think about the validity of that? Because that’s not something that you necessarily get from other testing.

Dr. Moss:             Yeah. Many of the markers are good indicators of malabsorption. Certainly, the gut section specifically is suggestive for malabsorption. But I think the sections that are underappreciated are the the mitochondrial sections, the sections that relate to mitochondrial function-

Dr. Weitz:            And so cellular

Dr. Moss:             … which would be the fatty acid sections, adipate suberate, the carbohydrate metabolism sections, pyruvate lactate, beta hydroxybutyrate, and particularly the mitochondrial section. One thing we often underappreciate that was brought up to me about 10 years ago was that all of these mitochondria metabolites are metabolites of amino acids.  And therefore, generally speaking, the thinking has been they are only significant if they’re too high. But if you’re taking in too little amino acids or you’re malabsorbing amino acids, there’ll be too low. And this is an area that I’ve really emphasized in my courses, in my teaching that traditional thinking with a Genova profile was that the low values tended to be insignificant, the first quintile.  The literature suggests just the opposite. When you seek kind of everything trending low, one of the things you have to find out, number one, are they getting enough protein in their diet, and many people are not getting optimal amounts or is there a protein malabsorption issue, which is also very common or a combination of the two?

Dr. Weitz:            Yeah, there seems to be a lot of controversy in the nutrition world right now about protein as the plant-based documentaries are proliferating especially all over Netflix and you’re hearing from advocates of a plant-based program that you get plenty of protein in spinach and just eating vegetables, and there’s really no need for concentrated sources of amino acids like from animal products.

Dr. Moss:             My position on that is I understand the need to have generalizations for population recommendations, but I’m a clinician, I deal with one person at a time. And so my mind defaults to what is right for this particular person, and I find I can judge best by checking all my agendas at the door, plant versus animal.  I find some people do better on an animal-based, the right amount. Too much of anything is bad, but optimal amounts, some people do better on animal, some people do better on plant, some people do better on more of a Mediterranean blend of plant and animal. I tend to think of what is right for the individual, and so I find in terms of treating individuals, generalizations I find hurt more than help.

Dr. Weitz:            To be honest, I totally agree. In fact, I think the time for these broad-based generalizations for recommended diets for the entire population, I think we should be past that. The time for biochemical individuality is here and I think we shouldn’t be recommending the one best diet for the whole culture or society.

Dr. Moss:             Yeah. We are on the same page on that, biochemical individuality, everybody is a different, and yes, I think trying to convince one size fits all is really a big disservice to the population.

Dr. Weitz:            Yeah. I remember going to Jeffrey Bland seminars 25 years ago, talking about biochemical individuality, but I think the time is really here now, instead of trying to find the best recommended diet for everybody, let’s find what program’s going to be best for each individual.

Dr. Moss:             Exactly right. I was at those seminars and profoundly influenced me, and I’ve really been on that page ever since Bland talked about it, that we have to look at everybody as an individual, not as someone who has to fit into our agenda.

Dr. Weitz:            Give us some pearls about energy metabolism and mitochondrial status from organic acids.  What are a couple of tests that and what steps can we take to optimize a person’s health on the basis of that?

Dr. Moss:             Sure. I think right now where I have been most influenced, like many of us, I’m sure you’re familiar with what is known as intermittent fasting.

Dr. Weitz:            Sure.

Dr. Moss:             The idea not so much of what you eat, but when you eat it.  And the idea is that to maintain optimal health, we have to have two basic energy periods.  We have what is known as the postprandial right after the meal, which is what we call insulin mediated. In other words, we eat something, maybe a carbohydrate, but any food and we have a shot of insulin, which is designed to stimulate conversion to various factors such as pyruvate…

Dr. Weitz:            By the way, when you say a shot of insulin, this is not something you’re drinking.

Dr. Moss:             No, no, no. You’re right. The body makes that-

Dr. Weitz:            This is something being secreted by your pancreas.

Dr. Moss:             Right. No, no, exactly. This is already… I don’t want to give the wrong info… Basically, you get a little squirt of insulin from your pancreas literally. And the food is metabolized, and this is what is known as postprandial metabolism. But then we are supposed to have a period, what they call fasting metabolism, where fat is broken down, protein is broken down, including muscle, and those are converted to energy also.  Now, if that goes on too long, we’re going to lose too much fat or lose too much protein, but then we have the next meal. So it’s supposed to be this continual ebb and flow, but what we see in many people of course, is they’re grazing, they’re continually eating, constantly secreting insulin.

The one indicator that we look at in terms of is that eating too much, if you will., there’s an indicator called beta hydroxybutyrate, it’s a ketone body. Now, this is a fasting test. It’s a fasted test.  In other words, you stop eating and then you take the urine sample, the first thing the next morning.  In a healthy situation, we want good fasting, fat burning metabolism, and so we want to see that beta hydroxybutyrate trending high, trending high, so we know that we’re getting good fat burning because that’s the… 

Dr. Weitz:            By the way, this is the same thing that people are measuring when they’re doing a ketogenic diet and they want to see that they’re actually burning ketones.

Dr. Moss:             Yes, exactly right. And so the beta hydroxybutyrate is a ketone. It’s an excellent measurement if you’re burning fat well. So right now in terms of two things, number one, are you burning fat well, but also, if your beta hydroxybutyrate is high, that means the insulin is not high. If you get excess insulin production, you’re going to get production of energy and other pathways, the lactate will tend to be high. The pyruvate will tend to be high, the beta hydroxybutyrate will tend to be a little bit lower.  And now this chronic elevation in insulin called hyperinsulinemia is now considered to be a primary factor in all kinds of chronic illness, a tremendous amount of research is going on now looking at what happens when we’re eating all day, constantly stimulating insulin production.  So right now I’d say in terms of a general health, dietary recommendations, I’m looking at that beta hydroxybutyrate and if I see it not a little bit high, I’m wondering if you’re eating too much, not having a long enough fasting period.

Dr. Weitz:            Okay. And what about any of the other markers for energy metabolism? What can you tell us about… And by the way, do any of these markers for mitochondrial function, has there been research to correlate these with like muscle biopsies to assess mitochondrial function? What kind of validation has there been for some of these markers?

Dr. Moss:             Good point. These specific mitochondrial markers on the profile, citrate there are several of them. Lord and Bralley in their book looked at several different scenarios. And from a practical clinical standpoint, the scenarios can be they’re so numerous and so confusing that it’s really hard to apply them clinically in my experience.

Dr. Weitz:            Okay.

Dr. Moss:             So I’m looking for trends. I’ve looked at the literature and when you tend to see all these mitochondrial markers trending high, you’re thinking about chronic inflammation, not making conversions properly. They’re being inhibited usually by inflammation. Trending low, I’m thinking about deficiency or a malabsorption issue of amino acids.  Now, there are some specific markers that can be looked at for other scenarios. The HMG, which is a precursor to cholesterol synthesis, that can be very high on a person on statins because it inhibits cholesterol synthesis.

Dr. Weitz:            Oh, interesting.

Dr. Moss:             So that can be a useful. Citrate, we need a certain amount of citrate in our urine to-

Dr. Weitz:            One more time on the HMG because that’s one I’ve never really paid any attention to it-

Dr. Moss:             Okay.

Dr. Weitz:            … if I happened to be looking at NutrEVal here. So say it again. HMG is a precursor for cholesterol synthesis …. and what’s being blocked by statin drugs. Right?

Dr. Moss:             That’s exactly right. And so if you’re taking a statin drug, they can’t make the conversion, the HMG will tend to go up. So if you see high HMG, you want to rule out statins, that’d be one clinical pearl certainly.

Dr. Weitz:            Or red yeast rice.

Dr. Moss:             Yes, correct. Typically, red yeast rice, when taken the in the correct dosages is more metabolically kind, if you will. It doesn’t have that gross effect that a statin drug would. But yes, if they’re not using it correctly, you could see it with red yeast rice.

Dr. Weitz:            Okay. And then if it’s low.

Dr. Moss:             If it’s low, again, you’re thinking about this issue of deficiency of precursors, malabsorption, malnutrition. Very often the people I encounter, either my patients in my small practice or people who are referred to me from my customers are older patients where malnutrition… Shouldn’t say mal, sub optimal nutrient intake or malabsorption is incredibly common.  Older people for many reasons are not eating well, they skip meals for a variety of factors.  One of the things I find that’s often missed when they analyze diets, they’ll take a look at the nutrient content and very often the nutrient content will be excellent. What they forget to do is ask how much did you actually eat? And sometimes you have to ask the kids. “Yeah, I know what you put on the plate, how much on the plate did mom actually eat? Add it up.”  And so this is where we get fooled very often older populations, the quality is good and we know there was enough but on the plate, but they aren’t finishing their food and they get into a malnutrition issue, which can be exacerbated by malabsorption, very common in older populations.  And so if we see mitochondrial indicators trending low and I asked the question, “Oh, tell me about your diet.” And, “I’ve already done that,” and I hear about the high quality, the broccoli and the fish, I hear about all that. But then my next question is, “How much did you eat?” And the patient, “Oh, I eat fine.” And then if available, I ask the kids, “How well does your mother eat?” “Oh, she doesn’t eat at all.” She’s always skipping meals.

Dr. Weitz:            And of course that HMG, and so now we’re talking about the anorexic, the bulimic, the undernourished… 

Dr. Moss:             That’s what I find the mitochondria indicators most valuable for is these general trends.

Dr. Weitz:            And so that HMG pathway, which produces cholesterol is also the pathway that produces coenzyme Q10-

Dr. Moss:             Yes, 

Dr. Weitz:            … so if they don’t have enough HMG, they’re not going to produce CoQ10, and that’s a super important mitochondrial nutrient.

Dr. Moss:             Yeah, very good point. Very misunderstood, underappreciated is the need for coenzyme Q10 and the body makes it. And yeah, we need these nutrient precursors, and again, it’s underappreciated that certain populations, suboptimal intake is extremely common.

Dr. Weitz:            So if that HMG is high though and they’re not taking a statin, and they also have high cholesterol, then that would be a clear correlation of something going on, right?

Dr. Moss:             Sure. Something is going on. Again, the most common thing in the ailing population is going to be looking for a chronic inflammation. They can’t make the conversions, the inflammation is a major enzyme inhibitor. It’s a common thing, and the next thing would be a chemical or metal toxins acts as enzyme inhibitors.

Dr. Weitz:            Right. Now organic can also be markers for neurotransmitter status.

Dr. Moss:             Yeah.

Dr. Weitz:            What can we learn about this?

Dr. Moss:             Oh, this is a really one of the most important sections for me mainly because when I were trying to help people who are not responding, one of the things we tend to under-appreciate or sometimes the patient can hide it is the impact of psychological stress, worry. Well, just thinking about stuff all day and this kind of PTSD type scenario where just everything reminds them of something bad. And so-

Dr. Weitz:            Being in sympathetic mode the whole day.

Dr. Moss:             Exactly right. And so-

Dr. Weitz:            Not spending enough time in parasympathetic rest and relax state.

Dr. Moss:             Right.  You’re right.  And so the indicators the homovanillic, there’s a couple of other indicators out there.

Dr. Weitz:            Kynurenic acid.

Dr. Moss:             Yes. They first two indicators in that profile are indicators of catecholamine metabolism, and in many people they tend to be on the high side and that would indicate, oh, we were dealing with a stress situation, the sympathetic nervous system is just being turned on too often, most often due to chronic worry, and thoughts, and negative thinking.  The other section, the other indicators and there relate to the serotonin mediated pathways or more precisely the tryptophan meted pathways. Almost all the neurotransmitters are derived from amino acids. The catecholamines are from the essential amino acid, phenylalanine, and we’ll see how well they’re converted, but the others the kynurenine, quinolinic acid, picolinic acid, 5-HIAA, these are all tryptophan metabolites.  Now the 5-HIAA tells us about how well are we converting tryptophan to serotonin. Now, tryptophan actually can go in two major directions and it has to do both for good health. We all know about the serotonin direction. We want some tryptophan to go to serotonin. Serotonin is like the life is good neurotransmitter. Everything’s fine, no problems.

The problem is people chronically stressed, they’re inflamed, they’re worried or they have other stressors such as poor diet, or toxins, or whatever, the body is in a stress response scenario, and so the body says, “Well, life is not good.” So the body says, “Well, we’re not going to take tryptophan over to serotonin and melatonin because it’s not time to sleep. We’re worried, we’re stressed. We have to get into the reaction phase, the worry phase.” And the tryptophan is redirected to what is known as the kynurenine pathway.  And there’s several indicators on organic acids that can tell us about this is how much the tryptophan is going down this other pathway. Now, it’s not a bad pathway, it’s supposed to be there. The end point of the kynurenine pathway is the production of niacin, B3. So it’s supposed to be there.

But with chronic stress, toxins, et cetera, we can get too much going down this pathway, and the big one we’re looking at is the quinolinic acid because this is not only an indication of inflammation, it’s an also a good indicator of neuro-degeneration. It’s a neuroexcitatory metabolite and that has been highly linked with virtually every behavioral and neurodegenerative disorder you can think of from depression, bipolar disorder, anxiety, Parkinson’s disease, but most notably elevated kynurenine and the quinolinic acid have been highly correlated with Alzheimer’s, senile dementia profiles.

Dr. Weitz:            Wow. Interesting.

Dr. Moss:             Somebody says, “My father got Alzheimer’s disease at 60 and I’m 40. Is there any way that you can tell me that I’m more prone to heading in that direction?” This is a good early screen. Now it’s not 100%, but it can basically say, “All right, you’re heading down this pathway and…” but most people think, oh my God, just write your will, it’s all over.  No, this pathway tends to be elevated because of lifestyle issues. And so this is one of the things that is misunderstood. Alzheimer’s disease is not a hardwired genetic disease. Maybe 5% of the population is hardwired genetic. The research is clear, this is mainly a lifestyle disorder.  So we see the elevated kynurenine and the elevated quinolinic acid, all right, you’ve got a tendency, but if we can change your lifestyle, good self meditation, exercise, stress management, we can easily change this to a more health producing pathway, most health promoting scenario.

Dr. Weitz:            So what particular factors are these quinolinic acid and kynurenic directly related to in terms of lifestyle diet?

Dr. Moss:             They go up because of inflammation.

Dr. Weitz:            Right.

Dr. Moss:             So anything that’s causing inflammation and everybody’s different. Somebody, it may be due to a poor diet, somebody it’s due to a toxin. Infection is a big factor. What are the things that we often miss is we understand the infections like Lyme disease and viruses we’re all hearing about now, but some of the infections that are most underappreciated are the infections that we get in our gut.

Dr. Weitz:            Right.

Dr. Moss:             Chronic low grade dysbiosis, chronic pathogens are often due to over use of antibiotics, and this can be immensely pro-inflammatory. And so we see this elevation, one of the things you may want to check out, did we miss something in the gut?

Dr. Weitz:            Right? And this is where a good stool test like the GI Map from Diagnostic Solutions can be helpful.

Dr. Moss:             A big fan of that test.

Dr. Weitz:            You were talking about what can we do to screen for the possibility of Alzheimer’s and I wanted to mention that Cyrex Labs has an awesome test called the Alzheimer’s Linx Test that looks for antibodies to see whether your immune system is starting to attack any of the tissues related to your brain function.

Dr. Moss:             Oh yeah. Cyrex is great, these antibodies are really wonderful. And certainly if we see these trends on a basic organic acids screen, yes, we’d want to go ahead and do additional testing to gain more information, and we’d do that with Cyrex. Absolutely.

Dr. Weitz:            Right. Now the last area I’d like to touch on, you mentioned toxins and organic acids can give us some information about toxins as well. So can you talk a little bit about what we can learn about exposure to toxins from an organic acids test?

Dr. Moss:             Sure. What we measure in the organic acids is not the toxins per se, but the enzymes and, I should say, the pathways involved in toxin metabolism. And for many people, this is really more important than knowing the toxins. For most people, what do we know about toxic exposure? That for most people it’s the same as everybody else, we live in a toxic world.

Dr. Weitz:            Right. We’re all getting exposed.

Dr. Moss:             We’re all getting basically the same amount, but this particular person for whatever reasons seems to be less able to handle the load that everybody else can handle, and what do we-

Dr. Weitz:            This person gets sick where somebody else is exposed to the same thing as him.

Dr. Moss:             The soap everybody else uses with no problem, this person reacts to the soap, they get headaches from the perfume. Why are they reacting to something that most people don’t react to?

Dr. Weitz:            Right.

Dr. Moss:             And what we’re learning-

Dr. Weitz:            You have mold in a household and one family member gets really sick and so many other family members don’t.

Dr. Moss:             Right. So why are they reacting is the key question. Obviously, practicalities aside, it would be great if we can just eliminate all the toxins, but from a practical standpoint, it’s just not going to happen. The world’s not going to get any cleaner anytime soon. And to tell people, “You’ve got to completely rip out all your dry wall, repaint, new carpeting, $10,000 filtration system,” not really practical for most people.  So we want to focus on how can we better and help them improve their ability to metabolize of the toxins. And so the indicators, these glutathione indicators, we can look at these… this one is a hippurate pathway, glycinate pathway, all help us, tell how well are they metabolizing these toxins.  Now, history is very important. Very often if we’re dealing with an occupational situation, occupational exposure, that’s entirely different, they work with it. A dentist working with mercury, people who work in beauty parlors, nail salons, these are occupational exposures where history is going to be an important indicator.

But for the person we can’t find any obvious source of excess exposure, organic acids will tell us, “All right, you’re having a problem with metabolizing.” Is there a nutrient problem? Are you getting enough sulfur in your diet, which mainly comes from protein. Maybe they need some supplementation for that.  There is the other amino acid pathways that are underappreciated involved in detoxification, known as the glycine pathway. Very important in this pathway particularly-

Dr. Weitz:            What role does the glycine pathway play in detoxification?

Dr. Moss:             That is involved in detoxification of key solvents such as taurine in particular that taurine type compounds are very common solvents in cosmetics for example. Now, this is one of the things that I know very often female patients don’t want to hear about, but sometimes we have to talk about this is that I’m sick, we’ve ruled out the usual things, so I like to ask about the unusual, and I ask the question.

I know they don’t want to hear, “Tell me about your hair dyes and your cosmetics,” which commonly have these solvents in there. So if I see elevations of the hippurate pathway, the glycine pathway, I’m thinking about, are we getting excess exposure from solvents that can be found in things like hair dyes and cosmetics.

Now obviously to tell a woman, “You can never do that again.” That’s impractical and on harsh. We don’t want to be cruel. So what can we do to maybe create more reasonable utilization, but along with improving lifestyle supplementation to improve these detoxification pathways so that to a certain extent they can use the things, these cosmetics they’re used to, but at the same time get better health. That’s how [crosstalk 00:51:18]-

Dr. Weitz:            How can you promote the glycine pathway? Is that through taking glycine or?

Dr. Moss:             It’s interesting, the body makes glycine. It’s a non essential amino acid and so it’s been virtually ignored because the body makes it, but the literature is now is showing in certain selected individuals, particularly those who are having a toxic challenge, they’re not making enough. And so yes, using a glycine supplementation has been very impressive in the literature for these detoxification pathways. Sure.

Dr. Weitz:            What other supplements can be beneficial if we see problems with detoxification pathways?

Dr. Moss:             The big one that we see, the alpha hydroxybutyrate and the pyroglutamate, these are indicators for glutathione. And the big thing with glutathione is that we’re not getting enough sulfur. Sulfur is really an underappreciated mineral. Traditionally, according to the literature I saw was basically ignored by the research community for the simple fact sulfur is very common in red meat.

And in the early days when they were doing the research, nobody ever thought you could ever be too low in sulfur because everyone’s seeing too plenty of red meat. But now we’ve gotten people to stop eating red meat and we’re seeing more and more sulfur deficiencies because there’s not a lot of sulfur in a plant-based diet. And what is in there is very hard to digest and absorb.  So sulfur deficiency is becoming much more common, so we’re looking at the supplements in this case like N-Acetyl Cysteine, alpha-lipoic acid, methylsulfonylmethane (MSM) can be very helpful in this situation.

Dr. Weitz:            Interesting. So I normally think of NAC as a precursor for glutathione, but you’re saying it also supplies sulfur, which helps with that whole detox pathway as well.

Dr. Moss:             Absolutely. Yeah, it certainly is great for building glutathione. And many of these people have two… There’s two indicators there; one, the alpha hydroxybutyrate tells us how well they’re making it, and the pirate glutamate… Glutathione basically you use it, what known always reduced unused glutathione, the GSH and the body converts that to oxidized or used glutathione.  And what the body is supposed to do, it wants to conserve it. It’ll take that used glutathione and convert it back to unused, the GSH converted, and there is an indicator called pyroglutamate. If that’s too high it tells you’re not recycling glutathione very well, so you’re not using your sulfur well.  And the other extremely important indicator is the urinary sulfate, which is often too high in the chronically ill people, and what that tells you basically is you’re peeing out all your sulfur. Certainly you want to do things to help improve metabolism, with these indicators, it tells us we’re probably going to need more sulfur supplementation and a diet that is a more replete in healthy sulfur resources.

Dr. Weitz:            And what would be the healthy sulfur sources?

Dr. Moss:             Number one, I know I sound [crosstalk 00:54:36] politically correct, but a meat-based or an animal-based diet. Too much of anything is bad, but good quality variety of protein sources. When I say red meat may be good, I’m not saying every day, and not saying go to your fast food restaurant. What I’m saying is if you can-

Dr. Weitz:            Live a carnivore diet.

Dr. Moss:             Yeah, a good quality source. If you go to the farmer’s market and they have these grass-fed cuts of meat, the local and eat that maybe once or twice a week, and maybe a couple of meals a week or a couple times a week, you’re going to have a plant-based diet, and then a fish-based, and then eggs, so variety.  Eggs are a very good source of sulfur. That’s a really good way to get good sulfur in your diet without getting into any overload situations. And then of course the supplementation is very helpful.

Dr. Weitz:            Why wouldn’t somebody recycle their glutathione?

Dr. Moss:             The big X factor, I keep on coming back to it is because it’s underappreciated, inflammation.

Dr. Weitz:            Inflammation.

Dr. Moss:             Inflammation is such a massive enzyme inhibitor, virtually every enzyme you can think of so why… And again we know they’re inflamed, our job is to do is that why, why are they inflamed? What did we miss? Was it a toxin? Were they worrying too much? Are they getting enough sleep? Are they spending up to 2:00 AM on the computer? All pro-inflammatory, we just have to weed that out and make proper recommendations.

Dr. Weitz:            That’s interesting. So maybe we’ve done a CRP and that’s normal, but this is still telling us that there’s inflammation that’s not being picked up by the CRP.

Dr. Moss:             Yeah. It’s been thought that C-reactive protein is kind of like a universal indicator and very sensitive. And the high sensitivity hsCRP is more sensitive, but yes, you will see many people who have excess inflammation due to other pathways, and that’s where the Cyrex testing for example, could come into play.  Very often we know they’re inflamed, but the C-reactive protein is negative, what are the other sources or indicators of inflammation? Cyrex testing can be very helpful in that regard.

Dr. Weitz:            Okay, good. I think those are the questions that I had prepared. Are there any other things you’d like to talk about?

Dr. Moss:             I guess I would finish up by saying that the test is… there’s so many people who are just, they’re discouraged, and they’re confused, and they’re depressed because they’ve been suffering, and everybody is trying to throw supplements at them, “Take this, take this, take this, take this.” Most of these people are searching its cart before the horse. The issue right now at this point is not which supplements to take, it’s not a treatment challenge, it’s an assessment, it’s a diagnostic challenge, what’s wrong with them?  We’ve done the usual, we’ve done the usual blood tests, where can we turn to on cost-effective basis to answer that question to this patient. What’s wrong with me? Organic acids is a great gross screen to answer that question, what’s wrong with me?

Dr. Weitz:            Right. Great. Can you tell us about your organic acids course and about your Moss Nutrition supplements?

Dr. Moss:             Yeah. The organic acids course basically came from a need I felt to really look at organic acids as more than just a simple test to determine micro nutrient deficiency. I started reading the literature and I noticed, boy, there’s just so much information here related to inflammation, all the things that I’ve talked about and I really wasn’t seeing any good information geared towards the practitioner where they could basically get this in one place.

So I decided, well, might as well do it myself. And so I created a very in depth, a series. It’s 15 parts where I go into each section for basic an hour, hour and a half, using this idea of what did you miss? And look at each section in terms of what information can you gain to answer that question, what did I miss?  It’s a 15 session course and to learn about it, you can go to our website or give our office to call. In terms of our Moss Nutrition line, it is a practitioner [crosstalk 00:59:09]-

Dr. Weitz:            Hang on one second. I just wanted to give a plug for your course.

Dr. Moss:             Thank you.

Dr. Weitz:            It’s very well organized, very well in depth and Jeff keeps using this sort of format that sort of reminds me of the IFM course is to organize information in terms of the different types of problems like toxins, and et cetera, and keeping us focused on the patient and how we can use the information to help the patient rather than getting too focused on the course, which I think is very, very helpful. So-

Dr. Moss:             Yes, it’s very patient-

Dr. Weitz:            … I do recommend his organic acids-.

Dr. Moss:             Thank you.

Dr. Weitz:            … course.

Dr. Moss:             It’s meant to be very practical and very patient centered.

Dr. Weitz:            Okay. And what’s the cost of that right now?

Dr. Moss:             Right now, what are we offering it? I think it is… my goodness. I don’t even know off the top of my… It’s right around in the $200, $250 range.

Dr. Weitz:            Okay.

Dr. Moss:             My wife keeps track of all of that. I can’t even tell you what we’re charging for it now-

Dr. Weitz:            Okay.

Dr. Moss:             … but it’s in the $200 to $300 range.

Dr. Weitz:            Okay. And then about your Moss Nutrition line.

Dr. Moss:             Our Moss Nutrition line, it’s a practitioner baseline. It’s geared towards practitioners and I emphasize that. You will not find our product line on amazon.com or any major retail sites. We do allow practitioners to sell our supplements on their own websites to their patients, but the idea is, is we want to have a product line that is geared specifically towards the needs of chronically ill individuals answering this question of what’s wrong and what tools can we use specifically to help them metabolically to get to better health?

We’ve designed products specifically for that and in particular addressing some of the very underappreciated metabolic imbalances. Certainly, we have a lot of good products for example, for gut health, but one of the areas that’s grossly underappreciated is loss of muscle mass, very common in older populations.  One of the things that’s underappreciated is that most glucose receptors sites are on muscle so that type 2 diabetes is not a disease of the pancreas. That’s end-stage diabetes. Early onset is a muscle disease. And so building muscle is incredibly important in maintaining muscle, so we have products like SarcoSelect that are specifically designed, particularly older patients to help them build and maintain muscle.

Acid alkaline imbalance, grossly underappreciated. And of course this is an issue of electrolytes. When we think electrolytes, we all know about sodium, and chloride, and magnesium, but what’s the big one that it’s under appreciated that you never hear about in the seminars? Potassium.  So we talk a lot about potassium, we have a very bio available form potassium, Potassium Bicarbonate. We have the pH strips to look at first morning urine pH. We talk about how to assess serum potassium, and it’s one of our foundational products. And we’ve heard so many good reports how people don’t believe, how could this complicated problem nobody could solve got resolved by electrolytes, potassium?

Well, we hear about it all the time, so we’re back to basics. That’s the other aspect of Moss Nutrition. We’ll address complexity, but we like to bring things back down to simplicity and basics, and very often for many of these people, everybody assumed it was complicated and so they never looked at the simple stuff. We look at the simple stuff at Moss Nutrition. That’s the heart of our product line. Simple answers for complicated problems.

Dr. Weitz:            Excellent. Thank you, Jeff.

Dr. Moss:             Thanks Ben.


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