In today’s world, health coaching clients have access to a wide range of options for better understanding their health through direct-to-consumer (DTC) lab tests. Clients no longer have to order lab work through a medical provider. With this increased availability comes the question of how health coaches can effectively coach clients around lab work within the scope of practice.
Can health coaches order labs for their clients through direct-to-consumer tests? Are they able to recommend lab tests based on their clients’ health concerns? Can health coaches interpret DTC lab work results and recommend treatment?
In a recent webinar, Monique Class, FMCA Senior Content Developer and lead Educator, shed light on how health coaches can navigate this changing landscape. According to her, DTC lab testing can make health coaches a vital part of a client’s collaborative care team. You can watch the replay here.
Types of lab work testing
Generally, health coaching clients will ask about two different types of lab testing, prescriber lab testing and direct-to-consumer testing. Coaches need to understand the differences between each option.
- Doctor-requested lab testing: Ordered by primary care physicians and specialists, these tests are ordered yearly or when a doctor requires a test to help diagnose a problem. Because medical professionals must order these tests, patients may need to ask for specific tests and advocate for themselves.
- DTC lab testing: DTC tests can be ordered by clients directly. As these have become more widely available, there are different forms DTC tests can take. The results of these tests are then sent to the client directly, which can result in confusion and concern.
Where Health Coaches Can Help with Lab Work
“I think what’s happening in the lab industry is going to elevate the status of coaching in a large way,” said Class.
There is a need for informed guidance when it comes to both doctor-requested and DTC lab testing. Those without a medical background can read and interpret their own medical results, potentially leading to misunderstanding the information, and making important decisions based on incomplete information. The same can happen when working with a doctor, especially as doctors spend less time working directly with patients and don’t always explain results clearly.
This is where health coaches can make an impact. Health coaches regularly work with their clients to co-create personalized health and wellness plans. They understand the goals their clients are trying to achieve. So, when it comes to working with labs, coaches should have credible places, practitioners, and DTC lab tests they can recommend to inquiring clients for requesting and interpreting lab work.
To stay within their scope of practice, health coaches must focus on educating their clients. If a client expresses interest in getting specific lab tests, a health coach can provide guidance on where to get the tests done. They can educate on credible DTC labs but do not directly prescribe specific tests or tell clients what to order.
“Our expertise lies in behavior change,” Class explains. “An abnormal lab value remains abnormal without effective behavior change. What’s often overlooked is that the focus should be on improving lifestyle, not just labs.”
Collaboration is Key
Class emphasizes collaboration. Health coaches should help clients build a collaborative care team that works together to help them achieve their health goals. Health coaches can offer clients recommendations to visit trusted medical professionals. This approach helps clients build a collaborative care team that works together to help them achieve their health goals.
Health Coach Scope of Practice
“We’re experts in behavior change,” says Class. “An abnormal lab value without behavior change stays abnormal. What’s misguided right now is that everybody is focusing on the labs, focus on the lifestyle.”
Lifestyle change is where health coaches truly excel. While they may not be experts in lab work, coaches possess the knowledge and skills to help clients implement the behavior changes necessary for overall health improvement. Behavior change is a critical component of a collaborative care approach because it is where transformation begins and where lab results can be positively impacted.
“Labs don’t change people, coaches do.”
Health coaches help change people, change behaviors, and change overall health. By empowering clients to make informed choices and supporting them in implementing sustainable lifestyle changes, health coaches play a crucial role in guiding individuals toward better outcomes and a healthier life.
Watch the Webinar: How To Coach To Labs
Monique: First, let me start off with thank you all for showing up. I think it’s a hot topic. And as I was saying to, you know, our colleagues at the FMCA meeting, I think what’s happening in the lab industry is going to elevate the status of coaching in a large way. So, I’m incredibly excited about it, but it’s nuanced. And there’s lots of questions around it, so I think that’s why we’re doing everything we can to, kind of, hit it upfront so you know how to interact with this and engage with this so it actually makes you a pivotal part of the collaborative care team, a crucial part of the collaborative care team, and not practicing medicine without a license that can get you into trouble.
So, within that scope of practice, the scope of practice depends on what your degree is. So, not all coaches going through our program or graduating from our program have the same background. So, if you’re a clinician and you’re licensed to interpret labs, by all means, you play to your highest degree. If your state, if you’re a nutritionist… I know, in certain states, if you’ve got a nutrition professional degree, you’ve learned and you’re allowed to interpret labs. So, according to your state or according to your country, if you’re allowed to interpret labs, you’re allowed to interpret labs.
So, there’s a couple of different categories to know that you can play to your highest degree. If you don’t have a degree and you’re not licensed in your state to interpret and prescribe, then it would be considered practicing medicine without a license if someone came to you with a lab and you started saying, “Well, it looks like you have metabolic syndrome. Looks like your thyroid is off.” You know, those are things that are out of the scope of practice.
So, with that as the backdrop, you’re not all created equal, so we’re going to be answering questions for different layers of coaching so that everybody feels comfortable. But where we stand with this, and this was kind of a mantra that came up is what everybody can do, your job is to educate, and we’re going to be doing a lot around education, meaning we’re going to have Kerry Jones and myself giving lectures about the different types of labs, what’s the difference between a dried urine, a urine sample, a serum and a saliva, and when does someone want to do what. Not that you would be prescribing it if that’s not in your degree, but you need to know as much as possible to be the pivotal person to guide your clients in the right direction. And that’s the key thing that you’re going to do. So, we’re going to be having lots of education around that.
So, the mantra is educate. You want to collaborate. If you don’t have a license to interpret, you want to develop your own network. I know, like, I have a lot of nutritionists in our area that they’ll order the labs…they can order them, which is a weird slippery slope, but they can’t necessarily interpret them. So, they order the labs. Clients come to me, I do the interpretation, and then I send them back to the nutritionist for coaching and counseling around nutrition. So, you want to develop your network. You want to reach out. It’s a great opportunity to go out into the community and find practitioners that you think are practicing functional medicine or medicine in a way that’s collaborative. And you want to reach out and you want to start partnering with them if you’re not working in a practice.
So, collaborating…so, you’ve got incredible places that you bet in to send people when they show up with these labs is really important. And then you’re going to be responsible for coordinating this. Just because we’re clinicians and we can interpret, most clinicians have no idea what to do on the lifestyle end. So, at the end of the day, what’s ever going on in the lab values requires major behavior change. We’re experts in behavior change.
So, we may not, and some of you may be experts on the lab, but by and large, most of us are not expert coaches that have gone through without a degree. You’re not experts on the lab, but you’re experts on behavior change. And so all of it needs to happen. An abnormal lab value without behavior change stays abnormal. It’s just the way it is.
So, these things are intimately connected. And I think what’s going to happen with this direct-to-consumer is going to be driven by the patients. They’re going to be ordering these labs. They’re going to be showing up. They’re going to need behavior change. Absolutely. And they’re going to need credible clinicians to interpret for them and help track this because there are some people… Listen, I’m as holistic as they go, but sometimes I prescribe metformin. Sometimes I prescribe Prozac if necessary, right? So, medication sometimes is indicated as a bridge while you’re working on the lifestyle stuff, and then you get people off meds.
So, you know, all of it is on the table, and it’s going to be a chaotic time because people are going to be showing up with all these labs and coaches from other curriculums aren’t going to be ready and set to understand, number one, their place in the collaborative care team, and number two, their golden opportunity to really elevate their status and their necessity. So, I look at this as a cool opportunity to show people how we vibe with everybody else on the team, how important we are and how well we can play in the sandbox.
And saying that, I know there are some of you that have a degree, and you’re going to have a solo practice, and you’re capable of doing all of the above. So, again, if you can do all the above, do all the above, but a majority I know who’s going through our curriculum, majority of you aren’t. So, there’s going to be two scenarios, either you’re working with a practice and you’re part of the collaborative care team, or you’re working independently and you don’t have a license to interpret.
So, if you’re working independently, this is community outreach. You’re going to be reaching out to key people in your industry. You can go on the functional medicine website, put in your zip code, and you can find credible people in your area that have graduated, that know how to interpret labs. And whether they’re MDs or chiropractors or MDs or nurse practitioners, begin to create your network or your referral network where it’s going to benefit both of you. They’re going to get new clients, and they’re going to refer people to you, meaning they’ll have people that they see that they didn’t even know about you. When they have abnormal labs, they’ll send them to you, so you’ll begin to grow your business through collaborative efforts, through community outreach.
And that’s the real opportunity. We all need each other. I’m going to repeat what I said in the beginning. An abnormal value without behavior change stays abnormal. You can keep jacking up people’s meds, but it’s never going to cut it. Eventually, you know, if they don’t change what they’re eating, you can give metformin, eventually they end up on insulin. It gets worse and worse and worse unless they reroute what they’re doing and become conscious of what they’re doing.
So, you know, we’re all in this together. And the key thing to do it right is understand what you know, what you don’t know. I always call it eclipsing your own ego. And I’m a clinician and a coach, right? So, I kind of know both ends of the story, but clinicians too, they need to know when they need to hand off to us as coaches. They need to know what they know and know what they don’t know or don’t want to do or not interested in doing or incapable of doing with behavior change. So, this is a great time in history, and I’m really excited about it.
So, I said a lot, but I’m going to repeat the kind of mantra, educate, collaborate with people in the community or even people at a distance because a lot of us can do remote Zoom and then coordinate care. You’re central to when do they need to go back to the clinician, when do they stay to you, when do they need to repeat labs, what are they not getting from the clinician. So, there’s this kind of constant communication, so everybody gets what they need and it’s in the best interest. It’s client-centered in that way when we all, kind of, eclipse our own ego and know what we’re good at and know what’s kind of out of our domain.
So with that, I’m going to be quiet because I said a lot. Patty, what kinds of questions do you have? And what kinds of questions do people have?
Patty: Yeah. Well, I think, to start, let’s maybe… And thank you. That was wonderful and beautifully said. And maybe at the end, I’m going to ask the question of, do you understand the role of a health coach and what you can and can’t do? So, as we continue to talk, think about that. Is this helping me to understand what I can and can’t do with labs? And then we’ll kind of take a poll at the end. So, you go out, and either you’re a entrepreneurial coach collaborating or you’re working within a provider’s office, what might a provider ask? What does that look like within that collaborative care team of what a health coach would be doing with a patient who has had some labs ordered? What does that look like?
Monique: Sure. So, the scenario is it’s a coach without a license to interpret or a coach with a license?
Patty: Without a license.
Monique: Without a license who has an independent practice and has the client come order their own labs or has the client…were labs ordered from a [inaudible 00:09:46]?
Patty: Let’s do that. Let’s do both. So, I ordered a lot of, you know…direct labs came in, and I’m having some questions. And I happened to have been working with a health coach who obviously didn’t tell me to go and order those labs, but I’m bringing them to them. And what, as the health coach, can they do?
Monique: Yeah. And I think you start with the crucial coaching questions, right? They’ve got all these labs, and I want to say wait for a second. This new lab that Mark Hyman’s doing, they’re having artificial intelligence, kind of, interpret the results, but this is my caution that I want you to understand. Just because artificial intelligence is flagging something doesn’t mean it’s a problem because they have not taken the patient’s history, understood the timeline of the patient. They don’t know what medications necessarily they’re on. They don’t know if they were eating the morning they took the lab. They don’t know if they were taking their thyroid before they did the thyroid. So, there’s lots of nuances to interpretation that artificial intelligence alone can’t tell you. So, they’ll come with these labs that have interpretation guides through artificial intelligence that may or may not apply to that client.
So, the first question is, you know, what I would do. This is what I would do, but everybody’s got their own style. I would ask them, “Well, what inspired you to draw the labs to begin with? What were you personally concerned about?” And that’s an opening question, right? They’ll say things like, “Well, I have a family history of cardiovascular disease. My mom died at 48 of a heart attack. I’m really concerned that I’m going to head down that trajectory. So, I wanted to know my risk, and I did this whole Cardiac IQ panel. And there’s a lot of things in the red, and I don’t know whether it’s a problem. I’m really scared now.” So, it will look something like that.
And then, you know, you can begin to say… You can have them put the labs down there. You can ask them more questions about their lifestyle, and what they’re doing, and, you know, where do they feel they need to go lifestyle wise to address this. Have they had a clinician look at these labs, right? And so you can look at the labs. You don’t want to deny that the labs are there. So, you can look at the labs, you can have them point out what they’re worried about, and you can say something like…you can validate them, “I see that there’s a lot of red here.” And you can say, especially as you learn more about it, “It doesn’t necessarily mean there’s a problem, but we need to coordinate care with a doctor you trust.” And then you can have a conversation about, do they have a doctor they trust? Is there something they want to go to, that they want a referral?
And then you can dig down into, you know, “My mom died early of a heart attack. I don’t want to be that person.” So, what changes… This is a question I would ask them, “What changes do you think you need to make so that doesn’t happen to you? Just because it’s your genetics, we can turn on and off genetics with lifestyle. Do you eat the way your mom ate? Was your mom a smoker?” You can, kind of, tether and show them how, you know, choices dictate. Yeah, you got the genes, but genes are turned on or off by what we put in our mouth, how we eat, the choices we make, the company we keep, the stress we manage or don’t manage.
So, you can work on that level because that’s the level it needs to be worked on. Ultimately, that’s where the power is, is in understanding what the fear is, understanding if the fear is real or imaginative, understanding what are they doing and what do they want to do, what are they capable of doing in that moment to move down the trajectory.
Now, you guys have all…well, some of you, if you’re new to FMCA, you haven’t done the cardio metabolic module, but the cardio metabolic module, we explain all about cardiovascular disease. We explain all about the Cardiometabolic Food Plan. And if that’s something they’re interested in, you can say, you know, “Well, there is a food plan, a modified Mediterranean diet that works on these dimensions,” and you can begin to educate if they’re interested in the Cardiometabolic Food Plan. We’re teaching you all about in that module how exercise changes the trajectory of cardiometabolic syndrome, lowers your risk. You know, sitting is the new smoking, right? This is the data. So, just working on getting them to move is going to decrease the risk of cardiovascular disease.
So, you’re going to learn all about essential oils that are preventive for cardiovascular disease. So, all this information is taught to you. And this is the stuff you can begin to work on, helping them lower their sugar, getting them moving, moving to a modified Mediterranean food plan. This is the coaching back and forth. So, you’re not interpreting the labs, but you’re not denying the labs, “Yeah, you got a lot of red. What can we work on? Where are you? What did your mom do? What are you doing? Are they different? You don’t have to be your mom. Let’s coordinate with somebody, but let’s work on lifestyle right now, because at the end of the day, we can change a lot of these things with lifestyle, but let’s prove it. Let’s make sure you’re safe. Let’s make sure someone’s evaluating you.”
So, those are the ways I would work on it. You know, I’m not saying, “Oh, I can’t look at your labs.” They want you to look you can look, just don’t say, “Oh, my God, your Lp-PLA2 is abnormal. You’ve got, you know, plaque in your arteries.” You’re not saying that, but you’re acknowledging there’s a lot of red. There’s a lot of ink on this page. You know, let’s work with somebody. And there’s a lot we can do to change it because there is. Everything abnormal on the lab value gets better when you change your lifestyle. It just does. So, I mean, that’s the hopeful message, and that’s the message.
You know, and they may need a calcium score. I’m using this as an example. If their Lp-PLA2 is elevate, they need a doctor to order a calcium score to see what’s going on in their arteries. But that’s not your job unless you’re credentialed to say that to them, right? It’s just beginning to work.
Patty: Yeah, that’s amazing and how to have that conversation. I would think as well that some people might come, they did a whole bunch of lab work, and they might be highly anxious about what they see. So, what would the coach’s role be there in terms of, you know… because they may be coming to the coach saying, “I just got all this back. I’m worried. What can I do?” So, can you lead us through a coaching conversation for that aspect of the situation?
Monique: Yeah, but you want to find out what is at the core of their fear, right? Are they worried about the blood sugar? Are they worried about that they’re going to have a leg amputated? They’ve got a fear, but it’s about a particular thing on the lab. And usually that particular thing on the lab relates to somebody…usually somebody in their family that had that thing and the can was kicked really far down the line like, “I’m really afraid because my father died of diabetes, or he had his leg amputated. And I see that my fasting blood sugar is 105,” even though their hemoglobin A1c, which is the three-month window is completely normal, right? Could have been what they ate the day before.
So, not that you’re going to say that, but you want to find out what the fear is, the origin of the fear, and just holding them in that. And oftentimes if they can just name it and say it and you can kind of… Not that you’re being their therapist, you’re just asking them what’s this about. It’s about somebody else that had this that’s making them afraid that it’s going to happen to them.
What I see, this is just like a clinical pearl. What I see over and over again, if you had a mom or dad or somebody really close to you die early of a particular condition, a lot of people feel like, when they hit that age, it’s going to happen to them, even though they’re different. They’ve led a different lifestyle. But it’s bigger than you think. So, sometimes just letting them express that, holding them in that, and then moving them towards what can they do right now on a lifestyle end to move the dial in a different direction, going back to our mantra, that genes aren’t your destiny. Just because you have this set of genes, they’re turned on and off by lifestyle, by inflammation oxidative stress, by your food choices, by how high your stress is. So, that’s the reverse engineering. That’s the silencing of those family genes so that they don’t have to be a problem. So, anyway those are…
Patty: That’s great. And I’ll just reiterate what you had said earlier is and it might differ. The magic is in that coaching conversation. The magic is in the behavior change because that is lifelong. And I want all of our coaches to own their part of the magic in the functional medicine model.
Monique: Oh, 100% that’s the magic, right, because oftentimes the fears are imaginary in the future and they’re not based in reality. They’re based on something that happened in the past that may or may not impact them. But it seems uncertain and out of their control. What’s 100% in their control is what they put on their fork, how they choose to move, what their sleeping is like, how they choose to manage their stress. So, what you’re doing is you’re putting the locus of control back into the client’s hands by saying these things. And so once they know that they’ve got control over them, these are the things that… When you look at the levers of well-being, there’s randomness and uncertainty. Sometimes things happen that we can’t control, [inaudible 00:19:27].
But choices and habits, 100%. Seventy-five percent of the equation is in our control. So, you refocus them into the choices and habits to 100% in their control. They’re going to change the lab value. Oftentimes, you can’t make this prediction, but I’m telling you this. Within 12 weeks, they can normalize labs. Hemoglobin A1c’s and, you know, glucose and insulin levels and cholesterol. I check them every 12 weeks, right? So, it’s not like it takes even a long time if they begin to focus and dial in if they become on point with this stuff. So, those are the hopeful messages. And like I said, you’re putting the locus of control back in their hands because the fear and anxiety, it’s because they feel like it’s out of their control. It’s their destiny because it happened to X, Y, and Z.
So, first thing is you validate them. You ask more questions, inquiry. What is it for you? What’s the fear? Let them release it. And then what can you do? Genes aren’t your destiny. And then you begin to work with all the tools we give you depending on what’s coming up around fasting. You’ve learned all this stuff. What are they interested in? Fasting, Cardiometabolic Food Plan, elimination diet, if there’s a lot of inflammation and food sensitivities. So, there’s all these tools that are in your domain that we have taught you to use that are incredibly powerful for moving the dial.
Patty: Awesome. Well, I’m going to start to bring up some of the questions that you guys have submitted beforehand. So, thank you so much. I think this is a great one to start with. So, can you give an example of what the coaching conversation may look like when the client’s doctors say you’re fine, the labs look good yet clearly there’s something going on, and it might be suboptimal. How does a coach not create any confusion for the client or potential distress if they’re presenting education on optimal versus normal lab ranges that seem to maybe go against what doctor’s saying that everything is looking great.
Monique: Yeah. Well, one or two things. You never contradict their clinician, right? And so, again, you always bring it back to, “My total cholesterol is coming in at 200 and everything over 200 is abnormal. And my doctor said he’s not worried about it.” Well, why is your doctor not worried about it? So, even if their total cholesterol is 210. So, it could be that there’s really nothing to worry about because, if someone has a total… I’m going off on tangents. If someone has a total cholesterol of 210 but their good cholesterol is 98, it doesn’t matter. And their LDL is lower because you’re adding the LDL and the HDL together. So, the clinician may be correct that there’s nothing to worry about, but that is kind of a moot point. If they’re still worried, the crucial question is, what are you still concerned about? You’ve got to know what is it for them, “My doctor told me I’m fine, but I don’t feel fine.” Number one, what do you feel? Is it fatigue? Whatever it is. Is it brain fog? What is the symptom? Even though your labs are fine, what doesn’t feel fine to you?
And then, again, you work with lifestyle and you see if you can move the dial, because oftentimes if the labs are fine but they’re still feeling tired… This is just a heads up. They’re still feeling tired and a little bit foggy but all their labs look great, it’s not pathology. It’s usually probably something lifestyle. Probably something they’re eating or they’re not sleeping or their stress is too high. Elimination diet is always a great place to start. So, it’s not like you’re prescriptive with the elimination diet, but you’re asking questions like, “Okay, he’s saying everything looks great. You’re still fatigued. Are you interested in finding out how food is impacting your symptoms? Would that be something you’d be interested in, if food could be causing the fatigue? We know that the bloods look normal, but are you interested in finding out?” If they are, then you begin to coach them around the elimination diet, “Here’s some materials. Are you interested in this? Are you capable of eliminating all these foods or do you want to start with two and see how that…?”
So, you can work them around lifestyle to see if they feel better. So, you never contradict what the clinician said. And it’s always good news if everything is in the normal range. It’s good news. There’s two categories. If they’re still symptomatic, you can start with lifestyle and see if you move the dial. And if the symptoms don’t go away, you should have a functional medicine doc that you refer to, because they may need further testing. They may need to look at mold. They may need to look at Lyme. It may be something else. But there’s nothing wrong starting with, “It’s good news. Everything’s normal. I hear you. You still don’t feel well. Are you interested in working on lifestyle stuff to see if we can resolve it? If it’s a food, if it’s a stress-related thing.”
So, that’s how I would work with it. I would do that and see how you move the dial. And if they still don’t feel well after an elimination diet, if they’re working on the stress, if they’re incorporating exercise, if you’re doing all this stuff, they need a second opinion. And so you can ask them, “We’ve done all this stuff. We know it’s not food. We’ve worked on your stress. You’re sleeping great. You’re doing everything we need you to do, and you’re… Not everything we need you to do, but everything you wanted to do you’ve been able to do. Are you interested in a second opinion?” And then, again, if you’ve established your network, you refer them to someone for a second opinion. So, I mean, that’s how I would work with it if I was a coach without a license to prescribe and do these things.
Patty: Great, that’s wonderfully detailed, and a great action plan if you’re in that situation. The next question has been asked in a couple of different ways but essentially, it’s back to the scope question. And it is, is it okay for coaches to order labs by sending them to direct-to-consumer lab services, as well as help them to interpret? I see a lot of coaches advertising this, so I just wanted to make this clear.
Monique: Unless the coach has a license to order labs, and you tell them to go to direct-to-consumer, you’re out of your scope. If you’re saying, “Well, go get a Cardiac IQ and this, that, and the other, and come back to me. We’ll work on it.” That’s out of scope, right? So, unless you have a license. If you have a license to do that, and I saw someone put up their acupuncturists have a license to order labs, order labs. So, if it’s in your license, if it’s in your state, if it’s under your thing and you’re a coach, you can play to your highest license. By all means, tell them to do it.
If you’re a lay coach, you can’t be prescriptive and say, “Go get these labs,” and then interpret them. So, if they’re telling you, “I want to go get labs,” and you ask them, “Well, what are you going to go get?” and you ask them why and they want to do it, that’s different than you saying, “Here, go get these.” So, it’s nuanced, but the moment you tell them to go get labs or you interpret and you don’t have a license, it’s over the line of practicing medicine without a license, because then if you tell them to go get a lab, you are 100% responsible for what’s on the lab slip.
So, when I tell someone to go get labs, I’m responsible for every value on that, for understanding it, and for managing it. So, if I order the labs and they don’t come back to me, 10 years later, they develop something, they can sue me. I’m responsible for everything I tell someone to go do from a lab perspective. And every supplement I prescribe and every medication I prescribe, I’m responsible for everything that happens.
Patty: Yeah, so someone had asked, could they get training in learning how to interpret and order labs? And so that training is available if you go back for that in a licensed area, so, MD, DO. Some states, acupuncturists can do it. Some states, chiropractors can do it. Again, I’m an OT in the state of California. I could do that, but I would never…but it’s still, in terms of my practice, would be out of scope. So, the ability to order a lab doesn’t always mean that you have the licensure but to be able to do that, so just to be clear there, but you can go back to school in terms of, if you’re a coach and just getting a certification, there’s nothing available like that right now.
Monique: Correct. Yeah.
Patty: Okay, great.
Monique: I mean, this is a wider conversation. There are these curriculums out there that call themselves coaching curriculums, and they’re teaching about labs, but they had doctors that are responsible. It’s a slippery slope. I’m just saying we’ve had a lot of problems in the industry, and the clinicians in the industry, the functional medicine clinicians in the industry don’t like to collaborate with them because they are over the line. Often they’re missing stuff. So, it’s a little bit…you got to watch it. And they’re ordering under a doctor’s license. And ultimately, if they do something wrong and there have been some lawsuits, the doctor is responsible for their misinterpretation or misstep.
So, there are some renegades out there. I’m not saying they’re not. This is a personal opinion. I don’t think it’s a wise thing to do, which is different than if you’ve got a license to do it, do it. I’m not telling you not to do it, but if you don’t have a license, you’ve got to really collaborate with people. There’s a fine line.
Patty: Yes, so here’s another question I think in terms of… We talked about what coaches can do around labs. So, this question is people are often wondering what labs to ask their doctor to order. So, what does a coaching conversation around that look like?
Monique: Well, what is their concern, right? So, if their concern is cardiovascular… And this is something we can teach you. We can teach you what they should ask their doctor for, right? So, Cardiac IQ from Quest is one of the most far reaching tests that you can order for cardiovascular risk, right? So, it’s sent to Cleveland Heart. And so you can say, “There’s a bigger test. Ask your clinician,” or you can send them to clinicians that order these tests like functional medicine doctors. Like, I order that all the time. So, it’s far reaching because LDL cholesterol is not a problem unless it’s keeping bad company, unless the particle sizes are small. They’re dense. They’ve got a tail. They’re oxidized. They’re sticky, right? So, it looks at all of these markers and insulin and glucose and looks at the interface.
So, there’s labs like that. And as we teach, as we run these things, we’re going to teach you labs like that. So, 100% you can say something like, “Go to your doctor and ask,” or, “Here’s a clinician, and these are some things they may think about.” But once they get to the doctor, the doctor may want to add stuff in. After they talk to them, they may say, “You know what? I need to look at your liver function. You know what? We’ve also got to look at X, Y, and Z.” So, it’s a starting point, and there’s nothing wrong, but you’re not saying it willy-nilly. You’re saying it based on a conversation of someone saying, “I’m worried about my cardiovascular risk. I really want to check my cholesterol. What do you think?” I think it’s a great idea, and you can educate them. There’s a test out of Quest called the Cardiac IQ that looks to see what kind of company the LDL is keeping. So, you may want to ask your clinician if they can order that for you. So, that’s the way that conversation looks. It’s not you saying, “You know what? I think you should get a Cardiac IQ.” Again it’s a fine line, so you’re responding to their concerns. You’re not initiating the conversation.
Patty: Okay. So, then just to clarify, because Mary asked this question, can a coach suggest to a patient that they ask their doctors to order labs?
Monique: A hundred percent if the patient initiates it. So, you don’t sit there and take an intake and say, “You know what? I think based on what you’re telling me, you need a stool analysis, and you need liver function tests, and you might need a NutrEval.” That’s not your job. But if they say to you, “You know what? I would really like a better evaluation of my stool. Do you know anything about it?” “Yeah. You know, stool analysis, a lot of functional medicines do these elaborate stool analyses. Here’s the name of somebody. You can go in and ask for it.” You can do that kind of stuff.
And usually patients are pretty savvy. They’re on Instagram. They’re watching Mark and the rest of us. So, they come in already saying, “I’m interested.” So, it’s not like you got to pull it out of them. So, I mean, that’s your moment. If they’re interested, then you can educate them, because we’re going to educate you on stuff. You can educate them on the difference of these things, and people in the area that can order them. And then they can collaborate with you after they get the results on the lifestyle stuff that one needs to do. A hundred percent after we order all these lab works, everybody needs lifestyle changes. And so that’s where your collaborating with everybody and forming really good partnerships with people in your community.
Patty: Great. So, I want to, here, take a quick breath and say, does everybody understand the role of a health coach in this area and all of its nuances around labs? If not, please answer that question. And more importantly, do you understand all the things you can do around labs? I’m getting some yeses. All right, that’s awesome.
Monique: The most important thing is the behavior change around the labs. You know, what’s misguided right now is that everybody is focusing on the labs. Focus on lifestyle. You don’t even really need the labs. So, it’s the wrong emphasis. I’m not even going to go down that rabbit hole about the economics of that, but you can’t change labs without the lifestyle. The most important thing is what the coaches are doing. That’s how you get people well is you work… You’re 100 percent the experts on behavior change. And so the labs are a luxury. A lot of people can’t afford them, which is annoying, right? So, there’s a big diversity, but you can accomplish everything you want to accomplish with lifestyle. Labs are a luxury. They’re a tracking tool.
Patty: I just want to highlight what Laurie Dean just said because this is… Laurie Dean’s a nutritionist, you know, and she just said, “I find I don’t even need the labs, that most people get better with lifestyle change.” Because I always bringing this up, I want you to feel confident in the power of behavior change. That’s the cherry on top and the basis, right? It’s all. It’s the whole package in terms of that. So, thank you. And, yeah.
But, okay, so we do have some other questions that I want to get back to in terms of… So, they’re asking, “It was my understanding that we cannot prescribe a lifestyle plan to our clients. And yet it feels like we are being encouraged to help them create their plan through that coaching conversation though. So, if a client comes to us and doesn’t know where to begin, what do you recommend we do?” I feel like you’ve sort of outlined that, but, you know, maybe just highlight what that conversation looks like.
Monique: So, I can assure you of this. Everybody that comes to you has thought through and knows what they’re doing and what they’re not doing, right? You just ask them like, “Where do you want to start with food?” And they’ll tell you, “You know what? I feel like I’m eating too much sugar, or I heard a lot about fasting. How do I start fasting?” I mean, that’s your cue. Just ask them where they want to start. And if they can’t come up with an answer, give them a menu, “Well, you’re worried about cardiovascular disease. I mean, are you interested in starting with the Cardiometabolic Food Plan, with learning about fasting, with taking out sugar?” because this is after you’ve had a long conversation, done their MSQ, looked at their food journals. You understand what they’re eating, what they’re doing, the timing of their food.
But like I said, most people come to me and they say…they know exactly like, “Well, I’m interested in fasting. I’m interested in a ketogenic food plan. I’m interested in… I just need to start somewhere. I was thinking about going vegan or vegetarian, but I’m not sure. I just need to start cleaning up my diet.” That’s the core of your plan. So, we’ve got all these food plans that can match whatever it is they’re saying. And if they’re not saying anything but they want to change what they’re eating, what does that look like? Do you want to start by understanding how food is impacting you by doing an elimination diet and taking away all these foods and seeing if food is causing inflammation and maybe your joint pain and it’s maybe making you fatigued, or do you want to start with something a little bit more easy just like a modified Mediterranean food plan where we’re just watching doing better versions of carbs but you can eat everything?”
So, that’s where you can explain all these things. And it’s the power of choice, and they’re choosing. So, I know this is nuanced and maybe, when we first rolled out our curriculum, we didn’t roll it out that way, but we’re doing it now. We’ve just redone all the… I’ve just finished redoing every single food plan. And this is how we’re going to be teaching it is that you can lean into it and educate them. And you’ve got all these great tools. And then you’re coaching them through it. So, it is part of the coaching conversation, but you’re not being prescriptive. You’re not saying, “Oh, you need an elimination diet.” You’re saying, “Are you interested?” The subtle shift of, “Are you interested? This is what it is.” They say yes or no or they say, “Well, I can eliminate most of those things, but I can’t give up my coffee.” “All right, keep your coffee and let’s roll.”
So, that’s coaching, right? And the power of choice. My background is nursing as most of you know, but Elizabeth Barrett and many moons ago, just this whole thing, change and transformation is about the power and choice. And that’s where you get what we call knowing participation and change, right? When people choose it instead of you telling them, there’s incredible power, and they’ve studied it and researched it. There’s power and participation and change with choice. So, just giving them a choice is not prescriptive, it’s education. And then once they choose, then you’re rocking and rolling, then they take it on, then they’re engaged, then they’re leading it. Way different outcomes.
Patty: Yeah, awesome. A quick question about if you’re working with a doctor, right? And they might say to you, “Hey, listen, I’m going to give some additional duties to you. And here’s their lab. Please tell them what their lab results are, and then I want you to do lifestyle changes with them.” If that’s out of scope, how do you have that conversation with the provider to say what you can do with that and what you can’t?
Monique: Sure. So, what you say to the provider is I can’t do the first rollout, but if you meet with the client and you tell them what’s abnormal and that you want them to do X, Y, and Z, I can reinforce what you’ve just said. So, I’ve had coaches sit in with me, and I’ve gone over a Cardiac IQ and highlighted it, written on it, and then said, “This is the lifestyle change I want.” I hand it over to the coach. And the coach can say, “Well, I don’t really understand. What does it mean that my insulin level’s high?” So, you can educate off of the interpretation, right? So, you can educate around what you’re comfortable with, but you can’t do first rollout of saying, “Okay, you’ve got metabolic syndrome. Your insulin’s five times what it should be. This is what we got to do.” You can’t do first rollout, but you can reinforce and keep educating about the labs that have already been interpreted. You can do that. He wants to put me on thyroid medicine, but my TSH looks normal, and you can say, “Well, it’s the T3, that’s the active form. That’s why he’s giving you this and this.”
So, it’s a really cool thing to do. It’s kind of like the value add of working closely with the clinician, because then you’re learning and you’re not practicing medicine without a license but you’re able to educate at that level. And we love that. Like, I love when my coaches can reiterate the labs. And I’ll educate them to do that. I’ll say, “Okay, this is why I’m doing this.” You know, and so it’s forming these relationships and asking questions. You’re going to learn a ton if you work side by side a clinician, because it takes the workload off us if you can reinforce what we’ve just said, so we don’t get all the emails and the phone calls, but you’re educating and you’re learning.
So, that’s what I would say, just tell them upfront, “Listen, as long as you…” And most of us don’t hand that off to a coach. Just saying. We’re not saying, “Here, interpret the labs.” Like, it’s not our game, right? So, most of us are doing the follow-up. We’re telling them what’s wrong with the labs, but then we’re handing it off to a coach. But the coach also needs to reinforce because the clients walk out and they’re like, “I don’t remember what they said. Like, why is T3 an issue? Why is insulin a problem? They said that it’s causing me to gain weight, but I don’t really understand.” So, that’s where you can come in and you can educate off of our interpretation.
And I would say 99% of the time that’s what’s really happening. Just from an economic standpoint, we get reimbursed for going over the labs. If we hand it off to a coach, we don’t get reimbursed, right? So, economically speaking, we do that because we get reimbursed for that, both in the payer system and in the insurance system. So, the doctor is always going to do that but then they need more education, and that’s where it’s going to get handed off.
Patty: Great, thank you.
Monique: Unless you have a license.
Monique: If you’re a coach and you’re a nurse, if you’re a coach and you’re a nutritionist, if you’re a coach and you’re an ND and MD, you’re doing it all on your own.
Patty: Yes. All right, so talk to us about that coaching conversation when clients are hyperfocused around the lab values and are constantly ordering and checking their own labs. Where does that play into a coach’s role and conversation?
Monique: Yeah, and I think it always goes back to the why. What’s their fear? What is this about for them? Because you got to know they’re driven to do this because of something, right? And so it’s working with whatever that is. And listen, if that’s their game, if that’s what they need in that moment in time, they need to order their labs, do the lifestyle staff, and then keep tracking their labs so they see the changes, then that’s what you do.
But it’s raising consciousness always, right? What you want to do is help people raise consciousness around what are they thinking, what are they doing, what are their choices? Even around becoming hyperfocused on labs, what’s that about? Is that helpful or is it anxiety-provoking? Like, just asking them the question like, “Oh, you know what? It’s actually anxiety-provoking. I prefer to do it every six months.” But letting them come up… Your job is to ask the profound questions so they can raise consciousness about why are they doing what they’re doing and is it useful. If it’s useful, keep doing it. If it’s anxiety-provoking, do they want to continue? That’s going to be their choice, not your directive, right? This is the self-directed process.
So, I think these continuous glucose monitors, again, they need a prescription, but sometimes people are getting them online but it’s cool biofeedback because people can actually connect the dots between what they’re eating and what happens in the next moment. But what they often don’t realize is what are the ranges because there’s different pages fasting and one hour after you eat, right? So, not all blood sugar is created equal.
So, again, it’s looking at the whole picture, collaborating with the doctor when they come in with this kind of information, but the most important thing for you to do with that is use the biofeedback, “Okay, so how did you feel? Like, you ate that vegan blondie that you eat every night at 8:00, and an hour later, you’re up to 180. So, what are you thinking?” Do they want to continue doing that? Is that good for them? Can they cut it back? You know, so it gives information and at the same time, I keep going back to if you have a license, like rock and roll with the ranges that you like. If you don’t have a license, have them collaborate with their doctors and say, “Well, what is the range fasting one hour and two hours after eating that you’re looking to maintain, right?” And so everybody’s working together in the best interest of the client, so we’re not missing some diabetic numbers and the need for a transition met.
Patty: Yeah, the powers in those questions. Yeah, thank you so much.
Monique: They’re big, they’re big.
Patty: Yeah. Okay, I’m going to ask this. I know we know the answer, but because Mark is coming in, we’re going to be talking about function health. I do want to specifically bring this up. So, the question is, can you speak about the specific cases of folks doing function health or tally health? Do we treat these any differently than a specific lab test? I’m wondering about if you could suggest those, if someone expresses a concern about aging, for example.
Monique: So, you know, again, you can educate them that there’s all these… It’s a slippery slope, okay? So, you can’t say, “Well, you’ve concerns about aging. Well, let’s check your mTOR and your… Let’s check your [inaudible 00:46:28] genes. Let’s check your mTOR and all of these things, right?” You can’t be prescriptive that way, but if they say to you, “I’m looking for labs that I can order to check particular genes or to check particular tests. What direct-to-consumer labs are you…?” You can educate them on credible direct-to-consumers, but you can’t prescribe it. So, if they come in worried about genes or aging and things like that, this is the long and the short of it. You measure all these things. You know what we tell people to do when they’re abnormal? Lower your inflammation and oxidative stress with how you’re moving. That’s the answer to it all. So, if they want it checked and they’re asking, you can educate them on the labs that are out there, but you can’t recommend they go get them. The moment you tell them to get something, you’re 100% responsible and that’s out of scope for not all of you but many of you. So, it’s a slippery slope, but you can say, “Here’s companies that are doing it. They’re credible. Look into it,” but you can’t tell them what to order.
Patty: And you also want to ask them why they’re interested in getting them, what they’re looking to…
Monique: A hundred percent. A hundred percent. And, again, with all these longevity levers that they’re talking about, all these longevity levers are measuring the level of inflammation and oxidative stress. And so those levels are often high because of what they’re eating, their lack of movement, their lack of sleep, their stressful life. And today, it comes back to behavior change and the crucial, crucial role that coaches play in changing health and well-being oif all of our clients. Labs don’t change people, coaches do, and people change themselves in relationship.
Patty: There’s so many little… I feel like you say certain things and I can see a little Instagram post about what you said. So, these little great takeaways. So, thank you so much for bringing all of that up. Okay, one more time. I want to ask. Is everybody clear about what they can do with a client around labs? Are you excited about what you can do with labs? Do you feel the power in what… Yeah, I use that loosely because that’s a weird word, but do you feel solid and strong in your abilities as a coach around labs?
Okay, yes, because it’s okay if you’re still not clear. I just want you to ask the questions so that you are. Not yet. Okay. Not yet? What’s the question? What aren’t we sure about? Because I get it. It’s okay. It can be confusing. It can be confusing because there are so many…
Monique: Yeah, that’s true. Stay in your lane. I love that phrase, stay in your lane but embrace the “what is.” The “what is” is direct-to-consumer labs are here. It’s not going away. So, we want to embrace it, stay in our lane. And like I said, if you collaborate and you refer out and you ask the coaching questions, and you do the behavior change, it’s all going to be good. I mean, really good. Like, things are going to change. People are going to get better. It’s the appropriate use of the labs and what’s coming down the pike that’s going to happen. It’s going to be really good.
And like I said, this is a time for us to elevate our status in the collaborative care team as a crucial and pivotal person. And how you play in the sandbox makes a difference like how you reach out, how you collaborate. The more you collaborate, the more referrals you get. It sounds like, oh, if I could do everything, I’d have more clients. It doesn’t work that way. The more you reach out and stay in your lane, the more people trust you. And they’re going to refer to you. You’re playing well in the sandbox. I refer all the nutritionists that refer to me and I refer back. I refer to them all the time because they’re staying with it. They know what they know, and they know what they don’t know. And they’re playing well in the sandbox. I love working with them.
So, it’s a really cool time in history. I know that there can… I’m not imposing meaning on you. There can be a little anxiety that, well, you should know the labs. No, you shouldn’t. You don’t have to know labs. We’re going to educate you so that you understand them, but play well with others. And like I said, the most important thing is that they change their lifestyle. That’s how you change the labs.
Patty: Yeah. So, someone’s asking, besides Quest, what other labs can we suggest? So, I’ll just go back to you wouldn’t suggest, or I’m going to… You tell them.
Monique: So, this is like a self-awareness thing. The moment you hear yourself saying, “You should,” or, “I think,” or, “Why don’t you…” reel it back in, right? Because those are prescriptive terms. If you ask, “Well, what are you thinking about? What are you interested in?” And they say, “I’m interested in this, this, and this.” Well, depending on what they say, you can refer them to… I think it’s always better to refer them to a clinician that’s ordering these than a lot of this direct-to-consumer stuff. That’s me. I think some of this direct-to-consumer… Again, if they go direct-to-consumer, then they come to you with the labs and you don’t have a license. You’re going to have to refer them out anyway so might as well get it right the first time where they are collaborating with a clinician. Because once people see me, I oftentimes order more or less of what they’re thinking they need, so I’m saving them money. And then you get it right the first time, you get all the data you need.
So, that’s kind of how… I don’t know if that’s helpful or not helpful, but you want to watch what’s coming out of your mouth and ask them what they’re interested in doing. And then if they say they want all these kinds of tests, find someone to refer to them. If they say, I really want to do it on my own direct-to-consumer, educate them on what’s out there, which is function labs. And there’s a couple others—we’ll be putting it down for you—that are out there, and we can detail the nuances of each labs, again, but once they get those labs, they’re going to need a clinician to sit with them unless you have a license.
Patty: All right, so the action plan is, especially for our coaches, if you don’t have a license that allows you to interpret and order labs, build your network because, one, even if you’re a current student, you’re going to be a coach and be able to start your business off on the right foot, that… Thank you so much for either attending live or watching this recording, and I hope this is helpful to you. It’s okay to still have questions. You know, our alumni program members, you know how to contact us if you have questions about this. We can continue to talk about it in CCBs and other places there. If you are a current student, bring this to your course facilitator with a question, and we will make sure that we continue… And as you’re learning, there’ll be things that you’ll be learning around labs. We will continue to have the conversation for as long as you have questions. So, thank you so much, Monique. I love that we had this conversation. It was so needed. And, yeah.
Monique: More to come. Including some webinars on understanding labs so that… We just want you as prepared as possible, which is different than ordering them. It’s just understanding.
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