Optimize Your Health with Polygenic Risk Scores

Robert Rountree:

This is The Thorne Podcast, the show that navigates the complex world of wellness, and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Roundtree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Hi, everyone, and welcome back to The Thorne Podcast. This week we have returning guest, Dr. Joel Evans, my good friend who's a board-certified OB-GYN, a functional medicine doctor, and educator. He's the Chief of Medical Affairs at the Institute for Functional Medicine, and he's also the Chief Medical Officer of Genetype, which is a genetic testing company, and we're going to go into that in a little bit more detail. So welcome to this show, Joel, anything new or interesting happening in your life in the last year?

Joel Evans:

Well, what I'm doing, I feel very blessed to be able to find passion in my work. Unfortunately, for most people, they have things they're passionate about, whether it be sports or cooking, whatever, and that is separate and distinct from their 9-to-5 experience. And I'm very blessed to… Now that I'm in my early 60s, soon to be mid...

Robert Rountree:

Not quite your twilight years.

Joel Evans:

I'm very blessed to be able to prioritize what I call passion projects. And that's really now where I can look through the literature, find out what excites me, and then follow it. And that's really an honest lead-in to what we'll be talking about now, because the way I became affiliated with this company was by looking at the science associated with the genetics of what we call polygenic risk, found out about this company, and I actually called them and I said, "I want to work for you." So I want to spread the word. And so this, what we're talking about now, really is a source of passion for me.

Robert Rountree:

Great, so that's a perfect lead-in. Right now our understanding of genetics and health is really evolving a lot, and one of the things that's coming out is this notion of polygenic risk scores, which might be a new thing for a lot of our listeners. So these scores are emerging as a powerful tool to predict the risk of conditions like cancer, heart disease. So hopefully you can tell us what these scores are and how people can use them. So it's one thing to just go, "Here's your score." It's another thing to say, "Here's how this fits for you." So we're going to unpack the science behind these scores and how they might revolutionize the future of medicine. So can we start by just talking about what this is, and how specifically is it different from the kind of genetic testing that more people are going to be familiar with, like the BRCA1 and 2, the quote “breast cancer gene” or the “colon cancer gene”? What's unique about these scores?

Joel Evans:

What I would say is we've always understood from very early on that there's some genetic basis for who gets sick. We couldn't really define it well, but we knew it was there. And that was primarily from family history, we would see clusters of diseases in family. Ultimately, the science progressed to the point where we could identify some of these genetic abnormalities, but we looked for them with one particular genetic defect leading to one particular problem.

So you use the term BRCA as an example, the breast and ovarian cancer gene. And we not only were able to identify it, but we were able to understand its function, meaning the gene itself was a tumor-suppressor gene. So if you had an abnormality in that gene, or a SNP, it would take away its function. And so when you decrease the function of the tumor suppressor, you end up with more tumor. 

As you know, our understanding of genetics and illness is that we found that when you have these changes in genetic structure, it codes for enzymes, because that's what genes do, is they code for proteins which are primarily enzymes. And those enzymes facilitate chemical reactions or biochemical reactions. And sometimes the change in the gene facilitates a change where the reaction is upregulated or increased, and sometimes it facilitates a reaction where the...

Robert Rountree:

The other way around, yeah.

Joel Evans:

It's the other way around. So that's our understanding of genetics. We understand, for example, MTHFR is a big one, or COMT, which is about adding methyl groups. And when you have COMT, you decrease your methylation, and that has negative effects. So that's our basic understanding of genetics. And now that we can really understand the human genome, we know a lot of these SNPs and what they're associated with, and we know their function.

Robert Rountree:

SNPs, single nucleotide polymorphism.

Joel Evans:

Right, which is one particular nucleotide, which is the smallest unit of DNA. So one thing is off, all it takes is one little change to be off.

Robert Rountree:

But that's a single gene.

Joel Evans:

A single gene.

Robert Rountree:

Creating one problem.

Joel Evans:

Creating one problem. Now, there used to be a little bit of snobbery or arrogance amongst geneticists, where they needed to know the function of this change of whether it increased or decreased function, and what was the enzyme that it worked on? And then if you didn't know that, they weren't particularly interested in what was going on. And that was the difference between association and causation. So what we were just talking about with these changes in nucleotides is a causation of a problem, and we understand why it caused the problem. When there was association, there wasn't that much interest. And then our breakthrough was being able to do a complete genome study or study everyone's total genetic component. And when you could do that, you could see things that were associated with problems, even if you didn't know why or how.

Robert Rountree:

So you're talking about thousands of genes, the genetic analysis of thousands of people in a country, a state?

Joel Evans:

Our entire genome. Those were called GWAS, or genome-wide association studies. So you could see what's associated with a particular disease. So for example, you could look at hundreds of thousands of women and say, "I'm going to group them into two groups with and without breast cancer, and let's see the difference in their genes." You know what? They found over 300 genes that were different in women with and without breast cancer. And they're not able to know, because we don't know yet what the function is of those genes. In fact, some of them are in areas of the DNA called junk DNA, which means it's junk, it has no function.

Robert Rountree:

Or at least we thought.

Joel Evans:

That's what we thought. So we still don't know what it is. We haven't changed the name, it's still called junk DNA, but they're going to change the name.

Robert Rountree:

Yeah, it's not junk.

Joel Evans:

Right.

Robert Rountree:

So you're saying there's an identifiable repeating pattern of genes?

Joel Evans:

Absolutely, that's scientifically valid. And it's this whole field called GWAS, genome-wide association. So it's about association and not causation. And when I read that I said... Or learned about that, I said, "This is biohacking; this is anti-aging medicine; this is longevity medicine." Because the current way we look at longevity is you go to a longevity clinic, you spend a lot of money, and you get tons of tests. You're scanned up the wazoo, and you're scanned for all these things whether you're at risk for them or not.

Robert Rountree:

Everybody gets the same test.

Joel Evans:

Everybody gets the same tests. And if you go to a doctor, you can't say, "Oh, I want you to do everything you need to do to prevent heart disease, prevent diabetes, prevent cognitive decline, prevent colon cancer, prevent breast cancer." You just can't do it all.

Robert Rountree:

Everything for everybody, not practical.

Joel Evans:

Right, you can't be imaged for everything. So if I were to design the ultimate longevity plan, it's to start out with a panel of these GWAS tests to know what I was at risk for. Because if I have a genetic predisposition for something, then I'm going to spend the money to do whatever testing to look at the biochemical markers for that disease. I'll spend whatever I need to do for the radiology to find a diagnosis earlier. Let's say I have a predisposition to a cancer, it's worth fancy X-ray testing to see if I've got a tumor or not. And if I have a predisposition for diabetes and not so much for heart disease, I'll eat differently. So I want to know what I need to do in terms of tests, images, diet, and of course supplements. And how do I direct my functional medicine testing for particular issues?

So I want to know what I'm predisposed for, and that's this GWAS testing, which has a new name now. Well, it's still GWAS testing, but the result of a GWAS test is called a PRS, which is polygenic risk score. Polygenic, “many gene.” So you find the result of many genes, and then you get a score of what your genetic risk is, or what your predisposition is, or your likelihood of getting something. And that's the state of the science now for most. Now, the reason I called this particular company called Genetype, and I said, "Please hire me," is because they were able to take what's called a polygenic risk and combine it with personalized risks. So let's just say we find out that your polygenic risk for breast cancer is high, but we know that there are other risks for breast cancer that increase your risk, like breast density.

Wouldn't it be great to have a mathematical formula to combine the polygenic risk with these other facts that can increase your risk? And that's what this company does. So we'll be talking about heart disease, and we'll be talking about breast cancer specifically today. And what we know in the test for breast cancer, it's 313 genes, but when we're doing the test for heart disease, it looks at over 1,000. Then you look at the lifestyle factors and you get answers that you can't get through any other test. So you're looking at the heart disease risks, you don't get that anywhere else. 

So you're looking at age, and gender, and race, and what's your HDLC, and what's your total cholesterol and your blood pressure? Do you smoke? Are you a diabetic? Those are things that increase your likelihood for a coronary event. And you can combine that with the results of the thousand genes and find out what your real risk is for getting heart disease.

Robert Rountree:

So I'm hearing two things that differentiate this kind of testing from the testing you might get from a company that says, "Hey, we'll test all your genes." Several companies, 23andMe, they're the well-known, like, "OK, you send us a sample, we'll test all of your genes." Which I don't know what the latest number is, 20-some thousand, 22,000, somewhere in that ballpark. "So we'll give you a printout, how many dozens of pages, with all your genes on it."

But then the report you get says, "Oh, well, you got the gene for wet earwax.” [Laughs] Or, I'm not making this up, "You are more prone to be a night owl or a morning lark." Or some things like that. I don't mean to trivialize it, but they're still looking at the single gene hypothesis, they're looking at one gene at a time. So that's one difference I hear you saying. They're not looking at a collection of genes and then saying, "What's the collective risk of that collection, of that pattern?" And they also, they may ask you, "Do you go to bed late or early?" They may ask you if you have high cholesterol. But that's not an important central part of how they determine your ultimate score, am I right? Am I getting this right?

Joel Evans:

That's absolutely correct. And so that's what's so exciting. So you have this new technology that's out there called polygenic risk. And for example, the Mayo Clinic has a department within their division of genetics that studies polygenic risk, and even polygenic risk for breast cancer. And I've had conversations with them, and they're very excited about this. And what we do now is the part that's different, and new, and unique, and is copyrighted and patented, is adding these lifestyle factors to come up with a true personalized risk. So if we're talking about heart disease, are you low risk? What does that mean? It means less than a 5% chance that you'll get it over the next 10 years. Borderline, 5to 7.5. Intermediate, 7.5 to 20. High risk is greater than 20, over 10 years. Breast, high risk for breast cancer, greater than 20% lifetime.

And then if we're talking about a five-year risk for breast cancer, depending on the guidelines, U.S. Preventative Services Taskforce or NCCN, anywhere between 1.66 and 3.5% roughly. Once you know those numbers, then you can do what you need to do. The first thing you do is make sure you don't have the problem now. So this high risk for heart disease test, if you're at high risk, I want to make sure your vessels are okay, so maybe I'll get a calcium score, the fancy lipid paneling that we talked about. There are some fancier tests now imaging tests that look for not just hard plaque, but also soft plaque. So maybe doing that.

Then, as I said, all of the markers. If it's breast, getting an MRI, mammogram, ultrasound, or maybe a new test called QT imaging scan, which is a very sophisticated ultrasound now just finally becoming commercially available, something that I'm very excited about. And just sent a very high risk patient for that scan, and was happy to know that it was negative. The next step with that is, do they have the cancer now? Well, not by any of our imaging, now let's try a gallery test looking for analysis of cell-free DNA. And then we'll find out if there's some tumor cells or not. And if all those are negative, then we go into prevention.

Robert Rountree:

So let me tell you about a patient I saw not long ago, because I think it illustrates what you're talking about. She's 50-some years old, and I'd been dealing with her around a really specific health problem. And at one point I said, "Well, what's your cholesterol?" She said, "I don't know." That isn't why she came to see me. I did the test, and she had very surprisingly high cholesterol level for somebody who seemed to be eating a really healthy diet.

And then I said, "Well, what about your other health issues? Did your mother have breast cancer? Anything running in your family?" And she says, "I don't know, I was adopted." And I said, "There is this test you can get called a polygenic risk score that might help define what your risk is, because you're basically telling me, I don't have any idea what my genetic risk might be." And so as soon as I mentioned doing the Genetype test, she just lit up and went, "That's exactly for me." 

So I guess my question is, who do you see as kind of an ideal person for getting these kind of scores? Is there a certain age group, a certain kind of person when you would say, "This is the perfect candidate for doing this testing."

Joel Evans:

Listen, I think it's really good for everybody. I'd say we start at age 30 or 35. It's good for everybody, those that are high risk from our conventional approach as well as those that are low risk. Because when we do this test on people that are low risk, we call it reclassification, we reclassify people from low risk into high risk almost 20% of the time. So that's important. So from my perspective as a patient, of course I want to know what I'm at risk for so I can be most proactive in keeping myself healthy.

And if I'm a doctor, I want to know what patients are at risk for so I can know what to test for and then do the right protocols. And we have... I don't know if your viewers are familiar with the name Eric Topol from Stanford, medical adviser for Medscape. And in February, he came out on his blog that he calls Ground Truths, and he said, "Polygenic risk scores..." The title was “Polygenic Risk Scores: Ready for Prime Time?” And his summary statement was, "Polygenic risk scores should be a part of medical practice and be used widely by clinicians to promote prevention of disease."

Robert Rountree:

Wow.

Joel Evans:

I mean, that's...

Robert Rountree:

That's the best endorsement you can get.

Joel Evans:

That's the best endorsement you can get. And then there's an actress by the name of Olivia Munn, who you may know, and she was diagnosed with breast cancer because she was risk-assessed, found to be at high risk, had the MRI, and the cancer was diagnosed, very early stage.

Robert Rountree:

So one thing that I want to be really clear on is these scores just don't tell you you should worry, these scores will lead to a combination of perhaps more aggressive screening test. Like you said, something like the gallery test for a cancer signal in the bloodstream, or maybe more advanced scannings, better breast scans, maybe more than mammograms. So these are not just worry scores.

Joel Evans:

Correct.

Robert Rountree:

These are action scores.

Joel Evans:

Totally actionable, yeah.

Robert Rountree:

Yeah, and I think when we get into the questions, we'll have a chance to talk a little bit more about what some of those actions might be. So we're going to take a break now, and then after the short break, we'll come back and answer some questions that have come in. So this has been a great discussion, Joel. 

-- AD BREAK --

When it comes to your health, your body deserves the best, that's why Thorne invests in comprehensive testing, sourcing the highest quality ingredients, and creating the cleanest manufacturing processes to provide unparalleled solutions for your health.

Thorne's approach to quality and science has earned the trust of more than 100 professional sports and U.S. National teams, thousands of medical practitioners, and millions of customers worldwide. It's also why Thorne is the only supplement manufacturer chosen by Mayo Clinic to collaborate on clinical research and educational content, discover more reasons to trust Thorne on your journey to a happier and healthier you by visiting Thorne.com. 

-- END AD BREAK --

And we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asks, "If I have a high polygenic risk score for something like cancer, does that mean I'm definitely going to get it? So how do I interpret the result?"

Joel Evans:

So what's great about this polygenic risk combined with these other personalized factors, that's the Genetype test, is that you get a number which says your risk of getting cancer in X number of years. And it's different for the test. So breast cancer gives a lifetime risk and a five-year risk, colon cancer gives a 10-year risk. So you always know what the window is that we're referring to. And then you get a percentage, and you say, "Your lifetime risk of cancer is..." And let's say it comes back 12%. And then you might say, "Well, how do I interpret that?" And we also tell you what the average risk is. So there's a number that you get, it says, "The average risk of breast cancer in a lifetime is 12%, and your risk is 12%, therefore, you're at average risk." So you get a number in terms of a percentage risk, the number of years of what that risk applies to.

We compare it to an average risk, and then we give you a word that says you're at average risk, increased risk, decreased risk, slightly increased risk. So not only do we give you the number, but we give you the language to interpret that number. So it's not a test where you don't know what the answer means. 

Then when you know what the risk is that you have, and this is your personal risk, you then can decide what you want to do based on your level of concern. So for example, if the risk for breast cancer is what we call high risk according to NCCN of 1.66% over five years, and you come back at 3%, you might say, "I'm really nervous, I have essentially doubled the risk of breast cancer in the next five years."

And then it's up to your doctor to say, "Well, yes, but you're starting at 1.6 and you went all the way to 3, that's nothing. A 3% risk means 97% chance you're not going to get it. So let's not really get too anxious about this, but let's look at what the things are that may be causing this increased risk of breast cancer that we can change things, like what's your weight or your thyroid function? We can just do things to make you healthier." So that's so wonderful about these tests, is that you can look at it and compare it to the average, and then you can decide what testing you need and then what your interventions are to reduce your risk.

Robert Rountree:

So you're really telling people, "This is where you should focus your energy. So if your risk is high, you need to put more energy on this."

Joel Evans:

Right. And focus your energy and your money. And even if it's not your money, the insurance companies want to know where to spend their money. They want to spend it on what's going to likely be affecting you.

Robert Rountree:

Where's the payoff going to be?

Joel Evans:

Right.

Robert Rountree:

So tell me if this is a good analogy. Let's say you have a client that comes in and says, "I just got a new Bugatti motorcycle. I got a high-performing motorcycle, and I want to know if I should wear a helmet." And you can say, "Well, if you don't wear a helmet, here's your risk of having a serious head injury if you crash. If you do wear a helmet, here's the lower risk." And then you can take your pick, what are you going to do? So you're giving people options of saying, "We're not saying this means it's inevitable that you're going to get this disease, this just means you're in a slightly different category than other people, and maybe you really need to eat more broccoli than everyone else."

Joel Evans:

Bingo.

Robert Rountree:

Yeah, even if you don't like broccoli, you're the one that's going to benefit from the broccoli.

Joel Evans:

Right, buy the SproutMaster.

Robert Rountree:

You get the SproutMaster and eat those sprouts every day, so it can into some really basic actionable things.

Joel Evans:

Yeah, that's the key word, actionable.

Robert Rountree:

OK, so that leads into the next question. Are these tests expensive? Are they worth the cost for someone who's just trying to stay fit? So there's a lot in that question that you could unpack.

Joel Evans:

Well, what I would say is people want to stay fit because they want to stay healthy. And so this absolutely is important if you want to stay healthy, because it tells you what you need to focus on to stay healthy. What are the cancers you're at risk for? And then when you figure out what that is, like for example let's say it's colon cancer, we know that the amount of red meat you eat makes a difference with colon cancer. So you have to watch out for red meat, even if your risk for heart disease was not a problem. And even if your cholesterol is OK, you might say, "Oh, I feel good about red meat." But you know what? If you've got a high colon cancer risk, then you're the person that would be lulled into a false sense of security about red meat.

Robert Rountree:

So maybe if you have a high risk, you don't want to eat it every day. Right, OK. So when you say worth the cost, there's a lot of things that factor into cost.

Joel Evans:

If this particular company, Genetype, will look at between seven and eight tests, depending if you're a man or a woman, prostate cancer for a man, ovarian and breast for a woman, then for everybody they get type 2 diabetes, heart disease, pancreatic cancer, melanoma. That's what you want to know what's coming down the pike for you in terms of risk, so you can risk adjust after you've risk assessed.

Robert Rountree:

So again, when you say worth the cost...

Joel Evans:

400…

Robert Rountree:

This initial... I know, but it's initial 400, 500 bucks, you've got an initial investment. So it's like anything you invest in in life, you have to say, "Is this worth the cost of my investment? Is the motorcycle helmet worth the cost of the helmet?"

Joel Evans:

Absolutely. No, exactly, that's a great way to put it.

Robert Rountree:

Yeah, so the helmet cost a certain number of dollars, but what is the payout that you get over the years of having a decreased head injury? 

So are polygenic risk scores the same as ancestry DNA tests? Do I need to do both?

Joel Evans:

They're totally different, totally different. So ancestry DNA, just by its term ancestry, will tell you what part of the world your ancestors are from. This looks at your risk for certain diseases, that doesn't do that. That, if you add a health add-on to your ancestry panel, will look at single genes that can be associated with biological phenomenon or some can be associated with cancer risk like BRCA. But BRCA is associated with 5% of breast cancers, one in 400 women are BRCA positive. So it's not a big thing, we all know about it. But this gene type for breast cancer, 85% of breast cancers are in these polygenic risk zone. And that's what you want to protect yourself against, that's the information you want to know about.

Robert Rountree:

Well, I think this next question takes that one step further. “How do polygenic risk scores work exactly? Is this just a DNA test or is there more to it?” And then a part B is that, “Do I need to be worried about privacy?” And I know people are worried about their genetic information getting out there, so that's kind of a separate issue. But you've got these genetic variants, you said for breast it's 313 genes, or heart it's a thousand genes, what exactly are you doing with those genes?

Joel Evans:

So what we do is, we started with looking at hundreds of thousands of people with and without those clinical conditions, and we just, because we can do full genome sequencing now said, "Is there a difference in their genetic makeup?" And then we saw the difference in the gene. So now we have probes that look for those genes, and we know the math that says if you have one particular gene of these 300 for breast, for example, it affects your risk by 1% or 2%.

And we call those low penetrance, meaning they don't make a huge difference. Whereas a BRCA gene has high penetrance, meaning a high likelihood, 60 to 80% chance, of getting a cancer if you're BRCA’s high. So we look at the probes, we know the math of each of these genes. We have a mathematical formula that's been validated, patented, signed off on by Harvard and Memorial Sloan Kettering, and published in the literature. We've got a lot of literature on this. And then we combine that with your height, and weight, and breast density, etc., and that's how we come out with a personalized score. And that's what everybody wants, and that's what's most important to stay healthy, that's optimal aging, and that's biohacking.

Robert Rountree:

So there's a lot of data involved in interpreting those genes, does this require sophisticated AI? Or is it... I guess people are wondering, how do you put it together?

Joel Evans:

You don't have to put all that together; we have a simple report that's color coded. So it's very easy.

Robert Rountree:

Easy to interpret.

Joel Evans:

Yeah, very easy to interpret.

Robert Rountree:

And the person's genetic data, how is that kept safe?

Joel Evans:

Well, it's kept safe because there's different laws everywhere on genetic data, and so that's up to your doctor to be consistent. The company is never asked for data for a particular person, we use what's called de-identified data, which is data that's put together and grouped when we're doing studies. So it's never connected to name, or social security number, or anything like that. And then your doctor who has the results is responsible for following all of the legal prohibitions about sharing genetic information.

Robert Rountree:

So that genetic data is not just floating around in the cloud somewhere?

Joel Evans:

Correct.

Robert Rountree:

Yeah, it's all locked up.

Joel Evans:

Locked up.

Robert Rountree:

Locked up, OK. One last question. I'm really into optimizing my health, how can I put these polygenic risk scores to use?

Joel Evans:

This sums it all up.

Robert Rountree:

So this sounds like a person who's got a problem, so what...

Joel Evans:

Right, this sums it all up. So you think you've got no family history of breast cancer, and then we find out you're at increased risk for breast cancer, what do you do? Well, the first thing we do is a breast MRI, maybe that breast QT scan. We make sure that, depending if you're in menopause or not, what's your estrogen level? We do a baseline serum estradiol if you're in menopause. If you're still cycling, you may want to get a DUTCH test to do cycle mapping and see your estrogen relative to your progesterone. We want to see if you're inflamed with cardio CRP, we want to see what's happening with your glucose and insulin, because elevated insulin is in risk for breast cancer. We want you to have ideal body weight, we want to do what we can to diminish your breast density, so we increase your detoxification enzymes. We want to make sure you're not constipated, checking beta-glucuronidase enzyme, which increase your estrogen. So there's so much that we can do.

Robert Rountree:

A lot, there's a lot.

Joel Evans:

So much that we can do. And you only want to do all that stuff if you have the right reason. And this gives you the reason, this tells you how to take care of yourself.

Robert Rountree:

And again, the contrast with mainstream medicine is we only identify problems and fix the problems that we find. Like your blood pressure is high, we treat that. Your cholesterol is high, we treat that. Your liver's inflamed, we treat that. But that's different than optimizing your health. This is saying, "Hey, we're going to help you figure out where you need to focus, and then fine tune that." 

Well, Joel, this has been an awesome discussion, but that's all the time we have this week. So thank you so much for coming on the podcast. If listeners want to follow more your work, and specifically if they want to find out about doing these polygenic risk scores, where do they find about the research? How do they get it done?

Joel Evans:

Yeah, Genetype.com. G-E-N-E, type, T-Y-P-E.com. And they can actually order tests through their doctor, or they can order through the website.

Robert Rountree:

They can order directly.

Joel Evans:

Yeah.

Robert Rountree:

Right, so they don't have to come to your office and get it done in your office.

Joel Evans:

Correct.

Robert Rountree:

And if they want to follow what you're doing personally, your website?

Joel Evans:

Yeah, TheCFFM.com for The Center for Functional Medicine. The-Charlie-Frank-Frank-Mary dot com.

Robert Rountree:

Great. Well, thank you so much for this work you're doing, I really appreciate how you're taking your passions and making it into something that is going to help humankind.

Joel Evans:

Thank you, thank you, thank you, and thanks to all your listeners.

Robert Rountree:

You bet. Thank you everyone for listening, until next time. Thanks for listening to The Thorne Podcast, make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in, and don't forget to join us next time for another episode of The Thorne Podcast.