Glossary

The terms, plainly.

The clinical vocabulary I use across the practice. If you saw a term in a lab report, a blog post, or a pillar page and want it explained in plain English, it should be here.

8-OHdG: 8-hydroxy-2-deoxyguanosine. A urinary marker of oxidative damage to DNA. When elevated, the free-radical load is winning against the body's repair systems. A direct read on cumulative oxidative stress, measured on Metabolomix+.
AA/EPA ratio: The ratio of arachidonic acid to eicosapentaenoic acid in the bloodstream. A practical read on the inflammatory tone of your fatty acid status. A lower ratio favors resolution; a higher ratio favors inflammation. Modifiable by diet and supplementation in weeks.
Anaerobic threshold: The exercise intensity at which lactate begins accumulating in the blood faster than the body can clear it. Defines the upper boundary of sustainable effort. Below it, you can hold the work for hours; above it, minutes. Also called lactate threshold. Measured precisely on a CPET.
ApoB: Apolipoprotein B. The count of every atherogenic particle in your bloodstream. Outperforms LDL cholesterol as a predictor of cardiovascular risk and is the single most useful number on a modern lipid panel.
APOE: A gene with three common variants (E2, E3, E4) that shape how the body handles cholesterol, inflammation, and the brain's response to aging. APOE4 carriers carry higher Alzheimer's risk and benefit from earlier metabolic intervention. Tested once.
Beta-glucuronidase: An enzyme produced by certain gut bacteria that can reactivate hormones and toxins after the liver has prepared them for elimination. Elevated activity slows clearance and recirculates compounds the body has already paid to remove. Measured on GI Effects.
Bioidenticals: Hormone preparations with the exact molecular structure the body produces (estradiol, progesterone, testosterone). Distinct from synthetic analogs. Second in the treatment hierarchy: lifestyle first, bioidenticals second, phytoceuticals third, pharmaceuticals as a last resort.
Calprotectin: A protein released by neutrophils. Stool calprotectin separates inflammatory bowel disease from irritable bowel syndrome and tracks gut inflammation precisely. Measured on GI Effects.
CGM: Continuous glucose monitor. A small wearable sensor that measures interstitial glucose every few minutes for 10 to 14 days. Roughly four thousand readings paired with what you ate, when you slept, and what you did. The pattern is usually more revealing than the average.
Chronobiology: The science of biological rhythms. How time of day shapes hormones, immunity, digestion, and repair, and what happens when those rhythms drift out of phase.
Cortisol curve: The daily rhythm of cortisol secretion: high in the morning, declining through the day, low at night. When the curve goes out of phase (tired-and-wired evenings, wakeful 3 a.m. nights, energy crashes at consistent times), it explains a category of symptoms standard cortisol tests miss.
CPET: Cardiopulmonary exercise test. A maximal exercise test with a mask that measures every breath. Outputs your true VO2 max, your anaerobic threshold, and the fuel mix your body uses across exercise zones. Ground truth for cardiorespiratory fitness; watch-estimated VO2 max is a guess against it.
Detoxification: The continuous biological process by which the liver and other organs neutralize and clear endogenous metabolites and exogenous chemicals. Phase I and Phase II liver pathways carry the bulk of the work; nutrient cofactors run each step. When the load exceeds the clearance, the burden shows up in symptoms.
DEXA scan: Dual-energy X-ray absorptiometry. A whole-body scan that separates total mass into fat, lean tissue, and bone with millimeter precision. The image behind every meaningful metabolic conversation. Reads visceral fat and bone density at the same sitting.
Dysbiosis: An out-of-balance gut microbiome. The wrong mix of microbes, often after antibiotics, ultra-processed diets, or chronic stress. Drives inflammation, immune dysfunction, and hormone metabolism downstream.
Epigenetics: Chemical modifications that turn genes on or off without changing the underlying sequence. Methylation is one mechanism among several. The mechanism by which lifestyle, exposures, and time reshape gene expression across years.
Exposome: The total burden of environmental exposures across your lifetime. Air, water, plastics, pesticides, mold, heavy metals, and the chronic chemical inputs that shape every other system. Measurable.
Fasting insulin: Insulin measured after an overnight fast. Moves first, years before HbA1c rises. The single number that catches the silent middle of metabolic decline, when standard glucose panels still look fine.
Ferritin: The protein that stores iron. The lab's normal floor (15 ng/mL) is enough to prevent overt anemia but well below the level needed for energy, hair, mood, and exercise tolerance. I target above 70 for most patients.
GI Effects: Genova's comprehensive stool analysis. Reads digestion, gut inflammation, and the microbial ecosystem in one collection, with culture and sensitivity testing that makes treatment targeted rather than empiric. The most clinically useful gut panel I order.
Glycemic variability: The minute-to-minute swing in blood glucose around the daily average. Two patients with identical HbA1c can have very different variability, and variability is what damages tissue over time. Best measured on a CGM.
HbA1c: Hemoglobin A1c. A weighted three-month average of blood glucose, indirectly measured through how much sugar is glycated onto red blood cells. Useful but lagging. Fasting insulin and CGM data move first.
Health Optimization Medicine: A clinical framework built around an explicit definition of health, not the detection of disease. Measures against optimal physiological function across seven biological pillars. The system I am certified in. Often abbreviated HOMe.
Healthspan: The years of your life spent in good health. Different from lifespan, which is just how long you live. Healthspan is the goal of Health Optimization Medicine. Longevity is its echo.
HOMA-IR: A calculation from fasting glucose and fasting insulin that estimates how insulin-resistant you are. Most useful when HbA1c is still normal but insulin is climbing, which is the window I most want to catch.
Homocysteine: An amino acid intermediate in methylation. When methylation is backed up (often from B-vitamin gaps or MTHFR variants), homocysteine accumulates and raises cardiovascular and cognitive risk. Cheap to measure, responsive to targeted nutrient support.
hsCRP: High-sensitivity C-reactive protein. A marker of systemic inflammation. Elevations predict cardiovascular events and explain symptoms that other panels cannot.
Insulin resistance: The condition where cells stop responding to insulin's signal to take up glucose. Drives weight gain, mood, energy, sleep, and most age-related disease, often for years before HbA1c rises.
Lp(a): Lipoprotein (a). A genetically determined cholesterol particle measured once in your lifetime. About 20 percent of the population has elevated Lp(a), and most have no idea. Dramatically reshapes cardiovascular risk when present.
Metabolomics: The study of the small molecules your cells produce as they make energy. A direct readout of how metabolism is actually running, upstream of the standard lipid and glucose panels.
Metabolomix+: Genova's at-home urine metabolomic panel. Reads cellular energy production, B-vitamin function, oxidative stress, neurotransmitter metabolites, and elemental status. The most informative single read on functional nutritional status that does not require a blood draw.
Methylation: A chemical process that turns genes on and off, builds neurotransmitters, regulates detoxification, and recycles homocysteine. Genetic variants like MTHFR change how efficiently you methylate.
Methylmalonic acid (MMA): A urine organic acid that accumulates when vitamin B12 is functionally low. Catches B12 deficiency in patients whose serum B12 looks normal. Read on Metabolomix+ and other metabolomic panels.
Microbiome: The community of bacteria, fungi, and viruses living in and on the body, especially in the gut. Shapes immune function, hormone metabolism, neurotransmitter production, and inflammation.
Mitochondria: The energy machinery inside almost every cell. Responsible for turning fuel into the cellular currency (ATP) that powers every other system. When they underperform, energy, cognition, and recovery follow.
MTHFR: A common genetic variant affecting methylation efficiency. Slows the conversion of folate to its active form (5-MTHF), can elevate homocysteine, and changes how the body handles methylated B-vitamins. Tested once, factored in for life.
NutrEval: Genova's serum-and-urine nutritional panel. Reads vitamins, minerals, and amino acids directly in blood, paired with the urinary metabolomic markers Metabolomix+ also measures. The right call when a phlebotomy draw is appropriate and the serum picture is needed alongside the flow picture.
Omega-3 index: The percentage of EPA and DHA in red blood cell membranes. Target is roughly 8 percent or higher. Strong predictor of cardiovascular outcomes and a useful gauge of dietary omega-3 sufficiency. The nutrient gap that reliably shows up in brain-fog presentations.
Optimal range: The narrower band of a lab value associated with how the body actually performs best. Different from a reference range, which only flags disease. The difference between these two ranges is most of the work I do.
Oxidative stress: The imbalance between free-radical production and the body's antioxidant defenses. When free radicals win, mitochondria, DNA, and cell membranes take damage. Read on Metabolomix+ through markers like 8-OHdG and lipid peroxides.
Pancreatic elastase: A digestive enzyme produced by the pancreas. Low stool elastase points to pancreatic insufficiency and explains a category of bloating, weight loss, and nutrient malabsorption that other gut tests miss. Measured on GI Effects.
Peptide hormones: Short chains of amino acids that function as signaling molecules in the body (growth hormone secretagogues, repair peptides, metabolic peptides). One of the clinical specialties in my practice. Distinct from steroid hormones in mechanism, half-life, and dosing.
Phytoceuticals: Botanical and nutrient-based compounds with measurable physiological effects, used as targeted therapeutics. Third in the treatment hierarchy: lifestyle first, bioidenticals second, phytoceuticals third, pharmaceuticals as a last resort.
Precision Call: A complimentary 30-minute call by phone or video with me. You tell me what is going on. I tell you how I would approach it. You decide if I am the right physician for you. The starting point for every patient in the practice.
Precision Health Plan: The written synthesis of your biology I produce for every patient. Built from every lab and panel you have, interpreted against optimal ranges, with a specific plan to move each system toward optimal. The deliverable of a Precision Partnership.
Precision Partnership: The ongoing monthly membership that holds the work after the Precision Health Plan is built. Async messaging access, prescription management, lab and supplement pricing at vendor cost, and a Plan refined as your biology shifts.
Reference range: The statistical band that holds the middle 95 percent of a lab population. A normal result inside it means not diseased, not necessarily well.
Respiratory exchange ratio (RER): The ratio of CO2 produced to oxygen consumed during exercise. Tells me what fuel you are burning at every intensity. Low RER means fat oxidation; high RER means carbohydrate. The crossover point is a marker of metabolic flexibility. Measured on a CPET.
Reverse T3: An inactive form of the thyroid hormone T3. Often elevated under stress, illness, or chronic inflammation. A normal TSH paired with a high reverse T3 explains thyroid symptoms in patients told they are fine.
Secretory IgA (sIgA): The antibody that lines mucosal surfaces, including the gut wall. The first immune barrier between the microbial world and the body. Low sIgA opens the door to dysbiosis and food reactions; high sIgA flags ongoing immune activation. Measured on GI Effects.
SHBG: Sex hormone binding globulin. The protein that carries testosterone and estrogen in the bloodstream. A high SHBG locks up your sex hormones; a low SHBG releases them. Total hormone numbers are nearly meaningless without it.
T-score: A DEXA bone-density measurement comparing your bone density to a young adult reference. T-score above -1 is normal; -1 to -2.5 is osteopenia; below -2.5 is osteoporosis. Catches bone loss years before a fracture forces the conversation.
TCA cycle (Krebs cycle): The central metabolic pathway inside the mitochondria where carbohydrates, fats, and proteins are processed into energy. Urinary intermediates of the cycle (citrate, malate, succinate, alpha-ketoglutarate) flag specific cofactor gaps when they back up. Measured on Metabolomix+.
Time in range: The percentage of a CGM wear period your glucose stays inside the target band. A practical readout of glycemic stability that complements the average. I use tighter target bands than standard diabetes care.
Visceral adipose tissue (VAT): Metabolically active fat surrounding the abdominal organs. Distinct from subcutaneous fat under the skin in inflammatory tone, hormonal disruption, and cardiovascular risk. Measured directly on a DEXA scan; cannot be inferred from BMI.
VO2 max: The maximum volume of oxygen your body can use per kilogram of body weight per minute at peak exercise effort. The most powerful single predictor of all-cause mortality in the medical literature. Rises with training, falls with detraining. Measured directly on a CPET.