As many of my patients know, I run a busy chiropractic office in Austin, Texas… but I also have a thriving Functional Medicine practice that allows me to consult with and help people all over the US and abroad.
Still, many of my you have been asking me questions surrounding Functional Medicine and what it entails.
My philosophy to health is pretty simple: Move Well, Eat Healthy and Cultivate Happiness.
As a chiropractor, my goal is to make sure that your spine is healthy, your joints are mobile and you have no physical limitations in movement. Functional Medicine allows me to address the other 2 components: eating well and cultivating happiness.
In this article, I’d like to discuss my approach and how it works.
Conventional medicine has a doctor for every part of your body. There are cardiologists for your heart, gastroenterologists for the digestive system, neurologists for the brain and nervous system, podiatrists for your feet, and ophthalmologists for your eyes.
Due to specialization, conventional medicine often focuses on individual body systems, rather than trying to understand the whole person and ultimately that individuals underlying causes of disease and chronic illness.
In light of this, symptoms are used to name a disease and find a corresponding drug. That’s typically your treatment.
- High blood pressure gets you blood pressure lowering pills.
- High cholesterol, gets you cholesterol lowering pills.
- Infections of any kind almost always get you antiobiotics
- Imbalanced hormones, gets you hormone replacement therapy.
- Etc. Etc. Etc.
Basically, your symptoms are treated with no regard for the “cause”.
In functional medicine, the goal is to view your body as an interconnected whole, within a larger environment.
In other words, your health is the sum of all nongenetic (your external environment) and genetic (internal environment) exposures in your lifetime, starting from the moment of conception to death. It encompasses the food we eat, the air we breathe, social interactions, lifestyle choices and inherent metabolic and cellular activity.
Functional Medicine doctors recognize that in order to treat one part of the body, all other parts must also be considered. This breaks apart artificial divisions of the body.
What Functional Medicine Addresses
I have a hierarchy of importance for which factors to address when starting with a patient:
- Diet, Lifestyle and Environment.
- Nutrient imbalance, gut and HPA-axis
- Cellular Dysfunction, Toxic Burden, Hormone Imbalance
- Chronic Infections and Immune Dysregulation
- Treating symptoms for diseases that cannot be fixed
Diet, Lifestyle and Environment
As a good rule, any doctor interested in improving health should begin with diet, lifestyle and environment. It is what it is and there’s no way to self-medicate, supplement or artificially create what life requires.
Nutrient Imbalances, Gut Infections or Dysbiosis and HPA-axis
There are two reasons why we address this next:
First, these factors are often at the root of, or at least strong contributors, of other pathologies such as hormone imbalances (Low T, Thyroid problems, PCOS, etc), cellular dysfunction (Energy balance, Diabetes, Heart Disease, Weight) and immune dysregulation (autoimmune disease, cancer, arthritis, tissue repair).
Second, even if there are other problems occurring, this will lead to a significant clinical improvement towards helping any other condition.
I believe that up to 80% of health problems can be addressed by simply getting #1 (Diet, Lifestyle, Environment) and #2 (Nutrient imbalances, gut infections or dysbiosis and HPA-axis) in check.
Cellular Dysfunction, Toxic Burden, and Hormone Imbalance
In some cases we have to dig deeper. This involves assessing methylation, heavy metals, mold/biotoxins, impaired detoxification, thyroid, sex and metabolic hormones. Again, most of these problems can be addressed by improving diet, lifestyle, nutrient imbalances, gut health and stress.
Chronic Infection and Immune Dysregulation
Some patients have infections (Lyme, co-infections, parasites) that are pretty nasty and almost always require a more specialized and even integrated (Medical Prescription) approach.
How can you get started?
If you’re interested in a functional medicine consult, here’s my flow:
The consult has 2 parts: A 20 minute case review and an hour to 2 hour case review
STEP ONE: INITIAL 20 MINUTE CONSULT
After purchasing an initial consult, we will setup a time for us to meet over the phone or in person. During this 20-minute appointment, I will interview you to determine which lab tests to order for your Case Review, based on your chief complaints and your history.
This appointment has two purposes: to make sure that I have all of the information needed to gain a comprehensive understanding of the factors affecting your health and to give you a head start on your treatment before you meet with me.
The exact lab testing ordered after the Initial Consult depends on your individual circumstances, but may include:
- A comprehensive blood chemistry panel. This is the single most efficient, effective and affordable tool for quickly evaluating your health. It screens for a wide range of conditions, including several types of anemia; gut, viral and bacterial infections; insulin resistance and hypoglycemia; liver and kidney issues; and thyroid and adrenal problems. It offers important clues for how to structure and focus your treatment to get the best results. It also provides a baseline of biomarkers that can be used to objectively track the progress of your treatment over time.
- Additional blood tests for specific conditions, such as high cholesterol, hypothyroidism, autoimmune disease and gluten sensitivity.
- Advanced stool testing to screen for parasites, fungal overgrowth, bacterial infections, intestinal inflammation, dysbiosis and a deficiency of beneficial gut bacteria.
- Urine organic acids testing to screen for small intestinal bacterial overgrowth, fungal overgrowth, problems metabolizing fat or carbohydrates, B-vitamin status, methylation issues, detoxification capacity, oxidative stress and neurotransmitter metabolism.
- Urine hormone testing for adrenal and sex hormone status.
You will also be provided the Case Review health history paperwork to complete.
This paperwork includes:
- A detailed health and medical history questionnaire
- A survey of your chief complaints and most important health goals
- An assessment of your most troubling and frequently experienced symptoms
- A diet survey and questionnaire
- A survey of your current supplements and medications
Once we’ve received your lab results and completed the Case Review paperwork, I will give you specific protocols to start working on before moving on to part 2: the case review consultation.
This typically occurs between 60 and 90 days after the Initial Consultation, because some of the labs we use take up to 8 weeks to deliver the results to us after receiving your sample.
STEP TWO: THE CASE REVIEW CONSULTATION
The Case Review Consultation is a 60-minute to 120-minute in-person, phone or video appointment.
Prior to the consultation, I will have reviewed the results from the labs that were ordered along with your Case Review paperwork, medical history, diet and supplement survey, assessment forms and relevant prior lab work. I will also create a Report of Findings, which is broken into three parts:
- A summary of the underlying patterns that are contributing to your symptoms.
- An outline of the suggested treatment plan, including dietary, supplement and lifestyle recommendations.
- Recommendations for further testing (this will typically be minimal, if necessary at all, because of the completeness of the Case Review process)
During this visit, I will present the Report of Findings as well as your treatment plan. I will also review all of your test results with you and answer any questions you have about the findings or the treatment plan.
In previous articles I discussed 2 of the most common, but worst supplements you could be taking for your health. These supplements included Iron and Calcium.
Certainly these 2 nutrients are important for our health… but when it comes to supplementing with iron and calcium, it can be detrimental to your health.
For example, iron is a pro-oxidant, which causes oxidative stress and when present in large amounts can literally lead to organs and tissue damage. Calcium is associated with a 139% increased risk of heart attack and a 20% higher risk of stroke.
In this article, I’d like to finish up my series of the “Most Common Worst Supplements” you may be taking by discussing Vitamin E, Vitamin A (Beta Carotene) and Folic Acid.
Vitamin E (Alpha-Tocopherol)
Let’s talk about vitamin E. Vitamin E is a potent fat-soluble anti-inflammatory vitamin that protects us from free radicals and tissue damage. It’s also involved in immune function, cell signaling, regulation of gene expression, and other metabolic processes.
There are three different types of vitamin E, or isomers. There are phenols, tocopherols, and tocotrienols. Alpha-tocopherol is the form that most supplements contain. While vitamin E is an important nutrient to get in the diet, I definitely don’t recommend supplementing with it, with the possible exception of tocotrienols.
Now, before we proceed it’s important to have some understanding of the difference between synthetic vitamins and whole food or natural isomers of vitamins.
When checking vitamin labels, natural vitamin E is usually listed as the “d” form followed by “alpha-tocopherol”. On the other hand, synthetic vitamin E will be listed as “d” followed by an “l” or dl-alpha-tocopherol”.
This is important when it comes to understanding research outcomes.
At best, dl-alpha-tocopherol (synthetic vitamin E) shows no benefit, but in several studies, it actually shows harm. For example, in a meta-analysis in JAMA with 230,000 total participants, vitamin E supplementation caused increased risk of death from all causes. Another review of 78 randomized controlled trials with almost 300,000 total participants found that vitamin E supplementation increased mortality by a small but significant margin.
So, again, you want to aim for whole-food sources of vitamin E only.
These include nuts and seeds primarily but also tomato sauce, cranberry juice, some fruits such as apricots and avocado, and fish such as trout.
The RDA is 15 mg a day. Most Americans get their intake from polyunsaturated vegetable oils. That is perhaps one of the only benefits of these industrial seed oils.
Paleo sources for people who are avoiding those oils or minimizing them, again include nuts and seeds, some greens, and some fish such as trout. It’s important, by the way, to eat foods that contain vitamin E, and any fat-soluble vitamin, for that matter, such as D, K2, and A, with fat because they are fat soluble.
Fat will be necessary to absorb fat-soluble vitamins such as vitamin E, and studies have consistently shown that when fat is consumed, the absorption of these vitamins is much greater.
Vitamin A (Beta Carotene)
Okay. Now let’s talk about vitamin A or beta-carotene. Beta-carotene gives plants an orange or yellow color, and this is a precursor for active vitamin A, retinol. Beta-carotene can also be converted into potentially harmful substances, and it can increase the risk of oxidative stress similar to Iron. Studies show that beta-carotene supplementation may increase the risk of heart disease and cancer in people who drink heavily or smoke.
High levels of betacarotene may have anti-vitamin A properties. This means it actually works against active vitamin A by disrupting the metabolism and action of active vitamin A.
Of course, the best option for getting beta-carotene is from food! And this is easy to do on a Paleo-type diet. Foods that are rich in beta-carotene include carrots, tomatoes, sweet potatoes, broccoli, cantaloupe, winter squash, bell peppers, spinach, lettuce, pumpkin, and kale.
However, if you are going to supplement… then make sure your Vitamin A’s label reads Betatene or Mixed carotenoid complexes. A complex of beta-carotene will include beta-carotene, lycopene, lutein and other carotendoids.
Folic Acid (Methyl Tetra Hydrofolic Acid)
Finally, let’s have a talk regarding Folic acid.
Folic acid is an oxidized synthetic compound that is only found in dietary supplements and fortified foods.
It’s now well understood that synthetic folic acid compounds are not metabolized by the body and can actually accelerate the progression of certain cancers. WOW… many physicians regularly recommend this to their patients.
Folic acid is not a natural form of folate found in nature. It was introduced into the food supply to reduce the risk of neural tube defects during a malnourished pregnancy, which it definitely does.
Folic acid can be converted into natural folate, but unfortunately, that conversion is limited in humans.
It undergoes initial reduction and methylation in the liver using dihydrofolate reductase as an enzyme, and if the patient has low activity of this enzyme, she can end up with high levels of unmetabolized folic acid in her system and circulation. A new study was released that found that nearly all babies, children, adolescents, and adults in the U.S. have measurable levels of unmetabolized folic acid in their systemic circulation, so this is a big problem that has only recently been recognized.
Why are high levels of unmetabolized folic acid in the blood problematic?
- They can mask vitamin B12 deficiency.
- They may lead to the deterioration of central nervous system function, especially in the elderly.
- They can cause anemia and cognitive impairment.
- They can accelerate the progression of certain cancers, including colon and prostate cancer.
- They can depress immune function, and they are associated with increased risk of death from all causes.
Folate, or Methy Tetra Hydrofolic Acid, aka natural folate on the other hand, which is found in foods in nature and in supplements with natural forms of folate is not only very necessary for health but is also safe to supplement with.
If you currently take a multivitamin and its a cheaper type of brand, you may want to make sure to look for folic acid. If it says folic acid on it or it doesn’t specifically mention that it is one of the active forms of folate such as 5-MTHF, metafolin, or folinic acid, then it probably has folic acid and should be avoided.
Foods that are naturally rich in folate include beef liver, and chicken liver is actually the highest source of folate and the best source; also dark, leafy greens such as spinach and collards. Lentils are a good source of folate if your patients tolerate legumes, as are beets, cauliflower, parsley, mustard greens, turnip greens, and even some lettuces.
The Real Food Multivitamin
For all the reasons listed above as well as in my previous articles on the dangers of iron and calcium supplementation, this is why I decided to start my own nutrition company a few years ago (DNA Formulas).
My multivitamin is a food sourced multivitamin made to contain the specific forms of vitamins that are deemed safe and actually necessary for optimal health.
How do you know if you’re vitamin is good or bad? I have a quick checklist when it comes to reading labels:
If you’re looking for a good multi, consider The Real Food Multivatmin!
I make numerous recommendations with respect to what nutritional supplements, herbs and botanicals a patient should take to improve their health.
In many cases, supplements are necessary for therapeutic treatment and I believe that many people cannot heal their bodies without them.
However, there are many supplements I know my patients are taking that are unnecessary and even harmful.
Last week I discussed the risk of Iron supplementation and how you should proceed with caution if you’re taking them.
This week, I want to continue the discussion with calcium supplementation.
The Risk of Calcium Supplements
Calcium is important for the proper formation of bones and teeth. It plays a role in cell signaling, contractability of muslces and excitation of neurons.
Calcium levels are tightly regulated by parathyroid hormone and vitamin D. If calcium intake isn’t high enough, calcium levels will be maintained at the expense of bone health. That’s something important to understand.
The RDA for calcium is 1,000 to 1,200 mg a day, though other experts have suggested that lower levels are probably adequate, especially if vitamin D and K2 levels are sufficient, because those nutrients help to regulate calcium metabolism.
This is exactly why I recommend taking my Vitamin D3+K2 supplement.
Quite honestly, the easiest way for someone to get their RDA of calcium is by consuming an ancestral or paleo based diet.
In short, consuming foods with anti-nutrients, or nutrients that block the absorption of vitamins and minerals, is what is causing massive human nutrient deficiencies in the first place. On a Paleo diet low in anti-nutrients, the need for calcium is lower due to increased absorption of dietary calcium.
As I mentioned, vitamin D and vitamin K2 are both required for optimal calcium absorption. So before taking calcium, make sure that your vitamin D and K levels are optimized!
You should also be aware that higher-protein diets increase calcium absorption, and higher intakes of calcium through supplements but not through diet can lead to hypercalcemia, which can be fatal if left untreated.
Certainly the media has contributed to the popularity of calcium supplementation.
This is especially true with older women wanting to help prevent osteoporosis. Most older women who come into my office are taking calcium.
Unfortunately, the overwhelming research shows that calcium supplementation doesn’t reduce fracture rates in the elderly and seems to actually increase them. The same research also indicates that it particularly harms men!
While calcium is a crucial mineral, supplemental calcium has been shown to increase the risk of cardiovascular disease and cardiovascular events. It’s not hard to understand why. We want our arteries to be soft and pliant. When our arteries become calcified and they become brittle and hard, that increases the risk of cardiovascular disease.
Supplemental calcium has a much greater effect on circulating calcium concentrations than dietary calcium.
Humans evolved to get calcium from diet just like all of the other nutrients, and our body has regulatory mechanisms for handling that, even if we’re getting more calcium than we need, but those regulatory mechanisms appear to be less effective with large boluses of supplemental calcium.
So make sure that you are getting adequate amounts of K2 and consuming enough vitamin D and vitamin A because all of those play a role in regulating calcium homeostasis.
Calcium and Cardiovascular Risk
In a study of 24,000 men and women aged 34 to 65 that was published in BMJ in 2012, those who supplemented with calcium had a 139 percent higher risk of heart attack versus those whose calcium intake came from food who had no change in risk.
Meta-analysis in BMJ of 12,000 individuals showed that those taking supplemental calcium had a 31 percent higher risk of heart attack, a 20 percent higher risk of stroke, and a 9 percent higher risk of death from all causes.
Finally, another analysis in JAMA Internal Medicine, also looking at 12,000 participants, found that intake of more than 1,000 mg of supplemental calcium per day increased the risk of death from cardiovascular disease by 20 percent.
So, now you can understand why I’m not a fan of supplemental calcium.
Even without purposefully supplementing calcium, many people may be accidentally supplementing because of fortified foods and multivitamins. Multivitamins almost always have calcium in them.
Foods such as orange juice; cereal; non-dairy milks such as almond milk, rice milk, or soy milk; bread; instant oatmeal; and several other foods are often fortified with calcium.
Best Food Sources of Calcium
I recommend that most patients get their calcium from food if possible, and I’ve listed the food sources of calcium on this slide based on serving size.
Things such as sesame seeds; sardines with the bones in; dairy products, of course; dark, leafy greens such as collard greens and spinach; and sockeye salmon with the bones in are a great source of calcium.
Sardines with bones in and canned sockeye salmon with bones are probably two of the best ways for you to get calcium.
If you’re concerned about bone health, then eat the foods listed above and lift heavy things!
Weight-bearing exercise is probably one of the most important things you can do to promote healthy bones.
I promise, if you are consuming enough dietary calcium as well as other synergistic vitamins and minerals such as K2, D, A, and magnesium and performing weight-bearing exercise, there is probably no need to supplement at all, and supplementing would likely do more harm than good.
I have many patients who ask what supplements they should be taking. The answer to that question is largely dependent on that individuals current health status, health goals and lifestyle.
But what about the supplements you most likely SHOULDN’T be taking?
In this article, I’d like to talk about the supplements you should be cautious with and in some cases, never take (unless you absolutely know what you’re doing).
Iron is a part of several enzymes and proteins in the body, and it’s found in foods as both heme and nonheme iron.
Heme iron comes from hemoglobin and myoglobin in meat, poultry, and fish. Despite being only 10 to 15 percent of the iron found in food, it makes up more than one-third of what we absorb.
Nonheme iron is found in plants, dairy products, and in some meats. Unlike heme iron, nonheme iron absorption is significantly influenced by food components in the same meal. These things include enhancers such as vitamin C and other acids as well as sources of heme iron and inhibitors such as phytic acid, polyphenols, and soy protein.
The recommended daily allowance for iron is 8 mg, except for in menstruating females, who need to get 18 mg, or pregnant women, who need to get 27 mg.
While iron is clearly an important nutrient, it is also essential to make sure you don’t get too much of it.
Hemochromatosis is a genetic disorder that causes aggressive iron storage and iron overload.
It is associated with a broad range of adverse effects and health Conditions such as liver disease, diabetes, metabolic syndrome, cardiovascular disease, Alzheimer’s dementia, Parkinson’s and other neurodegenerative disorders, impotence, infertility, and hypogonadism.
Why is Iron So Bad? Because iron is a pro-oxidant.
Meaning it causes oxidative stress (damage), and it literally leads to the organs and tissues in our body rusting. Another example of oxidative stress would be when you take a bite out of an apple, and you leave it out on the table, it turns brown.
That’s exactly what happens inside of our body when we have too much iron.
List of possible conditions associated with Iron overload.
A lesser known fact is that even mild iron overload (where iron levels are in the upper end of the reference range) can cause increased morbidity and mortality.
For example, the range for iron saturation in the U.S. typically goes up to about 55 percent, but studies show that increased mortality happens as iron saturation climbs above 50 percent.
Likewise, many of the lab ranges for ferritin in men go up to about 400 in the U.S. and in other parts of the industrialized world, but studies suggest that you see an increase in blood sugar and an increase in morbidity and mortality in men as ferritin climbs above 150 or 200.
These are people who don’t necessarily have hereditary hemochromatosis, or perhaps they are a carrier for hemochromatosis.
Iron overload is significantly associated in particular with impaired insulin sensitivity and glucose tolerance. So If you have high blood sugar, you should definitely get checked or screened for iron overload.
Iron reduces insulin synthesis and secretion. It decreases insulin sensitivity in the liver, and iron deposits in the liver can decrease glucose uptake.
Above, you’ll find my optimal ranges for the various iron indices. They’re based on the recommendations from the Iron Disorders Institute, which is a group that advocates for greater understanding of the effects of both iron overload and iron deficiency.
If you have been diagnosed with metabolic disease, diabetes, metabolic syndrome, liver abnormalities, weakness, lethargy, or skin hyperpigmentation, and you have iron levels that are outside of these ranges —and remember TIBC and UIBC are inverse markers, so low levels of these mean high iron—then you should be thinking about hemochromatosis or iron overload.
Iron Overload Treatment
Treatment for iron overload is typically either blood donation or prescription phlebotomy. Phlebotomy is the removal of blood, typically a unit of blood at one time. It’s the same when you donate blood or get a prescription for phlebotomy.
There is also a substance called apolactoferrin. It’s a natural protein that can help remove iron from tissues in the body, iron that is already stored in the body. The dosage there would be 300 mg of lactoferrin one to two times a day on an empty stomach.
Patients with hemochromatosis should not take supplements that contain iron. Unfortunately, you’ll often see people with iron overload who weren’t aware that they had it who are taking iron supplements. They may also need to avoid foods that are very high in iron.
The biggest offenders are shellfish and organ meats.
What I’ve found is that patients with iron overload definitely need to avoid shellfish and organ meats. Some studies suggest that just standard muscle meat such as beef and bison don’t make a huge difference for most people, so we start by telling them to avoid the organ meats and the shellfish.
I also want to advise patients to cook with ceramic, stainless steel, or glass instead of iron skillets. Finally, avoid substances that enhance the absorption of iron.
This includes limiting alcohol (limit consumption to two drinks a week), supplemental vitamin C, Betaine hydrochloric acid and high doses of zinc.
If you have iron overload, consider downloading this handout and iron reduction strategies:
Iron Reduction Strategies
A group of liver function tests are often performed as part of routine laboratory testing. However, as you will learn in this article, these tests may also highlight dysfunction or disease in systems other than the liver.
As a Functional Medicine practitioner, I don’t rely solely on the results of one specific test. I also carefully evaluate your symptoms, diet, lifestyle, history, and other lab test results to further narrow down all potential sources of dysfunction or disease.
When interpreting results, Functional Medicine considers “optimal” ranges as opposed to “normal” ranges (learn more here). This allows us to identify and treat signs of dysfunction before a full-blown disease occurs.
When combined, the tests described below provide insight into how well (or poor) your liver is functioning. And it’s important to recognize that your diet and lifestyle are two key factors that affect liver function. For example, when the liver is overburdened with toxins, it may become congested. As a result, toxins may build up in your body and lead to additional problems.
Some common signs and symptoms of liver dysfunction include:
- Abnormal cholesterol levels
- Gas and bloating
- Dietary fat intolerance
- Fatigue and weakness
- Blood sugar imbalances
- Brain fog
- Poor memory
- Food allergies
- Skin rashes
- Hormonal imbalances
- Severe menopause or PMS
- Liver spots (brownish spots on skin)
Thus, if liver dysfunction is suspected, Functional Medicine attempts to identify and eliminate all possible sources.
Common Liver Function Tests
Below are descriptions of the most common liver function tests performed.
Albumin is a protein synthesized and secreted by the liver. And it’s the most abundant protein found in human blood. It plays a role in balancing fluids, transporting nutrients and hormones, metabolism, pH balance, blood vessel health, and fighting free radical damage.
The rate of albumin synthesis depends on liver function as well as nutritional intake. Specifically, the body needs a source of energy and amino acids (building blocks of protein) to manufacture albumin.
Thus, abnormal albumin levels may indicate a variety of potential problems in addition to liver dysfunction.
Decreased albumin levels are typically associated with:
- Liver dysfunction
- Systemic inflammation
- Nutrient deficiencies
- Digestive dysfunction
Elevated albumin levels may be a sign of dehydration.
The total protein test measures both albumin and globulins, which combined make up a majority of blood proteins.
Globulins are synthesized and secreted by both the liver and the immune system. Similar to albumin, energy and amino acids are required. And one of the key roles is to transport minerals, hormones, and fats throughout the body.
However, one very important type of globulins are known as immunoglobulins (a.k.a. antibodies), which play a crucial role in preventing infections and neutralizing toxins.
Decreased total protein levels may be a sign of:
- Liver dysfunction
- Nutrient deficiencies
- Digestive dysfunction
- Kidney dysfunction
Elevated total protein levels may be associated with:
- Systemic inflammation
- Chronic infections (i.e., viral hepatitis and HIV)
- Bone marrow disorders
However, it’s worth noting that an optimal total protein level may still be detected even if albumin or globulin levels are out of range. Thus, it’s essential to consider albumin levels when interpreting total protein levels.
Albumin/Globulin Ratio (A/G Ratio)
Total protein and albumin are often used to calculate the ratio of albumin to globulins.
A low A/G ratio may be a sign of:
- Liver dysfunction
- Autoimmune disease
- Kidney dysfunction
A high A/G ratio may indicate low levels of immunoglobulins, which are observed with genetic related disorders and leukemias (blood cancer).
Bilirubin is a waste product created from the degradation of old red blood cells. And it’s the liver’s job to process bilirubin in a way that makes it easy for the body to eliminate.
There are two tests associated with bilirubin – total bilirubin and direct bilirubin.
Total bilirubin measures both indirect bilirubin (prior to liver processing) and direct bilirubin (after liver processing). However, as with total protein, total bilirubin doesn’t provide a complete picture.
Thus, direct bilirubin levels are also measured. And indirect bilirubin levels can then be calculated.
Elevated levels of indirect bilirubin may be a sign of:
- B12 deficiency
- Liver cirrhosis
- Oxidative stress
- Autoimmune disease
- Hemolysis (premature destruction of red blood cells)
Elevated levels of direct bilirubin may be associated with:
- Liver dysfunction
- Viral hepatitis or other liver infections
- Alcohol induced liver disease
- Cholecystitis (inflammation of the gall bladder)
- Liver tumors
Liver Enzyme Tests
The remaining three tests below evaluate blood levels of specific enzymes that reside in the liver. However, it’s worth noting that these enzymes are also found in other tissues within the body. Thus, these tests provide insight into a variety of potential issues, especially when evaluated together along with other laboratory tests.
Alkaline Phosphatase (ALP)
Alkaline phosphatase is found in the liver as well as the bones, skin, and digestive tract.
Elevated levels of ALP may be a sign of:
- Viral hepatitis or other liver infections
- Liver cirrhosis
- Liver tumors
- Fatty liver disease
- Bone disorders
- Leaky gut (increased intestinal permeability)
- Cholecystitis (inflammation of the gall bladder)
The activity of ALP is highly dependent on the presence of the mineral zinc. Thus, while low levels of ALP are optimal, abnormally low levels of ALP may be associated with a zinc deficiency.
Aspartate Aminotransferase (AST)
Aspartate aminotransferase is an enzyme found in the liver as well as the heart, muscles, kidneys, lungs, and pancreas. It is released into the bloodstream as a result of cellular damage or destruction.
Thus, elevated levels of AST may be a sign of:
- Liver dysfunction
- Cellular damage (in heart, liver, pancreas, muscle tissue)
- Heart dysfunction or disease
- Infectious disease
The functionality of AST heavily relies on the presence of vitamin B6. Thus, while low levels of AST are optimal, abnormally low levels of AST may be associated with a vitamin B6 deficiency, which can be caused by alcoholism.
Alanine Aminotransferase (ALT)
Alanine aminotransferase is found mostly in the liver, but smaller quantities are also found in muscle, kidney, and heart tissue. As with AST, it is released into the blood when cells are damaged or destroyed.
Thus, elevated levels of ALT may be associated with:
- Liver dysfunction
- Fatty liver disease
- Viral hepatitis or other liver infections
- Alcohol induced liver disease
- Liver cirrhosis
- Cellular damage (in liver, heart, or kidney tissue)
Similar to AST, abnormally low levels may be a sign of a vitamin B6 deficiency, which can be caused by alcohol abuse. In addition, abnormally low levels may also be associated with very a early stage of fatty liver disease.
The liver function tests discussed above provide valuable information related to the health of your liver. However, the test results must be interpreted carefully. In addition, many factors and other laboratory tests must also be considered before drawing any conclusions.
Thus, if you suspect your liver isn’t functioning at top speed, functional medicine can help. We’ll look for signs and symptoms starting with a series of laboratory tests as well as thorough data analysis.
If dysfunction is detected, we’ll work closely together to identify and correct all possible sources. While this process will improve your liver function, it will also most likely improve your health in many other ways.
- Giannini, E. G., Testa, R., & Savarino, V. (2005). Liver enzyme alteration: a guide for clinicians. CMAJ : Canadian Medical Association Journal, 172(3), 367–379. http://doi.org/10.1503/cmaj.1040752
- Laker, M. F. (1990). Liver function tests. BMJ : British Medical Journal, 301(6746), 250–251.
- Limdi, J. K. (2003). Evaluation of abnormal liver function tests. Postgraduate Medical Journal,79(932), 307-312. doi:10.1136/pmj.79.932.307
- Weatherby, D., & Ferguson, S. (2002). Blood chemistry and CBC analysis: clinical laboratory testing from a functional perspective. Jacksonville, OR: Bear Mountain Pub.
Blood Biomarkers and What They Mean
Biomarker is a shortened name for biological marker. Biomarkers are used as an indication that a biological process in your body has occurred or is ongoing. Biomarkers have to be something that can be measured accurately with reproducible results.
According to World Health Organization, a biomarker is almost any measurement reflecting an interaction between a biological system and an environmental agent – which may be chemical, physical or biological .
For our purposes, the biological system is your body and environmental agents include things like: your diet, your exposure to toxins, your stress levels, and your sleep patterns.
Most conventional medical doctors order blood tests to rule out disease. But rather than using blood tests to screen for diseases like diabetes or hypothyroidism, my focus is on anyone interested in optimizing health (Athletes) and I know how to use biomarkers to understand adaptations to training. Insights and interpretations in your personalized results relate to sports performance outcomes. Every individual should maintain an ongoing dialogue with their physician about health and wellness.
Why Blood Biomarkers Are Important
Blood biomarkers are important because they give you a detailed snapshot of your health at any given moment in time. They can give you an indication of:
- Exposure – to things like environmental and dietary toxins (supplement overload).
- Effect – from possible health impairments, your ability to recover and/or develop disease.
- Susceptibility – to various health problems that you cannot feel developing or occuring.
Taken together, blood biomarkers give you a wealth of information regarding your current health status. A trained Functional Medicine practitioner can use blood biomarkers to identify weaknesses in your health and prescribe a course of action to strengthen them. Because biomarkers are reproducible and accurate, they can be used as a powerful measuring stick to determine if your health is improving over time.
Blood biomarkers can measure many aspects of your health. So, keep reading and we’ll go into further detail on several of these aspects that can be reliably measured with blood biomarkers.
Metabolism & Weight Control
Keeping your weight under control and ensuring your metabolism is running at an optimal rate is crucial to your health – particularly your risk of heart attack (link to heart attack article). Some of the key blood biomarkers that can give you an early warning that your nutrition isn’t optimal include:
- High-density Lipoprotein (HDL) cholesterol – Nicknamed “good” cholesterol, HDL cholesterol “cleans” LDL cholesterol from your arteries. In general, the higher your HDL cholesterol, the better, especially when compared to LDL cholesterol.
- Low-density Lipoprotein (LDL) cholesterol
Nicknamed “bad” cholesterol, LDL cholesterol is the main source of plaque that causes your arteries to harden and put you at risk of heart attack. The higher your blood levels of LDL, the greater your risk of poor health is.
These are a type of fat found in your blood. After you’ve eaten, your body manufactures these with any calories it doesn’t need right away. The triglycerides are then stored in your fat cells and released later by your hormones for energy. If you regularly eat more calories than you need (especially from carbohydrates), you’ll likely have high triglycerides which increases your risk of heart attack and is an indicator of poor overall health.
Glucose is sugar in your blood your body manufactures from the digestion of carbohydrates. Low blood glucose levels result in increased energy, lowered blood pressure and optimal weight control. High blood glucose indicates that you’re at risk for weight gain, diabetes, high blood pressure and poor heart health.
Strength & Endurance
Blood biomarkers can provide remarkable insight into your ability to stay strong and optimize your stamina. Some key blood biomarkers that you should look at include:
Testosterone is a hormone that is crucial to both men and women for overall health, athletic performance and sexual function. Testosterone helps to increase muscle mass, strength and body’s ability to utilize oxygen. While men require much more testosterone than women, a small amount is still important for women to maintain optimal health.
Free testosterone is the fraction of total testosterone that is circulating in the blood and available for use. Optimal free testosterone levels are extremely important for athletic performance and sexual health. It’s been shown that regular exercise is important for increasing free testosterone levels.
Creatine kinase (CK) is important in the formation and use of energy-providing molecules and is found in the heart, muscles and brain. Elevated levels can be found in athletes and could also point to heat disease, nerve damage, thyroid disorders and kidney malfunction.
Cortisol influences inflammation and is an important hormone in stress response. Levels typically spike in the morning and decline throughout the rest of the day. Long-term and repeated stress, however, can cause cortisol levels to spike which can lead to a whole host of health problems.
- Sex Hormone-Binding Globulin (SHBG)
Sex hormone-binding globulin is a critical biomarker of hormonal balance. The interaction of SHBG with testosterone and estrogen affects overall hormonal balance. Hormonal imbalances caused by abnormal levels of SHBG are associated with cancer, type 2 diabetes and sleep apnea.
- Testosterone: Cortisol (T:C) Ratio
Increased cortisol levels adversely affect testosterone levels. In fact, a low T:C ratio can negatively affect your athletic performance. T:C ratio is crucial to monitoring your response to exercise intensity so that you can prevent overtraining or “too much exercise”.
Bone & Muscle Health
Keeping your bones and muscles healthy is important, especially as you age. Weak muscles and bones can lead to immobility and create a cascade of negative health effects on your body. A few key bone and muscle health blood biomarkers are:
N Vitamin D plays an important role in bone mineralization and muscle health. Often considered more of a hormone than a vitamin, Vitamin D has been shown to exert wide-ranging effects and Vitamin D deficiency is linked to poor muscle and bone health .
Calcium deficiency has been determined to be a major public health concern because it is critically important to bone health. The average American consumes levels of calcium that are far below the amount recommended for optimal bone health .
Electrolyte & Fluid Balance
Electrolytes are important for maintaining proper heart and kindney health, among others. In fact, electrolytes are vital to your entire body’s cellular function. Fluid balance is also important because an imbalance can cause a host of problems like high or low blood pressure, swelling, dehydration and can cause you to pass out. Some important electrolyte and fluid balance
Potassium plays an important role in muscle contraction and helps your body maintain a normal heart rhythm. High or low potassium can cause heart beat irregularities, muscle aches and fatigue.
Sodium is what draws fluid into your body’s arteries and blood vessels. High or low sodium can cause imbalances in your vascular fluid level which can lead to dizziness, heart arrhythmia and heart beat irregularities.
Maintaining low inflammation in your body is vital for your overall health and sense of well-being. Important markers of inflammation include:
- High Sensitivity C-Reactive Protein (hsCRP) Test
C-reactive protein (CRP) is made by your liver when there is inflammation in your body. CRP is also considered a marker of whole body inflammation and can be measured with an hsCRP test. High hsCRP levels are often linked to heart attacks and strokes .
White blood cells can be thought of as your body’s first and last line of defense. Your white blood cell count is an indicator of infection or inflammation in your body.
Oxygen Transport & Blood Function
Hemoglobin is an indicator of the number of red blood cells in your body. Low hemoglobin can cause anemia which can lead to symptoms of fatigue.
Ferritin is a measure of iron in your blood and important inflammatory disease marker. Serum ferritin, found in your blood, is mainly a leakage product from damaged cells . Low ferritin typically means you have an iron deficiency caused by low dietary iron or bleeding inside the intestinal tract.
Serum iron is a blood biomarker that indicates the amount of circulating iron that is bound to transferrin, an iron-binding blood protein that controls the level of free iron in your body.
- Total iron-binding capacity (TIBC)
Total iron-binding capacity (TIBC) can tell you if you have too much or too little iron in your blood and helps you determine how well the protein transferrin can carry iron in your blood. High TIBC indicates low iron and can point to anemia. Lower than normal TIBC can point to inflammation and liver disease .
- Transferrin Saturation (TS)
Transferrin saturation (TS) is calculated by dividing your serum iron by your TIBC. This value indicates how much of your serum iron is bound. Low TS values can indicate chronic iron deficiency, chronic infection and inflammation .
Blood biomarkers can tell you a ton of information about your cognition or brain health. Maintaining a healthy brain is vital for your success at work and school, and can help you maintain a sharp memory as you age.
Recent studies have shown that an intake of magnesium above what is traditionally considered the normal dietary amount has a dramatic effect on improving multiple aspects of memory and learning. In fact, elevating brain magnesium content by increasing magnesium intake may be a useful new strategy to enhance cognition and brain health .
Vitamin B12 is found mainly in meat, egg and dairy products and is essential for the formation of red blood cells and maintenance of a healthy nervous system. Many studies also point to Vitamin B12 as an important factor in preventing mood disorder and dementia .
Folate, or folic acid, is important to people of all ages for proper nervous system function. In fact, it has become clear to researchers that folic acid affects mood and cognitive function, especially in older people .
Liver health is essential to your body’s overall health and longevity. The liver perfors over five hundred functions, holds about 13% of the body’s blood supply at any given moment and filters over one liter of blood each minute. It filters blood, makes bile, makes and process hormones, regulates blood sugar and filters harmful toxins . Some key liver health blood biomarkers include:
ALT and AST are important enzymes found mainly in the liver. While not always indicative of liver disease, high ALT and AST is a good indicator of liver damage or injury from various disease or Conditions .
Albumin is an important protein manufactured by the liver. Low blood albumin can indicate kidney or liver disease, like hepatitis or cirrhosis .
GGT is another important liver enzyme that is often elevated due to various liver diseases or Conditions .
Proper hormonal balance is crucial for a woman’s overall health and well-being. Dehydroepiandrosterone-sulfate (DHEAS) is an important female hormonal health biomarker as it is required to make other sex hormones and steroid molecules in the female body.
DHEAS is a hormone manufactured by the adrenal glands which is then turned into testosterone, which is important in small amounts to female health. Testosterone is made in small amounts by the adrenal glands and ovaries in women. DHEAS is often measured in women to help diagnose polycystic ovarian syndrome (PCOS), to rule out infertility, irregular menstrual period and presence of excess facial and body hair .
Our survey of various blood biomarkers is a good introduction to how they can help you diagnose your current state of health which can then be used to take steps to strengthen any weaknesses in your health profile. For more information on any of these specific biomarkers and more, or an individualized consultation on what biomarkers you should be tracking, contact me today.