Testing
Conventional Medicine is the medicine of WHAT – What disease you have, determines What pill to take. Whereas Functional Medicine is the medicine of Why – Why is the symptom occurring, Why is the disease developing and what's at the root of it. This is where diagnostic testing to assess the root causes of illness can help. Functional Medicine testing utilizes advanced testing methodologies to identify dysfunctional pathways and develop a road map to treat patients more effectively.
The best treatments occur when you have an accurate diagnosis and understand the causes of that diagnosis.
Medical diagnosis has it's place, but its also rooted in an old paradigm largely based on symptoms and anatomy as opposed to molecular biology, biochemistry, genomics and metabolomics.
The study of metabolomics – the complex relationship between physiology and biochemistry uniquely connected to an individuals genetic expression – allows us to understand more complex patterns and disruptions of disease.
Rather than defining someone's health status based on what we see – tissue changes under a microsope or static pathology observed from CT's, MRI's and gross aberrations in blood chemistry (excessive glucose or cholesterol) – why not assess your health on function?
Why not assess systems, rather than symptoms?
Why not address someone's trend towards disease and pathology rather than waiting until the develop it?
Functional Medicine testing offers a new roadmap based on systems biology, function and causality.
Ultimately, all the conditions classified by the ICD as “diseases” can be viewed through the lens of 2 questions, 5 causes of illnesses and 7 core concepts.
The 2 Most Important Questions:
- Does the patient need to get rid of something, such as toxins, infections, stress, a poor diet?
- Does the patient have some unmet individual need that must be corrected to improve function, such as nutrients, water, sleep, movement, social connection, meaning or purpose?
The Five Causes of Illness:
- Toxins (biological, elemental, synthetic)
- Allergens & Intolerances (food, mold, dust, pollens, chemicals)
- Microbes (bacteria, yeast, parasites, worms, etc)
- Stress (physical or emotional)
- Poor Diet (nutrient deficiencies, toxicitiy)
The 7 Core Physiological Systems and Imbalances
- Digestion and Absorption and Gut Imbalances
- Hormonal and Neurochemical Imbalances
- Immune and Inflammatory Imbalances
- Detoxification & Biotransformational Imbalances
- Mitochondrial Dysfunctions
- Structural Imbalances (cellular dysfunction, musculoskeletal problems)
- Mind & Body Imbalances
Taking into account all of this information, we can then proceed with a road map of functional medicine testing to identify the cause of your imbalance. Let's discuss some of the foundational tests you might consider.
Functional Blood Chemistry testing is one of the most efficient and cost effective screening tools available to clinicians who understand how to properly interpret the results.
Let me repeat.
Functional Blood Chemistry testing is the best place to start if you know how to interpret the data.
Mastering functional blood chemistry analysis involves learning how to differentiate when individual biomarkers are important and when they are not, in order to identify patterns of imbalance and pathology and how to use additional testing to clarify imbalances.
For this reason, almost every single patient will start with a comprehensive blood chemistry panel.
Experience has taught me that most people have either never received a comprehensive blood chemistry evaluation or the blood chemistry testing they had done previously was not interpreted appropriately.
There are major problems in conventional medical settings when it comes to blood chemistry analysis.
The first problem is that most conventional medical lab orders are routine at best. Generally speaking, they only order what insurance will cover and it leads to missing potential health problems.
In addition, most lab panel interpretations only focus on individual markers such as elevated glucose or cholesterol.
It's important to understand that patterns tell us much more about what is happening than individual markers. So if you have a low, normal or high blood chemistry marker, it needs to be assessed in the context of other markers to determine the presence of a functional imbalance, pathology or disease.
This is why comprehensive testing is so powerful. The more markers you measure, the more patterns you can observe.
Another problem is that most doctors reference the standard laboratory reference ranges for blood chemistry.
Standard laboratory reference ranges are simply an average of the results of the current population. They are not based on optimal states of physiology and do not take into account someone's current health status, age or sex.
This means that if the majority of the population has higher than normal blood sugar, the “standard reference range average” is going to be higher than normal.
This is why patients are told that their labs are normal and there's nothing to be concerned with, when in fact their labs are demonstrating all sorts of imbalances that can impact health.
The most basic blood chemistry tests will include a CBC or complete blood count, CMP14 or Comprehensive Metabolic Panel, Lipid Panel, Thyroid Panel and a few markers measuring nutrient status (B12, Folate, Magnesium, Vitamin D) and inflammation (C-reactive protein, uric acid, homocysteine).
Have a comprehensive functional blood chemistry analysis is helpful, but approximately 90% of my patients will undergo digestive health or gut testing.
If there's one thing I've learned in working with patients for as long as I've been doing this – it's that the brain and digestive system or gut is really the key to health.
If you don't have a strong and healthy brain, you can't be healthy overall (including having a healthy gut).
If you don't have a strong and healthy gut, you can't be healthy at all (including having a healthy brain).
One of my very first patients came to me with a primary concern of elevated lipids and cardiovascular risk.
I remember he had a history of high cholesterol, very high lipid particles (LDP-P) and no other symptoms. He didn't have any gut problems or issues with digestion. He slept very well and had decent energy. His primary goal was to reduce his risk of having a heart attack.
In working with him, I explained how high LDL particles were merely a symptom of some underlying cause of inflammation. Of course, one of the sources of inflammation is gut inflammation and intestinal permeability.
It's very common for me to find individuals with gut infections that cause elevated cholesterol (especially LDL-P).
And sure enough, despite his lack of digestive or gut related symptoms, we did some digestive testing and we ended up discovering that he had a massive fungal infection and moderate amounts of small intestinal bacterial overgrowth.
Now there are a lot of different way to test the gut, but the three things that I consider to be the most important are a comprehensive stool test, a breath test for SIBO and a urine organic acids profile that evaluates nutrient status, cell, bacterial and fungal metabolism.
In terms of stool tests – there are a lot out there and most of them are insufficient. So make sure you get tested by a reputable company with proven methodology.
There is absolutely a right and wrong way to measure hormones in the human body.
First, there's no perfect science to measuring hormones. Not only do hormones exist in various states (active, inactive and metabolized), but they also change dramatically throughout the day, week and even year.
For example, at 9 AM a woman could have really high levels of estrogen, and then just two hours later at 11 AM those levels could drop down to what would be considered low levels of estrogen.
This means that measuring her hormones in the morning would yield completely different results from noon and even evening hours.
Second, there are 3 accepted methods of measuring hormones including blood hormone testing, salivary hormone testing and urine based hormone testing.
One of the major limitations of blood or serum hormone testing is the “snapshot” nature of single point testing.
Because hormones are secreted in a pulsatile nature, it's difficult to know whether the levels detected via blood are a true representation of what is happening.
Therefore, blood hormone testing is ideal for peptide hormones such as FSH, LH, prolactin, fasting insulin and thyroid hormones including TSH, Free T4, Free T3, Reverse T3 and thyroid antibodies.
I do not suggest blood testing for stress or sex hormones including cortisol, estrogen, progesterone and testosterone. For most sex hormones, blood testing does not differentiate between the total and free hormones present.
This can lead to misleading results where hormone levels appear to be low, normal or high, but the patient can be functionally off.
Saliva and Urine based testing is more useful when measuring either stress or sex hormones because it does differentiate between free and and total amounts of hormone present.
In addition, Urine based hormone testing reveals how the individual is metabolizing those hormones to give a complete picture of what is actually happening.
Finally, saliva hormone and urine hormone testing provide an average of the amounts of hormone being produced, thereby reducing the false positives or negatives that can accompany blood testing results
The organic acids test is one of my favorite tests because it gives so much information about various aspects of health.
Organic acids testing is a diagnostic tool that every healthcare practitioner should know about and utilize.
The information provided by an organic acids test can help identify the underlying causes of a variety of chronic illnesses, including the symptoms of autism, neuropsychiatric disorders like depression and anxiety and neurodegenerative disorders like Alzheimer's disease.
Only requiring a urine sample, the organic acids test provides information on energy production, fat metabolism methylation, carbohydrate metabolism, bacterial and fungal metabolism, oxidative stress or tissue damage and neurotransmitter production.
Organic acids are chemical compounds that are excreted via the urine as byproducts of metabolism.
These compounds are a reflection of major metabolic processes occurring due to lifestyle and dietary factors such as nutrient deficiencies, toxicity, infections and overall cell function.
If someone is suffering from mood disorders, cognitive dysfunction, fatigue, digestive issues and weight loss or metabolic dysfunction, an organic acid test can provide guidance for the development of personalized supplementation of nutrient deficiencies that could be a contributing factor.
In addition, organic acid testing allows for the assessment of genetic inborn errors, enzymatic defects and poor detoxification processes that are otherwise hard to diagnose.
Organic acids testing can indicate the functional need for antioxidants, B vitamins, minerals, digestive support, diet modification, detoxification, methylation support and other therapies.
Every day we are exposed to toxins from our environment.
We inhale thousands of industrial chemicals, ingest lead and copper from drinking water, phosphate from processed foods and soda, synthetic chemicals from plastic wrappers and food containers and pesticides from fruits and vegetables.
Toxicity is a growing concern for both doctors and patients. In the United States, there are over 80,000 chemicals that have been registered for use.
And every year, there's an average of 2,300 new chemicals submitted for review to the EPA, with less than half being tested for toxic risk to humans and only 7% tested on the developmental effects in children.
These natural and synthetic chemicals can dramatically influence our digestive health, hormones and brain function.
With more and more exposure to these chemicals, we have been confronted with an accelerating rate of chronic disease such as cancer, heart disease, chronic fatigue syndrome, chemical sensitivities, autism spectrum disorders, ADD/ADHD, autoimmune disorders, Parkinson's and Alzheiemer's.
The exposure to environmental pollutants has been linked to many of these illnesses.
For this reason, environmental and toxicity testing should be considered.
Some of the environmental and toxicity testing that I would suggest includes mold and mycotoxin testing, toxic non-metal chemicals, heavy metals and glyphosate testing.
Food and Nutrient testing has become very popular in the last 10 years.
While food intolerance testing, food sensitivity testing, food allergy and nutrient testing are all very valuable, they are far from perfect.
For example, Food sensitivity and intolerance testing is all based on immune function. This means that the results you get from these food panels are going to depend on the state of your immune system.
Because 80% of your immune system resides within the digestive tract, your results will also be dependent on gut health and overall digestion.
Ironically, people who choose to get food sensitivity testing have immune and gut dysfunctions to begin with.
And while testing for food intolerance or sensitivity is helpful, it's certainly not a place to start.
In other words, you would want to undergo comprehensive blood chemistry testing and digestive health testing first; and if all is clear, then proceed with food and nutrient testing.
There is also a big difference between Food Allergies and Food Intolerances.
A food allergy is a histamine or exaggerated inflammatory response in the body, while a food intolerance is an inflammatory reaction to food.
Intolerances are low grade, lingering reactions that can cause symptoms including brain fog, skin breakouts, gut issues and autoimmunity.
Food allergies will cause hives, swollen air ways and/or acute allergic reactions.
