Functional Medicine Lab Testing

Believe it or not, most doctors don’t order nearly enough testing.  The human body is extremely complex, consisting of many different systems that interact in an intricate web, with every system influencing all of the others.  All of the different major physiological functions have special relationships with each other and all affect each other.  This is all well and good, as long as your body is humming along pleasantly, with everything working the way it should.

I might boldly venture to say that there is not a single person on this planet who fits that description.  Instead, stress, environmental toxins, food and environmental allergies, lack of proper nutrition, lack of exercise, dysbiosis, hormone fluctuations, infections, and even genetics, all throw a monkey wrench into this smooth interaction between all of your body systems.

And that’s where the domino effect starts.  Before you know it, a problem in one area becomes a problem in multiple areas; pretty soon everything seems to have gone haywire.

This is why comprehensive testing is important.  Since this level of testing is unfamiliar to most people, I thought it might be helpful to outline some of the lab testing most commonly run by a good Functional Medicine practitioner.  (Notice I said “a good Functional Medicine practitioner”!  Not all are created equal.)

Conventional blood testing – this usually includes a blood cell count, a metabolic panel, a lipid panel, a basic thyroid panel, and a few other miscellaneous tests, such as iron and/or B12 and others.

Adrenal stress testing – this often includes several readings of cortisol (the adrenal stress hormone) and DHEA (another important adrenal hormone).  There are several variations of this panel; depending on which type I order, it may also include screening for anti-gliadin antibodies, progesterone, or other male/female hormones.

Digestive analysis – this assesses your digestion and absorption, and often includes screenings for harmful microbes such as yeasts, parasites, and opportunistic bacteria that can interfere with intestinal function.  There are many varieties of this test available as well; some may include pancreatic function while others include stomach acid levels.  Some tests only screen for antibodies to a known pathogen such as candida or giardia, whereas others analyze the DNA of the microbes and compare it against a comprehensive database of microbes known to cause problems in humans.

Liver detoxification – unfortunately, the liver enzymes commonly tested for in a routine blood test don’t tell the whole story.  In fact, your liver can be in pretty rough shape and those tests will still be well within the normal range.  They don’t even start to show a problem until a liver issue is very advanced.  The good news is, there are much more efficient tests that assess liver function.  They do this by measuring levels of end-products of liver metabolism.  This gives a much more accurate picture of how the liver is functioning now, rather than waiting until advanced stages of damage and dysfunction have set in.

Heavy metal and nutrient mineral screenings – surprisingly, hair analysis is NOT the most accurate method of checking for the presence of heavy metals.  This is because hair analysis depends on proper excretion of heavy metals and some people tend to retain heavy metals inside their bodies instead of excreting them.  Luckily, there are several other methods of testing.  Some versions of this test only check for heavy metals, while other versions also evaluate the more beneficial nutrient minerals such as molybdenum and zinc to assess mineral levels.  These tests are much more accurate and reliable than blood-test versions of these minerals because the body will actually sacrifice tissue levels of nutrients to keep the blood levels constant.

Immune system panels – we can use several different tests to check various functions of your immune system.  One such test gives us clues regarding whether your immune system is fighting a foreign invader, or your own body.  Another test tells us whether your immune system is balanced (which is extremely important!) or whether one side has gotten a little overzealous and out of hand.

Thyroid test panels – to test TSH alone is never enough.  That’s like being blindfolded and trying to get an idea of what an entire elephant looks like by simply touching its trunk.  The trunk is what it is, but it does not tell you very much about the rest of the body.  I view the TSH test the same way; it is important, but it does not give the whole picture and testing TSH alone falls very short of good testing.  Thyroid test panels vary, but they can include the thyroid hormones themselves, how much of those hormones are being taken up by your body, the level of thyroid hormone transport protein lives in your blood, or even whether or not your body has started to attack your thyroid gland (i.e. the presence of thyroid antibodies).

Nutrients (Vitamins and Minerals) – there is a huge variety of different nutrient test panels available.  Some assess fat-soluble vitamins (A, E, D, and K), while others check water-soluble vitamin (B-complex, Vitamin C) levels.  Some evaluate minerals, like we talked about above.  Some measure other nutrients such as CoQ10 and/or glutathione.

Food allergy/sensitivity testing – here again, there is a variety of testing available.  In fact, there are several different types of reactions to problem foods.  One type is an immediate reaction involving histamine; another type is a delayed reaction that does more damage in the long run, but it is less obvious at first.  Several different companies test for several different types of reactions, and may include a wide variety of different panels or groups of foods.  In fact, some tests also include environmental irritants such as pollens, molds, and others.

Male/Female hormone panels – these tests look at the levels of various forms of estrogen and testosterone.  Some even include progesterone.  Most tests involve a “snapshot” of the present levels, while another test measures a female’s monthly cycle over the entire duration of the cycle!

Note 1: This list is by no means complete!  Functional Medicine doctors literally have thousands of individual tests at our disposal, which means we can explore lots of possible avenues and get to the root of the problem.

Note 2: truth be told, I order testing based on what I believe the patient needs.  Some people may need more testing, while others need less.  Some may need a particular test, while others may not.  I don’t order every one of these lab tests for every patient, but I do order every test I feel is necessary for that particular person so that I have all of the information I need to help them heal.

Natural Weight Loss Alternatives: Part 1

One of the most common questions people ask is, “how do I lose weight?”  Indeed, most of us are carrying around a few extra pounds.  If you are, you’re not alone; two-thirds of the population is now officially overweight.

There is good news and bad news.  The good news is, the problem can usually be solved.  The bad news is, it’s not a simple answer.  If it were, we wouldn’t all be struggling like we do!

Weight gain is a symptom of an underlying problem, and as with any healthcare dilemma, it’s extremely important to get to the bottom of what’s causing the extra weight to accumulate.  There are lots of causes of extra weight gain, too many to explore completely in one article, but I will touch on the most common causes and perhaps write a continuation in the future.

Cause #1: Low Thyroid Function – your thyroid gland makes thyroid hormone, which is a biochemical gas pedal for your cells.  It tells your cells how fast their metabolism should be.  It keeps you going, but also eases back on the throttle when necessary so that you don’t burn out. If your cells aren’t getting enough thyroid hormone, their metabolic activity slows down.  When this happens, your cells don’t burn fuel (blood sugar, oxygen, etc) like they should and the extra fuel gets stored in the fat cells.

Now, consider this: there are literally 22 different causes that fit into 7 different categories of thyroid dysfunction.  And it may not even be an actual problem with the thyroid gland at all!  The real culprit may be coming from any one of several other body systems, and the thyroid gland could be the victim, not the suspect.  This is why it’s extremely important to have a *complete* thyroid function panel done, and to have it interpreted correctly.  There are two problems that most people encounter; one is, most conventionally-trained doctors will only run TSH and maybe T4 or if you’re lucky, they’ll add T3 Uptake. The second problem is, the lab results aren’t interpreted in a way that evaluate for proper function, so many conventional doctors miss an underlying thyroid problem.

Cause #2:  Overactive Adrenal glands – your adrenal glands are small triangular-shaped glands that sit on top of your kidneys.  Their main function is to help us deal with stress.  They produce and release cortisol, our “stress hormone” whose job it is to raise blood sugar and heart rate so that we have more energy to handle the stress we face.

The catch is this: we’re only designed to handle immediate stressors that quickly pass.  If we’re under too much stress for too long, our bodies pay the price.  If cortisol levels are consistently too high, they will promote weight gain, especially around the lower abdomen and hips.  If the problem worsens, a person’s face can become rounder and slightly more pale.  It is important to have your cortisol hormone levels checked.  The best test for this is actually not a blood test; it’s a saliva test.  The cortisol found in saliva is the amount of active hormone readily available for your body to use, so it’s a more relevant test.

Cause #3: Liver Congestion – the liver is a large organ under the right side of your rib cage that basically acts as a garbage disposal or water treatment plant.  It has more than 500 jobs, and detoxification is at the top of the list.  Every toxic chemical we breathe, eat, or drink (air pollution, food additives), and every metabolic waste product from all your cells passes through the liver to be cleansed and converted to a less- or non-toxic substance.  The result is that the wastes go to the kidneys and the circulating blood is clean.

If your liver gets bogged down with too many toxins (poor diet, polluted area, or excess hormones), then it creates a traffic jam and all the toxins waiting in line to be detoxified start to back up.  As a defense mechanism, your body will try to pick the safest spot to store the excess toxins, where they will do the least amount of damage.  That would be (drumroll, please): the fat cells.  There are excellent tests that evaluate true liver detoxification function that go much further beyond the basic blood tests your conventional doctor is familiar with.  The functional tests are usually part of a much larger panel designed to evaluate a wide variety of body functions.

Please see Part 2 for more!

Foods or Herbs to heal stomach lining with Gastritis?

A reader writes:

“My doctor informed me that I have gastritis and prescribed me medication.  Are there foods I can eat or herbs I can take that will help heal the lining of the stomach?”

There are indeed.  Some people are going to chime in:

“Marshmallow!”
“Glutamine!”
“Slippery elm!”

But before we get to that, a more important question to ask is, what’s causing the gastritis?  After all, everything mentioned above is just symptom relief. 

It doesn’t do anything to alleviate the real problem.

In Functional Medicine, a diagnosis is certainly helpful, but it doesn’t tell you anything about why you have the problem or what’s causing it.  For example, “gastritis” is a very nonspecific term for “an inflammation (irritation and swelling) of the lining of the stomach”.  That’s a good place to start, but what’s causing the inflammation in the first place?  (Most doctors don’t attempt to look for the cause.)  Until we know the underlying cause(s), all you can do is treat the symptoms; by getting to the “why” and the root cause, that’s how we figure out the most appropriate course of action so that the problem can be corrected from the ground up.

The reason it’s so important to identify the root cause is, a single symptom or disease can have several widely different causes, and each of those causes must be addressed differently.  In this case, gastritis has two extremely common causes, and I see these all the time in practice.

1. Reactive intolerance to certain foods – namely gluten, but definitely not limited to gluten only!
2. Intestinal microbes – these can include parasites (hookworms, pinworms, etc), yeasts/fungi (candida and others), and/or bacterial infections (Helicobacter pylori or opportunistic bacterial overgrowth).

Practically every single patient I see in my office has BOTH of these problems!  They are both incredibly common.  They are also both incredibly overlooked or worse, met with skepticism by most doctors if a patient attempts to bring up the subject.

In this case, there are some diagnostic tests that can be ordered to figure out why your digestive lining is inflamed.

One is a gluten intolerance/reactivity test.  This isn’t the same as some of the tests they usually run at a hospital for Celiac Disease (which usually involves an endoscopy, which often produces falsely “negative” or “normal” results).  There are several ways to test for various aspects or evidence of gluten intolerance, and there are several different lab companies that each offer their own versions of testing options.  Some offer lab testing services directly to patients and don’t require a doctor’s order!  A variety of testing methods are available, and some results can be obtained from a simple cheek swab.  Please visit my SA Gluten Free website for my free, no-strings-attached e-book on Gluten Intolerance and various testing options.

The other test I typically need to order is a digestive analysis with microbe screening.  This is actually a combination test panel that offers a whole lot of info about any microbes you might be carrying around (as mentioned above, these can be any one or combination of the following: yeast, bacteria, and/or parasites.  The average patient comes into my office with no less than 3 separate species of these microorganisms!).  In addition, the version of this test I run tells us a lot about the environment of your digestive tract and it offers some indirect evidence of how well you’re absorbing nutrients.

It’s especially important to order these tests because:

Reason #1: Everyone has these problems.  Out of hundreds of tests I’ve done, I’ve had only one single initial test come back clean, which means in my clinical experience, the incidence of these issues is extremely high.

Reason #2: Other doctors are NOT checking for these and if they are, the tests are very invasive and outdated and frankly, can give you incorrect results.  They may appear “normal” or “negative” even if something is going on.  It’s crucial that sensitive, relevant test methods are used to ensure accurate information.

Reason #3: These issues wreak havoc until they’re dealt with.  Food intolerances do not go away, and neither do intestinal microorganisms.  Intolerance reactions build with time and may become severe enough to promote destruction of your own tissues, organs, or glands.  Intestinal microbes act like squatters on your property (your intestines) until they’re forcibly evicted.

Reason #4: Treatment approaches for these issues are very different.  Many people make the innocent mistake of attempting to treat themselves using information gleaned from a Google search (I used to be That Person myself), but until we have the test results in hand, how will you know which approach to take?

If the problem lies behind Door Number 1 (the food intolerance), one must eliminate that food, identifying the infinite number of possible hidden sources, and this dietary modification is usually for life.  Some choose to forgo the testing and simply attempt to eliminate (or “cut back” on) the reactive food, but this approach is rarely successful and besides – why go through the trouble until you know for sure that you need to?

If the problem lies behind Door Number 2 (the intestinal bugs), it takes a very potent synergistic blend of herbs, nutrients, enzymes, and probiotics to manage and help eliminate intestinal imbalance, and it can take a considerable amount of time and expense.  Again, there’s no reason to spend 3 months or more (to do it properly) and spend a heavy investment if you don’t know for sure that you need to.  And more importantly, without the proper testing, there’s no way to know for sure whether or not the efforts were successful.

Maybe the problem lies behind an unforeseen Door Number 3.  In that case, even if the first 2 tests I discussed above were truly negative, the effort and investment was not wasted, because it’s good to at least have ruled out those very common ailments so that we can begin to look at other possible issues without having wasted time or energy elsewhere.

Once we know what’s going on, we can address the root cause of the problem so that we can give you a permanent solution and real, long-term RELIEF with an approach that we know is going to truly make a difference!

The REAL facts about Gluten Intolerance

I’m putting together a presentation for a class in which I’ve been invited to give a guest lecture.  When putting together any presentation, I bury myself knee-deep in searches for facts and figures, graphics and diagrams, and sources to cite.

When I searched for facts about gluten intolerance, I came across doctorgrandmas.com, a company that sells certain processed foods (which should probably be a red flag right there) that had the repugnant audacity to suggest that: “it has become very fashionable to be told by persons claiming to be health providers that a person is gluten-intolerant” and that “this is [a] serious disservice to the public.”

Uh, no.  Not even close.

Thus, in return, I felt I had no choice but to submit the following response (I’m posting it here; it may never otherwise see the light of day, as it is understandably awaiting moderation on their website):

“Hi there. I need to take a very STRONG issue with the comment above…

You said: “It has become very fashionable to be told by persons claiming to be health providers that a person is gluten-intolerant.”

I don’t know what kind of medical practitioner you are or what kind of formal education you have, but if you actually see patients every day with fibromyalgia, thyroid problems (including Hashimoto’s), other autoimmune disorders such as Lupus, gastrointestinal problems, adrenal fatigue, leaky gut syndrome, and the list goes on and on and on, maybe you would take a different stance.

There is absolutely *nothing* “fashionable” about this concept. In fact, getting the conventional medical establishment to recognize it has been like pulling teeth. And yet, it’s happening. In fact, it’s old news. Read about the estimated underdiagnosis of Celiac Disease here: http://www.webmd.com/digestive-disorders/celiac-disease/news/20080520/celiac-disease-underdiagnosed

And that’s just Celiac Disease itself. There is another mechanism concerning gluten intolerance that can be found here: http://www.glutensensitivity.net/VojdaniDiagrams.htm#GI; simply scroll down to the Gluten Intolerance picture; this is very well-documented in the most recent scientific literature. Dr. Vojdani himself (a PhD immunologist) has written roughly 200 papers on the subject. This particular phenomenon is even MORE serious than Celiac because now at stake is the ability to form antibodies to your own nervous tissue (i.e. brain and spinal cord).

I can understand your desire to sell your product and I can understand what sounds like a frustration with a shift in population needs, tastes, and demands–a shift toward gluten-free foods (which you are not at this time willing to produce)–and thus away from your products. However, to make light of–and scoff at–such a serious, legitimate, established disorder is nothing short of odious.

I wonder how many of you know someone with any of the disorders I mentioned above? You might want to do some research…and then perhaps change your tune.

Thank you for your time.”

I don’t know about you, but most of us arrived at our gluten intolerance diagnosis either by taking our health into our own hands after doing some lengthy investigation, or visiting a doctor (or other healthcare practitioner) who happened to have a clue.  In my case, it was both.  Judging from the people who seek my help, these practitioners are few and far between.  Thus, gluten intolerance is not anywhere near a “fashionable” diagnosis.  It is hard-fought, struggled for, and finally won.

I don’t know how many diagnostic lab tests a food processing company orders on its patients, but I run lab tests every day that indicate that the patient needs to eliminate gluten completely in order to have any hope of getting better.  Even if the tests don’t show it, the medically-supervised Gold Standard of food intolerances–the Elimination/Controlled Re-introduction regimen prove beyond the shadow of a doubt that there is a gluten problem.  I have seen the need to pull every single one of my patients off of gluten completely, except for one.

I’m sorry that this company feels so defensive.  Perhaps they’re feeling the pinch of competent doctors who pull their patients off gluten–or grains altogether, in favor of a hunter-gatherer diet of sorts that is much more compatible with our evolutionary design and genetic makeup.  And if they don’t feel this pinch, chances are that they will eventually.  The tide is turning, as people catch on to the real source of their chronic health problems and the accompanying misery.  Corporate farms, food processors, and restaurants who refuse to adapt will inevitably get left behind.

I just felt I had to speak up against this company’s assertion because the real disservice lies in their words.

How do I choose the right probiotic?

A reader writes…

“How do you go about selecting the right probiotic?  I’ve heard such conflicting information.  Some say that probiotics are useless, because you’re born with what you have and there’s no way to replenish.  What are your thoughts?”

My first thought is, who on earth is telling people there’s no way to replenish good intestinal bacteria?  Whoever it is, he or she is gravely misinformed on several counts.  First, we’re not actually born with any gut bacteria; we acquire it early on–first during a regular vaginal birth and next during breastfeeding.  (Those who did neither missed out on these opportunities and may not have adequate levels of good bacteria if they didn’t acquire it from other places.)

Next, it’s important to understand that our normal gut flora (beneficial or “good” bacteria) are constantly under attack.  These attacks come from anywhere: stress, processed foods, alcohol, tap water, soil, other animals, medications (especially antibiotics and antacids), other people, and lack of stomach acid, just to scratch the surface.

Why do we need these bacteria in the first place?  They carry out an extensive array of extremely important functions.  They help fight some major disease-causing bacteria; in fact, they help form most of our immune system!  They turn vitamins into their active forms so that our body can use them.  They help you absorb nutrients, including fats, carbohydrates, protein, vitamins, minerals, and others.  There’s even a growing body of evidence that suggests these bacteria may play a role in lowering cholesterol.

So, when we don’t have enough of these bacteria, the above benefits start to evaporate; the immune system becomes weak, other “bad” bacteria (as well as yeasts, fungi, and parasites) can become opportunistic and “install” themselves, you can become seriously deficient in multiple important nutrients, and if the recent studies are correct, your cholesterol may elevate.  Does any of this sound familiar?  It should.  Why?  Because most people are indeed missing much of the good bacteria they need.

So, we turn to probiotic supplements.  I would love to sit down with someone who doesn’t believe probiotics do any good and show them the before-and-after digestive analysis tests of my patients (with names protected, of course), and show them the growth of the colonies of good bacteria between the initial test and the subsequent follow-up.  The numbers of good bacteria do improve.  This is how I know the probiotics are working.

So how does one choose a good probiotic?  There are quite a few choices out there and unfortunately, not all probiotics are created equal.  The supplement industry is largely left to police itself without a lot of regulation, which has both advantages and disadvantages.  The bad news is, there are some that don’t do squat.  The good news is, there are many that are quite effective, and these companies are free to innovate and develop superior products, which many of them have done.

So how do we separate the “men from the boys”, so to speak?  There are two fundamental qualities to look for in a probiotic: a variety of species, and high, potent doses.

At your local health food store, most of the products contain anywhere from 3 to 5 species or so.  This is okay, but it’s not quite enough.  This is because your intestinal tract is essentially a small ecosystem.  There are literally billions, even trillions of different types of bacteria happily co-existing together, each of them occupying space and keeping each other in check, ultimately creating a delicate balance.  Supplementing with a 3-species formula won’t do much.  (Most formulas available only through healthcare professionals typically have much higher quality and potency than those available to the public at health food stores and other places.) The most diverse higher-quality* formulas we have found so far (and thus, the ones we use) contain 12 different species.  While that doesn’t sound like much of an improvement in the grand scheme of things, it seems to work quite well, each additional species having a compound effect.

Next, let’s talk potency.  Potency is measured in colony-forming units, or CFUs.  One CFU, theoretically, goes on to start its own entire colony.  It’s mind-bending to consider how many billions of microorganisms there are in just a teaspoon of probiotic powder.  The storebought brands tend toward lower dosages, somewhere around 5 to 35 billion CFUs.  The highest dose medical grade supplements we found (and incidentally, the ones we use) contain 100 billion CFUs…in a single quarter teaspoon.

And last but not least, as with all supplements, it’s important to avoid supplements that contain (or come from a factory that uses) gluten fillers (wheat germ, wheat flour, wheat proteins, food starches, etc), yeast, soy, egg, milk, corn, shellfish, and MSG, just to name a few.  This is because many (if not most) people actually have immunological hypersensitivites to various common foods, in which the body’s immune system perceives that food as a toxin and launches an attack against it, creating lots of inflammation and chronic, mysterious health problems.  Many storebought supplement companies may be contaminated with these common allergens, but most medical grade supplements specifically state that they are free of all of these substances.

Since our ability to maintain good bacteria balance declines with stress, age, and lifestyle, it’s good to take a high-quality probiotic as part of a maintenance regimen.  This is especially true after finishing a round of antibiotic treatment, such as that for an infection.

*There are other formulas that may contain up to 14 different species, but these are not potent enough to be considered medical food/medical grade supplements, which have the highest quality and potency.

In health,
~Dr. L. Sweeney
Functional Medicine, Functional Endocrinology, and Functional Immunology
San Antonio Family Alternative Medicine

If this article helped you, please feel free to “like” this post by clicking the small yellow star button below.  This ensures that this blog shows up earlier in searches so that you and others can have better access to our information!

“My lab tests are normal” (…or are they?)

Cindy* sits across my small round table during our first visit together.  She has hit a brick wall.  Last week, she submitted to my office her intake forms and previous medical records, which consist of lab test after lab test.  These are isolated individual tests, taken on different days (or even months), never all at the same time.  Some of the tests are repeated several times.

Cindy shrugs, throwing her hands in the air.  “I don’t know what to do.  They look at me like I’m crazy.  They tell me my labs are normal.  And yet–well, you’ve seen my questionnaires.  I’m a mess!”

So her lab tests were “normal”, eh?  Let’s see about that….

First, let’s talk about the blood test process.  After the doctor or nurse takes your blood, they send it to a lab, telling that lab to run various tests on it.  The lab analyzes the blood sample and determines the results of the tests ordered.  These test results are reported back to the doctor in the form of a number.  Some of those numbers are familiar–for example, a cholesterol of 183, triglycerides of 132, or a blood sugar/blood glucose of 94.  If you have a thyroid issue, you may also know your TSH level.  The lab will compare your number results with what is called a “reference range” – a “normal” range.

Next, it’s important to understand what “normal” means.  The conventional medical system only recognizes two states of health: either you have a disease or you don’t.  If they can’t establish the presence of a disease, the doctor tells you you’re “normal” or “fine”.

The problem is, the regular definition of “normal” (and the “normal range” used by the labs to determine whether you’re sick or not) isn’t based on good health or healthy function.  It’s based on that “normal range” we talked about earlier.  How are those ranges determined?

By statistics.  The large national lab companies are responsible for setting their own reference ranges.  To do this, they compile the test results of the samples submitted, established an average, and compare the results to the corresponding patients. Every so often, as the general health of the population shifts and the average number values change, these laboratories will adjust their average ranges accordingly.

Look around you; 60% of the population is overweight and 20% of the population has developed diabetes.  About 73% of the population is taking at least one medication.  Cholesterol problems, hormone imbalances, and digestive issues abound.  Alzheimer’s Disease and autoimmune disorders are skyrocketing.

Do you really want to be compared to those around you?
Do you really want your “normal” range to be based on those people?

Also, it’s important to understand that these labs do this on a regional basis.  This means that a patient in South Carolina and a patient in Utah may have the same fasting blood sugar levels, but get labeled “normal” in South Carolina, while the lab in Utah would “flag” the result as abnormal.  The South Carolina patient’s doctor would tell that patient he or she is “fine”, while the Utah patient’s doctor will make recommendations for preventing diabetes.

One huge problem is that in gathering these statistics, labs fail to take prescription drugs into account when establishing normal ranges.  Medications, by definition, artificially manipulate the body’s function, altering its chemistry.  Because of this, it’s important to consider their effects when determining what’s “normal” and what’s not and yet, this is not done.  As a result, people undergoing thyroid testing get lumped in with people taking thyroid medications, and people undergoing a blood sugar screening get lumped in with those taking insulin.

Do you want to be lumped in with people taking loads of medications?  Do you think that these “normal” ranges can be fully trusted?

Now…when most doctors get these results back, they scan them, looking for abnormal results.  If any test result falls out of range, the lab highlights it, usually in bold, stating “high” or “low” off to the side.  Most doctors, lacking the time to fully investigate these results, quickly scan each line item.  Anything not flagged in “pathological” (disease) range is passed over without a second thought.

So, back to Cindy.  When she hands me the printouts from her previous lab tests, I, too, scan for the lab’s flags.  However, that’s just the tip of the iceberg; I usually find many more abnormal results that lie outside of healthy range, but not yet far enough advanced for the lab to flag the result as “abnormal”.  It’s not that I run different tests, it’s that I use “functional ranges”, which are much tighter and designed for healthy function.

For example, a good healthy functional range for fasting blood sugar is about 85-100.  The lab’s established reference range is often 65-110. If Cindy has a fasting blood sugar of 77 , she begins to lose optimal function, and yet most doctors will tell her she’s “fine” because the lab won’t highlight her result as “abnormal” until she reaches 64.  By the time her blood sugar falls that far, she has lost a lot of function!  She probably started feeling dizzy and lightheaded around 79.

Is Cindy hypoglycemic at 77?  Nope, she’s what we call “functionally hypoglycemic”, because she falls below the lower functional blood sugar limit of 85.  When she gets to 64, we can officially call it true hypoglycemia.  But why wait until then?  Someone with blood sugar in the 70s can certainly have hypoglycemic symptoms and can still benefit from a blood sugar stabilizing plan.

That’s what Functional Medicine is all about, folks: good function.  It’s about catching health issues early, identifying breakdowns in proper function before they become established diseases.

Of course, once they do, it’s not impossible to turn it around.  But if you’ve got a train starting to travel in the wrong direction, picking up speed second by second, isn’t it easier to get it stopped and turned around before it reaches full speed?  True health works exactly the same way. 🙂

*real patient, but not her real name

Does my health insurance cover Functional Medicine?

That’s a great question.  In fact, that’s one of the first and most common questions people ask.  This is understandable; after all, chances are you’re paying good money for your premiums, not to mention deductibles and co-pays.  Your employer has no doubt touted the benefits of each plan, which seems generous at the time.

So where does Functional Medicine fit in?  The short answer is, I recommend that you first carefully review your policy, checking for any reference to “preventive” services, or possibly “nutritional counseling”.  When in doubt, it’s best call your insurance company directly and ask them if any of these types of service are covered under your plan.

To understand the long answer, we must first make an introductory foray into the world of so-called “health” insurance.  The first thing that you should know about health insurance is that the term is a misnomer; your health insurance company (be it Blue Cross Blue Shield, Aetna, Cigna, Humana, or worse, United Healthcare) has not made your health their top priority.  How can this be?

Well, let’s do a little research (I love research).  Quick Google searches show that the first Blue Cross plan was introduced in 1939.  Humana was founded in 1961.  United Healthcare is the new kid on the block, formed in 1977.  And the elder of the insurance companies?  Aetna has been around since 1853.

Since insurance companies are private corporations, this may go without saying, but it’s worth highlighting here: in order to survive, health insurance companies must turn a profit.  This is true of any company, family/household, or individual.  You must make more than you spend.  By definition, this means that they must take in (revenue) more than they pay out (expenses).  This means that their customers (that’s you) must pay more in premiums (as well as deductibles and co-pays) than they pay back out on your behalf (in the form of benefits, or covered services).

Functional Medicine itself requires the doctor to spend an enormous amount of energy behind the scenes between your appointments.  This time spent on your behalf includes deeply interpreting lab results and putting them together, attempting to find the underlying common cause or causes of the problem.  This may also take research and review of the newest published studies as they come hot off the presses.  No other healthcare discipline goes this far or invests this amount of time on each patient.

Since these doctors only have so many hours in a day, they’d rather devote that time to your case, (researching and reviewing your case, preparing information and treatment plans, and answering your questions), than wrangling with insurance bureaucrats, none of whom have any medical training themselves and thus lack the understanding that Functional Medicine doctors have.  Most Functional Medicine doctors would love to provide the convenience and assistance of filing insurance for their patients, but with the time and energy constraints, they find that they can’t do both well.  The bad news is, they don’t file your insurance for you and they furnish you with the receipt to submit instead.  The good news, though, is the most important: they’re not bound by their arbitrary rules, and their time can be spent where it counts–devoted to YOU.

So, about that receipt I just mentioned… Yes, most Functional Medicine doctors will provide a descriptive receipt upon request.  Depending on your insurance company, they may accept that receipt and perhaps reimburse you for part of the out-of-pocket investment you made.  I can never guarantee this, as insurance companies are like water, always changing and tough to get a firm grasp of.  Sometimes they will want codes, and this is where things get sticky…

The codes the insurance company likes to have essentially reduce you to a Dewey Decimal-like system of numbers.  Every established disease (official diagnosis) has a 4- or 5-digit number, in the form of “123.45”.  Each recognized type of treatment has a 5-digit code, too, in the form of 12345.  Although the two numbering systems are different, each recognized disease corresponds with its appropriate avenues of treatment, and vice versa.

So what’s the problem?  The difficulty arises in that these coding systems are old and outdated.  They fail to consider dysfunction (i.e. breakdowns in healthy functions or processes, the earliest signs of disease) and they also usually neglect to include contemporary health issues.  In other words, there is a language barrier between Functional Medicine and health insurance, especially considering that health insurance is actually structured around–and oriented toward–conventional medicine, which intervenes only when the dysfunction has advanced for years to decades, resulting in a blatantly recognizable, established disease condition.

The common scenario is this: you start to feel that something’s not quite right.  You visit your conventional/regular doctor, who runs the blood tests and, after scanning them quickly, says “everything is normal”.  You know that it’s not, but now they’re hinting that it’s all in your head.  Meanwhile, your health does slide further and further away from healthy ranges, toward the outlying borders of “normal” and eventually it does cross into “abnormal” territory.  This may be years later, and by then it may or may not be too late to effectively use natural methods.  But the insurance company now has a number it can assign you, a little numeric box it can neatly put you into.  They’re happy, they’ve been satisfied.  But what about you?

That’s where Functional Medicine comes in, and hopefully you’ll be able to see a Functionally-oriented doctor before you reach the disease point.  With any luck, your insurance company will cover at least part of the tab.  If they do, look at it as a secondary bonus, and if they don’t, simply consider it part of the cost of living.  After all, when owning a vehicle, we understand that if we don’t invest in maintenance, the car breaks down and stops working.  We must pay for regular oil changes, state-mandated vehicle inspections, license plate tags/stickers, brake pads (which are actually designed to wear out!), tires, and many more.  Why give your body any less?  Make your health your top priority, even if it’s not your insurance company’s.  Why?  Because you only have one body, and it only treats you as well as you have treated it.  We’re a product of the decisions we have made every day.  Up until now, people have relied on their insurance coverage for any kind of medical care.  But if we want a different result, we may have to consider a different approach…whether an out-of-touch insurance company thinks it’s medically necessary or not 🙂

How to find a good Functional Medicine doctor, Part 2

In my most recent post, I started laying out some guidelines I use to help people find a good Functional Medicine practitioner.  To sum things up so far…

The most important aspects of a good Functional Medicine practitioner include holding a doctor license of some kind (doctors of all kinds receive similar training where it counts in Functional Medicine – all receive extensive Anatomy, Physiology, Endocrinology, Biochemistry, Embryology, Histology, Cytology, Biology, Lab Diagnosis, and more).  Doctors of all kinds can order and interpret diagnostic lab testing in nearly all states, whether he or she is an MD, DC, or DO.  There are indeed MDs and DOs who practice exclusively Functional Medicine without using medications at all, and there are indeed DCs (Doctors of Chiropractic) who practice exclusively Functional Medicine without ever doing a single spinal manipulation or physical rehab therapy session.

So now, let’s move on to a few more guidelines that can help separate the “men from the boys”, so to speak, and maximize your chances of finding a good practitioner that meets your needs.  Here are a few more important clues to look for:

Guideline #4: Look for mentions of diagnostic lab testing, when surfing the web or calling around.  Some websites will mention some of the tests the doctor will order.  Look for standard lab work such as CBC (Complete Blood Cell Count), CMP (Metabolic Panel), immune profiles, antibody testing, and thyroid panels.  Look for specialty testing such as salivary testing, hormone testing, digestive analysis, or stool testing.  Shy away from anyone who says they can test your neurotransmitters by analyzing your urine; those tests are NOT reliable, diagnostic, or accepted.  In fact, they have been disproven.  Shy away from anyone using muscle testing instead of lab testing.  A combo of muscle and lab testing is OK, but I would personally ignore any “diagnosis” or assessment given by muscle testing alone.

Guideline #5: When surfing the web (or calling the clinics), look for (or ask about) the depth of the paperwork.  They should put a lot of stock in the intake forms.  They should want to know your life story in terms of your physical, mental, and emotional health.  They should want to know ALL KINDS of things about you, as far as your lifestyle, your travel history, your birth, childhood, adolescence, adulthood, and more.  If what is posted on the web is very basic and there is no mention of additional paperwork to come, I would call the clinic and ask what kinds of questions and information the doctor wants to know.  Doctors practicing real Functional Medicine want to ask a lot of questions, and their receptionist should be able to tell you that.  Proper healthcare begins with an extensive gathering of information, and it’s not uncommon to see intake packets of 20 to 50 pages or more.

Guideline #6: Some Functional Medicine doctors list their preferred supplement companies online.  Word to the wise: many supplements, notably Standard Process, will inadvertently make their patients’ conditions worse, especially any autoimmune condition, because they contain wheat products.  Another word to the wise: Many supplements are either multi-level marketing companies (such as Juice Plus or some glutathione supplements), or they are affiliated with cults such as Scientology.  A Scientology-affiliated company can still make excellent products, but upon asking myself the question of whether or not I wanted to contribute financially to that type of organization, the answer was no.

Guideline #7: If they mention multi-level marketing companies (think Mona Vie acai berry juice, Juice Plus whole food supplements, Kangen water, or Nikken magnet products to name a few), I would personally shy away.  MLM products are generally fads that produce little to no results.  Some truly are good (such as the pH-based water); however, they tend to be overpriced and you may face some high-pressure sales tactics.  Many claim to have undergone testing or research, but typically the testing is useless because it is done in-house, and not by an objective, standard third party.  Thus, there’s a vested interest, which renders the scientific validity questionable at best.

Now…I’ll bring these next few things up because you’ll probably come across it in your research and if you’re like I was, you’ll wonder about the following:

• Many Functional Medicine doctors do sell supplements in their practice.  Yes, this is ethical, as long as when they recommend a supplement, it is for a reason that benefits YOU, and it’s something YOU actually need.  Again, beware MLM supplements.  Google for a list of MLM companies; you may need to check several sources, as many MLM companies are newer and may not be on older lists.  Chances are if you see the product/supplement advertised on someone’s car/SUV, it’s an MLM.
• Many Functional Medicine doctors do not file insurance.  (This topic alone will probably be discussed separately in the future.)  This is because insurance takes a lot of time and effort that the doctor would rather devote to your case instead of wrangling with bureaucrats.  Coverage for these types of services will depend on the policy you chose; doctors don’t know anything about the literally tens of thousands of policies out there.  Also, even if your insurance policy does not cover this type of care, that doesn’t mean it’s not valid or necessary.  Health insurance companies do not care about your health; they’re trying to minimize costs, even at your long-term expense.
• Functional Medicine doctors should have no problem openly communicating with conventional medical doctors.  If they seem shifty about this, think twice.
• Some Functional Medicine doctors may charge a fee to analyze your paperwork and review your records and history.  This is perfectly normal and legitimate.

This is by no means an extensive list – there are always other indications of a quality practitioner, as well as pitfalls to watch out for.  I’ll try to cover additional items as they arise.  For now, however, you should be armed with a little more information to begin your search.  Of course, the best bet is to ask around; although not many people are seeing a Functional Medicine doctor (yet!) you never know who may know someone. 🙂

How to find a good Functional Medicine doctor, Part 1

I administer several forums, most notably a group on the social networking site Facebook called “Functional Medicine“.  To find it, simply enter “functional medicine” in the search box and select the “Group” (not the “Interest” – that’s different).  One of the most common questions I encounter both on- and offline is, “I need a good Functional Medicine doctor.  How do I find one?”

The short answer is, sometimes it takes a little digging and reading between the lines.  Sometimes it doesn’t.

The long answer is, there are several ways to find a good doctor who practices real, genuine Functional Medicine.

To get started, please see my two posts on what Functional Medicine is not, Part 1 and Part 2.  This will weed out a lot of the fat.  It’s important to keep in mind that each Functional Medicine clinician will practice slightly differently; however, a few basics should be consistent.

Guideline #1: The practitioner really should be a doctor of some kind, or perhaps a nurse practitioner–maybe.  I would not visit an acupuncturist, massage therapist, physical therapist, pharmacist, nurse, midwife, or non-doctor clinical nutritionist for this type of care.  Not only can many of them not legally order or interpret diagnostic testing, they also many times lack the depth of foundational information that doctors receive.  I also would not visit any unlicensed practitioner for Functional Medicine, such as a holistic health counselor, wellness coach, or, depending on the state, naturopath.

Beyond that, however, the type of doctor does not matter.  Whether he or she is an MD, DO, DC, or, (depending on your state!) ND, a good Functional Medicine doctor will practice much like another.  A good Functional Medicine MD (medical doctor)  will practice just as well as a Functional Medicine DC (Doctor of Chiropractic) and vice versa.  It’s nearly impossible to tell the difference other than the initials behind their names.

Guideline #2: The practitioner should be from the United States, or possibly Canada.  It’s possible to find good Functional Medicine practitioners elsewhere*, but the quality of education could be questionable and there may be a lack of standard.  Although Functional Medicine in North America is largely unregulated, true Functional Medicine doctors generally do a decent job of regulating themselves and raising the bar of quality for themselves, constantly striving to complete more training, stay on top of current research, and invest in elective training, conferences, and symposiums, both domestically and abroad.

Many Functional Medicine doctors here in the States will care for patients/clients outside of their state or even country, via telephone, fax, email, regular mail, or Skype.  Often, the distance between doctor/consultant and patient/client is not important at all.  Some doctors require that their patients make the trip to the office or clinic at least once; others don’t have this requirement.

Guideline #3: When searching for a good Functional Medicine doctor, the web could very well be your best tool.  Look for those who specifically mention Functional Medicine.  Look for some who list their CV (curriculum vitae, a professional type of resume) online, including where they went to school, their areas of focused study, and their continuing education beyond school.  Many will list the post-doctoral classes they’ve taken.  Look for information; if the website is scanty and it barely offers any information, move on.  Now, not every site will be filled to the brim with information like Mercola or Mark Hyman, but it should be more than a single page with hardly any information. If it strikes you as cheesy or high-pressure sales-like, with lots of bold or red text, or yellow highlighted text, they may be a good doctor, but move them down your list.

More to come!  Stay tuned…

*If you live outside the United States and you need Functional Medicine care but a trip to the US is out of the question at this time, please email me through our website (just scroll all the way to the bottom and click “Email Us”) and I will send you a list of members of a reputable organization I’m personally familiar with – although it is based here in the US, it is truly international.

What Functional Medicine is NOT, Part 2:

In the last post, I brought up a few myths that I frequently come across and dissected them.  As I mentioned before, when different practitioners use the same term (in this case Functional Medicine) to mean various things (such as nutrition, bioidentical hormones, or fad diets), this confuses people.  People are just starting to find out about Functional Medicine as it is, and many people aren’t exactly sure what it means.  And who can blame them?  It seems as though there is too wide a variety and not enough consistency, and people aren’t sure where to turn or who to trust.  I thought I’d help sort things out.

Since the last post got longer than I expected, I decided to split it into two parts.  Here is the second part…

Truth #5: Functional Medicine is not a scam, voodoo witch-doctor healing, or old wives’ tales.  The Institute for Functional Medicine (IFM) has published an authoritative textbook that covers nearly all aspects of true Functional Medicine.  The author page boasts an enormous amount of inter-disciplinary collaboration, meaning that Medical Doctors, PhDs, Doctors of Chiropractic, Doctors of Osteopathy, Naturopathic Doctors, Certified Clinical Nutritionists, Dentists, Massage Therapists, Physical Therapists, people with Masters degrees including Masters in Public Health, and Acupuncturists have all worked together to produce this resourceful body of knowledge.  The book cites numerous solid references to genuine studies published in standard, respected peer-reviewed journals across the world.

And that’s just the textbook that many of us use.  In addition, there are classes affiliated with educational institutions that are recognized and accredited by the US Department of Education.  There are cutting-edge authoritative books written for the public by esteemed authors such as Datis Kharrazian, whose protocols I follow (with a few modifications for individual needs and sensitivities), which by itself cites over 600 genuine references.

True Functional Medicine bases their holistic treatment approaches on diagnostic lab test results ordered through standard blood laboratories (the same ones that any hospital or conventional doctors would use), and other CLIA-certified specialty laboratories.  The reference ranges used to interpret lab work are narrower than these labs have set, but are nonetheless based on respected organizations such as the American Endocrine Society and the Vitamin D Council.

Truth #6: Functional Medicine has nothing to do with muscle testing or AK.  Some practitioners utilize “muscle testing”, also known as Applied Kinesiology (AK).  This involves having you hold your arm out, resisting the practitioner’s attempts to push/pull your arm in a certain direction (or directions).  Once he or she establishes that the muscle group s/he’ll use for testing is working properly, s/he’ll have you touch certain points on your body, make certain movements, hold certain positions, or hold certain objects.  These practitioners claim that the results of this “testing” can show if you have a liver problem or adrenal issue.

I have several significant problems with this.  First, the test itself may not be accurate or reliable.  Not only is it incredibly vulnerable to practitioner manipulation (whether he or she is aware of their influence or not), but the scientific research has not been done to back up the validity of this so-called testing.  Not only that, but even if its results are accurate (and let’s say the test really is valid for adrenal dysfunction), there are multiple kinds of dysfunction.  There is overactivity, underactivity, and normal activity but in a chaotic rhythm.  Muscle testing can’t reliably break things down that far, and it certainly can’t quantify it into objective numbers like real lab testing can.

Truth #7: Functional Medicine is a real, recognized form of medicine, not something the alternative medical community made up.  Functional Medicine is not a “chiropractic thing”; in fact, it’s not specific to any single healthcare discipline.  It’s definitely not a fly-by-night approach to be considered second to conventional medicine, with conventional medicine holding the ultimate authority, from whom everyone else (patients and other practitioners) must seek approval.  Functional Medicine, in most situations, can very well be regarded on an equal playing field as any medication-based approach, and Functional Medicine doctors are every bit as knowledgeable in their approach as (and sometimes even moreso than) conventional practitioners who have not studied this approach.

Functional Medicine is indeed a medical subspecialty; its non-pharmaceutical approach allows any non-drug practitioners, including Naturopathic Doctors (in states that license them–of which Texas, where I live, is not one), Doctors of Chiropractic, and others to practice.  Essentially, as long as the practitioner is licensed in the state in which they practice, and their license covers the ordering of diagnostic lab testing, then they may also legally interpret the results and offer a Functional Medicine approach.

I hope that clears up some of the confusion out there. 🙂