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.

How to supplement serotonin? Natural alternatives for depression

A reader writes:

Is there any way to supplement serotonin?  I used to be such a happy person; now I am very angry…irritable…depressed.  I MISS the happy-go-lucky girl that I was.

I am so sorry to hear that you’re going through such a hard time.  Unfortunately, there is no quick fix, but you do have options.

The lion’s share of the serotonin your body makes is not actually made in your brain.  Although it’s important for your brain and your brain uses quite a bit of it, it is actually produced in the intestines.  The intestinal environment is delicate and can be prone to problems.  Any one of over 10,000 different microorganisms can interfere with intestinal function, so it is very important to be screened for these organisms.  It is also important that the test be very sensitive.  Most conventional stool cultures used by family physicians and hospitals are not nearly sensitive enough and may not reveal an existing problem.  Many Functional Medicine doctors use a DNA-based test that is anywhere from 200-1000 times more sensitive.

In addition, food intolerances can create digestive inflammation, which can also interfere with proper serotonin production.  Many food allergy/sensitivity tests can be misleading as well; a positive result can almost always be trusted, but a negative result may well be a false negative.  Test panels that evaluate multiple types of immune reactions are best.

And then there’s stress.  Stress suppresses stomach acid production, which is required to break down protein.  If your body is not efficiently breaking down proteins into their building blocks (called amino acids), then it cannot make serotonin or other neurotransmitters (a fancy word for brain chemicals), because several particular amino acids are precursors to major neurotransmitters.

Next, to manufacture serotonin requires several complex biochemical reactions.  For these reactions to take place, several vitamin and mineral cofactors are needed, such as B vitamins and iron.  Many ladies are lacking in iron due to heavy monthly cycles or uterine fibroids.  Lots of people also lack iron because their bodies can’t convert it to a usable form.

Chronic stress and adrenal dysfunction often deplete B vitamins because of B-complex’s role in supporting adrenal function.  Extremely high short-term stress or even mildly high long-term stress force the adrenal glands to work harder, using up B vitamins before your body can use them in the production of serotonin.  There are excellent functional lab tests for both adrenal function and to assess cellular Vitamin B complex status.

And last but not least, if your liver isn’t functioning as efficiently as it should (usually due to toxin exposure, environmental pollution, heavy metals, hormone overload, or a diet heavy in processed foods), then it can’t fully clear your body of hormones, wastes, and toxins.  This causes a traffic jam in which these harmful substances will build up in the body, circulating in the blood and affecting sensitive brain tissue and serotonin usage.  Toxic overload is one of the most common causes of depression, and it is almost always entirely overlooked by the conventional medical system.

Note: There is no clinically reliable lab testing for serotonin or other neurotransmitters themselves yet.  There are some doctors and other practitioners who use a urine test that claims to indirectly evaluate levels of various neurotransmitters.  Current research failed to verify the validity of the claims made by the proponents of this type of testing (typically the lab company offering the test).  So, please do NOT fall for these claims!  At present, the closest we use clinically are some excellent questionnaires derived from observations in academic settings and a superb lab test panel that measures several principal biochemical pathways (including some by-products of neurotransmitter production pathways) for their efficiency and metabolic activity.

So as one can see, a LOT of variables come into play here – we’ve covered adrenal stress, gastrointestinal function, liver detoxification ability, hormone overload, environmental and heavy metal toxin exposure, and even uterine fibroids!  Truthfully, there are probably more to add to the list that are beyond the scope of this post.  Since the appropriate treatment is different for each, it is crucial to narrow down the cause to avoid lost time and money, and the progression of the underlying condition!

I certainly hope your world begins to look up for you soon!

Additional Information:

Serotonin deficiency symptoms: how and when to suspect you’re short on serotonin:

• You seem to be more sensitive to pain than you used to
• Your appetite is irregular
• You experience sadness, but can’t pin down the cause – you just feel sad.
• You sleep poorly
• You have tinnitus, or ringing in the ears that isn’t linked to any particular event (or if it can vary every so often)
• You’ve lost pleasure or enjoyment from activities/people/situations that you used to enjoy before.
• Your self-esteem is low

What about Selective Serotonin Reuptake Inhibitors (SSRIs)?

Antidepressant drugs such as Zoloft, Prozac, and Paxil don’t actually produce any serotonin at all.  Instead, they attempt to concentrate the levels of existing serotonin to keep it viable for a longer period of time.  The problem with this is that brain cells have been shown to adapt to their surrounding environment; if this environment is saturated with serotonin (since pharmaceutical drugs cannot duplicate the delicate balance of normal body mechanisms and will often “overshoot” the level needed), then the cell may become desensitized to serotonin.  An in-progress study that will soon release its results has suggested that long-term use of SSRI medications may actually reduce serotonin levels, which is the last thing a person wants if they are suffering any of the symptoms above.

Dr. L. Sweeney, DC is the Director of the Functional Medicine program at San Antonio Family Alternative Medicine.  She works  with a wide variety of patients, many of whom suffer depression, insomnia, fibromyalgia, migraine headaches, gastrointestinal dysfunction, adrenal fatigue, and more.  She runs a wide variety of quality diagnostic lab testing, leaving no stone unturned.  She can be reached at (210) 340-2150 or you can visit the clinic website at http://mysanantoniochiropractor.com.