by Dr. Will Cole
Sometimes, the problem is obvious. You twist your ankle, you get heartburn, you have a migraine, you didn’t get enough sleep. For these problems, most of us know what to do: Wrap the ankle, treat the heartburn or the migraine, take a nap. However, sometimes (often!), the problem is less obvious. You may not be able to pinpoint one dominant symptom, but you just feel “off.” Maybe you have been suffering from chronic bloat, weird random headaches, general achiness, unexplained fatigue, insomnia, or a combination of vague symptoms. When this happens, it might be to search for that one hidden illness, dysfunction, or deficiency, but this kind of search is often fruitless because every system in the body is inextricably connected to others. That means health problems – especially numerous vague ones – are almost always multifactorial. In other words, different small dysfunctions and imbalances throughout the system have built up and influenced each other so that, over time, they finally show up as various symptoms, and that general feeling of unidentifiable poor health.
As a functional medicine practitioner, I run a lot of lab tests for my patients, and one of the main reasons is that labs are great for pinpointing specific problem areas. The results help guide my treatment recommendations in a major way. Each person’s health situation, genetics, and biochemistry are unique, and labs can suss this out more effectively than general symptom identification. That’s why talking to your doctor about testing is a great place to start reclaiming your good health.
There is a problem with this approach, however. Unfortunately, many of these test won’t be covered by insurance (although you should always call and check to be sure). Unless you have a particularly open-minded conventional medical doctor who is willing and has the time to explore these tests with you, the typical general practitioner probably won’t be ordering these tests on the reg or be comfortable making them part of your treatment plan. They are trained to follow certain standard procedures that involve matching sets of symptoms to particular lab tests and pharmaceuticals, and if you don’t fit the conventional model of a patient warranting a particular test or set of tests, your doctor may tell you that the tests are not justified. You could demand them, but many people are uncomfortable with this. For this reason, I recommend working with an integrative or functional medicine doctor who is well-versed in the wide array of available lab tests, and how to read the results from a holistic perspective.
Then there is the question of finances. If you don’t have the means or the inclination to pay for a battery of tests out-of-pocket through a doctor, another option would be to order the labs yourself. Companies like Thorne, EverlyWell, and Found My Fitness all have at-home tests you can purchase, administer yourself, and send in to be processed. Doing this can also be pricey, but may be less expensive than ordering them through a doctor. You also won’t have the benefit of interpretation from a doctor who knows you personally and has examined you, but it can be a start as you search for answers. Many of these tests come with a detailed description of your results and/or a health plan based on your results.
Whatever path you take (doctor-ordered or DIY), these are the tests I recommend exploring, to see if they are right for you and worth the investment. The return is the knowledge you gain about yourself:
1. A 24-hour adrenal stress index
Dysfunction in your adrenal glands can be at the root of a wide variety of symptoms related to fatigue, anxiety, depression, blood sugar imbalances, brain fog, weight gain, irritability, decreased sex drive, and trouble sleeping. The reason is that the adrenal glands release several hormones, including your body’s main stress hormone (called cortisol), through a complex web of communication between your brain and adrenal glands, known as the HPA-axis. Adrenal fatigue occurs when there is an imbalance in cortisol due to miscommunication in the HPA-axis. This causes cortisol to be low when it should be high, high when it should be low, always low, or always high.
Each one of these cortisol imbalances can result in different vague or even severe uncomfortable symptoms. Since your hormones play a large role in the rest of your health, this imbalance can throw off other hormones, as well, which contribute to the long list of symptoms that can be caused by adrenal fatigue. The 24-hour adrenal stress index is a saliva test that tracks your cortisol levels throughout the day, resulting in a general assessment of the functioning of your HPA axis.
2. A full thyroid panel
If the adrenal glands affect many parts of your system, the thyroid glands affect even more. Every cell in your body needs thyroid hormones to function, but unfortunately, thyroid dysfunction can be hard to nail down. Many underlying thyroid problems don’t show up on standard labs because conventional medical doctors typically only run TSH and T4. A full thyroid panel is a blood test that looks at TSH and T4 but also at T3 uptake, total T3, free T4, free T3, reverse T3, and thyroid antibodies, to give you the most accurate picture of your thyroid health and rule out possible autoimmune thyroid problems.
Functional medicine also has a narrower reference range when reading lab test results. That means that what a conventional doctor might deem as normal after surveying labs might well be considered abnormal to a functional medicine doctor. This can explain why you may be experiencing symptoms of thyroid dysfunction, like fatigue, weight gain, dry skin, hair loss, and depression, even though your doctor told you that you do not have a thyroid problem.
3. Gut permeability labs
All health begins in the gut—that famous saying attributed to Hippocrates, the founder of modern medicine, has a lot of truth to it. Research is finally starting to show that many chronic and autoimmune diseases can be connected to gastrointestinal problems. When your gut lining is damaged due to stress, poor diet, medications, and other triggers, it can cause undigested food particles and bacterial endotoxins to pass into the bloodstream, leading to a cascade of chronic inflammation that can pop up all over the body, leading to a wide variety of symptoms. This is commonly known as leaky gut syndrome. You can figure out if this is happening to you (and might be a cause of your symptoms) with a gut permeability lab test. This test checks for:
- Zonulin and occludin: These two proteins control how permeable the gut is by regulating the tightness of the “mesh” that lines the intestines. If the test finds antibodies in your blood to these proteins, that is a biomarker indicating that the intestinal tight junctions have been compromised.
- Actomyosin antibodies: These antibodies should also not be in your blood unless the the gut lining has been damaged.
- Lipopolysaccharides LPS: These bacterial endotoxins are supposed to stay in your gut. If they are in your blood, it could mean there was enough loosening of the intestinal junctions in the gut lining to let them pass.
4. Sex hormone labs
All of us, men and women alike, need balanced levels of estrogen, progesterone, and testosterone to maintain optimal health. The ratios are a little different in each of us, but all the sex hormones are players and when they get out of balance (either too much or too little of any of them), this can lead to many seemingly diverse symptoms, including weight gain, anxiety, depression, erectile dysfunction, mood problems, low sex drive, infertility, acne, and more. A female salivary panel as well as blood and saliva testosterone and DHEA panels look for ratios of these hormones.
5. Inflammation labs
That sprained ankle swells up because of inflammation, but there is another kind of inflammation that is far less obvious and far more insidious. Chronic, systemic inflammation is a factor in almost every health problem we face today. Whether a cause or a symptom or both, inflammation is certainly a culprit in autoimmune conditions, cancer, heart disease, brain fog, fatigue, and even weight gain. Even though a certain amount of inflammation is healthy to fight off infections, viruses, and injuries, inflammation becomes a problem when it doesn’t go away after the threat is gone and continues to perpetuate throughout the body, like an out-of-control wildfire.
A blood test can detect markers of inflammation in the body. As with other tests, the functional medicine reference range to determine what lab results are normal or abnormal are stricter than conventional reference ranges, so you can know sooner that inflammation is becoming a problem for you. that followed by conventional doctors). The inflammation labs I like to run for the most complete picture of chronic inflammation test for:
- CRP: C-reactive protein is an inflammatory protein and is tested alongside another pro-inflammatory protein, IL-6.
- Homocysteine: This inflammatory amino acid has been implicated in brain problems, heart disease, and autoimmune conditions.
- Ferritin: This is a measure of stored iron levels in the body. That may not seem relevant to inflammation, but ferritin it is considered an acute phase reactant—in other words, it is a sign of inflammation when the level is higher than usual.
6. Genetic testing
There is one aspect of health that is predetermined, but even though you may not be able to change it, you can do a whole lot to influence how your body responds. I’m talking about your DNA, which can affect many aspects of your health. Specifically, certain genetic mutations can make you more susceptible to certain nutrient imbalances, drug reactions, and other health problems. 23andMe and other specialized genetic lab tests will lay out all of your possible genetic weaknesses for your functional medicine practitioner to interpret. This can help you intervene, balancing risk factors with natural medicines and lifestyle changes.
You can read about the nine genes I take into consideration most often in my patients, but one of the main dysfunctions I look for is a methylation impairment. Methylation is a complex process that acts like your body’s biochemical superhighway. This process assists in keeping your gut, brain, hormones, and detox pathways healthy and fully functioning. Methylation happens a billion times every single second, so if it isn’t working well, it can greatly affect your overall health. Certain genetic mutations can impede certain methylation pathways, with a ripple effect of symptoms and problems. Attack the deficiency, excess, or imbalance at the source and you can prevent trouble down the line.
Keep in mind that this is a general list. Each person is unique, so the specific combination of labs your practitioner runs may be different based on your doctor’s assessment of your particular health case, health history, and previous lab work. However, these labs can create a foundation of knowledge on which you can build as you work towards sustainable health and meaningful health restoration healing that lasts.
If you want to learn more about your own health case please check out our free health evaluation. We offer in person as well as phone and webcam consultations for people across the country and around the world.
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