In functional medicine we use as much information as we can collect to get to the root cause of a patients health concerns. We start with an extremely detailed history so that we can identify any triggers or other contributing factors. As was discussed in a previous blog, this history is often a lot more detailed than anything a patient may have experienced in the past because we understand that the path to the root cause may be complex and could involve multiple body systems. We also use conventional lab testing on some patients that I'm sure you are familiar with, things like complete blood count, iron levels, thyroid levels, etc. What I would like to talk about in this blog are some of the specialty tests that are more functional in nature. Some labs just give you a number on a page, which is sometimes helpful information, but it doesn't always tell you what is actually happening in the body. One of the best examples of that is a cholesterol test. A normal cholesterol panel will give you the total cholesterol, and break that down into LDL cholesterol and HDL cholesterol. Typically, if the total cholesterol is over 200 or the LDL is over 100 you will be given a statin drug to lower it and then the same numbers will be monitored. Statin drugs block the conversion of something called Hydroxymethylglutarate(HMG) into cholesterol. HMG is also the precursor to CoQ10, which is an antioxidant and an important component in the body’s production of energy among other functions. Thus statin drugs can lower CoQ10 levels in the body and cause side effects including muscle damage, liver damage, fatigue, increased blood sugar, neurological problems and others. The problem is that cholesterol numbers by themselves have very little predictive value for cardiovascular disease. Not only that, but we are not asking the question "Why is my cholesterol elevated in the first place?". Instead we are just blocking an enzyme based on numbers that are not good predictors of a problem. In functional medicine we use more advanced lab testing to get more information about the makeup of the cholesterol in the body rather than just the number. For example, cholesterol with a small particle size is more dangerous than a larger particle size. Once we have more of this information, we can make changes in diet and lifestyle and use effective supplements to lower the numbers that actually convey risk. In future blogs, I will be going into more detail about cholesterol and how our understanding of cardiovascular risk factors are changing so stay tuned for that!
Another very common test for functional medicine practitioners is the Organic Acid test. This test shows the levels of about 70 different organic acids that are normally present in the body. They are the metabolic products of many different reactions in the body and can give you information about vitamin and mineral status, oxidative stress, nuerotransmitters, digestive enzyme sufficiency, and even assess the status of the bacteria in the gut. This test is usually part of other tests as well. For example, the Nutreval test from Genova Diagnostics includes a full organic acid array, plus amino acid, essential fatty acid, and toxic metal testing. It is a very comprehensive test that gives an excellent snapshot of a patients nutritional status as well as helping to uncover any deficiencies that may be causing their symptoms.
Then, of course, there is the digestive system. Through various stool tests we can assess the level of inflammation in the gut, detect any infections via bacteria, parasite, or yeast, and get information about the immune response of the gut. In functional medicine, the gut is typically where we direct our focus initially because it plays a role in so many different conditions. There are also breath tests for things like lactose intolerance, fructose intolerance, and something called SIBO. SIBO stands for small intestinal bacterial overgrowth, and is VERY common in the patients I have seen. There will be future blog posts covering these conditions in more detail, but the short version for SIBO is that essentially bacteria, which are normally extremely numerous in the large intestine, are less populous in the small intestine. However, when certain conditions are present, the small intestine can become overgrown. Since the small intestine is where almost all nutrients are absorbed this can cause a host of problems. Recognizing, assessing, and treating these types of conditions are essential in getting to the root cause of chronic health conditions.
One other common area of testing is hormonal health. Hormones drive nearly every process in your body. Again, conventional tests will give you numbers on a page, which may only be from a single blood test. The more functional labs have options for much longer assessment of hormones, from a 24 hour urine test to a full 28 day saliva test that measures hormone levels throughout a full cycle. Another nice benefit of a urine test for hormones is that they give you information about the breakdown products of the various hormones, especially estrogen. This information allows us to see how the body is methylating (this topic will require many future blogs, i’m sure), as well as which metabolite of estrogen is being produced and in what ratio. These metabolites can indicate a risk for estrogen related cancers and other illnesses and knowing how estrogen is being broken down can help determine how to shift the balance to the safer metabolites.
An example of some of the tests discussed above can be found on the following links: Nutreval, Comprehensive Stool Analysis, SIBO, CV Health, Complete Hormones. Even though these tests are much more comprehensive than conventional tests, I still use them as only one piece of the puzzle. That is why we do a comprehensive questionnaire followed up by a very detailed history, and combine it with the testing if we feel that is necessary. I hope you found this information interesting and useful! You can contact us for a functional medicine appointment here, or by calling our office at 317-817-WELL (9355).