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Typical Functional Medicine Labs

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Hello, everyone! It’s Dr. Trish, and today I’m going to cover a very interesting topic in the essence of we’re going to talk about a few of the most typical functional medicine labs that are done in the functional medicine clinical setting. How are they different from some of the traditional medicine blood work or lab tests that you would typically have through your primary care doctor?

So, the first one I want to talk about is basically a comprehensive stool analysis. Now, I’m showing you on the screen I’m using and with reading through this podcast you can see hopefully the image of the summary of what’s called a GI Effects™ Comprehensive Profile of the Stool. This is by one particular company, one particular lab, within the functional medicine world. There are other labs that do this other than the one I’m using their sample report for, but again the point of today is not for me to go over every single aspect of detail of the results of any one report because this is just a sample report that isn’t consistent with any one patient.

What I want to make the point of, folks, is that when you go to your primary care doc and you have abdominal pain or you have diarrhea or you have constipation or whatever you might have going on with your gastrointestinal system, and your primary wants to do a stool test, what they usually are testing for is simply they’re culturing your stool for a pathologic bug like giardia or, you know, some other pathologic bacteria or bug, parasite maybe, that is causing you to be ill. But that is the only thing usually that the stool tests, again, that a traditional medical primary care doc would be ordering.

What you’re looking at here with a comprehensive stool analysis is looking at the whole gastrointestinal tract and the different functions of the gastrointestinal tract. So, you’ll notice you’re going to get information about digestion and whether there is increased protein breakdown products in the stool. If there are, that means you’re not digesting and breaking down your proteins optimally in order to absorb them.

Also, it’s going to look at fecal fat, meaning how many fat particles are in your stool. Again, if you’re not breaking the fat down properly and you’re not absorbing it properly then where does it end up? It ends up going through the entire GI tract and coming out in your poop, in your stool. So, the fecal fat would be, for example, high in someone that’s not digesting properly and has mal digestion.

So, my point here is looking at this summary there are many different things that you’re going to learn about your gastrointestinal system function by doing a comprehensive stool analysis. One thing is digestion. Another thing they’re going to look at is inflammation.

There are certain markers that can be found in stool that would be consistent with an increased level of inflammation in your gut. So, in this one you’ll notice in the sample we’re looking at you’ll also notice that if the number…there’s numbers for each one of these categories and the numbers are also in a colored circle. It could be a green circle with a number less than two which means that that’s a very low need for support. There’s not really an issue in that category. It could be a gray circle which would be optional need for support. Again, very low, not really a concern. A yellow circle which moves us up into more moderate need for support or moderate need for concern of dysfunction, not pathologic illness typically but moderate need for functional improvement. Then a red circle would be a high need for support. Anywhere from seven to ten is a score.

So, you’ll notice again that this test is going to give you information about your digestion. It’s going to give you information about whether you have inflammation in your gut. It is not just going to culture the bugs in your colon and in your stool, it’s also going to look at genetic markers, and it’s going to determine your entire microbiome. What bugs, what cultures or what bugs, what microbials are living in your colon and making up your individual specific microbiome?

Another category is it’s going to look at metabolic imbalances. One of these metabolic imbalances, for example, is one of the best ways and examples that I can give to people of the symbiotic relationship between bacteria and us as humans. Again, folks, without the multiple pounds of bacteria that we have living in our colon in symbiotic relationship with us we’d be dead. So, the metabolic imbalance with short chain fatty acids…what I want to do is take a moment and explain this. When we eat fiber, we do not digest fiber. The bacteria that live in our colon when we eat something that’s full of fiber like a vegetable or a fruit or grains, we don’t digest them well. They go down into our colon and the bacteria break down the fiber of that food for us, and when they break down the fiber, they create short chain fatty acids. The short chain fatty acids that they create when they digest fiber is what feeds the cells that determines the nutrients that feed the cells that line our colon.

So, you’ll notice that we eat fiber, we don’t digest it. It goes down into our colon, the bacteria digest it for us, and what they give off is short chain fatty acids. Our cells that line our colon ingest and eat, if you will, or get the nutrients they need from those short chain fatty acids. That is the best example I can give you of the symbiotic relationship between bacteria in our microbiome and our own health.

If you have dysbiosis and your metabolic imbalance is off, and you have low short chain fatty acids then you would need to eat more fiber or you would need to promote the right bugs to properly digest that fiber so that you get the short chain fatty acids you need to feed the lining of your colon. You’ll see, these are the things that are way more robust of information on the function of your gut than any basic traditional medicine stool culture is ever going to give you.

The final and the fifth category of information on function that the comprehensive stool analysis will give is – is there any infection? It’s going to look for parasites; it’s going to look for candida particularly yeast that are bad. It’s also going to look at the total abundance of bacteria and tell you if there are certain bacteria that are out of balance that are not the good guys, meaning they may not make you pathologically ill to put you in the hospital, but they may be causing your constipation or maybe causing your diarrhea, irritable bowel syndrome, and things like this. The point is you would need to work on improving the right balance of bacteria so that the right beneficial bacteria with the right bandanas around their foreheads, for example, as a gang are running your microbiome.

Folks, the point here of going over this for you is for you to see that to do a comprehensive stool analysis in the functional medicine realm is going to give an enormous amount of functional information about how your gut from top to bottom, from digestion to whether there’s inflammation, to your microbiome, to the metabolite imbalance and the metabolic function, and whether there’s infection. This is way more robust and way more complex than any basic stool culture in the traditional medical model will give you. That was the first test I wanted to review on this podcast. Let’s go to the next one.

So, the next very typical and very common functional medicine test is a salivary cortisol test. Now, cortisol, folks, is a hormone that’s put out predominantly by our adrenal glands. It is our fight or flight stress hormone. People who have anxiety, people sometimes with depression, people who deal with insomnia, people who have fatigue many times have imbalances in their cortisol circadian rhythm or their cortisol levels. Now, the traditional medical model, folks, does not really assess your cortisol levels in a rhythmic way, meaning a natural circadian rhythm way. Your traditional primary care doctor as I did in the past before I ever studied in functional medicine, I might have done a blood test for cortisol or a 24-hour urine test for cortisol, but neither of those tests tell you what your cortisol level is, for example, first thing in the morning versus noontime versus the afternoon versus right before bed.

You see, the circadian rhythm of cortisol is that when we first get up in the morning you wake up, your alarm clock goes off, and you have to get out of bed. Well, you hit the snooze of course and you’re awake but you’re not really fully awakened out of bed yet. What’s happening, folks, is once that alarm goes off your cortisol levels from your adrenal glands should rise. The cortisol awakening response is that from the time you first awake to within the first thirty minutes of being awake and getting out of bed and being up and moving around, your cortisol level should spike by more than fifty percent. It’s like a natural stress test that your adrenal system should put out cortisol at the highest amount first thing in the morning when you first get out of bed. That’s normal.

Then as the day progresses from that peak cortisol level when you got out of bed in that natural stress test, your cortisol should naturally be lowering slowly throughout the day until it is the lowest at night right before going to bed. Cortisol, folks, gives us hot flashes; cortisol makes us wired; cortisol keeps us awake, and we don’t want a high level of cortisol when it’s time to go to bed. Melatonin, which is the opposite of cortisol, is more of our sleep hormone. That hormone should be highest at night when we’re going to bed and lowest in the morning when we’re getting up and getting ready for our day.

So, a salivary cortisol test, and the one we’re using here is called the Adrenocortex Stress Profile, is basically a test where you’re going to spit in a tube when you first wake up in the morning because saliva is what we use. You can do these multiple samples throughout the day, and you’re not going to pee in a cup or anything. You’re going to spit in a tube, and your saliva is a perfect fluid from your body that will tell us your cortisol level at that time. So, you’re going to spit in the tube first thing in the morning and we’re going to get your waking cortisol level. Thirty minutes later you’re going to spit in the tube again and get your cortisol awakening response concept. Then you’re going to do your level from 7 to 9 AM (that range of time), somewhere between 11 AM and 1 PM (so around noon time), your later afternoon (like 3 to 5 PM), and then finally later in the evening (like between 12 PM and 12 AM midnight).

Then you’ll notice that each one of these markers, each one of these times, is measured for its cortisol level and placed on a graph. Again, we should see that your circadian rhythm is optimal or not. Where does it fit in the standard deviations of value? This is the little black boxes for each measurement and then a line goes from one to the next to the next to the next. It should, again, be a step down from first thing in the morning to noontime and then down more at three o’clock in the afternoon or four and then down to the lowest again at night.

If your cortisol levels are abnormally high or abnormally low this is information that will tell us if your adrenal system, your fight or flight system, your stress system is functioning normally or not. If it’s not, there are ways to obviously help treat that. That’s another podcast discussion, and I’ve had podcasts where I’ve talked about stress before, but this is a salivary cortisol test and this is how it’s used to assess the function of your adrenal glands.

Now, one more thing that’s tested in this saliva is also a different hormone than cortisol and that’s a hormone called DHEA, dehydroepiandrosterone. DHEA, folks, is a vitality hormone. It is an anabolic hormone, a hormone that builds you up, a hormone that makes you feel strong and healthy. Cortisol, even though it may make you wired, if it’s too high all the time is more of a catabolic hormone, meaning it’s causing degeneration and it’s causing breakdown through your systems. So, this test when we also test the DHEA level will show you if you’re normal or not. Then, you can also do a ratio, a DHEA to cortisol ratio, and you can see where that stands.

Now, in the past I have done a podcast specifically on salivary cortisol and the ratio of DHEA to cortisol and the types of things we could do to treat Stage 1 versus Stage 2 versus Stage 3 adrenal dysfunction. You may want to look back through my podcast and see if you can find that episode if you’re finding this topic extremely interesting. The point of this discussion, the second discussion in this podcast on this typical functional medicine lab test, is that a salivary cortisol lab test can be used to assess the function of your stress system, your adrenal system, and to see if it’s functioning optimally or not. That’s number two.

Let’s go on to the third typical functional medicine test that I wanted to share with you today, and this is an amazing complex test. It’s called a nutritional functional analysis. It’s specific name through this lab is called the NutrEval, but this test is, again, functionally looking at someone’s overall nutritional function and status.

This test involves doing a urine sample first thing in the morning is the way this one is done. Then also going and getting blood drawn on that same day, and then the lab would give you a kit. You pee, you know first thing in the morning in a tube, you freeze it, then you take the kit, you bring it to a lab (obviously somewhere that’s agreed to do this for you), and they follow the directions, and they draw your blood, and they send it off as a kit through Federal Express to the lab.

The lab does an enormous amount of tests on all of the organic acids throughout your urine and your blood. It also tests for heavy metals and toxic exposures, oxidative stress, mitochondrial function of your body. It looks at fats, whether your level of omega-3 fatty acids versus your omega-6 fatty acids, saturated fats, as well as omega-9s. So, it also, again, looks at toxic exposures with cadmium and lead and arsenic and these things. It also looks at your typical minerals in your body and do you have enough magnesium, do you have enough potassium, and so on. It also assesses your methylization imbalance. Methylization is one of the primary forms of detoxification in your body and many people out there have heard of MTHFR imbalances. This test and this type of testing, this nutritional functional analysis, looks at all of these things, folks, and gives you these categories and assesses whether you’re functioning well.

You’ll notice it has the same circles with colored numbers in them to give you a ballpark of whether the function of, for example, oxidative stress is high, moderate, or low for you, whether your mitochondrial dysfunction or better your mitochondrial function which has to do with your energy system is optimal, moderately out of balance, or highly out of balance. Again, whether your omega fatty acid balance is good, optimal moderately out of balance, or high out of balance and so on. Toxic exposures and also methylation imbalance, and you can see in the list underneath those circles with the numbers in them there’s a lot of different organic acids and chemicals that they’re looking at and saying whether they’re optimal, moderately high, or red meaning overly high need for support and in need of real definitive correction.

So, this is an amazing test. Now, the other thing that comes out of this test that you don’t see in the image I’m providing you is that from all of this analysis they also recommend exactly how much, for example, Vitamin B12 you might need as a dosage in your multivitamin. It also tells you how much all of the different B vitamins, how much Vitamin C, how much magnesium you should be on, whether you need digestive enzymes. The point here, folks, is not only is it going to assess your overall individual nutritional function, it’s also going to make clinical recommendations as to exactly what vitamins you should be taking in, supplementing with, and exactly what dose you should be on.

This is an amazing test. Again, the third one I’ve talked about today is a more nutritional functional analysis, and this one specifically that I’m sharing with you is called the NutrEval. There are other labs out there in the functional medicine realm that do nutritional evaluations and give you this type of functional information.

So, these are the three lab tests: comprehensive stool analysis, the salivary cortisol test assessing the function of your adrenal system, and this overall nutritional functional analysis. These are some of the most common functional medicine labs that are way different than any of the traditional blood tests that a primary care doctor would do. Now, I of course do the traditional type of blood work that any other doctor would order, but when it fits with each individual patient that comes to see me as a functional medicine specialist I might recommend, for example, one of these functional assessment tests. We usually would gain an enormous amount of usable clinical information to help you improve the overall function of whether it’s your gastrointestinal system, whether it’s your adrenal stress system, or whether it is multiple of your systems, your detox system, whether you’re getting the right fat balance, your mitochondrial system and whether you’re looking like you’re overly toxic, or whether your methylization system is functioning optimally.

I hope this has helped. Again, if you’re interested just reach out through, which is my clinical website to even set up a free consult to possibly talk with me or one of my staff about any of these labs or whether you feel this is an avenue towards health you would like to pursue. So, signing off for this podcast. Take care everyone!


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