Functional vs. Conventional Lab Testing
I have often been asked by my patients why I order labs that are not listed in their insurance company’s lexicon. My office refers to these labs as “specialty labs”. They are “special” to us as we distinguish them from the more commonly ordered and reimbursed labs through traditional companies such as Quest, Labcorp, Biotech, etc., and also because they truly tell us about physiological imbalances that are happening in your body as a pattern rather than an actual value.
Almost every doctor has been trained to run a basic set of labs to assess wellness. These include lipids such as cholesterol and triglycerides; a comprehensive metabolic panel that includes liver, kidney, electrolytes and glucose; a complete blood count with differential that screens for anemia, diseases that cause high or low white counts or platelets; an iron panel if a female is still menstruating and more recently vitamin D.
Then there are labs to probe and investigate disorders that lead to various conditions such as anemia caused by low iron, low vitamin B12 or folic acid or other blood disorders; autoimmune conditions such as lupus tested with an ANA or rheumatoid arthritis with CCP and RF; diabetes labs such as hemoglobin A1c or labs that detect inflammation such as crp, sed rate or fibrinogen.
Largely, the emphasis of lab work is to seek out disease patterns so as to categorize them correctly for ICD 10 purposes and to match it with the correct treatment. This is how revenue is generated in a physician’s office.
A New Paradigm
Let’s take a look at some examples.
A woman with iron deficiency and heavy menstrual bleeding will be given iron tablets. She has been diagnosed and treated.
A person with high cholesterol will be labeled as having hypercholesterolemia and then given a drug to lower it. Often no question is asked about what might be causing their high cholesterol. Could it be diet, weight, lack of exercise or other hormonal issues?
Another example is a person with hypothyroid who is administered a levothyroxine preparation to correct the TSH often with no regards to the metabolic condition of the patient nor their free T4 and T3 levels or labs to detect the cause of the hypothyroidism.
Step into a newer paradigm in medicine- it is called Functional Medicine. The term functional denotes that we are looking at all causes and deterrents of function and also finding treatments that bring balance and function back to the organ system involved.
Therefore, we will often use all the labs described above and look beyond these to the root causes of the problem.
Allison’s Story - Functional Labs in Action
Take for example my patient, we will refer to her as Allison for her privacy. Allison was a woman in her 40’s with hypothyroidism who came to me on 88 mcg of levothyroxine and did not know why she felt puffy and inflamed, why she could not lose weight, why her periods remained heavy, why she was susceptible to multiple infections and stress and remained fatigued.
Through functional lab testing I was able to find out that Allison had Hashimoto’s thyroiditis leading to her hypothyroidism and that she was not converting T4 to T3 , the active metabolic hormone because she was suboptimal in both selenium and zinc, two minerals that are required to convert relatively inactive T4 to T3. Furthermore, she was gluten intolerant and it was leading to a leaky gut which was discovered by testing for gut permeability and also by stool testing to determine aspects of her digestion, inflammation and metabolism.
Removal of gluten, repairing her leaky barrier, replacing zinc and selenium, and in the interim switching her to a prescription for Natural Thyroid which is higher in T3 was the solution to get rid of inflammation, puffiness, help her fatigue and frequent infections.
Six months post the above testing, she was still not able to lose weight and was not at her optimal health. Here is where another very useful functional lab test for mold, heavy metals and environmental toxins came into play to finally help her lose weight, and rid herself of these toxins.
Allison’s final diagnosis using the functional medicine paradigm was Hashimoto’s Hypothyroidism caused by exposure to toxins (mercury and BPA), a leaky gut, multiple mineral deficiencies and inflammation from all of the above.
It took her nearly 2 years to bring herself back into balance and need the lowest amount of thyroid hormone. Allison is now able to eat gluten from time to time, manages her diet to be largely plant based, exercises at least 4 days per week and is close to her optimal weight and happy.
Looking Through a Different Lens
This is a fantastic example of how functional medicine labs helped elucidate the problems underlying relatively normal conventional lab testing. They help us understand the underlying mechanisms that lead to diseases when one knows and has been trained how to look for it. I could continue to give you many more examples of patients with chronic fatigue or fibromyalgia who start to heal or patients who get rid of chronic recurrent hives with the help of various specialty lab data.
Would conventional medicine ever consider mold or environmental toxins to be involved in any patient’s illness? It may happen but, rarely! There are sparse conventional labs that test for these but more functionally focused labs that have been vetted through CLIA ( Clinical Laboratory Improvement Amendments) are beginning to focus on tests such as this, testing for various environmental toxins and also testing heavy metals post a challenging agent to remove metals.
Other labs test genetic markers that can help explain why a person is more prone to autoimmune diseases and cancers and how diets can help them correct it. Testing for organic acids can help us determine if our energy generators known as mitochondria, function well. Serial salivary testing throughout the day can help us determine the nature of fatigue due to hypoadrenalism that is not yet severe to be labeled as Addison’s disease and the most impressive and ubiquitous problem to me is discovering that it is not sugar that leads to diabetes but a dysregulation of the hormone insulin that prevents amino acids, glucose and fats from entering cells. A wide array of testing for the LDL particle size, insulin levels, hs-CRP, triglycerides, and the measurement of testosterone and estrogen will help narrow this, namely insulin resistance, as the cause of silent blood inflammation.
So you see, functional medicine testing is able to get to the root of metabolic and functional imbalances, be proactive in measuring hormones, toxins, and sometimes testing your individual genetic susceptibility amongst other testing available. Many times, we may conduct tests to build resilience in each patient.
An example of this would be a patient who was cured of her Graves disease but continues to have high levels of mercury and lead. She is asymptomatic. Should we treat? I beleive that we should because in doing so, we are building resilience in her system. Think of building resilience with this analogy: if a cup is full, can you pour more into it? And, if you do, what will happen? Yes, the answer is “NO”. You cannot pour into the cup because it will spill out. Spilling out is analagous to having symptoms. But if the cup was half full, would you be able to fll it? Yes! and because nothing spilled, you may not notice symptoms. More reason to empty that cup, especially if it is filled with toxins, wouldn’t you agree? Since it is universally accepted that we live in a toxic world, then the least we can do is to keep the expression of these toxins low and also do the best that we can do to avoid them. When toxins enter our system imperceptibly, then we can think of cleaning up as a proactive step to avoid symptoms and illnesses. This is true prevention through building resilience in our systems.
I hope that this can help you understand why we functionally trained doctors yearn to be able to see data to help you. I love a quote of a current patient of mine who is known to quote his mentor who said, “In God we trust, for the rest of you, get me data!”. Amen!
