Testing technology continues to advance at tremendous speed, becoming more accurate, helping you to aid your patients/clients in a more customized and effective manner.
The year 2020 will be historic for several reasons, notably the first pandemic in 102 years. It has left indelible marks on society, especially how people become more proactive in self-care and illness prevention. They are meandering the internet, mining for as much information as they can learn to become more educated about general health, well-being and disease risk.
Frustration has surfaced as mandatory social distancing has turned the patient consultation on its head.
“The majority of people postponed testing and screenings this year except those deemed absolutely necessary,” observed Elizabeth Livengood, ND, owner and CMO (chief medical officer) Livengood Natural Health; co-founder and CMO, Restorative Methods Tempe, AZ. “Local governments and the CDC (Centers for Disease Control and Prevention) encouraged people to avoid seeing their doctor for elective visits or in-person testing, and use telemedicine instead. While telemedicine is long overdue its credit, most tests and screenings require an in-person visit. Unfortunately, many people put their health care on hold this year.”
Dr. Livengood’s patients relayed stories of postponing annual exams, endoscopies and lab testing which otherwise would have been deemed medically necessary to alleviate bothersome symptoms or to get prescriptions.
However, she pointed out, despite the overall decline in preventive health care, she saw a slight uptick in the use of private labs because they are able to drop-ship test kits directly to patients’ homes. These kits include saliva and urine tests which are exceptionally good for hormones. Since specialty labs are inherently more expensive than insurance-based labs, the pandemic has caused a polarization in spending—either a drastic reduction for patients who avoided testing altogether or an extra expense for those who opted for private-pay labs.
COVID-19 antigen and antibody testing practically swallowed the market whole. “Most of our labs were overwhelmed and took far too long to release results,” Dr. Livingood related. “This chasm between supply and demand led to private labs once again charging premium prices for faster results. While many doctors benefitted financially from this arrangement, patients were torn between high costs and a sense of urgency for information to allay their fears.”
Daniel Beilin, OMD, LAc, founder of Alfa Thermodiagnostics (Santa Cruz, CA), stressed, “Now more than ever, practitioners and patients need systemic whole-body views to guide them in developing preventive treatment plans and to address chronic and acute illnesses.”
Alfa Thermodiagnostics offers the AlfaSight, which Dr. Beilin described as an extremely sensitive and systemic analysis of weakened organ functions, physiological dynamics, and stress-responses which correlate with vulnerability to disease including viral onslaughts such as COVID. “Our patients are better prepared for the risks of the pandemic because the AlfaSight gives us the tools to address individual vulnerabilities to COVID attacks. Since its clearance by FDA (U.S. Food and Drug Adminsitration) radiology, we have been using this non-invasive technology to respond to a myriad of problems that increase risk to other disorders and diseases,” he explained.
“Initially, we recognized that our naturopath providers would be pivoting to virtual appointments, initially and most likely, continue this service indefinitely,” related Amy Paoletti, director of education and marketing, Oregon-based Precision Analytical Inc.
As such, the company has quickly adapted to this sea change in how practices now operate with patient visits, and has thus created a “ship the hormone test kit directly to your patient’ process. We instituted this immediately on March 13 and continue to offer and message. We have added prepaid return shipping and packing for all our domestic test kits. This change, as well, will make it quicker and easier for our naturopaths’ patients to return their specimens and in turn, quicker return of results to our naturopathic doctors.”
Texas-based Choose Health’s core business is providing remote lab testing solutions for practitioners and their patients, primarily for metabolic health. When the pandemic hit there were two impacts upon its practitioner partners, reported company CEO Mark Holland. First, the adoption of telehealth consultations and second, remote testing and screening. Holland began hearing more feedback from patients that they didn’t want to visit a lab or clinic to partake in regular screening or blood testing.
“As the year has progressed more individuals and practices have requested and adopted to remote testing and screening protocols,” he said. “We envision this continuing into next year as patients realize the ease and time saving practicalities of testing from the comfort of their home and accessing their own results to further their health journey.”
Still, there are tests that should remain routine. For example, Jacob Teitelbaum, MD, author of the new and updated edition of From Fatigued to Fantastic! considers a blood pressure and blood sugar screening every year or two (depending on the patient) to be the most worthwhile tests. In addition, he recommends glaucoma screenings every two years and colonoscopy every 10 years from age 50-75. However, he stated, “I find many of the other screening tests (e.g., PSA and thyroid sonograms) to cause more harm than good, though a CBC (complete blood count) in general chemistry every few years is also reasonable,” he said.
In Dr. Livengood’s practice, testing is especially vital for hormones and autoimmune conditions. For male hormones, prior to initiating testosterone therapy, she needs to determine if the cause is primary hypogonadism (e.g. Klienfelters) or secondary hypogonadism (e.g. opiate use, pituitary tumor) or mixed primary and secondary hypogonadism (e.g. obesity, type 2 diabetes, cirrhosis). Specific testing for these conditions based on a thorough history will help guide treatment. Also, finding luteinizing hormone/follicle stimulating hormone in a low to moderate level can help determine if the patient is a good candidate for less aggressive therapies such as herbs or clomiphene before resorting to TRT (testosterone replacement therapy).
Once a patient is already on HRT (hormone replacement therapy), testing becomes a little trickier, she related. Patients taking injectable HRT should be tested midway between doses. Saliva testing is best for those on topical preparations, and those on oral lozenges or troches should get serum levels tested first thing in the morning before any morning medications. DUTCH (Dried Urine Test for Comprehensive Hormones) testing can help diagnose subtle hormone dysregulation before full blown disease has occurred by looking at which metabolite pathways are more heavily used.
“Thyroid dysregulation is another example of hormones that require more in-depth testing than the standard TSH and free T3,” explained Dr. Livingood. “A comparison of the latter with free T4 can help determine if a conversion or peripheral issue is causing the symptoms; while TSH compared to both of these can help determine if the problem is primary or secondary. Finally, thyroid antibodies need to be evaluated and re-run after treatment to ensure that the immune system is becoming better regulated through treatment.”
Precision Analytical Inc. offers the DUTCH Test. By using four simple, dried urine collections, explained Paoletti, the DUTCH Test takes the advantages of a 24-hour urine test and adds the pattern of free cortisol, which has traditionally been acquired from saliva. Hormone and metabolite values correlate to 24-hour urine values, and free cortisol concentrations accurately replace its testing in saliva. Sex hormone analysis uses the most accurate method available (LC-MS/MS and GC-MS/MS) and offers basic hormones and extensive sex hormones and their metabolites. The adrenal hormone testing in the DUTCH Test is, said Paoletti, “the most comprehensive available,” including free cortisol and a better marker of total cortisol production by including cortisol and cortisone metabolites. Melatonin, oxidative stress and organic acids are also tested.
“DUTCH testing is also built to optimize HRT monitoring. Using special methods which separates free and conjugated hormones and adds metabolites for unparalleled testing, the DUTCH Test has the most reliable and trusted results both with and without HRT,” she added.
Alfa Thermodiagnostics’ AlfaSight, described Dr. Beilin, incorporates algorithms that help define and adjunctly diagnose, allowing practitioners to respond to root problems affecting the whole body and help their patients heal from the inside out. The AlfaSight consists of a hand-held sensor that records skin temperature as affected by neural networks traversing the spinal cord. These neurologically based projection zones include information from the organs and tissues in their segmental region. “This is a known thermoregulation physiological effect documented in most neurology texts,” he said.
He explained how it works: taking two measurements separated by 10 minutes of stress from exposure to cool-room-air, a dynamic before-and-after temperature monitor provides enough data to “recognize” specific patterns, which he said are known and proven by collaborative tests (blood tests, culture, X-Ray, CT, MRI, PET). These tell the practitioner where deviations from known healthy stress-responses are developing.
Similar to a treadmill test done by a cardiologist, described Dr. Beilin, the AlfaSight analyzes the dynamic changes between pre- and post-stress states and concludes with adjunct diagnostic information portrayed in a six-page report. “Recommendations regarding further tests or supplements to consider are provided; this information is not tied to any particular company endorsement and leaves choices up to the treating physician and the individual patient case,” he assured.
Casey Hersch, clinical social worker and founder of LightYourSparkle.life added, “Alfa Thermometry gives patients a MAP of their own bodies. It serves as an adjunct to other treatments. By providing immediate feedback on the interconnectedness of every organ and body system, it is easy to track and respond to changes. This empowers patients by allowing them to consider treatment options that were otherwise unexplored and are now brought into awareness.”
Texas-based SpectraCell Laboratories’ flagship diagnostic test is the micronutrient test (MNT), which measures 31 specific micronutrients—vitamins, minerals, amino acids, antioxidants and metabolites—and how they affect cellular function and to reveal existing subclinical nutrient deficiency. A magnesium subclinical deficiency, for example, can manifest in numerous ways including having no clinical symptoms, such as reducing bone density. MNT measures nutrient status in the context of cellular function, over a period of four to six months. All the factors that affect nutritional needs for each person—age, lifestyle, illness, injury, drugs, circumstance, genetics—are reflected in the MNT results. No amount of modern medicine can totally correct an improperly nourished cell.
The Choose Health test, said Holland, is a simple internal health tracking service to test and track a core panel of biomarkers linked to chronic disease and long-term health. “Created by three functional physicians, the kit is an affordable and convenient way for patients and practitioners to track and manage a core panel of markers from the comfort of the patient’s home,” he described. The core test measures and is used as a screening tool for total cholesterol ( total cholesterol:HDL), inflammation ( hsCRP), oxidative stress (GGT), insulin resistance (triglycerides:HDL), average blood sugar (hbA1C) and visceral fat (waist to height ratio), he elaborated, noting, “Additional markers are available upon request including ferritin, vitamin D, testosterone, etc.”
On the Horizon
Technological advancements continue, as is the norm in the evolution of medicine and healthcare. Paoletti said that emerging tests such as the Cortisol Awakening Response utilizing a true assessment with FDA-approved and patented collection devices called Salivettes are exciting, as are tests utilizing hair to measure cortisol and methylation SNPs (single nucleotide polymorphisms) testing.
“The potential of mass spectrometry is very exciting,” noted Holland. “There is the potential to gather a lot more data and relationship analysis between key markers of health using mass spectrometry analysis. The costs of testing should also decrease as more laboratories adopt mass spectrometry testing and samples are analyzed in bulk for a wider range of markers.”
As technology advances, some tests become glaringly inefficient. For example, explained Dr. Teitelbaum, the reliability of many tests is somewhat questionable. For standard lab testing, he advised, it is important to realize that if you order the same test twice on the same tube of blood (done on the same person at the same time), the results are often dramatically different. “When I ordered a cholesterol panel and a chemistry which included a cholesterol from one of the two major national labs on each new person I treated, the cholesterol results were routinely 40-120 points different,” he related. “When I pointed this out to the national lab manager, they fixed the problem by simply suppressing one of the two results when I ordered both panels. This is not a rare problem for standard testing and must be kept in mind.”
Meanwhile, he added, for holistic testing, the main problem is not having reference ranges readily available for a healthy population—it seems that ranges that are offered result in seemingly almost everybody being positive, therefore the specificity is often a problem. In addition to the reference ranges given, he opined, it would be important that these labs make information available about what percentage of the healthy population tests positive (using their “optimal” range), and what two standard deviations for the lab results are in a healthy population. Then in addition, they can also give their recommended reference ranges for health. “Otherwise, the likely lack of specificity simply results in most people being positive—whether or not the test is pointing to a key underlying issue for that person. So it, emotionally satisfying but often useless without the information above,” he commented.
Dr. Livengood observed, “Genetic testing has progressed from the cryptic 23 and Me results that required a geneticist to interpret to a plethora of genetic tests available through national labs or the easy access of urine samples that measure a wide variety of enzymes and co-factors involved in hormones and neurotransmitters.”
She added that accessibility has also increased for autoimmune testing. Avise recently partnered with Quest Diagnostics to improve accessibility to autoimmune specialty testing through conventional providers and a greater likelihood of insurance covering those tests. “Precise testing in this area is evolving so that we know better what to test based on a set of symptoms. For example, antipolymer antibodies are frequently correlated to fibromyalgia which can save a health care team a great deal of time in pinpointing this elusive diagnosis,” she explained.
New developments in testing for difficult diagnoses may help resolve chronic cases and create more targeted treatment plans, Dr. Livengood reported. For example, she offered, some of these new tests include coagulation panels such as MOCHA, A2AP & Hereditary Thrombosis Risk Panel (HTRP) from Lab Corp, which can help diagnose embedded infections that underlie chronic interstitial cystitis, fibromyalgia and IBS (irritable bowel syndrome). The clotting factors, lipoproteins and inflammatory markers in these panels show an increased risk for accumulation of LPS (lipopolysaccharide) particles from a lifetime of exposure to antigens. “Over time, these lead to chronic conditions in our weakest system,” she commented. “The weak link could be the gut, the respiratory system, the skin or the immune system. From that system, we see the vague symptoms that evolve into chronic syndromes such as IBS and fibromyalgia.”
Specificity is likely the key word when consulting, and much of the process of selecting the appropriate tests comes from how the patient conveys his or her symptoms. The beauty is that there continues to be new and refined tests available to provide precise care.
Healthy Take Aways
• Testing is especially vital for hormones and autoimmune conditions.
• Thyroid dysregulation is another example of hormones that require more in-depth testing than the standard TSH and free T3.
• The costs of testing should also decrease as more laboratories adopt mass spectrometry testing and samples are analyzed in bulk for a wider range of markers.
For More Information:
Alfa Thermodiagnostics, https://alfathermo.com
Choose Health, Texas, www.choosehealth.com
Precision Analytical Inc., www.dutchtest.com
Spectracell Laboratories, www.spectracell.com
