Testing Technology Update
Testing Labs & Methods
Improve the health and well-being of your patients by using data from innovative testing methods to develop personalized treatment plans.
People are more self-aware than ever—paying more attention to their bodies’ signals, habits and expressions and overall constitution. This is good news in that they can likely be more eloquent when describing what they are concerned about when they come into consult with you.
But that also brings with it a greater pressure to deliver exacting data and information about just what issue they are dealing with. They want to address causes more so than symptoms. And this is where the testing methodologies you use can help them, and by doing so, forging stronger bonds of loyalty and even increase referrals.
Practitioners like you are using a wide scope of tests they like and rely on. For example, Holly Lucille ND, RN, of Healing From Within Healthcare, Los Angeles, CA, noted that she likes to use reference range and functional testing for hormones, nutrients, environmental exposure, food allergies and sensitivities, as well as hyperpermeability (leaky gut). “The key is to have good clinical acumen, a clinical hypothesis and then choose the labs to confirm the clinical suspicion,” she advised.
According to Emily Telfair, ND, HeartSpace Natural Medicine, Baltimore, in Maryland, people need to have a primary care physician and if the patient is in between those visits and want to work with an ND she will order a range of tests that may include standard or traditional testing such as CBC, chem panel and lipids. In addition, she noted that she may also order thorough thyroid testing including TSH (thyroid-stimulating hormone), free T4 and free T3 along with screening for autoimmune antibodies. Dr. Telfair frequently screens for inflammation with ferritin and hs-CRP and also looks for deficiencies in vitamin B12, iron and vitamin D.
Occasionally, she added, she may order food allergy testing (US Biotech IgG and IgA panels) to screen for food sensitivities that may be exacerbating skin symptoms, GI (gastrointestinal) complaints, headaches or other chronic symptoms. Dr. Telfair related she likes to use the DUTCH (dried urine test for comprehensive hormones) hormone testing for women which looks at both sex hormones and cortisol levels and their metabolites. “The clinical support with this lab is excellent and provides a deeper window into how women process their hormones beyond just their basic hormone levels,” she commented. “And I have just started ordering comprehensive stool analysis testing (GI Effects test by Genova). Still learning about this test and when it will be most beneficial.”
The swiftly rising number of individuals obtaining their genetic information via such affordable testing kits as 23andme has created a new consultative atmosphere. These tests rely on identifying single nucleotide polymorphisms (SNPs or “snips”), which are the most common type of genetic variation among humans, and each SNP represents a difference in a single DNA nucleotide.
Dr. Telfair said she often has her patients run their 23andme results through a program that distills the data and pulls out SNPs related to phase I, phase II liver detox, processing of neurotransmitters, methylation, etc. She will then only frame interpretation of their SNPs as a tool to support them and prevent disease rather than use it as a predictor of what health concerns they may experience. “Often patients end up feeling validated that the ‘stuck’ symptoms they have been experiencing can be supported by aiding certain enzyme pathways in working more efficiently,” she said. “This becomes empowering as they implement a more individualized treatment plan that accounts for not only their unique genetic make-up but also how those genes express in them as a whole person.”
Testing Advancements
As with any other form of technology, health testing evolves at a rapid clip to reveal increasingly more information about health status.
Dennis Dougherty, vice president wellness development, Illinois-based Aurora Life Sciences observed that modern medicine is definitively evolving from a disease-based system to a preventative health-based system engaged in early detection, arrest and reversal of chronic disease. Diagnosis of disease is also evolving from labeling conditions based on recognizable clusters of signs and symptoms to a deeper understanding and identification of the root cause of disease, and then suggesting modifications through adopting therapeutic lifestyle change and supplementation. The medical climate is shifting from relying on the use of powerful drugs to suppress symptoms, and toward emphasis on providing tools to support the body’s innate ability to heal.
“Concurrently,” he said, “advances in laboratory testing to identify bio-markers in the preclinical stage of the disease has supported this evolution and is essential in enabling one to take measures to prevent the onset of disease and in many cases, arrest and reverse the disease.” For example, he provided, autoimmune diseases do not develop suddenly. When diagnosed with an autoimmune disease (eg, Crohn’s disease, psoriasis or rheumatoid arthritis), predictive markers of human autoantibodies and laboratory signs of up-regulated inflammatory response manifest well in advance (four to seven years) before clinical onset of disease. This is similar to the current use of fasting blood sugar (in the range of 100-124 mg/dl) and increased levels of HbA1c as preclinical markers for diabetes “Based on these evolutionary changes in laboratory science, one can now detect a problem early, address the root causes of disease and support the body’s natural ability to heal,” he summarized.
Pharmaceutical-based autoimmune treatment is about finding the right drug to suppress the symptoms of immune dysregulation and inflammation, noted Chad Larson, NMD, DC, clinical education advisor, Arizona-based Cyrex Laboratories. An emerging field of functional immunology is focusing on evaluation, identification and removal of trigger(s) that lead to the immune dysregulation and autoimmunity. Clinical research indicates that if the trigger(s) are identified and removed, the autoantibodies will decrease and associated symptoms will lessen. “Prior to Cyrex Laboratories, no lab was offering comprehensive screening for the four main trigger categories to immune dysregulation and autoimmunity, which are: barrier system breakdown, food immune reactivity, chemical immune reactivity and chronic pathogenic immune activation,” he stated.
Matthew Pratt-Hyatt, PhD, associate laboratory director for The Great Plains Laboratory, Inc., in Kansas pointed to dramatic advancements in liquid chromatography only in the last year, which he said have led to tests becoming more sensitive and accurate. “Being able to identify and measure small quantities of analytes in patients has dramatically improved testing,” he commented.
Testing Options
The main focus of Cyrex Laboratories, said Dr. Larson, is functional immunology, immune dysregulation and autoimmunity. Cyrex Labs’ Chief Science Advisor Aristo Vojdani, PhD, is the original developer of IgG food immune reactivity testing more than 30 years ago and, according to Dr. Larson, has continued to perfect the methodology as laboratory science has evolved. Using Enzyme-Linked ImmunoSorbent Assay (ELISA) as the foundation of antigen-antibody testing, a variety of immune reactions can be evaluated, ranging from tissue autoantibodies, like cerebellar and zonulin antibodies, to food and environmental antigen-antibody reactions, like gluten and bisphenol-A (BPA).
“If a patient is suffering from an autoimmune condition like Hashimoto’s thyroiditis or rheumatoid arthritis, or is suspected to be developing an autoimmune condition,” he explained, “Cyrex offers tests to help identify how and why the immune system has become dysregulated and what can be done to resolve it.”
And, according to Dougherty, there is a global epidemic of autoimmune diseases; such conditions have been continually rising and now one in six men and one in four women are or will become affected by one or more autoimmune diseases. Despite the increasing prevalence, he noted, autoimmune diseases have been very difficult to diagnose. Those with autoimmune disorders, on average, see up to four physicians during approximately five years to obtain a correct diagnosis. Further complicating matters, he said, is that individuals with an autoimmune disorder is at increased risk of developing a second or third autoimmune disease. Testing individually for an autoimmune disease is both costly and reliant on the suspicions of the physician.
Aurora Life Sciences’ aim was to “enhance wellness testing with a focus on developing a platform that provides the practitioner a cost-effective broad look into an individual’s immune system physiology,” described Dougherty. Analysis for simultaneous testing of greater than 30 autoantibodies associated with more than 20 autoimmune diseases is accomplished at a lower cost than traditional testing methods.
The company’s Autoimmune 30+ test panel utilizes a patented fluorescence imaging system (FIS) for the in-vitro detection and identification of autoantibodies based on the principle of immunoassay. Each patient’s test contains antigens, calibrators and controls. If present, the human autoantibodies will bind to the corresponding specific antigen(s). Bound antibodies are then detected by incubation with a fluorophore labeled conjugate. Following processing, the slides are read on the FIS and results are provided to practitioners in an easy-to-interpret format.
Aurora Life Sciences, said Dougherty, recommends practitioners utilize the autoimmune predictive panel—AutoimmuneS—in two ways. First, it can be included for all first-time patients to screen for any pre-clinical markers of autoimmune disease. For those patients who have preclinical markers for autoimmune disease, steps can then be taken to find the root causes—diet, stress, allergen, microbe or toxin—and make changes to prevent the onset of disease. Second, he explained, “practitioners could use it as a tool in the monitoring of each patient’s condition and response to treatment. Identifying bio-markers can objectively measure and be evaluated periodically as an indicator of response to a therapeutic intervention.”
When a patient tests positive for any autoantibody, regardless of the specific disease it may predict, Dougherty recommends practitioners to work with the patient to:
• Support healing a leaky gut
• Repair the microbiome
• Teach a plant slant anti-inflammatory diet
• Screen for and eliminate toxins and infections
• Practice stress reduction
• Introduce OTC nutraceuticals (vitamin D, curcumin, L-glutamine, omega-3s, etc.)
“As the leaky gut is healed, toxins are cleared, diet improves, and stress is reduced,” he explained. “The body begins to heal while antibodies fade, upregulated inflammatory responses are quieted and the immune system returns to rebalance.”
Also offering comprehensive autoimmune testing and testing for mild cognitive impairment (MCI) is Healthy Practice Solutions. The latter test is of particular relevance, as loss of mental abilities has become the number-one concern of aging people; the good news is that MCI is reversible if identified early. According to the company’s website, this test is the only computer-based test proven as effective at detecting MCI as a full neuropsychological exam.
The Great Plains Laboratory helps practitioners provide personalized care to their patients, according to Dr. Pratt-Hyatt. “We understand that many of our clients are suffering from chronic illnesses, and many of these illnesses have similar symptoms,” he remarked. “However, we also know that there are many different causes of these conditions. Our mission is to help uncover the root causes for our patients’ chronic illnesses.”
The Great Plains Laboratory’s methodology, he explained, is to use the most appropriate technology for the problem. This ranges from using ELISA for allergens to employing Mass Spectrometry to measure small molecules in the body. The lab’s Mass Spectrometry tests range from Organic Acids Test (OAT), which provides insights into many of the bodily processes that influence health, to its newer MycoTOX Profile, which determines if an individual has been exposed to harmful mold toxins.
Dr. Pratt-Hyatt said he advises all patients start with the OAT, a comprehensive, 74 marker test that provides an overall snapshot of metabolic processes in the body. These processes include gut health, mitochondrial functioning, neurotransmitters, glutathione status and nutritional markers, among others. Then depending on results from this test, as well as patient history, the lab can provide additional, complementary testing. For example, he offered, if the practitioner believes a patient may have toxic chemical or mold exposure and/or if the results from the OAT suggest this is a possibility, the lab would recommend doing either the MycoTOX Profile, the GPL-TOX (non-metal environmental toxin test), the glyphosate test (the primary toxic ingredient in the herbicide Roundup), and/or a metals test (typically hair). “Several of our most popular tests are simple urine tests, which can all be run on the same sample, which is convenient for patients,” he said.
Wisconsin-based QuinTron Instrument Company, Inc. provides non-invasive breath/trace gas analyzers measuring hydrogen, methane and carbon dioxide and breath/gas collection systems and test kits. QuinTron analyzers are primarily used in the gastroenterology field with aiding medical professionals to determine what may be the root-cause of their patients’ GI disorders/conditions such as carbohydrate malabsorptions/intolerances (lactose intolerance, fructose intolerance, etc.) and small intestinal bacterial overgrowth (SIBO). According to the company’s website, “SIBO is the culprit mimicking the symptoms of carbohydrate malabsorption issues or other digestive disorders occurring with your patient.” Studies have shown that greater than 80 percent of individuals with IBS (irritable bowel syndrome) have tested positive for SIBO.
Presence of SIBO causing GI issues is often related to conditions such as autism, eating disorders, opioids, as well as food intolerances and allergies. SIBO symptoms (similar to IBS) are abdominal bloating/distention, diarrhea, pain, gas and unexplained weight loss. The company recommends having the patient follow the Physician’s Elemental Diet, which consists of a powdered formula that is free of gluten, soy and dairy and is also hypoallergenic.
Elsewhere in 2018, True Health of Texas has launched a spate of in-depth tests. In January, the company announced it will be offering three new comprehensive allergy profiles (food allergy, regional inhalant allergy and pediatric allergy). “As many as 40 million Americans may have some form of allergies,” said True Health CEO Chris Grottenthaler. “Despite high prevalence, diagnosis of the specific source of allergic reactions can be difficult because various allergens often cause similar manifestations, such as respiratory or gastrointestinal symptoms.”
In February of this year, the lab began offering comprehensive testing for celiac disease and gluten sensitivity. Approximately 80 percent of people in the U.S. with celiac disease are undiagnosed. “Public awareness of gluten-related disorders is rising,” said Bobbie Sutton, MD, PhD, vice president and laboratory director at True Health. “Many patients self-initiate a gluten-free diet, which may be medically unnecessary, expensive and could result in weight gain or nutritional deficiencies. Our tests provide clinicians with actionable results that help identify a patient’s gluten-related sensitivity and help determine the appropriate next steps.”
And in August, noted Grottenthaler, the company added measles, mumps, rubella and varicella (MMRV) tests as part of its new Infectious Disease category. Its MMRV tests determine the immune status of individuals to MMR and varicella-zoster viruses, a pathogen that causes chickenpox and shingles.
Your patients who are found to “have something” in a sense can be comforted by the identity and clarity of the diagnosis through many of these tests, and then get back on the track to better health.
Healthy Take Aways:
• Genetic tests rely on identifying single nucleotide polymorphisms, which are the most common type of genetic variation among humans.
• Being able to identify and measure small quantities of analytes in patients has dramatically improved testing.
• Those with autoimmune disorders, on average, see up to four physicians during approximately five years to obtain a correct diagnosis.
• SIBO is the culprit mimicking the symptoms of carbohydrate malabsorption issues or other digestive disorders occurring with your patient.
For More Information:
Aurora Life Sciences, www.auroralifescience.com
Cyrex Laboratories, www.cyrexlabs.com
Healthy Practice Solutions, www.healthyps.com
QuinTron, www.breathtests.com
True Health, www.truehealthdiag.com
The Great Plains Laboratory, www.gpl4u.com
