RHR: Which Lab Tests are Essential?

this guy chriskresser even in his effort to list the barebone essentials, tends toward over-testing to a degree that would be costly to most incomes.  he relies on a neat triad:  breath test, stool test, urine test.  

but a budget-oriented MD turned FMD thankfully 'disagrees' with all the testing he does in her comment which confirms my hunch, says all this testing is not usually necessary in all cases and infers that experienced doctors like herself should have a clue what the patient has through examination/questionaires before any testing, using tests only to confirm etc.

so based on her 'minimal tests' comment, i looked her up and sent her a note yesterday.  but its a good read for the few good hints/clues in here to help the DIYer know more:

the Geneva report is a lot easier to read (if true, a good insight key for DIY budget)

RHR: Which Lab Tests are Essential?

https://chriskresser.com/which-lab-tests-are-essential/

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So I'm currently using the Doctor's Data Comprehensive Stool Analysis with three samples. It's a combination of stool culture, really advanced stool culture method, and something called the MALDI-TOF method, which stands for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. It's a proteomic method of identifying bacteria and yeast. It works by measuring the unique ribosomal protein fingerprints of microorganisms. Then they compare the spectra with a reference database for verification and identification. It's a lot more sensitive than many other technologies. They can identify over 1,200 species of bacteria and yeast. It's used by NASA, I believe, to detect microorganisms in launch vehicles. 

It was ranked 3rd last year in the Cleveland Clinic's Top 10 Medical Innovations list, which is a list of medical innovations that will improve patient care. I like it because it also has other helpful markers. It's a stool analysis; it's not just looking for parasites, yeast, and bacteria. It has some inflammatory markers like lysozyme and lactoferrin. It measures stool pH; secretory IgA (SIgA), which is a marker of gut mucosal barrier integrity; short-chain fatty acids like butyrate; beneficial bacteria; and some other interesting stuff. We also sometimes use BioHealth #401H, which is another culture-based stool method, and sometimes we'll run them together side-by-side.

For organic acids, we tend to use either the Genova—or former Metametrix—Organix Comprehensive Profile, or the Organic Acids Test from Great Plains Laboratory. This is probably, if I had to choose one of my top three tests, I would say urine organic acids is up there. That's because you can learn so much not just about the gut, but organic acids are also by-products of cellular metabolism. There are all these cycles in the body. Things tend to kind of go around in a cycle. Getting from one step of the cycle to the next step requires an enzyme, to convert one metabolite to the next metabolite in the cycle. Each of those enzymes requires certain nutrients to function properly. So if a nutrient is deficient, that cycle will not complete and you'll get a buildup of the metabolite or organic acid that's at the previous step of the cycle. That spills over into the urine and you can see it show up in the urine. Then that can give you some information about where these cycles are broken and what's happening in terms of metabolism, cellular energy production, fatty acid metabolism, carbohydrate metabolism, neurotransmitter breakdown metabolism, detoxification, methylation. 

One of the most sensitive markers for vitamin B12 deficiency is methylmalonic acid. That's an organic acid that's on this test. Formiminoglutamic acid (FIGLU) is probably the most sensitive marker for folate deficiency, for tetrahydrofolate deficiency. That's on this test. So you can learn a ton of stuff on these organic acids panels. Unfortunately, they're not very easy to interpret for patients. It's definitely something you need training and education about, and it's something that your doctor or practitioner can help you interpret, but not something that's too easy to figure out on your own.

Then there's the SIBO breath test. We use the one from Genova. We've used also one from Commonwealth Labs as well, but we prefer the one from Genova because I think it's more accurate in reporting methane, which we talked about on a previous show. And this is one of the ways to test for bacterial overgrowth in the small intestine. It's a good test overall. There is potential for false positive and false negative, so you can't rely on SIBO breath test results alone. But when it's combined with the organic acids and the stool test, I think that's a really great combination for assessing gut health.

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Methylation testing

Methylation, I'm doing an increasing amount of work in that area, and finding it to be really helpful and critical for some patients in their recovery. I do genetic testing to determine what the single nucleotide polymorphisms (SNP) are, the genetic mutations in methylation-related genes. But that's not enough. I know I've talked about this before, but it's a pet peeve of mine when practitioners just test for genetic mutations and start supplementing people only based on those mutations. That's because a mutation of a gene does not alone imply dysregulation of that gene. It means there's probably a greater likelihood that the enzyme that the gene produces won't function well, but it's not a guarantee. You can have people with genetic mutations in the methylation pathway but their methylation works perfectly well, and you can have people who have no mutations, or really minor mutations, in the methylation pathway that have serious methylation problems. So genes load the gun and environment pulls the trigger.

Environmental factors like diet and lifestyle, toxic exposure, et cetera, are far more important in terms of determining methylation status, which is why I always use a functional methylation profile that tests for patients' actual methylation capacity. That's with a lab called Health Diagnostics and Research Institute (HDRI). I'm hesitant to even bring this up, because they're the slowest lab that I work with. They take up to 10 weeks to get results back. So now more people are going to be ordering their tests, and I just shot myself in the foot. Thanks a lot. No, it's a good panel. I hope they can ramp up their staff and get more people on board, so they can turn around the test results a little bit quicker, because 10 weeks is a long time to wait for a test result.

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As far as I can tell, Great Plains tests for a wider array of markers, but the Geneva report is a lot easier to read

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Sunny

AUGUST 23, 2016 AT 9:24 AM

As a medical doctor practicing Functional Medicine, I disagree. Most people only need a smaller version of these tests with a practiced doctor who has a good clue about what is going on and what is needed before even getting the tests, just using the tests to confirm at each step or to suss out possibilities.
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Financial strain is not a small problem. Our type of medicine should be available to people of all financial capacities, not just the elite. It's a pet peeve of mine, so I try to keep testing to only what I really need.