Debra Gibson, N.D.
The plot of The Fantastic Voyage, a science-fiction movie from the 1960’s, centers on the adventures of a group of scientists who are miniaturized by a newly invented machine to a size small enough to enter an ill colleague’s body. Their mission? To navigate (inside a tiny submarine) the colleague’s cardiovascular system to his brain, save his life by dissolving a blood clot, and safely exit his body before the miniaturizing effect wears off and they revert to normal size. Along the way they witness up close the miraculous workings of the human body: the beating of the heart, the oxygenation of blood by the lungs, and, when their submarine comes under attack by white blood cells, the unerring power of the immune system to target invaders. A fun, imaginative and fascinating movie, even today, and one I am often reminded of when I review results of a functional laboratory test with a patient.
Because like that journey into “inner space”, this new breed of laboratory evaluation gives physicians and patients a window on the inner workings of the human body not provided by standard lab tests. Functional medicine biomarkers and test profiles are ahead of the curve of standard lab assessments, offering the closest thing to real-time insights into the way the body actually functions, and more importantly, providing specific information about body system dysfunctions. It is these “system failures” that can cause complex and puzzling symptom pictures and create the negative physiologic momentum that drives the development of many diseases. The ability to examine deeper, fundamental causes of illness through functional testing can guide treatment in more effective directions and allow progress and outcomes to be tracked in ways never before possible.
But it may be as tools for disease prevention that functional lab markers hold greatest potential for benefit, enabling us to “look upstream” and identify patterns of risk for illness that can often be resolved or significantly reduced with lifestyle and natural therapies. These markers also provide a practical and accurate way to personalize healthcare, as they reveal the unique metabolic “footprint” of an individual at a particular point in time. It’s a kind of brave, new world of laboratory testing, and it can be credited for many “miraculous” healing outcomes by those who work with it.
Biomarkers in Functional Assessment
The term “biomarker” can be applied to everything from something as basic as a red blood cell count to sophisticated genetic testing which checks the appropriateness of a particular drug for a person. Functional biomarkers are a special category of tests which identify otherwise hidden patterns of body system dysfunction. Some biomarker tests with functional applications are available from standard laboratories; those listed below can easily be added to an order for basic lab tests such as a metabolic panel or cholesterol test to screen for functional systemic imbalances.
- Homocysteine: originally identified as an independent risk factor for cardiovascular disease, an elevated serum level of this breakdown product of the amino acid methionine points to impairment of one or both of two crucial and common metabolic pathways. Because of this, increased homocysteine is a risk indicator for many diseases, among them rheumatoid arthritis, Type 2 diabetes and its complications, Alzheimer’s dementia, depression, anxiety, and osteoporosis. Nutritional support in the form of folic acid, vitamins B12, B2, and B6, and betaine leads to reduction in homocysteine and normalizes the flow of the metabolic pathways.
- Insulin: Elevated serum insulin, either in the fasting state or after a “challenge” of carbohydrate, contributes to heart disease and stroke, obesity, Type 2 diabetes, high blood pressure, high cholesterol, inflammation, polycystic ovary syndrome, and many other undesirable health issues. I also pay attention to a low insulin level, as that may indicate declining insulin output by the pancreas. An abnormal insulin level can appear years or decades before diagnosable disease presents itself, so it is the best kind of prevention to find it and treat it. Identifying this very commonly abnormal functional marker and prescribing lifestyle changes and nutritional support can lead to dramatic improvement, and while reducing long-term risk for serious disease, in the near term it improves weight, energy, mood and well-being.
- cardioCRP: Also called “highly sensitive CRP”, this test measures very small blood amounts of a protein which is produced by the liver in response to inflammation. Elevations in cardioCRP have been associated with significantly increased risk of atherosclerosis and cardiac events, as well as stroke, cancer, and depression. Natural medicine approaches to normalizing elevated cardioCRP include reducing inflammation by means of lifestyle change (a high-fiber Mediterranean diet is effective) and taking natural anti-inflammatory supplements such as fish oil, vitamin C, flavonoids, and curcumin.
Other biomarker tests which can be performed by standard laboratories include the VAP (Vertical Auto Profile), which provides more detailed information about blood lipids than standard cholesterol measurements; and the marker Lp-PLA2 (Lipoprotein-Associated Phospholipase A2), which can be paired with cardioCRP to more precisely identify those at greatest risk of cardiovascular disease, particularly stroke.
Functional Medicine laboratories
Functional medicine labs provide testing for a special category of biomarkers not generally available from conventional laboratories. Functional laboratories combine multiple biomarkers to create profiles, some of which are system-specific, some of which offer broad assessment of the status of multiple body systems. Some evaluate unhealthy body levels of toxins: for example, there are functional lab profiles which test for toxic reactions to foods; for excess estrogen due to inadequate metabolism and clearance from the body; for elevated body burden of toxic metals such as mercury and lead; and for toxic chemicals such as phthalates, styrenes, solvents and pesticides. Identifying higher-than-healthy amounts of specific toxins is key to developing an appropriate treatment approach to clear them from the body.
Described below are some of the systems-based tests which I find most useful:
Comprehensive Digestive Analysis
“Health begins in the colon”: this fundamental principle of naturopathic medicine, that our digestive tracts have multisystemic influences on our health, is the basis for the frequent use of digestive analysis in many natural medicine practices. Whether the problem is irritable bowel syndrome, constipation, colitis, or GERD; anxiety, depression, arthritis, or eczema; digestive analysis can reveal underlying imbalances which may contribute. This functional profile uses stool samples which are collected at home and sent overnight to the lab, to evaluate digestion of food, absorption of nutrients across the intestinal wall, and the “ecology” of the digestive tract – microorganisms such as bacteria, yeasts, and sometimes parasites which populate the intestines, and factors (such as acid/alkaline balance) which can influence the survival of healthy or harmful organisms. It’s not surprising that those factors which promote the survival of the “good guys” are hostile to the survival of the “bad guys”, and vice versa, so determining which markers are off-kilter is a powerful tool to tipping the balance in the right direction. Comprehensive digestive analyses also contain markers for increased risk for colon disease, colon cancer, gall bladder disease, and even hormonal cancers such as breast cancer, enabling preventive steps to be taken before increased risk can progress to disease.
Stress Hormone and Neurotransmitter Testing
Sleep issues, anxiousness, depression, attention issues, poor memory, obsessive compulsive disorder – all are characterized by changes to the healthy balance and interaction of stress hormones and neurotransmitters (“brain messengers” which influence mood, energy, focus, memory, motivation, impulsiveness and other aspects of brain function and emotion). Saliva and urine samples can be used to identify imbalances which can then be modulated or resolved using natural formulations specific to the pattern of dysfunction, and attention to improved lifestyle where appropriate.
Functional Nutritional Testing
Standard serum tests are for the most part of limited value in assessing nutritional status; for this purpose, functional medicine practitioners rely on profiles that evaluate and cross-reference a variety of biomarkers from plasma, whole blood, serum and urine to determine adequacy or deficiencies of vitamins, minerals (including trace minerals), fatty acids (such as the omega-3s and omega-6s), amino acids, antioxidants such as Coenzyme Q10 and glutathione, and even markers for free radical damage to cell membranes and cell nuclei.
Functional laboratory profiles stand at the intersection of medicine, biochemistry, and the new field of genomics, and give us a wide-angle view of a person’s health status. With such detailed and personalized insights, treatment can truly be “custom tailored” to the individual.
Debra Gibson, N.D. practices functional naturopathic family medicine in her Ridgefield, CT office. She can be reached at 203-431-4443 or at [email protected]. Her blog can be found at www.debragibsonnd.com.