Cost-Effective Functional Medicine Testing – Episode 13

Steve Wright from SCD Lifestyle joins Dr. Ruscio and Susan McCauley for this episode of Dr. Ruscio Radio to podcast-artwork newdiscuss cost effective lab testing. Is more lab testing better or should we be looking at how to get the most bang from our patient’s limited budgets?

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Topics:
Episode overview…..1:30
Blood draw preparation…..4:08
More testing vs. better testing…..5:30
Food allergy and food sensitivity testing…..9:56
Adrenal testing…..19:07
Robust autoimmune panels…..32:44
Episode wrap-up…..41:56

 

Links:

  1. (21:28) BioHealth Functional Adrenal Stress Profiles http://biohealthlab.com/test-menu/hormones/functional-adrenal-stress-profiles/

 

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Cost Effective Functional Medicine Testing

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine.
 To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey, guys. This is Dr. Ruscio. I am here with the lovely Susan, are typical host, and our special guest Steven ‘The Handsome’ Wright. Hey, Steve, how are you doing?

Steven Wright: I’m doing handsome.

DR: Right, right.

SW: Thanks for having me on.

DR: You’re welcome. Susan, how are you?

Susan McCauley: I’m hanging in there. I had a massive work weekend with my business partner, Kendall Kendrick. So, today feels like not like a Monday. It feels like just any other day of the week, which is a good thing.

DR: Right, right. I hear you. I hear you there. I was wrestling with my recording software for probably an hour over the past two days, which is one of the most frustrating things I can think to do, which is just waste an hour trying to look at why the program that worked a week ago is all of a sudden not working.

(laughter)

SM: Oh, the joys of computers.

DR: Yeah, all right.

SM: So, what do we got in store for today?

Episode Overview
DR: I thought we had two great minds here to help discuss the topic, and something that I am really passionate about, which is efficiency in functional medicine – meaning, you know, not doing thousands of dollars of lab tests on day one, trying to have a system in place, trying to be a little bit judicious and focus on the vital few tests rather than the trivial many so as to be efficient, both with the amount of fluids the patient has to donate and also with the amount of money that the patient may have to pay, or even the patient’s insurance. I’ve talked to both you about this separately in different conversations back and forth. So, I thought this would be something interesting to kind of open the floor up to.

SM: You know, one time I had 23 vials of blood taken.

DR: Yeah (laughter).

SN: Twenty-three.

DR: I actually had a patient. She was a friend of a friend, so she had my cell phone number. She came into the clinic, and this was a couple years ago, and we did a pretty robust panel on her. She was like, “Geez, that was some pretty robust blood work.” And I was like, “Yeah, you know, I don’t want to brag but we’re pretty good, we are pretty thorough.” And I didn’t realize what she meant was like,’Holy crap, that was a lot of blood.’ And she sent me a picture from her phone, and was 16 vials of blood that she donated at Quest for the testing. That for me was a pretty eye-opening experience, meaning, yeah, you know, sometimes you forget that you have to keep in mind that, for every boxer that you check off, there’s a corresponding amount of fluid that the patient has to donate in order to run that test. And so, if you go to too nuts, you can really make that an unpleasurable experience on the other side of the needle for the patient.

SW: I like to think about it as, you know, I’m just letting out some iron overload, if I have any.

(laughter)

DR: Sure.

SM: That’s a good idea, if you have it to spare.

SW: Right, right.

DR: Twenty-three. I’m sure that wasn’t fun, Susan, was it?

SM: No, it wasn’t fun. But, you know, over the years I’ve had a lot of blood taken. And so, you just kind of grin and bear it. You have to drink a lot of water before you go or they will have a problem drawing that much blood.

DR: Right, yeah. That’s a good one. Did you lose like five pounds that day?

SM: (laughter) Don’t give anybody any ideas about weight loss and blood being drawn.

DR: The blood donation diet.

(laughter)

SM: Yes.

DR: The next craze?

Blood Draw Preparation
SW:
You know, you just hit on something that is really I think actually important that doesn’t ever get talked about. And I think that this might be a great forum (for that). But, even when it comes to blood tests, doing everything the same every time you get tested, whether that’s how much water you drink, what time of the day you get drawn…What are your thoughts on that, Dr. Ruscio?

DR: Well, I definitely think for some markers, that’s important. Of course, thyroid has been the one that has been the most well documented that the time of day – you can have a significant impact on TSH levels. So, for thyroid I think that’s important. Of course, fasting for cholesterol and insulin and blood sugar I think definintely important. Yeah, for a few markers it’s definitely been well shown. And my basic approach with patient is to try to keep everything the same in terms of same time a day, same fasting state – and we standardize just to do all of our testing fasted just to standardize like that. So yeah, I think it’s definitely a good idea.

SM: Yeah, think I always say to make sure to drink plenty of water and fast for at least 12 hours, no matter the test. It just gets people in the habit of doing the same thing over and over again.

More Testing Versus Better Testing
DR: Right. Yeah, yeah. So, let’s jump in and kind of get into the meet of the matter here, because I know people listening, or hopefully anyway, are curious about what test they should, what test they shouldn’t do. I want to paint, maybe, a context that I’ve noticed, which is: Something immediately online healthcare community that I’ve noticed is this complexity for the sake of complexity, as is one of my colleagues, Dr. Jeff Moss, likes to say, which is making things complex just for the sake of making them complex. Sometimes it’s done to sell seminar tickets, (and) sometimes it’s done to have new information for a followership or for viewers. I think the detrimental part about that is, it can lead the consumer to think that things are more complex, or have to be harder or more complex, than they actually are. I think it creates a lot of waste. So, do you guys have any thoughts on that kind of initial background premise?

SW: Well, I think that No. 1, functional medicine basically saved my life. And then, when I was working with clients, which I haven’t been for the last six months. But, when I was working with them, I have this appreciation for tests, and for just having data. But, I have seen the other side of that equation, almost the dark side…

DR: Right.

SW: …where…Again, the question is curious. Is it complex because it’s complex for reason? Or, is it because of lack of clarity of a model of practicing? Or…

DR: Good point.

SW: But I think there are lots of things that wrap into that that definitely create confusion amongst patients who are trying to seek out functional medicine help.

SM: And I think that patients in the functional medical world are sick, and they’re looking for answers and they are listening and they’re reading and they are researching. And so, they sometimes think they know what tests they want to run, and they go to the practitioner and say, you know, “I need food allergy, adrenal…” And they come with this whole, you know, Word document…

DR: Right, right. (laughter)

SM: …of tests because they are looking for answers. But sometimes, the answers aren’t in more tests, but in the correct tests.

DR: Right. And I think those are both excellent points. And certainly, Susan, one of things I have to do with patients maybe would be 30% to 50% of the time is to talk them out of doing a number of tests right out of the gate. It’s exactly what you’re describing, where they’ve read up on certain tests, they head X,Y,or Z person recommended a certain test. In isolation, those may be a good idea. But, what I try to do is always be looking for patterns with patients, in terms of if patients come in with X,Y,and Z symptoms, over the past couple years I’ve run all these test repeatedly. Is there a pattern? Meaning, you know, this test and that test really seem to make a difference. But, these other two repeatedly have not really made a huge difference in terms of treatment or terms of providing any real, actionable data.

And I think that’s something important for patients to remember – that, yes, while you may have read about a test, and you may be well-versed in what it tests for, and why it could potentially be good, you have to remember that a good clinician has been running – well, hopefully anyway, a good clinician – has been running this test, or tests like it, on patient after patient after patient. So, hopefully they’ve run this on hundreds of patients over the course of a couple years, or even a year. And, they’ve gotten a good handle on when that test is necessary and when that test is unnecessary. Because, yes, sometimes I really do have to talk a patient out of a test, because they come in thinking it’s going to be so important. I wish there was a way for them to see inside my mind  – the 15 times before I’ve gone through the same dialogue with patients, or even run that test with a patient and seen it produce nothing, right? So I think that’s a great point.

Food Allergy And Food Sensitivity
DR:
Maybe that’s a good lead-in to one of the first ones I’d like to address, which is food allergy testing. My experience with this was, man…A number of years ago when I went from feeling great to feeling absolutely terrible. I was very much in the same position like you were describing, Susan, where I was searching for answers. The food allergy test is kind of one of the first stops, right? It’s one of the first things I feel like people come across. Certainly, it’s very alluring at first because it makes a lot of sense.

I ran an ALCAT on myself, and I had 23 food allergies. I very quickly went nuts…

SM: Of course! (laughter)

DR: …and there were like six things I could eat on the list. But then I said, “Gee, something doesn’t make sense to me here, because I eat this food and that fruit and this food all the time, and I feel fine when I eat that.” However, not even on this list of food allergies that are printed out in front of me, are this food and that food. And I’ve clearly noticed when those foods, I don’t feel well at all. I quickly learned that, if gut barrier health is compromised, you will have what’s called pan-allergy, where you will have multiple secondary food allergies or food allergies that have been acquired secondary to having a leaky gut. And so, the solution to this food allergies isn’t really avoiding those foods, it’s identifying what’s making the gut leaking and fixing that problem. And then, once you do that, your food allergies will probably be far, far fewer, and you may have a couple – like eggs or nuts or gluten or dairy – that are fairly well ascertainable through our kind of standard template of elimination and then reintroduction.

SM: For me it’s almost the opposite. My food sensitivity testing comes back as nothing – the only thing was mildly sensitive to mustard. I have an autoimmune disease, so (I have a) terrible reaction to gluten and dairy, and some of the nightshade. And none of those came up on the test at all.

DR: Uhm, interesting. I’d say that’s one of the other things that I…I did run this testing for a while with patients, and that was the same sort of narrative that I would see, where people would have pre-identified foods that they knew they didn’t well with. Sometimes, they wouldn’t even show up on the test. And then something unusual, like blueberries, would show up. OK, well let’s have you try cutting out blueberries. And, we’d see them 30 days later:  ” Did the cutting blueberries out make a difference?” Uhm, not really. It was usually what I heard, but the allergies that I would repeatedly would either see on testing or see patients do really well with are essentially all the foods that are listed in the autoimmune paleo protocol. Which would be grains, dairy, soy, eggs, nuts and seeds, and nightshade vegetables, and maybe beans of legumes. Certainly the most common would be the gluten-containing grains and dairy. And then, second to that would maybe be nuts, seeds, and eggs, and then a few people with nightshades, and a few people with beans and legumes. That was one test that, when I cut out and just standardized to…OK, Day 1 we do at least 30 days of the autoimmune paleo protocol, and then we go into a food reintroduction to help you sniff out, on an individual level, which foods work well and which foods don’t work well. That tended to really be…what seemed to produce the best results for people. And, I think that’s especially important to mention because, when people go through their reintroduction, they will either feel negative symptoms or not feel a negative symptom.

Let’s say they have brain fog that returns. So, they’ve clearly identified…say I bring dairy back in and it give me brain fog. That, to me, has been a much more long-lasting identifier for people than me handing them a piece of paper saying ‘You can’t have dairy’. The piece of paper works for a little while, I’ve found, but people eventually are going to test the boundaries. And, if they test the boundaries with no repercussion, I’ve found that the piece of paper doesn’t really work incredibly well in the long term. At least, that’s what I’ve found.

SM: What do you think, Steve?

SW: Well, I think when you’re looking at tests, you have to understand the pluses and minuses to each test. So, food sensitivity testing – I think there’s many different kinds, and I think some are more reliable than others. For the most part, they do seem very contradictory to what real life presents. And, as you mentioned, Dr. Ruscio,  we are talking about testing sort of a surrogate end-point game, where, basically, if you’re having chronic leaky gut, and you have 23 reactions, that means, basically, you can assume that anything you’re eating could be passing into the body, and be your body could be reacting to it.

DR: Right, right.

SW: Every meal – you could be reacting to everything that you eat, so people will react to beef and different, random things when they are really sick. In my head, it doesn’t – in this case – it doesn’t make sense to use this test, because most practitioners understand that the underlying mechanism here is a gut barrier dysfunction. We also know that, if we remove whatever’s causing the gut barrier dysfunction, and figure that out, then, like, right away over time – it’s not like it’s black and white or anything but – with every meal, those food sensitivities will maybe get worse or get better. So, what you’re hinting at is totally my philosophy, which is that the person knows best. Over time, most of us have gotten away from trusting and feeling into our bodies and what works for us. And so, to ask a test to tell you kind of like what your gut barrier is doing – that’s not even testing your gut barrier – I think is just missing the point. I think it’s definitely money that you could spend elsewhere to get more bang for your buck. I think the only case – and I am with you, Dr. Ruscio, that it’s diet first; when people work with me, you could even sign up with me if you weren’t willing to basically go paleo, or specific carbohydrate diet. So, that was just my barrier to entry, because I feel so strongly about this.

The one thing that I think is really fascinating is if you have a really stubborn person – I’m pretty stubborn myself – who just needs some hard data to convince them that something is going on. I think where these tests sort of got their fame. But, I don’t really know. That’s kind of my theory…

DR: And I agree with you on that application…

SW: Yeah, back before we had all this knowledge, and we had so much info on the internet, I feel like maybe food sensitivities kind of help start the sort of train that a lot of us are on now about talking about leaky gut, and talking about food sensitivities.

DR: Right. And I agree. I think that for someone who compliance is going to be an issue, it you can justify the use of the test. Yeah, I think that’s one definitely reasonable application. And, I agree with you completely where hopefully the continued dialogue that’s being had around this issue will help people who are a little bit stubborn, and realize, ‘Hey, a lot of people have been doing the testing, and an even greater number of people have been experimenting, and we have some pretty deeply entrenched, pretty well-defined trends in terms of the most common allergic foods. Maybe it’d be a good to start there.’ The way I phrase it for the patient is: “We could spend this $200, $300, $400 on food allergy testing. But, in my experience, it’s not really going to provide us with a whole lot of useful data.” And that’s money that I’d much rather use trying to identify why the gut is malfunctioning in the first place. That’s where doing good microbial workup for things like SIBO, candida, ursinia, worms, pathogens, maybe inflammatory bowel disease. That’s where those tests are really, really important, because they have a strong impact on treatment. And they can get fairly pricey – those can add up very quickly. And so, I think it’s really important to try to save money wherever so that we can do a really robust testing array in an area like that that I think really matter

DR: All right. So I think we’ve hopefully beaten that one to death.

SM: Like a dead horse? (laughter).

Adrenal Testing
DR: Uhm, how about adrenals? I think that’s another really interesting one. And, Susan, last time we were talking, you made a few remarks I thought were kind of interesting. And if you wouldn’t mind sharing your experience there. I think that’s a great real-world example for people to hear.

SM: Yeah, you know, my major complaint when I came into this lifestyle was fatigue. You know, just utter…not sleeping fatigue but just exhaustion most of the time. And, I’ve had adrenal test after adrenal test after adrenal test, and it got to be to the point – and every different protocol following now that  – you know I could tell you what my adrenals were doing. I didn’t need a test.

DR: Right, right.

SM: And I see that, you know, after hearing you speak at PaleoFX last year, that kind of started getting the juices flowing. Then I started looking and talking with my clients, and I could pretty much predict what their profile would look like. It’s become less and less of something that I look at anymore.

The time is that I do have a lot of chronic exercisers. Oh my goodness, I wish that I could just get it through to everybody. You know, like, CrossFit competitors…

DR: Right.

SM: …where I just want to see, like show them, here’s what is going on with you; you are on the verge of adrenal exhaustion.

DR: So again, it’s needed primarily for compliance in that case, right?

SM: But with my luck, I would run the test, and then it would come out showing them they were OK, and they would just take it as a license to continually trashing their health.

DR: Right, right.

SM: So, I’m curious, you know, what you guys think.

DR: Steve, have any thoughts on this?

SW: Yeah, I mean I think my experience is that the, like, sort of the patterns – I don’t know if you want to get too in depth here, but – the two big patters I think all of us are our worried about are, like, extremely high cortisol levels, because the research is extremely clear that that’s not going to be beneficial to your healing or your health; and low cortisol – like, (an) inability to produce it; more of that adrenal exhaustion. The confusing thing is that, typically, the symptoms are really close to the same. So, I do like specifically Biohealth saliva index for adrenals. And I know we aren’t suppose to name labs, but I’m just going to say that…

(laughter)

DR: No, don’t name…before the call, I said, ‘Let’s try not to name labs, but I meant more so a lab that we were going to criticize, because I don’t want any of the lab directors to come by and egg my house or anything like that.

(laughter)

SW: Fair enough. So, I ran Biohealth’s (saliva index for adrenals test) versus many competitors. And, nothing was quite as sensitive as that one. And so, even on myself it was quite remarkable. So, that’s kind of to the overall call here of, like, which tests are you choosing, and then which labs are you choosing inside of the test you’re choosing. It all really matters a lot. But, to get back to adrenals, I found it really helpful for those people who, sort of…we we’re wondering just how bad their adrenals were.

DR: Right.

SW: The other thing to note here is that client population or patient population really matters. So, the people that I worked with were really, really sick. I’m an engineer by training – you’re not going to consult with me unless you’ve typically been through the wringer and haven’t gotten results. And so, the people that I was talking with were extremely sick. We saw a massive prevalence of extremely low cortisol, and it was very helpful to understand how low it was because that dictated a lot about any sort of recommendations to get those back together. Because, if it’s too low, they might be so sensitive to almost any sort of protocol that you have to be really careful; verses somebody who is a little bit more robust in their hormonal health.

So, I’m typically in favor of it. But, I am only in favor of Biohealth, at this point. And, I’m also not practicing anymore, so it could have already changed.

SM: I think that you are making some really valid points. Like, the people I see usually are not…I don’t have the credentials or anything to see anybody who is really sick. So I am seeing kind of the higher level, you know? Just fat loss…

DR: So, when you say higher level do you mean people without quite as severe…

SM: Not as sick, you know?

DR: Got you.

SM: Not as sick. Mostly, people with lifestyle issues – I’m a nutritionist, so it’s like food, lifestyle, sleep…

DR: Sure.

SM: So, if I had a sicker type of population, then perhaps this would be a good test for me to run often.

DR: Right. And that’s…I’ve run quite a few hundred of these tests over the past couple years. One of the things I like to do is pit one lab against another one when I am suspicious of one being better than the other. And this is one case where I will break my rule, I guess, of trying not to name labs. But, I really did find that Biohealth performed a lot better than Diagnostechs ASI.

But that being said, what you said, Steve, was exactly what I saw reflected in my patient population, which was the vast majority of people had hyponatremia or hypercortisol – Everybody had low cortisol, for the vast majority. The exceptions for that were usually people who were younger and had a shorter duration of their illness. Really, what I found was almost everyone had adrenal fatigue. And then, from that point after awhile to me, I didn’t really see it making a huge difference in the way I treated the patient. Any adrenal adaptogens, for example, will work if the cortisol is high or low, or if the rhythm is somewhat altered. And Pregnenolone DHEA, another one of my favorites – there’s an opinion that the quantities and ratio of one or the other makes a big difference. I found that to be absolutely untrue. In fact, in some patients that were the most adrenal fatigued, they actually did best with a higher dose of DHEA relative to Pregnenolone in my experience. The other thing that I noticed was, most of these people don’t have adrenal fatigue because they had adrenal fatigue. They had adrenal because they had some other massive issue that needed to be addressed – meaning a lifestyle issue, very poor diet, a really bad  gut infection, Lyme disease, you know night shift working, or just not sleeping nearly enough. And so, when I started to really think about this a little more critically, the adrenals weren’t the reason for adrenal malfunction. And so, to me the adrenals were just a secondary system that we were supporting, while we were trying to find and correct the primary source of malfunction that was causing a secondary manifestation of a adrenal fatigue.

I haven’t been running this test now for a year, and I have to say I’m getting better results than I was before because I’ve put more focus on those primary drivers, like infections, or gut infections, or a certain type of autoimmunity, or something that’s been missed. So, that’s one test that I haven’t run, and it really hasn’t made a difference, with rare exception of, like you said, Susan, someone who is doing a lot of exercise training and trying to figure out if they are pushing little bit too hard. Where I do think it can make a difference is to know if someone cortisol levels are too high, because in my experience, when cortisol levels are high, you feel good. And I say that as someone who had high cortisol, and I verified that with a test. And, I can remember clearly, I literally remember one day bounding out of bed – like my eyes opened up and I literally jumped out of bed without even a split second hesitation because I just…I was…It was right when I contracted the amebic infection. My stress hormones were going through the roof, and that was reflected on my lab work. And, I felt awesome, and that’s one of the things that I love Dr. Kalish says, as he calls them the Stage 1, or the first stage, of the adrenal malfunction pattern is when all of the stress hormones. And those people are hard to help because they feel so good. It’s not until the pending crash that comes on the other end of that they are going to be compliant, because they feel so poorly. So…

SW: The one thing I just wanted to ask you was do you, now that you’re not testing, do you have a standard sort of adrenal support that all patients who you think are having adrenal issues that go on? I’m curious if the model of practicing matters in this case?

DR: I’ve got…it depends. People whom are highly re-actively – like, people who report B vitamin sensitivities or potentially even vitamin d sensitivity, or people just remarked that they are very sensitive to things in general, I oftentimes will not give will not give Pregnenolone DHEA, because DHEA I find in a small number of patients can cause reactivity; like, they can feel anxious, they can have heightened heart rate, they may even have sweaty palms. For those people, I oftentimes will withhold Pregnenolone DHEA. But oftentimes if people have really, really compromise gut health, I will lean toward Pregnenolone DHEA. That’s one piece I applied there. And the adaptogens I will use oftentimes if someone has had a history of any kind of hormonally mediated cancer or any kind of prostate hypertrophy – anything like that I will shy away from the Pregnenolone DHEA and use the adaptogens. And I usually end up using either Pregnenolone DHEA, adaptogens, or glandulars. There are some reasons to avoid the Pregnenolone DHEA, like I said, even though I think they work really well.

That being said, even some people will react to the adaptogens; for some people, the adaptogens tend to wind them up too much. Sometimes it’s kind of a trial and error sort of thing. But, in terms of is there a certain level of symptomatic manifestation that correlates with a certain protocol, no. And, it’s just more based upon what I think the patient needs. I think the important piece here is I will end up supporting the adrenals for a number of months, and then we usually curtail someone off of their adrenal support slowly. The majority of patients after six months are able to come off and maintain the improvement. I think the important thing is that we’ve addressed the underlying factor that was driving the adrenal fatigue in the first place. So, I know I didn’t quite answer your question there super clearly, but hopefully that provide some kind of an answer.

SW: Yeah, definitely.

DR: Cool. One other thing about the adrenals that I think is noteworthy, I almost forgot about: There’s been some new urine test that’s being discussed quite heavily about urinary cortisol. The thing that makes this test novel – I’m not buying into the tests or not yet; and again, I don’t even know how really relevant to the treating the underlying cause of the adrenals are. I think they are an important thing to address; again, because I don’t think they are the root of adrenal function. I don’t get overly sidetracked with them. But with the urine testing, you can now look at cortisol production as well as cortisol clearance. There may be – and I say there “may be” because I think the jury still out on this – but according to the people doing the work with the urinary cortisol, the clearance is as important as the levels. (That’s) because someone who has, let’s say, moderate levels but very, very impaired clearance, is actually in a much worse position than someone that has high levels of cortisol, but high levels of clearance.

That’s just another kind of theoretical to throw out there that shows us that hopefully illustrates the point that you can’t overly caught up treating labs – sometimes you just have to treat the whole person, especially if you address the underlying root cause of the issue; some of these lab markers become somewhat trivial.

SM: I’m really curious to look into that test and get some more information. That’s really interesting.

DR: Yeah, it is interesting. I thought about bringing it into the clinic, but again, I just haven’t really found the need because people seem to get better when we get some of these more core stressors resolved.

Robust Autoimmune Panels
DR:
Anyway, how about autoimmune panels – really, really robust autoimmune panels?

SM: They are really, really expensive.

DR: Yeah. they are really expensive and I’m not talking about assays that you might run through Labcorp or Quest. I’m talking about something that you’ll run dozens and dozens of autoimmune markers, and spend a whole lot of money. You guys have any input on that?

SM: You know, I got really excited about some of these panels, you know, (from) going to training classes and learning in getting really excited to run them. I do know I had a bad experience with a client because it was on one of the ones that had a lot of the different gluten autoimmune and antibody markers. I was trying to…she said, “I don’t want to stop eating gluten. Prove to me that I shouldn’t be eating gluten.” And she had some digestive issues, so she really probably shouldn’t have been eating gluten. So I ran them, and then weird results popped up. And I had a client that was freaking out on me. So, that was just kind of a anecdotal information that sometimes there’s too much information, and then what do you do with the information once you have it.

DR: Right, I think that’s a good point. There is a lot of fear surrounding the autoantibody assays, definitely. And what were you saying, Steve?

SW: I was just going to agree 100 percent with Susan. You know, my only experience with these is actually running them on myself. When I was running them on myself, I just had this methodology; I’d never try, or recommend, or do anything in the world unless I’m the guinea pig first. I started going down the rabbit hole, and I really think that the technology is a little too new.

DR: Uh-huh.

SW: I don’t know if you both will back me up here, but I think a lot of people will have that test as you run the same lab and the same test over and over again with all different types of people coming into it. You start to learn the nuances of the test. You start to learn what’s not being reported by the lab, and you can start to see patterns inside of the lab data that the lab’s just not calling out for your practitioner. I feel like these tests…they are so new, and they are overall just so new that you’d have to run like, I don’t know, 500 to 1,000 of them to really begin to see if there are any patterns there. And I just don’t know if anybody is doing that yet. I’m a little skeptical of them.

DR: Yeah, I agree with you, and I share both of your trepidation, because, yeah, I think there is so much we don’t know in this regard. I think one of the real pitfalls in testing is, just because we can identify a positive on a test doesn’t mean that changes the way we treat the patient. That’s really one of the big…it’s a stretch, where some of these labs identify these autoantibodies as if to say they have a reasonable…first of all, to say that those are even valid and have been validated, which many of them have not been validated. Second, you have some kind of treatment you can offer for that. And if not, you just kind of scare people. I think a good example of this the antiparietal cell antibodies. Antiparietal cell antibodies accompany anywhere from 20-40 percent of cases of Hashimoto’s. This is a cell in the lining of the stomach that produces hydrochloric acid and also produces intrinsic factor. And, it may account for some of the reason why people with hypothyroid also have digestive problems – because, if you have less hydrochloric acid, you are at risk for malabsorption and bacterial and fungal overgrowths, and also may account for the hypothyroid and fatigue connection because, if you can’t release intrinsic factor, you can become deficit in (vitamin) B12 and have a macrocytic anemia.

According to the standard dialog surrounding autoimmunity, a gluten-free diet treats every autoimmune condition under the sun, which I certainly don’t disagree with – that’s a good starting point for people. However, antiparietal cell antibodies, there have been two studies performed looking at a gluten-free diet with this condition. And, they’ve had no effect. The only data that I know that has shown any kind of effect – although there is only one study to support this – is vitamin B12 injections, (show are) showing the ability to dampen these autoantibodies. It’s one thing to say you have a bunch of stuff positive on a lab assay, and it’s another thing to show that you’ve actually have a treatment that’s going to have any kind of meaningful benefit for the person. And that’s one of the major reservations that I have about these tests. I’ve run them a handful of times, and then I always come back to, ‘Well, what did we do with that information?’ We are already going to make sure that you get adequate sleep, try to manage your stress as best you can, definitely go through a trial of the autoimmune paleo protocol, and then a re-introduction, and then also do a very comprehensive gastrointestinal workup. Also, if the patient is not responsive, we may do further workups for any additional kinds of infections that have been shown to cause autoimmunity. And then (we) try to do our best to quiet the gut using probiotics – you know, a various assortment of probiotics, maybe some prebiotics. Maybe if someone is super progressive, they look into helminthic therapy and do a warm inoculation for the potential inflammatory benefits there. But, outside of that, gosh, you know, there’s a lot that we don’t know in that regard. And yeah, I think it’s not something that we can really move on. I think people get caught up into that ploy that, ‘If I could just figure out if I have an autoimmune condition, I could feel well.’ But the next step is always, ‘OK, I have this autoimmune condition or antibodies against this tissue. But now what do I do to quell that?’ And that’s what is left out of the equation.

SM: Exactly.

SW: And I think this is really close to the food sensitivities conversation where autoimmunity…essentially, you have an immune system that is not acting correctly, or in the best way for health. The target in which they immune system is focused in on kind of matters; just like knowing whether you are reacting the beef, or gluten, or something. It does matter. But in the end, the practitioner is going to be focused in more on what is driving that immune system to continue the attack. And so, it’s kind of like one of those things that I am questioning (that) there are probably other, cheaper blood markers. You could take that amount of money – $500, $1,000, whatever it is – you could run a panel every week from LabCorp and track this stuff like on a real-time basis if you really wanted to get some fun data on this. But, that’s just me being weird and loving some data. That’s sort of the stuff where it might actually see some change, because, just like leaky gut or some sort of gut dysfunction is part of the food sensitivities issue, it’s more about what is going on with the immune system – what’s driving it – than it is where is it attacking.

DR: Exactly. It’s kind of focusing on the wrong end of the cascade, so to speak. I agree completely. And I also agree with your LabCorp comment because my approach is – regarding autoimmunity – in addition to what I mentioned previously, is yes, try to find a marker that we can track. But to do one that has been validated. And most of the big commercial labs are going to include the well-validated autoimmunity markers. They might be TPO, they might be a marker for Sjogren’s or RA, or what have you. There is certainly a food core of well-validated autoimmune markers that you could use to track. And I should also mention that not all autoimmune markers seem to correlate with disease activity. A lot of them do, but not all of them do. So, there is definitely more to this than just treating a number. I definitely like to have an objective gauge if we can.

Episode wrap-up
DR: But, I think it comes back to the boring and not super sexy – or not super complex but really, really important  – (job) of just treating the entire person and trying to get them as healthy as possible – sleeping well, good cognitive function, good energy throughout the day, good sex drive, good body heat production. Some of those, I think, simple measures really, really go a long way in determining health. And I should also add that body composition, right? (There is) great data on body composition in all-cause mortality. Yeah, kind of like Robb Wolf always says, something along the lines of, ‘We always talk about the same stuff, the same basics. But, I think those basics are tried and true, and they are really, really important to focus on.

SM: Well, it does look like we are running out of time. So, Steve, do you want to tell us how we can find you and what you have going on?

SW: Yeah, sure. So, the main website where you can find my writing – I think we have over…around 500 articles now at SCDLifestyle.com – kind of stands for Specific Carbohydrate Diet Lifestyle, so kind of one of those things when you choose to adopt paleo or any of these real food diets. It’s more of a lifestyle shift. It’s not a quote/unquote diet. So, there is lots of info over there for digestive health and things like that. And, if leaky gut is something that people are curious about, they can go to SolvingLeakyGut.com, and there is a 4,000-word article that I wrote on that site for free. And then our program – there is a free webinar on there that is one there that will probably, if you read that article and then watch the webinar, you will likely know more than, like, 90 percent of all practitioners out there. So, if you are one of those people who want to be on the know for this kind of thing, I think it’s a great resource.

SM: That sounds really cool. And, doc, what do you have going on?

DR: Just working on a thousand things at once, I feel like…

(laughter)

DR: …as usual. Nothing outside of the norm. And for people following this podcast, hopefully they are on the newsletter and that’s the best way to stay abreast of all the up-and-coming cool stuff that we are working on.

SM: OK. That’s all we have for today, guys.

DR: All right, well. Susan, thank you. Steven, thanks for a lot for coming. It was great having you.

SW: Yeah, thanks for having  me on.

DR: Absolutely. My pleasure.

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates.  That’s D-R-R-U-S-C-I-O.com.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

8 thoughts on “Cost-Effective Functional Medicine Testing – Episode 13

  1. I was listening to your podcast and I found it quite interesting that B12 injections have positive effect on reducing the thyroid antibodies, you referenced a study, do you have a link to that study? I have a positive anti-gastro parietal cell result, with anti-thyroglobulin being 170 ui/ml and anti-thyroperoxidase at 371 ui/ml, would this be a case where B12 injections would help, I do supplement with B12 and my B12 serum test show that I’m in middle of the range now after maintaining a gluten free diet initially, then a paleo diet for 6 months and now on a Autoimmune paleo diet. I ask this because I question my GP as to would he consider prescribing a B12 injection. I also suffer from dysautonomia.

    1. Thanks Jack. We recorded an entire episode on this issue and it should go out sometime in the next month or two, expansion will be provided there. The finding were preliminary but promising; B12 injections silenced gastric AI. I have been tracking this with my patients but don’t have enough data to be able to say if I have found it works or not.

      Here is the reference
      http://www.ncbi.nlm.nih.gov/pubmed/20659263

      Hope this helps.

  2. I am one of those really sensitive people with stage three adrenal issues. I have Hashimoto’s and many food intolerances despite being on an AIP, low FODMAP, low histamine diet (not much to eat). I’ve tackled all but H Pylori according to various tests (Cryptospordium and SIBO); I test my gut frequently. I’m now dealing with severe histaminosis and inflammation. It all started after being on adaptogenic herbs and glandulars for one year despite heart racing the entire time (Docs thought it was psychosomatic, but elevated heart rated stopped immediately when adrenal treatment was stopped to retest adrenals). Now I am at the rock bottom and no one knows how to treat me since I react to DHEA, pregnenelone, and adaptogenic herbs. In this discussion it was mentioned that there is a select population who are too sensitive to treat with these normal adrenal supports. What have you found has worked for getting the adrenals up and running in these situations?

    1. Hi Tanya,
      Gosh I wish I had a standard ‘go to’ for you on this one but given your level of reactivity and chronicity I think the best bet would be a good workup to determine what still needs to be addressed. Sometimes the best adrenal support is removing the internal problem that is causing the chronic stress to begin with. Sorry I don’t have more for you here, but feel free to contact my office and maybe we can get you in as a patient either in person or via/phone Skype. Hang in there!

  3. I am one of those really sensitive people with stage three adrenal issues. I have Hashimoto’s and many food intolerances despite being on an AIP, low FODMAP, low histamine diet (not much to eat). I’ve tackled all but H Pylori according to various tests (Cryptospordium and SIBO); I test my gut frequently. I’m now dealing with severe histaminosis and inflammation. It all started after being on adaptogenic herbs and glandulars for one year despite heart racing the entire time (Docs thought it was psychosomatic, but elevated heart rated stopped immediately when adrenal treatment was stopped to retest adrenals). Now I am at the rock bottom and no one knows how to treat me since I react to DHEA, pregnenelone, and adaptogenic herbs. In this discussion it was mentioned that there is a select population who are too sensitive to treat with these normal adrenal supports. What have you found has worked for getting the adrenals up and running in these situations?

    1. Hi Tanya,
      Gosh I wish I had a standard ‘go to’ for you on this one but given your level of reactivity and chronicity I think the best bet would be a good workup to determine what still needs to be addressed. Sometimes the best adrenal support is removing the internal problem that is causing the chronic stress to begin with. Sorry I don’t have more for you here, but feel free to contact my office and maybe we can get you in as a patient either in person or via/phone Skype. Hang in there!

  4. I was listening to your podcast and I found it quite interesting that B12 injections have positive effect on reducing the thyroid antibodies, you referenced a study, do you have a link to that study? I have a positive anti-gastro parietal cell result, with anti-thyroglobulin being 170 ui/ml and anti-thyroperoxidase at 371 ui/ml, would this be a case where B12 injections would help, I do supplement with B12 and my B12 serum test show that I’m in middle of the range now after maintaining a gluten free diet initially, then a paleo diet for 6 months and now on a Autoimmune paleo diet. I ask this because I question my GP as to would he consider prescribing a B12 injection. I also suffer from dysautonomia.

    1. Thanks Jack. We recorded an entire episode on this issue and it should go out sometime in the next month or two, expansion will be provided there. The finding were preliminary but promising; B12 injections silenced gastric AI. I have been tracking this with my patients but don’t have enough data to be able to say if I have found it works or not.

      Here is the reference
      http://www.ncbi.nlm.nih.gov/pubmed/20659263

      Hope this helps.

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