Clinical Testing by Integrative Medical Doctors
While Integrative Medical Doctors use the same standard medical tests as conventional doctors (bloods, urine, faeces etc) there are both underused conventional medical tests and complementary medical tests that they may employ to better evaluate your condition.
Top 10 Underused Medical Tests used by Integrative Doctors
2. Vitamin B12
3. Fasting Insulin
4. Fasting Homocysteine
5. Free T3- Active Thyroid Hormone
6. CRP- C Reactive Protein
7. Candida serology
8. TTGIgA/Total IgA (Coeliac Disease)
9. Urinary spot iodine
10. Fasting 25(0H)Vitamin D
If you are experiencing FATIGUE, it is important to have your Ferritin (Iron Studies) checked. Ferritin generally indicates your body’s iron stores. It is important to realize that even if a FBC (Full Blood Count) test confirms that you are not anaemic, you may still be iron deficient! This should be ordered separately from an FBC.
Acceptable nutrient levels vary between different pathology labs. Most will have 30-300 as an acceptable range for ferritin. Unfortunately, 40 is therefore often reported as being “normal”.
Nutritional doctors usually aim for a mid-range level ie. 150.
Please note, however, that ferritin becomes an “acute phase reactant” and may therefore falsely rise when you are acutely unwell, for eg. suffering from a chest or urinary infection. More than 2 raised ferritin levels when well indicates the need for a haemachromatosis gene test to exclude an iron storage disorder.
Unless you are elderly or have a family history of pernicious anaemia, you're Doctor may not decide to test your B12.
However, if you are experiencing FATIGUE, AMOTIVATION, LOW MOODS OR LACK OF THOUGHT CLARITY, you may very well be deficient in this most essential vitamin. As for ferritin (iron studies), a FBC (Full blood Count) showing that you are not anaemic does not necessarily mean that you are not lacking in Vitamin B12.
The average reference range for most pathology labs is 170-1500. Despite this huge discrepancy in “normal” levels, nutritional doctors aim for mid-range levels, eg. 750. When an individual displays levels <300 and suffers with fatigue, one may consider weekly 10mg intramuscular injections of Methylcobalamin for 6 weeks.
Unless you have pernicious anaemia (intrinsic inability to absorb Vitamin B12 orally) or coeliac disease, levels of Vitamin B12 normally remain adequately high for at least 18 months.
Vitamin B12 is found primarily in animal products (eg. beef), so your diet may be modified as long as you do not also have high cholesterol or an intolerance to beef.
Fasting BSL (Blood Sugar Levels) are routinely ordered to exclude Diabetes Mellitus, however, fasting insulin levels are largely ignored to this day. Insulin Resistance is extremely common and is contributing to our current epidemic of OBESITY AND METABOLIC SYNDROME.
High insulin levels (>10) generally mean that you body is not recognizing the insulin it is producing and hence it is sending messages to your pancreas to simply create more. Insulin is an anabolic hormone (ie. weight-gaining).
In the case of a 2 hour OGTT (Oral Glucose Tolerance Test), which is ordered after borderline/high fasting BSLs are detected, insulin should ideally be checked with glucose as sometimes INSULIN RESISTANCE can only be discovered in this manner.
Homocysteine is an amino acid that is important particularly in the case of HEART DISEASE AND MOOD DISORDERS. Although high levels (generally >10) may be just as important a risk factor for heart disease as cholesterol, unfortunately this test is hardly ever ordered.
Even more unbelievably, high homocysteine is incredibly easy to treat as, in most cases, it simply involves Vitamin B12 (1mg), B6 (50mg) and folate (1mg) supplementation for a period of 3 months. Remembering that a background B Vitamin is important to stop any competition that can develop between the various B vitamins. After that, hopefully and depending upon your own intrinsic biochemical pathways, it can simply be managed with diet.
Free T3 is the active thyroid hormone. Unfortunately, most doctors only order TSH (Thyroid Stimulating Hormone) with T4 (which is an inactive thyroid hormone), not providing a complete thyroid picture.
Furthermore, nutritional doctors have always considered TSH < 2.0 to be a sign of an adequately functioning thyroid, rather than up to 5.0 which was generally considered to be “normal”. It is great to see that in many labs the reference range for acceptable TSH levels has recently been lowered to 3.5. Free T3 levels are usually only conducted by the labs if the TSH levels are considered to be out of range.
It is important to note, however, that determining an underactive thyroid can best be done in the comfort of home, measuring your temperature first thing in the morning (before you get out of bed…have your thermometer ready!) for 3 mornings during your periods (if you are a woman and still menstruating).Temperatures below 35.0 celsius are certainly an indication that your thyroid may not be functioning optimally. In this case, a blood test for thyroid antibodies may also be considered relevant.
CRP- C Reactive Protein
CRP and ESR (Erythrocyte Sedimentation Rate) are both markers of INFLAMMATION within the body. Although they do not tell you where the inflammation is, they do let you know if something important is going on. CRP, in particular, may be raised in the presence of conditions including HEART DISEASE, ACUTE INFECTIONS, AUTO-IMMUNE DISEASE AND FATTY LIVER.
Therefore, if your CRP is raised, it is important to monitor this at 3-6 monthly intervals, depending upon what your doctor thinks may be the underlying cause.
Candida is a yeast that commonly causes THRUSH INFECTIONS. Usually, a person is able to describe localized thrush by the presence of an irritated vaginal passage, labia or penis which may or may not be associated with a cottage-cheese like discharge. However, Candida may also infiltrate other body systems such that it becomes a systemic infection. Often this may be indicated by GASTROINTESTINAL DISTURBANCES, however, Candida may also present with symptoms of generalized FATIGUE, HEADACHES, VAGUENESS and a variety of other symptoms.
Blood tests concerning Candida are by no means 100% accurate and, as such, they must always be interpreted with clinical history and examination. A history of recurrent infections requiring antibiotics is certainly an indication for testing. IgA+ Candida generally means a current infection whereas IgG+ Candida can indicate past infections. The infection may either be localized or systemic depending upon the individual’s general state of health. After systemic treatment for Candida, it is advised to wait approximately 6 months before re-testing as the antibodies may remain in one’s system for lengthy amounts of time.
TTG/IgA : Total IgA - Coeliac disease
Although COELIAC DISEASE can only be 100% accurately diagnosed by endoscopy, blood tests can give a good indication. It must be noted, however, that you must be eating large amounts of gluten-containing foods (wheat) for 1-2 weeks prior to testing.
It is also imperative to realize that even if your blood levels are negative, you may still be suffering with a gluten intolerance. As for any food intolerance, the symptoms are primarily GASTROINTESTINAL, however, they may also simply present with other symptoms such as FATIGUE, HEADACHES, VAGUENESS, SKIN CONDITIONS AND/OR MOOD DISORDERS.
Gluten intolerance is unfortunately extremely common in today’s society, hence the growing availability of gluten-free products on supermarket shelves.
Urinary Spot Iodine
Iodine deficiency is extremely common in both under-developed and developed countries around the world. There is now a growing body of evidence to indicate that simply iodizing salt is no longer sufficient enough to keep iodine at adequate levels.
Iodine deficiency, and therefore testing, is indicated particularly in cases of THYROID AND BREAST DISEASE (benign or malignant). If deficient, one can simply supplement with iodine or kelp for a period of 3 months before retesting.
Fasting 25(OH)Vitamin D
There is now a plethora of studies indicating that Vitamin D deficiency is endemic around the world. More importantly, these studies have linked Vitamin D deficiency to a multitude of chronic diseases, not simply BONE AND PARATHYROID DISEASE as was originally thought. Vitamin D deficiency has now been linked to 18 different forms of CANCER as well as many NEUROLOGICAL AND PSYCHOLOGICAL DISORDERS.
For this reason, testing 25(OH)D (as opposed to 1,25(OH)D) may be extremely relevant in many cases. Vitamin D is now actually considered to be a hormone, rather than “just” a vitamin, and therefore may be also important with any ENDOCRINOLOGICAL (HORMONAL) CONDITION.
Although “normal” levels are generally considered by most pathology labs to be between 50-100, studies show that “higher levels may be desirable”. Nutritional doctors prefer levels to be around 100 or higher.