Part of the challenges of being a healthcare professional is determining which tests a patient actually needs. When someone is suspected of having a thyroid or autoimmune thyroid condition, then certain tests obviously should be performed, such as a thyroid panel. Other serum tests can also be valuable, such as a CBC with differential, a complete metabolic profile, a lipid panel, and a test for 25-OH vitamin D. Most healthcare professionals would agree that these tests are valuable, but from this point on there is a dramatic difference in opinions with regards to which tests are necessary.
For example, many medical doctors will only recommend the blood tests I listed above, and won’t order additional tests. In fact, some medical doctors will only order a thyroid panel, and won’t order other serum tests. In my opinion EVERYONE should obtain the tests I listed above. And of course if someone already has a chronic health condition such as Graves’ Disease or Hashimoto’s Thyroiditis, then they probably will need some of these tests measured on a frequent basis.
Is There An Overreliance of Tests By Natural Healthcare Professionals?
While some will argue that many medical doctors don’t do enough testing, others feel that some healthcare professionals do too much testing. Other than the serum blood tests recommended by most other doctors, I usually recommend a few other tests, most commonly saliva testing and the “controversial” hair mineral analysis test. There are times when I will recommend other types of testing, but these are the most common ones I recommend to my patients. Some natural healthcare professionals will recommend much more testing than this, and sometimes it can run the patient thousands of dollars for the tests.
The goal of this post isn’t to criticize other healthcare professionals for recommending too many tests. After all, I’m sure some might accuse myself of doing too much testing, although I personally don’t feel this is the case. I’ve had a few people tell me that a competent healthcare professional shouldn’t rely on using tests, but instead should rely more on their diagnostic skills. I agree that it’s important to have good diagnostic skills, as one needs to not only be able to take a good case history, but they also need to do a good job of interpreting the information, as well as evaluating the patient’s signs and symptoms. However, when trying to find out the cause of a person’s thyroid or autoimmune thyroid condition, many times more information is required. So in my opinion, a combination of good diagnostic skills and the appropriate testing is required to find out what the cause of the condition is.
This of course is easier said than done, as different healthcare professionals will have different opinions with regards to which tests are “appropriate”. As I mentioned earlier, I usually recommend saliva testing and a hair mineral analysis test to my patients. Some healthcare professionals laugh at the thought of using a hair mineral analysis, yet use other “controversial” methods of testing, such as food intolerance testing or micronutrient testing, both of which are also controversial, and are also very expensive. Obviously each natural healthcare professional will have their own personal biases with regards to testing, and the most important factor is the results one receives with their patients. I know numerous healthcare professionals who utilizing testing which is controversial, yet they receive excellent results with their patients. For example, even though I don’t routinely do food intolerance testing, I know some healthcare professionals who routinely recommend this type of testing with their patients and receive excellent results. And of course I wouldn’t recommend hair mineral analysis testing if I didn’t think it had some value in helping my patients restore their health.
What Are The Limitations Of The Different Tests?
What I’d like to do is take a look at some of the different types of tests and discuss some of their limitations.
Salivary cortisol testing. I recommend for just about all of my patients to do saliva testing to measure the cortisol levels throughout the day. I also commonly test for other things through the saliva, but the focus here will be on the cortisol levels. I find the cortisol testing to be accurate, meaning that when I test someone initially and find the cortisol levels to be elevated or depressed, frequently on a follow-up test I see the cortisol levels improve. Of course this isn’t the case with everyone, and when someone isn’t showing improvement then we want to find out the reason why.
One of the most important factors to consider when measuring saliva cortisol levels is that cortisol responds to stress. When someone has chronic stress, cortisol will become elevated for quite some time, sometimes for many years. As the adrenals weaken over time the cortisol levels will become depressed, along with the DHEA levels. However, “abnormal” stress can have a negative effect on such testing. For example, if someone is collecting the saliva samples and gets into an argument with someone on the day of collecting the samples, there is a good chance this will result in a false elevation of cortisol levels, and will therefore lead to an inaccurate result. Similarly, if someone is collecting the samples and has a migraine, this will also lead to a false elevation of cortisol.
As a result, it’s important to collect the saliva samples on a “normal” day. Now when I say “normal”, keep in mind I’m not suggesting that you have to wait for a stress free day. If this were the case then most of my patients would never be able to collect the samples. If someone’s day is normally very stressful, then it’s fine to collect the saliva samples on this day. On the other hand, if there is an unusual amount of stress then it’s best to not collect the saliva samples, and if you have already started to collect the samples on this abnormally stressful day then it’s best to start over.
By the way, even though I’m focusing on “salivary” cortisol testing, this also applies to serum cortisol. For example, some people will get a one-sample serum cortisol test done at the doctor’s office, and because they get stressed out when they visit the doctor this will falsely elevate their cortisol levels. Some will even get stressed out when receiving the injection to get the blood drawn, which once again can elevate the cortisol levels, thus leading to false results.
Obviously taking cortisol will affect the results of the testing. And even certain nutrients can affect the results, which is why when collecting a saliva sample you always want to carefully read the instructions which come with the collection kit. Saliva testing can provide some wonderful information, although hopefully you now understand some of the potential drawbacks of such testing as well.
Hair mineral analysis. This is another test I commonly recommend to my patients. And I admit that it is a very controversial test, and if you are relying on a hair mineral analysis test to tell you about all of the minerals and whether you are sufficient or deficient in them, you will be disappointed. The truth is that the hair mineral analysis can be a wonderful, low cost method of looking at certain mineral imbalances, as well as heavy metal toxicities. However, there definitely are some limitations as well.
For example, most hair analysis companies will test for the mineral iron. The problem is that you can’t rely on the hair mineral analysis when it comes to evaluating the iron levels. Many times I find the iron to be low on a hair mineral analysis test, yet on an iron panel consisting of serum iron, ferritin, and iron saturation, everything is well within the normal limits. In other words, these values are well with the “functional” reference range on a serum iron panel, yet iron might look completely depleted on a hair mineral analysis. And iron is one of those minerals that you don’t want to take if you don’t need it. Copper is another mineral which might appear as low on a hair mineral analysis test, but the person might not be deficient, and in some cases they might actually have a copper toxicity. As a result, when interpreting copper in the hair you want to look at some of the other values, such as zinc and calcium. Just keep in mind that some of the minerals on a hair mineral analysis can appear to be low, but they might be biounavailable.
Another drawback of a hair mineral analysis is that certain external factors can cause a false elevation of the minerals. For example, if someone has a water softener, then this can spike up the sodium levels on a hair mineral analysis. As a result, if someone has a water softener then they will want to wash their hair in an alternative source (i.e. distilled water) for at least a few days before collecting the hair sample. If someone is using a shampoo for dandruff, which commonly is high in selenium sulfide, this will mostly likely elevate the selenium levels. Using pubic hair can elevate the phosphorus levels.
You might wonder why you can’t just do serum testing to look at the minerals. Well, the problem is that serum testing isn’t completely accurate for most minerals. And one reason for this is that with some of the minerals, the body will do everything it can to keep the minerals at a normal level. For example, serum calcium will almost always be normal, even if someone has a calcium deficiency. And the same is true with magnesium, along with some of the other minerals. In any case, the hair mineral analysis isn’t perfect, but if someone takes the proper precautions (i.e. doesn’t wash their hair with a water softener or use dandruff shampoos), AND if the healthcare professional knows how to interpret it correctly, then it could be a very valuable tool.
Heavy Metal Testing. In addition to looking at the minerals, I also use the hair mineral analysis test to look at the toxic metals, such as aluminum, mercury, cadmium, arsenic, and lead. One can also use urine and serum testing to look at toxic metals. Serum tests are usually good for detecting acute heavy metal exposure, whereas both hair and urine are used for testing heavy metals that are stored in the tissues. Although I think both urine testing and hair testing has value, the limitations of these tests is that they won’t reveal everything, as there will be always toxic metals stored in the tissues on the body which don’t show up on these tests. Plus, when it comes to testing for mercury, the hair does a better job of testing for organic mercury, also known as methylmercury. This type of mercury is more commonly found in fish. On the other hand, urine testing for toxic metals is more accurate for determining levels of inorganic mercury, which is the type found in dental amalgams. Thiomersal, which is still used in some vaccines, is a form of organic mercury. Keep in mind that inorganic mercury is converted to organic mercury, and is considered to be more toxic than organic mercury.
Food intolerance testing. I know many healthcare professionals who require all of their patients to order a food intolerance panel. In fact, when I was still in chiropractic school I had one of these done for the first time, and if I recall correctly I think I spent about $600 for this test. There are different variations of these panels, as the most commonly recommended food intolerance panels utilize IgG testing. Another common test is called the ALCAT”, which utilizes a different technology that involves something called the “Coulter” method, which involves “measuring white blood cells using the electronic principle of particle counting and sizing”.
Keep in mind that I have nothing against food intolerance testing. In fact, if I knew for certain that such testing would be accurate I would recommend this type of testing to all of my patients. After all, if there was a way to detect all of the food allergies and intolerances in a person that would be wonderful. However, false results are very common with these tests. This is especially true if someone has an increase in intestinal permeability (a leaky gut). But even for those who don’t have a leaky gut, I can’t justify having my patients spend hundreds of dollars on a test which is likely to provide false results.
Once again, I’m not suggesting that these tests are completely inaccurate. I’ve known some people who have obtained such testing and agreed with the positive findings. In other words, upon eliminating the foods which came out positive on the food intolerance test they noticed an improvement in their symptoms. However, false negatives are common, and so there is a decent chance of the person testing positive for certain foods, which might be accurate, yet they might have some false negatives. And so what of course will happen in this scenario is that the person will avoid the foods they test positive for, but they will continue eating some foods which they might be sensitive to, yet didn’t show up as being positive on the test.
And as I mentioned earlier, having a leaky gut can completely throw off the results of the test. Dr. Natasha Campbell McBride, who developed the GAPS diet, discusses this. Here is what she has to say about leaky gut and food intolerances: “The reason for allergies and food intolerances is so-called ‘leaky gut’ when the gut lining is damaged by abnormal micro flora. Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them. Many people try to identify, which foods they react to. However, with a damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later). As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day. Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere.”
Stool testing for pathogens. There are times when I will use stool testing for pathogens. And when someone has a positive finding for certain pathogens, such as yeast, parasites, or other pathogens, there is an excellent chance that this is a true finding. However, false results aren’t uncommon. In other words, someone might test negative for yeast, even though they have a Candida infection. As I mentioned in my article on Candida entitled “Candida and Thyroid Autoimmunity [1]“, stool testing isn’t the best method of detecting a Candida infection. One can also have parasites and test negative for these on a stool panel. This seems to be true even with the newer technology some of the labs are using. So does this mean such testing shouldn’t be utilized? Well, I think there is value in doing such testing at times, but these are also expensive tests, costing hundreds of dollars. And so it’s not one I would routinely run on all of my patients. On the other hand, I know some natural healthcare professionals who do recommend stool panels to all of their patients.
Micronutrient testing. I mentioned some of the flaws with the hair mineral analysis test, but what about micronutrient testing? This type of testing looks for intracellular deficiencies. In other words, it measures how certain nutrients are functioning within the white blood cells. This type of testing evaluates all of the vitamins, minerals, amino acids, and numerous antioxidants. I was very excited when I found out about this method of testing. The problem is that the research is still lacking. If there was a test which could accurately detect all of the nutrient deficiencies of my patients I would recommend this type of testing to everyone. And although I find micronutrient testing to be interesting, I once again have a hard time recommending such expensive testing to everyone if I’m not certain that the results are accurate. Keep in mind that I’m not saying that this type of testing isn’t accurate, but simply that there is no research I’m aware of which proves that this type of testing is accurate.
Organic acids testing. The company Metametrix is one of the companies which offers testing for organic acids, and gives the following definition of such testing: “Organic acids are metabolic intermediates produced in pathways of central energy production, detoxification, neurotransmitter breakdown, and intestinal microbial activity. Accumulation of specific organic acids in urine often signals a metabolic inhibition or block. This abnormality may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect. Testing for organic acids helps reveal activity and changes at the metabolic level, helping practitioners discover hidden issues and pinpoint where therapeutic focus is needed.” There are other labs which offer this type of testing, such as Great Plain Laboratories.
The organic acids test does have some value. However, it is another expensive test, and false results are possible as well. Plus, there is also controversy over the different types of methodologies used, which is GC/MS (Gas Chromatography/Mass Spectrometry) or LC/MS/MS (Liquid Chromatography/Tandem Mass Spectrometry). LC/MS/MS is the newer type of technology, but this doesn’t necessarily mean it’s the more accurate one. One of the labs which utilizes the GC/MS technology wrote a paper why this technology is superior to the LC/MS/MS. The paper is convincing, but of course has a biased view.
Applied kinesiology. This isn’t the same as the other types of testing listed here. As described by the website www.appliedkinesiology.com, “Applied kinesiology (AK) is a form of diagnosis using muscle testing as a primary feedback mechanism to examine how a person’s body is functioning.” The reason I brought this up is because I know of numerous healthcare professionals who won’t do any of the testing I mentioned above, but will only utilize applied kinesiology on their patients. In fact, some won’t even recommend blood testing, and so if someone has a suspected thyroid or autoimmune thyroid condition, they will just do applied kinesiology on the patient, and nothing else. And the reason why they don’t do any additional testing is because it won’t change their recommendations. This doesn’t describe everyone who uses applied kinesiology, as I know healthcare professionals who use this, but also require blood testing on all of their patients.
I have a good friend who practices applied kinesiology in his practice. And I’ve worked with numerous patients who have seen one of these practitioners and received very good results with them. The problem is that this type of “testing” solely relies on the skill of the practitioner. While this might be fine for someone who is competent and has been using this technique for many years, in my opinion it probably shouldn’t be relied on with someone who doesn’t have as much experience. Once again, I didn’t list this technique here because I disapprove of it. After all, let’s not forget I also listed the saliva testing and hair mineral analysis as having limitations, even though I recommend these tests to my patients. I decided to mention this in this post because even though those doctors who utilize this technique have the utmost confidence that it will provide them with the information they need to restore the person’s health back to normal, it still has limitations as well.
There are other tests I haven’t listed here which have limitations, but these are some of the most well known ones. And this doesn’t mean that these tests don’t have value. Obviously I wouldn’t continue recommending the saliva testing and hair mineral analysis to my patients if I didn’t think they provided information which helped to restore their health back to normal. Similarly, other healthcare professionals utilize other types of testing which have limitations, but provide them with valuable information. My goal wasn’t to try to criticize any specific testing method or technique, but was just to make you aware of some of the limitations and controversies involved.