For those with thyroid and autoimmune thyroid conditions, in order to achieve a state of optimal health you need to detect and remove your triggers. While signs/symptoms and a comprehensive health history can be helpful, testing is the main way I find triggers in my practice. So I’ve decided to put together a post that discusses seven tests that can help identify your triggers. These are not listed in the order of importance, although towards the end of this post I’ll give you an idea as to how I prioritize these tests.
Test #1: Adrenal testing. Chronic stress is something that affects just about everyone…especially during this time with everything going on with covid-19. Of course most conventional medical doctors don’t do anything to help improve their patient’s adrenal health, including endocrinologists, and many refuse to do any adrenal testing unless if they suspect conditions such as Addison’s disease or Cushing’s syndrome. While many natural healthcare practitioners do test the adrenals of their patients, some just recommend general adrenal support to all of their patients.
Obviously there are things you can do to improve the health of your adrenals without testing. Eating well and improving stress handling are two things everyone can and should do regardless of what their adrenals look like. Similarly, if someone is intentionally getting less than 7 hours sleep on a regular basis then this is something they can work on without doing adrenal testing.
But some people do need additional support in the form of nutrients and herbs, and different people will have different adrenal patterns. And symptoms alone can’t always predict the adrenal pattern. For example, when I was dealing with Graves’ disease my energy levels were fine, yet my adrenal saliva test results showed what some would refer to as an “adrenal fatigue pattern”, as my cortisol levels were depressed, my DHEA was low, and a few other markers were also low. I ended up taking nutritional supplements to support cortisol, including licorice root, which extends the life of cortisol, and you therefore wouldn’t want to take this herb if you had high cortisol levels (or high blood pressure, as it’s contraindicated for those with hypertension). If someone has elevated cortisol levels they might choose to take something such as phosphatidylserine, but probably wouldn’t want to take this if their cortisol was low.
Sure, you can just take adaptogenic herbs while addressing diet and lifestyle factors, and this alone might help to restore the health of the adrenals. But there is a reason why many companies offer adrenal testing and why many natural healthcare practitioners like myself recommend adrenal testing to most of their patients. Simply put, healthy adrenals are very important for a healthy immune system, healthy sex hormones, etc. And while I mentioned earlier that those who are intentionally neglecting their sleep can modify their sleep habits, there are many people who have problems falling and/or staying asleep, and many times testing the adrenals can reveal why this is the case (i.e. high nighttime cortisol).
What Type of Adrenal Testing Should You Do?
When I was diagnosed with Graves’ disease I used saliva testing to evaluate the health of my adrenals. I used a company called Diagnos-Techs, although there are some other good labs that offer saliva testing. I still frequently recommend saliva testing to my patients, although for some of my patients I recommend the DUTCH test, which involves dried urine testing. If someone is just testing their adrenals then saliva testing is fine, but if someone is looking to test the sex hormones then I commonly recommend the DUTCH test.
Click here to watch a video tutorial I created entitled “What’s the Best Test For Adrenal Fatigue?”
Click here for more information on the Adrenal Stress Index test.
Click here for more information on the DUTCH test.
Test #2: Blood tests for stealth infections. As of writing this blog post the world is dealing with a new type of coronavirus (covid-19), but what really opened up my eyes to viruses and other stealth infections was my Lyme disease diagnosis in the summer of 2018. Before then I did some testing for viruses such as Epstein-Barr, and I did some research and wrote a few articles on viruses, along with Lyme disease and coinfections. I don’t have all of my patients test for Lyme disease, and one of the reasons for this is because the standard tests for Lyme disease performed at conventional labs (i.e. western blot) aren’t too accurate.
When I was diagnosed with Lyme disease I used a lab called Medical Diagnostic Laboratories. Although they did an IgM/IgG Western blot test, they also did another test called Lyme disease C6 peptide, along with testing for certain coinfections (i.e. Bartonella, Babesia, Mycoplasma). They also tested for Epstein-Barr, cytomegalovirus, and human herpesvirus-6 (HHV-6). That being said, while I wouldn’t rely on a Western blot from a lab such as Labcorp or Quest Diagnostics, I think it’s fine to use these labs for Epstein-Barr and other viruses.
I realize that currently many people are staying away from labs out of fear of getting covid-19, but if you’re dealing with a thyroid or autoimmune thyroid condition and haven’t at least done a test for Epstein-Barr then you might want to consider doing so in the future, as there is a lot of research showing a relationship between Epstein-Barr and thyroid/autoimmune thyroid conditions. While it’s true that Epstein-Barr can’t be completely eradicated from the body, if it reactivates it can be put back in an inactive state. Following a specific anti-viral protocol is sometimes necessary, although with any stealth infection the number one focus should be to improve the health of your immune system.
Click here to watch a video tutorial I created entitled “7 Blood Tests People With Autoimmune Conditions Should Get”
Test #3: Comprehensive stool panel. Gut infections such as H. pylori, Yersinia enterocolitica, and parasites can all be potential triggers of Graves’ disease and Hashimoto’s. Although I don’t currently recommend a comprehensive stool panel to all of my patients, there is a good argument that everyone with an autoimmune condition should get one when trying to look for triggers. The argument against having everyone do such a test is that many people have achieved a state of remission without spending hundreds of dollars on a comprehensive stool panel, and this includes myself.
However, I’ve also had patients who didn’t get a comprehensive stool panel initially but had to get one later because they weren’t improving. And some of these patients had positive findings…even though they didn’t have symptoms which would indicate that they had a gut infection. Once again, I commonly recommend conservative testing, but if someone has it in their budget to do more comprehensive testing upfront then they might want to consider doing a comprehensive stool panel.
Which Comprehensive Stool Panel Do I Recommend?
Over the last few years I’ve been recommending the GI-MAP to my patients, as this uses quantitative PCR to detect bacteria, viruses, and parasites. Genova Diagnostics also has a very good comprehensive stool panel called the GI Effects.
Click here to watch a video tutorial I created entitled “GI MAP Overview With Treatment Suggestions”
Click here for more information on the GI MAP and GI Effects.
Test #4: Tests for heavy metals. Environmental toxins can be a trigger, and while the focus here will be on heavy metals, it’s important to mention that other chemicals can trigger thyroid and autoimmune thyroid conditions. For example, xenoestrogens can directly affect the thyroid gland, and it might be a factor in thyroid autoimmunity. One problem is that there are tens of thousands of environmental toxins, and we are unable to test for most of these.
Based on what I just said, one can make the argument that it’s a waste of money to test for heavy metals. After all, can’t you just assume you’re toxic and do things to support detoxification? Without question you can and should do things to reduce your toxic load. But since heavy metals such as mercury have been proven to negatively affect the thyroid gland, and can also be an autoimmune trigger, I think it’s wise to start off with a baseline reading. Plus, depending on what method you use, testing for heavy metals is relatively affordable.
Most healthcare practitioners will test for the levels of heavy metals, and there are four ways to do this. You can test for heavy metals in the hair, urine, blood, and stool. Rarely do I see practitioners test for heavy metals using stool testing, and blood testing is mainly used to determine if someone has an acute exposure to one or more heavy metals. In my practice I utilize hair mineral analysis testing, while other practitioners will utilize urine testing. It’s important to understand that heavy metals can be deeply embedded in the tissues, and therefore might not show up on either a hair or urine test.
For this reason, some practitioners will utilize “provoked” urine testing, where the person does a baseline urine test, takes an oral chelating agent to mobilize the metals from the tissues, and then does a second urine test, which usually shows very high levels of heavy metals. Some question the safety of using oral chelators, which can be a concern if you have low glutathione levels. But there have been many doctors who have successfully used provoked urine testing in their practice.
What Lab Do I Recommend?
For hair mineral analysis testing I recommend Analytical Research Labs, as their specialty is hair testing, and they don’t wash the hair before being analyzed, which is important. For urine testing many healthcare practitioners use Doctor’s Data.
Click here for more information on the hair mineral analysis.
Test #5: Food sensitivity testing. I don’t commonly recommend food sensitivity testing to my patients, as I usually recommend an elimination/reintroduction diet as a way of identifying food triggers. The main reason for this is because false results are common. That being said, the elimination/reintroduction diet isn’t perfect, and many people would prefer to spend the money to try to identify their food triggers. And there is no shortage of companies that offer food sensitivity testing.
If you do choose to order a food sensitivity panel I would make sure of a few things. First of all, make sure you test for most of the foods you eat. Some companies will offer a panel where they test either 90 or 180 foods, and while the 90-food panel option will be less expensive, if you eat a good amount of foods that are included on the 180-food panel but not the 90-food panel then it makes sense to go with the more comprehensive test. Also, you need to be eating the foods that you are testing for. As an example, if you have been gluten and dairy free for a few months, and you do a food sensitivity panel that includes gluten and dairy, we wouldn’t expect your body to produce antibodies towards gluten and dairy (since you’ve been avoiding them for awhile), and as a result, we would expect the results to come back negative, even if you had a sensitivity to one or both of these. And this applies to other foods as well.
What Company Do I Recommend For Food Sensitivity Testing?
As I mentioned, I don’t recommend food sensitivity testing to most of my patients, but when I do there are two main companies I have used in the past…Alletess and Cyrex Labs. Of these two, I prefer Cyrex Labs for a few different reasons. First of all, Cyrex Labs runs all of their tests through twice and then compares the results, and a correlation between the two tests must be met before reporting the results. This of course decreases the chances of getting a false result. Second, their Array #10 panel tests some foods raw and others cooked, which makes sense, as some foods people consume cooked while others are eaten raw, and it’s possible to be sensitive to a specific food when it’s eaten raw, but not be sensitive to the same food when it’s cooked. Third, Cyrex Labs uses advanced purification techniques to ensure that it assesses reactivity to the unadulterated food antigen, resulting in greater specificity.
Click here to watch a video tutorial I created entitled “What’s The Best Gluten Sensitivity Test?”
Click here for more information on food sensitivity testing.
Test #6: Organic acids test. Organic acids testing involves collecting a urine specimen, and offers a comprehensive metabolic snapshot of a patient’s overall health with over 70 markers. In my opinion, organic acids testing is the best test for determining if someone has a yeast overgrowth. It also looks at certain bacterial markers, oxalates, markers related to mitochondrial health, neurotransmitters, ketone and fatty acid oxidation, nutrients, and indicators of detoxification. For more information I’d read an article I wrote entitled “Can Those With Graves’ Disease and Hashimoto’s Benefit From Organic Acids Testing?”
I love organic acids testing. In 2009 (the year I got into remission) I wasn’t familiar with organic acids testing, but I think I started learning about this test in 2015, and in 2016 I attended an organic acids workshop in New Jersey and decided to run an organic acids test on myself. Overall the results of my test looked pretty good, although I tested high for oxalates, which are a risk factor for kidney stones, and can deposit in other areas of the body, including the thyroid gland, bone, brain, skin, and nervous tissue. I can’t say that organic acids testing played a role in myself getting into remission, and while I don’t have all of my patients do this test, since I started utilizing organic acids testing in my practice I’ve found significant markers in some of my patients who ordered this test.
What Company Do I Recommend For Organic Acids Testing?
I usually recommend the organic acids test from Great Plains Laboratory, although Genova Diagnostics has a good one called the Organix. As of writing this blog post, the organic acids test from Great Plains Laboratory is the only one that tests for oxalates.
Click here to watch a video tutorial I created entitled “Organic Acids Test Interpretation with Treatment Suggestions”
Click here for more information on the OAT from Great Plains Laboratory and the Organix from Genova Diagnostics
Test #7: Testing for mycotoxins. Many people have mold problems, and in 2017 I wrote a comprehensive article entitled “Mycotoxins, CIRS, and Thyroid Health“. When talking about mold testing, many people think about testing their home for mold, and this certainly is something to consider if you suspect a mold problem. However, the reason why people experience symptoms is due to mycotoxins produced from mold, and this can also be tested for. Quite frankly, most people don’t need to do this test, but I’m bringing it up because many people aren’t even aware that you can test for mycotoxins, and sometimes this test can be valuable. Just remember that if toxic mold is a problem, while you can do things to eliminate mycotoxins from your body, the number one priority is to remove the source of the mold.
It’s also worth mentioning that the organic acids test from Great Plains Laboratory looks at a few markers that relate to mold, which if positive can suggest a toxic mold problem. However, if these markers are negative this does not rule out a mold toxicity issue.
What Company Do I Recommend For Myotoxins Testing?
I like the MycoTOX test from Great Plains Laboratory, as it’s a urine test that screens for eleven different mycotoxins, from 40 species of mold. Real Time Labs is another good option for mycotoxins testing.
Click here to watch a video tutorial I created entitled “Mold Markers on the Organic Acids Test”
Click here for more information on the MycoTox test from Great Plains Laboratory and the Organix from Genova Diagnostics
Are There Other Tests Worth Ordering?
Without question there are other tests to consider. For example, Great Plains Laboratory has a GPL-TOX test, which is a toxic non-metal chemical profile that screens for the presence of 170+ different toxic chemicals using 18 different metabolites. While the GPL-TOX, hair mineral analysis, and urine test for heavy metals all measure the levels of environmental toxins, there are tests that measure the immune system response to these chemicals. An example is the Chemical Immune Reactivity Screen by Cyrex Labs, which measures an expanded range of environmental chemical toxins that bind to human tissues and as a result cause an immune response.
Another test I didn’t mention that can play a role in one’s thyroid or autoimmune thyroid condition is the small intestinal bacterial overgrowth (SIBO) breath test. SIBO isn’t a direct trigger, but it can increase the permeability of the gut, which is part of the triad of autoimmunity. Testing for nutrient deficiencies can also be helpful, although there isn’t a single test that does this perfectly. I use a combination of the hair mineral analysis and blood testing to determine nutrient deficiencies. The NutrEval test by Genova Diagnostics and Micronutrient panel by Spectracell are other options to consider.
Which Do I Consider To Be The Most Important Tests?
Of course I don’t expect you to order all of these tests I mentioned. With regards to my patients, I most commonly recommend either the adrenal saliva test or DUTCH test, along with a hair mineral analysis, and certain blood tests. Sometimes I’ll recommend the GI-MAP and/or organic acids test. While after the initial consultation I send a follow-up email to my patients listing the most important tests and usually an optional test or two, the truth is that all of the tests are optional. In other words, ultimately the patient decides which tests he or she wants to order.
For example, sometimes a patient I work with can only afford a single test (i.e. adrenal saliva test), and so they might just start with this, and then we’ll see what imbalances are present. On the other hand, sometimes a patient will have certain tests in mind that I didn’t recommend (i.e. food sensitivity testing), and of course I have no problem with someone ordering additional tests, although if I don’t think they’re necessary I’ll let the person know.
How To Better Understand Your Test Results…For FREE!
Although I do think it’s wise to discuss your test results one-on-one with a healthcare practitioner so that you can receive specific recommendations, I realize that not everyone can afford to do this. As a result, in the fall of 2019 I started creating video tutorials to help people with autoimmune conditions such as Graves’ disease and Hashimoto’s better understand their test results. You probably noticed that I included some links to these tutorials throughout this blog post. If you have a non-autoimmune thyroid condition I’m confident that you’ll still find the information in these video tutorials to be beneficial. To watch some of these tutorials visit https://understandyourtests.com/videos.
Have You Used Tests To Find YOUR Triggers?
I’m sure many people reading this have ordered one or more of the tests I mentioned in this blog post. Perhaps you even ordered a test that I didn’t mention. Either way, I’d love to hear what tests you have ordered, and so please feel free to share this in the comments below, and also let me know if they were helpful in finding your triggers.