10 Essential Blood Tests for the Functional and Integrative Medicine Practice
Learn The Functional Approach to The 10 Most Important Blood Tests You Should Be Running On Each and Every Patient In Your Practice
Welcome to the archive page for Dr. Weatherby’s 2-part webinar series called “10 Essential Blood Tests”. The archive page has video and audio replays of the webinars plus any handouts that Dr. Weatherby made available during the live webinars.
CLICK HERE to download the handout from Part 1
CLICK HERE to download the “Functional Hierarchy” handout in PDF format
CLICK HERE to download the handout from Part 2
Answers to Your Questions:
Could you please address the issue of thalassemia and thalassemia trait affects the blood chemistry analysis?
Thalassemia is an inherited condition marked by iron overload due to ineffective hemoglobin production. It can be classified as alpha or beta and some individuals carry both traits. In cases like this, it may look like iron deficiency anemia, i.e. low MCV, MCH, and MCHC (i.e. a hypochromic microcytic anemia) but the iron and the ferritin are going to be quite high. In many cases of Thalassemia the RDW will be normal because, for some reason the red cells are all of the same size (RDW is a measure of the degree of variation in red cell size) it is usually elevated in Iron def anemia. However people with the alpha beta trait for thalassemia will have a much higher RDW than just the beta trait.
Does adrenal stress follow adrenal insufficiency or the other way around?
Chronic and/or severe stress causes an individual to undergo the “general adaptation syndrome” first proposed by Dr. Hans Selye. If the stress is not relieved they may well end up suffering from adrenal hypofunction or adrenal insufficiency. The stress response progresses through a number of different adaptive stages before fatigue sets in. The stress response can be divided into three stages:
1. The alarm reaction
2. The Compensation/decompensation stage (Adrenal hyperfunction)
3. The Fatigue Stage (adrenal hypofunction)
Does the functional hierarchy (blood) follow your functional medicine training (FMTown). So these are the things to look at first?
Yes. The Functional Hierarchy I talked about in the webinar is the same as I talk about in my 11 Module “Foundations of Functional Diagnosis” training at FMTown.
I have heard that increased bilirubin can be seen in gluten sensitivity. Can you comment?
An inherited condition (usually autosomal recessive) called Gilbert’s Syndrome (GS) causes unconjugated hyperbilirubinemia, i.e. elevated unconjugated or indirect bilirubin and total biulirubin. An enzyme called uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) is responsible for the conjugation of bilirubin in the liver, i.e. takes indirect or unconjugated bilirubin and conjugates it into conjugated or direct bilirubuin, which can then be excreted in the bile. Patients with Gilbert’s syndrome have a defect in the gene that encodes for the conjugating enzyme. The result of which is somewhere between 60 – 70% reduction in the ability of the liver to conjugate bilirubin.
I did come across this article that seems to make a connection between this conjugating enzyme and Celiac disease:
On Liver, bile markers. If all markers are within range, but AST/ALT are elevated (and lipids), what should I look for?
I usually use my rule of thumb and focus attention on the liver enzyme (ALT, AST or GGT) that is most elevated:
SGOT/AST increased above SGPT/ALT and GGTP
Problem or area of involvement is possible outside the liver and biliary tree (i.e. the heart, muscle, kidneys)
SGPT/ALT increased above SGOT/AST and GGTP
Problem or area of involvement is possible inside the liver itself
GGTP increased above SGPT/ALT and SGOT/AST
Problem or area of involvement is possible outside the liver but inside the biliary tree (i.e. gall bladder, common bile duct and pancreas)
Quick review… why LOW molybdenum would lead to a LOW uric acid level (decreased xanthine oxidase level but…please repeat connection with LOW uric acid level)
Xanthine oxidase, the enzyme that converts purine bases into uric acid, needs molybdenum as a cofactor to function optimally. Low levels of molybdenum, which is fairly common, will compromise Xanthine oxidase activity leading to downregulation of the enzymatic clearing of purine bases from the body leading to a decreased Uric acid (<208).
Molybdenum is integral to a process called sulfoxidation, which is part of the phase II liver detoxification pathways.
What about a burned feeling on the tongue, is this a zinc or B deficiency?
I don’t think there is an equivocal answer to that question. A burning sensation on the tongue may be secondary to a number of nutrient deficiencies, including zinc and B vitamins.
What about low BUN?
A low BUN is associated with a diet low in protein, malabsorption, pancreaticinsufficiencyy, a posterior pituitary dysfunction and liver dysfunction.
What is the difference in TIBC and UIBC?
TIBC is the Total Iron Binding Capacity and measures the amount of iron bound to proteins. Given that the protein transferrin is the primary iron-binding protein, TIBC is an approximate estimation of the serum transferrin level.
UIBC is the Unsaturated Iron Binding Capacity and measures the levels of transferring that has not been bound by transferrin. It has been called the reserve capacity of transferrin.
TIBC is the test that is built into the software and is used to evaluate iromn deficiency anemia. UIBC typically follows TIBC in terms of what it can tell us about iron deficiency anemia. UIBC is not commonly reported on US blood tests but you can calculate UIBC:
UIBC = TIBC – serum iron
What to look at if A1c is normal range but person eats massive amounts of candy daily? Glucose is normal too.
Consider running Fasting Insulin and C-Peptide and entering these results, along with Fasting Glucose, into the HOMA calculator. It will give you a sense of level of insulin resistance this patient is under. We will be adding the HOMA calculator into the software. It’s an amazing tool to get to te root of your patient’s blood sugar dysregulation.
Regardless of how the lab tests come out you must work with this patient to reduce their candyd/sugar consumption. Their body will oly be able to regulate for a short period of time befe the metabolic time bomb goes off and they hurtle into the world of insulin resistance, metabolic syndrome and Type 2 diabetes. A hell we should help all our patients avoid!
HOMA Calculator: https://www.dtu.ox.ac.uk/homacalculator/
Would it be common to see uric acid levels rise during or post detoxification protocols?
I wouldn’t say it’s a common finding
Are low cholesterol levels associated with low vitamin D since Vitamin D is essential synthesized from a molecule synthesized from cholesterol?
I think that one could say that low vitamin D levels may be associated with low cholesterol because of the reason you mentioned . But you need sun exposure on the skin in order to get the synthsis of Vitamin D. We know that many people are not getting enough sun exposure because of their geographical location, not being out in the sun and/or heacvy use of sub screens.
Aside from direct supplementation – how to increase levels of DHEA?
Stop doing things that deplete DHEA or block its production (statin drugs deplete DHEA, high insulin levels block production)
Deal with adrenal stress first
Address low cholesterol as DHEA is synthesized from cholesterol. If low cholesterol consider assessing diet to make sure there is enough healthy fat.
Correct Vitamin D insufficiency as D is involved in DHEA synthesis
Get adequate sleep
Use adaptogenic herbs
Personally, I recommend DHEA supplementation but start low and build up.
What are the newer tests included in the software? leptin, etc…?
Here are some of the other biomarkers that we have built into the software not covered in this webinar:
Cortisol AM and PM
Collagen cross-linked NTx
Insulin – Fasting
Sex Hormone Binding Globulin (SHBG)
For DHEA-s, and the sex hormones, would the optimal serum reference range be the same as for urine or salivary ranges?
How do you reduce fibrinogen?
Lumbrokinase (Boluoke) or Natokinase
High serum vitamin A and beta carotene
Reduce homocysteine B12, B6, Trimethylglycine, Folic acid
Inhibit platelet aggregation: aspirin, green tea, gingko, garlic, vitamin E
If taking DHEA, should pt take it in the AM before a blood draw? If want to check DHEA labs, what do you have the pt do?
This depends. If you want to see how the supplemental DHEA is affecting serum levels then having them take DHEA the day before testing may be what you want to do. If you want to see how they are coping without supplementation then have them not take supplemental DHEA a good 7 days prior to testing.
Is fibrinogen the main player for patients with the clotting factor mutation?
Sorry. I don’t have the answer for that.
May I please ask how much would these tests cost – all of them in total?
It really depends on the company you choose to do your testing. I suggest you contact one of these lab companies to get a sense of the cost:
Ulta Lab Tests
Doctor’s Choice (Both of these have direct import into the software)
Since TRH responds to a low T3 (FREE T3), does TSH itself also respond to a low T3 (total and/or free)?
The hypothalamus responds to levels of thyroid hormone in the blood via the classic biofeedback loop and releases TRH in response. Basically, high thyroid hormone levels suppress TRH (High T3 is the strongest inhibitor of TRH). Low hormone levels increase production of TRH (Low T4 levels are the biggest stimulant of TRH).
There is evidence that TSH output from the anterior pituitary may be directly inhibited by high levels of circulating T4. However, the hypothalamic feedback loop is by far the most important and active biofeedback loop.
What lab companies do you use to run these tests?
I use these 2 labs, which are both directly connected to the software, i.e. we have a direct import with them: Ulta Lab Tests and Doctor’s Choice
Can high Reverse T3 be related to adrenal function as well?
There are a number of factors associated with an elevated Revers T3, these include the following:
Elevated cytokine levels: IL6, TNF-alpha, IFN-2
Heavy metals: Cadmium, Mercury, or Lead
Increased epinephrine or norepinephrine
I would say that yes, adrenal function (or dysfunction) is related to an increased reverse T3
Boston Heart Labs uses a much different optimal range for free Testosterone, using same pg/mL.
The Free Testosterone ranges vary from lab to lab because of the methodology they use. This is why, in the software, we have ranges for Labcorp and Quest. I find the following calculator useful for determining Free testosterone and Bioavailable Testosterone:
It calculates these from Albumin, SHBG and Total Testosterone. We will be adding this calculator into the software so both Free Testosterone and Bioavailable Testosterone will be calculated rather than having to be measured directly. This will not only save money but, in my opinion, increase accuracy in our testosterone evaluations across the board.
What about E2 levels in menopausal women? I’ve never seen a woman have higher than 30?
Does estradiol change for post menopausal women? Teens, women and peri, meno, post menopausal levels changes?
Levels of estradiol change after menopause. In the software we do not take into consideration the menopausal or menstrual status of the patient. We use a static base measurement for optimal. The lab will usually give you a reference range for these. This is a sample of the standard reference ranges for Estradiol from a US lab (measurements are in pg/ml):
Follicular phase: 12.4 – 233.0 pg/ml
Ovulation phase: 41.0 – 398.0 pg/ml
Luteal phase: 22.3 – 341.0 pg/ml
Postmenopause: < 138.0 pg/ml 1st trimester pregnancy: 154.0 – 3243.0 pg/ml 2nd trimester pregnancy: 1561.0 – 21280.0 pg/ml 3rd trimester pregnancy: 8525.0 – >30000.0 pg/ml
In Vit D what about K1 and K2 added for absorption?
I am in agreement that taking other fat soluble vitamins along with D3 is a good idea. This would include K1 and K2, E and A. There is definite synergy between D and K but I’m not too sure whether it’s at the absorption level.
What about blood vs saliva in DHEA-S testing how accurate is blood testing compared to saliva testing?
I personally feel that serum DHEA-S testing is accurate but you don’t get the luxury of comparing it to 4 cortisol measurements across the day as you would with salivary Adrenal Stress Testing. The newer DUTCH Testing (dried urine testing) is said to be quite accurate but I don’t have much experience with it.