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A Functional Medicine Approach: 5 Tests You Should Request

When it comes to multi-disciplinary rehabilitation practice, functional medicine is making waves and stirring up a lot of issues that have previously flown under the radar of conventional medicine. This is because functional medicine is less concerned with a diagnosis and focuses more on the underlying imbalances or dysfunctions of the body’s biological systems. It aims to find the root causes and then help boost the natural healing mechanisms to target them.

Chronic conditions (allergic, digestive, hormonal, metabolic, and neurological problems) have made great progress with functional medicine. And there is one area in particular that has greatly benefitted and must continue to benefit from functional medicine—the epidemic of diabesity. “This is a term for the full spectrum of insulin resistance that encompasses pre-diabetes, diabetes, and metabolic syndrome. Half the country suffers from it and yet most people don’t even know they have it.

The problem is, most functional medicine practices are not covered by health insurance, so this much-needed patient-centric approach is out of reach for the vast majority of Americans. There is some good news though—if you forge a strong relationship with your primary care doctor, you absolutely can work together to get the tests needed to take a more holistic approach to your health. Here are the top four things to ask your doctor to test for outside of their convention spectrum:

1. Insulin levels.
To check for insulin resistance, only a glucose tolerance test is typically performed. Unfortunately, by the time your blood sugar is elevated enough to register a problem in this test, you’re already well on your way to diabetes. You should opt for both an insulin resistance test and a hemoglobin A1c test.

Insulin resistance test: To pick up on insulin resistance before this late stage, you need an insulin response test to truly find out if you’re the lucky one of every two people who suffer from diabesity. Insulin levels should be measured at fasting and then again at one- and two-hour intervals after consuming a 75 gram glucose drink. Totally yuck-o, tastes gross and makes you go crazy in the head for hours with a major sugar crash after.

How to interpret this test: Fasting blood sugar should be less than 80 mg/dl, and less than 110 after one and two hours. Fasting insulin should be between 2 and 5 mlU/dl—anything greater than 10mlU/di is significantly elevated. One- and two-hour insulin levels should be less than 30 mlU/dl. Anything higher indicates insulin resistance.

Hemoglobin A1c test: You need more than one blood sugar reading to give you a comprehensive view of your overall blood sugar. The hemoglobin A1c test (also known as glycosylated hemoglobin) can let you know if your blood sugar has been high over the previous six weeks. It should be used to screen for blood sugar balance.

How to interpret this test: Hemoglobin A1c should be less than 5.5% of total hemoglobin. Anything higher than 6.0 is considered diabetes, and higher than 7.0 is considered poorly controlled diabetes.

2. Blood Cholesterol

The old way of treating cholesterol was all about lowering LDL with statins. We now know however, that LDL is a terrible predictor of heart disease. There are better tests to take and results to consider—the best of which is the ratio of your triglycerides to HDL. It’s actually quite common to have normal LDL and total cholesterol, but very high triglycerides and very low HDL. This is a strong predictor of diabesity. And puts you at a much greater risk of heart attack. That said, not even knowing the levels of HDL, LDL, and triglycerides can give us all the information. We also need to know the size of all those particles to truly get a picture of what’s going on.

NMR Lipid Profile: When it comes to HDL, LDL, and triglycerides, it’s important to test particle size as well as number. Large, fluffy particles are not nearly as dangerous as the small dense particles. But what causes these dangerous little cholesterol particles? Sugar and refined carbs. Insulin resistance cause dense cholesterol particles to form, which is why this test is so essential to measuring degree of insulin resistance and cardiovascular risk.

How to interpret this test: Total cholesterol should be less than 180 mg/dl, LDL cholesterol should be less than 70 mg/dl, HDL cholesterol should be less than 60 mg/dl, triglycerides should be less than 100 mg/dl, total cholesterol/HDL ratio should be 3.0, triglyceride to HDL ratio should be less than 4.0 and you should have fewer than 1,000 total LDL particles and 500 small LDL particles.

3. Thyroid function

Diabesity often comes with thyroid problems. Sadly, most doctors don’t provide the right tests when it comes to the thyroid, either, leaving millions of Americans undiagnosed and suffering needlessly.

TSH: For an initial read on thyroid function, get a TSH test to measure the TSH in a blood sample. A high TSH level indicates a problem with the thyroid—usually hypothyroidism. When the TSH level is low, it typically indicates an overactive thyroid that’s producing too much thyroid hormone—hyperthyroidism.
How to interpret this test: Ideal range is between 1 and 2 mlU/L.

Free T3: Test to evaluate the function of the thyroid—primarily used to diagnose hyperthyroidism. T3 can also detect abnormal binding protein disorders.
How to interpret this test: Ideal range is 300-400 ng/dl.

Free T4: Test to evaluate thyroid function in individuals who may have protein abnormalities that could affect total T4 levels.
How to interpret this test: Ideal range is 1-1.4 ng/dl.

TPO: Thyroid peroxidase (PTO) is critical to the function of the thyroid. It has a role in the chemical reaction that adds iodine thyroglobulin, and generates thyroid hormones, which regulate growth, brain development, and metabolism.
How to interpret this test: Less than 20 IU/mL is ideal.

4. Inflammation

Inflammation contributes to almost every modern disease—heart disease, cancer, dementia, arthritis, autoimmune diseases, allergies, digestive disorders, and you guessed it—diabesity.

C-reactive protein (CRP) test. CRP measures the degree of hidden inflammation in your body. C-reactive protein is significantly elevated in most people with diabesity and when diabesity improves, the inflammation goes down.
How to interpret this test: Less than 1.0 mg/L is ideal.

Liver function test. An important test to measure liver damage from inflammation caused from insulin resistance. Liver function tests discover elevated liver enzymes—alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT)—which identify the death of liver cells, most often caused by elevated insulin resistance because of a fatty liver.

Fibrinogen test. Fibrinogen is a clotting factor in the blood that increases with inflammation and insulin resistance.
How to interpret this test: Less than 350 mg/dl is ideal.

Ferritin test. This is a measure of excess iron stores that increases with inflammation and insulin resistance.
How to interpret this test: Less than 200 ng/ml is ideal.

5. Functional Stool Testing

A happy gut is a healthy body. Your gut is the first line of defense in your body. Believe it or not, the largest lymph organ in the body, ie 50‐70% of the immune system and immunoglobulin producing cells are located within the GI tract. Traditional stool tests typically only test for most common parasites and bacterial infections, but functional stool testing is the gold standard for assessing the health of your gut and microbiome. This test gives you insight into the following: digestive enzyme function, pancreatic enzyme activity, markers of inflammation, a broader range of pathogenic bacteria, parasites and yeasts, friendly bacteria, and short chain fatty acids (markers of gut lining health). Measuring gut health is important, as gut dysfunction is usually the root cause of many health issues.

When it comes to your health, a collaborative approach can be very beneficial. Keep in mind that your primary care doctor may not even be aware of the right panel of tests. Or they may strongly believe it’s better to wait and see what happens once you’ve progressed down the path of disease. So go into the appointment prepared. Ideally, your healthcare should be a joint effort between you and your doctor. And honestly, this is your body. It’s up to you to grab the bull by the horns and optimize your health, so don’t worry if you feel demanding. It’s perfectly acceptable. Diabesity is a very real problem and you can’t fix a problem you don’t know you have.

For more information on a whole body approach to health, be sure to explore all that Urban Wellness Clinic has to offer.

Best in Health,
Dr Emily Kiberd