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Which Lab Tests Are Essential?


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There are certain things I test with every patient and others that depend on the specific needs of the patient. Find out what lab tests I prefer and what they tell me about your health.

Revolution Health Radio podcast, Chris Kresser

I’m going to go into a lot more detail on this sort of thing in the clinician training program that I’ve been talking about, and it’s coming up hopefully next year. The answer, of course, always depends on the patient and what their needs are, what they’re looking for, and what we need to find out. But I can tell you that there are definitely some trends.

In this episode, we cover:

1:14  What Chris ate for breakfast
6:22  Labs Chris uses with all patients
15:37  3 important gut tests
28:33  Hormone testing
30:58  Methylation testing
32:55  Immunological testing and food intolerances

Steve Wright: Good morning, good afternoon, and good evening. You are listening to the Revolution Health Radio show. This show is brought to you by ChrisKresser.com and I am your host, Steve Wright from SCDlifestyle.com. With me is integrative medical practitioner, healthy skeptic, and New York Times bestselling author, Chris Kresser. Chris, good morning.

Chris Kresser: Good morning, Steve. How’s it going?

Steve Wright: Pretty delicious right now. Life is really rolling.

Chris Kresser: Awesome. Good answer.

Steve Wright: Thanks.

Chris Kresser: We’ve got a really good question today, as usual. Thanks again, everyone, for sending in your questions and keep them coming. It’s really great to be able to answer your questions, and know that what we’re talking about is really relevant to what you want to hear about.

Steve Wright: Exactly. But before we get to that question, Chris, people want to know. What did Chris and family eat today?

What Chris Ate for Breakfast

Chris Kresser: It was a pretty stock breakfast today. We had some scrambled eggs with a little bit of Red Boat fish sauce mixed into the eggs, just to give it some umami. That was a little tip I picked up from Michelle Tam of Nom Nom Paleo. Then we had some furikake on top.

Steve Wright: What is it?

Chris Kresser: Furikake. It’s a Japanese seasoning with seaweed and sesame seeds, and I think some fish, bonito flakes, and a few other things. It makes the eggs really tasty.

Steve Wright: Interesting.

Chris Kresser: Then we had some plantains just sliced and fried in a little bit of coconut oil. Then sauerkraut. It’s kind of like the old standard, our version of the cereal, toast, and orange juice American classic breakfast.

Steve Wright: That’s cool. I had a pretty stock breakfast as well, just eggs and a banana. Now I’ve got my coffee.

Chris Kresser: All right.

Steve Wright: Before we get to the question though, Chris, how is 14Four going?

Chris Kresser: I’m glad you asked. It’s been amazing. Over 1,400 people have signed up so far, which has exceeded our expectations. There’s been a lot of enthusiasm and excitement about it. We’re going to do the first webinar for the founders group later this afternoon actually. The Facebook group has been super active, lots of conversation. What’s really cool is to see everybody helping each other out in the Facebook group. I mean, we have Kelsey and Laura—my two registered staff RDs—that are in there helping as well. But it’s really cool to see this sense of community that’s developing there and people helping each other out, because there are a lot of folks who know a lot in this community. It’s great to see that spirit of helpfulness there. You know, people are at different points in terms of when they might start and do it. But this initial group, it seems like it’s going really well so far.

Steve Wright: Being in the founding group is always a lot of fun, because that’s when producers like you and I are actually finding out about new additions we make to the programs. So I feel like being part of founding groups for programs like this is really important, because you get extra effort. There’s a little extra figuring out going on, and a little extra time and motivation that’s put into it by everybody involved. So that’s really cool. That’s where we’re going to see some awesome changes, I bet.

Chris Kresser: It’s great. And if you’re just hearing this for the first time, you can check it out at 14Four.me. The opportunity to join the founders group has passed, but you can join 14Four any time. There was a little bit of confusion about this early on, but it’s not a program that has a definite start and end date, like some other programs where they kind of start a few times a year. This is an ongoing thing. You can sign up any time and you can start any time. You can do it multiple times. Go over there and check it out, if you haven’t already.

Steve Wright: Perfect.

Chris Kresser: Let’s give this question a listen. It’s from Justine.

Justine: Hello, I wonder if you could talk a little bit about which tests you do with your clients. I understand that when you first see them, you give them all sorts of tests. What do you consider the essential tests and what are you looking to find out? How do you choose the brand, the make, the company who does your testing? I’m just really interested in that, because I know there are so many tests out there and it’s quite confusing to know which to go for. Thank you.

Chris Kresser: I get some version of this question probably on a weekly basis. I figured it was time to finally dive in. Of course, we could spend many, many shows talking about this. I’m going to go into a lot more detail on this sort of thing in the clinician training program that I’ve been talking about, and it’s coming up hopefully next year. The answer, of course, always depends on the patient and what their needs are, what they’re looking for, and what we need to find out. But I can tell you that there are definitely some trends. There are certain things that I do with pretty much every patient that walks through the door. Then there are other things that I would order that depend on the specific needs of the patient.

Labs Chris Uses with All Patients

So everybody gets a case review. That’s how I start with patients. I do a really exhaustive process called a case review, where I have patients fill out several pages of paperwork.

Steve Wright: Chris, don’t say several.

Chris Kresser: Several. A diet survey, diet journal; metabolic assessment form; body systems assessment; neurotransmitter assessment; we do a mold and environmental toxin exposure questionnaire; we have a case review questionnaire, a free answer format; and health and medical history. Then we have an initial conversation. Dr. Amy Nett, who recently joined the practice, does those for me now. She gets the chief complaints from the patient, has a talk with them about what they want to accomplish, what their goals are, what they’ve tried so far, what’s worked, what hasn’t worked. Based on that, she’ll order the necessary tests.

So everybody gets a case review blood panel. This is a blood panel that I’ve put together over the years and kind of refined and tweaked, which covers most of the basic stuff like blood sugar; lipids; comprehensive metabolic panel; thyroid panel; various nutrients like B12, magnesium, vitamin D; some inflammatory markers like C-reactive protein, homocysteine; things like GGT, alkaline phosphatase, lactate dehydrogenase; then a CBC with the basic immune markers. This is really helpful, because it just gives me information about how the basic body systems are functioning. These are crucial for everybody.

Steve Wright: I’d like to interrupt you for a second there and play the devil’s advocate. Does everybody need that many tests, Chris? That seems like a lot of tests right out of the gate already. If you’re a long-time listener of the show, maybe you don’t have that opinion, but I think some people are going to think that.

Chris Kresser: Certainly everybody doesn’t. But people who are coming to see me are sick and have typically been sick for a long time, and have typically seen anywhere from 3 to 4, to 15 to 20 and upwards doctors. They’ve typically traveled to see specialists, sometimes in other countries, certainly in other states. They’ve typically seen multiple, different alternative medical practitioners, everything from naturopaths to chiropractors, acupuncturists, homeopaths, energy healers, shamans, you name it. They’ve already typically spent thousands of dollars on supplements, medications, herbs, and done all kinds of special diets. They’ve been at this for a long time. So for a patient like that, yes, they do need all those tests. That’s because we need to figure out what’s at the root of their problems, which is the goal of functional medicine.

Steve Wright: What if you got half of those tests last year?

Chris Kresser: Well, things can change pretty quickly. That’s the thing. For example, TSH can change daily and even throughout the day. Blood sugar can certainly change on a daily, weekly, monthly basis. Lipids can change a lot. So certain blood markers are more stable over time. I do review previous lab work as part of the case review process. But to really see what’s going on now, more recent blood work is necessary. But even for people who aren’t that sick and haven’t seen all of those different doctors, this kind of testing is really illuminating in a lot of cases. It’s just a different approach.

You know, the conventional paradigm is, “Well, we’ll wait until you’ve developed a serious illness. Then we’ll use drugs and surgery to intervene.” That’s at a point where that illness has usually progressed so far that it’s difficult to reverse. That’s kind of the conventional paradigm. The functional paradigm is, “Let’s be proactive and prevent these diseases from occurring in the first place.” When you do that, when you catch them early on, it’s far easier to intervene and make changes than it is if—for example, with the blood sugar problems, if you catch it at a stage when you’ve got high-normal blood sugar or even low-normal, pre-diabetic numbers, it’s going to be far easier to intervene and there’s a potential to reverse it. Whereas if you wait until there’s full-fledged type 2 diabetes with beta-cell destruction, as far as we know, the beta cells don’t grow back. At that point, you’re stuck probably needing insulin. You can certainly improve things, but you may not be able to completely reverse it.

So the conventional approach, all of the interventions and the cost is heavily weighted at the end of the process, in the disease intervention side. Some of the drugs, like Actos, and the medications used for these diseases are thousands of dollars a month and someone’s paying for that. Even if you have insurance and you’re not paying for it, your insurance company is paying for it, and therefore, your premiums go up, and the whole system is paying for it in some way or another. In the functional medicine paradigm, more of the cost happens upfront with this kind of lab testing. I really believe—and some of my colleagues in the functional medicine community, like Dr. Hyman, are working towards this right now—that once insurance companies see how effective this kind of medicine is, how effective, and how cost-effective it is to intervene earlier, you spend a little bit more upfront—you know, the cost of these labs pale in comparison to the cost of the kind of drugs that become necessary when someone progresses to full-fledged type 2 diabetes.

Understandably, patients complain about the expense of functional medicine labs. They have a right to, because insurance should be covering those expenses. If you spend a couple thousand dollars on lab work upfront and avoid type 2 diabetes, that could prevent an insurance company from having to spend literally tens of thousands of dollars per year, for many years to come, to treat that disease. So it’s a different way of looking at things. My patients, as you suspected, Steve, don’t typically have a problem or need this kind of explanation. But for those who are unfamiliar with this kind of work, there it is.

Steve Wright: I think it’s really good that you explained that. I think it opens up two things that I just want to comment on real quick. First, I think of yearly lab work like this, of checking the whole body, almost like a report card. I mean, you don’t enter into a four-year college and not get any updates except for maybe a pat on the back or a scolding. You know, if you didn’t do this lab work for four years, it’d be like you just got patted on the back or some scolding looks from your professors. Then at the end of four years, you found out either you graduated or you didn’t, and you had no idea what was going on the whole time.

Chris Kresser: Yeah.

Steve Wright: There’s feedback in almost every system around the world, from the financial system to education. But in the medical world, they’re just slowly starting to get this feedback idea. So I think, as you said, it’s even going to pay for people to be investing now before the insurance companies really get it. Because I think that where we’re going in 10 or 20 years is that if you didn’t pay right now, they’re going to make sure you’re paying in the future. It’s going to catch up, and everybody’s not going to be subsidizing everybody like it is now.

Chris Kresser: There are also new developments in technology that are happening all the time. There are entrepreneurial companies that are trying to make blood testing cheaper. There are all the Quantified Self tools that are becoming available. So it’s going to become easier and easier for people to get this kind of data. And it already is. I mean, you can already go to places like DirectLabs.com and order your own blood work without even a doctor’s order. I actually have mixed feelings about that. It’s something that you couldn’t do even I think five years ago. So things are going to be really different in the next 10 to 15 years. It’s a necessary change, and it’s one that’s going to help people stay healthier, and prevent and even reverse disease. That’s what it’s all about.

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3 Important Gut Tests

Let’s go on to talk about some of the labs. I’m glad you asked me that question and I’m glad that we had a chance to talk about it, because it’s definitely an important topic. That’s sort of the minimum testing that someone would get when they come to see me as a patient. But I can tell you that probably 95% of patients also get a full suite of gut testing. If there’s one thing I’ve learned in working with people for as long as I’ve been doing it now—and, of course, we’ve talked about this ad nauseum on the show and I’ve written about it elsewhere—it’s that the gut is really the key to health. If you don’t have a healthy gut, you can’t be healthy overall. This is true even when you don’t have gut symptoms.

I want to tell a story just from yesterday in the clinic. I talked to a patient who came to see me. His primary concern was his lipids; you know, cardiovascular health and heart attack prevention. He had high cholesterol, also high LDL particle number (LDL-P), which we determined. But he really had no other symptoms. Overall, he felt really good. He didn’t have any obvious gut symptoms. He slept well and had good energy levels. He didn’t have any complaints. The main thing he wanted to do was to reduce his risk of a future heart attack.

Steve Wright: Did he have a family history of it?

Chris Kresser: He had some family history, but he was just kind of alarmed by—he had done some of this testing on his own, or he had it done with his doctor. He was kind of alarmed by his high levels. I proceeded to talk to him about all the underlying causes that can contribute to a high LDL particle number. Of course, one of those is gut inflammation and intestinal permeability. What happens with a leaky gut, an endotoxin like lipopolysaccharide (LPS) can get into the bloodstream. Then the liver will manufacture more LDL particles to deal with that. Chronic gut infections can also raise LDL-P for a similar reason. Poor thyroid function, because the LDL receptor requires T3 to function properly. Of course, metabolic issues like insulin and leptin resistance can cause it. Then, of course, you have genetics and a few other causes. But with no symptoms, it was interesting to talk to him about that and to convince him that we needed to order some stool testing, SIBO breath testing, and urine organic acids profile to determine if he had gut issues. I mean, he already knew a lot of this, so it wasn’t hard to convince him. He was totally game to do it. So we ordered that kind of testing. Guess what? He had evidence of SIBO and fungal overgrowth on both the stool test and the urine organic acids profile. So we set about treating those.

I just talked to him yesterday, and we did a gut test to make sure all that stuff was gone. He had something like 12 or 13 markers that were elevated on the organic acids profile and that went down to 1. The yeast that was on his stool profile disappeared completely. There was really no evidence of SIBO or fungal overgrowth anymore. We redid his lipid profile and his LDL-P went from like 2,600 to 1,700, which is still a little bit high by conventional standards, but a really significant drop. His small LDL-P went from like 1,100 to 100, which is well out of the range to being well into the range. His HDL-P increased. You know, pretty much all of his lipid markers improved in a really dramatic way. And that was only by addressing the gut issue. We didn’t even get into some of the natural things you can do to adjust the lipid profile, like changing the diet, tocotrienols, pantethine, and all the stuff I talk about in the High Cholesterol Action Plan. That’s just an example of where the gut can contribute to things in a really significant way, even when you don’t experience any gut symptoms. That’s why pretty much everybody who walks through my door gets this gut testing.

There are a lot of different ways to test the gut, but the three things that I consider to be important are a stool test, a breath test for SIBO, and then a urine organic acids profile that looks at certain organic acids that are by-products of bacterial and fungal metabolism, so they can indicate bacterial or fungal overgrowth in the GI tract.

In terms of stool tests now, I’m currently—this changes as I learn more and as new information comes to light. I used to run the Metametrix stool panel, but I’ve lost confidence in that after I read a study that didn’t mention Metametrix by name, but I think it was pretty clearly about Metametrix. After reading the study, which assessed the accuracy of the DNA PCR method that they were using, I lost confidence in it. Then Metametrix was purchased by Genova. A whole bunch of stuff happened there. So I’m currently using the Doctor’s Data Comprehensive Stool Analysis with three samples. It’s a combination of stool culture, really advanced stool culture method, and something called the MALDI-TOF method, which stands for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. It’s a proteomic method of identifying bacteria and yeast. It works by measuring the unique ribosomal protein fingerprints of microorganisms. Then they compare the spectra with a reference database for verification and identification. It’s a lot more sensitive than many other technologies. They can identify over 1,200 species of bacteria and yeast. It’s used by NASA, I believe, to detect microorganisms in launch vehicles. It was ranked 3rd last year in the Cleveland Clinic’s Top 10 Medical Innovations list, which is a list of medical innovations that will improve patient care. I like it because it also has other helpful markers. It’s a stool analysis; it’s not just looking for parasites, yeast, and bacteria. It has some inflammatory markers like lysozyme and lactoferrin. It measures stool pH; secretory IgA (SIgA), which is a marker of gut mucosal barrier integrity; short-chain fatty acids like butyrate; beneficial bacteria; and some other interesting stuff. We also sometimes use BioHealth #401H, which is another culture-based stool method, and sometimes we’ll run them together side-by-side.

For organic acids, we tend to use either the Genova—or former Metametrix—Organix Comprehensive Profile, or the Organic Acids Test from Great Plains Laboratory. This is probably, if I had to choose one of my top three tests, I would say urine organic acids is up there. That’s because you can learn so much not just about the gut, but organic acids are also by-products of cellular metabolism. There are all these cycles in the body. Things tend to kind of go around in a cycle. Getting from one step of the cycle to the next step requires an enzyme, to convert one metabolite to the next metabolite in the cycle. Each of those enzymes requires certain nutrients to function properly. So if a nutrient is deficient, that cycle will not complete and you’ll get a buildup of the metabolite or organic acid that’s at the previous step of the cycle. That spills over into the urine and you can see it show up in the urine. Then that can give you some information about where these cycles are broken and what’s happening in terms of metabolism, cellular energy production, fatty acid metabolism, carbohydrate metabolism, neurotransmitter breakdown metabolism, detoxification, methylation. One of the most sensitive markers for vitamin B12 deficiency is methylmalonic acid. That’s an organic acid that’s on this test. Formiminoglutamic acid (FIGLU) is probably the most sensitive marker for folate deficiency, for tetrahydrofolate deficiency. That’s on this test. So you can learn a ton of stuff on these organic acids panels. Unfortunately, they’re not very easy to interpret for patients. It’s definitely something you need training and education about, and it’s something that your doctor or practitioner can help you interpret, but not something that’s too easy to figure out on your own.

Then there’s the SIBO breath test. We use the one from Genova. We’ve used also one from Commonwealth Labs as well, but we prefer the one from Genova because I think it’s more accurate in reporting methane, which we talked about on a previous show. And this is one of the ways to test for bacterial overgrowth in the small intestine. It’s a good test overall. There is potential for false positive and false negative, so you can’t rely on SIBO breath test results alone. But when it’s combined with the organic acids and the stool test, I think that’s a really great combination for assessing gut health.

Steve Wright: Whew!

Chris Kresser: I need to take a deep breath. That was a lot of information there.

Steve Wright: I think it’s important to mention, number one, that no test on the market is perfect. There are downsides and upsides to every single test on the market. I think especially with gut testing, what most people don’t want to hear is that a lot of times, it does take multiple tests to figure out exactly what’s going on. That’s why retesting is such a big deal. That’s why if everything points to the gut—for instance, just one stool test you did previously came back negative, you might need to do two at the same time. I mean, personally, Jordan and I saw hundreds and hundreds of case examples where people who—like you said, those people who have been to everybody and just haven’t seen results, really, they just needed a couple of the same type of test from a different lab at the same time to really make sense of what was going on. Because they knew they had a gut issue. Everybody kind of thought it, but the generic tests or the single test at one time, not seeing the whole picture, yielded no results.

Chris Kresser: That’s a great point, Steve. I really want to reiterate what you said. Lab testing is only one tool in making a diagnosis. A good clinician won’t rely on lab testing alone. They’ll rely on their clinical experience, on the patient history, signs and symptoms. All of that is put together to develop a diagnosis. Lab testing, at the end of the day, is just a snapshot in time. There’s many times where we’ll see a blood marker that’s off. We retest it a week later, it’s fine, and we retest it four months later, it’s fine. You know, it was just a temporary blip. That can happen. There’s also times where we test really expecting to find something and we don’t find it. The fact that we don’t find it doesn’t necessarily mean that it’s not there. A good example of that are thyroid antibodies. Something like 20% to 35%, depending on what study you look at, of people with Hashimoto’s don’t test positive for thyroid antibodies. So you can’t do a thyroid antibodies test, see that it’s negative, and then rule out Hashimoto’s for that reason. You have to look at their symptoms. You have to look at other methods of testing, like histology or thyroid ultrasound. You can maybe do multiple antibody tests to try to catch it at a time when the antibodies are elevated, because that tends to be cyclical. So there are many, many different examples where the testing is insufficient for one reason or another. Of course, that doesn’t mean we shouldn’t do it. It just means that it’s only part of the overall picture.

Let’s quickly go through some other tests that I will sometimes do. I’m not going to go into a lot of detail on these, but I’ll just give you some headlines.

Hormone Testing

For hormone testing, I’ll often use the BioHealth #201, which is the diurnal cortisol rhythm, four cortisol values throughout the day, to figure out what your cortisol rhythm is, in addition to the estimation of the total amount of cortisol. Then they test for DHEA as well. 24-hour urine hormone testing is also arguably more revealing, because they test not only cortisol, but all the different cortisol metabolites like tetrahydrocortisol, tetrahydrocortisone. Then they test not only DHEA, but also the other sex hormones like testosterone, estrogen and progesterone metabolites, and then other androgens in the pathway like androstenedione. It’s important to know about these, because there are certain things you can figure out that you can’t figure out, really, any other way.

For example, yesterday, I had a patient who had high DHEA. He had some other high androgens in the pathway. But his testosterone and estrogens were low. And what you figure out, when you look at all the pathways, is that in that case, the enzyme 17-beta-HSD isn’t functioning well. Then that takes you down a whole other path of investigation. You’re not going to figure that out by just testing testosterone or even estrogen and progesterone in the serum or in the saliva.

Steve Wright: So the 24-hour test is a different one than the BioHealth #201. What’s the name of that one?

Chris Kresser: It’s a 24-hour urine test. So that’s Genova Complete Hormones. There are other labs that do 24-hour urine hormone testing as well. That’s the one we’ve been using. We are investigating a new lab, which is really interesting. It’s four samples of dried urine throughout the day. It kind of combines the diurnal cortisol profile with the advantages of 24-hour urine profile.

Steve Wright: Wow. Do I have to dry my own urine?

Chris Kresser: All you have to do is produce it, Steve.

Steve Wright: Okay, good!

Chris Kresser: Don’t worry about that. So I’m going to report back when I have some more information about that. I think I just ordered the first panel with them yesterday, so I’m excited about that. We’ll see how it goes.

Methylation Testing

Methylation, I’m doing an increasing amount of work in that area, and finding it to be really helpful and critical for some patients in their recovery. I do genetic testing to determine what the single nucleotide polymorphisms (SNP) are, the genetic mutations in methylation-related genes. But that’s not enough. I know I’ve talked about this before, but it’s a pet peeve of mine when practitioners just test for genetic mutations and start supplementing people only based on those mutations. That’s because a mutation of a gene does not alone imply dysregulation of that gene. It means there’s probably a greater likelihood that the enzyme that the gene produces won’t function well, but it’s not a guarantee. You can have people with genetic mutations in the methylation pathway but their methylation works perfectly well, and you can have people who have no mutations, or really minor mutations, in the methylation pathway that have serious methylation problems. So genes load the gun and environment pulls the trigger.

Environmental factors like diet and lifestyle, toxic exposure, et cetera, are far more important in terms of determining methylation status, which is why I always use a functional methylation profile that tests for patients’ actual methylation capacity. That’s with a lab called Health Diagnostics and Research Institute (HDRI). I’m hesitant to even bring this up, because they’re the slowest lab that I work with. They take up to 10 weeks to get results back. So now more people are going to be ordering their tests, and I just shot myself in the foot. Thanks a lot. No, it’s a good panel. I hope they can ramp up their staff and get more people on board, so they can turn around the test results a little bit quicker, because 10 weeks is a long time to wait for a test result.

Immunological Testing and Food Intolerances

For immunological testing and food intolerances, chemical sensitivity, I use the Cyrex panels. We order Array 3, which measures wheat and gluten proteome reactivity and autoimmunity—the gluten intolerance panel; Array 4, which covers other cross-reactive proteins. Array 5 is the Multiple Autoimmune Reactivity Screen. It screens for just autoimmunity in general, the production of antibodies to several different tissues. Array 7 I think is the relatively new profile, where they screen for reactions to certain environmental toxins.

I know Dr. Aristo Vojdani, the chief scientific advisor of Cyrex Labs, really believes that when it comes to environmental toxins, when you have low-level exposure to them—like pretty much everybody does now, at this point, living in 2014—when the levels are low, it’s not so much the difference in those low levels that determines how you react, but it’s your immunological response. For example, if you produce antibodies to mercury, even low levels of mercury in your body can be a real problem. Whereas, somebody else who’s not producing antibodies may have no issue with very low levels of mercury. So that’s an interesting test. I heard recently that Cyrex is coming out with an Array 10, which is going to be a food intolerance test that looks at intolerance to foods beyond cross-reactive proteins. That should be interesting to see.

Steve Wright: Do you use Array 2 for leaky gut, or do you use something else?

Chris Kresser: I don’t use it that much. In most cases, it doesn’t really change how I treat. And I think SIBO, parasites, all those other things, are really the underlying causes of leaky gut. So we have to address those things. If the patient continues to have problems, then we might go ahead and do Cyrex Array 2 for leaky gut. We’re getting kind of long on this episode, so I’m just going to quickly mention a couple others, and then we’ll wrap it up. Maybe we’ll do a part two sometime.

Nutrient status, I like the Genova NutrEval. Metametrix had one called ION. They’re both under Genova. They’re fairly similar. The ION has a few more markers than the NutrEval, so we tend to run that. Urine amino acids, that could go through Genova or Doctor’s Data. That can be helpful especially for people with methylation issues or kids with autism spectrum or behavioral disorders. Then for heavy metals, we use Quicksilver Scientific, Dr. Chris Shade’s lab, which does a great job with that.

So that’s a lot of stuff there. Hopefully, it’s helpful. I want to emphasize that just because these are the labs I use, it doesn’t mean the labs your doctor or practitioner are using are not any good. We all have our own preferences for various reasons. In a year, if you ask me this question again, I imagine I’ll be using some different labs that I’m not using now. That’s just part of the evolution in the practice of this kind of medicine.

Steve Wright: I can’t stop talking on this episode, but I know we need to end it. It’s also worth mentioning on that point, Chris, that it’s arguably as important that your practitioner runs a lot of the one specific lab, not necessarily that they follow exactly every lab that Chris mentioned here. That’s because there’s nuances within every single lab and seeing a bunch of symptoms match up to lab results is arguably as important, as is the lab company, sometimes.

Chris Kresser: Exactly. I hope this is helpful, everybody. Thanks for listening. Keep the questions coming. Go over and check out 14Four.me. Join us, if you haven’t already. It’s going to be a blast.

Steve Wright: Thanks, everyone, for listening. In-between episodes, if you want updates from Chris, make sure you go to Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser. Thanks for listening. We’ll talk to you again soon.

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Join the conversation

  1. Chris, thanks for all the great information here. My question is – How long does it take you to analyze the multiple lab reports/results you have for one patient to gain insights into their health?

  2. Hi:
    I was diagnosed with a rare illness, that makes the body grow fat & lipoma’s. Making the skin feel like bubble wrap. Most recently, l have learned my copper level is through the roof. It is also serendipity, that 40% if the symptoms of copper toxicity are identical to the so called ‘rare illness’, now l am feeling lately the rare illness is merely a symptom of something like, ‘metabolic syndrome’

  3. I would be interested in some more insight from anyone familiar with both of the organic acid tests Chris mentioned (OAT from Great Plains, and the Organix Comprehensive). My doctor is willing to order the test, and I think will just order whichever one I send him the info for, but I’m not sure which one would be better.

    As far as I can tell, Great Plains tests for a wider array of markers, but the Geneva report is a lot easier to read. Since my doctor isn’t familiar with the test, that could be a factor. (I’m not stupid, either, and fairly knowledgeable about the body — in school for CAM, ‘though not a doctor. But you’re talking about two reasonably intelligent/educated people who are bran-new to reading these things.)

    I don’t know where the differences lie between the markers tested, so I don’t know how much I’d be missing if I went with the Organix profile.

  4. Hi Chris,

    I have had chronic fatigue and cognitive issues for about 10 years. Have seen about 10 naturopaths and many doctors. Working on mold right now but not noticing much of a difference. Also have SIBO and EBV which I am going to work on next. As well have done Lyme testing which is negative but some bands are positive. Now doing co-infections testing and hope to get results soon.

    One thing that has stumped me is alkaline phosphatase which has always been low on my test results for years? Does this point to anything that could be causing my symptoms?

    Thank you in advance

  5. Hi Chris,
    Would it be viable to just take array 4 if I have type 1 diabetes? I am in the UK and budget is a consideration. I figured that Gluten is a fairly certain problem with an autoimmune disease, so perhaps just testing for the cross reactive foods would be enough?
    Thank you,

  6. Regarding Cyrex Array 3 and Array 4 …

    I don’t think I am celiac or gluten intolerant, but, I do think I have a leaky gut, so, I have been avoiding wheat for about 2 years. I’ve tried various variations of Paleo over that time. So, I probably get minor exposure to gluten and many cross reactants, eating sushi with the house soy sauce on a weekly basis. The vast majority of my food is whole foods, prepared at home.

    Do I get enough exposure to get meaningful results from Cyrex Arrays 3 & 4? Would it help if I ate a burrito? Should I risk some sort of flare to get meaningful test results?

    Surely somebody has some experience with this dilemna?


    • A post by Jordan Reasoner (Steve’s partner at scdlifestyle.com). His “annual re-testing regimen” (See also: Kalish method).


      These guys aren’t shy about spending money on their health.

      Here is a post by Steve on how he handled a stressful time. Note the expensive supplement regimen.


      It all seems pretty harmless, to me. That is, unless one truly can’t afford the costs.

      Sometimes I wonder if reading these blogs causes more harm than good. It can make me stress about my finances – the fact that functional medicine is out of my reach. There was a time when I could have afforded it, but, getting sick was debilitating.

    • don’t you know? you gotta be rich just to take the tests, and richer to visit the doctor and take the supplements. if you’re a working stiff, you’re sh*t out of luck (for the immediate future).

  7. Do you guys ever talk about Candida? I don’t see it in your search area. My question is regarding testing in this area.

  8. What is the study title and author of the study that caused you to doubt the DNA PCR method that Metametrix was using?

  9. Hi Chris,

    Is there a good online resource for interpreting stool analysis reports? I’m interested in doing the Metametrix at home kit, but the sample reports are baffling to me. Or, can you recommend someone in the Bay area post-test?


  10. What tests would you suggest for a healthy 55 year old male who only gets the standard lipid panel and A1C from my family doctor?

  11. Just wondering if there is anyway to test for issues associated with hemochromatosis homozygous c282y and methylation / organic acids.. To find out if there is any reason why the person(female) absorbs too much ferritin. Even though venesected regularly and in absence of menstruation.

    • I don’t think I can answer your main question. But a small clarification: IRON is absorbed (or not). Ferritin is made by your body. It’s primary function is as an iron storage site, but high ferritin can also be from inflammation (they are not full of iron in that case). I do not know the mechanism for why inflammation causes this – would love to hear it if anyone else knows.

  12. How do I find a Dr that will know these tests and be able to work with me? Do you have a website you recommend to find a doctor in my city? Phoenix?
    Also, can most of these tests be done through Labcorp?

  13. Great article, thank you!!

    I am from Germany where some practitioners talk about a phenomenon called Hydroxipathy – the theory is that the root cause for any disease to develop is cellular acidity. It says that acidic cells have a positive electric charge and the reason why alkaline supplements or diet doesn’t work is because these alkaline nutrients also have a positive charge so therefore can’t get into the sick cells. Therefore they suggest that for any treatment to be effective we need to change the electric charge of these cells for which we need an ‘active alkaline water’ that comes with a highly negative charge and therefore can penetrate the cells and convert them into negative cells so they can participate in the cellular metabolism again.

    The next step to treat persistent pathogenic microorganisms would be to do a ‘swing’ or ‘terrain’ therapy where you alternate between this active alkaline water and a positively charged water throughout the day over a course of a week, then pause, repeat etc. to ‘rouse’ these microorganisms out of their comfort zone and then kill them off.

    I am curious to hear your thoughts on this and if you have any experience with this sort of strategy at all as I can’t find anything about it on your page or anywhere in the English interweb.

    Thank you!

  14. Hi Chris,
    Great timing. I just got my Cyrex Leaky Gut test back today. The only out-of-range was Actomyosin IgA. The reference for this is 0-20 and mine was 30. Problem..?
    I also had a complex Genova/Metametrix test done and Fecal Secretory IgA was also high at 881 (normal is less than 885). I also had some commensal bacteria in the high range.
    The reason for this testing was high LDL-P (2700). I’m still waiting for SIBO results…
    Any thoughts?

    • At the time of this writing, there is an “About” link at the top/left of this page. You can probably make a determination based on what is written, there. My short answer is “No”.

      • I think it’s a fair question. We’re having discussions about essential tests to order, how to treat autoimmune conditions and supplements to boost immunity to fight infections – and calling people patients. Sounds like doctor talk to me.

        But thanks for the sassy response John. ; )

        • Chris is a licensed acupuncturist I believe. I used to worry about titles and credentials too. But I have been mis-diagnosed by so many credentialed doctors that I’ve come to understand that the diploma means nothing in terms of effectiveness of the treatment.

          • I am totally in agreement with you, these days the work you do is a lot more valuable than the title you hold…thanks Chris for such an amazing information and research you are putting out here for everyone!

            • The fact that Chris orders a battery of test, the shot-gun approach, is a true testament to the fact that his style is not sustainable on a larger scale or for anyone outside the top single percentages of socioeconomic status in this country. More testing is not always good, which is why many thoughtful scientists/doctors have recommended against prostate screening with PSA or against mammograms before the age of 50, for examples. Ill-health effects can result from chasing abnormal test results. I’m sure Chris has helped plenty of people with medical issues, but I also wonder how much damage this had done, if not physically, at least financially. Thankfully, LAc can’t prescribe pharmaceutical drugs after they order these medical tests.

              • You are welcome to your opinion Angela. And you are correct. But the majority of people probably don’t need all those tests. But then they wouldn’t be going to Chris, because conventional medicine could fix their problem.

                The thing is, there are a number of us out here who have gone to many many conventional doctors who have not been able to diagnose our conditions. Most of these so called professionals run a few blood tests, then declare that you are fine and your problems are all in your head. Then they tell you to be on your way now. When you have a condition that nobody has been able to figure out, at that point, I don’t care how many tests it takes to get answers. It will be worth it to get some relief.

                • As a medical doctor practicing Functional Medicine, I disagree. Most people only need a smaller version of these tests with a practiced doctor who has a good clue about what is going on and what is needed before even getting the tests, just using the tests to confirm at each step or to suss out possibilities.

                  But the majority of patients DO routinely need and benefit from a couple of these tests and won’t get this 99.99% of the time from conventional medicine docs.

                  Financial strain is not a small problem. Our type of medicine should be available to people of all financial capacities, not just the elite. It’s a pet peeve of mine, so I try to keep testing to only what I really need.