Ep 6 Test and Assess, Don’t Guess

Now we’re into step 4 of my “Get Your Shit Together” system, which comes down to functional medicine screenings at regular intervals. “Functional” means something is working optimally, doing what it’s supposed to be doing.  Functional medicine investigates how and why illness occurs rather than treating symptoms.  Typical ranges for blood work interpretation is looking for treatable disease, not dysfunction.  Functional medicine looks at a much narrower range to find imbalances before they become disease.

  1. Understand what functional lab tests are and what functional ranges are 
  2. Have someone on your team or learn how to interpret your labs
  3. Retest at regular intervals

This is just a taste of what functional lab testing is all about. You can learn to interpret your labs yourself, starting with this book: Blood Chemistry and CBC Analysis

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Music credit: “New Way Forward” by Young Presidents

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Welcome to Science and Shit, the podcast where I show you how a healthy gut leads to a happier life. I’m your host, Michelle Casey. I’m a functional health coach who specializes in all things digestion, from heartburn to IBS to auto immune inflammatory bowel disease. I’ve seen it all. I’ve spent the last eight years in private practice helping people with chronic illness, reverse their symptoms and live their best lives. In this podcast, you will get empowered about what you can do to impact your health naturally. I’ll help you sort through the information overwhelm to figure out what’s relevant to you. If you want a holistic scientific approach, you’ve come to the right place! 

All right, first things first, if we’re going to talk about holistic health, we need to first acknowledge that white supremacy and colonization has wiped out much indigenous wisdom all over the world. And has led to gross disparities in equity and health care access. The ʻāina (land) on which I live and work is located in the ahupuaʻa (subdivision) of Kaloko, in the moku (district) of Kona, on the mokopuni (island) of Hawai’i, in the paeʻāina (nation) of Hawai’i. I recognize that Her Majesty Queen Liliʻuokalani yielded the Hawaiian Kingdom and these territories under duress and protest to the United States to avoid the bloodshed of her people. I also want to acknowledge that the Hawai’i that we enjoy today was very much shaped in a holistic and sustainable way by many generations of indigenous Hawaiians, Polynesian people. For these people, and for this work, I express my deep reverence and gratitude. Mahalo nui loa. 

It’s important to recognize and acknowledge the history of the land that we live on. Even though you or I may not be directly responsible for the harms done to native peoples. All of us non natives who live in the United States directly benefit from this harm. If you want to learn more about the land you’re on, you can start by entering your ZIP code at the native land website at Native-land.ca. 

Now let’s jump into today’s episode. Let’s get this party started.

Hello, and welcome back. In this episode, we’re going to be talking about step four in the Get Your Shit Together system, which is Test and Assess, Don’t Guess. If you scored low on this one when we did the workshop in episode two, that’s either because you don’t understand what functional lab tests are and what functional ranges are, you don’t know how to interpret your own labs from a functional perspective, or you don’t have anyone on your team that can do that for you, and/or you’re not retesting at regular intervals.

Today, we’re going to talk about all of these different things. Let’s just start first with a quick definition of the word functional. If you just Google the word functional, it says ‘of or having a special activity, purpose, or task relating to the way in which something works and operates’. Basically, functional means something is functioning optimally, right? It’s doing the thing it’s designed to be doing. And when we’re looking at functional medicine, and functional nutrition, it talks about finding the root cause of how and why illness occurs. So we’re not talking about treating symptoms, we’re not just chasing our tails in that way. We’re not talking about layering on prescription drugs and then taking more prescriptions for the side effects of the first ones. We’re talking about looking at what caused this illness. Or what caused the signs and symptoms? What is the root cause? What’s the root imbalance and how can we bring balance back to that system? That organism, that person, right? 

When we think about lab testing, most of us probably grew up getting a physical every year or maybe more often, if you were in sports. And you get your blood drawn and then the doctor interprets that blood work in a particular way. So we would call the ranges that the doctors are looking at in conventional medicine, we would call those maybe the lab ranges or the conventional ranges. They’re working on a disease model. They’re looking at your blood work to see if there’s anything that they can diagnose and treat. That is the function of medicine, right? So the ranges that they’re looking at are pretty broad. They can vary from state to state and lab to lab, depending on the specific marker. That’s actually based on the population demographics and the general health of people in that area. The point is that these ranges are not necessarily looking for dysfunction, they’re looking for these bigger, more dramatic numbers, where they can diagnose and treat. 

When we think about functional testing, we are looking at a narrower range. We’re looking for where is the beginning of the dysfunction before it gets to that disease state? And we’re asking the question, how can we address this imbalance before it becomes a disease, before it becomes something that’s diagnoseable? You may have even heard the term subclinical. A lot of times people will get diagnosed with subclinical hypothyroid. Well, that’s functional hypothyroid. Functionally your thyroid is not producing, they call it sub clinical, because it’s not necessarily in that diagnosis range, but they may still put you on medication before you get into that out of the lab range. Now, that’s a whole other topic for a whole other day, they’re not looking at the root cause of the thyroid dysfunction, blah, blah, blah. 

But back to functional testing. Functional doesn’t only mean that we’re looking at a narrower range of numbers, it can also mean that we’re looking at additional markers to gain more context. So for instance, if we’re looking at iron deficiency anemia, we might also want to look at total iron binding capacity. We might also want to look at ferritin and transparent. We might also want to look at B 12. We might also want to talk to the client to see if they’re having any vitamin C in their diet, because that helps us absorb iron. We might also want to look at inflammation markers. Depending on what they’re dealing with and what they’re reporting that their symptoms are, we may want to check their white blood cells to see if there’s some kind of infection going on, some kind of inflammation where the body is sequestering iron because iron is very inflammatory. So from a functional perspective, if I see on someone’s bloodwork that their iron is low, I’m not necessarily recommending an iron supplement, because there may be an underlying reason, a root cause why that iron is low. 

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The other thing about diagnoseable, or clinical, iron deficiency anemia is that the lab range for many labs is approximately 35 to about 150-155 micrograms per deciliter. But the functional range that I’m looking at, that I want to catch it before it gets to that diagnoseable state, is between 50 and 100. So if someone’s below 50, I’m going to start investigating why their iron is functionally low. I’m not going to wait till it gets down to 35. And if they’re over 100, I’m going to investigate potential iron overload or hemochromatosis. So the range is narrower. 

Now, the other thing about functional testing that is super fun is that it’s not just limited to bloodwork. It’s not just taking this one test and looking at it through a functional lens. There are also many different types of functional tests that you can order at home. And some of them are more scientifically researched and proven than others. Some of them are very new and experimental, which is cool, you just have to understand the context of what you’re looking for when and understand the technology behind them. Are they specific? Are they sensitive? Are they going to impact your actual protocol? Or are you just gathering a bunch of information?

Some people like to run the same five tests on every client. I think that’s a waste of money and time and resources, personally, but it will give you some cool information and you can make a protocol out of that information for sure. But in any case, some of my favorites include stool testing to look for pathogen and bacterial imbalance as well as digestive markers. I also like to do urine testing for organic acids that can give us another type of insight into what’s happening in the gut as well actually, because there’s some markers for byproducts of bacteria and yeast. It also gives us an insight into how our body is doing at using certain vitamins. And if there’s any type of oxalate overgrowth, things like that, that can be causing different symptoms, that’s a pretty good like bang for your buck kind of test that organic acids are the oat. I also like to run a urine test for hormones, whether that’s a one day kind of a map throughout the day for adrenal and sex hormones. Or we can map your entire menstrual cycle and see, based on what a functional range would look like, if that system were functioning optimally, what are your hormones actually doing? And as I’ve gotten into my 40s, I actually run that one on myself about once a year just to check on what the heck’s happening because things change, you know, things are changing. And then, sometimes I like to run, some of my colleagues hate this test they think it’s useless, but I like to run a micronutrient blood test and micronutrient deficiency tests just to see what is showing up in the blood. Blood is a short term, momentary snapshot. So doing something like hair mineral tissue analysis gives us a longer term, like a three month view of what’s happening with nutrients. But it’s nice to have both. Because our body is always going to prioritize the health of the blood, and the pH of the blood. And so understanding, having that nuance and having the ability to interpret those in those ways is really helpful.

We talked about food allergy testing in the last episode, and there’s not a ton more to say about that. The technology is definitely changing and it’ll be really interesting to see what happens with that over the next decade or so. I definitely prefer an elimination diet whenever possible. I think that’s still the gold standard for figuring out food intolerances. But it can be helpful in certain circumstances, especially with things like gluten or dairy, that are inherently addictive for a lot of people, can be really helpful to see that in black and white, if you’re a very data driven person. Sometimes symptoms just aren’t enough, even if it’s totally kicking your ass. Sometimes people really need the test. So, again, kind of depends on the person, their personality. Are they very data driven? Or do they just want someone to tell them what to do? Or do they want to really have all the information? 

So then, obviously, having someone like me, someone, a functional practitioner on your team can interpret your labs for you, that’s really helpful. But there’s also lots of ways that you can learn, especially for bloodwork to interpret your labs yourself. There is a book called Blood Chemistry and CBC Analysis by Dickon Weatherby and Scott Ferguson, they’re a couple of naturopathic doctors. And maybe that’s where you’re starting. Maybe you don’t have the budget for Functional Medicine Practitioner, but you have your doctor that’s covered by insurance. You have your regular bloodwork, and you just want to know, okay, I don’t feel good. My doctor says everything’s normal, what can I look at. But certainly, if you are working with a practitioner, and they are running these type of tests ask them to record your zoom sessions, or what I like to do is record a loom video for my clients reviewing everything so that they can just refer back to it later. Especially if it’s your first time doing that test, you may want to watch it a couple of times, and really get the context for it. Ultimately, figuring out where your baseline is, and where you feel good is another piece of that functional puzzle. Because not everyone fits into the math problem, or the algorithm of what is average for some of these markers. So I always put my blood work into a spreadsheet. I’m kind of a spreadsheet nerd, but I just track it over time. And I look and I’m like, Okay, well, my sodium is usually low, and I do drink a lot of water. And I do like to work out and sweat and I live in the tropics. So maybe that’s my baseline is my sodium is just always going to be a little bit functionally low, right? And then I started taking electrolytes more regularly, this last year, and my last blood draw, my sodium was not functionally low. And I was like, oh, okay, well, maybe that was my baseline before but that doesn’t necessarily mean it was healthy. Just little things like that, over time it can be really helpful to track. 

Okay, so checking out that blood chemistry book, that can be really helpful for just kind of DIYing it. Or having someone on your team that is looking from a functional perspective, they don’t even have to be your main doctor. But just having that second opinion, and just having especially one of the things that I like helping my clients with is knowing what tests to ask for, based on what they already have, the data they already have, and their symptoms. Super helpful. 

Alright, so then retesting at regular intervals. Let’s talk about stool testing for a minute, because this is one of these things. I’ve had people hire me because this is one of these tests that I can order and they get really excited. And they think that finding out exactly what’s happening in their microbiome is going to explain their gastrointestinal symptoms, which is totally possible, 100% possible. And stool testing is great, I’m definitely a fan. It is also a snapshot. It’s maybe not as short of a time window snapshot as blood but it definitely, if you do the same stool test every day for seven days in a row, you may see different information on each of those seven days. Now, there are definitely infections that you can catch that way. I have helped multiple clients really just transform their health with stool testing. So I’m not knocking it, I just want people to understand the limitations of some of these tests. 

And one of the things that is really frustrating and I see this a lot when people have had ulcers, and they’ve been diagnosed with an H Pylori infection (this is a bacteria that can overgrow in the upper GI and cause ulcers) maybe they do treatment, they do a round of antibiotics. And then they never retest to see if that infection was cleared. So that’s a really frustrating thing. One of the things with stool testing, and with any testing that I’m asking clients to do, is I always let them know upfront, I’m gonna want you to do this again in three to six months depending on the test. Same with things like small intestinal bacterial overgrowth. Anytime we’re going after a bug, and we want to make sure we kill it, we definitely want to retest to ensure that that worked. Whether you’re self treating at home with botanicals and herbs or whether you’re doing antibiotics, you want to make sure that treatment worked. 

The other thing to think about when we’re thinking about retesting, maybe we have an auto immune disorder. Like Hashimoto’s thyroiditis, for instance, where maybe our symptoms are not very easy to pin down. Like a lot of Hashimoto’s people have fatigue. It’s kind of hard to tell, am I less tired than I was three months ago? I don’t know, right? Sometimes there are ways to track that it’s a whole other topic. But if we’re not testing our antibodies, that can be one of the only ways we can see at first if our protocols are working. So we want to make sure that when we have things like autoimmune disorders, that we’re always checking our antibodies every time we get blood work, that we’re doing a full thyroid panel, we’re not just looking at the hormone levels.

And then obviously, if you have blood sugar issues, if you’re diabetic or pre diabetic, you know the importance of checking your blood sugar regularly. But testing at regular intervals could mean different things for different people. If you have type two diabetes, for instance, and you’re trying to reverse it, you are going to have to make some major lifestyle changes, maybe some supplements, maybe you’re also on medications. And a lot of these major changes can impact how much medication you need to be taking. So testing at regular intervals might be more often than someone who has no interest in reversing any of these things. And they’re just testing as often as their doctor says so that they know how much medication to take. Little different relationship. So the regular intervals really depend on what your goals are, what your needs are, and what your specific health concerns are.

Okay, and then the other thing that I want to say briefly about this step, which isn’t one of the things that you were meant to rate yourself on because it’s not necessarily something that I expect people to know how to do, but it’s called test and assess, don’t guess. I use a combination in my practice of objective testing and subjective questionnaires in order to help me design my protocols for people. Every single protocol I make is individualized. I sometimes wish I could do cookie cutter, that would be so much faster. I wouldn’t have to charge as much. I would just send you the thing I sent the last person. But that is not how I roll. And honestly, I wouldn’t have it any other way. It’s much more rewarding to do it this way, much more effective, right? But the assessments are important to track regularly as well. To track your progress. I guess one way you could do that actually, on your own, would be to do things like if your goals are around weight and measurements. That might be one thing like taking subjective symptom questionnaires, or objective measurements might be another way to track your progress. 

All right. So again, the three areas that you want to look at here for step number four in the Get Your Shit Together system. Number one, understand what functional lab tests are and what functional ranges are. Number two, have someone on your team or learn how to interpret for yourself your own labs from a functional perspective. And number three, retest at regular intervals, whatever that looks like for you. Alright, thanks so much for joining me. Catch you next time. 

Thank you so much for listening to this episode of Science and Shit with Michelle Casey. If you want to stay in touch, head on over to michellecaseynutrition.com/podcast to get in on all the goodness. I know you have a lot of things you could be doing with your time and I really appreciate you choosing to spend it with me. If this episode was valuable for you, please subscribe, follow, and share it with your friends and family and or leave a review as an offering to the algorithm gods. Until next time, be excellent to each other!