How To Talk To Your Functional Medicine Doctor About Your Labs

Functional Medicine Practitioner By William Cole, D.C., IFMCP
Functional Medicine Practitioner
Dr. Will Cole, D.C., IFMCP, is a leading functional medicine expert who specializes in clinically investigating underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. Cole is also the bestselling author of Ketotarian and The Inflammation Spectrum.

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We in functional medicine know that health is a complex and dynamic force. Someone who appears to eat a junky diet may have glowing health because of the positive influences of a low-stress lifestyle, a supportive social group, and lots of exercise. Someone else may eat like a health rock star, throwing back kombucha and kale salads on a daily basis, but may be withering from loneliness or the crushing stress that can trigger serious health issues. Even if we limit our focus to food alone, one person's health food may be inflammatory for another person—that kale you eat may give someone else digestive issues, and the dark chocolate your friend seems to enjoy without consequence may give you a migraine. This is why dieting dogma is antiquated and has no place here. 

Instead, those of us in the functional medicine community look at people within the context of their environments to see how well they are functioning and to assess the big picture: what they eat, how they live, and how every aspect of their existence may affect them physically, emotionally, and spiritually. My goal is to get you actively moving toward health by helping you discover the foods, lifestyle habits, and other therapies that best nourish and meet your individual needs in the context of your life. This is your big-picture approach, and it begins with taking a good close look at how you live. With its personalized profiling, customized elimination process, and clear, organized reintegration of foods, the Inflammation Spectrum program can help anyone discover what may be best and worst for them to eat, take, try, and do. It resolves the internal battle between lifestyle choices and health needs by answering that ultimate question: "What do I need?" Let's illuminate your personal path to health.

Other than quizzes I provide in my book, The Inflammation Spectrum, another way to gauge where your inflammation levels are right now is through testing. Below are some of the lab tests that I run for my patients, to get a comprehensive perspective on where they are on the inflammation spectrum. Although you don't have to get any lab tests to get started tackling inflammation, you could ask your doctor to have some or all of these labs run to get a baseline on your inflammation before you start your journey. Having the extra information can motivate you to stay the course and make progress. A functional medicine doctor is likely to be your best source for some of these labs, as this testing is more comprehensive than is standard for conventional medicine. (I run and interpret these labs for people around the world, and so can your functional medicine practitioner.)

1. hsCRP

C-reactive protein is an inflammatory protein, and this test will show you how much of it you have. The high-sensitivity CRP test is also a surrogate lab to measure IL-6, another pro-inflammatory protein. They are both linked to chronic inflammatory health problems. The optimal range is anything under 1 mg/L. Higher levels are a risk factor for heart disease and can contribute to many other inflammation-based health issues.

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2. Homocysteine

This inflammatory amino acid is linked to heart disease, destruction of the blood-brain barrier, and dementia. It is also commonly elevated in people struggling with autoimmune problems. The optimal range in functional medicine is less than 7 μmol/L.

3. Ferritin

This lab is normally run to look at stored iron levels, but high levels can also be a sign of inflammation. The optimal range for men is 33 to 236 ng/mL; premenopausal women: 50 to 122 ng/mL; postmenopausal women: 150 to 263 ng/mL.

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4. Microbiome labs

This panel helps assess the health of the gut, where around 80% of the immune system resides. By looking at bacterial and yeast overgrowths as well as inflammatory markers like calprotectin and lactoferrin, we can assess gut-centric inflammation.

5. Intestinal permeability

This blood test looks for antibodies against the proteins that determine the integrity of your gut lining (occluding and zonulin), as well as bacterial toxins called lipopolysaccharides, which can cause inflammation throughout the body.

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6. Multiple autoimmune-reactivity labs

This array shows us if your immune system is creating antibodies against many different parts of the body, such as the brain, thyroid, gut, and adrenal glands. The labs are not meant to diagnose autoimmune disease but rather to look for possible evidence of abnormal autoimmune inflammation activity.

7. Cross-reactivity labs

This panel is helpful for gluten-sensitive people who have gone gluten-free and eat a clean diet but still experience symptoms like digestive problems, fatigue, and neurological symptoms. In these cases, relatively healthy food proteins—such as gluten-free grains, eggs, dairy, chocolate, coffee, soy, and potatoes—may be mistaken by the immune system for gluten, triggering inflammation. To the immune system, it's as if the person never went gluten-free.

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8. Methylation gene labs

Methylation is a biochemical superhighway that regulates many of the functions necessary for a healthy immune system, brain, hormones, and gut. A process occurring about a billion times every second in your body, methylation needs to work well if you are going to work well. Methylation-gene mutations, such as MTHFR, are closely associated with autoimmune inflammation. For example, I have a double mutation at the MTHFR C677t gene; this means that my body is not good at managing an amino acid called homocysteine, which can cause inflammation in some people. I also have autoimmune conditions on both sides of my family, which is a red flag that I need to be even more careful of my place on the inflammation spectrum. You can't change your genes, but by knowing your genetic weaknesses, you can pay extra attention to supporting particular processes in your body to reduce risk factors as much as possible.

9. Cannabinoid Gene CNR1 rs1049353

Our endocannabinoid system regulates everything from sleep, appetite, pain, inflammation, memory, and mood to reproduction. The cannabinoid gene CNR1 rs1049353 is a significant gene in this system, and changes to this gene are significantly correlated with food sensitivities and autoimmune-inflammation issues. Studies indicate that the gut nervous system is the main site of CB1 cannabinoid receptors.

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10. APOE4 and APOA2

Variants of these genes affect how the body metabolizes saturated fats. For these gene variants, eating foods higher in saturated fats is associated with inflammatory health problems and weight gain, respectively. People with these gene differences should limit or avoid foods such as dairy, red meat, eggs, coconut products, and other foods higher in saturated fats. Focus instead on plant fats like avocado, olives, and nuts and seeds.

Your inflammatory symptoms exist on a spectrum, but what moves you in one direction or the other is extremely personal. One person's food medicine is another person's food trigger. By acting as a lifestyle detective—committed to solving the mystery of what foods nourish and energize you—you come closer to learning how to optimize your life.

Adapted from The Inflammation Spectrum: Find Your Food Triggers and Reset Your System by Will Cole, D.C., IFMCP, arrangement with Avery, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2019, Will Cole, Eve Adamson.

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