By Dr. Shawna Darou, ND
I am a big fan of lab testing to assist in a full workup and assessment. I find very often that people have not been thoroughly assessed. This is key for hormone imbalance, infertility, cognitive decline, fatigue, hair loss, fatigue and more. Without proper assessment, it’s difficult to get to the root of the problem. In most cases this is simply more detailed bloodwork, but in some cases additional more advanced testing can be useful. When we test, it makes the treatment plan much simpler, and gives you the confidence that with patience things will improve. I know it’s hard to stick with a treatment plan, or even to take supplements regularly when you don’t fully understand what they are for.
I’m going to go through some common complaints, and a list of possible lab testing to do. Bear in mind that a detailed health intake helps to direct this testing, so we may not do all of it!
The most common marker tested for fatigue is ferritin, or iron stores. Here is a more thorough list of blood tests to consider with fatigue:
- Ferritin (iron stores), vitamin B12, morning cortisol, fasting insulin and glucose (checking for insulin resistance), a full thyroid panel (TSH, free T4, free T3 and thyroid antibodies), and vitamin D levels.
- More advanced testing could include food sensitivities, checking for cortisol rhythm (saliva panel), Organic Acid test for mitochondria function, Epstein Barr virus panel, Mold toxin testing, or a sleep study checking for sleep apnea.
Many people are unaware that there are many physiological causes of anxiety. Depending on health history and susceptibilities, a full work-up may include:
- Vitamin B12, Ferritin (iron stores), Estradiol (low estrogen can cause anxiety), Vitamin D, a full thyroid panel (both under and over-active thyroid is associated with anxiety), morning cortisol, fasting insulin and glucose (blood sugar instability can also trigger anxiety).
Since the more common causes of hair loss are nutrient deficiencies, insulin resistance, high androgens and prolonged high stress, here is a list of lab markers:
- Ferritin, zinc, vitamin D, full thyroid panel, am cortisol, full testing of androgens (testosterone, DHEAS, DHT, androstenedione), fasting glucose and insulin.
[If there is more extreme hair loss that indicates autoimmune alopecia, it would require a different workup].
RESISTANT WEIGHT LOSS:
I get a lot of referrals with women who are on a sensible nutrition and exercise plan and are not losing weight. Some common causes of resistant weight loss include insulin resistance, high cortisol levels, poor sleep quality, subclinical hypothyroidism, inflammation and low or high estrogen.
- Testing may include: fasting glucose and insulin, full thyroid panel, morning cortisol, hormone panel (estradiol, progesterone, FSH, LH), C-reactive protein.
- Advanced testing may include a look at personal genetics to be more specific with exercise and nutrition recommendations – for example learning protein needs, sensitivity to saturated fats, and whether more endurance cardio or high-intensity workouts are more effective.
- Other tests that can be helpful are food sensitivity testing and comprehensive digestive stool analysis – foods that are inflammatory can contribute to difficulty losing weight, and there is also a lot of evidence that imbalances in the gut microbiome can affect both appetite and body composition.
Some of the most common causes of persistent acne include food sensitivities (especially dairy products), high androgens from hormone imbalance, and insulin resistance.
- Testing could include: food sensitivity panel, bloodwork for androgens (testosterone, DHEAS, DHT, androstenedione), fasting glucose, insulin and sex hormone binding globulin.
PMS / PMDD:
For women who experience major mood changes premenstrually, we first thoroughly check out hormone levels.
- Hormones typically tested include: day 21 estradiol and progesterone (checking for estrogen dominance or low progesterone), prolactin, fasting glucose and insulin, testosterone, DHT, DHEAS and am cortisol.
- If the answer isn’t in the hormones, the next step is to see if there are issues with how the hormones are cleared through the liver. This can be assessed either with a DUTCH urine hormone panel, or looking at personal genetics.
INFREQUENT OR ABSENT PERIODS:
Here we are testing to determine whether the cause of missing periods is hypothalamic amenorrhea, stress-related, menopause/ perimenopause or premature ovarian insufficiency.
- Testing would include day 3 FSH, LH and estradiol, prolactin, a full thyroid panel, am cortisol, androgens (testosterone, DHEAS, DHT), fasting insulin and glucose, and possibly AMH (anti-Mullerian hormone).
HIGH RISK OF HEART DISEASE:
If you have begun to have signs of cardiovascular disease, are prediabetic, have developed high blood pressure or have a strong family history of heart disease, a simple cholesterol / lipid panel is not enough!
- A full workup would include: Lipoprotein panel (measuring particle size), high-sensitivity CRP for inflammation, apolipoprotein B, homocysteine level, fasting glucose, insulin and HbA1C, a thyroid panel (hypothyroidism increases cardiovascular risk in women), and a sleep study to check for sleep apnea.
I wanted to also make some notes about the results, and especially reference ranges. A reference range for a lab value is an average from the population, but does not necessarily indicate your own optimal reference range. It’s very important to keep track of changes in your lab values over time. Also, being in the high-normal or low-normal range of any lab value may leave you very symptomatic, but perhaps not at a severity of requiring a medication. For example lab results showing low on the reference range of ferritin (iron), vitamin B12 and free T3 could create symptoms of fatigue, anxiety and hair loss, even though they don’t flag as abnormal.
If you have a health issue and feel that you haven’t been tested thoroughly, please ask at your next appointment. We can fill in the gaps with more complete testing so you can truly get to the root of your health concerns.