Diagnostics

I. History and Examination

90% of diagnosis is based on history. The rest of the diagnostics are done to support what the doctor believes is wrong and to delineate the severity of the problem(s). Therefore, a complete history is taken both verbally and via questionnaire.

Three questionnaires are used. The first is called the Symptom Survey Form. This will go through each system of the body asking symptom questions. It is best to fill in the circles off any symptom that is remotely a “yes” (ie. 1 for MILD, 2 for MODERATE and 3 for SEVERE).

Also, any symptom that is being controlled by a drug should be filled in. A notation in the margin can be made to that effect. The next is a Family History. This sheds light on genetic predispositions. The third is Dietary Data. Once a complete diagnosis is made, recommendations will be given as to how the diet should change, if at all, to aid in the patient’s attainment of health.

The examination is similar to most any physical exam given by a doctor. The difference is in what is noted as significant. Since our patients are wanting to achieve optimum health rather than simply health that is defined as the absence of disease, any change from optimum could be significant. For example, when a conventional doctor shines a light into the patient’s eyes, a constriction, or lack of constriction, of the pupil is noted. Although this is very important to note, once a constriction is seen, the light is held a bit longer on the pupil to see if the pupillary constriction will hold. If a pulsing of the pupil is seen, this too is considered as a significant change from optimum.

II. Clinical Tests

A. Normal blood test

A very thorough blood test is routinely performed. This includes 28 different chemistries (ie. cholesterol, blood sugar, liver enzymes, thyroid hormones, etc.), red and white blood cell counts, inflammation indicators, blood typing and urinalysis.

These results are used not only for the detection of disease, but also for the evaluation of physiological imbalances. This is accomplished by the use of homeostatic (literally meaning “to stay the same”) ranges, as well as, the usual clinical ranges that are reported on the blood test results from the lab. Any other specialized blood test, such as tumor markers for different cancers, may be performed as-needed.

B. Food Allergy Testing

This is not the usual skin scratch test done by an allergist. Rather, it is done using blood and is called cytotoxic (literally, “cell poison”) testing. So, it is not only an allergy test in which the immune system is stimulated to make antibodies, but it also detects foods that harm the body and possibly do not elicit antibody production.

For our purposes, this is a more complete test than antibody testing. The blood is sent over-night to the lab so the cells are still alive. A specially prepared drop of the food to be tested is put on a slide with a drop of the patient’s blood and then inspected under a microscope. If the food causes any reaction with the cells (ie. swelling, fragmenting, shrinking, etc.) then that food is considered to be an allergen to that person. Degrees to which the food damages the cells are noted and put into categories of severe, moderate and limited reactions.

C. Urinalysis

Dipstick urinalysis is convenient. Specific gravity provides a reliable assessment of the patient’s hydration status. Microhematuria has a range of causes, from benign to life threatening. Glomerular, renal, and urologic causes of microhematuria often can be differentiated by other elements of the urinalysis. Although transient proteinuria typically is a benign condition, persistent proteinuria requires further work-up. Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture.

D. Saliva Hormone Testing (Female and Male)

Although blood is traditionally used in medicine to measure hormone levels, it is not the best to evaluate hormone function. Saliva is a far better fluid to use because it reflects what is happening at the cellular level. A patient could have normal blood hormone levels and still be dysfunctional hormonally. Just because there are hormones in the blood, does not mean those hormones are actually doing their job in the cell. This is what ultimately matters to a patient’s well-being and can only be detected using saliva.

E. Adrenal Stress Index (saliva study)

The Adrenal Stress Index (ASI) is a non-invasive way to help evaluate the effects of stress on your body. It includes 10 tests for six different hormones and immune markers that may be affected by chronic stress or other conditions.

The Adrenal Stress Index can:

Help to identify possible causes of excessive fatigue
Help your physician understand how to reduce your food cravings and build and maintain muscle mass
Identify underlying reasons for chronic infections such as sinusitis or other recurrent respiratory infections
Help your doctor to determine if a gluten-free diet may be right for you
Identify possible reasons why you may have difficulty falling asleep or staying asleep

The Adrenal Rhythm and Its Importance

The human adrenal glands do not secrete steroid hormones at a constant level throughout the day. The hormones are actually released in a cycle, with the highest value in the morning and the lowest value at night when functioning properly. This 24-hour cycle is called the circadian rhythm. An abnormal adrenal rhythm can influence many functions of the body, some of which are described below.

Energy Production

Abnormal adrenal function can alter the ability of cells to produce energy for the activities of daily life. People who have a hard time rising in the morning, or who suffer from low energy throughout the day, often have abnormal adrenal rhythms and poor blood sugar regulation.
The maintenance of a stable blood sugar level depends on food choice, lifestyle, adrenal function and insulin activity. The Adrenal Stress Index™ panel measures stress hormones and insulin, to help ferret out the causes of fatigue, cravings and obesity.

Muscle and Joint Function

Abnormal adrenal rhythms are known to compromise tissue healing. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint wasting with chronic pain.

Bone Health

The adrenal rhythm determines how well we build bone. If the night and morning cortisol levels are elevated, our bones do not rebuild well, and we are more prone to osteoporosis. Stress is the enemy of the bones. In postmenopausal women, the effect of stress worsens due to female hormone imbalances.

Immune Health

Various immune cells (white blood cells) cycle in and out of the spleen and bone marrow. The immune system trafficking follows the cortisol cycle. If the cycle is disrupted, especially at night, then the immune system is adversely affected. Short- and long-term stress is known to suppress the immune response in the lungs, throat, urinary tract and intestines. With reduction in the surface antibody (called secretory IgA), the resistance to infection is reduced and allergic reactions are believed to increase.

Sleep Quality

The ability to enter REM sleep cycles and experience regenerative sleep is interrupted by high cortisol values at night and in the morning. Chronic lack of REM sleep can reduce a person’s mental vitality, vigor and induce depression.

Skin Regeneration

Human skin regenerates mostly during the night. With higher night cortisol values, less skin regeneration takes place. Therefore a normal cortisol rhythm is essential for optimal skin health.

Thyroid Function

The level of cortisol at the cell level controls thyroid hormone production. Often, hypothyroid symptoms such as fatigue and low body temperature are due to an adrenal maladaptation.

Chronic Fatigue Syndrome (CFS)

A common HPA axis defect in CFS is impaired corticotrophin release. As a result, low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel. Simultaneous use of several therapies can help improve the debilitating effects of CFS.

Glycemic Dysregulation

Chronic hypoglycemia can impair normal adrenal function by repetitive overstimulation of cortisol production. Recurring exposure to high cortisol will impair insulin activity, and invariably lead to insulin resistance and beta-cell exhaustion (diabetes). The ASI™ panel investigates the insulin-cortisol relationship under real-life conditions to allow targeted and meaningful interventions. This panel is useful in the following clinical situations: rapid weight gain and obesity, deranged blood lipids, sugar blues, early diabetes and associated emotional disturbances.

Allergies/Autoimmune Disorders

More than fifty years ago, Dr. W. Jefferies (author of Safe Uses of Cortisol) discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically benefited when given cortisol for other purposes. More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases. The findings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can benefit from cortisol supplements.

Depression/ADD

Several recent publications report a hyperactive HPA axis in depressed patients. Elevated midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On the other hand, cortisol elevations and rhythm disruptions throughout the day are typical of attention deficit disorders (ADD). The anomalous cortisol findings in depression and ADD can be diagnosed successfully with the ASI™. Subsequent interventions to rectify the time-specific cortisol elevations (during the day or night) are usually effective when applied under proper supervision.

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The Adrenal Stress Index can:

Help to identify possible causes of excessive fatigue
Help your physician understand how to reduce your food cravings and build and maintain muscle mass
Identify underlying reasons for chronic infections such as sinusitis or other recurrent respiratory infections
Help your doctor to determine if a gluten-free diet may be right for you
Identify possible reasons why you may have difficulty falling asleep or staying asleep

F. 23andme Genetic Testing

How your DNA becomes a report.

Human DNA is about 99.5% identical from person to person. However, there are small differences that make each person unique. These differences are called variants. Your DNA was passed down from your parents—and their parents and so on. Variants can be linked to certain health conditions, traits and ancestry groups. Your saliva contains DNA from cells in your mouth. We send you a saliva collection kit and instructions for providing your sample.

Our CLIA-certified lab extracts DNA from cells in your saliva sample. Then the lab processes the DNA on a genotyping chip that reads hundreds of thousands of variants in your genome.

Your genetic data is analyzed, and we generate your personalized reports based on well-established scientific and medical research