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Laboratory Testing

Laboratory Testing

So much of your treatment plan depends largely on an accurate diagnosis.  Images and lab tests can assist us in making that diagnosis, but don't replace a thorough history and physical exam.  Dr. Noah uses all kinds of testing to help identify the root cause.  We use a Functional Medicine approach in analyzing your labs by looking at them through a different lens.  We use optimal ranges, and order specialty tests, which include stool, blood, hair, urine, hormones, heavy metals, genetic, and much more.  

Gluten Sensitivity despite negative Celiac Disease tests

There remains a lot of miscommunication and misinformation about gluten sensitivity, even among health care professionals.  I still see quite a few patients coming in and telling me they have had every test known to man for their IBS (Irritable Bowel Syndrome), and all of them are negative.  They tell me that among those tests was one for celiac disease, and it was negative as well.  I then step off onto a tangent about how gluten sensitivity is much more than celiac disease.   You see, celiac disease is a very specific condition that results in destruction to the walls of your small intestine.  In fact, one of the best ways to diagnose it is to go in and take a biopsy of the intestinal wall to check for villi destruction (geez...doesn't seem like a good idea for an area that is already inflamed).   The main causative agent in this destruction is gluten/gliadin proteins, which are present in grains like wheat, rye, and barley. Doesn't it seem reasonable that some people might still be sensitive to gluten/gliadin, but that the destruction (more appropriately the immune system reaction) may be taking place in other locations?   We in fact do see that.  This is one of the reasons I rarely order a celiac panel, hardly ever order a biopsy, but often DO order a food sensitivity panel.  I care less about the site of destruction than I do about whether or not the person is reacting to the food.  To provide further evidence for this theory, there was a recent article in PubMed about this topic -  READ GLUTEN SENSITIVITY STUDY HERE.   The findings were that gluten sensitivity is a real and separate condition from Celiac disease.   There are many ways to determine if you are sensitive.  You can do an elimination diet, or get food sensitivity testing done.  Please contact our office if you have any further questions.

Finger prick Food Allergy testing now available

So many patients are interested in finding out which foods they are reactive to.  Often times your symptoms are a clue that you may be reacting to something you are eating.  For example - gas, bloating, rashes, fatigue, headaches, constipation, body aches, brain fog, and other annoying symptoms suggest you may have food sensitivities.  While it can be obvious when the reaction is immediately following a meal, other times you may not associate your meal with your symptoms.  That is because most of these are a result of delayed sensitivities (even 2-5 days later), which are not detected on a traditional scratch allergy test done by your Allergist or Family Physician. These symptoms are enough to prompt most adults to visit a doctor to figure out what is going on, but what about in children?  If a child starts having reactions at an early age, they may not be able to articulate the symptoms they are having, or perhaps even more tragic, they may come to accept that it is "normal" to have a tummy ache most of the time.  For these reasons, it is important for parents to communicate often with their children about how they feel.  Most kids should not complain of belly aches, itchy skin, or other problems on a regular basis.  If they do, then it might be time to have them evaluated by a health care practitioner.  An isolated episode of any of these relatively benign symptoms is not cause for major concern, but repeated episodes should trigger a closer look. 

If major allergies and other conditions have been ruled out, then often times it can be helpful to remove as many obstacles as possible between your child and optimal health.  Delayed food sensitivity testing will tell you what foods your body's immune system is reacting to.  Whenever the immune system ramps up, it releases small, local chemicals to signal the body there is an issue.  These chemicals are often the culprit for our symptoms.  In the past, it was hard to have proper food sensitivity testing done on pediatric patients, but we now have access to a finger prick blood test by one of top specialty labs in the nation.  We are excited to be able to offer this kind of testing for both adult and pediatric patients.  While we still prefer the complete blood draw method of testing IgG food sensitivities, we believe this will allow some patients an opportunity to check their reactions that otherwise wouldn't be able to.  If you have any questions about the testing, please call Dr. Noah Edvalson at  (208) 629-5374.

Food allergies - more than just test and remove!

Food allergies can cause a wide variety of symptoms - fatigue, gas, constipation, migraines, aches/pain, and much more.  When it comes to food allergies, there are some common misconceptions.  One of those is that if you get your food sensitivities tested, then avoid those offending foods, all of your symptoms will disappear forever.  This may be true for some people, but even though your symptoms will often improve dramatically, if you don't address the underlying problem, you are setting yourself up for future issues.  To understand why this is true, we must first understand what causes these food sensitivities. While many things can contribute to the development of food allergies, most cases have a few things in common:

  1. Genetic predisposition (we have to blame someone...might as well be your parents).  My stab at parents is actually pretty weak...though it plays a role, it is usually minor, so go back and ask them for forgiveness if you chewed them out for giving you food allergies.
  2.  Food is going through the digestive tract without being fully digested.  Stress, lack of vitamins/minerals, inflammation, and food allergies themselves, can all cause your digestion to slow down.  If you are eating on the go, or while you are screaming at your children, then chances are you aren't digesting your food very well.  Your body tends to be dominant in either the parasympathetic (rest and digest) mode, or the sympathetic (fight or flight) mode.  They don't work well together, so if you crank one up, the other is inhibited.  Remember how they used to blame ulcers on stress?  Well, they were partly right - it plays a role, but it is only what creates the environment for things to go awry in your gut.
  3. The intestinal walls are "inflamed" and letting larger pieces of food than they should.  We call this Leaky Gut Syndrome.  So, take those undigested chunks of food from #2 and send them down into an inflamed GI tract and these larger proteins are going to cross into your blood stream.  Once your blood stream encounters them, your immune system recognizes them as foreign and creates antibodies against them.

So, if you just eliminate the foods that were positive on your list, you won't be fixing any of the 3 problems above.  What might happen over time is that you will develop new sensitivities over time!  I have had patients get tested months or years after previous tests were done and they had a completely new list of foods they had to avoid, because they never fixed the underlying issues. To get more info about this topic, you can either set up an appointment at our clinic, or you can attend one of my community education courses through Boise Schools.

Best lab test for mercury (Heavy Metals)

Heavy metals seem to be a pretty hot topic among many of my patients who do a lot of research about health on the Internet. Some patients even present to Boise Integrated Chiropractic having already completed a test for heavy metals. While Mercury seems to be the most feared, these tests include other toxic metals such as lead, arsenic, cadmium, aluminum, etc.  Just like any other medical test, quality matters. There are some differences on how to test, but the Gold Standard for testing heavy metals is provoked urine. Hair may be an OK screening tool, but it is only effective if patients are actively excreting the metals (which requires healthy detoxification pathways).  Blood will only show current or ongoing exposure (think industry worker).  Here is a direct quote from the Textbook of Functional Medicine (which is from the leading educational entity- The Institute of Functional Medicine), please read it carefully: "...Metal-toxic patients present a unique clinical challenge and, if a significant toxic metal burden is present, the outcome of clinical intervention may be disappointing unless the metal burden is effectively diminished....Since tissue biopsy for heavy metal levels is impractical, post-provocative urine testing is probably the most reliable means to assess body burden of metals acquired through long-standing, low-level exposure, especially in the assessment of low-level inorganic mercurialism." This may help explain why some patients who have tried many natural cures, still don't get relief from their chronic illness. It also illustrates the importance of doing the correct laboratory test. I currently have a patient who has been tested for heavy metals in all three ways.  ONLY the provoked urine test was positive for heavy metals, and you guessed it - all other natural treatments were failing.  Had she stopped at the hair analysis for heavy metals (which was negative), she would still be in a downward spiral. If you, or someone you know, has a history of exposure to chemicals, heavy metals, pesticides, etc. you may want to consider the appropriate laboratory assessment. Symptoms of toxicity may include: fatigue, brain fog, joint pain, diarrhea, bloating, constipation, nausea, insomnia, depression, or other chronic issues.  If you have any questions at all, please contact Dr. Noah at his Boise Chiropractic clinic.

Different types of Food Allergy Testing Explained

Since there seems to be a lot of confusion about testing for food allergies, I thought I would take a minute to provide you with further information about your testing options.  Many of my patients tell me they have already had their food allergies tested, but when I asked to see a copy of the results, they are rarely done with the type of testing I prefer. As technology develops, more diagnostic laboratories are providing some form of testing for food allergies or sensitivities. 

Currently there are two major categories of testing:

1)  Immediate Allergic Response Testing - this type of testing is used to determine your true allergies.  Most traditional allergists use this form of testing to check allergies for both environmental (dust, weeds, grasses, pollen, mold, animal dander, etc...) and food sources.  This may be done using a skin prick test where you have small particles of the allergen applied to your skin, and the physician watches for the severity of immediate reaction.  The reaction is the result of a release of chemicals like histamine and interleukins, and the primary immunoglobulin involved is IgE.  That is why you might take an antihistamine to help combat this type of an allergic reaction.

2) Delayed Immune Response Testing - this type of testing typically checks for levels of immune cells in your body that are specifically elevated during a delayed response.  This delay may be as long as one or two days.  The most common immune cells tested for delayed sensitivities are IgG and IgA.  The difference between these is mostly just location.  IgG is the predominant immunoglobulin found in the blood, whereas IgA is found in secretions such as tears, saliva, colostrum, and the secretions of your lungs and gastrointestinal system. There are a couple labs that now offer a quantitative analysis of all combined mediators of a delayed sensitivity.  They take a much wider look at histamines, IgG, IgA, and other immune cells.  This type of testing is a bit more expensive, but provides the assurance you aren't missing a reaction not picked up by IgG alone.

Now that you have a basic understanding of the different types of tests offered, let me explain why I prefer to test the delayed immune response.  First of all, I believe that the testing for environmental allergies is of very little use clinically.  So what if you are allergic to ragweed and pine trees?  Sure, you might not plant them in your yard, but unless you are willing to pull up your roots and move to a different area of the country, you are going to have a difficult time avoiding most of these environmental allergens.  In other words, regardless of what the test results are, the treatment will likely be the same (Albuterol, Claritin, Flonase, Zyrtec, Allegra, etc...)  

In addition, if the immune response is immediate, you typically know what the source is.  If your cousin Vinny has three cats, and every time you go to his house you start to get a sore throat and itchy eyes, it probably doesn't take an expensive laboratory test to tell you that you are allergic to cats.  The same goes for food - if you eat peanuts and  five minutes later your tongue is swollen to the point that you can hardly speak, I trust you to connect the two together.

However, when we move into the world of delayed food sensitivities, finding the culprit becomes much more difficult.  It is much harder to connect the symptoms are having today with the food you ate two days ago. To make matters worse, most of us eat the same foods over and over again, so rather than a flare up of symptoms, we see an overall decline in health. This decline leads to many chronic and degenerative conditions.  Food intolerances can be very taxing on your immune system and take away valuable resources that could be used to fight another battle in your body.  These intolerances can also be responsible for a constant demand on your adrenal glands to release cortisol to calm this chronic inflammation (more on the adrenal glands and cortisol in another post).  Symptoms of Food sensitivities include swelling, bloating, nausea, fatigue, weight gain, eczema, rashes, headaches, migraines, chronic constipation, IBS, halitosis (bad breath), insomnia, depression, anxiety, blood sugar imbalances, and more...

If you want to know what your body is reacting to, one simple blood test can give you a lot of answers.  I offer the 94 and 164 food panels for IgG or IgG and IgA responses.  Call today to get your test scheduled - 208-629-5374, or visit our Boise website