Laboratory testing is an essential part of diagnosis, treatment protocol and condition monitoring. I am pleased to announce that in addition to most blood tests that your medical doctor can order, my office offers allergy testing, saliva and urine hormone tests, as well as stool analysis!
I. ALLERGY TESTING
The immunoglobulin G (IgG) allergy blood spot test and the IgG/IgE serum test are now available in my office.
1. IgG Allergy-blood spot test
The Food Intolerance Test is a finger stick IgG test that utilizes ELISA (Enzyme Linked Immunosorbent Assay) method to detect circulating Immunoglobulin G (IgG) antibodies which recognize and bind to food antigens.
This blood spot test investigates 96 general foods, 48 herbs and spices and 95 vegetarian foods. NO BLOOD DRAW REQUIRED!
Two of the antibodies involved in allergic reactions are immunoglobulin E (IgE) and immunoglobulin G (IgG). Type I immediate hypersensitivity reactions are a primary consequence of IgE production and occur right after ingestion or inhalation of an allergen. Type III delayed hypersensitivity reactions occur over several days and are primarily due to IgG production.
IgG Delayed Onset Allergies
In a type III hypersensitivity reaction, IgG forms an immune complex with the allergen/antigen (Ag), which activates the complement pathway and releases inflammatory mediators at the site of immune complex deposition. Although macrophages pick up the IgG-Ag complex immediately, they have a finite capacity to do so. If there is an overload of allergen/antigen, these macrophages may saturate their capacity to remove the immune complexes, causing the excess to be deposited in tissue. Depending on which tissues are involved, deposition of these IgG-Ag complexes may result in significant health concerns:
- Headaches, hypertension from deposition in blood vessels
- Alveolitis, asthma and recurrent infections: deposition in lung tissues
- Dermatological conditions: deposition in the skin
- Joint pain: deposition in joint spaces
- Rhinitis and angioedema: may occur as a result of histamine release by immune complexes
- Mood disorders including hyperactivity, depression, anxiety, inability to concentrate: deposition in nervous tissue
- Leaky gut syndrome: deposition in gut lining
IgG allergies are difficult to diagnose because reactions do not occur until hours or days after ingestion of an allergen. This makes determination of the cause by observing dietary intake very complicated. Blood spot testing for IgG provides simple and practical means for practitioners to uncover potential causes of allergic reactions and allergy related disease.
Occasionally, ‘No reaction’ will appear for an allergen to which the patient is known to be intolerant. There are several possible reasons for this: that specific allergen was not consumed in the previous 3 weeks, the form of the allergen being tested is not the same as the one that the patient reacts to, or the patient has non-immune food intolerance rather than an allergy. Food intolerances may mimic the symptoms of a food allergy but are not the direct result of an antibody-antigen reaction. For example, lactose intolerance is due to a deficiency in the enzyme lactase, the enzyme responsible for the digestion of milk sugar lactose. Adverse reactions to food additives may also be defined as food intolerance. Another type of food reaction is a psychosomatic food aversion, which results from a previous negative food experience. Thus, a negative result on the IgG Blood spot test does not necessarily mean that the patient is tolerant of that specific food.
The blood spot test cannot test for inhalant allergies while the IgG/IgE serum test described below can.
2. IgG/IgE serum allergy tests
This requires a blood draw which will be performed at the MDS laboratories. This serum test investigates 96 general foods, 48 herbs and spices, 95 vegetarian foods and 48 common inhalant allergens including: grasses, molds, trees, weeds and airborne indoor particles.
IgE Immediate Onset Allergies
IgE mediated hypersensitivity reactions occur in about 20% of the population. IgE is produced in response to an allergen/antigen and binds to the mast cells and basophils. This triggers the release of histamine and the production of other inflammatory mediators, resulting in an early allergic reaction phase that appears within minutes of exposure.
IgE mediated hypersensivity can result in the following:
- Redness and swelling: due to release of chemicals like histamine
- Tightening of airways: histamine can cause congestion and constriction
- Itching: Release of inflammation-casing chemicals can cause stimulation of nerve endings, which produce pain and itching on skin surface
IgG Delayed Onset Allergies
See information above described in section on IgG blood spot test.
II. SALIVA TESTING
- Saliva testing is excellent at uncovering hormone imbalance
- Saliva allows the measurement of hormones that have actually made it into tissues, because hormones pass through saliva gland tissue before getting into saliva. Blood is a measurement of hormones that might eventually get into tissue
- Saliva collection is painless and easy to do at home
- The stress of a needle puncture for blood collection tends to raise cortisol levels. Saliva collection is not known to raise cortisol levels.
1. FEMALE PANEL
Female Panel Saliva test measures: Estrogens (estradiol, estrone, estriol), Progesterone, Cortisol, DHEAs, Testosterone
Common hormone conditions:
Weight gain: High levels of stress hormones, cortisol, can cause unstable blood sugars and may increase sugar cravings. High estrogen levels may interfere with thyroid gland function and result in weight gain. High levels of testosterone and/or DHEA may be associated with polycystic ovarian syndrome, a condition that makes weight loss very difficult.
Depression/ Difficulty coping/ Irritability: 2/3 women who self report depression or difficulty coping and 7/10 who report irritability have at least one hormone that is out of range. There is no guarantee that restoring hormone balance will lessen these mood symptoms, many women experience some relief from mood disorders when their hormones are in balance.
Sleep Disturbances: High or low levels of cortisol may affect sleep, as may low levels of estradiol. For some postmenopausal women, difficulty sleeping is directly related to hot flashes and night sweats, which are often signs of hormonal imbalance. Once hormone imbalances are addressed, sleep issues may resolve. The Melatonin-Cortisol Index saliva test is also important for understanding sleep problems.
Hot Flashes: Having too little estrogen can be associated with hot flashes, but so can supplementing with too much estrogen! Maintaining the right amount of estrogen is at least one factor in controlling hot flashes.
Bone loss: Testosterone and estradiol help to build bone. High cortisol is of particular concern because it breaks down bone and interferes with the bone building action of testosterone.
Breast cancer: A common pattern of hormone imbalance that shows up in women with breast cancer: above range estradiol, below range progesterone, above range evening cortisol and out of range DHEAs. The Estrogen Metabolism ratio urine test also gives insight into breast cancer risk.
2. MALE PANEL
Male Panel Saliva test measures: Testosterone, Estrogens (estradiol, estrone, estriol), Cortisol, DHEAs.
Common hormone related conditions:
Bone Loss: Testosterone and estradiol help to build bone. High cortisol is of particular concern because it breaks down bone and interferes with the bone building action of testosterone.
Erectile Dysfunction: Testosterone receptors are plentiful in the brain, so lack of testosterone may result in decreased arousal response. Testosterone is also needed for muscle contraction, so low testosterone may result in poor erectile quality. Low testosterone may lead to increased wait time between erections.
Memory Loss: Because testosterone receptors are abundant in the brain, low testosterone levels often affect memory.
Apathy, Depression, Grumpiness: 3/5 men with self reported symptoms including aggression, apathy depression, irritability and an inability to cope have at least one hormone out of range. It is not clear whether restoring hormone balance will lessen these mood symptoms, but many men experience some relief from mood disorders when hormone balance is restored.
Breast enlargement: Men who carry extra weight around the middle have more enzyme aromatase, which converts testosterone to estrogen. Increased estrogen can lead to increased breast enlargement.
Weight gain: High lvels of stress hormone, cortisol, can cause unstable blood sugar levels that may increased cravings.
Benign Prostatic Hypertrophy (BPH): Most men over 60 have signs of prostate enlargement, known as BPH. Some researchers have suggested that low testosterone and/or high estradiol may be contributing factors in prostate enlargement.
3. INSULIN RESISTANCE
What is insulin resistance?
Insulin is a hormone released by the pancreas. One of the major functions of insulin is to help transport glucose into tissues so it can be broken down and used for energy. Regular transport of glucose into tissue keeps blood sugar levels within a “normal” range. With insulin resistance, tissues start to resist the effects of insulin, which means that the pancreas must produce more and more insulin to maintain normal blood glucose levels. Over time, the pancreas becomes unable to sustain increased insulin production. This results inhigh blood glucose levels and a likely diagnosis of type II diabetes.
Conditions associated with Insulin Resistance
Diabetes: People with insulin resistance are over 5 times more likely to develop diabetes than those with normal insulin levels.
High Blood Pressure: Approximately half the people with high blood pressure also have insulin resistance. There is evidence that improving insulin sensitivity also improves blood pressure.
Heart Disease: People who are insulin resistant are up to 4 times more likely to have a heart attack or stroke than those who are not insulin resistant.
Polycystic Ovarian Syndrome (PCOS): In PCOS, ovaries contain numerous small cysts and may be enlarged. Women with PCOS often have hormone related problems like excessive bleeding, no menstruation, unwanted hair growth, and/or infertility. Women with PCOS are about 7 times more likely to suffer insulin resistance than women without.
4. ADRENAL FUNCTION
Stress is an unavoidable fact of life, which is why we have physiological systems in place to help us cope. Under stress, the adrenal glands produce the hormone cortisol plus the catecholamine hormones adrenaline and noradrenaline. Exposure to stress can result in what is known as the General Adaptation Syndrome, which has three major stages:
Alarm stage: In this stage bursts of the hormones cortisol, adrenaline and noradrenaline are released in response to a stressor resulting in the traditional “fight or flight” responses.
Resistance stage: The body uses high cortisol levels to free up stored energy that helps the body physically resist the stressor. However, a prolonged Resistance Stage may increase the risk of developing stress related diseases. If the cortisol levels remain elevated, symptoms may include: feeling tired but wired, difficulty sleeping, and anxiety. Excess cortisol also interferes with the action of other hormones (progesterone, testosterone and thyroid), creating more hormone imbalance and more symptoms.
Exhaustion stage: Adrenal glands are either depleted from producing too much cortisol or are reacting to the detrimental affects of high cortisol, and thus reduce cortisol production significantly. Symptoms of low cortisol may include fatigue (particularly morning fatigue), increased susceptibility to infection, decreased recovery from exercise, allergies, low blood sugar, burned out feeling, depression, and low sex drive. Other hormones can be affected, particularly aldosterone and DHEA. Symptoms of low DHEA are not well defined, although low DHEA often occurs with chronic illness.
Since cortisol is the major stress hormone produced by the adrenal glands, measurement of cortisol levels is an excellent means of assessing adrenal gland function. For accurate assessment of adrenal function, it is necessary to measure 4 cortisol levels throughout the day: within ½ hour of waking, before lunch, before supper, and before bed.
5. MELATONIN-CORTISOL INDEX
Melatonin is the main way that tissues are synchronized to daily cycle of light exposure and physical activity. Cortisol on the other hand, is critical for maintaining energy homeostais and modulating immune function. Melatonin and cortisol tend to run opposite to each other.
Cortisol approaches its low point at bedtime, whereas melatonin reaches a peak a few hours after cortisol bottoms out. The melatonin-cortisol index (MCI) is an innovative way of examining the balance between these two vital hormones. Deviations from the normal patterns for these hormones can have significant implications for overall health. Melatonin levels are measured in saliva samples taken at 3-4 hours after the patient is asleep in full darkness. Cortisol levels are measured in a saliva sample at bedtime.
Conditions associated with abnormal melatonin and cortisol levels
Breast cancer: research clearly links low late night melatonin levels with increased risk of breast cancer growth. Cortisol levels are also tied to breast cancer risk. Breast cancer patients with high average cortisol throughout the day and elevated cortisol levels at night have less effective mechanisms to protect themselves against cancer.
Other cancers: Circulating levels of melatonin are depressed in a wide variety of cancers including breast, endometrial, prostate, lung, gastric and colon. Lower nocturnal levels of melatonin are associated with larger tumours in patients with primary prostate cancer.
Immune function: Inhibition of melatonin synthesis correlates with lowered immune system.
Cardiovascular disease: Low night time melatonin has been reported in patients with coronary heart disease and heart failure. Similarly the link between high cortisol and hypertension is well known.
Depression: Depressed patients have a lower level of melatonin than non-depressed patients.
Bone: Melatonin inhibits bone reabsorption and increase bone mass. High cortisol levels can contribute to bone loss.
Weight management: Restoring melatonin to levels of early adulthood may suppress age-related gains in visceral fat. In addition high cortisol levels promote deposition of visceral fat
Primary epilepsy: Recent studies have suggested that people suffering from primary epilepsy have high cortisol and night and high melatonin during the day.
III. URINE TESTS
1. ESTROGEN METABOLISM RATIO
Estrogens are hormones produced in both men and women. Estrogens circulating in the blood eventually get broken down by the liver into estrogen metabolites, which are eliminated in the urine. The re are several different pathways estrogen can take on its way out of the body. Two of the major metabolic pathways are: 2-hydroxyestrone (2-OHE1) and 16-alpha-hydroxyestrone (16-OHE1). Research shows that a ratio of 2-OHE1 to 16-OHE1 in urine greater than 2 is associated with a lower degree of severity, or risk of developing, certain diseases. Maintaining a healthy balance in favour of 2-hydroxyestrogens may help preserve good health.
The estrogen metabolism ratio can be used to help women and men assess their risk of the following conditions associated with imbalances in the breakdown of estrogens.
Conditions Associated with Estrogen Metabolism Imbalance
Breast cancer: Several studies have shown that women with a lower ratio of 2-OHE1 to 16-OHE1 than age-matched disease-free women.
Cervical dysplasia: is a condition where pre-cancerous cells are found in the cervix. Studies have shown that that the severity of the dysplasia is greater in women with a lower Estrogen Metabolism ratio.
Recurrent Respiratory Papillomatosis (RRP): is a condition where non-cancerous tumours grow in the larynx, vocal cords and trachea. Studies show that the severity of RRP increases with a lower Estrogen Metabolism Ratio.
Prostate cancer: Men with prostate cancer are significantly more likely to have a low Estrogen Metabolism Ratio than disease-free men.
IV. STOOL ANALYSIS
1. Comprehensive Stool Analysis
Gastrointestinal complaints are among the most common reasons that patients seek medical care. Symptoms associated with GI disorders include persistent diarrhea, constipation, bloating, indigestion, irritable bowel syndrome and malabsorption. Comprehensive stool analysis can be used to assess digestive and absorptive functions.
2. Comprehensive Stool Analysis with parasitology
As above, but with the addition of the presence of opportunistic pathogens (parasitic worms, fungi, bacteria, amoeba, Giardia, Cryptosporidium) and to monitor the efficacy of therapeutic remediation of GI disorders.