As an acupuncturist and doctor of traditional medicine, I often see people who have been to functional medicine doctors, naturopaths, and other healers for functional lab tests. While these providers fill an invaluable niche – offering labs that are not always covered by insurance to solve stubborn, chronic, idiopathic and complex issues – there are often preliminary steps that can be taken to increase patient compliance in testing, retesting and adhering to therapeutic protocols. One simple step is to clarify the value of a “functional” vs conventional test, so that a person knows what their options are and can adjust or change their approach as their health status evolves.
The DUTCH (Dried Urine Test for Comprehensive Hormones) lab is one of the most frequently used functional labs. Let’s take a closer look at the DUTCH lab to not only explain why it is a good example of a “functional” lab, but also the instances in which it can be most useful, as well as the optimal timing for testing and retesting.
Though somewhat arbitrary, some of the main variables defining a lab as functional include:
Collection method
Ideal test range standards
Application of test results in healing protocols
Functional labs can provide a more holistic picture together with, or even as a substitute for, more frequently used, conventional collection methods. The DUTCH lab alone has an advantage in the fact that it not only looks at hormones and metabolic markers, but includes four testing strips to allow for measurement of cortisol level fluctuations throughout the day. This helps pinpoint exactly when the cortisol is higher or lower than average. If we just looked at the overall number, then someone whose levels are too high at one point of the day and too low at another point, would average out to have similar test results to that of someone with healthy levels. Tracking fluctuations means we can look deeper into stress factors occurring at certain times of day and tap into the circadian rhythm with specific activities or supplements, saving time and money while giving optimal results.
Blood serum panels are a common conventional testing method for cortisol, reproductive hormones, thyroid hormones, insulin, growth hormone and many others. While often covered by insurance, serum testing may be too vague to provide a plan of action that meets the higher standards of a holistic approach. For example, blood serum tests can be helpful when assessing autoimmune based thyroid issues, but can also present as normal if there is another underlying reason for thyroid based symptoms.
Saliva is another collection method for cortisol and sex hormones, but may be challenging to collect in large quantities several times a day for some. Specimens can also be easily contaminated by food, drinks, products applied on the mouth or even slightly bleeding gums. Saliva tests are also greatly affected by hormone replacement therapies. Overall, it may be an adequate test for assessing the bioavailability of cortisol, DHEA, estrogen, progesterone and testosterone to bodily tissues. However, saliva testing is not as good at revealing how these hormones are metabolized over a period of time through the body.
Of course, the above mentioned examples are only to illustrate specific instances of how one kind of test can leave out valuable information. Comparing several methods is the optimal approach, but if you were going to start with just one that reflects a general picture of metabolic function, the DUTCH provides the best baseline. Since the goal of holistic health is to encourage your body to produce and circulate hormones and other metabolites on its own, this method may provide the most simple and cost-effective starting way forward in helping the body to self regulate and minimize dependency on outside sources.
A “functional” reading of lab results generally involves a higher standard, therefore, a narrower, more precise ideal test range. In the case of the DUTCH test, being more precise means looking at cortisol level fluctuations through the day in relation to other metabolites as this may provide a key to hidden sources of imbalance.
By aiming for a higher standard in health, and not just whether or not something falls into a zone associated with diseases or syndromes, correlation of test results with signs, symptoms and other labs provide a holistic understanding of a patient’s health profile. This is valuable not only in the case of preventative medicine, but also when someone has an unknown cause of illness due to conventional labs requested being directly related to their issue instead of adjacent or holistically related.
There are specific instances where something like the DUTCH lab could be beneficial, especially if the issue is not being resolved with previous efforts. These instances often involve aspect related to stress, energy levels, mental, hormonal and reproductive health. If you have an acute injury or stress response from something that is self explanatory – like an accident or a traumatic event – then observation through things like orthopedic assessment or simple verbal inquiry may be all that is needed. If these issues lead to, or occur along with chronic and/or internal symptoms and syndromes, like pain from fibromyalgia or being unable to sleep well weeks after a stressful event, then a DUTCH test may be helpful. Some specific examples include:
Migraines that occur during certain times of the menstrual cycle
Chronic back pain that flares up during times of increased stress
Energy levels that fluctuate due to thyroid issues
Sleep quality that has been drastically reduced after becoming dependent on medications
Mood or outlook negatively affected after attempting to reduce addictive substances
Ideopathic infertility where serum and/or saliva based markers have not sufficiently helped
For any lab, knowing when to test and retest are crucial for cost-effective, targeted results. In traditional medicine, constitutional types and observations like tongue and pulse reading can help correct underlying issues, so that reliance on testing is reduced. Holistically speaking, there are many ways outside of labs used to gage health markers, from observing the mood, gait, posture, tongue and pulse of an individual to careful assessment of medical history and lifestyle details. These methods can offset the need for costly labs or even provide lifestyle guidelines that, when adhered to for a period of time, create a baseline for clearer, more useable test results should they be needed later.
Thus my general approach involves the following flow of action:
- Establish patient history – including labs done in the past year, any hormone replacement or other medications that may alter test results, and the relationship of chronic, underlying issues to acute and/or recent concerns
- Using tongue, pulse, and other traditional observational methods to establish the individual biodynamics of the patient; in other words, what is considered normal for the particular person’s constitution (i.e. bodily frame, overall coloring, personality, energy levels, expectations, goals, etc.)
- Treat the patient with a combination of acupuncture and basic supplemental considerations, with the addition of other specific modalities, herbal formulation or basic lifestyle suggestions as needed; this reduces acute symptoms that may through off baseline test results, as well as establish a healthier circadian rhythm of daily sleep, energy levels, mood, etc.
- Once symptoms are stabilized for a month after taking a break from treatments, testing or retesting may then be suggested in order to get a true baseline reflecting the actual overall health status; specific, more targeted testing may then be done as well to assess whether more intensive overall interventions are truly necessary or if balance can be restored with simpler, more gentle approaches
When presented with the overwhelming amount of options available for not only testing, but subsequent therapies and supplementation, it is necessary to establish a clear picture of the current issues and concise steps forward connecting the healing and maintenance phases of holistic health. Functional testing can provide insight into what kind of intensive modalities, herbal formulations and nutraceuticals should be employed immediately, while moving toward specific lifestyle habits, superfoods and modalities that can be done for a prolonged time as part of a maintenance lifestyle. Retesting can provide valuable insight on the effectiveness of treatments and the evolving picture of health as a patient ages or undergoes specific life changes.
Besides preparing a patient mentally for functional testing by helping them understand their benefits, we can prepare physically as well. By using balancing modalities like acupuncture to address constitutional issues, a baseline can be established for optimal lab results. This is done by clearing out transient issues that are not truly reflective of longterm, overall health, while also activating the self-healing process that allows healing properties in the body to become more bioavailable and self-regulatory. This allows the body to be self reliant for longer without as much dependence on conventional or even holistic interventions. It can help differentiate chronic, underlying issues from those that are short term, superficial and/or easier to ameliorate. In addition to things like acupuncture, there are other methods for preparing the body for functional testing. In the next blog post, I will go over preliminary steps to consider before you start testing, in order to have clearer results and plan of action.