In order for you to rebuild yourself and prevent another health catastrophe, you need to understand what in your internal terrain may have contributed to the development of your disease or chronic health issues. In this chapter, I’ve given lists of biomarkers and medical tests that can uncover the reasons for your poor health.
What are biomarkers? They are biological clues that can be measured through blood, saliva, or urine, and are used to evaluate normal physiological function; a pathological (disease) process; and your response to drug or supplement therapy. Biomarkers identify your potential for developing disease, as well as the current state and severity of disease, and they help predict future disease and probabilities for recurrence. Testing for certain biomarkers will provide information that will allow you to take appropriate action so you can rebuild. In addition to tests that will provide clues to the origins of your poor health, you will find specific tests that will give you information about your active disease—the current state of your condition. Identifying the specific clues outlined here will enable you to identify the dysfunction in your physiology and then create the best plan of action to resolve those issues, allowing you to rebuild your health.
Most chronic diseases have common threads and common causes. For example, inflammation is a core reaction in the body and a major player in the development of chronic disease. Abnormal blood sugar levels (dysglycemia) and high insulin (hyperinsulinemia) are markers of another important disease process linked to cancer, heart disease, dementia, Alzheimer’s, and other chronic diseases. High blood sugar and high insulin levels are also implicated in the onset of endocrine (hormone) disorders, including polycystic ovary syndrome (PCOS). If you are dealing with or rebuilding from coronary artery disease or cancer— or if you are concerned about Alzheimer’s disease—you should read the diabetes section. For any of the major diseases, definitely read the section on obesity and metabolic syndrome. The specific clues in the biomarkers will enable you to identify the dysfunction in your physiology, allowing you create the best plan of action to rebuild your health.
ALEX’S STORY
Alex is a college student who came in with her parents looking for causes for her weight gain, amenorrhea (absence of menstruation), increased body hair, and acne. She was also dealing with anxiety and obsessive-compulsive behaviors. Alex had been told by another doctor that her behavioral issues were caused by multiple tick-borne infections, including Lyme, babesiosis, and ehrlichiosis. She took four different drugs for six months to combat these infections. I asked what that doctor had told them would indicate that Alex was getting better. Her parents responded, “When the babesiosis marks turn white.” Babesiosis marks? I’m not an infectious-disease expert, but that sounded very odd. I asked to see the marks on her skin, and I was shocked to see everyday stretch marks. That doctor had convinced Alex and her parents that the stretch marks on her waistline were due to a tick-based infection, and the lightening of her stretch marks (often pink to reddish in color) was due to a response to the drugs. When I showed them similar stretch marks on countless images from a Google search, they were surprised and angered. Alex immediately stopped all the drugs she had been prescribed for Lyme, babesiosis, and ehrlichiosis.
To me, rapid weight gain, amenorrhea, and more abundant body hair all sounded like polycystic ovary syndrome (PCOS). Using saliva testing and whole blood or capillary blood to assess hormones, I found that Alex was low in progesterone and estrogen and that her testosterone was slightly elevated. In addition to hormone testing, general blood work revealed elevated blood sugar. This pattern is often seen in young women with PCOS. To help regulate her blood sugar, I worked with her to eliminate all bread, dairy, and processed sugars from her diet while providing substitutions, including healthful plant-based carbs and dairy alternatives. I also gave her nutrient supplements to help her with her hormone deficiencies and the PCOS. Within three months, she had lost weight (body fat) and started a more regular menstrual cycle.
Z NOTE: Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age; it is characterized by chronic lack of ovulation (anovulation) and the elevated androgen testosterone. Small cysts develop in the ovaries because of chronic elevated blood sugar and insulin levels. Hyperinsulinemia (elevated insulin) has been shown to maintain elevated androgens (male hormones), including testosterone, which can cause increased body hair and acne, as well as abnormal or absent menstrual cycles. The key to improving or resolving PCOS is controlling blood sugar and insulin.
While you rebuild yourself, you and your health professional can use these tests to assess your current health status and how your health is improving over time. You should test these biomarkers— depending on your health issue—at the beginning of and during your personal rebuild. Some of these biomarkers may be familiar, but many may not. No worries. Talk to your doctor or find a specialist in functional medicine who will get these tests done for you and help you interpret the results. Where applicable, I have listed labs that test specific biomarkers.
The Cardiovascular Terrain
If you are rebuilding from heart disease or want to prevent another heart event, testing the cardiovascular terrain and your potential for developing coronary artery disease must include biomarkers for inflammation, heart muscle damage, and potential root causes of atherosclerosis.
TESTING FOR ARTERIAL INFLAMMATION
This first set of biomarkers provides information regarding inflammation in the arteries. Since atherosclerosis is an inflammatory condition in the wall of the artery—not the accumulation of cholesterol—these biomarkers can provide information about the potential for plaque rupture and a pending heart attack or stroke. Testing arterial inflammation must include:
These tests should be your first priority. After all, for many, the first sign of coronary artery disease is sudden death.
TESTING FOR HEART MUSCLE DAMAGE
This set of biomarkers will tell you if the muscle of the heart has been damaged after a heart attack:
TESTING THE CARDIOVASCULAR TERRAIN
Damage to the endothelium, the layer of cells that lines the arteries, is the first step in developing heart disease. The following biomarkers provide the clues to how the endothelium got damaged, why you developed atherosclerosis, and what to test for to prevent recurrence or regression of the disease:
CLINICAL NOTE: High homocysteine indicates a risk for atherosclerosis and coronary artery disease, as it can oxidize LDL. A vitamin B12 or folate deficiency can cause elevated homocysteine. To determine if you have a B12 or folate deficiency, check the health of the red blood cells in a complete blood count. A true deficiency of either B12 or folate will cause an elevation in mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). MCV is a measurement of the average size of a red blood cell, and MCH is a calculation of the average amount of hemoglobin inside a red blood cell. Most blood panels test these levels, but check with your doctor to confirm. Elevated homocysteine levels are also seen in people with a common genetic variant called methylenetetrahydrofolate reductase (MTHFR). This defective gene leads to high homocysteine levels in some people who inherit the MTHFR variant from both parents. Blood testing can be done to determine if you have mutations in the MTHFR gene.
Z NOTE: Research published in Circulation found that thyroid hormones also have a profound effect on the heart and blood vessels. A weak or overactive thyroid will cause changes in cardiac contractility and output, blood pressure, and endothelial function. If you are recovering from a heart event and rebuilding yourself to prevent the progression of atherosclerosis, get your thyroid hormones (T3 and T4) evaluated.
The Cancer Terrain
From initial gene dysfunction and uncontrolled cell growth to angiogenesis (blood vessel growth) and metastasis (the spread of cancer from its original site), all stages of cancer development occur due to some disturbance in your physiology—your body’s internal terrain. Biomarkers in the blood can give clues to your genetic risk for developing cancer, why you ultimately developed cancer, your prognosis, and the effectiveness of your treatment.
TESTING FOR ONCOGENIC POTENTIAL
Your likelihood of developing cancer is called oncogenic potential. If you are rebuilding after cancer care and looking to prevent recurrence, assessing your continuing oncogenic potential is a must. The following biomarkers provide valuable information regarding your internal terrain and the disrupted physiology that increased your oncogenic potential and set you up for the development of cancer. Oncogenic potential tests include:
CLINICAL NOTE: Lactulose/mannitol test can be done through Genova Diagnostics (www.gdx.net). I recommend ZRT Laboratory (www.zrtlab.com) for hormone testing and hormone metabolite testing.
TESTING FOR PROGNOSIS AND THE EFFECTIVENESS OF TREATMENT
Biomarkers associated with cancer are usually used to monitor the extent of the disease, determine your prognosis (probable outcome), and evaluate the effectiveness of your treatment. If you are actively going through cancer care, your cancer team should be testing you to monitor your progress to determine how well your treatment is working. The following biomarkers are associated with different types of cancer:
If you are getting biannual or yearly cancer screenings, consider:
Z NOTE: Mammography has been the standard imaging method for detecting breast cancer since the late 1960s. The technology has changed since then, with more advanced machines and much less X-ray exposure. However, current research is now redetermining the best method for imaging breast tissue, and the contenders are mammography, ultrasound, and MRI. Researchers have found that ultrasound is more accurate for dense breast tissue, and mammography is better suited for fatty breast tissue. Data reported in the American Journal of Surgery and the Medical Journal of Malaysia showed that ultrasound was a more accurate diagnostic method than mammography in the detection of breast cancer in dense breast tissue. Diagnostic ultrasound was also found to be more accurate than mammography in predicting residual tumor size following chemotherapy. A study published in the American Journal of Roentgenology found that ultrasound was more accurate than mammography in detecting breast cancer in women forty-five years old and younger. Ultrasound detected 84.9 percent of cancers, while mammography detected 71.7 percent. However, mammography was found to be a better tool at detecting breast cancer in fatty breasts and in women fifty years old and older. If the presence of breast cancer is questionable on both an ultrasound and a mammogram, an MRI is suggested for evaluating residual disease and for detecting the subset of tumors not seen on ultrasound and mammography. Discuss these tests with your doctor to determine which screening method is right for you.
CLINICAL NOTE: The toxicity associated with chemotherapy can be devastating during cancer care and, for many people, long after. Following your chemotherapy regimen, you may develop chronic anemia consisting of low red blood cells, hemoglobin, and hematocrit. You may also be suffering from fatigue, low energy, and general brain fog. If so, get your thyroid tested. The thyroid hormone T3 affects all systems of the body and is also responsible for producing a hormone called erythropoietin (EPO) in the kidneys, which causes bone marrow to make more red blood cells. By increasing your red blood cell mass, you can quickly rebuild from anemia caused by chemotherapy, so making sure your thyroid is functioning optimally is essential.
TESTING FOR GENETIC RISK
If you have a family history of cancer—or are in the throes of cancer care—talk to your doctor to determine which of these genetic tests (if any) you should have done. Remember, genes don’t determine whether you develop a disease, but they can indicate if you’re at risk of developing the disease. Here is a list of genetic markers that can be tested to determine risk of certain cancers:
You may not need all these genetic tests. However, you may want to discuss them with your doctor to determine which are appropriate for you and your specific cancer.
The Diabetic and Alzheimer’s Terrain
Diabetes mellitus is a condition of high blood sugar resulting from either inadequate insulin production (type 1 diabetes) or lack of cellular response to insulin (type 2 diabetes). Alzheimer’s disease is also linked to abnormal blood sugar, insulin resistance, and inflammation.
TESTING FOR DIABETES AND YOUR RISK OF ALZHEIMER’S DISEASE
If you are rebuilding from diabetes and/or you want to understand your risk for developing Alzheimer’s disease, make sure to have these biomarkers tested:
CLINICAL NOTE: Your fasting blood glucose level must be tested when you have not eaten for at least eight hours. If you do not fast for eight hours prior to the test, your test results will be inaccurate.
The Autoimmune Disease Terrain
Autoimmune diseases are complex dysfunctions of the immune system involving an imbalance of the Th1 and Th2 immune responses. If you are dealing with an autoimmune disease and/or are in active treatment, ask your doctor about testing the balance between your Th1 and Th2 cytokines, along with CD4 and CD8 T lymphocytes. You must also consider looking at a leaky gut. It’s vital to eliminate any foods containing gluten from your diet, even if you have no apparent symptoms after eating gluten.
TESTING THE IMMUNE RESPONSE
These tests will give you a more in-depth look at the abnormal immune response:
TESTING FOR CELIAC DISEASE
TESTING FOR LEAKY GUT
CLINICAL NOTE: When testing for celiac or the other diseases associated with gluten and zonulin, don’t refrain from eating foods containing gluten. The tTG-IgA antibody test is a sensitive test but will be valid only if you are eating gluten-containing foods. If this test and the others come back positive, you must then give up eating anything containing gluten. Note, however, that not all people who are sensitive to gluten have celiac disease. If you have any symptoms after eating foods containing gluten but your tests come back negative, you must avoid gluten-containing foods anyway.
TESTING FOR PRIMARY BILIARY CIRRHOSIS
TESTING FOR MULTIPLE SCLEROSIS
TESTING FOR RHEUMATOID ARTHRITIS
TESTING FOR HASHIMOTO’S THYROIDITIS
The Obesity Terrain
Excessive body fat and visceral fat (fat surrounding the organs) can release hormones, modify your appetite, increase inflammation, and increase your risk for cancer, heart disease, and diabetes. Metabolic syndrome is a state of upper-body (truncal) obesity, high blood pressure, high blood fat (triglycerides), and elevated blood sugar. When rebuilding from obesity and/or metabolic syndrome, consider these tests:
General Health Profile
If you are looking to rebuild your body because of an unhealthful lifestyle, or you want to stay ahead of the disease train, here is a good overall biomarker panel to assess your internal terrain. If any markers are out of range, further investigation will be needed.
Note: When looking at anemia, include with the above:
Record Your Rebuild
As you apply the supportocols in this book, record your initial medical tests and your progress during your personal rebuild. Enter the name of the test and the results in the Medical Tests Report to track your progress. As you move forward with your rebuild, check your current levels with the results from your past tests and note any changes. For example, if you have problems with blood sugar, you would want to check your hemoglobin A1c and fasting glucose. If you have cardiovascular issues, you would check your lipid profile and inflammatory biomarkers. The frequency of testing depends on the severity of your condition. Ask your doctor if you should be retested every twelve or twenty-four weeks.
While you are improving your internal terrain and rebuilding from your current state of health, consider recording the changes in your body composition. We’ve already covered the instructions for calculating your BMI, total metabolic rate, and body fat percentage, as well as how to take your physical measurements. After your calculations are complete, enter the initial values in the 12-Week Progress Report. Every four weeks, weigh and measure yourself again, recalculate your BMI and other values, and enter them in the appropriate column. The comparison will provide evidence of your progress.
Here is a sample medical tests report:
MEDICAL TESTS REPORT |
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Name of Test |
Start |
12 Weeks |
24 Weeks |
Hemoglobin A1c |
6.8% |
5.3% |
5.1% |
Glucose |
120 mg/dL |
97 mg/dL |
86 mg/dL |
And here is a blank worksheet for you to use:
MEDICAL TESTS REPORT |
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Name of Test |
Start |
12 Weeks |
24 Weeks |
12-WEEK PROGRESS REPORT |
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Name of Test |
Start |
4 Weeks |
8 Weeks |
12 Weeks |
Body Mass Index (BMI) |
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Total Metabolic Rate (TMR) |
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Basal Metabolic Rate (BMR) |
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Body Fat Percentage |
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Body Measurements |
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Chest |
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Waist |
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Hips |
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Biceps |
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Weight |
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What other changes have you noticed? Do you have more energy? Are you sleeping better? Has your digestion improved? Make notes about any changes you have noticed regarding any symptoms you may have been having. |
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4 Weeks: |
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8 Weeks: |
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12 Weeks: |
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Whether you are recovering from an illness, want to prevent the recurrence of disease, are looking to improve your body composition, or just want information about your state of health, biomarker testing provides information about your internal terrain, and can show you the improvements you’ve made in your health as you progress through your personal rebuild.
Here’s to your victory.