Testing: Where to Begin?

Improve Patient Health with a Logical Flow of Testing
Many clinicians new to functional medicine often wonder if there is a logical starting point. They see extensive test menus and unfamiliar terminology, and it can be overwhelming.

If your patient is presenting with highly specific complaints, such as chronic diarrhea or bloating, it would be obvious to consider GI screening or SIBO breath testing. Or perhaps your patient wants as much diagnostic work all at once and can afford to do so. In general, however, it is almost always recommended to start – if just choosing one initial lab test – with a HPA Stress Profile.

HPA (hypothalamic-pituitary-HPA) axis dysfunction is involved in virtually every physiological process in the body. It does not matter whether the condition is caused by, or simply correlated with, an increase or decrease in HPA axis dysfunction (otherwise known as maladaptation to stress).

Unhealthy lifestyle habits (poor diet, inadequate exercise, insufficient sleep, lack of relaxation, and internalizing emotional stress) are sources of chronic stress that may be underlying causes of HPA axis dysfunction and hormone imbalance. Other common sources of chronic stress include: food sensitivities, inflammation, GI infections, and heavy metals. Chronic stress erodes health and compromises longevity by impairing the function of critical systems in the body.

Under chronic stress, the HPA axis downregulates the output of cortisol—often referred to as the “stress hormone.” The principal hormones produced by the HPA glands—cortisol, DHEA, aldosterone, testosterone, estrogens, and progesterone—can all suffer when HPA axis dysfunction or maladaptation to stress occurs.

By supporting proper HPA function, you take great strides in restoring and improving health:

1Relieve your patient’s symptoms.
They can get some form of immediate relief and begin to start feeling better. For example, just getting enough sleep can do wonders for a patient’s mindset. HPA testing with Cortisol Awakening Response (CAR) measurement, highly detailed insights into your patient’s stress response can be obtained. Lifestyle, nutrition, and supplement support will be refined as a result.

2Increase the body’s metabolic reserves and improve the stress response.
Once the metabolic reserves are being replenished, the body can begin to better adapt to stress. Whether that’s something like an increased immune response to an infection or better mental stamina to confront challenging work issues, the HPA plays a vital role in regulating the capacity to heal and thrive.

3Give your patients confidence.
When you can start helping them feel better immediately, it gives them the assurance to know that they are in the right clinical hands. This greatly helps improve patient compliance, which as we all know is half the battle in helping people get better.

For a thorough foundational assessment, we recommend starting with the HPA Stress Profile with CAR +5 & SIgA (#205A-S-CAR).

You have a wealth of information there that is extremely valuable for an initial workup. Not only will these results help direct therapeutic options, they will also help you take the next step in identifying sources of chronic stress. For example, an elevated SIgA reading may be indicative of a chronic infection, while a low melatonin value guides decisions on how to assist a patient with sleep difficulties.

Patient on Tight Budget?
If your patient is on a tight budget, we recommend starting with the basic HPA Stress Profile (#201A), ideally with the Cortisol Awakening Response (CAR) measured. This HPA/CAR screen provides the diurnal rhythm of cortisol, CAR, cortisol to DHEA-S ratio, and includes a perceived stress survey which adds value to interpretation. These measurements have been determined by peer-reviewed literature to be the most reliable lab tests to assess the impact of maladaptation of stress on the body.

If you still have questions about how to start, please contact us! We have lab advisors ready to help. Each advisor has been working in functional medicine for many years and can share their personal experiences and a host of relevant information to help you make the best choices for your patients.