There are a number of specialized medical laboratories that have emerged in the last 10-20 years in response to the growing number of chronically ill people in the western world. Many have either been left undiagnosed by traditional medical testing, or have been diagnosed with "untreatable", or controversial illnesses, including those covered on this site, for which there is no standard treatment. These labs cater mainly to doctors practicing 'functional medicine' and offer testing of various nutrient levels, oxidative stress and digestive function to name but a few.
Listed here are the most useful and most commonly used of these tests in relation to environmental illnesses.
Organic Acids Urinary Analysis
This is definitely the one single lab test that will yield the most information about a patients overall state of health. Traditionally, similar tests have been used to determine specific metabolic abnormalities in infants. They have now been developed to assess efficiency of cellular energy production, metabolic toxicity problems/detoxification function, functional vitamin, mineral and amino acid deficiencies and neurotransmitter metabolism. In addition, this analysis provides important information about clinically significant gut flora imbalances by detecting elevated levels of metabolic waste products from bacteria and yeast. All of these factors have been implicated in environmental illnesses by many different sources.
The organic acids analysis is the best place to start when attempting to solve chronic health problems. It provides a broad range of information which will identify areas that treatment should be aimed at and will also indicate the possible need for more specific tests in certain areas.
Approx cost: $125-$200 (US)
Comprehensive Digestive Stool Analysis (CDSA)
This test is one of the most widely used by functional medicine physicians, especially when gastrointestinal symptoms are present. By analyzing a single stool sample a lot can be learned about how well the digestive system as a whole is functioning and about the composition of the gut flora.
The CDSA provides information about the following:
- Digestion - enzyme level markers, stool pH, detection of undigested food particles.
- Intestinal Absorption
- Intestinal Metabolism
- Microbiology - detection of pathogenic bacteria, levels of normal/beneficial bacteria.
- Mycology - levels of yeast.
- Macroscopic Observations - observation of fecal colour, detection of pus, mucus and occult blood.
- Gut Immune Function - sIgA levels
From this information you will know whether, for example, you need to improve digestive function by supplementing digestive enzymes, whether you have a dysbiosis situation needing treatment with antimicrobials and/or probiotics and if your immune system is functioning effectively to control pathogenic organisms in the intestines. The CDSA can also help diagnose a specific disease when symptoms could point to many alternatives. For instance, a patient suspected of having irritable bowel syndrome may in fact have an inflammatory bowel disease which could be very serious left untreated; the CDSA can determine if this is the case.
Although the CDSA does test for yeast and hence is often used if a Candida overgrowth is a suspected problem, many top functional medicine doctors agree that this particular test is not particularly reliable for this purpose as yeast can be found in the stool of perfectly healthy people and it will often give false negative results, i.e. indicate that no yeast were detected when in fact the patient DOES have a significant intestinal overgrowth. One reason for this is because overgrowth of yeast is predominantly a problem in the small intestine and since the stool is formed in the colon, the yeast do not get caught up in it, and hence show up on examination.
The CDSA is available from Genova Diagnostics
See a sample CDSA result report here
Approx cost: $150 (US)
Intestinal Permeability Analysis
This is essentially a test for leaky gut syndrome and malabsorption, both of which are likely to play a part in all environmental illnesses. All you have to do is drink a special solution that contains different sized molecules and then provide a urine sample at a specific time afterwards. The amounts of each size of molecule detected in the urine sample will indicate how permeable your intestine is. If more large molecules than is normal are detected then your intestine is letting through larger pieces of material than it should. This will lead to increased activation of the immune system, allergies, intoxication by increased absorption of microorganism waste products. This test is simple and cheap so it is a good idea to make this one of the first test you have. If it finds that you have a leaky gut then you may wish to have allergy, liver function and nutrient level testing done as a leaky gut will lead to problems in these areas. Allergy and liver function tests are typically a lot more expensive.
See a sample intestinal permeability report here
Approx cost: $75 (US)
Liver Function/Detoxification Potential Tests
Sufferers of environmental illnesses commonly have impaired liver function. If the liver isn't functioning correctly it will lead to symptoms throughout the body due to the presence of toxins in the blood and increased oxidative stress. Liver function can suffer due to nutritional deficiencies (nutrients needed to produce liver enzymes), and increased workload due to leaky gut and intestinal dysbiosis. Chronic impairment of liver function coupled with intestinal dysbiosis can ultimately lead to multiple chemical sensitivities (MCS) if left untreated due to chronically increased levels of toxic chemicals (specifically acetaldehyde from yeast metabolism) in the blood.
There are a various tests that can assess liver function, the most used is probably the challenge test. Patients are given a number of challenge substances, typically caffeine, acetaminophen, and salicylate. These substances each require a different detoxification process so an overall picture of detoxification potential is produced. As with the intestinal permeability test, a urine sample is collected after a certain period of time and this is tested for metabolites of the challenge substances to see how efficiently they were detoxified by the liver.
Another way to test liver function is by looking at the levels of liver enzymes and certain important substances used in detoxification such as glutathione. Another important substance to test for is D-glucaric acid in the urine. If this is elevated it indicates that there is an increased amount of toxic substances entering the liver either from the gut or in the form of airborne chemical exposures.
If intestinal dysbiosis and leaky gut is severe enough, liver abnormalities may show up in standard liver enzyme tests used to detect liver disease.
Detoxification profile is available from Genova Diagnostics
D-glucaric acid levels are tested for as part of organic acids tests and also as part of the toxic effects screen available from Biolab (UK).
See a sample toxic effects screen report here
Approx cost: $100 (US)
Allergies are a very common part of environmental illnesses, be they the classical immediate reaction (IgE allergy) to pollen or animal dander or the delayed reactions (IgG allergy) to foods that are said to result from poor digestion and leaky gut syndrome.
Both IgE and IgG (these are different types of antibody) allergy testing is available from a great number of labs and they usually test for a vast number of possible triggers. Once allergies have been identified and are eliminated from your environment and diet, many people report feeling a great improvement in their overall condition.
The Environmental Illness Resource offers home testing kits for allergies that are cost effective and easy since they don't require a health professional to order them.
See a sample food allergy report here
10 Most Common Foods IgG: $100 (US)
Comprehensive Foods IgG : $200 (US)
10 Most Common Inhalants IgE: $100 (US)
Comprehensive Inhalants IgE: $150 (US)
Chemical Sensitivity Testing
Research has shown that MCS sufferers often show signs of toxic effects on immune cells. Tests have been developed that examine the response of immune cells, specifically lymphocytes, to a range of chemical substances said to trigger symptoms in MCS sufferers. These tests are carried out on a single blood sample and can give an indication of whether you are indeed having a physical reaction to inhaled chemicals and which specific chemicals are causing problems.
In the future as more is learnt about chemical sensitivities, other tests probably focusing on the brain may become available but until that time, these immune cell tests can be useful.
See a sample lymphocyte sensitivity test report here
Approx cost: $100 (US) for most common substances (extra chemicals may cost more)
Live Blood Analysis/Darkfield Microscopy
Live blood analysis is a special technique that allows you to see your blood in its natural state using a special 'darkfield' microscope. Unlike conventional microscopy where a bright light is shone directly through the sample, darkfield microscopy involves illuminating the sample laterally. As a result. blood cells and other blood constituents appear bright white in colour against a dark background allowing details to be seen that otherwise would not be. In addition, practioners using live blood analysis usually look at dried blood samples under normal microscopy conditions to analyze the way the blood clots.
The combination of live blood analysis and dry blood analysis is said to provide a wide range of information about the patients state of health. Some of the factors identified using this technique include:
- Vitamin and mineral status
- Toxicity levels and type
- Level of free radical activity
- Regulation of the body's acid/alkaline balance
- Health and efficiency of the red blood cells
- Activity levels and efficiency of the immune system
- Condition of the blood serum
Most practitioners will have a video camera connected to the microscope that allows the patient to view everything he/she is seeing on a monitor. These images can then be printed out and kept with other medical records. This is a unique experience and allows you to see exactly what is going on within your body. Looking at the red blood cells for example it is possible to discern from their size, shape and colour, information about iron and vitamin B12 status, the status of various other minerals and how well food is being metabolized.
This testing is usually quite expensive but it provides a vast amount of information from the level of gut dysbiosis to oxidative stress and nutritional status, it's rather like an all-in-one approach and could be used as an alternative to using multiple lab tests as such as those described above.
Obviously to obtain this test you'll need to find a local practitioner as an office visit is required.
Approx cost: Variable
Adrenal Stress Tests
Adrenal function has been found to be low in a large number of CFS anf fibromyalgia patients so this test may be useful as a low result would provide a sufferer with another angle at treatment. Many people feel dramatically better when treated for low adrenal function. A number of the major labs used by functional/integrative physicians provide an adrenal function test. These are usually in the form of a home kit for taking saliva samples at 4 hour intervals during the day. Tests indicate levels of cortisol and DHEA/DHEA-S. Multiple samples are required as the levels of these hormones vary naturally throughout the day.
The Environmental Illness Resource offers home testing kits for adrenal stress that are cost effective and easy since they don't require a health professional to order them.
See a sample adrenal stress report here
Approx cost: $100 (US)
Lyme Disease Testing
Lyme disease, caused by the Borrelia burgdorferi spirochete, is spread by tick bite, and the rate of infection is said to be increasing rapidly. Estimates for the US range from 18,000 to 200,000 new cases every year. Testing for Lyme disease is important because the symptoms closely match those attributed to chronic fatigue syndrome, fibromyalgia, gulf war syndrome, candida overgrowth, and others. The predominant symptoms usually being chronic fatigue, muscle/joint aches and pains, and cognitive dysfunction such as "brain fog" and poor concentration and memory. It has been suggested that a large number of patients diagnosed with these, and other illnesses, are actually suffering from Lyme disease. Testing for Lyme disease is often said to be less than accurate, but if you get the right tests done and the right lab, a dignosis may go a long way to improving your health once the correct treatment is started.
Western Blot - This test is used to determine if a person is making antibodies to Borrelia burgdorferi, and related bacteria, indicating the presence of infection.
Serum & Whole Blood PCR - Some people, especially those who have been ill for a long time, may not be producing antibodies to the Lyme bacterium. This may be due to immune dysfunction. It is therefore a good idea to also make use of the PCR tests available. PCR is short for Polymerase Chain Reaction, and is a method for directly detecting the presence an organisms' DNA in a patients blood (in this case Borrelia burgdorferi DNA).
IGeneX labs estimate an above 90% accuracy rate for detecting Lyme disease when these two tests are used together.
We recommend Western blot and PCR testing from IGeneX and Medical Diagnostic Laboratories
Approx cost: Contact labs directly for pricing
Bowen Q-RiBb (Quantitative Rapid Identification of Borrelia Burgdorferi) - A new testing method, that potentially represents a major breakthrough, is the Q-RiBb test, which has now been approved a US patent. The method uses a fluorescent antibody technique on whole blood. As it is "quantative", the test can determine the extent of infection and may therefore be able to distinguish the carriers from the patients with serious disease. Other advantages include the brief time required to complete the test, the final report includes digital photographs of the findings, and the Q-RiBb is the only test that is unaffected by whether the patient is currently (or recently has been) taking antibiotics.
Q-RiBb available from Bowen Research & Training Institute
Approx cost: Contact lab directly for pricing
ATP/Cellular Energy Tests
Energy production within the cell mitochondria is lower than normal in environmental illness, which has a knock-on effect on every process within the body. There are many factors that can influence the efficiency of ATP (the body's main energy molecule) production within the cell including nutritional status, digestive dysfunction, hyopglycemia, oxidative stress, and exposure to toxins. There are a few labs that provide specialized testing in this area:
Biolab UK - ATP profile
"ATP (adenosine triphosphate) is hydrolysed to ADP and phosphate as the major energy source for muscle and other tissues. ATP is normally regenerated from ADP by oxidative phosphorylation. ATP is present as a complex with magnesium. When aerobic metabolism fails to provide enough energy, extra ATP is produced during the anaerobic breakdown of glucose to lactic acid.
ADP re-conversion to ATP can be blocked or partially blocked by some environmental contaminants. Specifically, the translocator protein [TL] in the mitochondrial membrane can be chemically inhibited and its efficiency is also pH dependent. Changes in acid:base balance, magnesium status and the presence of abnormal metabolic products can have similar effects to zenobiotic inhibition of the [TL].
The profile looks at whole cells (neutrophil) ATP with and without added magnesium. The efficiency of ADP to ATP conversion is checked, as is the recovery of ATP production after artificial blocking of the reaction. The mitochondria are isolated and the [TL] is biased first to favour ATP provision from mitochondria to the cytoplasm and then to confirm normal use of ATP when the [TL] site is biased to ADP recovery from cytoplasm without return of ATP. Comments and conclusions are included in each report."
Genova Diagnostics - Cellular Energy Profile
"Evaluates fourteen organic acids that play a pivotal role in the generation of cell energy. Using a urine sample, the test can reveal metabolic distress associated with generalized pain and fatigue, which may arise in response to toxic exposure, nutrient imbalances, digestive dysfunction, and other causes. The profile also analyzes mitochondrial dysfunction and acquired errors of organic acid metals."
Approx cost: Contact lab directly for pricing
RNase L Panel
It is becoming clear that in chronic fatigue syndrome intracellular immune dysfunction is central. Researchers are finding that people with CFS become ill due to an abnormal immune response to a viral infection. This immune dysfunction is centred around the RNase L pathway which remains active when it should switch off following viral infection. As a result of this immune dysfunction ensues with a reduced ability to fight off infections while at the same time an increased risk for allergies and autoimmune conditions develops. This all has a knock-on effect on other body systems, particularly in terms of brain function and the regulation of hormones.
The RNase L Panel can be used to screen for the immune abnormalities that appear to be characteristic of CFS. It can therefore be used as a confirmation of a CFS diagnosis (in the absence of an officially recognised definitive CFS test) and can point to the need for further testing to identify specific infections.
RNase L Panel available from Redlabs USA, Inc
Cost: $445 (US)
Home Testing Kits from The Environmental Illness Resource Store
We are now able to offer an extensive range of home test kits that don't require a doctor to order and can be completed quickly and easily in the comfort of your home. Once you have taken your sample you simply post it to the lab in the prepaid envelope and await the report.
Tests available include:
- Mineral Check
- Stress Hormone Check
- Sleep Hormone Check
- Thyroid Hormone Tests
- ELISA allergy testing
- Water Quality Test
Household Mold Test
These books, written by some of the most prominent and experienced doctors in the field in integrative/functional medicine, contain a lot of information relating to the lab tests on this page. The doctors share their experiences over many years using the tests to diagnose and help target treatment of patients with environmental illnesses. Included in both books are case studies of patients who were successfully treated using the information revealed by these lab tests.