What Are Functional Medicine Tests and How Can They Help Your Health?

Have you ever felt dismissed by your doctor?

One of the most common stories I hear from my patients when they come to me for functional medicine treatment is that they primary care doctor told them they were “fine.” In some cases, their doctors even ran a blood panel, reviewed the test results, and proudly told the patient that nothing was wrong. The problem is, for these patients, that wasn’t good news.

That’s because they didn’t feel like everything was “fine.” Quite the opposite, actually! These patients had made appointments with their doctors (and often waited a long time to see them) because they were dealing with troubling, debilitating symptoms. From fatigue and brain fog to digestive distress, and more. Seeing a healthcare provider only to be told there is no diagnosis feels dismissive, invalidating, and frustrating because no answers means no treatment; and no treatment means they need to keep feeling bad.

The Problem With Traditional Medicine and PCPs

The traditional medical model sets us up for failure in these cases. If a PCP exhausts his or her tools for screening a patient, that patient is left in the dark to figure things out on their own, or to find another model for medical care. That’s where functional medicine comes into play.

Functional medicine’s goal is to identify the root cause of disease. That means understanding the patterns of breakdown in bodily systems that lead to devlopment of disease. Diagnosing disease, for the most part, is not that hard. You simply need to run the right tests and conduct the right clinical exams. In some cases, doctors do a bad job of this, but that phenomenon isn’t simply a consequent of traditional medicine. (There are good doctors and bad doctors everywhere!) But where a given disease process isn’t obvious, we need to also recognize that underlying processes which will one day result in clinical disease, create pathological symptoms in the mean time.

Take blood sugar problems, for example. Type 2 Diabetes is a disease in which the pancreas fails to produce enough insulin, and the body’s cells fail to respond effectively to insulin, enough to keep blood sugar levels from rising dangerously. In this disease, the high blood sugar levels cause poor blood circulation, organ damage, vision problems, nerve pain and loss of sensation, low energy and weight gain. However, before Type 2 Diabetes develops, we see prediabetes. Before prediabetes, we see insulin resistance. Before insulin resistance, we see patterns of abnormal blood glucose spikes and drops. Where traditional medicine says “You’re good! You’re not diabetic!” in thise early stages, functional medicine recognizes the red flag that those early pathological states are, and validates the fact that patients in those early disease states still experience symptoms worth addressing.

But we need to be able to clinically diagnose those early disease states, because the feeling of rising-and-falling blood sugar are similar to the early stages of subclinical hypothyroidism, perimenopause, allergies, anxiety, and so many other things. In the absence of accurate test results, it’s easy to tell a middle-aged woman that her symptoms are “probably” due to aging and perimenopause, for example, or a a young adult with chronic allergies that the other symptoms are “probably” just part of those allergies. “Allergies are bad this year!”

But “probably” is not a diagnosis. “Probably” doesn’t help anyone.

Functional Medicine Tests to The Rescue

With the blood sugar example outlined earlier, in order to understand whether a non-diabetic patient is dealing with prediabetes, or insulin resistance, or poor blood sugar control, or a problem entirely separate from metabolic dysfunction, we need to run testing to identify what’s going on.

To do that, functional medicine doctors use two types of testing: more comprehensive standardized tests, and specialized functional medicine tests.

Comprehensive Standardized Tests

In this discussion, “standardized tests” refers to testing that a traditional medical provider could and may actually run, but typically doesn’t. As an example, about 50% of PCPs that I co-manage care with run vitamin D tests on patients as part of an annual screening and the other 50% do not. My husband’s primary care doctor ran it without him even asking and mine did not put the order in until I directly asked. Some others flat out refuse even though it’s completely reasonable for them to do so.

Similarly, with the topic of metabolic health, PCP’s could run fasting insulin levels in addition to hA1c, fasting glucose and triglycerides. In the realm of cardiovascular health, a PCP could easily test LDL Particle Number in addition to LDL levels on a cholesterol panel. It’s not typical but it is definitely possible.

Here are some other examples of comprehensive testing that could be run in a standard medical office:

• Fasting insulin in addition to hA1c, fasting glucose and triglycerides
• A full thyroid panel instead of just TSH
• Inflammatory markers, like hs-CRP and sedimentation rate
• Cycle-specific testing of estradiol, testosterone, progesterone and DHEA levels
• Ferritin, serum iron, % saturation and TIBC in addition to a CBC
• Vitamin B12, folate, zinc, magnesium and vitamin D levels

The Cost of Testing

Because these tests are available through traditional labs, they are often able to be covered by traditional health insurance, provided they are used correctly and coded for correctly. In some cases, however, you should be aware that insurance companies may refuse to pay for certain tests to be used as screening. So, if a provider orders them for you, as with all testing and procedures, you should call your insurance company first to know what you might be expected to pay.

The reason most primary care doctors don’t run these comprehensive tests is because it’s not the easy, standard model. It’s more complicated to code for these tests, and more comprehensive follow-up is necessary. Unfortunately the way our current medical system is built, doctors just don’t have time for those things. The average doctor’s appointment is less than 20 minutes, and patients typically see their doctors less than once per year. It’s an overburdened and broken system for sure. That’s why we need not only functional medicine doctors to fill gaps, but a reform of the system to provide better care in general.

Functional Medicine Specialty Testing

Beyond the comprehensive testing that’s available through traditional labs, functional medicine doctors sometimes run tests that are not available through the traditional medical model. Additional training and enrollment in laboratory services is required for these higher-level tests. These tests are at the cutting edge of medical testing, and they don’t necessarily lead to diagnosis of a clinical disease, like Type 2 Diabetes, for example. However, they help identify some of the earlier disease processes that lead to both current symptoms and future development of disease.

Here’s an example: there is no medical diagnosis in the traditional model for a deficiency of beneficial bacteria in the human body. However, we all know just how important probiotics are for human health, and the problems that are caused when we wipe them out (like from overuse of antibiotics.) We know that bacterial imbalances cause severe digestive distress, and also that they create a breeding ground for new infection (C. diff for example.) Functional medicine offers stool testing to identify bacterial imbalances which both create risk of future disease as well as present-day symptoms.

Here are some other examples of “above-and-beyond” testing in functional medicine:

• Salivary and urinary hormone metabolite testing
• Microbiome testing
• Intestinal markers of digestive enzyme activity, inflammation, and short-chain fatty acids
• Cardiovascular markers like LPA PLA2, lipoprotein(a), omega-3 levels and more
• Comprehensive heavy metal testing
• Mold testing
• Organic Acids Testing
• SIBO Testing
• Continuous Glucose Monitoring

…and so much more

Cost of Testing

Because these tests are highly specialized and on the cutting edge of medical advancement, most insurance companies will not pay for them. While some testing panels may include elements that would be covered by traditional insurance, such as occult blood in stool or 17-hydroxypregnenolone, for example, the laboratories themselves do not contract with insurance companies and therefore it is not possible to have coverage for them. The cost of individual tests that may have coverage outside of the panel are negligible when run as a full panel, which offers much greater value than trying to piece together individual tests a-la-carte and not having the full picture. The primary value of these tests, of course, comes from their ability to explain symptoms where traditional labs fall short.

The beauty of functional medicine tests is that they provide a way of diagnosing and describing a person’s symptoms and health status with objective, medical data, creating the possibility of creating a treatment plan as a next step. When doctors and patients understand the health condition at play, the suffering person can finally find healing.

Because, I think we can all agree that if a person is experiencing symptoms, they aren’t “fine.” If the lab tests come back normal, it means the right lab tests haven’t been run yet. And until a diagnosis is made, that person is going to keep on feeling terrible and potentially create lasting health problems in the long run. But functional medicine offers the solutions needed to meet patients where they are and help them restore their health before it is too late.

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I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.

I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.

If you’re looking for a new way to approach your health, I’m here to help you through it. Click to learn more.