Chronic pain and inflammation are two of the most common ailments that drive patients to see a healthcare provider. Designing a clinically effective treatment plan requires a precise understanding of the root cause. Laboratory testing can provide a more nuanced and detailed view—going beyond merely high and low values—to assist you in personalizing your treatment plan to a specific patient’s needs.
Dr. Dan Kalish, DC, is a leading voice in functional medicine and the founder of the Kalish Institute. A published author and practitioner for more than 30 years, Kalish’s collaboration with Dr. Richard Lord, PhD, has given him a front-row seat to the power of functional medical testing in clinical practice.
Treating Chronic Pain and Inflammation With Lab-Based Programs
Kalish shared this unique perspective and provided a deep dive into the practical application of lab data in an insightful live webinar with Fullscript practitioners. You can watch the hour-long session right here to gain a more comprehensive understanding of treating chronic pain and inflammation with lab-based programs. Below you can explore some highlights and key takeaways from the full webinar that you might find interesting.
“We’re running a program to make the patient feel better, so they keep coming back and are enrolled and engaged,” Kalish explains, “and we’re running a program to find the underlying cause, which is the heart and soul of functional medicine.”
To do so, Kalish thinks it’s crucial to look beyond the test numbers and find the story behind them. This is the critical insight from years spent with Dr. Lord, a leading figure in the development of many of the functional medical tests we use today. Tests can provide a clearer vision beyond the lab values. Rather than viewing lab results as isolated numbers, they exist on a spectrum of meaning. This is of critical importance when considering factors of chronic pain and inflammation, such as oxidative stress, omega balance, and mitochondria.
Kalish shared, “I think one of the most important lessons I’ve learned in the last three years of working with Dr. Lord so intensively is that he’s taught me not so much specific information but more like a worldview and an attitude and how to look at these labs.” Kalish underscored the importance of understanding the full spectrum of lab results, from high to low, and how they relate to a patient’s condition. This deeper understanding has led to an approach for more personalized and precise treatment plans—the ability to recommend highly targeted programs and watch for dramatic improvements in patients’ conditions.
1. Examining the spectrum of oxidative stress
While it’s well-established that a high level of oxidative stress can lead to a variety of serious conditions, it’s also essential to understand the impact of low levels of oxidative stress. This may challenge traditional thinking, but low oxidative stress can be equally concerning and problematic in certain contexts. Low oxidative stress might indicate issues related to inadequate mitochondrial energy production. As most oxidative stress comes from energy production in the mitochondrial pathways, a reduced level could indicate an insufficient number of mitochondria.
Dr. Kalish stresses the clinical implications of understanding both high and low levels of oxidative stress. This understanding can significantly enhance the ability to design effective treatment programs. By interpreting oxidative stress levels in conjunction with other lab data, practitioners can make more informed decisions about antioxidant support and other therapeutic interventions designed to minimize the impact of free radicals. These advanced interpretations of oxidative stress can lead to better effective treatment strategies that address complex health issues.
2. Finding balance between omega-3s and omega-6s
While it’s commonly thought that boosting omega-3s is always beneficial, this convention is being challenged as we develop a greater understanding of the interplay between omega-3s and omega-6s. Each can play a complex role in health and disease, so a clearer picture of the balance between them is helpful in achieving a more personalized and effective treatment plan.
Kalish explains, “If you’re assuming omega-3s are low then omega-6s are normal or high,” Kalish explains, “and you’re certainly not thinking about giving people a ton of omega-6s. But what you’ll see in labs, some people who aren’t low in omega-3s are actually very low in omega-6s. And in the sense that we don’t even really have a word for this. They’re under-inflamed, I don’t know what the term is, but you can actually have not enough omega-6s.”
Both omega-3s and omega-6s can play an essential role in health. Excessive omega-3 can exacerbate low omega-6 levels in some patients, leading to detrimental health issues. Mitigating assumptions with lab testing can better inform practitioners on proper balance and potentially deter what Kalish sees as a common practice of universally recommending high doses of omega-3s when not appropriate.
3. Understanding mitochondrial function
The powerhouse of our cells, evaluating mitochondrial function is the key to understanding a patient’s condition. The mitochondria generate most of the cell’s supply of adenosine triphosphate (ATP), the source of all energy use and storage within the cell. In functional medicine, the health of mitochondria is seen as central to overall well-being, impacting everything from energy levels to the management of chronic conditions.
These energy-production markers can play a very important role in controlling inflammation and the development of different kinds of pain syndromes. The Organic Acids Test (OAT) is a panel of essential biomarkers that evaluates mitochondrial function. For example, if certain organic acids are high, it can indicate low levels of CoQ10, vitamin B, and magnesium. These findings are easy to understand and address with dietary changes.
However, a more concerning state is where patients express patterns of extremely low markers. This is typically worse as it can demonstrate a reduced number of mitochondria. By measuring the different stages of energy production, it’s now possible through the OAT to see where blocks are occurring. As Kalish explains, “All the latest research now shows that this is what Dr. Lord calls a hypometabolic state, meaning there aren’t enough mitochondria present to make these reactions move forward.” Once understood the solution can be as simple as a proper supplementation plan. However, this only becomes clear by analyzing the full spectrum of results via the insights of diagnostic labs.
The bottom line
Patients are always looking for a quick solution to their problems, but the spirit of whole-person care is about uncovering the root cause. Diagnostic testing, including functional testing, is the key to unlocking a healthcare provider’s need to develop more personalized and precise treatment plans and improve overall outcomes. They’re a critical tool in better patient care.
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