There is a common saying in integrative medicine: test, don’t guess.
To illustrate this industry adage, Dr. Carrie Jones, who is a naturopathic physician board certified in endocrinology, uses the example of fatigue. “Fatigue is a common reason people go to the doctor, but the actual cause of the fatigue often requires some investigation,” explains Dr. Jones. “Is the fatigue due to a thyroid problem? Low cortisol? Low vitamin D or B12? Is it mold or food intolerance? I don’t know the answers to these questions until I take a thorough medical history and then order the appropriate lab work.”
What is a lab test?
Laboratory tests collect samples of blood, saliva, stool, urine, or even hair to determine if there is an underlying health issue that needs to be addressed. (6) “The best use of labs is to complement a thorough history and clinical visit to either confirm, rule out, or screen a patient for potential conditions that could be relevant to that patient,” said naturopathic oncologist Dr. Tina Kaczor, ND, FABNO, who is a naturopathic oncologist and the co-host of the Cancer Pod podcast.
Following is a list of some of the basic clinical laboratory tests that are frequently ordered:
- Basic metabolic panel: measures eight different substances in the blood, including blood urea nitrogen, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, and sodium
- Complete blood count: measures hematocrit, hemoglobin, mean corpuscular volume, platelets, red blood cells, and white blood cells
- Glucose test: measures glucose (blood sugar) levels in the blood
- Lipid panel: looks at total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides
- Liver function tests: may include albumin, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, bilirubin, gamma-glutamyl transferase, lactate dehydrogenase, prothrombin time, and total protein
- Thyroid function tests: measure thyroid stimulating hormone (TSH), T3, T4, thyroid stimulating immunoglobulin (TSI), and antibodies
- Urinalysis: checks the urine for bacteria, traces of blood, white blood cells, color, concentration, crystals, bilirubin, pH, and other abnormalities (2)
An integrative approach to lab tests: going beyond the basics
There are hundreds of different clinical laboratory tests available to doctors that help them detect a condition, determine a diagnosis, develop a treatment plan, and monitor progress over time throughout a patient’s lifetime. (4) For practitioners, it’s important to understand which laboratory tests are appropriate for each individual patient.
“I have found that integrative and functional medicine practitioners do a more comprehensive job because they will often go well beyond basic foundational tests,” said Dr. Jones. As a hormone specialist, she uses the example of a male patient with low testosterone. “For this patient, the primary care doctor may only order total testosterone, but that may be omitting key aspects that can influence testosterone status, such as free testosterone, sex hormone-binding globulin, estradiol, thyroid numbers, and more.” Another example she says is with heart health as “there are now more advanced lipid panels to help further evaluate cardiovascular disease beyond the basic fasting cholesterol test.”
Another good example of knowing which test to choose is with C-reactive protein (CRP). CRP measures inflammation, but it should not be confused with high-sensitive CRP (hs-CRP), which measures much lower levels of CRP to specifically determine the risk of heart disease. (5)
Utilizing laboratory tests as an educational tool is also important according to integrative medical expert Dr. Ronald Hoffman, host of the popular nationally syndicated Intelligent Medicine radio program and podcast. “Lab tests provide a teachable moment for patients that highlights potential health risks,” said Dr. Hoffman. “They also provide patients with a report card gauging progress and showing them the impact of their diet, exercise, supplements, and if necessary, medications.” And as we know, patient progress leads to better adherence to the treatment protocol.
Education for the healthcare professional is also important. “The lab testing field is exploding, and I never stop learning about different lab testing options,” said Dr. Jones. “Lab testing can be overwhelming for the practitioner so ongoing education is key or a referral in more complex cases may be necessary.”
Avoiding over testing
Laboratory testing is not without downside. According to a 2021 systematic review looking at the issue of overuse of diagnostic testing, “the use of a diagnostic test is not always appropriate, as it may generate false positives, produce downstream cascades of more testing, expose patients to radiation or other harms, and create unnecessary patient anxiety…” (3) That review did find that over-testing in healthcare is presently occurring, and in some cases such as non-specific low back pain, it is frequent.
“I will not order labs for a patient when the signs and symptoms give me a clear picture,” said Dr. Kaczor. “If the patient has a hard time accepting my assessment or if my initial assessment proves not to be correct, I will then order labs.”
“I started out as a major lab test enthusiast, but I soon discovered that sometimes this resulted in too much information with false leads and disparate findings that were overwhelming,” said Dr. Hoffman. “Now I am very targeted about the tests I order, especially because over-testing imposes costs and inconveniences to patients.”
Both Dr. Kaczor and Dr. Hoffman say that the longer they have been in practice, the less they utilize laboratory tests.
Dr. Jones also works hard to avoid over-testing. “I was taught that a good intake and history during the initial visit is more than half the battle,” she says. “This will help determine what lab work may be necessary or not and what lab work can wait.”
The bottom line
Lab testing is only as good as the interpretation and treatment protocol they help create. “Over the years, I’ve seen many patients who bring in reams of test results with them who are frustrated because no one has properly interpreted the results and there is no concrete action plan,” said Dr. Hoffman.
Each year, billions of clinical laboratory tests are performed, many of which help with disease prevention and early detection to save lives and protect the patient’s quality of life. (1) For the patient to get the most benefit from laboratory tests, most integrative health practitioners will agree a prudent, targeted approach is best.
- American Clinical Laboratory Association. (Accessed 2022, April 26). Value of lab testing. https://www.acla.com/value-of-lab-testing/
- Horton, S., Fleming, K. A., Kuti, M., Looi, L., Pai, S. A., Sayed, S., & Wilson, M. L. (2019). The top 25 laboratory tests by volume and revenue in five different countries. American Journal of Clinical Pathology, 151(5), 446-451. https://academic.oup.com/ajcp/article/151/5/446/5237639?login=true
- Muskens, J., Kool, R., van Dulmen, S. A., & Westert, G. P. (2021). Overuse of diagnostic testing in healthcare: a systematic review. BMJ Quality & Safety, 31(1). https://qualitysafety.bmj.com/content/31/1/54
- National Institutes of Health. (2022, April 12). Medline Plus medical tests. https://medlineplus.gov/lab-tests/
- National Institutes of Health. (2020, December 3). Medline Plus C-reactive protein (CRP) test. https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/
- Picó, C., Serra, F., Rodríguez, A. M., Keijer, J., & Palou, A. (2019). Biomarkers of Nutrition and Health: New Tools for New Approaches. Nutrients, 11(5), 1092. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567133/