- Is about probabilities
- Not Absolutes
- No marker on any test is an absolute indicator of pathology
- Only a probability
When defining laboratory values of certain levels of Saliva, Blood and/or Urine, there are no absolutes that can be written in stone because the value that “Should Be Here” has to be balanced against other values that “Should Be There”.
Blood Serum Tests
The next question of – “Do the symptoms match the lab test should be asked with every lab analysis.” It is highly unlikely that a person with cholesterol of 258 and triglycerides of 373 would wonder into the office one day and be totally asymptomatic. Knowing that chronic inflammation is associated with insulin resistance and diabetes. This makes white blood cells of 4.4 highly suspect as being in normal range. This may be an indication of fatiguing bone marrow production and an InflammAged immune response.
The body is set up for short sharp bursts of inflammation, to combat microbial, mechanical or chemical insults. This inflammation is guided by the Neuro-Endo-Immune Supersystem. The whole point is to generate enough inflammation to combat the threat through (acceleratory neurotransmitters, inflammatory cytokines & chemokines, white blood cells and the sympathetic nervous system) and then cool, repair and close up the area of injury ending the inflammation through (inhibitory neurotransmitters, anti-inflammatory cytokines and chemokines, white blood cells and the parasympathetic nervous system).
Disruption of the NEI Supersystem through long-term stress, the ingestion of inappropriate foods and chemical irritants; plus the constant boosting, stimulating and strengthening of the immune response through supplements create a state of chronic inflammation. Our immune system can become fatigued, working at a low level, no longer able to generate enough energy for full protection, but still causing on going cell damage through low-grade inflammation. We become both depleted of certain white blood cells while others continue to maintain the inflammation.
If the patient has history of autoimmune diagnosis and symptoms of inflammation. A lab report with white blood cells in the normal range could indicate that this is the best the bone marrow could produce under the circumstances.
The problem with inflammation is not how often it starts, but how often it fails to subside. Perhaps no single phenomenon contributes more to the medical burden in industrialized societies than non-resolving inflammation. Non-resolving inflammation is not a primary cause of atherosclerosis, obesity, cancer, chronic obstructive pulmonary disease, asthma, inflammatory bowel disease, neurodegenerative disease, multiple sclerosis, or rheumatoid arthritis, but it contributes significantly to their pathogenesis.
The problem with inflammation is not how often it starts, but how often it fails to subside.Dr. Dave
Despite its name, Ominous Markers accompanies chronic as well as acute inflammatory states and is associated with a wide variety of serious disorders, including infection, trauma, infarction, inflammatory conditions, other systemic autoimmune and inflammatory diseases, and various cancers.
How Doctors Critically Analyze Lab Tests?
Doctors, Yes, even those Certified at a Functional Medicine Course are not taught to look critically at Laboratory Test Result. They are taught to look for highs and lows. The difference between Free-Fractioned and Protein Bound Hormones is rarely discussed. Free-Fractioned and Protein Bound Hormone analysis will fall into various camps according to the Professional and Social Media Influencers they follow. Each side claiming the other is invalid.
The Doctors sit through a three day seminar drinking from a firehose are rarely able to practice any critical thinking presented at the seminar. Typically, all they come away with is a list of supplements to recommend. But not much of an idea of when the should be used.
There is nothing wrong with the Lab companies. It is the lab analysis that creates the problem with poor results. Lab companies must be certified. The lab results are accurate. The problem is the lab analysis. A Hormone Lab analysis with roots in the erroneous Bio-Identical Hormone information (Figure 2), using the Standard Medical Hormone Blood/Salivary Steroid Testing chart.
Blood (serum), Free-fraction, Saliva, and Urine Hormone Tests are not equal.
The human endocrine system consists of a network of organs and glands that produce the hormones. A hormone is a chemical produced in one area of the body; is released into the blood to communicate with and controls another area of the body. Enzymes increase the rate of the thousands of conversion of hormones in the body without being consumed or altered.
The chart above (Figure 1) shows the 41 hormones that can be examined through blood, saliva and urine hormone testing. All have their individual role in maintaining health. Some have immune suppressing properties, while others have immune stimulating properties. This can be very important, especially with Hormone Replacement Therapy (HRT).
One could argue that is important to know what a Menopausal woman’s Estradiol levels are. This is true. But then why are Doctors then prescribing Estradiol or Alternative / Functional Doctors recommending Selective Estrogen Receptor Modulators (SERMs) in addition to foods that increase estrogen levels? Some would further insist Estradiol and SERMs are balanced out by including Progesterone or Wild Yam creams. This is based on a Pg/E2 Ratio theory promoted by John Lee, M.D. in the book “What Your Doctor May Not Tell You About Menopause” using the Figure 2 Hormone Chart.
When symptoms return; those using the Figure 2 Hormone Chart will attempt to explain it away with: “This case example highlights a misunderstanding that topical progesterone therapy only works for a limited period. It’s not that the progesterone stops working, it’s that the patient’s E2 level has declined further and the Pg/E2 ratio is now too high.”
This misleading statement leads to a further increase in Progesterone and Estradiol dosage, in a misguided attempt to get the Pg/Ex ratio back in balance. All the while assuming that an unbalanced Neuro-Endo-Immune (NEI) Supersystem will be restored to a balanced state by over-loading the NEI Supersystem with drugs, supplements and food.
Further confusing the matter, those following – knowingly or not – John Lee’s tenets never consider the fact that Progesterone converts into Estrogen(s). Especially, in excess quantities when using Pharmaceutical and Supplemental Progesterone. See Figure 1 if you question the possibility.
Blood/Serum Testing Measures Protein Bound Hormones
- Blood / Serum Hormone testing measures hormones that are bound to carrier proteins:
- Sex hormone binding globulin
- Thyroid binding globulin
- Represents potential Circulatory Hormone levels
- Must be Free-Fractioned test to measure bio-available hormones.
- More expensive
- ~250 times that of saliva
Free Fraction Hormone Testing
Bioavailable: the unbound (free) fraction of a hormone that has left the bloodstream to enter target tissues in the body. This unbound fraction is present and measurable in saliva. Free-Fraction hormones are NOT measurable in standard serum blood tests.
Water soluble hormones (peptides and catecholamines) are dissolved in blood plasma and transported by it to the target tissues.
Half-life, Onset & Duration of Hormone Activity
- Hormones are potent
- Blood level of hormone depends on:
- Quantity and rate of synthesis
- Rate of degradation/clearance from blood
- Availability of transport proteins
- Half-life: persistence of a hormone in the blood; usually from 1 min to 170 min depending on the hormone
- Time to onset of hormone action variable:
- Enzyme activation – rapid (minutes)
- Enzyme removal of Sex Hormone Binding Globulin (SHBG)
- Enzyme production – hours to days
- Duration of hormone action also variable (hours to days)
Saliva Hormone Testing
- Saliva unbinds the hormones allowing the level of hormones that are “bio-available” to bind to receptors and induce a cellular response.
- Less expensive.
- Collected at home.
- Sent to lab by patient.
- Can measure circadian rhythms of hormones.
- Able to measure hormones of the entire menstrual cycle.
- Lack of general understanding
- Comparing Serum/Blood results to Saliva results to Urine results is not comparing Apples to Apples.
- Healthcare providers are erroneously comparing Serum/Blood, Saliva and Urine results as “Hormones” with identical bio-availability and activity.
- Lack of general understanding
Urine Hormone Testing
- Measures hormones and hormone metabolites that have passed through liver conjugation (made water soluble).
- Phase 1 and Phase 2 conjugation pathways may be impaired.
- Many use “detoxification” in lieu of “conjugation” without understanding that hormones must be made water soluble and deactivated to be eliminated – AKA: detoxified.
- Phase 1 and Phase 2 conjugation pathways may be impaired.
- Not reliable to determine amount or rate of hormones produced by organs or glands.
- Results can be altered by the rate of liver detoxification and clearance.
- Can be used to measure the amount of hormone metabolites.
- For example: the amount of Estrogen metabolites to determine the risk of Estrogen Proliferative disorders.
Fibroids and Cysts
Uterine Fibroid and Ovarian Cysts produce hormones independent of normal hormonal controls. The same occurs with breast fibroids and cysts. The fibroids and cysts alter the delicate hormone balance in the body.