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The optimizations described on this page require repeated specialized testing and the professional support of a trusted physician trained in functional medicine
Functional testing takes our longevity strategy to the next level by applying in-depth monitoring and optimizing our health. This involves taking various specialized blood, urine, saliva, hair other tests and reviewing the results together with our physician and our dedicated doctors.
Choosing the right Doctor
For all of this, it is paramount that we have a personal physician and specialized doctors that we trust and that we can talk openly with and discuss our issues and questions. To have a meaningful conversation with our doctors we need to educate ourselves on the things that we talk about, and we need doctors that treat us as a partner in our quest for optimum health. Doctors that treat us top down as ignorant patients won't help us at all.
Measuring our Well-Being
To get a holistic view of the state of our health we monitor several biochemical markers and risk factors, most of them by blood, stool, urine, hair, and saliva testing.
These markers serve as indicators if there is something wrong with how we treat our body, the external influences that we are exposed to or our genetic programming. Usually, we do not counter imbalances directly with medication like conventional medicine would suggest (e.g. treating high cholesterol with cholesterol-lowering drugs, which by the way is totally useless). It is necessary to remove the root cause for an elevated risk factor or out of range biochemical marker.
Tracking risk factors and biochemical markers over time gives us an excellent indication how our measures like nutrition, detox, workout, mental well-being and supplementation change our body biochemistry for the better, and can be a highly motivating progress indicator in our quest for the dramatic extension of our healthy lifespan.
A stool sample makes it possible to analyze the distribution of the different kinds of bacteria in our gut. Additionally, the test shows the state of the gut's immune system and the condition of its lining by measuring IgA.
Imbalances can be treated with supplementation and change in diet. They usually resolve once we switch to healthy nutrition, detox our body and consume enough fiber in our food. Adding pre- and probiotics to our supplement regimen assists in regaining a balanced gut biome.
see more: GI Effects Comprehensive Profile (gdx.net)
A healthy gut is the hidden key to weight loss (chriskresser.com)
Chronic inflammation is an abnormal, long-term activation of our immune system. During a chronic inflammatory response, our immune system unsuccessfully tries to deal with an infection, injury or other disease processes. Damage to the tissues in our body frequently occurs during this type of inflammation. Chronic, low-level inflammation is associated with common diseases including cancer, type II diabetes, osteoporosis, cardiovascular diseases, and others. It can be triggered by uric acid crystals, oxidized lipoproteins, homocysteine, mitochondrial dysfunction, food toxins, gluten, and advanced glycation end products (AGEs).
There are several biomarkers that we can use to detect our level of chronic inflammation. The two most common ones are c-reactive protein (CRP) and fibrinogen. For CRP we use the high sensitivity test (hsCRP) that measures CRP in the range of 0 - 10 mg/L.
Optimum hsCRP in men: < 0.55 mg/L
Optimum hsCRP in women: < 1.0 mg/L
Optimum Fibrinogen: 200 - 300 mg/dL
Implementing the building blocks of the foundation is the key to reducing chronic inflammation. Additionally, supplementation can help in that regard.
see more: Chronic Inflammation (lef.org)
When under stress, the body responds by increasing cortisol output from the adrenal glands. At normal levels cortisol is beneficial and protective by controlling blood pressure, blood sugar levels, inflammation, as well as strengthening the cardiac muscle. A normal cortisol rhythm should peak in the morning hours and then steadily decline through the day with the lowest levels at night.
An acute rise in cortisol is not necessarily unhealthy, as it is the natural adrenal response to stress. However, when stress becomes unresolved or chronic, cortisol is continuously elevated, and our body enters a state known as adrenal resistance.
Chronically elevated cortisol levels are both inflammatory and catabolic.
They cause a myriad of disorders including:
- thyroid and metabolic dysfunction,
- cognitive decline
- low serotonin levels resulting in depression
- carb cravings
- immune suppression
- altered glucose metabolism
- elevated lipid levels
- increased blood pressure
- low melatonin levels resulting in altered sleep patterns
- musculoskeletal issues, resulting in difficulty recovering from exercise and possible subsequent injuries
Cortisol levels are also related to mental acuity and can contribute to degenerative diseases such as dementia and Alzheimer’s.
DHEA, a precursor to many other hormones also relates to adrenal function as well and unfortunately can have an inverse relationship to cortisol. Thus, if we have chronically elevated cortisol levels, we may have proportionately low DHEA, resulting in further metabolic disturbances including weight gain, poor immune function, and hormonal imbalances.
A saliva cortisol test that samples our cortisol level multiple times throughout the day is the most convenient and accurate way to observe the amount of free cortisol and its daily cycle.
Like other risk factors, cortisol will usually normalize when implementing the foundation of nutrition, detox, exercise, mental well-being, and stress relief. Adrenal balancing supplements like Rhodiola, Ashwagandha, Ginseng, and Holy basil can help us in that respect as well.
An impaired glucose metabolism is a major risk factor for cardiovascular disease, diabetes, accelerated aging and other age-related malignancies.
In order to track our glucose metabolism we monitor fasting blood glucose, fasting insulin, Hb1Ac & fructosamine in our quarterly blood draws.
However, in order to make informed decisions we have to be aware of certain widespread misconceptions and some lesser known facts.
Monitoring the trend is important
Conventional medicine uses arbitrary thresholds to classify people into healthy, pre-diabetic and diabetic. This is not really helpful. If a fasting blood glucose of 140 makes us diabetic, a level of 139 will not make us any healthier. In addition to the actual levels, we look out whether any of our values creeps upwards over time.
Hb1Ac is not a reliable marker for diabetes
Hb1Ac is supposed to measure the average level of blood glucose over a three months period by assessing how much of the blood cell's protein hemoglobin has bound to sugar molecules and formed AGEs. Since its value is in direct relation to the average lifetime of our blood cells, Hb1Ac can vary vastly from one person to another. On average the lifetime is 90 days, but the blood cells of diabetics turnover in as few as 80 days, while they live as long as 140 days in non-diabetics. At the same average level of blood sugar a shorter average lifetime of blood cells directly translates to a lower Hb1Ac, since the cells have less time to accumulate glycated hemoglobin proteins.
Fasting glucose goes up low carb
Restricting carbohydrates results in a natural drop in insulin levels, which in turn activates the hormone Lipase. Fat tissue is then broken down and released into the bloodstream. These fats are taken up by our muscles, which use them as fuel. And since our muscle’s needs for fuel has been met, it decreases its sensitivity to insulin.
On a low-carb diet a borderline high FBG of 90-105 may not cause concern. However, uninformed physicians might diagnose this as pre-diabetic.
Oral Glucose Tolerance Tests (OGTT) can be misleading
OGTTs are supposed to measure the performance of our glucose / insulin metabolism. These are done by measuring baseline glucose and then consuming 75 g of glucose dissolved in water. Blood glucose is then measured every 30 minutes for up to three hours.
Unfortunately, this is a completely artificial test, stressing the body in a way no regular meal would. This is especially true if we are on a low carb diet, where an OGTT, without consuming high amounts of carbohydrates for at least three days prior to the test, would almost always indicate that we are diabetic, even when in perfect health.
Post Meal Glucose Levels are most relevant
Our preferred method of evaluating our glucose metabolism, apart from monitoring absolute values and trends in our regular blood draws, is tracking its operation while our body processes food that we regularly consume. This can be easily done at home using either an inexpensive blood glucose meter or a continuous blood glucose monitor.
When using a glucose meter we sample our glucose level before lunch and then every hour for three hours. A continuous glucose monitor will sample glucose levels every five minutes all day long. This is particularly convenient if we want to track our response to certain kinds of food.
This will also help us to identify the most damaging situation in our glucose metabolism: blood glucose spikes after the consumption of high carb / high GL foods.
As a rule of thumb, post-meal blood glucose levels should not spike above 140 mg/dl one hour after the meal, should drop below 120 mg/dl after two hours and return to pre-meal levels after not more than three hours.
When your “normal” blood sugar isn’t normal (Part 1 & 2) (chriskresser.com)
Why hemoglobin A1c is not a reliable marker (chriskresser.com)
Physiological insulin resistance (high-fat-nutrition.blogspot.de)
Continuous Glucose Monitoring (dexcom.com)
Wavesense Glucometer (amazon.com)
The primary function of our thyroid gland and its two hormones T3 and T4 is to regulate our metabolism by controlling the rate at which our body converts oxygen and calories to energy. In fact, the metabolic rate of every cell in our body is regulated by thyroid hormones, primarily T3.
There is is a good chance that our thyroid is either over- or under-active, due to genetic variations, auto-immune reactions or our aging process. These imbalances directly impact our metabolism with numerous secondary effects detrimental to our health and well-being.
To verify and ensure proper operation we measure relevant antibodies and hormones and adjust the hormones accordingly.
Optimum Vitamin D levels promote strong bones, a healthy immune system, offer protection against various types of cancer, protect against heart attacks and reduce the risk of cardiovascular diseases.
Vitamin D is produced by the body during sun exposure. However, most of us don't get enough of sun exposure, especially during winter.
Vitamin D can be supplemented easily and is quite inexpensive. Required doses range from 2.000 to 10.000 IU/day. The amount of D3 in conventional multivitamins is usually not sufficient to maintain healthy levels of 50 - 60 ng/ml.
Imbalanced blood lipids, particularly cholesterol, are major risk factors for our cardiovascular system. However, there are huge misconceptions on blood lipids, especially in the older medical community, that we have to be aware of to make informed decisions on our health.
LDL & HDL are not Cholesterol
Both are just transport proteins that the body uses to distribute cholesterol where needed.
Dietary cholesterol is irrelevant
Dietary cholesterol accounts for less than 10-20% of total cholesterol in our body, which manufactures almost all of its cholesterol by itself. The scientific myth of dietary cholesterol influencing the blood levels of cholesterol originates of experimenting with animals that had an entirely different lipid metabolism than humans. Nevertheless, these results were applied 1:1 to the human realm.
There is no need at all to cut back on eggs. Quite the contrary: Eggs are amongst the most healthy food that we can consume.
No healthy level of "Total Cholesterol" has so far been established
Almost unbelievable, but true nevertheless: There is no scientific proof for the often quoted healthy level of total cholesterol of < 200. There is even one Canadian study that places the healthy level of total cholesterol between 250 and 300.
Studies on cholesterol usually aim at the correlation of the amount of total cholesterol and the occurrence of heart disease. Unfortunately, correlation is not causation. We also need to keep in mind that these relationships are analyzed for an average population that lives on an entirely unhealthy diet of sugar, wheat, and dairy.
Using total cholesterol to make a statement about one's health is about as accurate as to determine the health of a car by combing tire pressure, oil pressure, oil temperature, water temperature and water pressure in a single number and flashing it one on the dashboard.
Conventional LDL & VLDL measurement is no measurement at all
The LDL values reported by our blood test are almost always only calculated and never actually measured at all. To avoid the much more costly correct LDL measurement values are estimated by one of two formulas:
LDL = Total Cholesterol - HDL - Triglycerides/5.0 (mg/dL)
LDL = Total Cholestorol/1.19 + Triglycerides/1.9 – HDL/1.1 – 38 (mg/dL)
VLDL is often not measured but only calculated by dividing triglycerides by 5
Reporting a single number for LDL completely misses the point
LDL comes in three different particle sizes and unfortunately, in traditional reporting, no distinction between the various LDL particle sizes is made at all. However, only the smallest size, type B LDL, is the real risk factor for heart disease. LDL-B oxidizes quickly and is small enough to get stuck in between cells. Oxidized LDL-B in conjunction with a chronic systemic inflammation (measured by CRP) triggers an immune reaction causing the particles to be eaten by our immune systems macrophages which in turn get bloated. The bloated macrophages start to accumulate in the walls of our blood vessels - up to a point where the vessel wall ruptures, releasing a blob of bloated macrophages into the bloodstream, blocking the blood vessel and causing a heart attack or stroke.
Two people with the same calculated LDL can have an entirely different risk profile for heart disease. One might be perfectly healthy, the other one in grave danger.
Calculated LDL can go up on a healthy diet
When we switch from an unhealthy, toxic, carb-loaded diet based on wheat, sugar, and dairy to a healthy, evolutionary diet and implement the other building blocks of the foundation as well, the distribution of our LDL particle size will shift from high-risk factor small particle LDLs to the good large LDLs.
Unfortunately, standard LDL measurement under-represents small LDLs and will mostly show the increased number of large LDLs. This leads to an increased "measured" total LDL despite the decrease of high-risk factor small LDL.
Unaware physicians will diagnose this as a sign of an increased risk factor even so quite the opposite is true. They might even suggest counteracting with medication to lower LDL.
No use for drugs to lower LDL
Imbalanced cholesterol levels are not a root cause for heart disease, but secondary effects and an indicator for imbalances in the metabolism. They are the consequence of an unhealthy lifestyle, with excess carbohydrates, lack of exercise, bad detox, negative stress and to some extent of our genetics.
Combining this insight with the knowledge how LDL is "measured" it becomes apparent that using drugs to lower cholesterol makes little sense and could be compared to putting at sticker over a red light on the dashboard.
Markers that matter are LDL-P, Triglycerides, Lp(a), Lp(a2)
Triglycerides are circulating blood fats. Their level is mostly driven by our carbohydrate consumption.
Optimum triglycerides: 50 - 80 mg/dl
Correlation studies have identified two other lipoprotein subclasses that are associated with an increased risk of cardiovascular disease.
Optimum lipo-protein A - Lp(a): < 20 mg / dl
Optimum lipo-protein A2 - Lp(a2): < 235 mg / dl
The foundation is the key
Once we implement the building blocks of the foundation, we see our relevant lipid blood markers normalize to healthy levels. And even if some of them are a bit off compared to the (unhealthy) population average (most probably due to our genetic makeup), we must remember that they are only a subset of the risk factors attributed to lead to heart disease. We still have a lot of control over the other factors as well.
Advanced glycation end products (AGEs) are molecules that form when sugar molecules bind to proteins and lipids in the body. This process is called glycation. Glycation, unfortunately, is a normal part of aging, it is far from desirable.
AGEs are one of the major causes why our body ages
AGEs cross-link with themselves and the surrounding tissue, forming unbreakable bonds and stiffening our tissue as we age. Rigid blood vessels due to AGEs lead to age-related high blood pressure since the vessels cannot expand anymore when the heart pumps blood. Stiffening of our heart muscle results in a loss of power, volume and thus the ability to pump blood, oxygen, and nutrition through our body. Stiffening of our lung and the connected muscles leads to loss of lung capacity. Cross-linking of the collagen in our skin leads to wrinkles and age spots. Cross-linking in the lenses of our eyes causes clouding and thus a loss of vision. AGEs contribute to cataracts, atherosclerosis, kidney failure and are a contributing factor in the development of various age-related diseases.
We can track the level of glycation to some extent by monitoring hemoglobin A1c (Hb1Ac), that measures the percentage of glycated hemoglobin proteins in our blood cells. An elevated or an upwards trending Hb1Ac over time is a serious risk factor.
Healthy Hb1Ac: < 5.3 %
Optimum Hb1Ac: < 5 %
We have to keep in mind that Hb1Ac can vary from person to person. Its measurement is about the average lifetime of our blood cells. On average that is 90 days but may vary considerably from person to person. With the same rate of glycation, a shorter average lifetime of blood cells directly translates to a lower Hb1Ac, since the cells have less time to accumulate AGEs.
We want to keep the rate of glycation in our body as low as possible. We do this by preventing or blood sugar from spiking, implementing a proper diet and exercise regularly. Additionally, we can supplement with Benfotiamine (a form of vitamin B1), pyridoxal 5'-phosphate (a form of vitamin B6) and Carnosine, which all reduce glycation reactions that occur in our body.
We have to be aware that not only we make our own AGEs, we also consume pre-manufactured AGEs with our food. AGE form from sugar and fat under excess heat, e.g., in baking or on a BBQ, especially if the food is partly burned.
A Word on Fructose
Fructose (60% of the carbohydrates in fruit), is seven times more reactive than glucose (the primary carbohydrate in rice or sweet potatoes) in regards to forming AGEs.
As opposed to glucose, which can be used by all the cells of our body, fructose can only be processed by our liver. Hence excess fructose, which cannot immediately be handled by our liver, floats in our bloodstream, readily forming AGEs until the liver can take care of it.
Additionally, our liver has only a limited capacity to store sugars. Excess fructose that cannot be stored in our liver is converted and directly transferred to our fat cells for storage.
Thus, we want to keep excess fructose, which our liver cannot process and store to an absolute minimum. If we consume fruits, which are our primary source of fructose, we do so in the morning, when our liver's storage capacity for sugars is still depleted from the night. We always consume the whole fruit, as opposed to fruit juice, since the fiber in them slows digestion and absorption of fructose into the bloodstream. We avoid fruit juices, even freshly squeezed ones since they lack that fiber.
In the Future
Unfortunately, our body can not break-up or get rid of formed AGEs. Right now all we can do is try to limit their formation and accumulation.
Scientists are already developing technologies that will allow us to break-up cross-linked AGEs and return stiffened tissue to its youthful state. This would result in real rejuvenation techniques, undoing one of the leading causes of aging.
Our body has to keep a very tight regulation of its alkaline-acidic balance. The pH of our blood has to remain within a tiny window of 7.35 - 7.45. Even slight deviations have significant health implications.
Base excess (BE) indicates the amount of bicarbonate in our system used to balance pH. A negative BE means a base deficit in our blood and is equivalent to an acid excess. A value outside of the normal range (-2 to +2 mEq) suggests a metabolic disorder.
The most common reason for an imbalance is excess acid due to bad diet, alcohol, coffee, environmental toxins, smoking, stress or lack of sleep.
see more: The Ultimate pH Solution
We analyze the distribution and possible imbalances of fatty acids in our body on the cellular level — especially Omega 3, 6, 9 and saturated fats. It's very motivating to see these values change for the better once we implement a healthy diet, the other building blocks of the foundation and a basic supplementation program.
Chronic Allergic Reactions
Consuming an unhealthy diet, excess carbohydrates, sugar, bad fats, wheat, gluten, lactose or casein and being exposed to environmental toxins will usually cause an allergic reaction of our body. We can partly track this situation by measuring Immunoglobulin E (IgE). Switching to a healthy diet and detoxing our body will most likely dramatically ease the allergic reaction and can return an elevated IgE to optimum levels.
Optimum IgE: < 100 kIU/L
Micronutrients on the Cellular Level
Optimum health requires that all our cells receive the necessary nutrients, vitamins, minerals and other essential compounds in adequate amounts.
Due to genetic mutations that are present in every one of us, we all process food and nutrients with different efficiency, sometimes to an order of a magnitude. A balanced diet and supplements do not necessarily assure that our cells benefit at the optimum levels. Blood levels alone don't provide the real picture either since our deficit might be related to inadequate transport or reduced cellular uptake of a particular compound.
Fortunately, there is a test that allows us to measure the levels of the essential micronutrients within in the cells, which makes it possible to detect deficiencies directly at a cellular level - and counter them by supplementing the missing compound.
SpectraCell Micronutrient Testing (spectracell.com)