Reading your health | How to interpret your lab results

This is content drawn from my talk last week at EPIC Fitness on Beechwood Avenue in Ottawa.

Click here for a complete list of lab testing available via your licensed Naturopathic Doctor in Ontario.

Common lab tests

Complete blood count

This is probably the most commonly done lab test. It examines your red and white blood cells looking for infection, inflammation, immune dysfunction, cancer, anemia, etc. As a general rule it’s a gateway test that leads to further testing.

Lipid panel

This test measures your total cholesterol, triglycerides, LDL, and HDL. Low HDL and high LDL are risk factors for heart disease. This type of testing may give you insights on your long-term risk of a cardiac event. Other markets may be better for determining your short-term risk: myeloperoxidase, high sensitivity C-reactive protein, homocysteine, insulin, apolipoprotein A+B, Lp(a), LDL particle #/concentration/size.

Then you must do an intervention risk:benefit decision. Though some medications may dramatically lower your cholesterol and therefore potentially your risk of cardiovascular disease (statins can lower risk by 25-35%), they may also put you at risk of negative psychological side effects like anxiety and depression Another thing to note is that over 50% of people who have a heart attack have normal lipids

We also have to assess any elevated cholesterol as potentially pointing us to an underlying hormone imbalance as many of our hormones are cholesterol-based molecules, and the body can sometimes increase our cholesterol levels in an attempt to increase the lacking hormone.

Here is a great tool for assessing your cardiac risk.

Blood glucose + hba1c

These are markers of metabolic syndrome and diabetes. Blood glucose is a snapshot in time, whereas the HbA1C is a measure of how well regulated your blood glucose has been over the past 3 months. The more sugar you have in your blood stream, the more sugar crystals get stuck to the red blood cells floating around in your body. Measuring how glycated (how sugar crystal covered) your hemoglobin is will tell us how at risk the rest of your tissues are as well. Improving your HbA1C by 1% leads to a 25% reduced risk of microvascular complications like retinopathy (damage to your vision), neuropathy (damage to your nerves), and nephropathy (damage to your kidneys which can lead to dialysis). You’re aiming for a HbA1C of less than 6%.

Iron panel

An iron panel will measure your ferritin (stored iron), transferrin (protein that transports iron in the blood), and total iron binding capacity. Low iron can explain anemia, and sometimes fatigue and hair loss, and high iron can point to inflammation, infection or hemochromatosis.

Liver enzymes

When testing your liver enzymes (AST, ALT, GGT, ALP and bilirubin) essentially within normal range is good, above normal range means there is some liver damage that warrants further investigation.


(Should be) common lab tests

Thyroid panel ~$40

This set of tests includes thyroid stimulating hormone, T3, T4, TPO (antibodies against your thyroid), reverse T3 (an inactive form of T3 that is incapable of delivering oxygen and energy to the cells, as T3 does, and therefore blocks the action of T3).

Check out this page for a great summary of thyroid function.

Vitamin D ~$30

Vitamin D is important for calcium absorption, bone health, muscle function and the immune system. It may also help prevent some cancers (colon, prostate and breast), and to some degree prevent/treat diabetes, heart disease, multiple sclerosis and high blood pressure.

There are 3 sources of vitamin D:

  • Sunshine’s UV: amount of skin exposed, time of year/day, proximity to equator, pollution
  • Diet: cod liver oil, fish, liver, egg, fortified foods (OJ, cereal, dairy)
  • Supplements

In Canada we are hard-pressed to get adequate levels of vitamin D all year long, and the best policy is to test instead of guess. Testing in the early fall is ideal so that you can determine your best dose of vitamin D for the winter months.

Vitamin B12 ~$15

B12 is important for nerve function, blood cells and DNA. Unless you have pernicious anemia, if you’re a meat eater your levels are likely fine. However, I like to test for B12 as a marker of general nutritional status. If you’re not well absorbing B12, what else are you missing? In my practice I have actually found that vegans nowadays often have high levels of vitamin B12 due to a high intake of nutritional yeast, but it’s always best to test to be sure.


Advanced Testing

DUTCH ~$350

Dried Urine Test for Comprehensive Hormones is my new favourite test. Though it is expensive at $350, it’s easy to collect and not only measures your hormones but also their metabolites. Knowing which metabolic pathways are operating well, and which are backed up is a HUGE advantage for creating a direct path to wellness with an accurate treatment plan.

For this test you collect 4 urine samples on paper strips throughout the day (much easier than collecting the full urine sample and carting around a jug of pee all day). It’s indicated for those with insomnia, fatigue, PMS, menopause, andropause, really anything that can be hormonally-based.

Comprehensive stool analysis ~$300

This test measures markers of inflammation, digestion and absorption. Not only does it test for the bacteria, yeast and parasites in your body, but also informs us of their susceptibility to certain antimicrobial medications and herbs, which is very helpful for symptom resolution.

It also tests for nutrients that should not be coming out in your stool as an indication of improper absorption like carbohydrates, fat, muscle fibers (animal protein), and vegetable fibers.

It tests for occult (not visible) blood and red blood cells that could indicate local trauma, IBD, or cancer. It also measures inflammation by testing for white blood cells, secretory IgA, mucous, calprotectin, lactoferrin, and lysozyme.

A comprehensive stool test also analyses your short chain fatty acids (acetate, butyrate, valerate and propionate), which are produced by the friendly bacteria in your gut but are also the main fuel source for the cells in your colon. They may reduce your risk of inflammatory disease, heart disease, type 2 diabetes, etc.

Elastase is tested as a marker of your pancreatic digestive function. And pH (acidity) is also tested as a marker of milieu (i.e. is it the right environment for the proper microbiota balance).

Comprehensive stool analysis is useful for:

  • Gastrointestinal symptoms
  • Autoimmune disease
  • IBS/IBD
  • Inflammation
  • Food sensitivities
  • Nutritional deficiencies
  • Joint pain

SIBO breath test ~$70

This test measures the amount of hydrogen and methane produced by bacteria in the small intestine. For 1-2 days prior to testing you do a preparatory diet which essentially starves the bacteria. You then drink a sugar solution of glucose or lactulose to feed the bacteria and measure the hydrogen and methane gas produced by the bacteria, has diffused through the blood and is exhaled via the lungs.

SIBO breath testing is indicated for those with nausea, flatulence, diarrhea, constipation, malnutrition, Irritable Bowel Syndrome (IBS), Irritable Bowel Disease (IBD), Leaky Gut Syndrome, Chronic Fatigue Syndrome, Acid Reflux, Rosacea, Restless Leg Syndrome (RLS), Fibromyalgia, Gastroesophageal Reflux Disease (GERD), Celiac Disease & Diverticulitis.

Food allergy testing ~$300

Food sensitivity testing refers to testing for a delayed reaction to certain foods triggered by an IgG-mediated immune response. This reaction can only occur in conjunction with leaky gut, and often leads to autoimmune conditions. It is what I call a phase 2 reaction. A phase 1 reaction would be a food reaction with symptoms limited to the inside of the digestive tract. For example, if a patient has diarrhea and gas, but no systemic symptoms like eczema, migraines, joint pain, thyroid issues, MS, brain fog etc, then I would generally discourage them from doing this test right off the bat. Often we can sort out those patients in a few visit with dietary changes and perhaps a few supplements/herbs.

I also discourage people from doing this test as a general screening, as high levels of IgG (in particular IgG4) can actually indicate the person is developing a tolerance to the offending food. But if symptoms are present, even if they are in the process of adjusting to the food item, it can be very helpful to identify the exact food via testing, eliminate it temporarily while we do work to heal the gut and balance the immune reaction, and then the food can often be re-introduced at an appropriate time. 

This is very different than the more immediate and life threatening IgE-mediated immune response as discussed here.

ORganic acid testing $300

In contrast to the IgG test, organic acid testing is a great general screening test to get a good baseline of how your body is doing on many levels. It’s a good test for athletes and measurement of overall health (anyone looking for produce more energy). Organic acids are metabolic byproducts of cellular metabolism and they can be measured from a urine sample. Information obtained from the results includes: 

  • How well you’re burning (beta-oxidation)
  • Blood sugar stabilization (how well you’re burning carbs)
  • Energy production (citrate acid, krebs cycle)
  • Methylation (how our body turns on/off genes, detox, MTHFR)
  • Toxins and detoxification (xylene from paint etc)
  • Oxidative stress/antioxidants
  • Neurotransmitter turnover/metabolism (not reflective of brain levels)
  • Intestinal bacterial overgrowth (SIBO)

Heavy metal testing ~$100-200

There are 3 principal ways to test for heavy metals in your body:

  • Blood: which is a measure of your ACUTE exposure. So if you are in a mining accident, the doctors in the ER will test your blood levels for toxic exposure.
  • Hair: is a measure of chronic exposure (or of exposure for as long as those hair strands have been growing. This measurement can be impacted by hair dye, shampoos, etc, so sometimes taking a pubic hair sample is best.
  • Urine challenge: which is a measure of “body burden”.

The accuracy of testing for non-acute heavy metal exposure is tricky. Hair testing is imperfect, and the urine challenge may draw out toxins that are best left to lie dormant. Is it better to err on the side of caution and identify and eliminate exposure? I’d say it depends. I think everyone should clean up their environment as much as possible, but I would leave the heavy metal testing to those cases that don’t resolve with a more straight forward approach first. We do have more exposure due to industry than our ancestors, which exceeds our body’s ability to completely eliminate without help, so making dietary and lifestyle modifications that compensate for that is a must. Heavy metal toxicity can contribute to hormone dysfunction, autoimmune conditions, and neurological disorders. If you know you’ve had a previous exposure to lead, mercury, or other toxic metals, a test is a good idea for you.

The problem with good Naturopathic Doctors | Dr. Sarah Goulding, an experienced Naturopathic Doctor

We are all looking for our health care providers to have wisdom and experience. When I moved to Ottawa very pregnant and with a 1.5 year-old, I booked an appointment with a local experienced Naturopathic Doctor just to get a second opinion and make sure my pregnancy brain wasn’t letting any detail fall through the cracks. It was a great appointment and reassured me that I was on track, however booking a follow-up proved to be problematic. Her schedule was packed for months. I went back to her website a few times over the past few months hoping there was an opening, but no luck.

This is the downside to seeing a good experienced naturopath. Accessibility and continuity of care suffers because of a jammed calendar. Luckily I am healthy with no major issues to correct, but for those who need an actual treatment plan complete with follow-up and accountability, they are left out in the cold! Brrr…

Good news! I’ve got 7 years experience practicing as both a Naturopathic Doctor as well as a clinic owner, so I’ve learned how important it is for patients to have access to their health care practitioners. As I have closed my Sudbury practice and am starting fresh here in Ottawa, I have lots of room in my calendar and a well rested medical brain keen to dig into tricky cases.

You can easily book online. I’m looking forward to meeting you!


Hours

Wednesdays (@Beechwood) 11am to 4pm

Thursdays (@Newell Physiotherapy) 10am to 4pm

Fridays (@Newell Physiotherapy) 9am to 1130am

Saturdays (@Beechwood) noon to 4pm

Small steps towards being environmentally responsible | Dr. Sarah Goulding, Naturopathic Doctor

One of my New Year’s resolutions is to reduce my environmental burden. I know better, I should do better. There are times when I have definitely been lazy about the smaller details, but I’m now trying to change my ways.

Here are a few things that we can do to minimize our environmental burden:

Eat less meat

“Transitioning toward more plant-based diets that are in line with standard dietary guidelines could reduce global mortality by 6–10% and food-related greenhouse gas emissions by 29–70% compared with a reference scenario in 2050” (Springmann et al.).

But be careful not to consume too much processed foods or fruit, as those food choices can ramp up the environmental toll of your diet.

Soy is fine to eat in moderation, but be sure to buy organic to avoid ingesting chemicals. Soy production is known to be hard on the environment, but in reality eating beef costs more soy than eating the soy directly.

Grow your own food when possible

Garden in the summer.

Sprout instead of buying greens (especially those boxed in plastic) during the winter months.

Grow your own herbs.

Keep house plants to clean your own micro-environment

Some plants are better than others for filtering the air inside your home.

Eat seasonally

Look at where your fruit comes from in the winter months. Is it better to live on apples in the winter or to ship exotic fruits from South America? You decide. I’m constantly debating about this in the produce aisle.

End food waste

Plan your meals and update your plans based on what is actually in the fridge. Leftovers can force you to creatively create amazing meals.

Turn down your water heater

The water coming out of your faucet should only be as hot as you want it. You should not have to also turn on the cold water to achieve your ideal temperature bath.

Conserve power

Put everything you plug in on a power bar and turn it off at night.

Reduce your impact as a consumer

Take care of things so that you don’t have to replace them so much (from small items like clothing to bigger purchases like vehicles).

Buy pre-loved instead of new when possible (which also contributes to your local economy).

Buy in bulk to save on packaging.

Stop buying books. Use the library (again another way to be out in your local community).

Reusable grocery bags of course. Say no to straws.

Eat out less. And definitely don’t get take-out.

 

A great tool to calculate your environmental impact is the
Ecological footprint calculator.

It’s transition time – naturopath in Ottawa

I have officially moved to Ottawa, expecting baby number two to arrive any day now. My Sudbury patients are in the very good hands of Dr. Cayla Bronicheski ND, and we will continue to consult on patient cases as needed, both for the benefit of our patients, as well as for mutual learning. I will be taking a short maternity leave and expect to start practicing naturopathic medicine in the Beechwood neighborhood in January. Stay tuned for more updates coming this fall 🙂

Entering a new phase of life + practice!

We are switching hats!

A new baby has shifted my priorities and I’m very happy to report that Matt Lynds, our cherished Registered Physiotherapist, is now the owner and operator of Nickel Ridge! This way I can focus more on my naturopathic practice (spending more time on patient research and continuing education) and I can have my weekends to hang out with my little munchkin. I couldn’t be more excited about going back to work with this clear setup, and I’m looking forward to digging deep into stagnant cases with fresh eyes.

Matt is going to mostly keep things the same, spiffing up the rough edges, add more reception hours and a small gym to support the physiotherapy offerings. You’ll see the clinic name change to Nickel Ridge Physiotherapy, but don’t be fooled, your Naturopathic Doctors and Massage Therapists are still here too.

Let us know if you have any questions or concerns, but we don’t expect any bumps in the road along this transition.

Over and out my friends! See you in the clinic!

All the best,
Sarah.
Dr. Sarah Goulding, Naturopathic Doctor
[email protected]