The Proper Use of Clinically Relevant Laboratory Testing and Biochemical Individuality

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The Proper Use of Clinically Relevant Laboratory
Testing and Biochemical Individuality

• Mark Schauss, MBA, DB

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How I Choose Lab Tests

• People ask me about how I go about determining
  whether a test is valuable or not.
• Above all, it must have clinical relevance.
• If Aunt Martha comes in complaining of fatigue
  and the test I use doesnt address this issue,
  there is no reason to run it.
• If the results change the way the patient is
  treated, then it may be valuable.
• This is utilizing the concept of biochemical
  individuality
• Does the test and the use of the results have
  scientific backing.
• In the case of Fatty Acids, targeting the
  imbalances and making changes based on those
  results have not been shown to be an efficient
  way of balancing the fatty acid results

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How I Choose Lab Tests

• Measuring an item in the blood or within a cell
  and applying a reference range to it may not
  reveal anything about the functionality of said
  item.
• Say two people do a test to measure the amount of
  magnesium in their cells.
• The reference range is 10 50 with a mid point
  of 30.
• Both people get a 30 yet person A is magnesium
  deficient and person B is not.
• How is this possible?

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How I Choose Lab Tests

• When we do a functional test, say looking at the
  level of Ethanololamine in a Plasma Amino Acid
  test.
• It is a strong marker for the presence of a
  functional magnesium deficiency.
• If person A shows up for a number of functional
  magnesium deficiencies than maybe the level of
  magnesium present in the sample of their cells
  may not be adequate due to genetic or
  environmental reasons.
• Person B may not need as much magnesium to
  function as efficiently compared to Person A.
• In order to get the best clinical outcomes, I
  look at the test in a true functional way.

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How I Choose Lab Tests

• Lab competence is critical.
• I typically visit the lab, talk to their lab
  directors and talk to practitioners about their
  experiences.
• In an interview in Lab Interpretations CD and
  podcast series, Laboratory Medical Update, I
  talked to Mark Newman, Assistant Lab Director for
  ZRT Labs in Oregon about this issue.
• I have seen lab results that made me believe that
  the lab used a random number generator to come up
  with the results.
• If the results cannot be trusted, what good is
  the interpretation?

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Why Another Lecture About Lab Testing?

• Albert Einstein once said when told his final
  exam he had given his students was the same as
  last years, True, but this year the answers are
  different.
• In laboratory testing, we learn new things from
  new research every day.
• We find new ways of testing, new results we can
  interpret and better techniques of testing things
  we already know about.
• We also find new meanings about results causing
  paradigm shifts in treatment protocols.

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Why Another Lecture About Lab Testing?

• An example of a new interpretation for a pair of
  well known test variables.
• Vanilmandelic acid is the main metabolite of
  catecholamines and Homovannilic acid is the main
  dopamine metabolite are both urinary metabolites
  .
• Vanilmandelate is related to phenylalanine and
  homovanillate to tyrosine.
• A few labs use these two to recommend the
  appropriate amino acid complex as well as the use
  of these two amino acids alone.
• This may be contraindicated because of newer
  research that has come to light.

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Why Another Lecture About Lab Testing?

• According to research published in the last year,
  both or either of these variables being elevated
  in urine have been correlated to environmental
  toxins such as heavy metals and petrochemical
  solvents and pesticides.
• Extremely elevated levels of these two
  metabolites may be indicative of tumor growth and
  possibly the onset of a myocardial injury.
• Toxins are implicated in a number of cancers so
  here may be one of the early warning flags before
  the disease presents itself.

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Reference Ranges

• Labs typically run a number of tests on a wide
  variety of people in order to determine the
  reference range for a result.
• The range is where 95 of the test subjects
  results are.
• In some cases the reference range is overwritten
  by the medical director in order to propose a new
  definition of healthy.
• There are significant problems with these two
  scenarios.

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Reference Ranges

• In the case of the 95, there is a problem when
  the population is not healthy.
• This is the case with Ultra-Sensitive Thyroid
  Stimulating Hormone (TSH).
• The typical lab range is .5 5.5 uIU/mL.
• Unfortunately, an estimated 25-30 (it could be
  higher) of the population is hypothyroid and fall
  into this range.
• Research has suggested that the proper reference
  range for TSH should be 1.1 2.5.

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Reference Ranges

• The journal Circulation has an editorial that
  pointed out the risks for many diseases goes up
  when Total Cholesterol is below 160 mg/dL.
• Hulley, S., J. Walsh, et al. (1992). "Health
  Policy on Blood Cholesterol Time to Change
  Directions." Circulation 86(4) 1026-1029.
• The pressure put upon the editorial staff of
  Circulation by the pharmaceutical industry was
  immense for obvious reasons.
• Still, within the alternative supplement
  industry, there is a great deal of marketing
  money put into to the lowering of cholesterol
  paradigm despite evidence that it may not be
  beneficial in the prevention of coronary heart
  disease.

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Reference Ranges

• In the other scenario, medical bias comes into
  play.
• In a number of labs I have seen, the reference
  range for Total Cholesterol is 0 199 mg/dL.
• According to Bernard Statland, MD PhD, a world
  renowed clinical pathologist states in his book
  Clinical Decision Levels for Lab Tests, when
  discussing a Cholesterol of 90 mg/dL or below
  Values below this level are often associated
  with severe liver insufficiency.
• So a person is in the reference range can be
  deathly ill as often times the prognosis for
  people at that level is poor.

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Tips and Tidbits

• When comparing cholesterol levels you must do so
  carefully.
• Levels of cholesterol rise in the fall and winter
  and drop in the spring and summer.
• This variance can be as much as 20
• If you were to set up a clinical trial to test
  the efficacy of a drug or supplement in its
  ability to lower cholesterol, when would you
  start the study and end it?

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Type II Diabetes
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Type II Diabetes

• With any diabetic, running a comprehensive blood
  chemistry should be a given.
• Monitoring blood sugar, triglycerides,
  cholesterol with LDL and HDL are critical to any
  dietary intervention.
• Electrolyte depletion, particularly sodium,
  potassium, magnesium, calcium, bicarbonates and
  chlorides are often seen and need to be addressed
  if deficient.
• Some of the markers for oxidation like uric acid
  are also seen along with elevated fibrinogen.

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Type II Diabetes

• Here is the pattern often seen with people with
  Type II diabetes
• Elevated Alkaline Phosphatase, Basophils,
  Cholesterol, Creatinine, Fibrinogen, Glucose,
  GGT, Hemoglobin A1c, LDL, Triglycerides, BUN, and
  Uric Acid
• Decreased Albumin, CO2, Calcium, Chloride, HDL,
  Iron, Phosphorus, Potassium, and Sodium.

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Type II Diabetes

• An Environmental Pollutants Biomarker test is
  also very helpful if the person has been exposed
  to high levels of a number of toxins.
• Phthalates have been shown to affect insulin
  resistance.
• Stahlhut, R., E. Wijngaarden, et al. (2007).
  "Concentrations of Urinary Phthalate Metabolites
  Are Associated with Increased Waist Circumference
  and Insulin Resistance in Adult U.S. Males."
  Environmental Health Perspectives 115(6) 876-82.
• Chemicals like toluene, xylene, benzene and
  styrene have been implicated in a wide array of
  endocrine disruption and blood sugar regulation.

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Type II Diabetes

• Many of the chemicals and heavy metals that may
  affect the receptors also affect the thyroid.
• People with diabetes who develop hypo- or
  hyperthyroidism have a much harder time
  controlling their blood sugar.
• Making sure the diabetic patient is controlling
  their toxic loads and are becoming good toxin
  excretors will go a long way in helping them
  control their blood sugar and insulin levels.
• This is why a urine test is so important. It no
  longer is a question of whether we have the
  toxins in our blood but do we excrete them
  efficiently.

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Type II Diabetes

• As with most disorders, inflammation is a key
  component in the progression and/or control of
  diabetes.
• Diet is critical.
• Assessing the foods that can trigger inflammatory
  reactions is important in helping your patient
  achieve optimal help.
• There are a number of good tests on assessing the
  inflammatory reactions of foods.

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Type II Diabetes

• Reducing this inflammatory response will improve
  the quality of life of the diabetic since many of
  them have numerous other symptoms like arthritis.
• Recent pharmaceutical research is following the
  anti-inflammatory direction in the treatment of
  type II diabetes.
• Drugs used to treat arthritis like anikinra
  (Kinemet) have been shown to help regulate blood
  sugar because of their effect on the cytokine
  IL-1 (interleukin-1).

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Type II Diabetes

• The immune system produces cytokines in response
  to inflammation in the body. The cytokine,
  Interleuken-1 (IL-1) shows up in areas of
  inflammation, like in the joints or other places
  in the body. Anakinra blocks the production of
  interleukin-1. That's why it's used to treat
  arthritis.
• In diabetes, interleukin-1-beta is produced in
  the pancreas. High glucose levels appear to
  trigger the release of interleukin-1-beta. This
  not only reduces the function of beta cells in
  the pancreas, but can cause beta cells to
  self-destruct.

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Infertility/Pregnancy
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Infertility/Pregnancy

• At no time in human history has infertility
  reached such epidemic proportions.
• The blame clearly has to lie at the feet of our
  toxic environment.
• According to the Center for Disease Controls
  National Survey of Family Growth the fastest
  growing segment of the population with impaired
  fecundity (infertility) is women under the age of
  25.
• In 2005 the CDC did a survey across America where
  the average citizen had the presence of 148
  chemicals in their blood. The report is 475 pages
  long.
• Third National Report of Human Exposure to
  Environmental Chemicals, Centers for Disease
  Control and Prevention 2005. www.cdc.gov/exposurer
  eport/pdf/thirdreport.pdf

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Infertility/Pregnancy

• One line in the report struck me for different
  reasons than it might strike others.
• Under Public Health Uses of the Report it states
  To establish reference ranges that can be used
  by physicians and scientists to determine whether
  a person or group has an unusually high exposure.

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Infertility/Pregnancy

• This will somehow be used to allow for an
  acceptable level of toxicity for each of you
  and your patients.
• Some chemicals have an effect at low levels only.
• Polymorphisms in genes coding for metabolizing
  enzymes contribute to interindividual variability
  and may vary by more than 50-fold in humans
  (Guengerich et al. 1991).
• What is a poison for you may not be for me.

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Infertility/Pregnancy

• In the 1970s, Danish researcher Niels Skakkebaek
  of the Copehagen University Hospital showed links
  between testicular cancer in adults and
  abnormalities in genital development.
• At 3 months, baby boys experience a surge of
  testosterone.
• In a study of 65 infants published in 2006, they
  discovered that the higher the level of
  phthalates, the greater the evidence of
  anti-androgenic hormonal activity.
• By depressing the testosterone surge, the
  likelihood of a male to develop testicular cancer
  as an adult rises dramatically.

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Infertility/Pregnancy

• If the findings that chemicals like Bisphenol A
  (BPA) and phthalates are found in the drinking
  water, house dust, and ambient air are true and
  at tiny levels they can affect estrogen receptors
  think of the types of cancers our children will
  have.
• In the 1950s a womans lifetime risk of breast
  cancer was 1 in 22.
• Today it is 1 in 7.
• It is not a genetic epidemic, it is
  environmental, it is due to endocrine disruption.
• BPA is worth 100 million an hour.
• Banning it will take enormous guts.
• Becoming good detoxifiers forever is critical.

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Infertility/Pregnancy

• When it comes to testing strategies, with all
  people, male or female, it is imperative to do an
  Environmental Pollutants Biomarker test.
• Phthalates, xylene, toluene, benzene, styrene,
  and dimethylbenzene are all developmentally
  toxic.
• Phthalates can damage male DNA in sperm.
• It can also cause shortening of pregnancies by up
  to two weeks and according to research full-term
  babies have markedly higher cognitive scores
  later in life (Larroque, et al, The Lancet, Vol
  371, pg 823).
• Urinary markers of phthalates are vastly superior
  to serum.
• Hogberg, J., A. Hanberg, et al. (2008).
  "Phthalate diesters and their metabolites in
  human breast milk, blood or serum, and urine as
  biomarkers of exposure in vunerable populations."
  Environmental Health Perspectives 116(3) 334-9.

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Infertility/Pregnancy

• For women, I would highly suggest doing two
  additional tests.
• A Whole Blood Elements test would be 1 as quite
  often women trying unsuccessfully to have a child
  are very mineral deficient.
• Also, any toxic heavy metal load could decrease
  the chances for a healthy pregnancy.
• In the March 2008 EHP journal, researchers led by
  Leasure, et al, showed that gestational lead
  exposure produced permanent male-specific effects
  including an increase in obesity as well as motor
  deficit, and altered dopamine.
• The responses were dose-dependent.

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Infertility/Pregnancy

• Secondarily, a Plasma Amino Acid test often times
  show broad deficiencies in both essential and
  conditionally essential amino acids.
• With women, there have been some issues with
  increased tryptophan and elevated serotonin
  (especially with 5-HTP) and an increase in
  miscarriages, dysmenorrhea and tubal spasms.
• With males, it may improve sperm viability.
• In a study by Schacter in 1973, 4 grams of
  arginine was used on 178 men and 111 had
  significant improvement, 21 moderate and only 25
  showed no improvement in sperm motility and sperm
  counts.

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Infertility/Pregnancy

• A urine iodine challenge is another critical test
  to do for pregnant women.
• In the autism pesticide study (Roberts, et al,
  2007 EHP), iodine deficiency may be the mechanism
  by which the incidence of autism rose to exposed
  mothers.
• Since many environmental toxins affect the
  thyroid and the lack of iodine can adversely
  affect the fetus, this is another very important
  test to run.

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• If there is a hesitation to do all of the testing
  here are a few tried and true general
  recommendations.
• Since we all have petrochemically based toxins in
  our system, both the mother and the father should
  begin using a broad spectrum amino acid complex
  with at least one gram of glycine per serving.
• Women should be put on a broad spectrum trace
  mineral supplement.
• They should also be put on a balanced
  electrolyte.
• Add DHA/EPA combination.

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Autism
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Autism

• In my many years of work, it is striking that in
  the field of autism more unnecessary tests are
  run on autistic children than any other disease
  or syndrome which testifies to the desperation of
  parents of autistic children.
• My goal is to provide the least number of tests
  necessary to make the greatest impact on children
  with autism.
• Another important issue is not putting the
  children through traumatic testing more often
  than is necessary.
• Testing should direct treatment, not illuminate
  the health care practitioner mind.
• Conservation of resources while improving outcome
  is essential and should be the overriding
  principle.

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Autism

• Here are a few tests I would avoid for the
  treatment of most autistic children.
• RBC fatty acids
• Fatty acids are typically abnormal in most
  autistic children but there is no evidence that
  targeting fatty acids through a test is
  beneficial.
• Co-factors such as magnesium and vitamin B6 can
  lower arachidonic acid which is not uncommonly
  high in autistic.
• There are better tests not requiring a blood draw
  that can give you the same information.
• One researcher has astonishingly claimed that
  autistic children have higher Omega 3 to 6 levels!

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Autism

• Fatty acid metabolism can be negatively affected
  by environmental toxins.
• Affecting the fatty acids does not address the
  toxicity issue.
• It is minimally beneficial in removing heavy
  metals or pollutants.
• When dealing with autistic children, if we can
  avoid a blood draw, you reduce the stress on
  these children.
• A traumatic draw can change the results on a
  test.
• Levels of liver enzymes, hormones, electrolytes,
  blood cell counts can all be negatively affected
  by the way the draw is done.

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Autism

• Urinary porphyrin testing is the latest rage.
• It is theoretically useful if the specimen is
  handled correctly.
• There lies the rub.
• Porphyrins are highly light and air sensitive.
• Pee into a bucket with a fluorescent light and
  half the analyte is gone.
• Shaking instead of gently rocking the specimen
  can cause depletion of the porphyrin analyte.
• There is a very high incidence of false negatives
  with this test.
• Even with proper handling, the false negative
  rate reduces clinical utility.

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Autism

• Urine heavy metal challenge tests are also
  commonly used with children with autism.
• Its clinical utility is questionable.
• The risk of developing side-effects due to the
  use of a chelating substance is substantial.
• It does not indicate the burden and/or the
  disruption of biochemical pathways due to mercury
  or other heavy metals.
• A hair elements test, using the counting method
  developed by Dr. Andrew Cutler and spelled out in
  his books Hair Test Interpretation and Amalgam
  Illness (available at www.noamalgam.com) is safer
  and superior.

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Autism

• According to the data from the DAN website,
  chelation therapy has a very high positive
  outcome with a low negative and relatively low no
  effect rate.
• http//www.autism.com/treatable/form34qr.htm
• Out of 803 cases reported the positive response
  rate was 74 with negative results being at 3
  and no response being the lowest of all
  treatments at 23.
• With those numbers I would suggest chelating
  using the Cutler method over testing for heavy
  metals.

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Autism

• Cutler method
• DMSA ¼ mg per pound per dose along with the same
  for Alpha Lipoic Acid every 3 to 4 hours no more
  than 1 mg per lbs. Three days on four or 11 days
  off.
• DMPS ¼ mg per pound per dose every 8 hours with
  Alpha Lipoic Acid every 3-4 hours. Again 3-4 days
  in a row then skip several days.
• Each day you chelate, you remove between ½ to 1
  of the mercury in the brain.
• According to Cutler (pg 90 Amalgam Illness) it
  would take between 70-140 days to remove 50 of
  the mercury in the brain.

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Autism

• Urine Organic Acids (OAT) along with an
  environmental pollutants biomarker test is a
  non-invasive, helpful test to assess abnormal
  biochemical pathways in autistic children.
• Yeast markers among these children using an OAT
  test has been vastly over blown.
• The markers Tartarate and Citramalic acid are not
  markers for yeast.
• Tartaric Acid actually kills yeast and is not a
  byproduct of yeast.

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Autism

• So why do children with autism improve using
  anti-fungals if yeast is not so prevalent?
• Many children with autism have upregulated Phase
  I detoxification pathways and down regulated
  Phase II.
• The intermediary chemicals created in Phase I are
  more neurologically toxic than the original
  chemical, especially with petrochemical solvents.
• Anti-fungal drugs down regulate Phase I which
  allows Phase II to catch up.
• This is also why they do so poorly after removing
  the drugs.
• Improving Phase II through the use of amino acids
  such as Glycine will help upregulate Phase II.

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Autism

• I see a high percentage of autistic children,
  especially boys with high urinary phthalate
  levels.
• They also often times have other solvents such as
  xylene, toluene, styrene, and benzene.
• Detoxifying these ubiquitous chemicals seems to
  lower many of the common traits such as stimming,
  head banging and hand flapping.
• This may be due to the upregulation of Phase II
  detoxification.

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Autism

• A Plasma, Blood Spot or Urine Amino Acid test
  would be beneficial in assessing these important
  builders of neurotransmitters.
• A customization of a broad spectrum amino acid
  base has been shown to be clinically useful in
  helping autistic children.
• We see a number of children with autism with
  dramatically abnormal amino acid profiles.
• Taurine is typically low and autistic children
  benefit greatly from its supplementation.

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Contact Information
Dr. Mark Schauss, DB Lab Interpretation LLC 18124
Wedge Parkway, Ste 432 Reno, NV
89511 775-851-3337 marks_at_labinterpretation.com www
.labinterpretation.com www.labinterpretation.podho
ster.com www.MarkSchauss.com www.ToxicWorldBook.co
m www.whatifhistory.podhoster.com