The Role of Laboratory Testing in Mental and Physical Health
Our bodies use symptoms, whether mental or physical, to tell us that we are ill. But to understand the meaning behind those symptoms, we must listen to and understand another language through which our imbalanced physiology speaks – biochemistry. Laboratory testing is one way those biochemical messages can be made audible.
In addition to the psychosocial contributors to mental and emotional pain, there can be multiple potential physiological causes. Our approach to uncovering these physical factors is a scientific one – gathering objective laboratory data that may include a close examination of a patient’s nutritional status, hormone levels, gastrointestinal function, energy metabolism, immune system, environmental toxin exposure, and genetic profile.
To give a drug, herb, or supplement based on only the symptoms of an illness is guesswork. The risk is that what makes each person biochemically unique can be overlooked. Our aim is to provide the physiological intervention that the patient’s body tells us it needs. While a thorough history and physical exam are vital, sometimes laboratory tests provide the most complete translation of what someone’s symptoms are trying to say.
Commonly Recommended Lab Tests and Costs
Please note that while these tests can be costly, they are only ordered when medically necessary. And, of course, not all or even most of these tests are ordered on every patient. Some patients may not require any, or the relevant laboratory studies may have been done recently enough to provide the necessary information. Diagnostic assessments, like the treatments we employ, are highly individualized, and based on a comprehensive initial evaluation. In some case, labs other than those listed here will be utilized, if doing so enables patients to optimize insurance reimbursement.
The doctors at The Mind-Body Clinic earn no commission or profit from tests that are ordered. In some cases these laboratory examinations can pose a significant up-front expense. However, if they lead to the identification of treatable upstream causes of downstream neuropsychiatric or other symptoms, ordering them can ultimately save a lot of money for patients, as well as foreshorten or prevent unnecessary suffering. While the lab assessment needs of each patient will vary, individuals with complex chronic conditions that have been refractory to other treatments should expect to spend a bit more. The out-of-pocket cost for such patients (prior to insurance reimbursement, in the event that that is forthcoming) can range from $1500.00 to $2000.00. Putting such an expense into a larger perspective, that would buy about an hour in a typical intensive care unit -- an outcome our approach is designed to foreclose.
Comprehensive metabolic blood panel, CBC, and urinalysis : Although run through Lab Corp, a large mainstream national laboratory, this is a much more thorough and significantly discounted version of the conventional screening blood and urine test patients often receive at their annual physical exams. Among the factors assessed are hormone imbalances, liver dysfunction, anemias, inflammation, nutrient deficiencies, blood sugar dysregulation, and blood fat abnormalities. Included on this panel are markers for thyroid function: TSH, thyroid hormones (free T4, free T3, and reverse T3), and thyroid autoimmune markers. Hypothyroidism can often be a contributing factor to depression and fatigue conditions. Although less common, hyperthyroidism can be a source of agitation, nervousness, and insomnia. $199.00. For some patients, their symptoms and history indicate that other items should be added to this basic screen, and the cost is increased accordingly.
Glucose/insulin response profile test: This test is recommended when blood sugar imbalances are suspected. It looks at fasting glucose and insulin levels, and then records post-glucose drink levels of glucose and insulin drawn at ½ hour, one hour, 1 ½, and two hours. This test measures how effective insulin is at facilitating the movement of sugar from the blood into cells. Impaired insulin sensitivity of cells is associated with and contributes to obesity, low-level chronic systemic inflammation, heart disease, atherosclerosis, anxiety, depression, and mild cognitive impairment, and dementia. $120.00.
Celiac/gluten sensitivity screen : When cost is a major concern, this salivary test for elevated immune responsiveness to gluten can be useful. It looks at secretory IgA, anti-gliadin IgA and IgM, anti-transaminase IgA and IgM. $115.00.
Wheat/gluten proteome sensitivity and autoimmunity panel : This is the most comprehensive test available for gluten sensitivity that looks for 24 different markers of wheat/gluten immune reactivity, and thus greatly reduces the risk for a falsely negative test. Patients with this condition can have antibodies against their own neurochemicals and brain tissue. $325.00. Sometimes, the immune systems of gluten-sensitive patients cross-react with other foods, which can then result in a failure to respond to a simple gluten-free diet. To assess for this possibility in patients who don't feel significantly better from gluten avoidance, a gluten-associated cross-reactive foods panel is ordered. The cost of this is $225.00.
NutrEval panel : This includes five very valuable tests – urinary organic acid profile , plasma amino acids , nutrient and toxic element analysis, essential fatty acids, and an oxidative stress profile . This comprehensive panel can be profoundly useful in detecting the upstream causes of a variety of illnesses, including chronic mental health conditions. They are bundled together to reduce costs.
The organic acid test is like a CAT-scan of metabolic processes, revealing a wide range of biochemical disturbances related to detoxification, neurotransmitter function, nutrient malabsorption, chronic infection, and mitochondrial energy production. The amino acid test shows the blood levels of the essential biomolecules that comprise the building blocks of all the body’s proteins, including neurotransmitters. The nutrient and toxic element component can reveal blood levels of essential minerals, as well as any current exposure to certain toxic metals, like lead and mercury. The levels of essential fatty acids, which are also measured in this panel, determine the healthy functioning of our cell membranes. And deficiencies, which are common in the United States, have been linked to multiple disease conditions, including neuropsychiatric disorders.
Oxidants are highly reactive chemicals that are produced in normal metabolic processes, and can also result from the exposure to toxic substances from the environment. If not neutralized by antioxidants, damage can occur to the body in multiple ways. Even our DNA can be affected, and thereby increasing our risk for cancer. By detecting the end products of oxidation, the oxidative stress component of this panel can enable early correction of a major disease risk factor. The cost for those not covered by accepted insurance plans is $707.00. The cost for those on covered plans is $169.00.
Comprehensive stool analysis : This thorough test of large intestine function looks at markers of digestive dysfunction, inflammation, parasitic infection, and microbiological imbalances such as bacterial or fungal overgrowth. Gut inflammation and disturbances in intestinal microbial ecology can have systemic effects, and even impact brain function. $275.00.
Breath test for small intestinal bacterial overgrowth (SIBO): This is a test for the presence of pathogenic bacteria in the small intestine. SIBO can not only produce a wide range of gastrointestional symptoms, such as irritable bowel syndrome (IBS), it can also contribute to various neuropsychiatric conditions.
Urine hormone and metabolite panel: This is a test that assesses the levels of sex hormones (estrogen, progesterone, and testosterone) and their metabolites (the breakdown products of hormones), as well as adrenal hormones and their metabolites – all of which much be in balance for optimal psychological and physiological functioning. In some cases the metabolites have more significant implications for health than the hormones themselves. For example, the test can reveal whether estrogen is being transformed downstream into a protective metabolite or broken down into a more high-risk, potentially carcinogenic end product. This panel also looks at the level and pattern of cortisol secretion through out the day, which shows how you are adapting to stress. $250.00.
Saliva and blood spot hormone test: This hormone test uses saliva and blood spot (finger prick) samples for analysis, and is collected at home. The saliva test It also provides a good indicator of the extent to which sex hormones, especially if applied topically, are reaching the tissues of the body – something standard blood level don’t do as effectively. The blood spot is used to determine tissue thyroid hormone levels, as well as the presence of anti-thyroid antibodies. $299.00.
NeuroGenomic profile : This is a genetic panel that looks for mutations in a number of genes that control a range of biochemical functions, such as methylation, detoxification, and protection against oxidative damage. The brain and nervous system are exquisitely sensitive to impairments in these processes. Knowing about the presence of mutations in the genes that control these functions can be an important guide to treatment. $336.00.
DetoxiGenomic profile: Neuropsychiatric symptoms are often the first indicators of environmental toxicant exposure. This panel assesses for the presence of multiple genetic variations that affect ones capacity to detoxify environmental chemicals, hormones, and prescription drugs. Understanding a patient's genetic vulnerabilities is an essential part of any detoxification protocol. $470.00.
Psychiatric drug response genetic panel: This test has some similarities to the above gene test. But it is more focused on genetic variations that affect a patient's capacity to benefit from, develop adverse reactions to, and detoxify common psychiatric medications. It can also identify genes related to the synthesis and utilization of neurotransmitters. Included on this panel is a MTHFR gene test. This is a genetic test that looks for the presence of a mutated gene that codes for an enzyme needed to metabolize folic acid. When present it can impair the utilization of folic acid from the diet, and be a significant contributing factor to a variety of neuropsychiatric conditions due to dysregulations of serotonin, norepinephrine, and dopamine. According to psychiatric researcher, Dr. Lawrence Ginsberg, up to 70% of those with depression have a mutation on this gene. When this gene is found, the patient must be supplemented with a bio-available form of folate, which can cross the blood-brain barrier. Given the potential importance of these genes in clinical outcome, we believe that running this panel should be part of the standard of care in any treatment that includes the use psychiatric drugs. This lab will bill insurance.
Gluten and casein peptides test: Assesses levels of gluteomorphin and casomorphin, which are products of the incomplete breakdown of wheat and milk, respectively, and which can react with brain opiate receptors, and produce effects that mimic heroin and morphine and impair cognitive function. $110.00 (patient cash price).
Hair metals test : Detects toxic metal exposure as reflected in hair residues. Toxic heavy metals when present in sufficient quantities, especially in an individual with an impaired capacity for detoxification, can be profoundly debilitating and affect nearly every part of the body, especially the brain and nervous system. $135.00 (patient cash price).
Urine heavy metal test: This is the most thorough test for the body burden of heavy metals. It involves collecting two 6-hour samples on two seperate days. On the first day the urine is collected for 6 hours. On the second day a small amount of a chelating agent, DMSA, is ingested. Its function is to draw out metals from storage in the body. The urine is also collected over 6 hours.
Urine Porphyrins Profile: This test assesses the metabolic impact of heavy metal and other toxic exposures, such as might result from aluminum, arsenic, mercury, lead, benzene, dioxin, polyvinylchoride, and excessive alcohol consumption. Some individuals can have relatively high body levels of these toxins, and still be able to manage their presence in the body without incuring significant physiological damage. Many other people, whose detoxification and elimination functions are not working effectively, can suffer serious damage from even modest exposure. In other words, toxicity is not just an index of exposure. More importantly, it reflects the impact of that exposure. Porphyrins are proteins that are part of biochemical pathways in nearly every cell of the body. They are very sensitive to the presence of various toxins, and therefore changes in their levels can have great value in assessing whether toxicity is an important contributor to a patient's symptoms. If this test is positive, follow up testing should be done to identify the specific toxic metals that are comprising the body burden of toxicity. $174.00.
Toxic Effects Core Profile: This new panel combines what had been formerly six separate tests. It assesses the body burden of phthalates and parabens (found in plastics, cosmetics, fragrances, and other personal care products, and implicated in male infertility, breast cancer, behavioral and attention problems in children, and obesity), polychlorinated biphenyls (PCBs are industrial chemicals that have found their way into farmed fish, dairy, and human breast milk, and function as poison to our mitochondria -- the energy-producing factories of our cells), bisphenol A (found in plastics and resins, and functions as a hormone disruptor and mitochondrial toxin), chlorinated pesticides (ubiquitous in our food supply, especially non-organic produce and in animals given non-organic feed, and associated with multiple neurological and endocrine disorders), organophosphates (used as pesticides and as chemical warfare agents, in both applications functioning as neurotoxins), and volatile solvents (easily inhaled chemicals found in gasoline, car exhaust, furniture, cleaning agents, paints, and adhesives, and which can produce impaired cognitive function, depression, fatigue, and other central nervous system impairments). Before being bundled into one package, the total cost of these separate components cost over $1000.00. Combined into this profile, the cost is $599.00.
Intestinal Antigenic Permeability Screen: One of the serious long-term effects of inflammation in the small intestines is increased permeability of the gut lining. This can result from immune reactions to gluten or other foods, sustained stress, or from pathogenic microorganisms. The erosion of gut barrier integrity allows the leakage of large partially digested food particles or bacterial toxins into the blood stream. This in turn can provoke an antibody response, which can then lead to a chronic low level of systemic inflammation and other serious consequences, like cross-reactive autoimmune attacks on the body's own tissues. Many scientists believe that, combined with genetic susceptibility and environmental toxicant exposure, intentional permeability is a primary upstream cause of many severe autoimmune disorders. In addition, the chemicals produced in the systemic inflammation resulting from a leaky gut can even cross the blood-brain barrier, and induce a wide range of neuropsychiatric conditions.
This test looks for antibodies to the tissues that comprise the lining of the small intestines, and antibodies to the cell walls of pathogenic bacteria. The presence of both of these types of antibodies in the blood confirms that, as a result of gut permeability, exposure to (and thus stimulation of) the systemic immune system has occurred. The good news is that once discovered, this is a treatable condition. $195.00
Autoimmunity Panel: This test looks for 24 different anti-self antibodies, which can be involved in diseases that affect multiple parts of the body, such as the heart, reproductive organs, joints and connective tissue, endocrine glands, and brain tissue. When found early, these antibodies can predict illness, i.e., they can sometimes show up decades before an illness produces serious tissue damage or gets expressed as symptoms. This enables patients to initiate treatments that have the potential to prevent future disease. The cost for the entire panel is $575.00. However, if one is only concerned about a single body system (say, the brain and central nervous system), a small panel can be ordered at a reduced cost (in the latter example, $275.00) .
Note: The prices listed above are those of the labs, and are of course subject to change.
Where Patients from The Mind-Body Clinic Can Have Their Blood Drawn
Phlebotomists from Heath Exam, Inc. will come to your home or place of business for $60.00 for the first lab kit. (Each of the above tests is considered one kit, even if there are multiple components.) Additional kits are $10.00 each. If you come to their lab in San Francisco or the South Bay, the fee is $40.00 for the first test. To make an appointment by phone call 800-404-3926. Their hours are 8am-7pm, Monday-Friday, and 9am-2pm, Saturday. Also, you can go here to request an appointment online.
The other mobile phlebotomy lab we use is Bayside Phlebotomy. Contact them here to make an appointment, and to obtain their current prices and hours of operation.
Specimens for all Lab Corp tests must be drawn from a Lab Corp draw center. Check online for the location nearest you. They may or may not be willing to draw for other labs. They are less inclined to do so than they have in the past, according to reports from patients.