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Advanced Laboratory Spotlight: The NutrEval® Comprehensive Nutritional Testing

ADVANCED LABORATORY SPOTLIGHT:

NutraEval® COMPREHENSIVE NUTRITIONAL TESTING

A Comprehensive Test for Identifying Nutritional Deficiencies, Toxicities, Gut Imbalances, and More

by Genova Diagnostics


b2ap3_thumbnail_nutreval-fm-nutritional-test-blood-urine-small-1.pngIn my Integrative & Functional Medical practice, there is no one-size-fits-all approach to diet.  Patients come to me following a variety of diet plans - everything from vegan to keto - and I also prescribe a variety of food plans for my patients.  Regardless of the food plan of choice, I like to dig deep with data to answer the question: Is your current diet plan meeting your nutritional needs?

The NutrEval® laboratory test by Genova Diagnostics is the most commonly ordered specialty laboratory test in my practice. This test serves as an excellent starting point for evaluating nutritional status and investigating the root causes of chronic illness, as well as a useful follow-up tool to measure how well lifestyle changes and supplement regimens are working.


OVERVIEW

The NutrEval® test is an advanced nutritional analysis designed to reveal nutritional imbalances or inadequacies. NutrEval Plasma® evaluates the functional need for antioxidants, B-vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. The test also provides insight into gut health, heavy metal toxicity, mitochondrial function and more.


YOUR REPORT INCLUDES:

Elemental Markers (both mineral nutrients and toxic metals) This section provides direct measurements of minerals and heavy metals. Mineral results can be used to identify mineral deficiencies or excess. Heavy Metal results can be a useful screening tool, if elevated levels are identified, provoked urine heavy metal testing is often recommended. Analyses measured include:
  • Copper
  • Lead
  • Magnesium
  • Mercury
  • Manganese
  • Antimony
  • Potassium
  • Arsenic
  • Selenium
  • Cadmium
  • Zinc
  • Tin

Essential and Metabolic Fatty Acids (red blood cell essential and non-essential fatty acids, including Omega-3 and Omega-6 fatty acids) The Fatty Acid Analysis is a red blood cell measurement, representing approximately 100-120 days prior to testing. When interpreting these results with patients, I am able to accurately identify what type of diet they are following, which types of oils they are cooking with, and whether or not they are supplementing with fatty acids (like Fish Oil). This section can provide valuable insight insight for diet and supplement recommendations for:
  • General Wellness
  • Inflammatory Disorders
  • Cardiovascular Risk
  • Mood and Brain Disorders

Amino Acid Analysis
(amino acids are the building blocks of protein)
The Amino Acid Analysis represents a 21-day “window” into your protein intake and amino acid balance. I use this section most often to:
  • Evaluate protein intake, digestion and absorption.
  • Evaluate amino acid balance in relationship to mood disorders.

Oxidative Stress Analysis Oxidative Stress represents the balance of antioxidants and free radical damage in the body. When describing Oxidative Stress to patients, I often describe it as “rusting” on your cells and DNA. This analysis measures markers of this “rusting”, as well as levels of Glutathione, a powerful antioxidant that plays key roles in healthy aging and detoxification (learn more here). Our levels of Glutathione are determined by both our genes and our lifestyle, so if low levels are detected, we can implement protocols for improvement.

Learn more about Glutathione HERE.


Metabolic Analysis (urine organic acids)
Urine organic acids are not something I learned about in Medical School. This analysis, often utilized by Naturopathic Physicians, measures metabolites in the urine that reflect processes going on in your body. This analysis provides insight into:
  • Digestion
  • Bacteria and/or Fungal Overgrowth in the Gut
  • Mitochondrial Function (cellular energy production/Krebs Cycle)
  • Neurotransmitter Balance (stress/mood)
  • Functional B-vitamin Need (not measured values in your body but rather a measurement of how your body is utilizing these vitamins)
  • Need for Detoxification Support

b2ap3_thumbnail_LabTesting.jpg


SPECIMENS:

First-morning urine and a blood draw at a participating laboratory.

COST:
  • Varies per insurance. 
  • Covered completely by many Medicare plans.
  • Commercial plans require and out-of-pocket co-pay of $200-300.
  • Not covered by Medicaid.

Note: I do not profit off of ordering this (or any other) laboratory test. Any co-pay goes directly to Genova Diagnostics.

Visit the Genova Diagnostics Website and view a Sample Report HERE.  

Ready to get started with your nutritional testing?  Contact our office at 231-638-5585 to schedule an appointment!



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like advanced laboratory testing) to find and correct underlying imbalances.
I see patients from all over Michigan using a secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Female Hormone Testing 101

FEMALE HORMONE TESTING 101

Which test is right for you?


Achieving Hormone Balance in women starts with evaluating your hormone levels. While symptoms can often suggest hormonal patterns, I use laboratory data to confirm these patterns, and also to evaluate the safety and effectiveness of prescribed hormones, supplements and lifestyle recommendations.


WHICH HORMONES DO WE TEST?
The term “hormone balance” refers to the interaction and balance of a variety of hormones in the body, therefore when evaluating hormones we need to do so BY keeping all of these interactions in mind. While there are many hormones we are able to test, the hormones I most routinely test in my patients include:
  • Adrenal (stress hormones) - cortisol, DHEA-S
  • Sex-steroid hormones- estrogen, progesterone, testosterone, DHEA
  • Thyroid - TSH and free thyroid hormone levels
  • Other - insulin (think blood sugar regulation), pregnenolone (a hormone precursor often referred to as “the mother of all hormones”)
b2ap3_thumbnail_TESTTUBES.pngThere is no perfect hormone test for everyone.

Hormone levels can be measured in blood, urine or saliva. There are many factors taken into consideration when choosing which test is appropriate for each patient, including:
  • patient age
  • type of hormone(s) being measured
  • the number of samples needed to test
  • pre-, peri- or post-menopausal
  • whether the patient is currently on hormone therapy
  • cost of test

So which test is right for you?

Below I’ve broken down the pros and cons of each test and provided information on the tests I most often order in my practice.


HORMONE TESTING 101

BLOOD
Pros: Blood testing is simple and cost-effective (covered by most commercial insurance policies as well as Medicare and Medicaid).

I routinely use blood testing for thyroid hormones and fasting insulin regardless of age. Blood testing of DHEA and pregnenolone is useful for both baseline levels and to monitor when supplementing these hormone precursors. For sex-steroid hormones (estrogen, progesterone, testosterone), blood testing can be useful in the following situations:
  • Pre-menopause - an early-cycle draw (around day 5) can help evaluate for PCOS (polycystic ovarian syndrome).
  • Peri-menopause - a luteal phase draw (day 22-24) helps to evaluate PMS imbalances and estrogen: progesterone balance.
  • Post-menopause - blood hormone levels can be used to confirm menopause and also to monitor hormone levels while on hormone therapy.
Cons: Blood hormone testing gives us information on one moment in time. It is not practical to use blood for multiple-day specimens, or for several samples in one day. Blood measurements are also limited in their ability to provide information on hormone metabolites. Hormone metabolites give valuable insight info which “pathways” hormones take in your body, some of which are healthier than others, and can help stratify risk for hormone-related cancers.

Click HERE to read my previous blog on estrogen metabolite testing.


SALIVA
Pros: Saliva tests can be performed and shipped from anywhere, bypassing a trip to the laboratory. Saliva tests are convenient when multiple specimens are needed and can be kept in your freezer if testing over a month cycle.
I routinely use saliva hormone testing to test adrenal hormones. I also use saliva sex-steroid hormone testing in pre- or peri-menopause to look at cyclical trends and hormone fluctuations, testing anywhere from 5-28 day periods.

Cons: While Medicare covers saliva hormone testing, most commercial insurance companies do not. Saliva hormone testing does not provide hormone metabolite information. While saliva testing can be useful for adrenal and sex-steroid hormones, it is not used to measure thyroid hormones or insulin. Some patients have trouble producing enough saliva for testing, especially if they have chronic dry mouth or are on medications that reduce saliva production.

MY MOST ORDERED SALIVA HORMONE TESTS BY GENOVA DIAGNOSTICS:

URINE

Pros: Urine hormone testing can be done and shipped from home, bypassing a trip to the laboratory. One of the biggest benefits of urine hormone testing is the ability to get an abundance of information on hormone metabolites (see above and my prior blog). Hormone metabolites are especially useful in stratifying risk for hormone-related cancers and also in evaluating the efficacy and safety of hormone replacement therapy.

Cons: Most commercial insurance companies do not cover the cost of urine hormone testing. Some urine hormone tests in postmenopausal women require a 24-hour urine collection, which can be cumbersome for patients. While I use urine hormone testing to measure adrenal and sex-steroid hormones, I do not use urine to measure thyroid hormone or insulin.


b2ap3_thumbnail_DUTCHwheel.pngMY MOST ORDERED URINE HORMONE TEST BY GENOVA DIAGNOSTICS:
Complete Hormones (either 24-hour or first-morning urine, depending upon patient age)

MY NEW FAVORITE TEST BY PRECISION ANALYTICAL INC. COMBINES BOTH SALIVA AND URINE:
DUTCH Complete and DUTCH Plus testing




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone imbalance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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