The age of information has given us access to incredible health technologies and testing like never before. Many of which are direct-to-consumer, granted patients a sense of agency, a right to choice, and a wealth of knowledge that was once only available to and through healthcare providers.
While this is certainly a wonderful advancement that technology has granted us, it is important to know where and how your money is being spent as a consumer. You need to understand how these advancements are relevant to your health. How can you use them in making decisions about your health, and more importantly, SHOULD you use this information to make potentially life-altering decisions?
That’s what we’re diving into this month so that YOU can be fully in-charge of YOUR health.
There are many incredible scientist, doctors, and companies who are diligently working to both cure diseases and provide the most cutting-edge tests, interventions, treatments, and technologies that allow us full control of our health.
At the same time, biotechnology is a $458 billion industry (1). The dark side of an industry this lucrative unfortunately includes individuals who are more interested in their paycheck than the live they impact.Case in point, I just watched The Dropout on Hulu which is ultimately what inspired me to make biotech the focus of this month’s Newsletter. The series is based on the true story of Elizabeth Holmes who managed to defraud billions from investors for the production of a finger-prick blood test that would allegedly replace blood draws.
The technology made its way into many reputable clinics and stores including the Mayo Clinic, Walgreens, Safeway, and was covered by major insurance providers. It was finally Medicare that forced the truth in 2016. There was no actual testing software to be found within – Theranos. Test results were 100% fraudulent with no validity whatsoever (2).
This was a major company that managed to fool this many practitioners, investors, insurance providers, and major health clinics for years on end. This got me thinking about the myriad of testing and biofeedback technologies that are available direct-to-consumer and how easy it would be for this to happen again.
Turns out, it’s widespread. You might have even tried some of these products yourself in hopes of taking charge of your health without knowing that many of these companies are just stealing your money, time, happiness, and peace of mind (imagine receiving a false positive result for something as scary as cancer!).
I also just finished reading Tony Robbins new book “Life Force“. And while this book was like reading a script for the worlds longest infomercial, it was also very insightful on some incredible breakthroughs happening in the world of medicine and biotechnologies. It is a must-read for anyone interested in regenerative medicine or those wanting to stay on the cutting edge of medicine . Some of these interventions will change the world. Even still, there were quite a few recommendations in this book that ARE NOT VALIDATED BY SCIENCE and should not be used to inform health decisions.
I.e. You shouldn’t use DNA analysis to determine your dietary patterns, the GRAIL test is subject to high false-positve rates (scary when we’re talking about cancer), and based on the research, I believe people should be eating much more protein (clean and lean, of course) than is suggested.
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WHO do We Trust with Something as Valuable & Personal as Our Heath?
First and foremost, the best thing your can do is find a reputable provider whom you trust – and yes, it’s okay to visit many different ones until you find the best fit.
Ask them how they stay up to speed on pertinent health information and topics. Do they read scientific journal articles? Stay up-to-date with the latest breakthroughs in medical sciences? Or is their primary source for new information from their pharmaceutical reps or medical marketing catalogs which are subject to major biases?
Are they open-minded and encouraging of engagement in “less-conventional” therapies like nutrition, chiropractic, acupuncture, mental/emotional/spiritual health and wellbeing, and social environments?
Do they LISTEN to you and your concerns with respect and empathy? Do they treat you like YOU know best when it comes to your body and health or are they pushy and act as if you must have done something wrong if their treatment didn’t work?
Are they open to trying alternative options if you’re averse to starting a new medication (in cases where it is safe to do so)? Do they support you in finding someone to work with on this?
Functional medicine certified MD’s often posses many of these qualities and are great to have on your health team.
And to that point – it is a great practice to have what I like to call a your “healthcare team” you may need to see some more than others and that’s okay. It’s good to know that you have a trusted professional in a particular field for when you need them. This can include everything from counselors, nutritionists, chiropractors, TCM providers, personal trainers, and medical doctors to name a few. We can’t be all things to everyone but there is always a time and a place.
These providers can also help guide you to the most valid and appropriate biotechnologies for your health. Let’s dive into those below.
WHAT do We Trust with Something as Valuable & Personal as Our Heath?
Now, for the tests, interventions, and biofeedback we have direct access to outside of our providers. The list is very large so we’ll review some of the more common options, which ones are worth it, which are not.
Blood Tests:
Blood Tests You SHOULD Do at Home:
Basic Blood Test
A blood draw is your tried and true method of testing and is something everyone should test each year. Here I’m talking the basics – red blood cell health, metabolic panels, hormones, and lipids. And yes, this is now something that YOU have access to entirely on your own (I know many people have gone years without seeing a doctor – you absolutely need to still be running blood tests).
It’s as simple as purchasing the panel online and taking your requisite into Quest Diagnostics. They send the results to you.
- Here’s a very basic but essential panel: Baseline Biomarkers – Basic
- Here’s a more comprehensive option: Baseline Biomarkers – Basic Plus
This is all that most people will need to get started. It’s great way to determine if further testing is warranted – and more affordable. It’s unnecessary to spend hundreds to even thousands on abroad range of blood test upfront (unfortunately as many FM providers often do).
If you run these tests on your own, you should absolutely see a doctor if anything comes back out of range. Additionally, you can also have the results review by an FM provider like myself to see if anything is outside of optimal range and learn what you can do to correct it (usually via diet, lifestyle, and/or supplements).
Glucose Monitors and CGMs
As a T1D, this is something that’s been part of my life for most of my life but they can also be very useful for individuals who do not have diabetes. You can purchase a glucose monitor at any major grocery store. Checking your fasting morning glucose and post-meal glucose can offer great insight into how your metabolism if functioning and your insulin/glucose management.
CGMs or continuous glucose monitors are also available to everyone through programs like Nutrisense and AgelessRX. They can provide great insights into the best foods to eat to support healthy blood sugar metabolism.
It is also important to run these results by someone with a detailed understand of what they mean before making drastic changes to your health routine.
Blood Tests You Should NOT Do at Home:
I’m going to start this one off by saying that no one should ever have you spend $1000+ in testing on your first round of test (very common in FM). Get a second opinion in this case, if not warranted by major disease/diagnosis. Unless, of course, you’ve requested it because you want very detailed insights so you can to optimize health.
Food Sensitivity Testing
These are wildly popular in the FM field despite major lack of scientific validation. Studies have shown that food-sensitivity-based diets are little to no more effective than anti-inflammatory or elimination diets (3).
Most of these test read IgG levels and claim that if you have IgG antibodies to certain foods that your immune system is reacting to them and you should stop eating said food. But science does not support this claim. Rather, having IgG antibodies to foods is a normal immune response and it’s a more accurate reflection of TOLERANCE to those foods. Many people actually end up eliminating foods that they tolerate well. (4)
Check out this podcast for an even deeper dive: https://drruscio.com/food-sensitivity-testing-ffmr/
Food sensitivity tests are available direct-to-consumer but these are something that I would never recommend people waste money on. While they may be helpful in extreme cases for some, and they do offer the benefit of improved compliance rates and the placebo effect, we can often achieve the same results with careful dietary monitoring and intervention as well as with healing the gut.
Finger-prick Hormone/Nutrient Blood Test
While these tests may be helpful for warranting further testing from your provider, they are not something I recommend for several reasons:
- They are not diagnostic and can lead to confusion if not interpreted properly – this can lead one to make unnecessary or even unsafe decisions regarding health interventions. You should always review the results with your healthcare provider (5)
- While some results have been validated, other studies have found results to be “generally inadequate” (6) and “insufficient” in terms of understand the context of the results, leading to false-positive or false-negatives (7).
These test may be helpful for guiding one to a more detailed blood test, but this can also be accomplished by a provider who understands the complex interplay of health symptoms. A blood draw test will be required in order to diagnose and make treatment decisions.
Because these tests can often be expensive, I do not recommend spending your money here. Instead, it would better serve you to work with an experienced healthcare provider and go straight to more validated forms of testing.
At Home DNA Tests for Dietary & Lifestyle Interventions
This was another topic raved about in ‘Life Force’. There are test which claim to be able to tell you how you should eat (low-carb/high fat, plant-based, high-carb, etc.) and what lifestyle habits you should adopt based on your DNA. My science-focused mind wouldn’t let me accept this without verifying validated research and it turns out, there’s not much.
This is certainly a biotechnology that’s improving at exponential rates, genomics are very important for predicting certain health outcomes. It won’t be long before these tests are used as part of regular health screenings. But as for determining dietary, supplement, and lifestyle interventions, the evidence is more in favor of epigenetic factors influencing outcomes – ‘epi’ meaning “above the genes”.
This was actually made evident from study run by a company that offer such genetic testing to determine dietary needs. They found that physiological response to food was more predictable based on participants gut microbiome composition than from their genetics. This study was done in identical twins so the DNA aspect was tightly controlled for (8)
DNA tests that ARE very useful. and informative is DNA methylation or your biological age. Dr. Steve Horvath at UCLA has laid the foundation in this field. This test is actually testing epigenetic factors rather than the genome itself, this tells you how your lifestyle is impacting your healthspan and lifespan.
There are several companies that claim to test DNA methylation, but Elysium is currently the only online company that touts using the Illumina technology which is currently the only validated method for reading DNA methylation. For most other options online I was unable to verify who/what they were using for testing.
Breath Tests & Urine Test
Breath & Urine Tests You SHOULD Do at Home:
Urine Tests
Some tests are very reliable such as urine test for assessing ketone level’s (for diabetics and those desiring ketosis – if you have diabetes and have ketones, you need to get to the ER!). Pregnancy tests, and just the basic biofeedback of assessing the color of urine to determine if you should drink more water are also valid.
Urinary Organic Acid or OATs tests can be performed at home but often do require orders through providers (I would only recommend this option opposed to direct-to-consumer options) These tests can inform you about a broad range of metabolic functions but the results need to be reviewed by individuals who understand what the results mean for health.
Breath Tests
These can inform information about gut health and states of ketosis. You should always perform a breath test for gut health/SIBO in the setting of a doctors office and even then these are subject to false-positives and false-negatives. Breath testing for ketosis is a newer technology but is turning out to be a more informative and reliable method of testing for ketosis as opposed to blood or urine testing. Biosence reads the acetone levels in your breath which lets you know if your body is actually using ketones as fuel.
Breath & Urine Tests You Should NOT Do at Home:
Urine Nutrient/Health Status Test
There are urine test out there like Vivoo that I’m going to suggest you steer clear of. This test claims to be able to inform you about nutrition status, oxidative stress, mineral levels, organ function, certain toxin exposure, and more via scanning a stick with your phone after peeing on it. They tout that their technology is backed by science though I could not find any reference to any studies, nothing in PubMed supporting their claims, and they also do not provide any information on how the technology accomplishes this task.
The only reliable information here is likely hydration status, electrolyte levels, and pH – though that is still uncertain without explanation of how they’re assessing and quantifying these number. Additionally, urine pH has been shown to be a less reliable method for determine pH levels that are relevant to health – a blood test (via CO2) is a more reliable read. Urine pH changes with hydration and nutrition status as well as time of day (9).
Breath Test for Gut Health
As briefly mentioned above, these are subject to a high rate of variability, false-positives, and false-negatives. This is a test that should be performed within a clinicians office and not at home.
Microbiome & Stool Testing
Microbiome &Stool Testing You SHOULD Do at Home
This is more of a discussion of reliable brands and how to/not to use results.
Cologuard
This a great safe and reliable screening test for colon cancer and would make for a great yearly regular screening test for those at-risk.
Microbiome Testing
This is another testing service that’s on-the fringe and can be very helpful for health when used in the right setting. It’s important to note, however, that this is a still a very young field of science and there is still much we don’t know about the microbiome. There are some microbes listed as “parasites” for example, that don’t actually cause issues in many people but do in others i.e Balstocystis hominis. Results like these may result in unnecessary antibiotic therapy.
The way in which these results are most relevant to your health is in having an understanding of the diversity of microbes in the gut, the number and ratios of species, identifying potential pathogenic bacterial or fungal overgrowth, and assessing for parasites.
These are most helpful in cases where symptoms are not improving despite addressing other related issues (10).
Additionally, if you order an at-home test, you’ll want to choose a company that uses DNA-PCR as their testing method. While some may say this is outdated, it is most scientifically validated method for informing clinical decisions. I would also recommend working with a provider who understands the complexities of these tests and their interpretations (11).
Microbiome & Stool Testing You Should NOT Do at Home
Tests like VIOME and Ombre may provide more information on what the diversity and ranges of your microbes look like which may be cool data to have, but at this point in our scientific understanding of the microbiome, it is not worth much in terms of clinical relevance (12).
I’m going to recommend avoiding these companies until we have further understanding of our microbes. These companies claim to be able to inform dietary and supplement needs based on your microbiome despite the lack of sufficient evidence to support them. Your microbiome shifts depending on what you eat (13), and it also changes with the seasons (14). So looking at one snippet in time of your microbes and making clinical decisions based on this data is not a wise practice in my opinion.
Other Common Biofeedback Technologies: the Pros and Cons
I am very much a fan of wearable techs like the Ora Ring, Garmin, iWatch, WHOOP, and Heart Rate Variability (HRV) monitors. I myself wear the WHOOP which monitors heart rate, daily strain levels, recovery, HRV, and sleep patterns. We can gain great insights into our health from such devices – for example, I’ve learned about many things that hinder my recovery and I’ve gradually improved my baseline HRV since I began wearing the WHOOP last Aug. At the same time, we do need to be mindful of the pitfalls of these devices. Most of this data is assessed via heart rate patterns – including your estimated REM sleep and slow-wave sleep. So it’s more correlative than an absolute measure. Additionally, the wrist is not the gold-standard area for reading such biomarkers. I point this out because of the work of a brilliant Harvard researcher who studies the effect of mindset, Alia Crum. Our perceptions of how we slept the night before (which we rely upon our wearable devices to inform us) influence how we feel. If we think we got poor sleep, we’ll feel worse, even if our body went through its healthy 8hr cycle. I encourage you to give this podcast a listen if you’d like to learn more: https://hubermanlab.com/dr-alia-crum-science-of-mindsets-for-health-performance/ And just be mindful of how your mind can influence your body! Sometimes trusting how you feel is better than trusting your devices.
And there you have it. This of course is not an exhaustive list and there are many things out there that can both help or hurt your health progression. I encourage you to do your research and consult with professional in the field to ensure you’re investing in the right things for your health.
As always, I hope you’ve found this information helpful and informative. I would love your feedback or request for future newsletter topics.
You can also reach out to me if you’re interested in learning more about functional medicine. You can schedule a free consultation here.
In Health,
Jordan Smith MS
Functional Medicine Nutritionist
