Functional Medicine

Modern medicine equates the absence of disease with health. Often, people walk into a doctor’s office feeling tired and run down, have an exam and a battery of tests, and come back a week later to hear, “Nothing’s wrong with you. You’re perfectly healthy.” While relieved, they still don’t feel well.

This is where functional, complementary, and alternative medicines play a critical role, helping people focus on wellness and improved function. The primary concern of functional medicine, a new paradigm in nutritional healing, is finding health problems before they become illnesses.

Questionnaires and lab testing are used to determine how well organs and systems are functioning. Functional medicine recognizes that each of us has specific biochemical needs that are determined by our lifestyle, genetic structure, and environment.

It focuses on restoration of health and health status, rather than progression of disease. It looks for improvement in the quality of life and an increase in a person’s health span. The ultimate goal is for people to live a healthful existence throughout life.

Many years before most illnesses occur, people have a steady, cumulative, measurable decline in body function. To quantify this, holistic health practitioners require different tools than those most commonly used over the past fifty years. By the time you need a cardiogram, you already have heart symptoms.

By the time you have a lower or upper GI test, you are experiencing some digestive problems. Even so-called preventive medical testing such as mammograms and cholesterol screenings are really tests for early detection of disease rather than true prevention.

Innovative individuals in medical laboratories worldwide have been designing tests to determine function rather than disease. Tests for functional medicine are numerous. The following are the ones I’ve found to be most useful for digestive problems. Most of these are laboratory tests, but a few are home tests you can perform on your own.


The CDSA checks for bacterial balance and health, digestive function, and dysbiosis and is used to determine which types of bacteria are present and measures beneficial, possibly harmful, and disease-producing microbes. It also checks to see levels of candida.

If present, they are cultured to see if they grow and which agents will be most effective in eliminating them. In addition, the CDSA measures digestive function by determining how well a person can digest proteins, fats, and carbohydrates; the level of pancreatic enzymes produced; and the amount of short-chain fatty acids and butyric acid in the colon.

Some labs also include a dysbiosis index, which uses the combined testing to give a measure of normalcy or abnormalcy. The CDSA provides a quick reference for your health-care provider and can determine your therapeutic needs.

Many labs also culture any abnormal fungi, bacteria, and parasites to determine which medications and herbal preparations may be most effective at bringing you back into balance. CDSA is useful for everyone who has digestive problems. If you only choose one test, do this one in conjunction with the comprehensive parasitology screening.

Parasitology Testing

We tend to think of parasites as something we get from traveling in other countries. However, according to the June 27, 1978, Miami Herald, the Centers for Disease Control (CDC) in Atlanta found that one out of six randomly selected people had one or more parasites.

Great Smokies Diagnostics Laboratory in North Carolina has similar results. They find parasites in 20 percent of samples tested. More than 130 types of parasites have been found in Americans. Parasites have become more prevalent for many reasons, including contaminated water supplies, day-care centers, ease of international travel, foods, increased immigration, pets, and the sexual revolution.

Most people will meet a parasite at some point in their lives. Contrary to popular myths, having parasites isn’t a reflection of your cleanliness. My family contracted giardia in Chicago. We hadn’t traveled and have absolutely no idea how we contracted it.

If you have prolonged digestive symptoms, you should really consider having a comprehensive parasitology screening. Some symptoms of parasites can appear to be like other digestive problems:

  • abdominal pain, allergy
  • anemia, bloating
  • bloody stools
  • chronic fatigue
  • constipation
  • coughing
  • diarrhea
  • gas
  • granulomas
  • irritable bowel syndrome
  • itching
  • joint and muscle aches
  • nervousness
  • pain
  • poor immune response
  • rashes
  • sleep disturbances
  • teeth grinding
  • unexplained fever
  • and unexplained weight loss.

Sometimes parasites are found without accompanying digestive symptoms. Other health problems, such as arthritis, that seem to be unrelated are resolved after the parasites are treated. Many physicians request parasitology testing on random stool samples.

This can be highly inaccurate, so repeated testing is often necessary to get definitive results. For example, eight random stool samples would be needed to definitively rule out giardia. Because numerous parasites live farther up the digestive tract, many labs now give an oral laxative to induce diarrhea to detect these parasites. The most accurate stool testing is usually done by labs that specialize in parasitology testing.

Intestinal Permeability Testing

The method that has rapidly become the recognized standard for intestinal permeablility testing is the mannitol and lactulose test. Mannitol and lactulose are water-soluble sugar molecules that our bodies cannot metabolize or use. They come in differing sizes and weights and are absorbed into the bloodstream at different rates.

Mannitol is easily absorbed into cells by people with healthy digestion; lactulose has such a large molecular size that it is only slightly absorbed. A healthy test shows high levels of mannitol and low levels of lactulose. A leaky gut condition is indicated when large amounts of mannitol and lactulose are present.

A general malabsorption of all nutrients is indicated when low levels of both sugars are found. Low mannitol levels with high lactulose levels have been found in people with celiac disease, Crohn’s disease, and ulcerative colitis. Your doctor can give you a test kit to collect urine samples.

After collecting a random urine sample, you drink a mannitollactulose mixture and collect urine for six hours. The samples are then sent to the laboratory. This test is often done in conjunction with a CDSA or a parasitology test.

Indican Test

The indican test gives a general indication of how well you are digesting foods by measuring the amount of putrefaction in your digestive system. High indican levels are found in people with dysbiotic conditions and malabsorption.

Indican testing offers a quick way to screen for faulty digestion but does not give enough detailed information to know exactly why or where the problem originates. Some doctors find it a useful office screening test because it is inexpensive and noninvasive.

Hair Analysis

Hair analysis is a useful tool to see how well you absorb essential minerals and screen for heavy metal accumulation. Hair is cut as close to your head as possible—only the one to two inches that grow closest to your head will be tested because it reflects your mineral status during the past few months.

The lab burns your hair in an electrochromatography scan to measure the levels of minerals present. Low levels of six or more essential minerals indicate a problem with absorption of nutrients, which could be due to drug therapy, dysbiosis, low HCl levels, or poor flora. Hair analysis is also an accurate screening test to determine whether you have high levels of toxic minerals such as aluminum, arsenic, cadmium, lead, and mercury.

Heidelberg Capsule Test

The Heidelberg capsule test has proven to be accurate and sensitive in determining stomach pH levels. A radiotelemetry test for functional hydrochloric acid (HCl) levels, it is a simple, effective technique to determine how much HCl your stomach is producing.

After you swallow a radio transmitter that’s about the size of a B-complex vitamin, the transmitter measures the resting pH of your stomach, alternating with challenges of baking soda, which is very alkaline. By observing how well the stomach returns to an acid condition after administration of the baking soda, the physician can determine whether or not you produce adequate amounts of HCl.

Normally produced by the parietal cells of the stomach, HCl is necessary for the initial stage of protein digestion and the absorption of vitamin B12 and many minerals.

Common symptoms of low-stomach acidity include belching or a burning sensation immediately after meals, bloating, a feeling that the food just sits in the stomach without digesting, and an inability to eat more than small amounts at any one sitting.

Poor HCl levels have been associated with childhood asthma, chronic hepatitis, chronic hives, diabetes, eczema, gallbladder disease, lupus erythematosus, osteoporosis, rheumatoid arthritis, rosacea, under- and overactive thyroid conditions, vitiligo, and weak adrenals.

As we age, we produce less HCl. As many as half of all people over the age of sixty may be deficient in this important substance. The test, unfortunately, is not widely available.

Small Bowel Bacterial Overgrowth Test

The small bowel bacterial overgrowth test measures breath levels of hydrogen and methane to determine if a bacterial infection is present in the small intestine. This test differs from the comprehensive digestive and stool analysis in that it tests for dysbiosis of the small rather than the large intestine.

Small bowel overgrowth occurs when bacteria in the large intestine travel to the small intestine, often the result of poor HCl production in the stomach or an insufficient amount of pancreatic enzyme function. It is often found in conjunction with parasitic infections.

Chronic pancreatitis, Crohn’s disease, and lupus erythematosus can also cause small bowel overgrowth. People with small bowel bacterial overgrowth experience diarrhea, poor nutrient absorption, and weight loss. Other people who may be affected are those with poor ileocecal valve function, poor intestinal motility, scleroderma, or recent gastric surgery.

People infected with small bowel overgrowth often have difficulty with digestion of fats, which come through undigested in the stool, called steatorrhea. They may also experience B12 deficiency, chronic diarrhea, and poor absorption of the fat-soluble vitamins A, D, E, and K.

Breath testing provides a simple, noninvasive alternative to the more widely used method of obtaining a small bowel aspirate and is more accurate. To perform the test, you drink either a lactulose or a glucose drink and collect breath samples. Hydrogen is produced when lactulose or glucose come in contact with the gut flora. A significant rise in hydrogen levels indicates small bowel overgrowth.

Electrical Acupuncture Voltage (EAV) Testing

After much promising research, the EAV test is widely used in Europe. Although it has met with FDA resistance in the United States, many skillful professionals use this test to successfully diagnose and determine appropriate therapies. The test measures the electrical activity of your skin at designated acupuncture points.

You hold a negative rod in one hand, the practitioner places a positively charged pointer on a variety of points on your skin, and a meter measures the voltage reading between the points. The test can determine which organs are strong or weak, which foods help or hurt you, which nutrients you need or have excessive levels of, and how old patterns are contributing to your health today. It is a fast, noninvasive screening test.

Organic Acid Testing

Organic acids are produced throughout the body and by intestinal microbes as metabolic products. High levels of organic acids in the urine can indicate metabolic problems, hormone irregularities, and dysbiosis. They can also give good indication about detoxification pathways, inherited enzyme deficiencies, and drug effects.

Organic acid testing is a simple way to screen for a large variety of nutritional and immunological factors in one simple urine test, including fatty acid metabolism, neurotransmitter metabolism, carbohydrate metabolism, oxidative damage, energy production, detoxification status, B-complex sufficiency, dysbiosis, methylation abilities, and inflammatory reactions.