Biomedicine

Lecture 20:
Laboratory
1

Copyright CNM 2014-15: Biomedicine – Laboratory 2014-15.

Updated 30th April 2015 SM
LABORATORY TESTING

2
 HEALTH
WHO definition of HEALTH:
Complete Physical, Mental and Social well being.

Not the Objective Finding but the SUBJECTIVE

FEELING of the patient is the measure of
health.

So:
1. Sometimes severe diseases can go
without symptoms for a long time.
e.g. Cancer
2. Sometimes the patient can have symptoms but
no abnormal laboratory results
e.g. Chronic Fatigue, Sub-clinical Hypothyroidism
3
• To find out what is wrong with a patient we have
to find a description of an illness which fits
our patient’s symptoms.

• One Diagnostic Technique Common to both

complementary and conventional medicine is
GOOD CASE TAKING (Makes up about 80% of
the diagnosis)

4
 NATUROPATHIC
Diagnostic Techniques
These include:
1. FACIAL SIGNS
2. IRIDOLOGY
3. TONGUE DIAGNOSIS
4. NAIL DIAGNOSIS
5. BIO-ELECTRIC TESTING – E.G. VEGA
6. REFLEX ZONES
 1. FACIAL SIGNS
• Facial Diagnosis is something
we subconsciously perform
every time we engage into a
communication with someone:
• “You look all gaunt, what’s up - are
you trying to do too much?”
• “You look really well,” “your eyes are
shining, your skin feels so soft….",
• Someone’s expression can also
give us important cues as to how
they are feeling
 Facial Signs
• Facial signs are also often used to diagnose the
presence of certain diseases

Down’s syndrome
Cushing’s syndrome

Acne Rosacea
 Facial Signs
• Just like the tongue and the feet,
the face can be divided into
segments that represent body
organs
• Certain colour changes, lines
and other distinctions can be key
health indicators
e.g.
• Vertical lines between eyes –
Low stomach acid
• Blue/black shadows under eyes
- Kidney and adrenal exhaustion
• Grey/yellow skin - Constipation
 Facial Signs
Other signs to look for....
• Acne on the jaw line – PCOS
• Spots round mouth -
Hormones/Constipation
• Long sideburn hairs in women –
PCOS
• Fold in ear lobe –
Arteriosclerosis: Connective
tissue matrix in ear collapses
when circulation become
compromised
 2. IRIDOLOGY
• Iridology is the study of the 'Iris' of
the eye - the Circular & Radiating
muscle fibres which make up the
coloured part of the eye, each of which
are connected to the brain.

• A trained Iridologist sees the Circular &

Radiating muscle fibres) as a 'map',
revealing information about:
• The body's genetic Strengths and
Weaknesses
• Levels of Inflammation and Toxaemia
• The efficiency of the Eliminative
Systems and Organs
 Iridology
• An iris map is used as a guide to show a
practitioner which parts of the eye relate to the
different organs in the body
 Iridology
• A person's constitution can be analysed through the study of
their eyes. For example, below are two iris images.

• Silk Constitution - The strongest of all the constitutions. This

person has a strong genetic structure and is less prone to
disease. This is shown very clearly by the tightly-packed
fibres of the eye. This person has a very strong constitution
• Hessian Constitution - The second image is from a person
who has a "hessian" constitution - the weakest
constitution. They will need to be careful about the way in
which they eat and their lifestyle choices. This person has a
weak constitution
 Iridology
• 50% of individuals with a corneal arcus have
high cholesterol.
• A ratio of 2 to 1 disadvantage towards
atherosclerosis and related diseases is
predominant in persons who show this
phenomena.
 3. TONGUE DIAGNOSIS
• Tongue diagnosis is used
extensively in Chinese
medicine
• A practitioner can look at the
shape, colour and coat of a
tongue as well as any
markings
• A healthy tongue should be
pink and moist with a thin
clear coat
 Tongue Diagnosis
Colour
• Pale - Coldness, deficient Yang and
blood
• Red – Heat, excess, infection or fever
• Purple/blue - Stasis of blood

Coating
• The tongue coating is a physiological
by-product of the Stomach digestion
of food and fluids.
• White - Cold pattern
• Yellow - Full heat
• Brown - Stagnation
 Tongue Diagnosis
Crack down the centre – Digestive
deficiency, deficiency of B12,
folate, Iron
Scalloped edges – Weak
digestion, pancreas and fatigue
Swollen tongue – Problems with
fluids, dampness
Thin tongue – Weakness, fluid
deficiency or blood deficiency
Enlarged veins under the tongue -
Indicate circulatory problems
 4. Nail Diagnosis
• VERTICAL RIDGES – Poor
absorption of nutrients
especially Vit A, B C Minerals
and EFAs
• HORIZONTAL RIDGES – Stress,
shock, injury, infection (Nail =
http://www.patient.co.uk/images/OM985a.jpg

about 6 months growth)

• WHITE SPOTS – Zinc or Vit A
deficiency
• BRITTLE or easy SPLIT –
Mineral deficiency, low stomach
acid
• PALE – Anaemia
SPOON SHAPED nails – Severe
http://www.knowabouthealth.com/wp-content/uploads/2009/08/common-nail-conditions.jpg
•
iron or zinc deficiency
• CLUBBING – Sign of
Respiratory and CV problems

http://www.knowabouthealth.com/wp-content/uploads/2009/08/nailclubbing.jpg http://s2.hubimg.com/u/320421_f520.jpg
 Conventional Diagnostic
Techniques
• X-rays
• MRI
• CT scan
• Ultrasound
• Laboratory tests
“The most common diagnosis is the
misdiagnosis.” (Alfred Adler)
• Naturopathic Diagnosis can
reveal functional problems
• Conventional Diagnosis reveals http://en.wikipedia.org/wiki/File:Adler.jpg

mostly structural problems SEE FOOTNOTES

• So we have to use different methods as well

as multiple diagnostic techniques to come to a
final diagnosis.
 Tests can be big business...
Internet offer:
• TOTAL BODY SCAN MRI + CARDIO *
Package price: £ 1390
Examination:
• MRI Brain & Skull
• MRI Arteries to the brain (to detect chance of cerebral
infarct or bleeding)
• MRI Abdomen (organs)
• MRI Pelvis (incl prostate for male and uterus and ovaries
for female)
• Spirometry (measures function of the lungs)
• Exercise ECG (measures function of the heart and risk
for heart attack)
• * Prices are excluding £ 70 for a GP consult.
20
… and the therapist can not afford
to go wrong!
It is all too easy to choose the wrong test!

Tests need to be chosen sensibly...

‘As much as necessary, as little as possible’.
Every Complementary Therapist
has the need to know about
Conventional Tests too!
• To understand LAB Results
which the patient is presenting
• To suggest Appropriate
Investigations
 Programme for Today...
CONVENTIONAL Tests
1. Blood Analysis
2. Urine Analysis: Stick test
3. Scans and X-rays

COMLEMENTARY MEDICINE Tests

1. Food intolerance pin prick test
2. Saliva Analysis
3. Hair Mineral Analysis
4. Stool Analysis
 Blood Tests
A therapist needs to
know about blood tests
in order to...
• Interpret results which
the patient brings to
the consultation.
• Order an investigation
in order to come to a
proper diagnosis and
reveal possibly
dangerous conditions.
 Blood Tests
Blood has a special function as a
mediator between areas and
systems of the body:
It is the body’s delivery +
communication system.
• Blood readings can reveal
illnesses and we can monitor a
therapy.
• However: Results must not be
overestimated. They are just a
snapshot in time.The blood
keeps the best possible
homeostasis.
 Problems With Blood Tests
• Normal readings – Some problems will not show
up in standard blood tests.
• E.g. Sub-clinical hypothyroid patients show
‘normal’ blood test results but still suffer from the
symptoms associated with low thyroid activity

• Only represent one snapshot in time!

Common Blood Parameters
 Full Blood Count
A full blood count measures the status of a number of
different features of the blood, including:
• The amount of haemoglobin in the blood;
• The number of red blood cells (red cell count);
• The percentage of blood cells as a proportion of the total
blood volume (haematocrit or packed cell volume);
• The volume of red blood cells (mean cell volume);
• The average amount of haemoglobin in the red blood
cells (known as mean cell haemoglobin);
• The number of white blood cells (white cell count);
• The percentages of the different types of white blood
cells (leukocyte differential count)
• The number of platelets.
 Leukocyte Count
• In response to an acute infection, trauma, or
inflammation, white blood cells release a
substance called colony-stimulating factor
(CSF).
• CSF stimulates the bone marrow to increase
white blood cell production. In a person with
normally functioning bone marrow, the numbers
of white blood cells can double within hours if
needed.
• Some viral infections can kill white blood cells
e.g. HIV
 Leukocyte Count
Leukocytes High Low

Normal (Leukocytosis) (Leukopenia)

4 - 11 (x 10 9 /l) Bacterial infection Some bacterial infections
Inflammation Some viral infections
Panic
High physical strain Bone marrow
(sport) insufficiency (after
Pregnancy radiation, intoxication
Cancer
Intoxication Nutritional deficiency
Medication
Leukaemia Bone marrow cancers
Hormonal diseases
 Red Blood Cells
Erythrocytes High Low
Normal Polycythaemia A low RBC count may
Male: 4-6 (x 1012 /l) indicate anaemia,
Female: 3-5 (x 1012 /l) Actual increase in RBC = Absolute erythrocytosis bleeding, kidney
Low oxygen levels - Lung disease, training at disease, bone marrow
altitude failure (for instance, from
Enhanced erythropoietin production - kidney radiation or a tumour),
tumour. malnutrition, or other
Inherited problems with the erythropoietin system causes.
Hg mutations with a greater affinity for oxygen
Polycythaemia vera – Rare medical condition A low count may also
causes high number of RBC to be produced indicate nutritional
deficiencies of iron,
Apparent erythrocytosis = RBC become more folate, vitamin B12, and
concentrated vitamin B6.
Fluid loss
Diuretics
Kidney disease
Smoking
High BP
Stress

Complication: Blood flow to organs is reduced,

clotting is more likely
 Red Blood Cells
Haemoglobin High Low
Haemoglobin, in the red See erythrocytes See erythrocytes
blood cells, carries oxygen
around the body.

Normal
Male: 13-17 (g/dl)
Female: 12-16 (g/dl)
Haematocrit
Haematocrit measures the Low plasma e.g. High plasma or
amount of blood volume Dehydration Low RBC volume/number
taken up by red cells, and Raised RBC volume
depends on their number Raised RBC number
and their size. E.g. Lung disease, smoking,
tumour, altitude
Normal:
0.36-0.5 (36-50%)
 Iron
• On average:
– Men lose 1mg per day
– Menstruating women lose 2mg per day

• Low iron can also be caused by low intake or

poor absorption, often due to a lack of stomach
acid

• Anaemia without other major abnormal readings:

Always consider cancer. Low iron can also
indicate bleeding!
 Example
• 89 year old woman
• Fe and ferritin low
• Cholesterol low
• Carcinoembryonic Antigen (CEA): 639 (should
be <3, tumour-marker usually for colorectal
cancer)
• She had a big tumour in her abdomen,
• Still alive 1½ yrs post removal

33
The following parameters measure the size of the red cells and give overall clues to the type of
anaemia and possible cause
High Low
MCV Can be increased for example
80 - 100 (fl) by vitamin B12 deficiency or
Mean corpuscular (cell) prolonged heavy drinking
volume, a measure of the size
of the red blood cells

MCH High readings: the blood flows Iron deficiency anaemia

27 - 37 (pg) slower
Mean corpuscular (cell)
haemoglobin B12 deficiency
(Amount of haemoglobin in one
RBC)

MCHC High = High viscosity Iron deficiency, pregnancy,

30 - 35 (g/dl) blood loss, anaemia
Mean corpuscular haemoglobin
concentration = Viscosity of the
blood
(Concentration of haemoglobin
in a given amount of RBCs)
 RDW
• Measures the variability in the size of red blood
cells
• A High RDW indicate the early stages of iron
deficiency anaemia
• When there is insufficient iron for normal
haemopoiesis, the marrow produces microcytes
• In the initial stages these are mixed in with the
normal cells, so the RDW increases rapidly.
• This occurs well before the overall levels of MCV
and haemoglobin drop below the normal range
 Anisocytosis
• Unequally sized RBC’s
 Thrombocytes
High Low

Thrombocytes Thrombocytosis Thrombocytopenia

150 - 400 (x 10 9) High numbers may make clots Low numbers put you at risk of
likely haemorrhage

Causes Causes:
Infection – Especially in children Massive haemorrhage
Inflammation Autoimmune diseases
Injury/Blood loss Severe infections
Haemolytic anaemia – Spleen is Chemotherapy
too busy to breakdown old Certain drugs
platelets Leukaemia
Splenectomy – Spleen is no
longer removing old platelets
Some cancers
Chemotherapy rebound
Some medications
What Is Wrong With
This Client?
 Erythrocyte Sedimentation Rate
(ESR)
Normal:
• Men
– After 1hr: 3-8 mm
– After 2 hrs: 5-18 mm

• Women
– After 1hr: 6-11 mm
– After 2 hrs: 6-20 mm
 ESR
• To perform the test, anticoagulated blood is
placed in an upright tube, known as a
Westergren tube and the rate at which the red
blood cells fall is measured and reported in
mm/h.
• A High ESR indicates inflammation
• When an inflammatory process is present, the
high proportion of fibrinogen in the blood causes
red blood cells to stick to each other. The red
cells form stacks which settle faster.
 High ESR
Up to 50 mm after 1 hour: Over 100mm after 1 hour:
• Pregnancy after the 8th • Nephrotic syndrome
week • Rheumatic fever
• Inflammatory diseases • Sepsis
• Hypothyroid function • Peritonitis
• Menstruation etc. • Cancers

50 – 100mm after 1 hour: Normal = Below 19mm/hr

• Chronic poly arthritis
• Appendicitis
• Acute bacterial infection
• Chronic liver disease
• After a myocardial
infarction
• Cancers 41
 Biochemical Parameters
High Low

Sodium Kidney insufficiency Vomiting, diarrhoea

Insufficient ADH – Too much urine lost
Potassium Haemolysis, hormonal diseases, Vomiting, diarrhoea, chronic
metabolic acidosis kidney diseases, hormonal
diseases
High potassium – Irregular heartbeat and
muscle weakness

Potassium chloride is one of the drugs

that is used for the lethal injection! When
used in lethal injection, potassium
injection affects the electrical conduction
of heart muscle. Elevated potassium
causes the resting electrical potential of
the heart muscle cells to be higher than
normal. Without a negative resting
potential, cardiac cells cannot generate
impulses that lead to contraction.
 Biochemical Parameters
High Low

Calcium Hyperparathyroidism, too Malabsorption,

much vitamin D, hypoparathyroidsm,
hyperthyroidism, chronic kidney insufficiency,
osteolytic processes liver cirrhosis, malnutrition

Magnesium Not relevant Malnutrition, pregnancy,

diabetes, kidney
insufficiency, hormonal
diseases, pancreas and liver
diseases
Low magnesium is
associated with muscle
cramps, problems sleeping,
tongue quiver
 Biochemical Parameters
High
Iron Haemachromatosis
(hereditary disease causing
excessive absorption of
dietary iron, frequent in
Scotland), liver cirrhosis
Copper Too much copper in water
Phosphate Kidney problems
Low
Malnutrition, alcoholism,
absorption problems,
bleeding,
chronic infections
Malabsorption, kidney
diseases, congenital
diseases
Malnutrition, antacid
medication, iron
supplementation, oestrogen
therapy,
hyperparathyroidism,
 Uric Acid
• Uric acid is a by product of the
breakdown of purines – Purines
form part of the nucleic acid in
cells.
• High levels usually indicate gout
• However, excessive cell
breakdown cause by
chemotherapy or radiotherapy
can cause raised uric acid levels
• High uric acid can also cause
kidney stones
• High uric acid levels can be
hereditary
Kidney Function Tests
 Kidney Function
Urea
(By-product of protein
breakdown)
Creatinine in serum
(Break-down product of
creatine phosphate in
muscles. Usually produced
at a fairly constant rate by
the body (depending on
muscle mass))
Protein (general)
High
Chronic kidney failure,
(when more than 75%
decreased glomerular
filtration), not high in all
kidney diseases
After strong physical strain, In people with reduced
athletes, acute kidney
failure, chronic kidney
failure, obstructed urinary
tract
Dehydration
Low
In strict vegetarians, with
fasting, pregnancy (due
to changes in fluid
distribution rather than
change in urea levels)
muscle mass
Hyper-hydration, loss of
albumin in kidney
disease,
can be compensatory lack
of albumin with increased
globulins = inflammation
47
Blood Fats

48
 Cholesterol Revision
• Chylomicrons - carry triglycerides from the intestines to the
liver, skeletal muscle, and to adipose tissue.
• Very low density lipoproteins (VLDL) - carry (newly
synthesised) triglycerides from the liver to adipose tissue.
• Low density lipoproteins (LDL) - carry cholesterol from the
liver to cells of the body. Sometimes referred to as the "bad
cholesterol" lipoprotein.
• High density lipoproteins (HDL) - collects cholesterol from the
body's tissues, and brings it back to the liver. Sometimes
referred to as the "good cholesterol" lipoprotein.

• Hyperlipidemia is the presence of elevated or abnormal levels

of lipids and/or lipoproteins in the blood, and is a major risk
factor for cardiovascular disease.

Readings
Cholesterol < 200 mg/dl = 5.2
Triglycerides <200 mg/dl
Cholesterol 200-250 mg/dl 5.2 – 6.5
Triglycerides < 200 mg/dl
Cholesterol >250 mg/dl > 6.5
Triglycerides < 200 mg/dl
Cholesterol < 200 mg/dl < 5.2
Triglycerides 200 – 400 mg/dl
Cholesterol <200mg/dl
Triglycerides > 400 mg/dl
Cholesterol > 200 mg/dl
Triglycerides > 200 mg/dl
Blood fats:
converting formula
Risk assessment for coronary artery
disease
No increased risk, except when HDL
25mg/dl or less
Increased risk when positive family
history or other risk factors
If high HDL ( 75-80 or higher) no
higher risk
If low HDL (like 50 ) increased risk
If no other risk factors: only diet
If risk factors: medication
Danger of acute complications
Mixed hyperlipidaemia, can have
different causes, increased risk
Has to be treated
(mg/dl) x 0.0259 = (mmol/l)
50
 Triglycerides
Conditions that may cause high triglycerides include:
• Obesity.
• Poorly controlled diabetes.
• An underactive thyroid (hypothyroidism).
• Kidney disease.
• Regularly eating more calories than you burn.
• High sugar consumption
• Drinking a lot of alcohol.
• Certain medicines may also raise triglycerides. E.g. Hormonal
medication and steroids

• Certain types of high cholesterol and high triglycerides are

caused by genetics.

51
 Blood Fats
Parameter High Low

HDL Low readings with high

High density lipoprotein cholesterol indicate a
higher arteriosclerosis
risk
Women <45
Men < 35

LDL 150 – 190 moderate risk

Low density lipoprotein > 190 high risk of
< 150 arteriosclerosis

52
 Cholesterol Levels
Desirable cholesterol levels as taken from the
Genova Diagnostics website

Total cholesterol level

• Blood cholesterol is measured in units called millimoles per litre of blood,
often shortened to mmol/L.
• The UK government recommends that total cholesterol levels should be:
– 5mmol/L or less for healthy adults
– 4mmol/L or less for those at high risk
– LDL of 3mmol/L or less for healthy adults
– LDL of 2mmol/L or less for those at high risk 53
 Liver Enzymes
• GOT, GPT and GGT are enzymes found mostly in the liver
tissue
• Raised liver enzymes indicates a problem with the liver!
• When the liver is damaged these enzymes leak into the
blood stream

• GGT can also be used to screen for chronic alcohol abuse (it
will be elevated in about 75% of chronic drinkers).

A liver enzyme test may be used when:

• Persons who might have been exposed to hepatitis viruses
• Those who drink too much alcohol
• Persons who have a history of liver disease in their family
• Persons taking drugs that can occasionally damage the
liver.
• Persons who have mild symptoms, such as fatigue.
 Bilirubin
Bilirubin High readings:
Breakdown product of red blood
cells. If the liver cannot absorb the Mild rises:
circulating bilirubin from the blood Haemolysis,
and get rid of it via the bile ducts Gilbert’s Syndrome
then levels rise and finally the Moderate rise:
person will get jaundice. Drugs,
Hepatitis
High levels:
Neonatal hyperbilirubinaemia,
Bile duct obstruction,
Cirrhosis, liver tumours

• Gilbert’s syndrome - The source of this

hyperbilirubinemia is reduced activity of the
enzyme which conjugates bilirubin making it
water-soluble so it can be excreted in bile.
55
Jaundice

56
57
Pancreatic Enzymes
 Pancreatic Enzymes
• These parameters only change when there is
cell damage - Not so useful as routine diagnosis.
• Raised pancreatic enzymes normally indicate
pancreatitis or pancreatic cancer
• A blood amylase test may be ordered when a
patient has symptoms of a pancreatic disorder,
such as severe abdominal pain, fever, loss of
appetite, or nausea.
 Blood Glucose
Used to detect both hyperglycaemia and hypoglycaemia, to
help diagnose diabetes, and to monitor glucose levels in
persons with diabetes.

May be:
• Fasting (8 to 10 hour fast)
• Randomly (anytime)
• Post prandial (after a meal)
• As part of an oral glucose tolerance test (OGTT / GTT)

U. Allison, ND, 2007 60

 Blood Glucose
• An OGTT is a series of blood glucose tests.
• A fasting glucose is collected; then the patient
drinks a standard amount of a glucose solution
to "challenge" their system.
• This is followed by one or more additional
glucose tests performed at specific intervals to
track glucose levels over time.
 Blood Glucose

High Low

Glucose Diabetes mellitus, Secondary

Normal 70 – 110 mg/dl smoking (!), first reaction to
3.9 – 6.1 mmol/l reaction to stress, stress,
Drugs including
mg/dl x 0.0555 = mmol/l alcohol,
 Rheumatoid Factor
• Auto-antibodies which raise in rheumatoid
arthritis.
• Usually > 20 indicates rheumatoid arthritis
• May also be raised in Sjögren's syndrome,
• hepatitis, leukemia

• NB Rheumatoid factor is not always present in

RA
 C Reactive Protein
High Low

CRP Levels rise dramatically N/A

=C-reactive protein during inflammatory
A substance in the serum processes in the body.
of patients with acute Recent research suggests
inflammation. that patients with elevated
basal levels of CRP are at
an increased risk for
diabetes, hypertension
and cardiovascular
disease.

• How to lower CRP: Exercise, stop smoking,

flaxseed, aspirin, niacin, statins, clean teeth.
Thyroid Hormones

65
 Thyroid Hormones
Parameter High Low

TSH – Thyroid stimulating hormone Hypothyroidism Hyperthyroidism

Works on negative feedback in
response to T3 and T4 levels

T3 Hyperthyroidism, Hypothyroidism
= Triiodothyronine overdosing of
Derives mainly from T4, active form of hormonal
thyroid hormone. replacement
therapy
T4 Hyperthyroidism, Hypothyroidism
= Thyroxin overdosing of
Mainly precursor for T3 hormonal
replacement
therapy
 Differential Diagnosis
(Thyroid Testing)
TSH level Thyroid hormone Conditions
level

High High Benign tumour of the pituitary gland

(adenoma) or thyroid hormone resistance

Low Low Hypopituitarism

Low High Hyperthyroidism or Grave's disease
High Low Congenital hypothyroidism (cretinism),
hypothyroidism

67
 Partner Work
• Working with your partner please read the info
on thyroid tests in your handout
• Now try and work out what is happening in the
thyroid profile on the next slide
 Sex Hormones
• Remember – Sex
hormones are governed
by negative feedback
loops!
• Example: During the
menopause, a woman’s
ovaries gradually become
less responsive to LH and
FSH.
• Less oestrogen and
progesterone are
produced
• High FSH and LH level in
blood test results!
 DHEA-S
• A natural steroid prohormone produced from
cholesterol by the adrenal glands, the gonads
adipose tissue, brain and in the skin.
• DHEA is the precursor of androstenedione,
testosterone and oestrogen.
• ‘Anti-aging’ hormone
 DHEA-S
Normal levels
Help decrease insulin resistance, improve fat metabolism,
increase immune system function, increases lean muscle
mass

Over supplementation can lead to: Stunted growth,

palpitations and other arrhythmias, extensive growth of body
hair, or hirsutism, hair loss, especially male pattern baldness,
acne.

It is suspected that low levels can promote:

CVD, diabetes, hypercholesterolemia, obesity, MS,
Parkinson's disease, Alzheimer's disease, immune disorders,
depression, osteoporosis, decreased libido
 Tumour Markers
• Tumour markers have different organ
specificities.
• Some are rather unspecific. They are elevated
with most cancers and also in benign illnesses
or in smokers: Example CEA

• Others have a high specificity.

• By combining markers the specificity is
increased.

73
 Tumour Marker Examples
• CEA - Carcinoembryonic Antigen - Protein that is found in
developing babies. By the time a baby is born, detectable
levels in the blood disappear. Increased CEA levels can
indicate some non-cancer-related conditions, such as liver
disease, and inflammatory bowel disease. Also, smokers tend
to have higher CEA levels than non-smokers.
• AFP - Alpha-fetoprotein - To screen for and monitor therapy
for certain cancers of the liver and testes
• HCG - Human chorionic gonadotropin - To confirm and
monitor pregnancy or to diagnose trophoblastic disease or
germ cell tumours
• PSA - Prostate specific antigen
• Calcitonin – raised in thyroid cancer. Also elevated in
pernicious anaemia and thyroiditis
 Purpose Of Tumour Marker
Testing
a) For prevention screening

For example
• AFP + beta-hCG in testicle cancer
• AFP in patients with liver cirrhosis
• PSA in men over 50
• Calcitonin in patients with a family history of
• thyroid cancer

b) To monitor the therapy and healing of cancer

patients. Also to detect metastases and relapses
early.
75
 Limitations
Tumour markers are not always increased, often
only in progressed stages.
Also, slight increases can be occur with harmless
illnesses, smoking or alcoholism.

76
Most Common Tumour Markers
Affected organ Useful tumour marker

Breast CA 15-3, CEA, MCA

Ovaries CA 125, CA 72-4, CEA
Uterus CEA, HCG
Cervix SCC, CEA, CA 125
Intestine CEA, CA 19-9
Liver AFP, CEA
Stomach CA 72-4, CEA, CA 19-9
Pancreas CA 19-9
Lungs, bronchi NSE, CEA, Cyfra 21-1
Testes Beta- HCG, AFP, LDH
Prostate PSA, SP
Urinary bladder TPA
ENT tumours SCC, CEA
Thyroid Thyroglobulin, Calcitonin
77
 Tumour Markers: Testing
• Check CEA routinely from age of 35.
• Normal:
– <3 (healthy non-smokers)
– <5 (smokers)
• Abnormal:
– <7.5 (non-malignant intestinal inflammation)
– <10 (liver disease)
– >10 (danger of cancer)
• CEA gives no localisation. In case of high
readings a full investigation must be done

79
 Saliva Analysis
• Non invasive, samples can be collected by the
client at home
• Saliva testing measures the free unbound
hormone fraction so it is much more accurate
than blood testing for certain things

• Useful for:
– Hormone testing – Adrenal hormones, Sex
hormones, Melatonin.
– Antibody testing – Candida, Secretory IgA
 Female hormone panel
• Measurement from a single sample is of little use in
pre-menopausal women as the hormones fluctuate
throughout the menstrual cycle
• Need several collection points throughout the
month - Most tests use 12 saliva samples
• Unlike serum testing saliva measures free,
unbound fraction of the hormone, this tells us how
much active hormone is available to exert its effect
on the target tissue.
• Example: Genova Diagnostics - Female hormone
profile
 Female hormone panel –
Hormones measured
• Levels of progesterone and oestrogen over 28
days (or an extended cycle), by sampling
through the cycle.
• The relative levels of these two hormones can
then be plotted and graphically to represent any
abnormalities throughout the menstrual cycle.
• Some tests also measure testosterone which
can be elevated in woman, e.g. in those with
PCOS.
Normal Result
 Abnormal Example
Female Patient, 39,
Fertility problems
History of depression and
prone to constipation
• Oestradiol: pre-
ovulatory peak was
detected
• Progesterone: Luteal
surge was detected,
but it remained
elevated, failing to
drop prior to next
cycle.
84
 Adrenal Stress Index Test
• Uses four saliva samples to measures salivary
cortisol and DHEA levels and their ratios
throughout the day.
• Simple
• Non-invasive
 Adrenals
• Help us deal with stress by releasing the
'stress' hormones, cortisol and DHEA.
• These hormones are released in a cycle
called the circadian rhythm, with the highest
levels being in the morning and the lowest at
night.
• Long-term or profound mental or physical
stress can cause these glands can go into
overdrive, but later become exhausted.
• When this happens the hormonal levels of
Cortisol, DHEA in the blood stream become
imbalanced.
ASI sample report – Exhaustion
phase
 Urine analysis
• Non invasive, sample can be
collected by the client at home
• Easy to do in clinic
• Useful for:
– Measuring levels of hormone activity – Thyroid
hormones, Oestrogen metabolites,
– Can test detoxification – Toxic metal levels, Toxic
metal clearance
– Useful to measure metabolic imbalances – Organic
acids, Amino acids, Bone turnover
– Gut permeability
 Urine Analysis
Firsts impression:
Colour
• Light, pale straw colour: Drinks enough
• Dark: Does not drink enough, Food with dark
colour e.g. beetroot or possibly blood!
• Please! Do not confuse with beetroot

Smell:
• Bad smell often indicates infections
89
 The Use of Test Sticks
• Multi sticks can be ordered via
the internet
• For example at: www.easy-tests.com

Parameters include:
• Leukocytes
• Ketones
• Nitrite (bacteria)
• Urobilinogen
• pH - too acid - too alkaline
• Blood
• Protein
• Glucose: more than 160 mg/dl 90
91
Hair Mineral Analysis

• Non invasive, sampling can be

performed by the client at home
• Controversy over reliability and validity of
results
• Easy to do in clinic
• Useful for:
– Measuring mineral levels
– Measuring toxic metal levels
– Highlighting metabolic imbalances
Hair Mineral Analysis

• Hair is a tissue in which minerals become fixed

• Analysis of the hair tissue provides information
on accumulated minerals and toxic metal over
the hair growth period = approx three months.
• The US Environmental Protection Agency uses
hair as a medium for biological monitoring of
heavy metals.
• This client worked for a racing car company finishing engines
• Note the high levels of both nutritive and toxic metals
• Iron, Manganese, Chromium, Cobalt and Molybdenum + Significant
levels of Arsenic , Mercury, Cadmium, Lead, and Aluminium
 Hair mineral analysis results –
Mineral ratios
• As well as absolute
levels for minerals and
toxic metals, ratios of
minerals can give a
good indication of
metabolic imbalances
• This is due to a
biological antagonism
that exists between
certain nutrients
 Mineral ratios
• Correct balance is important = We don’t want
one mineral excess or deficiency to affect the
metabolism of another
• Vitamins cannot function properly without the aid
of minerals
• The body can synthesize some vitamins, but it
cannot manufacture a single mineral!
 Calcium/Phosphorus Ratio
• Indicates metabolic pattern
• A ratio of more than 2.6/1 = slow metabolic pattern
(Relates to a parasympathetic state)
• In the exhaustion state of stress the body becomes
parasympathetic because the sympathetic system is
depleted
• A ratio of less than 2.6/1 = fast metabolic pattern
(Relates to a sympathetic state)
• This is more common in the resistance phase of stress
 Sodium/Potassium Ratio
• An excess of sodium relative to potassium can
increase the need for potassium.
• Excess sodium relative to potassium may result in
weight gain and water retention.
• A potassium deficiency of this type can be a result
of inadequate intake and/or decreased potassium
retention.
 Sodium/Potassium Ratio

• A high Na/K ratio indicates, acute

stress, inflammation or pain
• It is also a sign of oestrogen
dominance
• A low Na/K ratio is more
indicative of chronic stress and
fatigue as well as progesterone
dominance
• Typical symptoms of a low Na/K
ration are mood swings,
depression, withdrawal and
phobias
 Calcium/Potassium Ratio
• High calcium relative to potassium will usually indicate
a trend toward hypothyroidism.
• The mineral calcium antagonises the retention of
potassium within the cell.
• Potassium is necessary for thyroid function and
cellular response to thyroxin.
• If this imbalance has been present for an extended
period of time, the following symptoms may occur -
Fatigue, Depression, Dry skin, Constipation.
 Sodium/Magnesium Ratio
• The adrenal glands play an essential role in
regulating sodium retention and excretion.
• Increased adrenal activity results in decreased
magnesium retention.
• The sodium-magnesium profile is indicative of
increased adrenal cortical function.
• A high Na/Mg ration is indicated by: anxiety,
muscle cramps, palpitations and increased
perspiration.
 Calcium/Magnesium Ratio
• The Ca/Mg ratio is the blood sugar ratio because
these 2 mineral help to regulate insulin
• A high Ca/Mg ratio is also common in alcoholism
and addictions
• Calcium and magnesium are also associated with
muscle tone.
• The higher the Ca/Mg ration the more tense a
persons muscles tend to be
• A high Ca to Mg ratio is common in stress!
 Zinc/Copper Ratio
• A zinc-copper imbalance in conjunction with low
copper levels is a strong indicator of a decrease in
the role of copper in many functions of metabolism.
• Copper is its necessity in collagen synthesis.
• If this profile becomes both severe and chronic, a
decrease in collagen synthesis can occur.
• This can then be an indication to capillary fragility,
osteoporosis, joint problems and premature greying
of the hair.
 Zinc/Copper Ratio

• A low zinc to copper

ratio is typical in
hyperactive behaviour.
• Common symptoms are
a racing mind while the
body feels fatigued and
exhausted
• Children with
ADHD/Autism typically
present with a low zinc
to copper ratio
 Iron/Copper Ratio
• Iron and copper are antagonists so the
correct balance is needed to avoid creating
a deficiency/excess situation
• A high Fe/Cu ratio is associated with
inflammation ad infections
• Low Fe/Cu ratio can lead to problems
associated with high copper and low zinc
(See before)
Slow oxidiser
with copper and
mercury toxicity
High Ca/P ratio – Slow oxidiser
High Ca/K ratio – Low thyroid, K
needed for thyroxin sensitivity
Low Zn/Cu ratio – Not enough
zinc to offset copper
Low Na/Mg ratio – Adrenal
reserve
Low Fe/Cu ratio – Copper
blocking iron,
High Ca/Mg ratio – Tendency to
muscle tension, stress and poor
blood sugar control

Toxic ratios – Lacking in

mercury antagonists, probably
as a result of copper toxicity
 Group work

• In group of 3 or 4,
practise your skills by
trying to interpret this
mineral ratio profile of
this male client
 Food Intolerance
• An adverse reaction to a specific food or food
ingredient which is not psychologically based.
• Not necessarily associated with clearly defined
immune reactions in the same way as food
allergy.
• May involve a number of different reactions.
 Food Intolerance
• IgE and other types of antibodies are found in
the gut wall and release histamine, leading to
leaky gut.
• As a consequence food can be absorbed when
it has only been partly digested, so large and
unusual food molecules may get into the blood
stream.
• These can then trigger a number of immune
responses and cause of many of the unpleasant
symptoms seen in food intolerance.
 Common Food Intolerance
Symptoms
• Skin - Rashes, swelling

• Airways - Asthma, stuffy or runny nose, frequent colds

and infections

• Gastrointestinal tract - Irritable bowel symptoms, colic,

bloating, diarrhea, vomiting, frequent mouth ulcers,
reflux, bedwetting, change in stools

• CNS - Migraines, headaches, anxiety, depression,

lethargy, impairment of memory and concentration, panic
attacks, irritability, restlessness, inattention, sleep
disturbance, restless legs, mood swings, PMT
 Elimination Challenge Diets
• Suspected foods are removed from the diet for a
set period of time (usually 1-2 months)
• After that time individual foods are tested again
(this is called a challenge), but only one per day
• Signs and symptoms on reintroducing foods are
noted
Disadvantages:
• Long winded
• Requires dedication on the part
of the client
• Can be boring and limiting
 FACTest
• Genova diagnostics (Food Allergen Cellular
Test)
• Cellular assay - measures the cellular reaction
to allergens
• Detects both IgE and non-IgE mediated
reactions to foods
• Detects inflammatory mediators called
leukotrienes - produced by white blood cells
upon activation by food allergens to which an
individual has become sensitized.
 FACTest - Options

• Full profile = 170 foods

• Dairy and grains profile
(Includes egg)
• Additives profile
• Antibiotics and
analgesics profile
 York IgG Test - Food Scan
• Test kit that can be performed by the client at
home.
• Tests 113 foods
• Detects IgG levels - another immunoglobulin that
plays a role in adverse food reactions, especially
delayed responses
• Test involves adding clients blood to a well tray
coated with food antigens.
• The tray is sent back to York in the post and they
analyse it for antigen/antibody interactions then
send you a report
 Stool analysis
• Non invasive, sample can be taken
by the client at home
• Easy to use in clinic
• Useful for:
– Digestive function
– Gut flora
– Gut immunology
– Detection of yeasts, pathogenic bacteria and
parasites (including helicobacter)
– Gut permeability
– Cancer markers
 Types of Test
1) Mycology: Investigation for all yeasts and moulds
(including Candida) pH of the stool, count of the friendly
bacteria and a virulence test for yeasts
2) Tumour Marker: Tumour-M2-PK in stool
3) Pancreas diagnostic: Pancreatic elastase as a marker
for chronic and acute pancreas inflammation
4) Intestinal inflammation: Secretory IgA in the stool
(intestinal immune system), PNM-Elastase in the stool
(inflammation marker), Alpha 1 antitrypsine (leaky gut
test)
 Types of Test
5) Tissue-transglutaminase-slgA: Test for Coeliac disease
from a simple stool test
6) Intestinal bleeding: Haemoglobin-haptoglobin complex in
the stool as a very sensitive marker for intestinal
bleeding (test for intestinal cancer and polyps)
7) Intestinal Parasites: Protozoa cysts and worm eggs
8) Complete status of intestinal colonization: Including
yeasts (+virulence test), moulds, aerobic and anaerobic
bacteria.
9) Helicobacter pylori antigen from a simple stool sample
 M2-PK Tumour Marker
• There is now a new test that detects specific
antibodies to Tumour M2 Pyruvate Kinase (M2-
PK), a compound that tumour cells produce
during their glucose metabolism.
• Useful for detecting any cancer within the
digestive tract, even oesophageal cancer
• Simpler and less invasive than the traditional;
sigmoidoscopy/colonoscopy and biopsy
approach
 Candida
• Remember, yeast can only overgrow if a
persons own gut flora or immune system is
compromised!
 Candida
• Not all yeasts are pathogenic. They can be harmless
symbionts in the intestinal flora
• Providing their number is low and they metabolise only
carbohydrates.
• However, if the conditions for these fungi become too
advantageous, these microbes can produce protein
digesting enzymes, which enable them to cling to the
intestinal walls making them hard to shift.
• A good Candida test should include a screen for the
enzyme secreted aspartic protease (Sap)
• Pathogen secreted aspartic protease is an indicator that
the Candida have started to grow filaments and digest
protein – allowing them to attach to the gut wall.
 Candida Diet?
• Diet alone will not eliminate Candida – Can grow well
even at very low glucose concentrations
• Reduce refined sugars and carbs and increase fresh
veggies and fruit in moderation.
• Ensure plenty of fibre to sweep the bowel through
• Every therapist will have their own special approach but
all diets should have in common that they promote
intestinal health and the immune system.
• Diets are only effective when combined with the other
procedures, supplements, hygiene and anti-fungals.
 Why Test For Candida?
• Motivation for the patient to sustain a Candida treatment
• Security of having a safe diagnosis, as many of the
typical Candida symptoms can be caused by other
conditions like mould overgrowth food sensitivities,
pancreas malfunction etc
• To avoid unnecessary anti-fungal treatment is case of a
negative result
• Monitoring of therapy success
• A safe diagnosis is essential because otherwise your
patient could waste money and you could possibly loose
valuable time in finding the real cause of their problem.
 Example of Stool Test
• Client: Male 28, IBS symptoms, recently been
through a very stressful period in his life,
displays a number of Candida symptoms.
Previously lived in a very damp basement flat
• Anal itching
• Skin problems
• Sweet cravings
• Fatigue
 Interpretation
• A number of good gut flora are low = E.Coli,
Enterococci, Lactobacilli
• Stool pH is low (acidic) = Sign of dysbiosis
• Medium strong Candida colonisation
• Pathogen Secretory Aspartic Protease is
Positive indicating that the Candida overgrowth
is pathogenic
• Medium strong colonisation with Mould –
Probably from living is a damp mouldy flat!
 Further Info
Your BTS Manual contains lots of extra info...
• Sampling Instructions
• How the tests work
• Candida questionnaire
• Advice on how to pick a suitable test
• Info on differential diagnosis
 Testing labs
• Genova Diagnostics www.gdx.uk.net
020 8336 7750
• The Doctors Laboratory www.tdlpathology.com
020 7307 7373
• Biological testing Service (Stool Tests)
www.biots.btinternet.co.uk 01903 893591
• York Laboratories (Pinprick food intolerances)
www.yorktest.com 0800 458 2052
• Biolab www.biolab.co.uk 020 7636 5959
• Mineral Check (Hair Mineral Analysis)
www.mineralcheck.com 01622 850 500