Written by Dr. Jennifer Lovejoy, Chief Translational Science Officer at Arivale
Have you wondered how we decide what labs to measure? Do you have a personal interest in particular lab tests and wonder why we don’t measure those?
Our clinical and research teams are constantly reviewing scientific literature to assess potential “metrics of wellness,” and we sometimes add or remove biomarkers from our list. For example, we’ve recently added a few new lab measures, such as magnesium, adiponectin and the inflammatory marker Lp-PLA2. (You can read more about these measures in our wellness glossary.)
We follow three fundamental tenets when considering adding a laboratory test to our panel:
- Is there credible scientific evidence supporting a relationship between the test and health risk? As part of this, we look at the number of studies that have been done, their size and methodological quality, and whether there is general consensus in the scientific literature about the importance of the test for optimizing wellness.
- Is the methodology for the test itself sound—are the results reliable and reproducible?
- Does the test fall within Arivale’s scope of optimizing wellness as opposed to diagnosing and treating disease? If the test has both medical and wellness implications, is the medical condition to which it’s linked one that could be comfortably managed by most community-based physicians?
Currently, the lab markers on the Arivale dashboard have met all three of these criteria.
We are often asked about two lab tests that we don’t currently perform: thyroid hormone testing and food sensitivity testing. Because many people are curious about these tests, it might be interesting to understand our research process in evaluating them against our three fundamental tenets.
Food Allergy / Sensitivity Testing
Before discussing testing methods, it’s first important to distinguish between food allergy and food sensitivity (or intolerance). A true food allergy causes a reaction by the immune system that impacts many systems in the body and can cause a life-threatening “anaphylactic reaction.” Food allergies are relatively uncommon, affecting 1-2% of the population.
Food sensitivities, on the other hand, are more common, generally not life-threatening, and can cause a variety of symptoms, with gastrointestinal symptoms being most common. Since most people with true food allergies are very aware that they have them, when people ask us about testing in this area, they are usually asking about testing for food sensitivities.
With regard to the three tenets we use to consider adding a laboratory test, it’s clear that food sensitivities impact health and wellness, so that meets tenet #1. However, current methods for testing food sensitivity do not meet tenet #2—they are not reliable or reproducible.1 While there are several types of blood tests for food sensitivities currently marketed, careful review studies have shown that the testing methodology has many problems. In one study, a single sample of blood was split into three tubes with different labels and submitted for food sensitivity testing—and three totally different results came back! Other studies also show very poor reproducibility and lack of validity of results of food sensitivity testing both within and across the labs that do this testing. For this reason, until the methodology improves, Arivale does not perform food sensitivity testing.
Thyroid Hormone Tests
The most commonly performed thyroid hormone test is TSH (“thyroid stimulating hormone”), although more comprehensive thyroid hormone panels include thyroid hormones like T3 and T4. It’s very clear that these measures relate to health and wellness. Both high and low levels of thyroid hormone are associated with significant symptoms which can include changes in weight, digestive symptoms, lethargy or goiter (an enlargement on the neck). These symptoms can dramatically impair wellbeing. So, tenet #1 is met. It’s also true in this case that tenet #2 is true—thyroid testing is very reliable and reproducible as performed by most clinical laboratories.
The challenge with thyroid hormone testing comes with tenet #3. Abnormal thyroid hormone levels require medical treatment. While diet and lifestyle therapies can be helpful as complementary interventions, they are not considered cornerstones of treatment. So, thyroid testing and intervention is not within Arivale’s scope of optimizing wellness through lifestyle coaching.
You might be thinking, “But my coach could just refer me to a physician if there is an abnormal level.” Unfortunately, in the case of thyroid hormone measurements, there is significant controversy among physicians about what levels should be treated and what treatment is appropriate. The controversy around what constitutes a treatment-worthy TSH value was even captured by the media in a well-written 2009 New York Times article.
Unfortunately, this debate remains very much unresolved in 2016. As a result, if we referred a Pioneer with an out of range TSH value to their physician, the controversy around what defines a healthy thyroid lab value may lead to the Pioneer being told there was nothing wrong. This seems like an unsatisfying situation all around, and so we feel it’s best to leave thyroid testing and interpretation to your personal physician, who knows you and your medical history best. Of course, if you know you have a diagnosed thyroid problem, your Arivale Coach will be happy to discuss any ways that lifestyle could help support whatever medical management is being implemented. Arivale Coaches are also trained to recognize potential symptoms of thyroid deficiency and will encourage someone who exhibits these symptoms to talk with their doctor about whether thyroid testing is appropriate.
In summary, we appreciate that there are many laboratory tests that are related to health and wellness, and we periodically look at new tests we might add that would be relevant for a large number of Pioneers. Whatever the future of Arivale tests may hold, our current test panel provides a large number of actionable opportunities for many Pioneers and addresses core systems related to long-term wellness.
As we decide to add new tests down the road, you will be the first to know!
- Mullin GE, et al. Testing for food reactions: The good, the bad and the ugly. Nutrition in Clinical Practice 2010; 25(2): 192.