Facilitated

16| Decoding Lab Testing: When Less Is More

• The Facility Denver • Episode 16

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Functional medicine practitioners Dr. Mitchell and Kate dive into the complex world of medical testing, explaining when testing helps, when it doesn't, and how to avoid getting overwhelmed by data without action. They share candid insights about their complementary practice styles and why clinical judgment is crucial for test interpretation.

• Testing should confirm suspicions, not go fishing for random problems
• Many patients spend money on tests but avoid making necessary lifestyle changes
• Basic tests like a CBC can provide tremendous value at low cost
• Avoid testing hormones during birth control use as results will be meaningless
• Testing isn't helpful when interventions aren't appropriate (pregnancy, breastfeeding)
• AI can provide test interpretations but lacks the ability to connect markers with patient history
• The most expensive tests don't necessarily provide the most valuable insights
• Clinical judgment means treating the patient, not just the test results

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Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.

Kate:

And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.

Mitchell:

We help people improve their biology and get out of their own way. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

Kate:

On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it.

Mitchell:

Double clap.

Kate:

Welcome. Hello, we're in it again, I don't have a title or really a theme for this episode.

Mitchell:

You kind of know what we want to talk about.

Kate:

I know the general idea. Wow, I'm proud of you. I always have an outline. We just don't always follow the outline.

Mitchell:

Am I good at following an outline for a podcast? Terrible. Why don't you just give a little our struggle? So this first few months of doing this?

Kate:

Yeah. So I love an outline, I love a storyline. Here's the points we want to talk about. Here's where the conclusion is. Here's how we wrap it up. I originally posted this outline on the computer in front of us so we could follow it. And somehow Mitchell would find himself at point six when we were hadn't even gotten to point two yet. And now I'm trying to re-wrangle this outline into a storyline when you're jumping all over the place so now I don't get access to the outline so now I hold the outline do I do?

Mitchell:

I show up extra early and prepared when we record.

Kate:

No, no.

Mitchell:

We I mean we this is. It's interesting when you start to share a voice like this, and I think I was so much in the beginning trying to like toss you softball questions, and then something you pointed out was well, how's the flow of a typical visit with us?

Kate:

You're the talker.

Mitchell:

And you're the organizer and the person who kind of brings it all home. So it might be weird if someone listens to this and then it's 50-50 talking and then you come see us and what is Kate upset? She's not talking and it's like, well no, her style is much different than mine and I think they compliment each other nicely. But it was actually Shantae and Kurt, two of the people that we really look up to for guidance, and all of that I brought up to Shantae and I just said I don't like it. That just feels like it's the Mitchell show and I'm very self-conscious about that and what. What was her point?

Kate:

well, how? How do you show up in a visit? It's, it's kind of the Mitchell show, but what the patient doesn't see until after the I was going to say episode, but after the visit is my magic comes in the organization, in the resources and the hey. I know we overwhelmed you with everything we threw at you, but here's the organization to it. Here's the follow-up. Go deeper on this, do this, here's what's next.

Mitchell:

And I think there's room for both. I appreciate how organized you are because, just because my brain works very non-linearly and I think it helps me when I'm thinking about patient cases, but it can be confusing and overwhelming to the individual in front of us, because I'm just, you know 20 years of information in my head and I'm excited and I see all the connections, but I do it. And I see all the connections, but I do. I've made excuses like well, it makes sense and it's like well, not. Like you got to imagine somebody that doesn't know anything about bicarbonate or you know, or about mass cells, and like it's great that you're excited and you're steering the ship. But this lack of organization can sometimes make it hard for someone to follow the direction. Actually, I just remembered something. I heard a quote this weekend on a podcast when I was traveling that really made me think about more of my purpose. It was by, I think, simon Simac. I know nothing about this person.

Kate:

Oh, he's, great.

Mitchell:

People don't buy what you do. They buy why you do what you do.

Mitchell:

And I think it's obvious why I do what I do with the patient, but sometimes they don't know what to do. I would say the excitement oozes out of me. But I think some part of my journey in the last 10 years of working with patients is how can I make it simpler, more concise but keep me in it? And I would say part of it is having you, but the other part is me just simply recognizing that my nonlinear brain I refuse to medicate myself for. I mean, say what you will. I had a pretty severe ADHD diagnosis and I definitely have some traits, but I don't like the options for medications. I already struggle with anxiety. I don't think taking amphetamines is going to help me in the longterm. So I've had to learn workarounds like have a super diligent business partner and simplify things and maybe say less. My girlfriend sometimes says that to me. Hey, mitchell, say less.

Mitchell:

So yeah we're trying to figure it out, so today I'm not talking. The rest of the podcast.

Kate:

That's not what's going to happen because, just like you've had to go through that in patient visits in practice, I really had to face it when we started a podcast. So this is me trying to learn and grow and still celebrate my own strengths, but push myself 10 years from now, we'll just be the same person.

Mitchell:

We'll just mesh to the middle.

Kate:

Please, no, yeah, I don't want that okay, so with all of that I do want to talk about testing more from a global perspective, of when to use testing, some decisions that go into testing, and really how it came up was right now people have so much access to testing and I love it. I'm so grateful for that. I think it's a great change change. But a lot of these testing companies, or wherever you're getting the access to testing, they rely on AI software to give you insights or tell you what to do about it, and patients are feeling lost and we've had multiple patients come in with hey, here's all of these tests that I ran on myself, but I have no idea what to do with them. I'm lost.

Mitchell:

Right.

Kate:

paralysis by analysis maybe, but it's all it's and I think ai has a place.

Mitchell:

But I mean, I've had multiple times where I've just played with it. I was stubborn about it and I would play with it a little bit and I would find errors specifically around, like cancer biology and certain nutrients that would be suggested for certain cancers, and I would push back on it and then it would give me like you're totally right, here's the nuance, and I just realized like you can't just rely on that.

Kate:

Because so much of our test interpretation is about the connection between markers, not the individual markers. It's not iron is high, let's take care of iron. It's why and what else is that affecting, or what else could be affecting, that?

Mitchell:

And what else do we need to look at? Right? Yeah, I don't think. Yeah we'll. I think we've got job security for now. That's what this podcast is about. Use us, not AI.

Kate:

No, no. The point of it is the why of testing. When you're the patient and you have access to tests and you just want to get answers, you kind of miss the clinical judgment and the history that we can provide to tell you is that test really going to give you the answer you're looking for?

Mitchell:

And a lot of times, less testing over, more testing Right which we're learning, saving patients money, getting to answers more quickly.

Kate:

We're not testing to go fishing. We're testing mostly to confirm suspicions.

Mitchell:

Yeah, and then to inform the bigger picture of the whole.

Kate:

There are certain times when testing doesn't help, which is what we have been alluding to, and some of it has to do with psychology. So testing as an avoidance of action.

Mitchell:

Yeah, we do see that A lot. I can think of multiple people in the last year that will invest all this money in testing and then they still won't put their phone away at night, they won't change their diet, they won't move. They're just like staring at these bad numbers and they're just I don't know what that is. They're just. Maybe they didn't find what they were looking for and they weren't ready to make a change and they just thought that that would be be a good step in their direction. But when you find a series of tests that don't look good, you probably should change something. You shouldn't use it to just be terrified and do nothing.

Kate:

Or if something is borderline, that is the key time for action before it gets progresses, before it gets worse.

Mitchell:

Like that 65 year old last week who's A1C? He came in as a new client and because the doctor said you now have a diabetic A1C. Uh, four years ago, april of 2021. Cause he, he sent me his the last like 10 years of labs. A1c was 6.3 four years ago and all they kept doing was giving him blood pressure medicine, a beta blocker, a diuretic, a statin, and just avoiding this thing, this ugly metabolic dysfunction marker, because it wasn't in that black and white of now you need diabetes medications. But he had a borderline diabetic a1c for the last minimum four years and now, all of a sudden, a1c is 6.5. I think, oh, now you qualify. There's no such thing as pre-diabetes, it's just low-key diabetes. If your a1c is even 5.7, we need to.

Kate:

We need to address that now there are certain times when we won't test. Sometimes it's because the intervention doesn't make sense for the individual, so knowing the data on paper doesn't really change direction, and sometimes it's because the history or the symptoms are so obvious that it makes more sense to go straight to intervention.

Mitchell:

Especially because the interventions we provide are focused on the whole body, the organism as a whole, and very low risk, I think. Are you thinking of something like Lyme? Yeah, or tick-borne illness with a history of exposure to a vector that could provide a spirochete illness, with certain questionnaires and history that we can take? The clinical diagnosis is typically the diagnosis for a lot of these things, and spending $1,200 on the type of tick testing? You need to really do good work, not just a Western blot and an ELISA, which are wrought with problems, especially if you don't test in time. It's just going to slow the patient down Right. And even like mold testing, that's a big one If you have.

Mitchell:

I'm big into and you sometimes ask me why are you doing this? Visual contrast sensitivity? Well, there's a. There's an online vision test that you can take. That's $15. That's been shown to have a 92% sensitivity specificity toward mold illness because of how mold affects the your vision. If you have that other histaminic type symptoms or TH2 or TH17 dominant symptoms and um, we can test your home in different areas and we see it there. I would rather not spend time on a mycotoxin test when we already see. You've got confirmation on the visual test, you've got known exposure and you've got symptoms consistent. Let's save that $500.

Kate:

Yeah, let's use your resources wisely your financial resources that you can put towards intervention and treatment instead of testing, and your time resource where we can get started on helping you feel better sooner.

Mitchell:

And I love testing. Yeah, of course. Right, you know, I see the world in numbers and in patterns, so I mean this is coming from a guy who loves testing.

Kate:

Right. But we say this we're clinicians, not salespeople. We're not here to tell you to order a test because we'll make money on it. We'd rather treat you with integrity.

Mitchell:

Yeah.

Kate:

There are times when we won't test because either the testing data doesn't make sense to us or the intervention isn't safe in that population.

Mitchell:

Big one is we're not going to test your hormones while you're on birth control yeah, and I think that moment when we explain that to somebody, it really dawns on them how oral contraceptives or even hormonal IUDs essentially hijack your brain and change output of hormones and activity of hormones so much that I don't even want to spend a few dollars to test them because it's irrelevant.

Kate:

Yeah, not a few dollars, but definitely not a comprehensive urine test either. Just going to tell us that your birth control is working.

Mitchell:

Yeah, same thing with even some like spironolactone, because it functions somewhat as an antiandrogen and a diuretic, where it's hard to know what a lot of those numbers mean, because it's such a uh, kind of just throws a wrench into the whole system. Kind of just throws a wrench into the whole system.

Kate:

The other situation is pregnancy and breastfeeding. A lot of the intervention hasn't been studied as safe in pregnancy or during breastfeeding, so it doesn't really make sense to get this data if we can't do as much about it.

Mitchell:

Specifically like adrenal stress hormone testing. I'll just tell you to work on parasympathetic activation without any sort of herbs or nutrients around that, because we don't know if they're safe. So why test it Right?

Kate:

The last situation is going back to testing as avoidance of action. We're not going to run a stool test on someone who hasn't mastered the basic habits. If you're not chewing your food, if you're not being mindful about your meals, If you're not avoiding foods that clearly make you feel like poop. We're not going to look at your poop.

Mitchell:

Yeah, you know when, and it's interesting, I've really changed the last five years on this Typically people with gut problems. We don't run poop tests, which might seem weird. I'm much more apt to run a stool test on someone with skin problems or mood disorders or Autoimmune diseases, chronic pain and not responding to interventions. That's when I'm interested in a stool test, much less than if you have heartburn or gas.

Kate:

Yeah, there's kind of a myth that a more expensive test means more answers. I think some of our most valuable tests are the cheapest tests we run.

Mitchell:

Like a CBC? Yeah, complete blood count when you have a differential of white blood cells you can learn so much about. I mean, shoot, you can learn about. Can you perform autophagy? Well, looking at a white blood cell we can look at. Are you potentially housing? We just found it in someone with really high basophils that had a tick issue, you know, and with all the consistent signs and symptoms and exposure. So, in that, what is that like a $22 test? Yeah, we get an idea about how your hollow spaces are reacting. Are you teaming with a chronic viral infection? A lot of that can be done just from a CBC. Are you inflamed chronically? Right?

Kate:

So some practical tips on how we decide and also to help listeners decide what they need. It's always starting with goals and symptoms. Are there low-hanging fruit that needs some intervention? First, when we're thinking lifestyle here, then considering timeline, budget and priorities. Is it worth running a test and waiting for the results to take action? Do you have the budget for the testing, but also for what it's going to take to treat Any findings, but also for what it's going to take to treat any findings?

Mitchell:

And then where are your priorities for taking that action in it. I think this is a good message for clinicians as well. You know I not frequently, but a few times a year I will get freaked out clinicians sending me a bunch of labs. What do I do? Number one if you're willing to run a test, you need to know what to do about it. And number two don't run things if you don't have a team of people or good referral sources. If you find something scary, you know, I mean I think prime example, I mean we use a lot of neurology referral, cardiology referral and even recently an infectious diseases doctor referral. You know we built that up so that if something is outside our wheelhouse, we at least feel comfortable not sending a freaked out text to a friend to try to solve your problems for you. So I think for clinicians as well like be aware of what you're testing. You've got to be willing to deal with the findings if they're not congruent with your basic skill set.

Kate:

In that same decision tree of timing budget priorities is what is the first phase of testing? Look like what is ongoing monitoring? Look like how soon do you retest something after taking some action steps?

Mitchell:

and different for every situation different for every marker yeah, because when people see something out of line they want to retestest it soon. But especially for something like thyroid hormone conversion, that might take a while to change. A hemoglobin A1c will take 90 to 120 days to change. I'm not going to retest that every month because you might be making good changes on the road toward that number coming down but you won't see it and it might discourage you toward that number coming down but you won't see it and it might discourage you.

Kate:

I think we're starting to sound a little anti-testing, which is not the case at all. We love data, we love tests, but we don't want patients to feel completely overwhelmed by data without any action steps. So the interpretation is so much more important than just getting results yeah, and then interpretation and then action.

Mitchell:

Right, yeah, don't don't run some tests as a way of not making change. You know, run tests give a good history to somebody who can interpret it. Take all of that in. You know, clinical, you said, like the decision tree, it's patient history presenting complaints, test results but then responses to interventions. And I think that's really how we think about the formula for success is testing has a place, but it is not the place. It's not the only thing and ai can give you test result information but if it doesn't fit your history, you know we always say treat the patient, not the test yep, I can't wait to find out how ai titles this episode, because we went in a full circle.

Kate:

And that's a wrap for this episode of Facilitated. If you enjoyed it, hit subscribe because, let's be honest, you'll forget otherwise. And if you really loved it, please leave us a review. Not only does it make Mitchell feel warm and fuzzy inside, but it also helps more people find functional medicine without falling into a Google rabbit hole. For more about what we do at the facility, check out our website, wwwthefacilitydenvercom. You can also follow us on Instagram at the facility Denver for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.