This blog covers the nutritional or functional testing I use with my clients, and what tests I’d run (and/or have my client’s doctor run) if everyone had unlimited funds.
Often it can be challenging to figure out the root cause/s of your anxiety, but that’s where questionnaires, nutritional/ functional/ testing, and a good practitioner (or team of practitioners like nutritionist, functional medicine doctor, nurse practitioner, therapist etc.) comes in – so you can put all the puzzle pieces together.
The following are what I have most of my clients do:
- The basic blood work that I like to see is a lipid panel, a CBC (complete blood count), a metabolic panel, an iron panel that includes ferritin, and a thyroid panel that includes TSH, free T3, free T4, reverse T3, thyroid antibodies (antithyroglobulin and antithyroperoxidase), vitamin D, and CRP (C-Reactive Protein). There is much we can determine by looking at functional values: digestive status, possible gut dysbiosis, adrenal function, malabsorption, inflammation, as well as low iron, low vitamin D etc. I’ll share more about the markers on this panel of tests in a later blog post.
- I also like to see an adrenal saliva test, which measures four times cortisol. So it’d be a saliva collection first thing in the morning, noontime, 5:00 PM, and 10:00 PM. It also shows DHEA; Secretory IgA; and an anti-gliadin antibody (a marker of gluten sensitivity)
- I rely on the Pyroluria Questionnaire and response to the supplements. The pyroluria urine test is a possibility. But I seldom have clients do it, because we can often see a false negative.
- For neurotransmitter imbalances – low serotonin, low GABA, low catecholamines and low endorphins – I rely on the Amino Acid Questionnaire and response to amino acids. Vitamin Diagnostics offer a platelet serotonin/dopamine/norepinephrine and epinephrine panel, which is the most accurate way to measure neurotransmitters, if you really wanted to measure them. I don’t ever recommend urinary neurotransmitter testing. It just doesn’t seem to correlate with symptoms.
- B12 levels. To determine a B12 deficiency, you would want to measure B12, methylmalonic acid (or MMA), and homocysteine.
- The 23andme genetic testing. This will measure MTHFR, COMT, MAOA, CBS, GAD and many more polymorphisms.
Here is other testing that may be helpful for certain individuals:
- A sex hormone saliva test. This will measures progesterone, estriol, estrone, estradiol, and testosterone. I have a wonderful nurse practitioner that I work with, and, if need be, will refer people out to the nurse practitioner if we need support when it comes to bioidentical hormones.
- A food intolerance test that measures IgG antibodies to 60+ foods. This shows a delayed reaction to the foods.
- A fatty acid test. This will measure omega-3s (EPA and DHA), omega-6s and omega-9s. And it’ll also measure trans fats. Doing this test is really helpful if you have pyroluria or think that you may have pyroluria.
- A RBC (red blood cell) magnesium test. Dr. Carolyn Dean talked about the usefulness of this test season 2 of The Anxiety Summit: Take magnesium and melt your anxiety away
- A stool test. Metametrix/Genova and Diagnostechs offers functional stool testing. It’ll show good bacteria, yeast, parasites, bad bacteria, and digestive markers.
- A hydrogen breath test or SIBO test. Genova offers this or you can ask your conventional doctor to order this.
- The H/pylori antigen test. Genova offers this or a conventional doctor can do this.
- Intestinal permeability profile. Genova offers this.
- A celiac panel. Genova offers this, or a conventional doctor can do this.
- The Cyrex panels, which will show gluten and food cross-reactions, and various autoimmune markers.
- The histamine whole blood is a useful test to see if you have high histamine/histadelia or low histamine/histapenia. This is offered by Vitamin Diagnostics and must be WHOLE blood.
- Spectracell shows vitamin and mineral deficiencies.
- A VAP test. If you have concerns about high cholesterol and heart disease, this is going to measure particle size, fibrinogen, Lp(a) and other cardio markers (since looking at only high total cholesterol is not particularly useful).
- The OAT/Organic Acid Test. Great Plains offers this and it has markers of digestion, yeast overgrowth, infections, B vitamin status and neurotransmitter function.
- A hair mineral analysis. This is a great way to look for toxic metals and mineral status. You want to look at ratios, not just levels. This is a good marker for copper toxicity as well. Analytical Research Lab offers this test.
- If you think your copper is too high, or you’ve got low zinc, you can measure copper or ceruloplasmin. This is in serum.
- Porphyrin testing. This is a measure of the effect of heavy metals such as lead and mecury. Kris Homme talked about this in Season 2 of the Anxiety Summit: Your hidden mercury burden – A likely root cause of the other root causes of anxiety – part 2
- An amino acid profile, which is a plasma or blood spot test. It’s not something that I use very often, but I have seen people with this test.
- You can also test candida antibodies in blood, which is not terribly accurate, but sometimes will show up.
I want to look into the following testing:
- The gene testing that Dr. Peter Osborne talks about in his interview on Season 3 of The Anxiety Summit: Grainflammation – How Grain Consumption Contributes to Anxiety and other Mood Disorders
- The mold testing that Dr. Jill Carnahan talks about in her interview, also during Season 3 of The Anxiety Summit: Is Toxic Mold the Hidden Cause of Your Anxiety?
- Testing of oxytocin by Meridian Valley – a 24 hour urinary test. I blogged about oxytocin, social anxiety and autism here
What functional/nutritional testing have you had done and have found to be helpful? Which of the above tests would you like more detailed information about?
Hi. Do you recommend the 24-hour urine test for amino acids?
Rebekah
I don’t often use this test
Trudy, do you have a company that can perform a reliable fatty acid test? I asked my doctor about this after reading your book (I have pyroluria). She said the ones she had used didn’t seem to give accurate results. Thanks!
Debbie
Genova/Metametrix has a finger-prick test and Vitamin Diagnostics/HDRI (http://www.europeanlaboratory.nl/) also offers a serum test
I’d love to know which ones your doctor doesn’t feel are accurate and why she feels they are inaccurate?
According to the 23andme website, they no longer do anything but genetic ancestry testing. Is there another site that does
this?
Evelyn
They still do (and always have) provided a raw data file of your polymorphisms. You take this file and run it through various other sites to get a nice report. I’ll be doing a whole separate blog post with details
Hello Trudy,
Thank you for providing such in depth and useful information on your site and in your summits. I’ve been re-listening to the past seasons to see what I could be missing.
Do you have a link to the other sites that you use to run the raw data file? Also 23andMe is now offering 2 choices the ancestry which it says includes the raw file for $99 or a health + ancestry for $199 if your using other sites do you need the health + ancestry? or which one would you recommend?
Hi Trudy
Thanks so much for all the valuable info you share, I am a functional nutritionist based in Cape Town. I was wondering in regards to a low Dopamine score on the Mood questionnaire, if adding Mucuna would be of support? As a precursor to Dopamine? Have you had any experience with this product?
Many thanks
Hi Lynne
Mucuna is a good precursor and is similar to tyrosine. I have always used tyrosine with my clients so can’t comment on mucuna.
Many thanks Trudy, I am finding more and more clients with neurotransmitter issues and your work has been invaluable.
Curious if you have run across this—I am watching video of a talk by a Dr. Tent DC who says the root cause of many of our autoimmune issues is viral in nature. He goes into depth on the history of vaccinations and the relation to viral infection https://www.youtube.com/watch?v=r8FCJ_VPyns
then there is a post on the blog http://mthfrliving.com
Immunosciences Lab Comprehensive Viral Panel
Health EBest Autoimmune Panel information
Mayo Clinic Mayo Medical Laboratories Natural Killer (NK) Cytotoxicity Profile
Thanks – I’m not familiar with this work of Dr. Tent but do agree that viral issues can be a factor in many conditions
Excellent list Trudy. Thanks for sharing this. Drew
Hi, you didn’t mention an important test for those of us who suffer from hypothyroid ism and that is Reverse T3. This plays a big part in our moods.
I await your reply
BTW, it’s a great article
Absolutely!
Hi Trudy- I would like to have the fatty acid test done (to see if I need EPO/GLA, and if so, how much), and also the copper or ceruloplasmin testing (as I always have low zinc.) Can you advise? Thx!
Also, I don’t seem to absorb Solaray Opti-Zinc (methionine) very well (unless it just gets depleted so quickly in me.). Can you suggest another form to try? Piccolonate? What brand?
Or maybe it’s just that 30 mg wasn’t enough. Yet 60 was way too much. Okay to break a capsule in half and try 45 mg? Thx.
Jane
Hi Jane
Sorry for the delay – I was out of the country dealing with a family medical emergency.
I like the bloodpost fatty acid test from metametrix. You can have your doctor order it from Genova/Metametrix or get it via Directlabs https://www.directlabs.com/TestDetail.aspx?testid=545
For copper and ceruloplasmin, these are pretty standard blood tests your doctor can order.
You could try any zinc picolinate or a zinc chelate, as long as it doesn’t have copper. You could try 45mg of the Optizinc too
Hi Trudy
Can the 23 and me genetic testing results (genome profile) show if I have pyroluria? If so how do I look for it?
If not, are there labs that you recommend for pyroluria testing? The lab you mention in your book (Health Diagnostics and Research Institute) does not seem to carry the test anymore.
thank you!
Renee
Renee
As far as I am aware there is no specific genetic test for pyroluria. There are some schizophrenia genes that could be used as clues (the original work Carl Pfeiffer did was with schizophrenic patients)
I don’t have any lab recommendations and don’t do pyroluria testing due to the high number of false negatives.
I contacted Health Diagnostics and Research Institute around the time my book was published and they were planning to offer the testing again but it didn’t ever happen. It’s unfortunate since this was accurate testing – results always correlated with the questionnaire.
I had a test for pyroluria done through Direct Healthcare Access online. Go to pyroluriatesting.com.
Thanks Rebekah – this is one of the labs offering pyroluria testing. But even this lab can give false negatives so do keep this in mind.
My results came back very high. I’m gonna retest at another time too.
What do you think of the Nutreval test, Trudy?
It’s a good test Rebekah
Hi Trudy,
Thank you for all this great info! I actually have used many of them and love to have validation from someone like yourself that I trust.
Thanks for sharing Jeanne! This is always good to hear
Hi Trudy,
I’m so glad I’ve found you. I love all of the valuable information you share.
I am at last trying to get to the bottom of my ongoing challenge with depression (since my teens) and severe anxiety that has only just happened this last month after a panic attack symptoms – like nothing I’ve experience before.
I’ve finalise realised I need to get some lab work done and get to the root cause so to speak.
I wondered if you could recommend any one you would highly recommend to work with in the UK that does similar testing and treatment to you ? I would really appreciate your direction.
Many Thanks
x Sarah
Sarah
I’m sorry to hear this. I don’t have a name for you but I’d suggest looking for nutritionists who have studied with Patrick Holford.
Hi Trudy! I love your book the antianxiety food solution. pg 136 you recommend the Comprehensive Metabolic Profile by Metametrix. Could you please point me to the correct test? I think I have pyroluria and also want to test for food sensitivities, so this test seems best. It seems they changed the names of their tests.
Is this effectively similar from GDX.net?
https://www.gdx.net/core/sample-reports/Organix-Comprehensive-Adult-SR.pdf
Thank you so much!
Lisa
Yes that is the same test and yes they did change the name when Genova merged with Metametrix
Thank you Trudy! Your work has been so beneficial to my family.
Hello Trudy!
I’m sure I remember seeing a recommendation for the best lab to test for Pyroluria. I know it’s not always 100% but I’d like to try. I stopped all my supplements several weeks ago so that I could get tested… but now I really need to get back on them because I am concerned about the return of my symptoms. I have felt uncomfortable several times.
I’ve spent the last couple of weeks trying to figure out where to order the test. I have your book is it there, on a blog or did you cover it in the Amnio class?
Thank you!
Jan
The lab I used to use no longer offers accurate pyroluria testing. I interviewed Dr William Walsh on the Anxiety summit in June (https://www.everywomanover29.com/blog/anxiety-depression-methylation-pyrrole-copper-zinc-imbalance/) and this is the lab he uses: DHA https://www.pyroluriatesting.com/
I’d love to hear the results when you get it done and find out your pyroluria score from the questionnaire now. I’m starting to create an informal database of results and the corresponding pyroluria questionnaire. Thanks!
Im a psychiatrist planning to do the training with William Walsh this Spring. In the meantime, I really appreciate your book and blog. Question: in patient’s whom I’ve found to have possible pyroluria by your questionnaire (often score around 15 or 16) I then use free copper calculation (calculated per dr walsh using ceruloplasmin and serum copper) and also ratio of copper to plasma zinc to get some further confirmation. I am not able to do the DHA lab testing since my state does not allow this test. After starting someone on zinc and B6/P5p, how often do you recommend adjusting the dose of zinc or B6 if they are not showing any improvement?
Kristen
The pyroluria chapter in my book has it mapped out. But in summary I do the zinc challenge and adjust after 1-2 weeks based on how it tastes; switch to another form and/or increased EPO to help zinc absorption. I adjust the B6 each week based on dream recall/nightmares up to 500mg B6 and then may switch to P5P or a combination.
Thanks for the feedback about my book and blog – glad to hear this! Fabulous that you’ll be doing the Walsh Training – we love psychiatrists who are incorporating this work!
Just making sure you know about the Anxiety Nutrition Institute. I plan to offer the first training later this year. We’ll start with amino acids and then there’ll be modules on pyroluria and benzodiazepines (and other anxiety nutrition connections). You can sign up here to be notified when we launch http://www.anxietynutritioninstitute.com/
Hi Trudy,
Forgive me if I have overlooked the answer but what can you recommend for someone who can’t afford any of the testing. They did your amino acid questionnaire and another one very similar and every single one was extremely unbalanced. Except for the blood sugar category. We have not read your book. She is going to have to feel better somehow to be motivated to do better.
Hello Ginger, Safety first. Permit me to suggest the following until you buy Trudys’ book: For research I recommend getting Julia Ross’ books, either the Mood Cure or any of her books from your local library. Some libraries may have mobile library vans that can deliver or even snail mail books to your location if your friend is an invalid or without transport. There are audio CDs of Julia Ross’s book as well. From there you or your friend must carefully determine if there are contraindications to taking any aminos such as medications or psychiatric diagnoses to be aware of…? Then does she need GABA to calm overthinking? Does she need DLPA for feelings of overwhelm and pain? Does she need L Tryrosine for more energy? There are more, yet that is what comes to my mind. Keep in mind one capsule of GABA can cause discomfort if not careful. The first time I ever took GABA I had an uncomfortable reaction so you must be careful. I do take GABA now after stabilizing other things over the years.
Andrejka,
Thanks so much for your suggestions. I just discovered Julia Ross so I will be looking at her books too.
She definitely needs to calm over thinking! I am starting to talk through the aminos with her and trying to help her see the benefits and want to try and read some of this information on her own.
Thanks Andrejka
Julia is my mentor – I worked in her clinic for 2 years an love her work and books.
Re your GABA comment I find this to be the case when too much GABA is used and start my clients on 125mg or less (based on a trial)
Ginger
Since your friend has done the questionnaires and scores high I would have her start with a trial in the area that is worst for her (https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/) and go from there. That way when she sees results she’ll have hope and be motivated to continue.
Read everything (my book The Antianxiety Food Solution has a single chapter on the amino acids detailing everything + other chapters on pyroluria, diet, blood sugar control – it’s more than just the aminos), Julia’s books and be informed before starting with the aminos.
Hi Trudy,
I’ve gone gluten free for about 1.5 years, however my hair started shedding when I switched to gluten free and hasn’t stopped. It looks a lot thinner now. Why might this be?
Thanks,
Anna
Kelly
Hair loss can be due to nutritional deficiencies such as biotin and zinc, and also thyriod problems but if someone was eating fortified bread and cereals (fortified with B vitamins and iron) they can end up low in these nutrients on a gluten-free diet. I’d check/test all of the above and be sure to address what is low
Hi Trudy,
What test/s would you recommend for a 5 year old with severe anxiety? Anxiety increased after a bout of gastroenteritis and antibiotics which suggests gut health but curious to know if testing would be helpful. She had also developed a specific phobia of vomiting (emetaphobia)
Shelly
I would start with basic blood work and the amino acid questionnaire and a trial of either GABA or tryptophan (https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/). I’d also address gut health with probiotics right away while waiting for a stool test.
If the antibiotic was a fluoroquinolone I’d address possible impacts from this (https://www.everywomanover29.com/blog/antibiotic-anxiety-fluoroquinolone/)
Hi Trudy,
Could you tell me what role nutrients and food might play in sensory issues? My 8 year-old daughter has cyclical issues with clothing where she has meltdowns over her clothing being ‘uncomfortable’–some mornings it can take up to an hour to get her dressed. Just when we think she’s outgrown it…it comes back. She is otherwise healthy and bright–she rarely has gluten and dairy, has never been vaccinated and is never sick (maybe a cold once a year). We’ve been to several naturopaths–we made some progress by addressing an issue with yeast overgrowth–she had a count of 120.
Lorraine
Yeast can be a factor for sure but I immediately think fatty acid imbalance – either low omega-3 or GLA/Gamma-linolenic acid (evening primrose oil helps). A ND or other functional medicine practitioner can run fatty acid tests.
However since it’s cyclical I would consider some kind of food sensitivity and keep a food mood log and look for pattern of exposure. “She rarely has gluten or dairy”…could it be after she does have it?
Doing lots of reading here in your site–thank you, thank you, thank you!!!
Is the Genova fatty acid bloodspot test still the one you trust? Have you ever used LabCorp’s Omega test?
Light bulbs are going off in my head regarding pyroluria. You mentioned GGTP <10 as a B6 deficiency indicator. Are there other tests you trust to evaluate B6 levels?
Alicia
Genova fatty acid bloodspot test: yes. Have you ever used LabCorp’s Omega test: no
Other tests to evaluate B6 levels: dream recall and markers on OAT
Hi Trudy,
My 15 yr old son was recently diagnosed with pyroluria and we’ve been giving him P5P ( 200 mg) and zinc ( 60 mg) for about a month and a half now. He still hasn’t improved but my main question is, does the spectracell test reflect pyroluria? We took a spectracell test and it showed his B6 and zinc as normal so I’m very confused???? Shouldn’t the spectracell also shown his B6 and zinc as low?
Thank you
Cindy
Cindy
I have not found the Spectracell zinc and vitamin B6 test to correlate with signs of low zinc and low B6 and pyroluria testing or pyroluria symptoms
I use this approach when the pyroluria symptoms are not resolving as we’d expect them to https://www.everywomanover29.com/blog/pyroluria-protocol-why-arent-i-getting-results-trouble-shooting-checklist/
I’d also like to add the 200mg of P5P is considered very high dose – 25mg of P5P is a starting dose and equivalent to about 100mg B6/pyridoxine
Okay thank you! I’ll ignore the spectracell when it comes to dealing with pyroluria.
Also, When I tried my son on pyridoxine (100 mg) he didn’t seem to tolerate it. A couple days after starting it he was more symptomatic – his behavior was more out of control and he was even more edgy and angry. The P5P doesn’t seem to affect him that way. Do you have any idea why he can not tolerate pyridoxine but can tolerate the P5P? I heard to treat pyroluria you need a combination of both forms of B6?
I’m also lowering his P5P level since you told me 200 mg was very high.
Dear Trudy,
Looking for your guidance in how to best approach testing for food allergy/sensitivity/intolerance and yeast for a teen in our family.
Dr. has ordered an IgE blood test, CBC with diff and platelets, lipid panel and vitamin D 25 hydroxy.
Symptoms include bouts of GI upset, sudden onset of constipation, occasional breakout of itchy hives especially on neck area. May also have overgrowth of candida- at times itchy ears, white coating on tongue, occasional carb and other food cravings.
1. Believe the IgE helps to identify true allergy – is this correct?
2. To look for food sensitivity/intolerance/delayed food reactions, is there a test or tests you feel are worthwhile?
3. Do you believe the ALCAT test could be helpful?
They have been trying to track symptoms and correlate reactions with food but are still not sure what the triggers might be. In between the episodes, they can have good stretches with no symptoms present.
4. They did the spit test which was positive for candida. Should they do a more conclusive test for yeast?
Thanks so much Trudy!