For Nutritionists Using Functional Lab Tests: Consider This First
By Erin Holt
So you want to offer your nutrition clients functional lab testing? GREAT!
Functional lab testing can absolutely benefit your clients, as well as enhance your practice.
A good functional nutritionist wants to identify imbalance of normal physiology so we can address these underlying dysfunctions and root causes. Functional lab testing is an excellent way to do so.
Having said this, being a “functional practitioner” isn’t just about ordering “functional labs.”
It’s about critical thinking, understanding the body systems and how they all speak to each other, using discernment with our testing and treatment strategy, and being a good listener. We can’t just jump right to lab testing.
If we’re relying too heavily on labs and not enough on our client’s story, then we’re really practicing no differently than a conventional approach.
If you want to offer functional lab testing, you should also be able to assess the time and place for them.
These are the exact questions I ask myself to determine if someone is a good candidate for functional lab testing.
Are they already doing the basics or should we start there?
I consider functional lab testing a “next level” intervention. You really don’t need a $400 test to tell someone they need to eat more broccoli and drink less soda.
A tenet of functional medicine is lifestyle and diet, so we must honor and uphold this to truly support our clients with a root cause approach. We can’t skip steps and expect to get people good results.
I don’t usually run labs on my clients unless they’ve already worked on dialing in the diet and lifestyle basics. There’s is one caveat here and that is sometimes the labs can actually motivate someone to make the important diet and lifestyle changes.
Is this person motivated by data?
Sometimes someone is self aware enough to know that about themselves and will tell you directly. Other times, we have to suss out clues through our clinical intake and listening skills.
Some folks simply need to see the data to make the requisite changes. The data doesn’t lie, so when people see the real physiological effects of how their current diet, lifestyle, or stress load is having on their body—they are more likely to take the appropriate action.
This is how functional lab testing can encourage compliance with behavior change—for some people.
Have I exhausted all horses?
There’s a saying in medicine, “When you hear hoofbeats, think horses not zebras.”
Meaning: you should first think about the more common and likely scenarios. In my practice, I see a LOT of zebras. But I’m still focusing on the horses FIRST to make sure we’re not overlooking something basic.
Years ago, when I was first starting out with functional lab testing in my practice—and very green—I made this mistake.
I had a client with SEVERE fatigue and immediately jumped to the zebras. Full thyroid panel! Functional hormone lab! EBV panel!
We were moving the needle a little bit with these tests, but not much.
Then, her doctor tested her iron and BOOM. It was low. A few weeks of iron supplementation and her fatigue started to lift.
::face palm::
That’s a mistake you only make once.
Will it change the intervention?
Because if the answer is no, then it’s really a waste of time and money. Remember, we really don’t need functional lab testing to recommend a whole foods diet, stress management, and digestive support.
When I first started mentoring clinicians, I was going over a client case with a mentee. She had run a comprehensive stool test on her client. Her treatment strategy based on these results was to recommend that her client start an HCL supplement.
Supporting stomach acid is a basic intervention that could have been made based on symptoms and a comprehensive health history intake alone—and saved the client almost $400!
The stool test really didn’t change the intervention.
Similar to the last question, will it provide relevant information?
I recently worked with a client who came to me from a prominent functional medicine clinic…with close to $5,000 worth of lab testing. Many of the results they didn’t even go over with her—because they weren’t relevant to her case! So she walked away with a bunch of information that really didn’t tell her much…and a sad bank account.
This is why I don’t recommend running the SAME set of labs on EVERYONE that you see. Discerning which specific functional lab tests you should order—based on the individual client and their unique set of symptoms and needs—is a skill. And this is a skill you should hone before you begin to implement testing in your practice!
Notable mention here is financial consideration.
While functional lab testing can end up saving money in the long run—they can direct the course and pace of treatment so we don’t waste time (and money) playing guessing games. They can also waste a lot of money if not carefully selected.
It’s been said before that “functional medicine isn’t very functional if no one can afford it.” Functional lab testing can be costly and many of them are cash pay.
While I run a labs-based practice, I am extremely discerning about what specific tests I run. And it always comes after an in-depth health history intake, conversation, AND making sure my client is already doing the basics. The labs I recommend from there are catered to the specific symptoms and budget of my client.
A good functional nutritionist should use critical thinking to determine which tools and resources they will use for each individual client. We should have MANY tools to pull from in our clinical toolbox—more than just labs. FNA helps you build a robust toolbox.
We should also be mindful about how we spend clients’ money, and attempt to stretch their dollars as far as possible.
The final, and potentially most important question to ask yourself before ordering functional lab testing for a client: Do you know what to do with the information?
This seems fairly obvious, however with the rise in popularity of functional lab testing, we are also seeing an uptick in ill-equipped practitioners running these labs. Interpreting lab data and organizing it into an effective treatment protocol is a skill and an artform that requires a lot of training.
This training goes beyond an introductory course or master class. Many of these basic training promote template medicine—addressing each imbalanced lab marker with a supplemental protocol. This is what I call "spot treating" a lab instead of treating the human being sitting in front of you. It’s usually not a very effective or sustainable solution because it doesn’t address WHY the client got to these imbalances in the first place.
Not all functional providers provide in the same way.
Critical thinking, discernment, and individualization should be the hallmarks of a great functional provider. This is why the Funk’tional Nutrition Academy exists. It provides not just the WHAT of functional medicine nutrition, but also the WHY and the HOW to integrate it into your own practice and into your own work with clients.
FNA gives you the tools to dive deep with your clients and take a true, root cause approach to support their healing.