optimal health is not complicated · nose with meals, many gi symptoms, taking spironolactone,...

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SAFM Diamond Coaching Retreat

Labwork Extravaganza and Clinical Tips

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the SAFM student program agreement.

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Case 1: 57 y/o female, low libido and dryness, reduced skin elasticity, difficulty waking up (no trouble sleeping), and brain fog. Using DIM.

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Case 1: 57 y/o female, low libido and dryness, reduced skin elasticity, difficulty waking up (no trouble sleeping), and brain fog. Using DIM.

Low hormones across the board. Why? Hypothyroid (Full panel) ?! Check cholesterol. Sufficient LDL? B5? Early AM sun exposure. Boosting adaptogens. Insulin resistance (Fasting insulin, HbA1c)? Consider DHEA (5mg bid women) or

Pregnenelone (~20mg). Topical estriol vaginally? Stop DIM.

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Case 2: 53 y/o female, potent insomnia, breast cancer 9 yrs earlier, Dx with Dx w polymyalgia Rheumatica, using Imitrex, Motrin, Off xanax 4 mos, Pure genomics BID, D3/K2, aloe, Meriva, MagMind, Kavinace, DHEA, P5P.

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Obesity? Address the gut! HPATG axis suppression (low cortisol) to allow body to fight

infections. Boost immune function. D, A, Zinc? Hypothyroid? Licorice (not too much!) to boost Free Cortisol. Very low cortisol = immune dysregulation, exhaustion (nothing to counter

melatonin!). Ensure sufficient intake of salt. Sleep is NOT a melatonin issue. Consider low cortisol and blood sugar swings.

Night-time snack? Sleep hygiene, l-theanine, calming herbs. What is DHEA dose? Insufficient. Perhaps add pregnenlone. Stress management?! Over-converting dopamine to adrenaline. Hyper-methylation? GSH low-ish. Check homocysteine to see if low? Make sure methionine intake not excessive. Balance with glycine.

Case 2: 53 y/o female, potent insomnia, breast cancer 9 yrs earlier, Dx with Dx w polymyalgia Rheumatica, using Imitrex, Motrin, Off xanax 4 mos, Pure genomics BID, D3/K2, aloe, Meriva, MagMind, Kavinace, DHEA, P5P.

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Case 3: 24 y/o female, med school student, OCP for acne, hair loss, headaches, runny nose with meals, many GI symptoms, Taking Spironolactone, Ritalin, Propranolol.

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OCP suppresses hormone synthesis! Vicious cycle Ritalin, high cortisol, hypothyroid function, poor focus/fatigue….

Seek a full thyroid panel. Gut symptoms – immunosuppression? Stool test. (Viral surge/load?) Food sensitivities? Eliminate at least dairy 100%. “Nightmare” of Ritalin insomnia is common. High cortisol blocks melatonin

synthesis. Beta blocker will make this worse! CortiSolv 3x/day, double dose nightly.

DopaPlus helps withdrawal from any ADHD meds. Lower neurotransmitter turnover. Needs B6 (P5P)! (will also

support GSH). Increased serotonin action will likely help headache. Spironolactone is diuretic! Check RBC magnesium. Check fasting insulin and RBC Zinc. Consider education about OCP and stopping

(support with vitex and ground flaxseed first).

Case 3: 24 y/o female, med school student, OCP for acne, hair loss, headaches, runny nose with meals, many GI symptoms, Taking Spironolactone, Ritalin, Propranolol.

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DUTCH Considerations

PlanSTRESS reduction!100% elimination of coffee and black tea; green tea first AM and early a'noonSleep support (primarily through sleep hygiene but also 5-HTP and taurine)Thorne Adrenal Cortex (3x/day)Gaia Energy-Vitality (first-AM, noon)Life-flow ProgestaCare (at night, days 14-28 of her cycle)100% elimination of sensitivitiesDaily kelp capsules (for iodine)

Transdermal Progesterone: Urine underestimates tissue levels of progesterone.

5a-pregnanediol is the metabolite of oral progesterone that can promote sleep. Our natural metabolic balance between 5a and 5b can vary.

Oral progesterone will not increase serum progesterone levels.

Testosterone can be falsely low due to impaired glucuronidation clearance (UGT – also bilirubin may be elevated re: Gilbert’s). This may also lead 5a-DHT to be falsely low. Look at Epi-testosterone (which doesn’t use this pathway).

Sulfation is the other pathway used for clearance.

Use Total and Free Testosterone blood test to confirm levels.

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Labwork Pearls - General

Always remember that Labwork is a frustrating, time-consuming, expensive(and potentially confusing and fearful too) step for your clients.

Run your own salivary, stool, & urine tests, so you have empathy and awareness.

The goal: uncover clues you don’t already know. Not bolster your confidence.

Your clients expect significant discoveries in exchange for their investments. Set their expectations appropriately and in advance.

Don’t use labs you aren’t well-educated in how to interpret and what the values mean and have some solid case review experience. 6 case minimum.

When patients approach their physicians well-educated on why they want specific Labwork, they are much more likely to have it done.

If a Labwork list is too long, a physician may choose to run none of it – including the obvious, conventional markers.

Stop taking all supplements (and non-essential meds) two full days prior to Labwork except digestive supplements (e.g. HCl, enzymes) because they are part of the “baseline”.

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Labwork Pearls – General - 2


Always consider the timing of any Labwork (fasting?, stressed?, menstrual period?, “white coat” effects?, post-vacation abnormal circumstances?)

Food sensitivity or stool test? Assess if their symptoms are persistent. Happen every day? Wake up with them?

Generally, benign experiments are a much better use of your client’s time and money if the information you have points strongly in a specific direction (e.g. dairy elimination, HCl challenge, magnesium supplement).

There are always multiple reasons why a lab marker can be awry. Always. There is no such thing as a black-and-white lab marker.

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Labwork Pearls - Specific


Most minor gut issues do not require an expensive stool test. Address the basics first: poor eating hygiene, stress, lack of sleep, sluggish thyroid, poor diet, food sensitivities.

Ensure free-flowing stool (magnesium?) before sample collection. Use a ‘biofilm buster” (e.g. Klaire Labs’ Interphase).

No food sensitivity test is comprehensive. Tell Your Clients This In Advance. All antibody (IgG, IgG4, IgA) tests require the food is being consumed.

Wait 6+ weeks after completion of steroid medication use before relying on any data assessing immune system reaction/strength (e.g. food sensitivity test, WBC data, Globulin, fecal sIgA). 3 mos. post stopping hormone supplementation.

It may take months for a gut microbial population to be re-stabilized after a course of antibiotics. Be willing to changeyour plan when the unexpected happens.

Always consider the entire set of information you know. Be cautious about hyper focus on the numbers. Labs do make errors. Most markers are a single point in time. One point is not a “trend”. There are one-time flukes.

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Clinical Tip - Fundamentals


The body follows the mind. There is a belief/mindset/emotional root of EVERY type of dis-ease in the body.

People intuitively KNOW what is at play in driving their disease. Creating rapport and trust can open the way for them to access their intuition.

Otherwise, what’s wrong? Crap food, Stress, and Toxins. Start here.

Peace of mind. Purpose. Love. Expression.

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Thank you!

optimal health is not complicated · nose with meals, many gi symptoms, taking spironolactone,...

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