Lab Testing For Autoimmunity: The Key to Personalized Healing

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone. Dr. Stillman here again, joined by Amy Arp. Hello, Amy. How are you?

Great. How about yourself?

Great. Great to be here today. We are talking about lab testing for autoimmunity, so we're just going to dive right in. So first of all, I started the autoimmune recovery program at the practice with Amy. Because I saw so many people coming in who had some combination of mystery illness. I don't know what's wrong with me. No one could fix me. I've seen everyone locally. I'm flying to see you now because I need better answers and better diagnostics to the people who had outright diagnostic or true diagnoses of autoimmunity. And I saw them getting great results with the program that I ended up putting together, which then we created into the Autoimmunity Program. So that whole program had as like its bedrock, the diagnostic testing, because if we didn't get diagnostic testing for these people, what were we going to do differently from anyone else?

Right.

And one of the things that we end up working on with patients is we'll help them with their diet, their lifestyle, all these other things. But the funny thing is, is if they're doing all of that right coming through the door, they get such better results. Like one case that I always refer back to for patients as a, you know, as a powerful testimonial is Emily Jerschak, who we just recorded a podcast with. And you know, she came in and I had almost no feedback for her on her diet or lifestyle. And I can't tell you how infrequently that happens. Her macros were right on, her food choices were right on, her lifestyle was amazing, she did the right supplement protocols, and boom, she got amazing results. It's also one of those cases where I just roll my eyes at these people who are like, you don't need supplements and you don't need hormones, you just need to go out and get more sunlight and wiggle your toes in the sand. I'm like, that's great, but I've got all these case studies of people getting great results with these supplements, not a ton, not crazy amounts, much less than most practices. But anyway, all of it starts with the testing because if you don't have the data, then you cannot tailor a protocol. So how do we approach this testing in the practice? So I used to do the Nutraval plasma from Genova Diagnostics. Still love that test. Still get it when a patient wants a deeper dive, but I stopped ordering that because I looked at the HTMA and got better or the same results with the HTMA. And in fact, now the formulas that I use for HTMA cover most of the major abnormalities I saw on Nutraval. So when I do run Nutrivals and HTMAs side by side, which I still do for patients occasionally, almost never is there a change in their protocol based on the Nutrival, which doesn't mean it's not a great test. It's just, I don't need it in most people. So we start with the HTMA. And for those of you wondering about HTMA, I see just the other day, email landed in my inbox, buy our HTMA kit program, whatever. I looked into it and I said, you have no idea what you're doing. You're picking. Picking the wrong supplements for these people. You're not interpreting these tests accurately. You're just going to make people worse and certainly not better. So be very careful who you work with on HTMA. There are some really bad practitioners out there.

I was definitely going to say that because I think even circulating on the internet, you see people talk about how HTMA is pseudoscience and all these things. And I'm like, it's because we have horrible practitioners out there. Trying to interpret them, trying to get results, and they're trying, but it's just you have to be very careful and find someone who actually understands how to interpret it well and then how to give the supplementation correctly. And I feel like even as we've been in this space, there are so few people that actually understand it, and it's unfortunate because it's a very powerful test. And so I think as you're hearing this, like, as we're talking about HTMA, no matter where you're coming from on it, um, we would just Come and do it with us. It's, it's a really powerful test and we get awesome results. Even the testimony of Emily, that was a huge part of her story was that you did HTMA. She had these different metal eliminations and symptom relief.

Well, I mean, yeah, her, her aluminum level on the protocol we came up with on the NutrEval was, was one of the highest aluminum eliminations we've ever seen. The only higher levels in the practice are people who have been actively exposed. They've got an ongoing exposure to aluminum and have consumer packaged good, you know, energy gel or a package like a beverage, like aluminum can beverage. Those people, I think we could probably make aluminum cans from some of the hair tests we've seen in the practice. But anyway, so that's the first test we do because it gives us the most. We can tailor a supplement protocol to someone pretty much 100% based on that. And when I say a supplement protocol, what I mean is I can go through every single element of the periodic table and infer what needs to change in the supplement protocol based on that test, which is part of what I love about it. The other thing is I can infer about B vitamins and hormones and neurotransmitters, not 100%, but I can infer enough data that I know what to do based on that. And then we get blood work, which also tells us about hormones, neurotransmitters, fed, fasted state metabolism, inflammatory markers. We have a comprehensive wellness panel. I posted that in a post on Substack called Testing I Trust in My Practice. I think it was that post. We've gotta post somewhere where I've got the whole comprehensive wellness panel listed out. We have that, a member's price on that. That's, I think it's in the $300s right now. I change it occasionally and pricing changes. So don't quote me on that. And for people listening to this, I want you to know the, the, the markup on labs is insane. So, and I'm telling you that because we see tons of patients come to us and they're like, I bought these labs here. I bought these labs there. I, I went through this other practitioner and bought these labs and they'll get billed $1,000 for labs we get for $200, or $4,000 for labs we get for $400, or $400 for labs we get for $40. I'm telling you that because if you work with a good practitioner, they will give you a— they should give you a massive discount on labs. And if they're not, they either don't know about it or they're just taking advantage of the mark— of the market economics of this and just marking the labs up, which is what it is. We get the comprehensive wellness panel that gives us a huge amount of data that we then combine with the HTMA to really tailor a supplementation protocol. And then beyond that, now in the Autoimmunity Recovery Program, we're offering an allergy test. I'm not actually going to say which one, and there's a reason for that. So over the years I've done testing with different companies. Well, I guess, you know what, I'll just tell you right now, we're using the mediator release test from Oxford Biotechnologies, but I, Caveat it with what I just said, because here's the thing I found. We used to use the lymphocyte response assay from ELISA ACT Biotechnologies. Russell is so— that's the founder and head of the company— is so dedicated to the quality of his lab that he's had the lab shut down for something like 9 months, which for me is an unacceptable amount of time for me to go without this test. I need an alternative. So we started doing Oxford Biotechnologies, and if Russell gets his lab back online, we'll look at it and, and possibly switch back to them. But my point with that is lab testing companies change. If you're listening to this in the future, there'll probably be a link somewhere to the allergy testing we're recommending right now. Whether you get that with us or another practice or whatever, we just want you to get some kind of testing that's actually good. And this is where people make a ton of mistakes with autoimmune testing. So, and we'll go back to the other mistakes people make with nutritional testing and things like that later. But the mistakes I see people making with the allergy testing is that they'll get IgE or IgG or IgM or IgA or immunoglobulin levels, which are very cheap to run and very, very easy to interpret. You either have it or you don't. The problem with these tests is they don't tell us if there's an actual immune response based on the, the antibodies. So you can have a positive antibody test and no reaction to the food or environmental trigger. So people will get these antibody tests back. They'll eliminate all the things that they're positive to and they won't get any better. And they'll also have these false negatives on those tests where they have a reaction, but it's not mediated by antibodies. Mediated by cells like T cells and other elements of the immune system. And so what ends up happening is you get people subpar results with the antibody testing. It's not useless. It's not bad. It's helped a lot of people, but it isn't the test we run because it doesn't test the majority of the immune responses that we see causing and triggering autoimmunity. Amy, your thoughts?

Yeah, no, I, I agree. And I think one thing that when we're doing allergy testing, we're looking to really eliminate things for a season and we really want your body to be in a place where it's healthy. Healthy and it's healed and you're able to handle all of the different, um, kind of triggers and food things that come into your life. But for a season, we are going to have to eliminate things. And so that's why this is really important, because it can help us really quickly get you to a place of less symptoms, no symptoms, all of that. And so that's what we really want to do. And then we figure out what that looks like for you long term, if that's something that you can add back into your diet on occasion. But there's just so much out there right now that that's like a whole nother topic. I feel like it's not as simple as like, okay, well, you can add back the different things that you're allergic to. There's so much with that. Our food system is so toxic in a lot of ways, and so it's not as simple as that. Um, but we really want your body to be in a place where you can handle it. And so I just do want to say that also. And then I want to say, I have people come to me all the time and they say, what about gut testing? Everyone wants gut testing because traditional naturopath doctors, that is what they're trained to do. And oftentimes they do a lot of different gut testing and a lot of that. And so we don't do that here. And so I'm gonna have Dr. Stillman explain a little bit of why we don't do that. Cuz I get emails on that all the time, or when I'm in practice membership evaluation calls with people, they say, well, don't you do gut testing? And I'm like, let me help you explain. No, we don't. These are the tests we do and why.

Question for you, Amy.

Yeah.

Did you see a huge difference in your recovery when you eliminated certain foods and triggers?

I didn't have a ton. I mean, I, well, okay. Let me think about this a moment. I was on. A very, very, very strict diet when I was healing because that's what I was told to do. So when I was healing, I was on an extremely strict diet. I ate basically only eggs, meat, and vegetables and oil. I didn't eat anything else, like, and I ate that very strictly. No cheating, no nothing. 7 to 9 cups of vegetables a day. I was on like very, very strict diet and I ate so many vegetables, like an insane amount of vegetables. I healed. Is that the best way? I don't necessarily think so. If I were to redo it, I would have changed my diet and added different things. But I did that because that's what I was told to do.

Yes.

Given that we are doing things a little bit differently than that, because we know that there's a better way to do it. I just didn't know any better. And so, well, it's a hard question because I did eliminate almost everything.

Hold on though. Cause I do have to say it's really tough to say that it wasn't the thing that gave you the— so it may have been, it may have been critical. Right. And that's the tough thing.

Yeah.

You never know what combination, like what do— and I think this is where it's a lot more, I mean, people just don't get it. It's a lot more like, say, winning at a sport. If you ask the members of a sports team, hey, why do you guys do this that way? They'll be like, we don't know, but we're winning. So we're going to keep doing it that way. You know what I mean? It's very funny.

Yeah, no, but now, you know, I just want to say like, I'm able to eat anything and everything and I feel absolutely great. I have no issues, no nothing. I don't choose to eat anything and everything, but I can. Of course. And, and so that's just like the nice thing about it. And I have no reactions to any foods at all, like no gluten, no dairy, no nothing, like literally nothing, which is great. But the diet piece is, it is interesting. It is hard to know if that was the thing because I eliminated so much. But I do know that when I was healing, I did have reactions to certain foods when I did eat them after being on the elimination diet for so long, I would have reactions to different things like gluten and not as much dairy. But some of these other things, I would eat something and my face would go numb and I'm like, oh no, I don't want that. And so eventually that went away. But so it, it very well could have been a huge part of it. Who knows? But I do want to say for everyone out there listening, we're not going to put you on that specific diet. We're a little bit more, we know a little bit more about how to create a beautiful diet that's going to be helpful, that eliminates certain things, but also adds other things in there because eating that strictly is really, really hard for a long period of time. So that is a really tough thing to do.

Very challenging.

Okay. Okay. Back to gut testing. We were talking about gut testing, why we don't do gut testing here.

Okay. So, and I'm going to caveat it because we do do gut testing if it's appropriate, but all comers, here's what happened in my practice. So I started out with a mentor, started out, I found a mentor who had this great system. You would order the gut test and the allergy test and the NutriEval plasma, which I mentioned earlier. And we would have all this data to go on and just come up with custom supplement protocols. And it was amazing, but Then I was, I was getting these GI results back that didn't sometimes make sense with what the patient was telling me. I'd have people who came in with a prior diagnosis of SIBO who had low levels of gut microbes. And then I would have people come in who had clear digestive enzyme insufficiency and problems with digesting their food and their enzymes were fine and their breakdown products were fine. And I just looked at it and I thought, this doesn't fit the case in front of me. And so then I had some conversations, notably with a friend, a friend and colleague, Michael Ruscio. And he said, look, I did gut testing for a long time. I didn't find any consistent consistency between the findings and the clinical state of the patient or the outcomes. So I stopped doing it. I thought, huh, that's really thought-provoking. And what I did find with supplement protocols I based on the GI testing is that we have a handful of things, digestive enzymes, bitters, betaine HCl that we combine in various products that have huge impact on gut health. And I also realized that it was easy enough to just pack and ship these products to patients and have them try them because that was actually less time and money spent on interpreting the labs than doing the labs and sitting down and going over them. And so many patients have come to me who just did the standard operating procedure we have between HTMA and the comprehensive wellness panel and the allergy testing, and their GI issues just disappear. And then why would we do any GI testing? So we can do GI testing. And I have had cases where people were not getting better. Their gut was still a disaster. We wanted to see what is here that we're missing. And so we would run the testing and we might get something back of interest, but at the same time, I would have people even do the GI testing and then not do the treatment and still get better. So I just stopped doing it because it wasn't changing what I did. And it was part of this process of how do I refine what I do so that it is as efficient as possible, and I'm not putting people through anything unnecessary. And it sounds like, I mean, for some people it doesn't seem like a big deal. They want to do all the testing, get all the data. But I got to tell you, between the lab draws and the urine collections and the stool collections, it turns into a big production. And what I love about our approach is it's book a comp, book a lab draw at, you know, LabCorp, get your haircut, ship it. Get the labs drawn for the allergy testing, which can't be done at LabCorp for various reasons. And we're done. That's it. Simple steps. All the testing's done.

And it saves people money. I think that that's one thing that we see a lot is people come in having spent thousands and thousands of dollars on tests. And I always ask them, what was the outcome of this? What protocol came about from this? Did that actually help you? And it's really tough because I think there's a lot of really interesting tests out there, fun to get the data. But how did that change the outcome of your protocols or your treatment or all of that? And so, you know, if you're working with someone and you're kind of questioning like, oh, do I need this? Or do I need that? I always ask a practitioner, how does this change the outcome of my protocol or of my treatment program? And oftentimes they may not have an answer. Sometimes they do. And that's great. And some of these tests might be really great in certain circumstances. And so we're, we're not saying it's a, you know, completely waste, a complete waste of time. We've just found that it doesn't. Give us a large amount of data to actually change the course of treatment for our patients. And so that's, yeah. And so I really like what you've done here, Dr. Stillman, with that because it's, it's a great way. And I remember doing all of the tests. I did every expensive test possible and the doctor would give me the test results back and say, okay, we're gonna do this. And I'm like, well, would we have done this anyway? And he's like, well, yeah. I'm like, well, what did we need this test for? And I have done so much gut testing and I also personally didn't feel like it was that helpful in instructing which protocols and supplements I was on. And so, you know, for some people it may be helpful, but other people it's not as helpful. So.

Absolutely. That's why we cut that from the, from the practice. Let's revisit some simple testing mistakes that I see people making. There's so many, there's so many. So it's hard to know where to start, but I'm going to be just really, really general. And you already alluded to it, Amy, which is really, they'll get, people will order tests that don't change what they do. It's like, I'll give you an example. There's a test for something called leptin. This has to do with the fed-fasted state. It has to do with your metabolism. I've never used it in my practice. Lots of people order it. I don't know if it changes what they do, but it's one of these tests where, again, as Amy mentioned, asking the practitioner, how does this change what we're going to do? If it doesn't, why order it? Every single test on the comprehensive wellness panel has changed what I've done with a case along the way over the years, and that's why it is what it is. And it's funny, I'm saying that now and I'm like, you know, I haven't changed anything based on the vitamin day in the last 6 months, maybe I should cut it, and maybe I will. But, you know, and the other piece of that is just having had the painful experience of missing stuff, which is you started with X battery of tests and you missed something and you found it Y months later, and you think, well, we better move that test up to the beginning of the program. And so that would be test mistake number 1, is ordering stuff that doesn't really change what you're going to do. I guess test mistake number 2 would be delaying the tests that matter most, which I find that I mean, almost invariably patients coming to see me have not had all the tests I want, which means that the opportunity to intervene is late. I mean, I just constantly get cases where I just think this wasn't that complicated. If only your practitioner had known this, that, and the other thing, they could have ordered the right tests and figured out what was really going on. But it's okay. These things happen. And then the next testing mistake I think I would say is failure to appreciate the error range for these tests and the importance of follow-up. So very, very frequently I will see people say, well, I got these tests done, these are 2 years old, and I've been taking these supplements based on that. Hold on, you cannot think— or I guess I shouldn't say you cannot think because you, you might think, and I don't know how this happens. I think it's just a fundamental lack of appreciation for physiology. But if, if you get a test 2 years ago and you take those supplements for 2 years, then we have no data to sort of guide. Did we replete the nutritional deficiencies? Are things balanced again? How do we know? I hate to say it, but I'm just going to say it. Supplement industry makes a lot of money when people just buy the same supplements over and over and over again with no testing. And so there tends to be a push towards like, just try all this stuff. And so we'll get these people from— I'm not going to name names— certain podcasts, and they're like, I'm on all this stuff. And I'm like, wow, you're on all this stuff. Do you have any testing to support this? Not a bit. Or it's 2 years old. Not a good strategy. The key to great results is often getting the testing on a quarterly or every 6 months or every year basis, because only then can you really iterate your approach and give a personalized supplement protocol. And so it is what it is. I don't hate the supplement industry. It's just about incentives. But whenever I get someone in the practice who's clearly basing their decisions on what they hear on podcasts and popular media and influencers, I know I have potentially an uphill battle ahead of me of, I know they said that, but they don't see patients. And I know from seeing patients that this is how it actually is. And respectfully, this is what I would do. And so on. So that's probably big mistake number 3. Amy, thoughts on those?

I just, I agree so much. I think that there is so much out there like that. So many mistakes people make, all of that. I think it's So difficult. I would say that it's really difficult for patients to know, or people, anyone in general to know what tests are valuable. And so that's where it is really important to work with someone because now you can order tests from any practitioner online that just gives you their code and you think they have a good reason for why you should get this test or this test, or, you know, all these ones on Instagram and other social media platforms. And you may not actually need that. It may not actually be helpful, but it's hundreds, sometimes thousands of dollars for these tests. And so I think that it's just really, really important when you're doing this to really work with someone who understands the testing and understands how to interpret the testing, because even if you get a test, you may not know how to interpret it, or you might get a practitioner who interprets tests, but doesn't really know that. I've done that before where When I was healing, I was trying to figure out, okay, as I'm working with doctors, but also I'm like, oh, there's this test on Instagram. I should do it. And I get one practitioner call. And so I remember this one time I did this test and the practitioner call, just the person was well-meaning, but did not know what she was doing. And it was very challenging. I was thinking, I spent this money because I wanted to know my results and understand how to move forward. And you can't even answer any of the questions that I'm asking you about what this means for me and what do I do about it? And so it's just unfortunate that there's so much of that out there and it's so hard to sift and sort through. And I have conversations every week with people where they're asking us, you know, how are you different from the other person? Because we do have all of this. And I get, I get it. It's a tough environment out there. And so I hope that this helps just kind of distill down the information a little bit better for what we do here and how we can help and how Dr. Stillman has crafted his practice. Because it's, you have a really great system. We do here.

Fourth big mistake I see people making is not appreciating the error changes for things, which is sort of related to some of the other ones, but I'll explain what I mean. So I, I became increasingly suspicious of lab testing over the years as patients in front of me told me they didn't feel the way their labs told me they should feel. And then I started to do my own labs out of an abundance of curiosity, as well as a conviction that I needed to kind of walk my talk. And also, I find it very suspicious that other doctors and influencers don't publish their labs. Now that I publish my own and I've talked about them on the podcast, very publicly and, and broken them down and what I think. And I started to do lab draws every couple of weeks or every month. And so I would have these long series of labs and the spread on my labs is insane. You know, my TSH will vary from hypothyroid to perfect and my cortisol will vary from adrenal fatigue to perfect. And I don't feel any different. I mean, not a bit different day to day. I am so consistent in how I feel because I have everything dialed in and I know what supplements to take and all the rest of it. And I was just floored by the amount of variability even in my data. And so that's something I share with patients now when we're going over their labs and there's a discordance between your lab says you are hypothyroid, but I don't have those symptoms. Well, the lab may not be correct. And a lot of practitioners, in fact, I don't hear any other practitioners actually talking about this, to be honest. They don't talk about the error range of these labs. And it's really important because if you're making therapeutic decisions based on lab data, understanding the degree to which they vary from day to day is, is critically important. You have labs like ferritin where, you know, I've had ferritins as low as 60 and I've had ferritins as high as 250. And I've, you know, look at thyroid hormone. I mean, ferritin, you know, that's like a 200%, 300%, 400% variability. In the number day to day, same patient, different week. And look at something like thyroid hormone. Free T3 is a marker that we use to judge thyroid hormone sufficiency and whether or not we've got them on an optimal replacement regimen. And, you know, 2.9 could tomorrow be 3.5 and could the next day be 2.3. And that's just because of the amount of error in the test itself, which is why retesting, targeting symptoms, treating patients, not numbers. And this is where the whole treat-by-numbers approach that's coming out increasingly on social media where it's buy my lab pack, get my supplement bundle, is just— and we, to be frank, we tested the idea in the, in the coaching programs we did. We tested the idea, well, could we just give people supplements and get them better? And the people who just did the supplements and didn't get any coaching, nutritional counseling, lifestyle diet input recommendations, they didn't get great results. And the people who did got great results. And that's one thing that— and one reason why I take the testimonials of the practice the way that I do, these long drawn-out testimonials, like 20, 30 minutes with patients, because I want them to explain what got you the results that, that you got, these amazing results. And it's always a combination of things, and it's never just the supplements. I've had one case where the supplements just was like 99% of the result, and it was because they didn't come to any coaching calls, they didn't book any follow-ups, and I just, I hit the nail on the head with the supplement protocol, which is very gratifying for me, but also not the takeaway I want you to take from this, this recording, which is that the supplements are part of it and you need the right testing and you need a practitioner who's got an understanding of how much these tests really vary from day to day and all, all the ins and outs of them, which is just where people just waste so much money and so much time and they suffer so much needlessly because they don't have a good practitioner to work with.

Absolutely. I 100% agree. And I was doing a lot of those H2As with people and it's tough when people think that the supplements are gonna be the only thing that's gonna fix them. I think that's like a whole different discussion, but a lot of people just want supplement, just like the pharmaceutical, to fix all their problems and not do all the other things. But we just, we find that having the HTMA testing, other testing, and then really pairing that with all of the different lifestyle pieces, that's really the key to success is all of that combined. As you mentioned earlier, grounding is part of it, doing that, but adding some of these other things in to correct imbalances and other things goes a long way and expedites the process. I think for people That's a huge part of it. We want them to get well as fast as we can within reason. And that's just what we see is when we pair these things together, it really helps that. I, I think it's, yeah, it's great.

On that note, thank you everyone for joining us. Take care. Have a great day.