In my 22 years of providing health and nutritional advice for children I have observed that all too often a haphazard clinical approach has been taken wasting time and money; and more importantly, has placed the child at further risk due to lack of diagnosis and the initiation of natural therapies. I have prepared a list of my top 10 lab picks for children. I have also provided appropriate scientific links for your reference. Most of these tests can be performed directly through commercial laboratories at no cost to the parent(s). Provided for each test below I have enclosed a clinical pearl, an essential and important, consideration for each test.
Regarding all of the tests mentioned within this article, their measurements within the so-called “clinical ranges” are not as sensitive for early detection as compared to the healthy or “functional ranges”. The functional ranges, as defined by Dr. Michael Wald (Blood Detective), are narrowed clinical ranges that detect functional loss of organ reserve at approximately a 25% cutoff of organ reserve. The clinical ranges used by commercial labs are designed for the detection of disease(s) predominantly already present requiring approximately 40% loss of organ function.
1. Vitamin D, B12, C – energy, tissue repair, cancer, diabetes and heart disease risk.
CLINICAL PEARL: The optimal blood value of vitamin D3(25-OH) is 75 according to Meta-analysis. Many commercial laboratory results printouts will state that an “optimal” vitamin D3 value is greater than 30 mg/dL; this is an unscientific statement and should be ignored. Keep in mind that if the child, or an adult for that matter, is clinically low in vitamin D3 (below 20 mg/dL), than a prescription of vitamin D in the active form, the vitamin D3 (1, 25-OH) form is appropriate. Failure to provide a script of vitamin D3 for clinical low patients may be considered malpractice. Blood detective functional ranges will identify any vitamin D3 level as sub-optimal if the value is anything less than 75. Blood Detective will alert the clinician to consider malabsorption and mannutrition as potential cause vitamin D3 deficiency and will suggest that levels of vitamin K, betacarotene and vitamin E levels be drawn.
2. Blood lipids – measures total cholesterol, HDL (good cholesterol), total LDL (small and large particles, Type A and Type B respectively), ApoB100, Lpa, Triglycerides along with all other aspects of a VAP (direct lipid panel).
CLINICAL PEARL: The VAP panel is by far the most comprehensive and accurate lipid panel. Keep in mind that this panel, as it is a direct measurement of lipids as opposed to the standard lipid panels practitioners are used to ordering from commercial laboratories, will most often show elevations in one or more lipids even when prior lipids tests (non-VAP panels) have failed to; this is not an error as the VAP panel is far more sensitive of a test revealing the potential for greater cardiovascular risk. It is very important to also realize the other advantage to ordering the VAP panel as compared to the standard commercial lipid (non-VAP) panel; namely that the former is non-fasting and the later is a fasting test. Blood Detective will indicate that low cholesterol, as opposed to elevated levels, increases the risk of various cancers (i.e. when below 150 mg/dL). Cholesterol is an antioxidant and deficiencies will increase cellular oxidative stress. Low cholesterol levels are further associated, according to Blood Detective interpretation, with low vitamin D3 levels, low or low normal testosterone and increased need for antioxidants.
2. Chemistry – levels of: iron, sodium, potassium, creatinine, glucose, etc.
CLINICAL PEARL: The iron level should be compared to the total RBC count and the hemoglobin, hematocrit, TIBC and percentage saturation and the serum ferritin for most thorough iron-indices investigations. Considering that iron anemia is the most common nutritional deficiency on the planet accurate assessment is a must. To distinguish the difference between and elevated ferritin and excessive iron storage order a standard, and NOT a sensitive C-reactive protein test. If CRP-standard is elevated than the high serum ferritin may have resulted from inflammation and not iron storage. More information: http://kidshealth.org/parent/general/sick/labtest5.html
3. Homocysteine/methylmalonic acid – energy, inflammation, immunity and future risk of many diseases.
CLINICAL PEARL: The homocysteine is a genetic test that indicates if the patient is either B-vitamin deficienct and/or has a potential genetic deficit of one or more genes involved in methylation known as the MTHRF genes. High homocysteine indicates either malabsorption, malnutrition overall and/or a deficiency of either vitamin B12, folic acid and/or B6. Methylmalonic acid is more accurate for B12 and homocysteine for folic acid such that these tests are complementary and should be performed simultenously (commonly commercial laboratories offer them as a single test). Low homocysteine is also a risk factor for increased cardiovascular disease as are elevated values; the former statement is often overlooked in clinical practice and may have major morbidity and mortality significance.
More information: http://care.diabetesjournals.org/content/23/9/1348.full.pdf
4. CRP—indicates inflammation, cancer, heart disease, diabetes, etc. indicator.
CLINICAL PEARL: CRP-cardio is likely the most significant single morbidity and mortality marker of overall death potential from early occurrence of preventable diseases such as diabetes Type II, strokes, osteoporosis, cancers and various autoimmune diseases. Blood detective will indicate that a normal blood level of CRP may be falsely normal in the presence of protein deficiency. Inflammation, that would have otherwise elevated CRP levels, may fail to provoke an elevated level if CRP cannot be endogenously produced (from protein in the presence of its deficiency). CRP elevations, according to Blood Detective interpretation, may also indicate a hidden infection.
More information: http://kidshealth.org/parent/system/medical/test_crp.html
5. HgA1c Diabetes screen – blood sugar control/diabetes.
CLINICAL PEARL: The optimal HgA1c value is between 4.5 and 5.5 percent. More information: http://www.cpnonline.org/CRS/CRS/pa_hemoa1c_pep.htm
6. Ferritin level – evaluates iron level in the blood – iron overload/inflammation.
CLINICAL PEARL: High ferritin levels may indicate an inflammatory state with or without iron storage. Perform a CRP-standard and if elevated then the high ferritin may be from inflammation only. Also, order iron indices including a TIBC and percentage Hg saturation. In iron overload, the TIBC will be low or low normal and the TIBC will be low or low normal. More information: http://kidshealth.org/parent/system/medical/test_ferritin.html
7. Gluten intolerance antibody test – for those with strange health problems and gut issues.
CLINICAL PEARL: Blood tests for celiac disease are often inaccurate and include the transglutaminase, reticulin, gliadin IgA, gliadin-IgG and anti-endomycelial antibodies. There are no accepted tests for non-celiac gluten intolerance although I have found the gliadin IgG and IgA tests to be of use. Blood Detective interpretation will indicate that elevations of the gliadin IgA, as opposed to the gliadin IgG, are an indication of neurological involvement or the potential thereof. The genetic tests known aas the HLADQ2 and HLADQ4 tests will indicate the potential for celiac disease, but are not necessarily correlated with gluten intolerance or celiac disease clinically. The bottom line in my opinion is to eliminate all sources of gluten and/or gluten mimickers, for six weeks and consider reintroduction to precipitate clinical signs and symptoms. More information: http://glutenintoleranceschool.com/gluten-intolerance-in-children/
8. Body composition testing – percentage of body fat, water, muscle & metabolic rate.
CLINICAL PEARL: Blood Detective will indicate that body composition, or bio-impedance analysis, is the single most accurate biomarker for the prediction of overall morbidity and mortality. Unfavorable results based upon age, gender, and height very accurately predict morbidity and mortality. Corrections in unfavorable bio-impedance results is therefore associated with an overall reduction in overall morbidity and mortality.
More information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082845/ 9. TSH – free T3 and T4 – metabolic rate, weight, thyroid hormone problems.
CLINICAL PEARL: Consider ordering thyroid antibodies including thyroglobulin and thyroid peroxidase antibodies. High levels of either one are associated with thyroid hormone sensitivity regardless of the value of thyroid hormones and/or TSH levels. The thyroid peroxidase antibody is a selenium dependent enzyme and can therefore be lowered with appropriate supplementation with the preferred form of selenium known as selenomethionine. Blood Detective will indicate that thyroid hormones should be measured along with TSH, but the clinician must bear in mind that a patient must generally lose 40% of thyroid hormone function before the sensitivity of this test will show measurably altered blood levels. However, Blood Detective values provide early indications of sluggish thyroid by redefining blood levels at approximately 25% loss of thyroid function.
More information: http://kidshealth.org/parent/system/medical/test_tsh.html
For more information about Dr. Michael Wald, patent-pending software for the nutritional and clinical interpretation of blood go to: www.blooddetective.com. Dr. Michael Wald can be reached at: email@example.com or by calling 914-242-8844 (Ext. 1)