COMPLETE CATALOG 2014 COMPLETE CATLOG 2014 COMPLETE CATALOG 2015 Getting Started To get started with Dunwoody Lab’s assays, e-mail us or give us a call to verify your right to prescribe testing in your state. Once that is confirmed we will send kits for each of the tests you would like to run. There is no charge for the kits themselves, only for the actual samples run by our lab. Kits The kits are sent to the provider’s office. Each kit includes everything you need to send the samples to Dunwoody Labs: instructions, requisitions, collection tubes, transfer pipettes (if needed), clinical packs, freezer bricks, insulated shipping materials, and a shipping bag. Your return shipping is pre-paid (for domestic shipments), so return labels are included in each kit. Most samples (all whole blood, plasma, and urine) are required to be shipped back overnight, so timely shipping is necessary and no over-weekend shipping is allowed. For all blood tests, your office must have the ability to draw a blood sample, or arrange for the patient to get a freshly drawn blood sample to you. If a plasma sample is required, your office, or an outside draw station, must have the ability to centrifuge the blood before the sample is shipped. All tests require a physician’s order or that of another appropriately licensed health care provider. Samples that require urine or saliva may be shipped directly by the patient in the provided pre-paid kit. When you need more kits, just let us know and we will send another batch. Billing 2 Insurance We do bill insurance for some of our tests, assuming a clinic has chosen to have us bill patients directly. Insurance billing availability varies by state. If you are interested in having us accept patient insurance, please contact us and ask to speak to an insurance specialist. Our testing may be reimbursable by insurance plans. Offices that opt to have us bill them directly may be able to submit insurance claims on behalf of their patients. Test Results Once tests are completed, your office will receive test results on each test run through Dunwoody Labs. These results are formatted in a similar way to those found in this information packet. Each results sheet includes an easy-to-read results table that indicates both raw data and a graph indicating the level or relative level of the analyte tested, norms for that analyte, and any high or low results and relative range of those abnormal results. These results sheets are suitable for both clinicians and patients. Each clinician’s office will be given a log-in for our website after we establish your account. This log-in will allow you to view and download patient results sheets as they become available and to track samples as they arrive at our lab. In addition, Dunwoody Labs will mail your office two courtesy paper copies of each results sheet for your records. Turn-around time varies depending on the test, but is generally one week after we receive the sample for Oxidative Stress, Oxidized LDL, and C3d/IgG; and two weeks for other tests. Follow-Ups and Clinical Consults Many of the tests run by Dunwoody Labs are profiles, where several different analytes are run to compile a more comprehensive profile of the patient in the category being tested. Many of these analytes can be ordered as individual tests, which offers a cost-effective way to follow-up after treatment with specifically targeted testing. Our clinical consultant and education director are also available for complimentary consults on individual patient results. Whether you are looking for a unique profile on a difficult to diagnose patient, or are looking to integrate a wider range of testing into your initial health screening process, let Dunwoody Labs partner with your office to fine-tune your patients’ medical care. 3 Heavy Metal Testing: Profile 1000 Why Test Heavy Metals? Analysis of the levels of toxic metals in urine after the administration of a metal detoxification agent is an objective way to evaluate the accumulation of toxic metals. Acute metal poisoning is rare. More common, however, is a chronic, low-level exposure to toxic metals that can result in significant retention in the body that can be associated with a vast array of adverse health effects. One cannot draw valid conclusions about adverse health effects of metals without assessing net retention. For an individual, toxicity occurs when net retention exceeds physiological tolerance. Net retention is determined by the difference between the rates of assimilation and excretion of metals. Many clinicians also request the analysis of essential elements in urine specimens to evaluate nutritional status and the efficacy of mineral supplementation during metal detoxification therapy. Metal detoxification agents can significantly increase the excretion of specific nutrient elements such as zinc, copper, manganese, and molybdenum. Chromium metabolism authorities suggest that 24-hour chromium excretion likely provides the best assessment of chromium status. Early indication of renal dysfunction can be gleaned from urinary wasting of essential elements such as magnesium, calcium, potassium and sodium in an unprovoked specimen. Variability in urine volume can drastically affect the concentration of elements. To compensate for urine dilution variation, elements are expressed per unit creatinine for timed collections. For 24-hour collections, elements are reported as both units per 24 hours and units per creatinine. 4 Heavy Metal Testing: Profile 1000 Heavy Metal Testing: Profile 1000 5 Serum and Salivary Hormone: Profile 1100 & 1150 Why Test Hormones? The hormone profile is a comprehensive look at all of the major hormones. By measuring all the major hormones at one time, one can determine their interactions and how to optimize their balance. Good hormones are like clean oil in the engine. Hormones make everything function better when they are optimal. They improve stamina, cognitive function, and general well-being. They reduce heart disease, improve bone density, and prevent aging and conditions of aging such as neurologic conditions, diabetes and even some cancers. The key to healthy hormone use is testing levels to make sure hormones are in normal range, but also in balance with one another. Hormone health can be a life changing event for many people. Restoring balance gives people a sense of youthfulness and returned self. Hormones working together in concert are critical for proper functioning and prevention of many age-related conditions. A decision to use either serum or salivary hormone testing is multifactorial. Dunwoody Labs sees the merit of both under certain circumstances and makes both available. Specific male and female profiles are also available. Also available on request is di-hydroxytestosterone. 6 Serum and Salivary Hormone: Profile 1100 & 1150 7 Serum and Salivary Hormone: Profile 1100 & 1150 8 Complete and Basic Thyroid Profile: 1200 & 1250 Why Test a Complete Thyroid Profile? Thyroid is one of the most under addressed conditions in medicine today. When the thyroid is low people feel fatigued, lack motivation, have difficulty losing weight, difficulty with concentration, feel depressed, and tend to have more trouble with digestion. If the thyroid is off, the entire system feels run down. Better thyroid function helps the immune system, our energy level, and reproductive function. There are thyroid receptors on every tissue in the body, demonstrating its necessity for all systems. When the thyroid is corrected it is like a light switch coming on in the system. We feel restored and more like ourselves. Standard measures of thyroid function, according to the Journal of Endocrinology, miss up to half of the population. You must assess each step in thyroid function to know that the entire pathway is workinag effectively. Abnormalities in thyroid function can be indicative of different nutrient deficiencies, auto-immune conditions and even a risk factor for certain cancers. Thyroid drives metabolism and is therefore critical for optimal well-being. Thyroid antibodies are indicative of certain nutritional deficiencies and are risk factors for cancer. Reverse T3 lets us know how stress is effecting metabolism. Basic Thyroid Profile A basic thyroid profile includes TSH, free and total T3 and T4. This can be used for an abbreviated snapshot or for follow-up test. 9 Complete and Basic Thyroid Profile: 1200 & 1250 10 Adrenal Stress: Profile 1600 Why Test for Adrenal? Stress? The adrenal glands are located on top of the kidneys and are responsible for the synthesis of several hormones. One key adrenal hormone is cortisol, which has the ability to regulate glucose levels, blood pressure, immune response, inflammation, and circadian rhythm (the sleep-wake cycle). Cortisol has also been called the “stress hormone” for its involvement in the reaction to stress and anxiety. Prolonged exposure to stress can cause the adrenal glands to become fatigued, which causes a corresponding decrease in cortisol levels, thus hindering the body’s response to stress. Because cortisol is involved in the sleep-wake cycle, it reaches maximum levels in the morning, which help us get out of bed and begin the day, and has minimum levels at midnight, helping us get to sleep. Abnormalities in this cycle can lead to fatigue, insomnia and depression among other things. Our cortisol panel utilizes four salivary samples collected throughout one day from the patient. This makes the test both noninvasive and easy for patient compliance. DHEA (DeHydroEpiAndrosterone), another hormone produced by the adrenals, is a precursor to androgens (testosterone) and estrogens. DHEA levels can be used to identify early adrenal fatigue. In addition to four cortisol and one DHEA sample, our advanced profile contains secretory IgA (sIgA) and anti-gliadin IgA. sIgA is a marker of intestinal integrity and gut immune health. The lower the immune health, the more “leaky” the gut is, the more likely there are to be food allergies and gut disturbances. Gliadin is a major protein constituent of gluten. Anti-gliadin IgA is an immunological reaction to gliadin. One in 5 people suffers from some level of gluten intolerance which may lead to nausea, fatigue, joint pain, depression, and diarrhea. 11 Adrenal Stress: Profile 1600 % Gliadin Antibody 12 Basic and Advanced Oxidative Stress Profile 2600 & 2800 Why Test For Advanced Oxidative Stress? Reactive oxygen species (ROS) such as superoxide and hydrogen peroxide are constantly produced by metabolic processes in all living cells. Under normal physiological conditions, cell generated ROS are neutralized by the action of antioxidants and antioxidant enzymes. Should these systems falter, excessive ROS accumulation can lead to cellular damage, including DNA damage, protein oxidation and lipid oxidation which may lead to damage of cell membranes and mitochondria as well as the progression of conditions associated with aging. The Oxidative Stress Test measures two systems for removing ROS from the cell. The first is intracellular reduced glutathione, the primary antioxidant found within cells. The second is the superoxide dismutase (SOD) family, the main enzymes which remove ROS from the cell and mitochondria. In addition to evaluating the cell’s ability to remove ROS, damage to lipids and DNA is also quantified using glutathione peroxidase, F2-Isoprostane, and 8-hydroxy-deoxyguaninosine (8-OHdG). Glutathione peroxidase is an antioxidant response element involved in detoxing the liver, repairing the brain, and protecting the thyroid. F2- isoprostane is pro-inflammatory, vasoconstrictive, is downstream from arachidonic acid and creates inflammation within the brain. 8-OHdG is correlates with an increased risk of cancer and neurologic disorders. This profile demonstrates the antioxidant capacity of the cell, the removal of ROS and the damage created as a result of excess ROS. Measuring and treating oxidative stress helps prevent aging and age related conditions such as cancer, heart disease, and diabetes. Why Test For Basic Oxidative Stress? This urinary profile is gives you highly evidenced markers of oxidative stress that indicate an increased risk of heart disease, neurologic conditions, lack of hormone safety and possible cancer. 13 Basic and Advanced Oxidative Stress Profile 2600 & 2800 F2-isoprostane is an eicosanoid produced by the oxidation of phospholipids and appears within plasma and urine. F2 isoprostane is vasoconstrictive and a marker of oxidative stress. It is a charged form of arachidonic acid that is highly inflammatory and implicated in depression, neurologic conditions and cancers. Glutathione is the major intracellular antioxidant within the lung, liver and brain. It minimizes the impact of reactive oxygen species in the mitochondria which slows degenerative processes. A decrease in glutathione results in an increased risk of diabetes, neurological conditions, heart disease and any condition of aging. 8-OHdG is a marker of DNA damage. High 8-OHdG has been implicated in cancer, diabetes and neurological conditions. Reactive oxygen species (ROS), such as superoxide and hydrogen peroxide are constantly produced during metabolic processes in all living cells. Superoxide dismutase is one of the most important antioxidant enzymes. Low levels are associated with aging processes and a system in decline. High levels are reactive to some assault to the system. Glutathione peroxidase is the antioxidant response element in the tissue of the brain, thyroid, and liver. It is involved in detoxification and reduction of reactive oxygen species. When it is low, we suffer from poor detoxification abilities. When it is high, we know the system is under toxic and oxidative stress. 14 Advanced Oxidative Stress Profile 2800 3.2 15 Bone Resorption: Profile 3100 Why Test Bone Resorption? Bone resorption is a process by which bone is degraded and leads to the release of calcium and proteins from the bone structure into the blood where it is filtered by the kidneys and detected in urine. During growth and development, bone synthesis occurs at a faster rate than bone resorption. However, as people age, the rate of bone growth slows and bone resorption occurs faster than new bone growth. When this occurs, bone density decreases, which may lead to osteoporosis and injury as a result of trauma. Low bone density is the leading cause of persons seeking assisted living. High levels of NTx (cross linked N-teleopeptides of type I collagen) can be a sign of osteoporosis, while low levels may indicate over-treatment of osteoporosis with bisphosphonates. 16 Bone Resorption: Profile 3100 17 Neurotransmitter Profile 4000 Why Test Neurotransmitter Levels? Neurotransmitters are major players in brain chemistry. Neurotransmitters help us think and process the world around us. Imbalances make us depressed, anxious or angry. They are critical to our emotional and mental well-being. Dopamine is the major neurotransmitter associated with the pleasure center of the brain. It is also involved in sensory integration. Conditions associated with abnormal dopamine levels are: High Dopamine: • Aggression • Paranoia Low Dopamine: • ADHD • Depression • Spectrum Disorders Serotonin is the neurotransmitter most associated with mood. Adequate levels prevent depression and modulate pain response. High serotonin is associated with a state of stress and can contribute to oxidative damage in the brain as well as bone loss. Conditions associated with abnormal serotonin levels are: Low Serotonin: • Fatigue • Disturbed Sleep • Changes in Appetite • Hot Flashes • Depression • Irritability • Mood Disturbances • Muscle Cramps • Bowel Cramps High Serotonin: • Serotonin Sickness • IBS • Celiac Disease • Oxidative stress in CNS • Bone Loss • Initial Stress State 18 Neurotransmitter Profile 4000 Why Test Neurotransmitter Levels? High levels of norepinephrine and epinephrine are associated with an increased stress response. Typically patients are in more of a fight or flight pattern when norepinephrine/epinephrine is high. Abnormal norepinephrine/epinephrine is associated with fatigue and other symptoms such as: High Norepinephrine • Aggression • Anxiety Low Norepinephrine • Depression • ADHD High Epinephrine • Aggression • Anxiety • Insomnia • Acute Stress Low Epinephrine • Weight Gain • Attention Deficit • Adrenal Fatigue GABA is the major inhibitory neurotransmitter in the brain. It helps with rest and relaxation. It is the most abundant neurotransmitter which makes it extremely important for overall well-being. Conditions associated with abnormal GABA levels are: Low GABA • Anxiety • Stress • Insomnia • Tension Headaches • Post-Traumatic Stress Disorder High GABA • Lethargy 19 Neurotransmitter Profile 4000 20 Food Sensitivity C3d/IgG: Profile 5000 Why Test Food Sensitivity? Within the US, approximately 50 million people suffer from allergies at a cost of $18 billion a year. The prevalence of food allergies has been increasing and it is estimated that 50% of adults and 70% of children suffer from food allergies. In extreme cases, food allergies can lead to anaphylactic shock and death if untreated. Fortunately, most people do not have allergic reactions that severe. The symptoms of food allergies are typically fatigue, joint pain, congestion, headache, rashes and chronic intestinal symptoms. In addition to common food allergens, our profile measures the preservatives, MSG, butylated hydroxyanisole (BHA), polysorbate-80, and the food additives Red#2, Red#3, Red#40, Yellow#6, along with the artificial sweeteners aspartame and saccharin. Allergic reactions are classified into four types. Our food allergy profile detects Type II/III responses, which are associated with a delayed allergic response mediated by an IgG response and immune complexes. Within this immune complex the complement component 3 (C3) is converted into C3d, which is an activator of the complement cascade. Our food allergy test is unique in that the test detects all classes of IgG and IgG-C3d immune complexes for a higher sensitivity. Symptoms of C3d/IgG Sensitivity Include: • • • • • • Fatigue Bloating IBS Constipation Anxiety/Depression Palpitations • • • • • • 21 Headaches Joint pain Eczema Circles under eyes Pain Auto-immune reactions Food Sensitivity C3d/IgG: Profile 5000 Food Sensitivity C3d and IgG Report: Profile 5000 Name: Age: NA Date of Birth: NA Date Drawn: NA Date Test Completed: NA Doctor: NA Color Key: Severe Reaction 4+ High Reaction 3+ Moderate Reaction 2+ Mild Reaction 1+ No Reaction Negative Contact Information: Dunwoody Labs Nine Dunwoody Park, Suite 121 Dunwoody, GA 30338 Phone: 678-736-6374 contact@nutratestlabs.com 22 Food Sensitivity C3d/IgG: Profile 5000 Agave Almond Apple Artichoke Asparagus Aspartame Avocado Bacon Baker's Yeast Banana Barley Basil Beef Beet Benzoic Acid BHA Black Pepper Blueberry Brewer's Yeast Broccoli Cabbage Candida Canola Oil Cantaloupe Carob Carrot Casein Cashew Catfish Cauliflower Celery Cherry Chick Peas Chicken Chili Pepper Cinnamon Clam Cocao Coconut Codfish Coffee Collard Greens Corn Cottonseed 0 1 2 3 Reaction Scale 23 4 5 Food Sensitivity C3d/IgG: Profile 5000 Cow's Milk Crab Cranberry Cucumber Dill Seed Duck Egg Albumin Egg Yolk English Walnut Flax Seed Flounder Garlic Ginger Gluten Goat's Milk Grapefruit Grapes Green Olive Green Pea Green Pepper Halibut Hazelnut Honeydew Melon Hops Kidney Bean Kolanut Lemon Lentils Lettuce Lime Lobster Millet MSG Mushroom Mustard Navy Bean Oat Onion Orange Oregano Paprika Peach Peanut Pear 0 1 2 Reaction Scale 24 3 4 5 Food Sensitivity C3d/IgG: Profile 5000 Pecan Peppermint Pineapple Pinto Bean Plum Polysorbate 80 Pomegranate Pork Pumpkin Raspberry Red #3 Red #40 Red Wine Rice Rosemary Rye Saccharin Saflower Seed Salmon Scallops Sesame Shrimp Snapper Soybean Spinach Spirulina Squash Mix Strawberry Sugarcane Sunflower Seed Sweet Potato Swordfish Tea Tomato Trout Tumeric Tuna Turkey Vanilla Watermelon White Potato Whole Wheat Yellow #6 Zucchini 0 1 2 3 Reaction Scale 25 4 5 Intestinal Barrier Assessment: Profile 5100/5150 Includes Diamine Oxidase (DAO), Histamine, and an Option for Lipopolysaccharides (LPS)* Up to 80% of the immune system is located in the gastrointesti- nal tract, and it is your body’s interface with the outside world. Foods, nutrients, medications, alcohol, pesticides, toxins, viruses, bacteria, and fungus all have intimate contact with your body through the gut. Together, the gut and the immune system act as the protectors of your health. They have to figure out the safe things to let into the body, and the bad things that should be kept out, attacked, or destroyed. When the gut barrier becomes damaged from food allergens, chemicals, antibiotics, junk food, or infection the important guardian function can be compromised. This kind of damage is referred to as intestinal permeability or “leaky gut.” A leaky gut means the GI barrier has broken down, allowing harmful elements to leak through and cause symptoms. Imbalances in histamine, DAO, and LPS are associated with leaky gut. When these markers are abnormal, it shows that your whole body is under attack. What Does the Test Tell Me? The Intestinal Barrier Assessment is a blood test that measures gut health, bacterial infection, and allergic inflammation. Diamine oxidase (DAO) and histamine can tell your doctor if you have leaky gut, problems breaking down histamine, or if there is inflammation causing allergic-type symptoms. High lipopolysaccharides (LPS) tell your doctor that your body’s defenses are down and can indicate an infection. If you have reflux, chronic diarrhea, or food sensitivities, your doctor is using the Intestinal Barrier Assessment to look for the underlying cause of these symptoms. What Will My Doctor Recommend If My Results are Abnormal? If your DAO is low, and you have high histamine, your doctor may give you supplements to help your body break down histamine effectively. Your doctor might also recommend dietary changes and supplements, such as probiotics, to help heal your leaky gut and restore a healthy balance of gut bacteria. With a combination of diet, supplements, and nutrition, your gut will get healthier, your system will recover, and your body will do a better job determining what is healthy versus what is a threat. Through this strategy, many GI symptoms, food sensitivities, neurological disorders, and autoimmune diseases can be improved. *Due to quality concerns, zonulin was removed from the profile September 23, 2014. We hope to offer zonulin testing again in the near future. 26 Intestinal Barrier Assessment: Profile 5100/5150 Nine Dunwoody Park, Suite 121 Dunwoody, GA 30338 678-736-6374 770-674-1701 (fax) info@dunwoodylabs.com Clinic ID: 00654 Clinic Name: Health and Wellness Clinic Clinic Address: 123 Main St Clinic City, State ZIP: Dunwoody, GA 30338 Clinic Phone: 404.555.1234 Clinic FAX: 404.555.4321 Patient Name: John Doe Patient DOB: October 01, 1965 Ordering Physician: Jones, Susanne Sample Date: April 04, 2014 Date of Report: April 04, 2014 Intestinal Barrier Assessment w/ LPS: Profile 5150 (Plasma) KEY Optimal results fall within the green shaded section. Population Distribution Borderline results fall within the yellow shaded section. Levels outside of clinical reference range fall within the red shaded section. Patient results indicator. Patient Results Reference Range Diamine Oxidase 36.4 ng/mL > 100.00 ng/mL Histamine 0.8 ng/mL 1.0 - 3.1 ng/mL DAO:Histamine Ratio Lipopolysaccharide 45.5 > 65.26 Negative (Below Detectable Level) > 0.10 EU/ml 27 27 Why Test Gut Ecology? The Comprehensive Digestive Analysis is designed to test the ecology and physiology of the gut. The gut is central to health and nutrition because without adequate digestion nothing gets into the system as it should. Gut health is inherent to optimal wellness. While we obviously think about the connection between overall health and specific conditions related to the gut, such as irritable bowel syndrome, colitis and Crohn’s, every health condition is impacted by the gut. While traditional stool cultures only look for a few pathogenic gut flora, this test evaluates hundreds of different species of flora to assess the impact on intestinal health. Often, many conditions that are thought to be permanent can be corrected or greatly improved by assessing gut ecology and treating accordingly. Bacteria, yeast, and parasites that may be harbored in the gut can contribute to fatigue, gas, bloating, diarrhea, and constipation. Also, infections in the gut weaken the immune system and create an environment that is more susceptible to systemic infections of all kinds. Harboring a chronic infection in the gut disrupts immune function in such a way that it can predispose us to autoimmune conditions. Infections in the gut affect our level of inflammation throughout the body. More histamine is produced in the gut than anywhere else in the system. Also, many neurotransmitters are made in the gut including serotonin and melatonin. When the gut is in disrepair our system is weakened in general. In addition to testing gut bugs, this stool culture shows you markers for inflammation in the gut to gauge improvement of care. Markers that show how well one is absorbing are also illustrated. A number of short chain fatty acids are shown which are indicators for how strong the gut wall is. All fundamental building blocks for gut health are included in this profile. The Complete Stool Culture Analysis includes all gut bugs, measures of gut lining to assess gut permeability, as well as measures of absorption and digestive enzymes. However, each major grouping of the stool culture can be done individually as well for more specific patient needs and follow-up care. 28 LAB #: PATIENT: ID: SEX: AGE: CLIENT #: DOCTOR: Complete Stool Culture Analysis BACTERIOLOGY CULTURE Expected/Beneficial flora Commensal (Imbalanced) flora Dysbiotic flora Bacteroides fragilis group Bifidobacterium spp. Escherichia coli Lactobacillus spp. Enterococcus spp. Clostridium spp. NG = No Growth BACTERIA INFORMATION Expected /Beneficial bacteria make up a significant portion of the total microflora in a healthy & balanced GI tract. These beneficial bacteria have many health-protecting effects in the GI tract including manufacturing vitamins, fermenting fibers, digesting proteins and carbohydrates, and propagating antiBACTERIOLOGY INFORMATION tumor and anti-inflammatory factors. Clostridia are prevalent flora in a healthy intestine. Clostridium spp. should be considered in the context of balance with other expected/beneficial flora. Absence of clostridia or over abundance relative to other expected/beneficial flora indicates bacterial imbalance. If C. difficile associated disease is suspected, a Comprehensive Clostridium culture or toxigenic C. difficile DNA test is recommended. Commensal (Imbalanced) bacteria are usually neither pathogenic nor beneficial to the host GI tract. Imbalances can occur when there are insufficient levels of beneficial bacteria and increased levels of commensal bacteria. Certain commensal bacteria are reported as dysbiotic at higher levels. Dysbiotic bacteria consist of known pathogenic bacteria and those that have the potential to cause disease in the GI tract. They can be present due to a number of factors including: consumption of contaminated water or food, exposure to chemicals that are toxic to beneficial bacteria; the use of antibiotics, oral contraceptives or other medications; poor fiber intake and high stress levels. YEAST CULTURE Normal flora Dysbiotic flora MICROSCOPIC YEAST Result: Many Expected: None - Rare The microscopic finding of yeast in the stool is helpful in identifying whether there is proliferation of yeast. Rare yeast may be normal; however, yeast observed in higher amounts (few, moderate, or many) is abnormal. Comments: Date Collected: Date Received: Date Completed: YEAST INFORMATION Yeast normally can be found in small quantities in the skin, mouth, intestine and mucocutaneous junctions. Overgrowth of yeast can infect virtually every organ system, leading to an extensive array of clinical manifestations. Fungal diarrhea is associated with broad-spectrum antibiotics or alterations of the patient’s immune status. Symptoms may include abdominal pain, cramping and irritation. When investigating the presence of yeast, disparity may exist between culturing and microscopic examination. Yeast are not uniformly dispersed throughout the stool, this may lead to undetectable or low levels of yeast identified by microscopy, despite a cultured amount of yeast. Conversely, microscopic examination may reveal a significant amount of yeast present, but no yeast cultured. Yeast does not always survive transit through the intestines rendering it unvialble. * Aeromonas, Campylobacter, Plesiomonas, Salmonella, Shigella, Vibrio, Yersinia, & Edwardsiella tarda have been specifically tested for and found absent unless reported. 29 v5.09 LAB #: PATIENT: ID: SEX: AGE: CLIENT #: DOCTOR: PARASITOLOGY/MICROSCOPY * PARASITOLOGY INFORMATION Sample 1 Intestinal parasites are abnormal inhabitants of the gastrointestinal tract that have the potential to cause damage to their host. The presence of any parasite within the intestine generally confirms that the patient has acquired the organism through fecal-oral contamination. Factors such as contaminated food and water supplies, day care centers, increased international travel, pets, carriers such as mosquitoes and fleas, and sexual transmission have contributed to an increased prevalence of intestinal parasites. It is estimated that close to one billion people worldwide are infected. Damage to the host includes parasitic burden, migration, blockage and pressure. Immunologic inflammation, hypersensitivity reactions and cytotoxicity also play a large role in the morbidity of these diseases. The infective dose often relates to severity of the disease and repeat encounters can be additive. No Ova or Parasites Sample 2 No Ova or Parasites There are two main classes of intestinal parasites that can cause human intestinal disease. They include protozoa and helminths. The protozoa typically have two stages; the trophozoite stage that is the metabolically active, invasive stage and the cyst stage, which is the vegetative inactive form resistant to unfavorable environmental conditions outside the human host. Helminths are large, multicellular organisms that are generally visible to the naked eye in their adult stages. Like protozoa, helminths can be either free-living or parasitic in nature. In their adult form, helminths cannot multiply in humans. In general, acute manifestations of parasitic infection may involve diarrhea with or without mucus and or blood, fever, nausea, or abdominal pain. However these symptoms do not always occur. Consequently, parasitic infections may not be diagnosed or eradicated. If left untreated, chronic parasitic infections can cause damage to the intestinal lining and can be an unsuspected cause of illness and fatigue. Chronic parasitic infections can also be associated with increased intestinal permeability, irritable bowel syndrome, irregular bowel movements, malabsorption, gastritis or indigestion, skin disorders, joint pain, allergic reactions, and decreased immune function. Sample 3 No Ova or Parasites In some instances, parasites may enter the circulation and travel to various organs causing severe organ diseases such as liver abscesses and cysticercosis. In addition, some larval migration can cause pneumonia and in rare cases hyper infection syndrome with large numbers of larvae being produced and found in every tissue of the body. *A trichrome stain and concentrated iodine wet mount slide is read for each sample submitted. GIARDIA/CRYPTOSPORIDIUM IMMUNOASSAY Within Outside Reference Range Giardia lamblia Pos range Cryptosporidium Pos range Comments: Date Collected: Date Received: Date Completed: 0001706 30 Giardia lamblia is flagellated protozoan that infects the small intestine and is passed in stool and spread by the fecal-oral route. Waterborne transmission is the major source of giardiasis. Cryptosporidium is a coccidian protozoa that can be spread from direct person-to-person contact or waterborne transmission. v5.09 LAB #: PATIENT: ID: SEX: AGE: CLIENT #: DOCTOR: Complete Digestive Stool Analysis DIGESTION /ABSORPTION Within Outside Reference Range Elastase 226 >300 Fat Stain High range Muscle fibers Few range Vegetable fibers None range Carbohydrates Few range INFLAMMATION Within Lysozyme* Outside 732 Reference Range <600 ng/mL Lactoferrin 54 <60 µg/mL White Blood Cells None None-few Mucus None None-few IMMUNOLOGY Within Secretory IgA* Outside 383 Reference Range 50-250 mg/dL Elastase findings can be used for the diagnosis or the exclusion of exocrine pancreatic insufficiency. Correlations between low levels and chronic pancreatitis and cancer have been reported. Fat Stain: Microscopic determination of fecal fat using Sudan IV staining is a qualitative procedure utilized to assess fat absorption and to detect steatorrhea. Muscle fibers in the stool are an indicator of incomplete digestion. Bloating, flatulence, feelings of “fullness” may be associated with increase in muscle fibers. Vegetable fibers in the stool may be indicative of inadequate chewing, or eating “on the run”. Carbohydrates: The presence of reducing substances in stool specimens can indicate carbohydrate malabsorption. Lysozyme* is an enzyme secreted at the site of inflammation in the GI tract and elevated levels have been identified in IBD patients. Lactoferrin is a quantitative GI specific marker of inflammation used to diagnose and differentiate IBD from IBS and to monitor patient inflammation levels during active and remission phases of IBD. White Blood Cells (WBC): in the stool are an indication of an inflammatory process resulting in the infiltration of leukocytes within the intestinal lumen. WBCs are often accompanied by mucus and blood in the stool. Mucus in the stool may result from prolonged mucosal irritation or in a response to parasympathetic excitability such as spastic constipation or mucous colitis. Secretory IgA* (sIgA) is secreted by mucosal tissue and represents the first line of defense of the GI mucosa and is central to the normal function of the GI tract as an immune barrier. Elevated levels of sIgA have been associated with an upregulated immune response. Comments: Date Collected: Date Received: Date Completed: 0001563 31 v5.09 LAB #: PATIENT: ID: SEX: AGE: CLIENT #: DOCTOR: B acterial S us ceptibilities : Pseudomonas aeruginosa NATURAL ANTIBACTERIALS Disk Content 1mg Berberine 33mg Black Walnut 46mg Caprylic Acid 11mg Oregano 10mg Uva Ursi 25mg Citrus Seed Extract Low Activity High Activity .17mg Silver Natural antibacterial agents may be useful for treatment of patients when organisms display in-vitro sensitivity to these agents. The test is performed by using standardized techniques and filter paper disks impregnated with the listed agent. Relative activity is reported for each natural agent based upon the diameter of the zone of inhibition or no growth zone surrounding the disk. Data based on over 5000 individual observations were used to relate the zone size to the activity level of the agent. A scale of relative activity is defined for the natural agents tested. PRESCRIPTIVE AGENTS Resistant Intermediate Susceptible Amoxicillin-Clavulanic Acid S Ampicillin S Cefazolin R Ceftazidime S Ciprofloxacin S Trimeth-sulfa I Comments: Date Collected: Date Received: Date Completed: Susceptible results imply that an infection due to the bacteria may be appropriately treated when the recommended dosage of the tested antimicrobial agent is used. Intermediate results imply that response rates may be lower than for susceptible bacteria when the tested antimicrobial agent is used. Resistant results imply that the bacteria will not be inhibited by normal dosage levels of the tested antimicrobial agent. Natural antibacterial agent susceptibility testing is intended for research use only. Not for use in diagnostic procedures. v5.09 32 LAB #: PATIENT: ID: SEX: AGE: CLIENT #: DOCTOR: Y eas t S us ceptibilities : Candida albicans NATURAL ANTIFUNGALS Disk Content 1mg Berberine 46mg Caprylic Acid 10mg Uva Ursi Low Activity High Activity 2.5mg Tannic Acid 11mg Oregano 45mg Undecylenic Acid 25mg Citrus Seed Extract Natural antifungal agents may be useful for treatment of patients when organisms display in-vitro sensitivity to these agents. The test is performed by using standardized techniques and filter paper disks impregnated with the listed agent. Relative activity is reported for each natural agent based upon the diameter of the zone of inhibition or no growth zone surrounding the disk. Data based on over 5000 individual observations were used to relate the zone size to the activity level of the agent. A scale of relative activity is defined for the natural agents tested. NON-ABSORBED ANTIFUNGALS Low Activity High Activity Nystatin Non-absorbed antifungals may be useful for treatment of patients when organisms display in-vitro sensitivity to these agents. The test is performed using standardized commercially prepared disks impregnated with Nystatin. Relative activity is reported based upon the diameter of the zone of inhibition or no growth zone surrounding the disk. AZOLE ANTIFUNGALS Resistant Fluconazole S-DD Susceptible R Itraconazole S Ketoconazole S Susceptible results imply that an infection due to the fungus may be appropriately treated when the recommended dosage of the tested antifungal agent is used. Susceptible - Dose Dependent (S-DD) results imply that an infection due to the fungus may be treated when the highest recommended dosage of the tested antifungal agent is used. Resistant results imply that the fungus will not be inhibited by normal dosage levels of the tested antifungal agent. Standardized test interpretive categories established for Candida spp. are used for all yeast isolates. Comments: Date Collected: Date Received: Date Completed: Yeast antifungal susceptibility testing is intended for research use only. Not for use in diagnostic procedures. v5.09 0001710 33 Complete Cardio Profile with Ox LDL 6100 Why Test For A Complete Cardio and Metabolic Profile? OXIDIZED LDL PREDICTS THE PROGRESSION OF HEART DISEASE AND PLAQUE FORMATION IN THE ARTERIES. Research from JAMA (Journal of the American Medical Association) and Journal of Internal Medicine and Circulation confirm that we can finally predict the risk of heart disease, even if symptoms do not present themselves, and in patients with no previous history of heart disease. Oxidized LDL (OxLDL) also reveals our needs for heart healthy antioxidants such as CoQ10. High levels of oxidized LDL is a predictor of plaque formation in arteries, metabolic syndrome, diabetes, and heart disease. As the rate of obesity increases throughout the world, there is an alarming rate of insulin resistance and cardiovascular disease, even in children. Oxidized LDL has been shown to be a predictive marker for early signs of atherosclerosis in children, even as young as 6 years of age. One of the leading causes of morbidity and mortality in patients with rheumatoid arthritis (RA) is cardiovascular disease. As a result of the increased inflammation associated with RA, there are structural changes within lipoproteins that may potentiate cardiovascular disease. It was shown that increased levels of oxidized LDL was associated with both subclinical atherosclerosis and inflammatory variables. The same pattern of a high oxidized LDL is seen in depression. The state of lipids is a valuable biomarker in many conditions. Oxidized LDL is implicated in a number of pathologies, as many conditions can be thought of as lipid dysfunction. Unoxidized LDL is used to repair the myelin sheath of nerves, the brain and aid in healthy cellular membrane formation. Oxidized LDL impairs function in all these areas. Research associates high oxLDL with conditions like MS, depression and PCOS as well as heart disease. Oxidized LDL can either be measured by itself, or with a comprehensive cardiovascular profile that helps to assess overall disease risk. The comprehensive profile assesses lipids, metabolic markers, and cardiovascular markers related to nutritional health. 34 Complete Cardio Profile with Ox LDL 6100 Adiponectin is a peptide hormone comprising of 244 amino acids and is exclusively expressed in adipose tissue. Adiponectin is a potent insulin enhancer and is involved in glucose metabolism. The levels of adiponectin are decreased as obesity increases. Leptin is a protein that inhibits food intake and stimulates energy expenditure. Leptin works to turn on fat burning, and increases cellular metabolism. These molecules can be nutritionally influenced to help with weight metabolism, diabetes, and other conditions of metabolic disturbances. A recent review article in Nature explains that leptin leads to altered cellular metabolism and immune function enhancing carcinogenesis in estrogen responsive tissues such as breast and prostate. Leptin increases the activity of aromatase, increasing conversion of testosterone to estrogen. Leptin increases inflammation and can decrease regulatory T cells causing impaired peripheral immune tolerance. Leptin also increases angiogenesis in cancer cells. 35 Complete Cardio Profile with Ox LDL 6100 36 Complete Cardio Profile with Ox LDL 6100 37 Complete Cardio Profile with Ox LDL 6100 Adiponectin Patient Results 62.4 Reference Range 2.5-87.4 ng/mL 38 Initial Screen 7000 This initial screen is designed to ensure health in your patient. It allows you to screen for extreme conditions so that you treat patients who can be safely addressed and refer out those who need special services. In addition to monitoring for organ decline, there are a number of markers that will give nutritional information and are fundamental to integrative medicine and health. This profile includes: – A complete thyroid profile – Growth hormone which improves sleep, tissue health, and stamina – Vitamin D to improve cognitive function, bone health and cardiovascular health – RBC magnesium to aid thousands of metabolic reactions in the body every second – Liver markers such as ggt which let us know about oxidative stress and glutathione need – Uric acid as a warning sign of blood sugar dysregulation While many labs offer basic screening, others do not provide reports and references as to what this means from a pathologic standpoint as well as a nutritional standpoint. Also, our representation of reference ranges will not just show “high” and “low” but will show dysfunctional and optimal. This allows you to monitor and treat trends before they become a pathology. Basic Initial Screen Various break-out profiles can be ordered to monitor systems as needed. These include: – CBC – Chemistry Screen 39 Initial Screen 7000 40 Initial Screen 7000 41 Initial Screen 7000 42 Initial Screen 7000 43 Initial Screen 7000 44 Initial Screen 7000 45 Initial Screen 7000 46 Urine Amino Acids: Profile 8000 Why Test Urine Amino Acids? Amino acid analysis aids in the diagnosis of: dietary protein adequacy and amino acid balance, gastrointestinal dysfunctions, forms of protein intolerance, nutritional deficiencies (vitamins, minerals), renal and hepatic dysfunction, psychiatric abnormalities, susceptibility to inflammatory response and oxidative stress, reduced detoxification capacity, susceptibility to occlusive arterial disease and many inherent disorders in amino acid metabolism. Many individuals have “hidden” impairments in amino acid metabolism that are problematic and often go undiagnosed. These impairments may or may not be expressed as specific symptoms. They may silently increase susceptibility to a degenerative disease or they may be associated with, but not causative for, a disease. Because of the wealth of information provided, it is suggested that a complete amino acid analysis be performed whenever a thorough nutritional and metabolic workup is suggested. Amino acid analysis provides fundamental information about nutrient adequacy: the quality and quantity of dietary protein, digestive disorders, and vitamin and mineral deficiencies (particularly folic acid, B12 and B6 metabolism, zinc and magnesium). In addition, amino acid analysis provides important diagnostic information about hepatic and renal function, availability of precursors of neurotransmitters, detoxification capacity, susceptibility to occlusive arterial disease (homocysteine), and many inherent disorders in amino acid metabolism. The patient’s results are presented in a functional format that permits ease of interpretation. A comprehensive summary of “presumptive needs” (e.g. B6, B12/folate, Mg) and “implied conditions” (e.g. maldigestion/malabsorption, abnormal gastrointestinal flora, impaired detoxification, oxidative stress) is presented based upon each patient’s results. Patient specific amino acid supplement schedules and user- friendly commentary paragraphs are provided to simplify nutritional intervention. The patient’s results are presented in a functional format that permits ease of interpretation. A comprehensive summary of “presumptive needs” (e.g. B6, B12/folate, magnesium) and “implied conditions” (e.g. maldigestion/malabsorption, abnormal gastrointestinal flora, impaired detoxification, oxidative stress) is presented based upon each patient’s results. Patient specific amino acid supplement schedules and user- friendly commentary paragraphs are provided to simplify nutritional intervention. 47 LAB #: PATIENT: ID: SEX: AGE: Amino Acids ; Urine 24-‐hour Urine Amino CLIENT #: DOCTOR: Acids: Profile 8000 SPECIMEN VALIDITY RESULT per 24 hours Creatinine 3130 mg 24 Hour Volume 514 mL Glutamine/Glutamate 187 Ammonia Level (NH4) 8598 REFERENCE INTERVAL 16th 50th 84th 97.5th 84th 97.5th 84th 97.5th 800- 2800 600- 2500 5- µM PERCENTILE 2.5th 160 12000-65000 Specimen Validity Index ESSENTIAL / CONDIIONALLY INDISPENSABLE AMINO ACIDS RESULT µM/24 hours Methionine 9- 73 Lysine 659 Threonine 224 Leucine 67 Isoleucine 16 Valine REFERENCE INTERVAL 166 Tryptophan 128 Taurine 782 Cysteine 41 Argenine 13 Histidine 228 28- 130 18- 3 Phenylalanine 700 123025- 16th 2.5th 16th 50th 56 4580- PERCENTILE 2.5th 400 65 85 130 140 350- 1850 31- 90 10- 70 390- 1900 NONESSENTIAL AMINO ACIDS RESULT µM/24 hours Alanine Aspartate 712 120- 690 45- 260 6- 65 9- 39 Asparagine 168 Glutamine 431 Glutamate 14 Cystine REFERENCE INTERVAL 250- 8 Glycine 3117 Tyrosine 179 Serine 510 Proline 42 PERCENTILE 50th 42 950 32- 130 30- 188 1- 70 550- 3000 200- 710 Analyzed by ©DOCTOR’S DATA, INC. ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 CLIA ID NO: 14D0646470 MEDICARE PROVIDER NO: 148453 0001714 48 PATIENT: DOCTOR: LAB#: PAGE: Urine Amino Acids: Profile 8000 GASTROINTESTINAL MARKERS RESULT REFERENCE INTERVAL µM/24 hours Ammonia (NH4) 12000-65000 72000 Ethanolamine 572 Alpha-Aminoadipitate 134 Tryptophan 80- 400 25- 29 Taurine 600 8- 73 Threonine 125- th 2.5 PERCENTILE 16th 50th 90 140 68th < 47 Beta-aminoisobutyrate 87 Carnosine 72 Gamma-aminobutyrate 31 Hydroxyproline 27 95th 35 < 400 369 Anserine 97.5th 350- 1850 229 Beta-alanine 84th < 110 < 60 < 55 < 35 MAGNESIUM DEPENDANT MARKERS RESULT REFERENCE INTERVAL µM/24 hours Citrulline 1- 67 Ethanolamine 125- 550 Phosphoethanolamine 67 Phosphoserine Serine 243 Taurine 214 20- 100 200- 710 0.06- 0.37 40 600 th 2.5 PERCENTILE 16th 50th 97.5th 0.8 350- 1850 68th Methionine Sulfoxide 84th < 8.6 95th 10 B6, B12, & FOLATE DEPENDANT MARKERS RESULT REFERENCE INTERVAL µM/24 hours Serine 863 Alpha-aminoadipate 79 Cysteine 63 Cystathionine 41 1-Methylhistidine 112 3-Methylhistidine 27 Alpha-amino-N-butyrate 5 200- 710 31- 90 8- 9- 90 th 2.5 PERCENTILE 16th 65 80- 450 8- 90 60- 1500 < 400 379 Beta-alanine 33 Homocystine 6.7 Sarcosine < 35 < 50 < 41 0001714 84th 68th Beta-aminoisobutyrate 50th 49 8 95th 97.5th PATIENT: Urine Amino Acids: Profile 8000DOCTOR: LAB#: PAGE: DETOXIFICATION MARKERS RESULT REFERENCE INTERVAL µM/24 hours Methionine 9- 92 Cysteine 31- 82 Taurine 1642 Glutamine 389 Glycine 572 Aspartate 550- 3000 4.2 16th 50th 84th 97.5th th 16th 50th 84th 97.5th 90 1850 9- th 56 350- 250- 2.5 PERCENTILE 950 42 NEUROLOGICAL MARKERS RESULT REFERENCE INTERVAL µM/24 hours Ammonia (NH4) Glutamine 12000- 65000 87000 829 Phenylalanine 52 Tryptophan 37 Taurine 950 30- 188 350- 1850 25- 114 Cystathionine 250- 30- 76 Tyrosine 2.5 PERCENTILE 9- 5.1 120 140 65 68th Beta-alanine < 28 95th 35 UREA CYCLE METABOLITES RESULT per 24 hours Arginine 97 µM Aspartate 39 µM Citrulline 28 µM Ornithine 21 µM 214 mM 11000 µM Glutamine 198 µM Asparagine 33 µM Urea Ammonia (NH4) REFERENCE INTERVAL 10- 70 1- 40 180- 900 250- 950 9- 2- th 2.5 PERCENTILE 16th 50th 84th 97.5th 42 55 12000- 65000 45- 68th 95th 260 specimen data Comments: Date Collected: Date Received: Date Completed: Volume: Collection Period: colltype 50 NH Chem Analyzer 4, Urea by Automated Methodology: LC MS/MS v3 55 Dunwoody Labs, Inc. 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