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Digestive Function and Nutritional Reserve:

• Complex aggregates of cellular and foreign detritus may indicate an increase in intestinal permeability, i.e. Leaky Gut Syndrome (LGS).


• Increased level of bacteria observed in the blood serum (i.e. blood plasma - yellow liquid - with clotting factors removed) - perhaps suggests increased intestinal permeability (LGS).


• Central darkening of fibrin may indicate inadequate digestive capability, e.g. low stomach acid production, diminished pancreatic enzyme production, bacterial overgrowth of small intestine and/or dysbiosis.


• Diffuse deterioration of the fibrin net integrity in the first two drops of blood may indicate protein malnutrition or absorption, or a functional deficiency of oestrogen, testosterone or the growth hormone DHEA.


• Large red blood cells (Macrocytes) suggest possible Vitamin B12 or Folic Acid deficiency.


• An increase in nuclear segmentation of neutrophils (white blood cells) suggests a functional deficiency of folic acid.


• Small red blood cells (Microcytes) suggests a possible Iron deficiency.


• Scallop-shaped red blood cells suggests membrane changes and possible deficiencies of Omega-3 or Omega 6 Essential Fatty Acids (EFAs) or Carnitine.


• Early crenation or shrivelling of red blood cells may indicate the need for increased levels of antioxidants and glutathione.


• Peripheral dispersed outer edge of blood clot may indicate an increased functional need for additional Vitamin C and other anti-oxidants.


• Striae radiating form the centre of the clot may indicate inadequate functional levels of Magnesium, Calcium or other essential minerals, and a metabolic acidosis of the matrix space and biological terrain.


• Peripheral black ring present in the blood clots may suggest and increased risk of heavy metal toxicity and/or an overwhelmed detoxification capacity.


• The separation of denatured red blood cells away from the blood clot, forming a kind of 'chemical sensitivity halo' may indicate environmental or chemical hypersensitivity (e.g. Multiple Chemical Sensitivity (MCS).


• The localised breakdown of fibrin in a circular-linear pattern may indicate a functional thyroid imbalance.


• Pinpoints of soluble fibrin deposits, seen centrally, may suggest increased adrenal stress and a decreased adrenal adaptation to stress.

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Immune System Function and Reserve:

• White blood cell count either markedly increased or reduced - would recommend a full blood count test to investigate further.


• Neutrophil (type of white blood cell) motility (spontaneous motion) reduced may suggest a sluggish immune responsiveness and possible deficiency of either the amino acid Taurine and/or Vitamin A.


• Lymphocyte (type of white blood cell) activation observed - may indicate chronic viral infection and ongoing antiviral immune system activation.


• Increased levels of bacteria observed in blood serum - occult infections should be excluded, e.g. Leaky Gut Syndrome (LGS), Dysbiosis, Dental Infections, Cystitis, Prostatitis and/or Upper Respiratory Tract Infection.


• Parasitic protozoa seen in the blood serum suggest an ongoing infection.


• Black 'bulges' in the blood clot sample may suggest an increased probability of parasitic infection.


• Fungal spores observed in the blood serum may suggest an ongoing infection of Candida and/or other yeast species.


• Fungal hyphae seen in the blood serum indicate a more aggressive form of Candida albicans overgrowth. A hypha (plural hyphae) is a long, branching filamentous cell of a fungus, and also of unrelated Actinobacteria.[1] In fungi, hyphae are the main mode of vegetative growth, and are collectively called a mycelium.


• Multiple soluble fibrin deposits observed peripherally may suggest an ongoing immune system activation.


• Liver spicules observedin the blood plasma may indicate an increased detoxification burden (overloaded liver) or impaired liver function. Spicules are skeletal structures that occur in most sponges. They provide structural support and deter predators.


• Spirochetes (spiralling bacteria) may indicate dental, gum and/or periodontal infection (supporting structures of teeth) - a visit to the dentist is recommended!

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Saliva, Blood, Urine and Stool Tests:

Depending on how you initially respond to treatment and the details of your case history, you may well require additional tests. Additional tests can include some of these listed below. Like or related tests have been grouped together where possible.

Amino Acid and Organic Acid Tests:



• Bloodspot Amino Acid Assay [Metametrix]
  
  The Bloodspot Amino Acid Assay is available for 11 or 20 amino acids, and is a blood test using a blood spot sample taken from the finger. The 11 test includes: Arginine, Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Taurine, Threonine, Tryptophan and Valine. A 30 day amino acid powder supplementation recommendation is also provided with the test results, containing relative proportions and amounts of a variety of amino acids, amino precursors and B-vitamins. Click here for more information about the blood spot, blood plasma and urine tests for amino acid analysis.



• Amino Acid Analysis Profile [Genova Diagnostics]
  
  This is a urine test examining amino acid conversion capability (including Homocysteine levels and implied methylation capability - subject to reagent availability - check with Genova Diagnostics) - to determine the essential amino acid levels critical for synthesis of enzymes, homrones, neurotransmitters, stomach acid, muscle, bone etc.; maldigestion and malabsorption of proteins; the nitrogen balance in the body; kidney function; adequate detoxification of excess nitrogen; function deficiencies of essential minerals, vitamins and co-factors (e.g. B-Vitamins such as B12, Folic Acid, P5P, and reserve of Antioxidants such as A, C and E) and mineral deficiencies (e.g. Magnesium).
  
  An information sheet on this test can be viewed by clicking here. A sample report can be viewed by clicking here. Interpretation guidelines can be viewed by clicking here.
  
  This test is also available in combination with the Metabolic Analysis Profile below in a test called Optimal Nutrition Evaluation. A complete analyte list can be seen from this page. Click here to read a sample report.
  
  Quoting from the ONE test report:
  
  'Analytes characteristic of cellular energy and mitochondrial function:
  These markers are metabolites from four important biochemical pathways in the body, all of which significantly impact the production and availability of energy at the cellular levl: glycoloysis, the citric acid acid (Krebs cycle) and both beta-oxidation and omega-oxidation of fatty acids. These analytes provide unique insight into macronutrient catabolism, and mitochondrial function in cells. Abnormal levels may be associated with fatigue, malaise, myalgia, headache, muscle weakness, myopathy, hypotonia, or acid-based imbalance. This test is intended to be a diagnostic aid for acquired disorders in these pathways. It is not intended for diagnosis of inborn errors of organic acid metabolism, as this would require extensive molecular genetics testing. However significantly abnormal findings could be consistent with such inborn errors. If significant abnormalities persist after removal of toxics, supplementation of appropriate nutrients, dietary and hormonal adjustments, and correction of intestinal dysbiosis or infection, it is suggested that the patient be referred to a medical center with capabilities for diagnosis and treatment of congenital metabolic defects.
  
  Cofactor-Dependent and Metabolites from amino acid catabolism:
  These analytes are formed from essential and protein amino acids via amino group transfer or by other enzymatic transformations. Many are sensitive to vitamin functions as coenyzmes and to minerals as enzyme activators. Excesses or deficiencies may lead to various conditions depending upon the particular metabolic imbalance, including fatigue, headaches, myalgias, metabolic acidoses, dietary intolerances, neurological problems and cognitive disorders.'



• Metabolic Analysis Profile [Genova Diagnostics]
  
  Also known as an Organic Acids Profile. This is a urine test examining the organic acids involved in the Krebs Cycle , i.e. energy production (mitochondrial dysfunction) and hormonal production. It can measure whether nutrients are being catabolised to energy efficiently; if mitochondrial energy production is impaired or not; whether there is excessive oxidative stress in the body; if functional deficiencies of vitamins and minerals are present (as above); whether intestinal malabsorption is present; if there is an excess of bacterial or yeast growth in the gut (by their byproducts); if detoxification capacity is impaired; and whether critical neurotransmitters are being in sufficient quantities for the brain, gut and one's adrenal function.
  
  An information sheet on this test can be viewed by clicking here. A sample report can be viewed by clicking here. Interpretation guidelines can be viewed by clicking here.
  
  As mentioned above, the Metabolic Analysis Profile is also available in combination with the Amino Acid Analysis Profile in a test called Optimal Nutrition Evaluation (ONE).




Mitochondrial Function Tests:



• Metabolic Analysis Profile [Genova Diagnostics]
  
  [Repeated from above section]
  
  Also known as an Organic Acids Profile. This is a urine test examining the organic acids involved in the Krebs Cycle , i.e. energy production (mitochondrial dysfunction) and hormonal production. It can measure whether nutrients are being catabolised to energy efficiently; if mitochondrial energy production is impaired or not; whether there is excessive oxidative stress in the body; if functional deficiencies of vitamins and minerals are present (as above); whether intestinal malabsorption is present; if there is an excess of bacterial or yeast growth in the gut (by their byproducts); if detoxification capacity is impaired; and whether critical neurotransmitters are being in sufficient quantities for the brain, gut and one's adrenal function.
  
  An information sheet on this test can be viewed by clicking here. A sample report can be viewed by clicking here. Interpretation guidelines can be viewed by clicking here.
  
  As mentioned above, the Metabolic Analysis Profile is also available in combination with the Amino Acid Analysis Profile in a test called Optimal Nutrition Evaluation (ONE).
  
  Please note that this type of test does not actually provide any information about the state of the mitochondrial membranes, if any unwanted compounds or partial detoxification products or viruses are clogging them up, or provide any quantitative measurement of mitochondrial efficiency, which the two mitochondrial tests described below do.



• Mitochondrial Membrane - Translocator Protein (TL) Study [Acumen]
  
  This is a largely qualitative white cell blood test examining energy production capacity (mitochondrial dysfunction), to establish the numbers of mitochondria, clumping, membrane structure, binding, pH and Calcium levels at the outer membrane, essential elements associated with mitochondrial function (K, Mg, Zn) and the presence of unwanted substances that can interfere with mitochondrial function (e.g. heavy metals, PCBs, toxic organic compounds and partial detoxification products like glutathione conjugates and peptide complexes (e.g. the body's detoxification molecule bondeds with a toxic organic chemical compound or a drug like antiobiotics) - these latter substances contribute to a condition known as Neurotoxic Membrane Syndrome. Although a membrane test, it is really concerned with toxin accumulation and measurement.
  
  Blood samples should ideally be analysed within 4 hours of collection, as the test is concerned with live blood cells. However, many doctors deem that the test result is ok as long as it is performed within a maximum of 72 hours after collection. This test includes Phase-contrast and dark field microscopy, and explores the mitochondrial membrane and the TL site using a series of specific and group-specific fluorescence probes.
  
  Parameters examined include: essential elements associated with mt-membranes (K, Mg, Zn), pH at the outer mitochondrial membrane, Ca2+ at the outer mitochondrial membrane, mitochondrial membrane binding of proteins, lipids, esterases and other substances bound. Other substances bound include detection of:
  
  
  • Glutathione conjugates
  
  
  • Organic Sulphate conjugates
  
  
  • Peptide complexes
  
  
  • Lactic acid & keto-acids
  
  
  • malondialdehyde - a naturally occurring lipid peroxidation product - whose levels may be elevated in those individuals with significant (endogenous) free radical damage of the mitochondrial (mainly phospholipid-based) membranes.
  
  
  • Chlorinated pesticides
  
  
  • Pentachlorphenol (PCP)
  
  
  • Polychlorinated Biphenyls (PCBs)
  
  
  • Polybrominated Biphenyls (PBBs)
  
  
  • Dichlorobenzene
  
  
  • Organophosphates (inc. OP pesticides)
  
  
  • Toxic metals
  
  
  • DNA/RNA (probably of viral origin)
  
  
  • Others
  
  
  Info: Translocator Protein (TL) scavenges ADP from the cytoplasm and returns ATP from re-conversion with 'new' ATP from oxidative phosphorylation. TL can be blocked by zenobiotics and/or partial detoxification products. The site is also extremely pH sensitive and can be affected by local or general acidosis, including the organic acid accumulation from over-dependence on anaerobic metabolism. the efficiency of TL can also be compromised by increased intracellular Calcium or reduced intracellular Magnesium.
  
  Any unidentified compounds (e.g. glutathione conjugates of a drug or chemical, or other) which are detected in the above test can be further isolated and identified with an additional procedure. This technique uses ATR (attenuated total reflection) Fourier Transform InfraRed spectral analysis using, for example, a Thermo Avatar Nicolet 330/370 Fourier Transform Infrared Spectrometer with horizontal ATR. An absorbance vs wavelength chart for each compound provides a unique spectroscopy graph (a signature) which can be used to correctly identify the compound on the mitochondrial membrane.
  
  Please note that mitochondrial function tests based on organic acid profiles (in the urine for example) provide no information on the state of the mitochondrial membranes and indeed if they are congested or not, and what with. One's organic 'Krebs' cycle acids may appear 'normal' but mitochondrial function may be significantly impaired (e.g. ADP to ATP recovery). Of course this TL Study does not provide any information on which parts of the Krebs cycle and associated cofactors are deficient or a bottleneck, unlike organic acid based mitochondrial profiles, which actually examine these parameters.



• ATP Profile [Acumen]
  
  This is a quantitative blood test measuring energy production (mitochondrial dyfunction). Includes ATP (Adenosine Triphosphate) studies on neutrophils (ATP of whole cells - with excess Mg added; with endogenous Mg only (readings in nmol/million cells); and the ATP/ATP(Mg) ratio. The test also includes ADP to ATP conversion efficiency (whole cells) - including ATP(Mg) as before, ATP(Mg) - inhibitor present, and ATP(Mg) - inhibitor removed; and ADP to ATP efficiency. Finally it includes ADP-ATP Translocator (TL) (mitochondria, not whole cells) including TL 'out' and TL 'in' (in ATP pmol/million cells). A paper regarding this test, research study data (from January 2009) and a sample report can be found in the PDF document here. Please note that mitochondrial function tests based on organic acid profiles (in the urine for example) may not always provide an indication of how well or poorly mitochondrial function is actually performing, as this test can. One's organic 'Krebs' cycle acids may appear 'normal' but mitochondrial function may be significantly impaired (e.g. ADP to ATP recovery). Of course the ATP profile does not provide any information on which parts of the Krebs cycle and associated cofactors are deficient or a bottleneck, unlike organic acid based mitochondrial profiles, which actually examine these parameters.



• Superoxide Dismutase (SOD) Studies [Acumen]
  
  This is a quantitative test to estbaablish the levels of various forms of SOD, the body's most important antioxidant that is involved in cellular respiration, in the Red Blood Cells (RBCs). It examines the in-vitro efficiency of the patient's different forms of RBC SOD when the neutrophil superoxide (a powerful oxidising agent and byproduct of respiration) production is maximally stimulated. As discussed on the Nutritional Deficiencies page, general cell protection from damage by superoxide is provided by intracellular Zinc:Copper SOD (Zn/Cu-SOD). Mitochondria are protected by manganese-dependent SOD (Mn-SOD). Extracellular SOD (EC-SOD - another type of Zn/Cu SODase) protects the nitric oxide pathways that relax vascular smoother muscle tissue. For each form of SOD, genetic variations are known, and mutations and polymorphisms can occur during excessive oxidative stress placed on the DNA. DNA adducts can chemically block these genes however.



• Methylation Panel - Red Blood Cell (RBC) and Blood Plasma [Breakspear Medical Group]
  
  These are two separate blood tests, often performed together, to determine the levels of key amino acids in the blood plasma, levels of sulphate, B-vitamins associated with energy production, TMG, enzymes associated with energy production and antioxidant protection (respiration), levels of Folic acid and Thiamin derivatives and also remnants of ATP/ADP/AMP in the blood. These profiles are therefore concerned with methylation and to some extentmitochondrial function.
  
  The RBC test measures the levels of cellular enzymes including:
  
  
  • Glutamate oxaloacetate transaminase (GOT)
  • Glutathione peroxidase (GP)
  • Glutathione reductase (GR)
  • Superoxide dismutase (SOD)
  • Catalase

The Plasma test measures the following plasma levels of:

• Amino Acids - Serine, Taurine, Glycine, Methionine, Cystathionine, Cysteine.


• Sulphate - Total Sulphate (serum/plasma), Free Sulphate (Serum/Plasma).


• Folic Acid Derivatives - 5-Methyl-THF (5MTHF), 10-Formyl-THF (10-FTHF), 5-Formyl-THF (5-FTHF), THF.


• Active Vitamin B2 derivaties - FMN in plasma, FAD in plasma.


• Active Vitamin B3 - NADPH


• Homocysteine Factors - Total Homocysteine, Trimethyl glycine (TMG), Dimethyl glycine (DMG)




Hormone and Neurotransmitter Tests:



• NeuroEndocrine Expanded Profile [NeuroScience]
  
  This test uses a urine sample to assess the levels of a variety of Neurotransmitters, Amino Acids and Hormones, including Estradiol, Estrone, Progesterone, Testosterone, Dihydrotestosterone, DHEA, Cortisol x4, Epinephrine, Norepinephrine, Dopamine, DOPAC, Serotonin, 5-HIAA, Glycine, Taurine, GABA, Glutamate, PEA, Histamine, Creatinine. Test information can be found here.



• Analysis of Brain Chemistry (Comprehensive) [Neurolab]
  
  This is a quantitative urine test to establish the relative levels of the neurotransmitters, the levels of neurotransmitter metabolites, levels of neurotransmitter precursors, additional neuroactive substances and neurotoxins and false neurotransmitters. The neurotransmitters measured include Adrenaline (A), Noradrenaline (NA), Dopamine (DA), Serotonin (5-HT), Gamma-Amminobutyric Acid (GABA) and Acetylcholine. The neurotransmitter metabolites are the products of neurotransmitter utilisation, i.e. their deactivation. The patterns of the respective metabolites therefore provide us with information about the activities of these neurotransmitters. Neurotransmitter precursors are the compounds from which the body manufacturers the neurotransmitters, either directly or indirectly. Various neuroactive substances are also evaluated as they are involved in different aspects of nervous system functioning. Finally, the harmful effects of various substances, i.e. neurotoxins and substances which mimmick the effects of neurotransmitters, are taken into consideration as a possible explanation as to why certain neurotransmitters are outside their reference range.



• Adrenocortex Stress Profile [Genova Diagnostics]
  
  This is a saliva test to measure the levels of the DHEA growth hormone and Cortisol adrenal stress hormone. Further information about the test can be reviewed by clicking here. An Interpretation Guide can be viewed by clicking here. A sample report can be viewed by clicking here.



• Complete Male Hormones [Genova Diagnostics]
  
  This test uses a urine sample to analyze key adrenal and androgen steroid hormones, providing a broad overview of hormone balance. Click here for further information. Click here for a sample report. Click here for the Interpretation Guide (of the old test). A Complete Hormones test is also available for female hormones, amongst numerous other urinary hormone tests.



• Comprehensive Thyroid Assessment [Genova Diagnostics]
  
  This test analyzes blood serum levels of TSH, free T4, free T3, reverse T3, anti-TG antibodies, and anti-TPO antibodies to assess central and peripheral thyroid function, as well as thyroid auto-immunity. For further information, click here. For a sample report, click here.




Liver Function Tests:



• Hepatic Detox Profile [Doctor's Data]
  
  This urine test is designed to establish liver health and liver function, and how the liver is handling exposure to (toxic) chemicals.



• Functional Liver Detoxification Profile [ARL Pathology]
  
  The FLDP is a serum blood test that measures the enzymatic detoxification capability of the liver. Further information can be see here. A sample report can be seen by clicking here.



• Short-Chain Fatty Acids (SCFAs) in Blood Plasma [Acumen]
  
  This quantitative blood test is a measure of the Acetate, Propionate and Butyrate - Short-Chain Fatty Acids (SCFAs) - in blood plasma. SCFAs are produced in the colon by the bacterial fermentation of dietary fibre, which helps to keep down the stool pH to suppress dysbiotic and pathogenic microogranism overgrowth.
  
  However, greatly elevated levels of these SCFAs is an indicator of Fructose Malabsorption. Unabsorbed fructose osmotically reduces the absorption of water and is metabolised by the normal colonic bacteria to SCFAs and the gases Hydrogen, Carbon Dioxide and Methoane. These SCFAs and gases are absorbed into the bloodstream, and thus elevated SCFA levels can be observed in the blood plasma.
  
  The reverse pattern is observed in the case of Hereditary Fructose Intolerance (HFI) and other genetic liver enzyme deficiencies of the Fructose metabolic pathway. HFI is a genetic condition whereby a liver enzyme deficiency prevents normal fructose metabolism and gluconeogenesis occurring in the liver. Inhibition of gluconeogenesis results in lactic acidosis as the cells underogo anaerobic respiration in the absence of glucose (i.e. Hypoglycaemia). The liver may try to compensate by producing glucose from the SCFAs Acetate, Propionate and Butyrate that are produced by the bacterial fermentation of dietary fibre. Rapid depletion of SCFAs in blood plasma is associated with HFI and can be detected with this blood test.
  
  The SCFA blood sample is taken 3 hours after food was last consumed. The Fructose-6-Phosphate test is usually performed in parallel to see if excessive Fructose intake is implicated in any way.



• Uric Acid in Blood Plasma [Breakspear Medical Group]
  
  This is a quantitative blood test to measure the Uric acid levels in the blood plasma, as an indicator of Hereditary Fructose Intolerance (HFI). Please see the Food Allergy page for more information.



• Lymphocyte Proliferation Test for Fructose [Breakspear Medical Group]
  
  This is a qualitative blood test to measure the ratio of white blood cell (lymphocyte) growth on a low glucose medium compared to that on a low glucose/high fructose medium. Values below the reference for low glucose only reflect a metabolic intolerance to excess fructose. Please see the Food Allergy page for more information.



Toxicity Tests:



• Porphyrins [Laboratoire Philippe Auguste]
  
  This is a quantitative urine test for the levels of the different Urinary Porphyrin. Porphyrins are intermediary compounds in the production of Heme, and the respective enzymes involved with converting one form of Porphyrin to another are particularly sensitive to the presence of heavy metals or certain organic chemical toxins. Presence of these foreign toxins can inhibit the enzymes involved in these intemediary steps, thereby resulting in elevated levels of these intermediary products in the urine; and consequently too little Heme being produced. As this pathway is particularly sensitive to toxicity, it is a particularly good indicator of toxicity. In other words, the Urinary Porphyrins can provide us with information about the extent of heavy metal toxicity in the body and the extent to which it is interfering with normal bodily biochemical processes. It thus differs from a urine test or blood test for heavy metal levels as it provides us with direct information about the problems the current heavy metal levels are causing in the body, which is arguably what is really important.
  
  The levels of the following Porphyrins are measured.
  
  
  • Uroporphyrins I & III (a.k.a. uP)
  
  
  • Heptacarboxyporphyrin (a.k.a. 7-Carboxyporphyrin or 7cxP)
  
  
  • Hexacarboxyporphyrin (a.k.a. 6-Carboxyporphyrin or 6cxP)
  
  
  • Pentacarboxyporphyrin (a.k.a. 5-Carboxyporphyrin or 5cxP)
  
  
  • Precoproporphyrin (a.k.a. PrCP)
  
  
  • Coproporphyrins I & III (a.k.a. cP)

  The absolute levels and also the relative ratios of the different Porphyrins in the urine can provide us with information about what kind of heavy metal is causing the problem in the Heme biosynthesis pathway, and thus assist in the determination of chelation strategy.
  
  Interpretive examples of the absolute values are listed below.
  
  
  • High uP = Aluminium (Al) Toxicity
  
  
  • High uP and 7cxP = Arsenic (As) Toxicity and toxicity from certain organic chemicals such as Polychlorinated Biphenyl (PCB)
  
  
  • High 5cxP, PrCP and cP = Mercury (Hg) Toxicity
  
  
  • High cP = Lead (Pb) Toxicity

  Interpretive examples of the relative ratios are listed below.
  
  
  • High PrcP/uP = Mercury Toxicity
  
  
  • High (5cP+PrCP)/(uP+7cxP) = Mercury Toxicity
  
  
  • High cP/uP = Lead Toxicity
  
  
  • Low cP/uP = Xenobiotics Toxicity

  Please see the Heavy Metal Toxicity section on the Effects of Toxicity page for more information about the role of Porphyrins and Heme.
  
  This Porphyrins test can be performed in isolation or in a combined test entitled 'Autism Panel' which also includes tests for urinary markers for cellular immuno-inflammation, DNA and RNA oxidative damage and lipid membrane oxidative damage.
  
  The Metametrix laboratory in the USA also offers a similar Porphyrins profile.



• Toxic Elements in Urine Scan [Biolab]
  
  This is a quantative urine test for establishing levels of toxic elements (toxic/unsafe at all levels) and some nutritional and trace elements that are toxic at high levels. This may be performed either by collecting a 'typical' set of urine samples over a 24 hour period (i.e. a measure of the metals that are present in the blood), or the method described below (provoked metals) which is better.



• The Provoked Urine Metals Test [Doctor's Data]
  
  This quantitative urine test is perhaps more reflective of the toxic metals that are present in the tissues. The test is also known as the Oral DMSA Challenge Test (pre & post). It works on the basis of comparing heavy metal urine levels, with and without a significant dose of a synthetic chelating agent (e.g. Thorne Research Captomer (DMSA)), to indirectly infer what the body's current heavy metal burden is. The chelating agent encourages the release of heavy metals from the tissues, fat cells and cell membranes, and measuring the levels of heavy metals in the urine, above the individual's 'normal' or 'expected' levels.
  
  On the day of the test, one fasts for the first few hours. One collects the first urine of the day (which is representative of the level of heavy metals without any 'provocation or chelation', and then one takes a 'standard' provocation dose of DMSA (or DMPS) for one's weight (essentially one's calculated daily dosage but consumed all in one go rather than split up during the day into smaller doses as one would normally do when doing a chelation programme).
  
  After taking the chelating agent, one collects one's urine for the next 6 hours, taking a sample of that 6 hour urine at the end (noting the total volume collected). This second sample is thus representative of the 'provoked' level of heavy metals excreted from the body in one's urine and their rate of excretion from the body's tissues given a fixed amount of DMSA input; and it is an indirect measurement of the amount of specific heavy metals in the body's tissues that are released into the blood by DMSA.
  
  The picture is quite complicated, because some tissue compartments release heavy metal toxins slower than others, even in the presence of a chelating agent, and some tissue compartments may be not accessible by certain types of chelating agent (i.e. DMSA cannot cross the blood-brain barrier to release heavy metals from the brain tissue, which is why it is used in conjunction with Lipoic Acid). The test is therefore measuring heavy metal release from the tissues in the body except for the brain.
  
  In addition, the provoked urine graph profile is dependent on the chelating abilities of the chelating agent with each heavy metal being measured in the urine. That is to say, DMSA is a better chelating of Mercury than say Lead, although it is still a good chelator of Lead. Thus if concentrations of these two heavy metals in the readily chelated and accessible tissue compartments are roughly the same, the actual concentrations observed in the urine (i.e. removed from the body by the chelating agent) may not be exactly equivalent. The test therefore requires a little interpretation. It is a useful guide, but one must take into account the properties of the exact provoking chelating agent in question.
  
  It should be noted that for those that have very high lymphocyte sensitivities to certain heavy metals, or have a huge amount in their system, a 'standard' dosage for their weight of the chelating agent may well be way too much, and may result in their becoming ill for a few days, in which case there is way more 'provocation' than is actually required. Anyone who has experience of chelation will know that the dosages can vary by 60x, according to how much chelation one has performed, and in some cases, by 1000x. There is not really such a thing as a universal comfortable standard dosage in chelation. The sensitivity to the dosage will depend on the individual of course. It is likely that one will feel slightly tired afterwards, as one is taking a full day's dosage in one go, and also going without food for a couple of hours too, so one's blood sugar levels may be low.
  
  Please see the Detoxification page for more information.
  
  A list of heavy metals tested for is detailed below.
  
  
  • Aluminium
  • Antimony
  • Arsenic
  • Beryllium
  • Bismuth
  • Cadmium
  • Lead
  • Mercury
  • Nickel
  • Platinum
  • Thallium
  • Thorium
  • Tin
  • Tungsten
  • Uranium

  Click here for a sample report.



• Screen for Pesticides and Related Substances in Fat Cells [Acumen]
  
  This quantitative test is a test for various forms of toxins, principally pesticides and other organic toxins, in the adipose tissue or fat cells, which store and hold the fat deposits in the fatty areas of the body. It is essentially a fat biopsy, but because such a small sample is required, it can be extracted with a syringe, usually in the buttock area and does not leave scarring. The following substances are tested for.
  
  
  • Organochlorine group - including Aldrin, Dieldrin, Toxaphenek DDT, DE, DDD and HCB.
  
  
  • Lindane - a.k.a. Gamma-HexaChloroCycloHexane (gamma-HCH), gammaxene or Gammalin (not included in above Organochlorine group) and other isomers of Benzene Hydrochloride (BHC).
  
  
  • Chlorinated Phenols group - penta- and tri-chlorophenols with other chlorophenols if present.
  
  
  • Chlorinated Benzenes - para-dichlorobenzene is the most commonly used.
  
  
  • PolyChlorinated Biphenyls (PCBs) - banned in 'open' use but still used in 'enclosed applications'.
  
  
  • Polybrominated Biphenyls (PBBs) - found in flame retardant plastics, textiles and foams.
  
  
  • Carbamates group, inc. Bendiocarb and Carbaryl.
  
  
  • Naphthols group - including Alpha-Naphthol (Carbaryl metabolite).
  
  
  • Organophosphate group
  
  
  • Organo-metal complex - usually methyl or ethyl complexes of heavy metals

  
  
• DNA Adducts (genomic DNA from Leucocytes) [Acumen]
  
  This qualitative test examines the DNA of White Blood Cells (WBCs, a.k.a. Leucocytes) and looks for the presence of organic toxin compounds attached to specific genes; and indeed their general concentration in the blood (from their representation in WBCs. It also measures the levels of DNA-associated Zinc, and whether this is within the normal reference ranges, or whether it has been displaced.
  
  The Genomic DNA from Leucoctyes is analysed using gas-liquid chromatography to detect for the group-presence of organic chemicals. It is also analysed using atomic emission to detect for the presence of toxic metals. Specific adducts are measured using a variety of techniques. Any abnormal proteins are selectively precipitated out, where possible, for further investigation by immuno-assay procedures and polarisation microscopy. If possible, the location of the adducted (added/attached) chemical on the DNA protein molecule, which may tell us whether it is associated with a specific gene or control factor.
  
  Al types of adducts are detected and identified. Some of the most 'commonly' occurring adducts that are found with this test (in a variety of patient profiles) are listed below.
  
  Organic Chemicals or Groups Adducts include:
  
  
  • Amines - general
  • Diamino componds
  • Diazo compounds
  • Nitrosamines
  • Pentachlorophenol (PCP) and other fungicide-type Chlorinated Phenols
  • Bacteriocide-type Chlorinated Phenols
  • Para-Dichlorobenzene
  • Other Halogenated Benzene compounds
  • Vinyl halide
  • Acrylamide
  • Malondiadehyde (lipid peroxidation product)
  • Other Aldehydes
  • Aflatoxin / Mitotoxins
  • Lindane (and other BHCs)
  • Toxaphene
  • Other Organochlorine compounds
  • Tetrachlorvinphos
  • Other Organophosphates
  • Organophosphate metabolites
  • Phthalates
  • Abnormal proteins
  • Abnormal peptides

  Toxic Metal Adducts include:
  
  
  • Aluminium
  • Antimony
  • Arsenic
  • Barium
  • Cadmium
  • Chromium
  • Cobalt
  • Copper
  • Lead
  • Manganese
  • Mercury
  • Nickel
  • Platinum
  • Rhodium
  • Silver
  • Strontium
  • Thallium
  • Tin
  • Titanium

  
  
• Mitochondrial Membrane - Translocator Protein (TL) Study [Acumen]
  
  This is strictly speaking a chiefly quantitative mitochondrial function blood test, but it also defines any chemical compounds (i.e. most likely toxins) present on the white cell mitochondrial membranes, clogged them up, which may impact mitochondrial function and hence cellular energy availability. The chemicals present at TL sites are specified and measured qualitatively. For more information on this test, please see the Amino Acid and Mitochondrial Function Tests section above.



• MELISA test [MELISA]
  
  The MELISA test is a qualitative white cell blood test to test for heavy metal sensitivity (only present available at one laboratory in Belgium, samples are posted to the laboratory for testing). White blood cells (lymphocytes) from whole blood are isolated and tested against allergens chosen accordingly to the patient's anamnesis, dental and occupational history. The blood is incubated for five days and the lymphocyte reaction is measured by two separate technologies: one based on the uptake of radioisotope by dividing lymphocytes; the other by evaluation by microscopy. The level of reactivity is measured as a Stimulation Index (SI). A value over 3 indicates a positive reaction to a given allergen. The results are presented with a graph. More information can be found be clicking here. Some doctors consider this test a little 'over the top' when other heavy metal tests are available, although it is still a very good test.



• Lymphocyte Chemical Sensitivity - Electrical Sensitivity [Acumen]
  
  This is a quantitative white blood cell blood test to test for heavy metal and organic toxin sensitivity in the immune system. It is a type of Lymphocyte Proliferation Test (LPT). Parameters include Metabisulphite, Salicylate, Benzoate, Formaldehyde, Petrol exhaust fumes, Natural Gas, Nickel, Titanium, Mercury (Inorganic), Mercury (Organic), Diamino compounds and Pentachlorophenol. When sensitized lymphocytes are exposed to a small amounts of an 'allergen', one of the responses includes the rapid passage of Calcium into the cells. This loss of cellular integrity and subsequent influx of Calcium can result in Calcium attaching to the proteins in the cell, leaving insoluble Calcium deposits, and leading to consequent cell death. Rapid absorption of Calcium into the Lymphocytes under test is measured quantitatively using a Calcium-sensitive fluorescent probe pre-loaded into the lymphocytes. A number of lymphocytes are measured in this way. The effect of the 'allergen' is also noted when the lymphocyte is exposed to an AC electrical field, which tends to amplify the effect in particularly sensitive individuals. Any result over 100 nmol/l of Calcium in the lymphocyte for a particular parameter is deemed to be a sign of lymphocyte sensitivity to that parameter. A result indicating a lymphocyte sensitivity/allergy to a particular parameter may also indicate a possible historical or present elevated level of that toxin in the body. Either way, if the lymphocytes are sensitive to a particular toxin, then the body will react very badly to its presence even if levels are much lower than for the next individual who does not have a problem with that toxin - although no levels of such toxins in the body are of course preferable. In other words, the test may highlight that certain levels are too much for you, rather than absolute statements of 'high' or 'low' levels of such toxins and their physiological impact on the body. This test is broadly similar to the MELISA test, but it is quantitative rather than qualitative, although the range of metals tested is perhaps somewhat wider in the MELISA test.



• Visual Contrast Sensitivity (VCS) Test [Stereo Optical Co. Inc.]
  
  This is a qualitative test to establish lipid status (and potentially Neurotoxic Membrane Syndrome). This is a test that can be done yourself at home. This test is recommended by Ian Solley, although BlackSpy has no experience of it and cannot comment as to its effectiveness or acceptance in the medical community. It was formerly marketed by E-Lyte, but is now handled by Stereo Optical Co. Inc.




Oxidative Stress and Damage Tests:



• 8-Oxo-2-Deoxyguanosine & 8-Oxo-Guanosine [Laboratoire Philippe Auguste]
  
  8-Oxo-2-Deoxyguanosine (a.k.a. 8-OHdG) is a DNA oxidative damage marker, a byproduct of the oxidation of DNA by free radicals or Reactive Oxidative Species (ROS).
  
  8-Oxo-Guanosine (a.k.a. 8-OHG) is a cytoplasmic RNA oxidative damage marker, a byproduct of the oxidation of RNA by free radicals or Reactive Oxidative Species (ROS).
  
  Cellular concentrations of both of these compounds are a direct measurement or indication of oxidative stress in the body as a whole. Oxidative stress may come from excessive free radical formation by the presence of heavy metals, or it may be related to excessive cellular immune activation response and inflammation (Neopterin production) or indeed from free radicals escaping damaged mitochondrial membranes, etc. Both of these DNA and RNA oxidative damage markers can be measured in this quantitative urine test by LPA in France. DNA damage is one of the key mechanisms in the ageing process and the development of cardio-vascular diseases and cancer. RNA oxidation is an early prominent feature of the main brain neurodegenerative diseases such as Alzheimer's Disease (AD), Parkinson's Disease (PD), Senile Dementia (SD), Amyotrophic Lateral Sclerosis (ALS) and Multiple System Atrophy (MSA).



• F2-Alpha Isoprostane [Laboratoire Philippe Auguste]
  
  F2-Alpha Isoprostane (a.k.a. 8-iso-PGF2 alpha) is a marker for oxidative damage of the lipid component of cell membranes. It is a downstream oxidation production of membrane oxidation. Isoprostanes as prostaglandin-like compounds created from the free radical attack of esterified of the Omega 6 Essential Fatty Acid (EFA) known as Arachidonic Acid (ARA) inside the membrane phospholipid. It is of course a very different molecule to a prostaglandin which is a lipid compound produced enyzmatically by the body using cyclooxygenase (Cox1-2) from EFAs and has nothing to do with free radical attack on cell membranes.
  
  Isoprostanes in general are valuable markers in clinical biology as they are found in all biological fluids and tissues and are stable in vivo and ex vivo. There are 10 times more isoprostanes in atherosclerotic plaque compared with normal vascular tissue. They are also only dependent on their production (in this case free radical attack) rather than metabolism or excretion without intraindividual variability. There are many studies validating Isoprostanes as the most accurate and reliable indicator of oxidative stress in vitro and in vivo.



• Mitochondrial Membrane - Translocator Protein (TL) Study [Acumen]
  
  This is strictly speaking a quantitative mitochondrial function blood test, but it also provides information on the general state of the mitochondrial membranes, in terms of any partial detoxification products or toxins attached to them, effectively reducing their permeability; and indeed if there are any signs of oxidised lipid byproducts attached to the mitochondrial membranes, such as the aldehyde derivatives, Malondialdehyde (MDA) and Crotonaldehyde. The presence of these latter compounds provides us with evidence of oxidative damage of the mitochondrial membrane lipids, and thus an oxidative stress problem. For more information on this test, please see the Amino Acid and Mitochondrial Function Tests section above.



• Metabolic Analysis Profile [Genova Diagnostics]
  
  Also known as an Organic Acids Profile. This is a urine test examining energy production (mitochondrial dysfunction) and hormonal production. It can measure whether nutrients are being catabolised to energy efficiently; if mitochondrial energy production is impaired or not; if functional deficiencies of vitamins and minerals are present (as above); whether intestinal malabsorption is present; if there is an excess of bacterial or yeast growth in the gut (by their byproducts); if detoxification capacity is impaired; whether critical neurotransmitters are being in sufficient quantities for the brain, gut and one's adrenal function; and also whether there is excessive oxidative stress in the body. It does not however provide us with any information about the nature of that oxidative stress and its origin.
  
  The Metabolic Analysis Profile is also available in combination with the Amino Acid Analysis Profile in a test called Optimal Nutrition Evaluation (ONE). The ONE also includes measurement of the amino acid Citrulline, an important marker in the evaulation of Nitric Oxide production (and Peroxynitrite formation).
  
  For more information on the Metabolic Analysis Profile and the ONE test, please see the Amino Acids and Mitochondrial Function Tests section above.




DNA and RNA Related Tests:



• DNA Adducts (genomic DNA from Leucocytes) [Acumen]
  
  This qualitative test examines the DNA of White Blood Cells (WBCs, a.k.a. Leucocytes) and looks for the presence of organic toxin compounds attached to specific genes; and indeed their general concentration in the blood (from their representation in WBCs. It also measures the levels of DNA-associated Zinc, and whether this is within the normal reference ranges, or whether it has been displaced.
  
  Please see the Toxicity Tests section above for more information.



• 8-Oxo-2-Deoxyguanosine & 8-Oxo-Guanosine [Laboratoire Philippe Auguste]
  
  [Repeated from Oxidative Stress and Damage Tests section above.]
  
  8-Oxo-2-Deoxyguanosine (a.k.a. 8-OHdG) is a DNA oxidative damage marker, a byproduct of the oxidation of DNA by free radicals or Reactive Oxidative Species (ROS).
  
  8-Oxo-Guanosine (a.k.a. 8-OHG) is a cytoplasmic RNA oxidative damage marker, a byproduct of the oxidation of RNA by free radicals or Reactive Oxidative Species (ROS).
  
  Cellular concentrations of both of these compounds are a direct measurement or indication of oxidative stress in the body as a whole. Oxidative stress may come from excessive free radical formation by the presence of heavy metals, or it may be related to excessive cellular immune activation response and inflammation (Neopterin production) or indeed from free radicals escaping damaged mitochondrial membranes, etc. Both of these DNA and RNA oxidative damage markers can be measured in this quantitative urine test by LPA in France. DNA damage is one of the key mechanisms in the ageing process and the development of cardio-vascular diseases and cancer. RNA oxidation is an early prominent feature of the main brain neurodegenerative diseases such as Alzheimer's Disease (AD), Parkinson's Disease (PD), Senile Dementia (SD), Amyotrophic Lateral Sclerosis (ALS) and Multiple System Atrophy (MSA).



• Gene Test for Gluten Sensitivity/Celiac Sprue [Enterolab]
  
  Enterolab offers genetic testing to ascertain one's predisposition to gluten intolerance - to identify the presence of the responsible HLA-DQ:
  
  
  • Gene Test for Gluten Sensitivity/Celiac Sprue - HLA-DQ testing from swab of inside of mouth - to detect for presence of one or more genes associated with (predisposition to) gluten sensitivity, celiac sprue and other autoimmune syndromes. This test detects the presence of the locus type HLA-DQB1*0201.

  Please see the Food Allergy Testing section for more information on genetic testing for Celiac Disease.



• DNA Technology [Australian Biologics]
  
  DNA Testing uses Polymerase Chain Reaction (PCR) technology to detect the present of certain pathogenic and opportunistic microorganisms, including Mycoplasma species and beta-hemolytic streptococcal infections, present in the Red (RBCs) and White Blood Cells (WBCs) in the blood stream. DNA for PCR analysis is extracted from both RBC and WBC blood components, not just from WBC nuclei.
  
  Please see the Live Blood Microscopy section for a qualitative method for identifying these types of intracellular bacterial infection, and also the Dysbiosis section for other tests for detecting the presence of bacterial overgrowth in general.




Virus Tests:



• Cell-Free DNA in Blood Plasma [Acumen]
  
  This is a quantitative test to establish the levels of free DNA present in the blood plasma (i.e. not tied into the nuclei inside blood cells), i.e. of viral origin. Most of the cell-free DNA present in blood plasma is associated with cell degradation. Some of course may be of viral origin. Very low levels are present in healthy individuals and increases are often associated with serious illnesses such as malignancy, stroke, auto-immune diseases, severe infections and indeed CFS. In studies on 87 CFS patients, positive results were found in 93% of those with CFS duration of 4 months to 4 years. In those with a CFS duration of 14 years, 75% had positive results.




Dysbiosis / Pathogenic Microorganism Tests:



• Comprehensive Stool Analysis / Parasitology x 1 [Doctor's Data]
  
  This is a qualitative stool test to establish a range of information pertaining to one's stool. A frozen stool sample is submitted along with two other stool samples using various preservative liquids. The physical nature of the stool can be examined, and also microbes can be cultured from the stool samples and then tested antimicrobial agents to determine which antimicrobial agents they are sensitive to and which they are resistant to. This can provide useful treatment guidelines to practitioners who do not use any forms of muscle testing etc.
  
  Parameters include:
  
  
  • Microbiology - examines the proliferation of beneficial flora species, such as Bifidobacterium, E. coli species (spp for short), Lactobacillus spp and Enterococcus spp. Also examined are non-pathogenic bacterial species that are out of balance (i.e. found in too high numbers); and also dysbiotic flora and the extent of their proliferation.
  
  
  • Mycology (Yeast) Culture is also examined, to see which yeast species are in normal amounts and if any are dysbiotic.
  
  
  • Parasitology/Microscopy (Trichrome Stain & Concentration) tests also test for the presence of Giardia Lamblia and Cryptosporidium by ELISA/EIA (Enzyme Immunoassay).
  
  
  • Campylobacter jejuni - pathogenic bacteria that frequential causes diarrheal disease. Presence detected.
  
  
  • Digestion/Absorption - Elastase, Fat stain, muscle fibres, vegetable fibres, carbohydrate fibres.
  
  
  • Inflammation - Lysozyme, lactoferrin, WBC, mucus.
  
  
  • Immunology - sIgA - Secretory IgA.
  
  
  • Short Chain Fatty Acids - Acetate, Propionate, Butyrate, Valerate.
  
  
  • Intestinal Health Markers - RBC, pH, Occult Blood, Yeast (Candida albicans).
  
  
  • Macroscopic Appearance - Colour (expected - brown), consistency (expected - formed/soft).
  
  
  • Bacterial Susceptibilities - To test a pathogenic or dysbiotic species (if present) with the following antimicrobial agents. Prescriptive agents tested - Amoxicillin, Ampicillin, Augmentin, Ciprofloxacin, Trimeth-sulpha. Natural agents tested - Berberine, Black Walnut, Caprylic Acid, Cat's Claw, Citrus Seed Extract, Goldenseal, Oregano, Uva Ursi.
  
  
  • Yeast Susceptibilities - To test a pathogenic or dysbiotic species (if present) with the following antimicrobial agents. Prescriptive agents tested - Fluconazole, Itraconazole, Ketoconazole, Nystatin. Natural agents tested - Berberine, Caprylic Acid, Goldenseal, Oregano, Tanalbit, Undecylenic Acid, Uva Ursi.
  
  
  
• Stool Analysis [Genova Diagnostics]
  
  This is a stool test for parasite analysis and amino acid profile (although a blood microscopy is probably more effective for observing parasite overgrowth).



• GI Stool Effects Profile [Metametrix]
  
  The GI Stool Effects Profile (a.k.a. Microbial DNA Ecology Profile and Microbial Sensitivity Profile) is a quantitative stool test. It can quantify the number of different major harmful microbes in one's stool including protozoan parasites, yeast/fungi, pathogenic bacteria and Mycoplasma. Click here for a sample report and here for more information.



• DNA Technology [Australian Biologics]
  
  DNA Testing uses Polymerase Chain Reaction (PCR) technology to detect the present of certain pathogenic and opportunistic microorganisms, including Mycoplasma species and beta-hemolytic streptococcal infections, present in the Red (RBCs) and White Blood Cells (WBCs) in the blood stream. DNA for PCR analysis is extracted from both RBC and WBC blood components, not just from WBC nuclei.
  
  Please see the Live Blood Microscopy section for a qualitative method for identifying these types of intracellular bacterial infection.



• Neurotoxic Metabolite Test (NMT) [Protea biopharma]
  
  The Neurotoxic Metabolite Test Kit is a qualitative home urine test kit that measures the presence of abnormal levels of metabolites in the uring, related to the production of Hydrogen Sulphide (H2S) - known as Hydrogen Sulfide in the US! The body naturally produces some H2S, and it plays a part in normal physiological functions, but an excess in production may be extremely detrimental in terms of reduced oxygen circulation and impaired mitochondrial function. Overproduction is thought to result from metabolic dysfunctions as well as from the overgrowth of certain pathogenic bacterial species. A test request/order form can be downloaded from Health-Spy.com here. This has been recently introduced (in June 2009) and is presented as a test for CFS and ME, although it may relate only to a subset of patients, and is only really an initial indicator - as many more tests would be required to ascertain exactly what is going on in the body in other respects. The NMT Test Kit should be refrigerated if to be stored for any length of time.




General Pathology Tests for Essential Fatty Acids, Vitamins and Co-Factors:



• Essential Fatty Acids [Biolab]
  
  This is a quantitative red cell blood test to establish to exact levels of each EFA (omega 3 and omega 6) and also non-EFA fatty acids, and to note that they in the correct ranges and relative ratios.



• Niacin Status (vitamin B3) [Acumen]
  
  This is a quantitative blood test to establish red blod cell levels of active B3 (NAD).



• Functional (Blood) Test for B3 [Biolab]
  
  This is a quantitative blood test to establish levels of Vitamin B3.



• Functional (Blood) Tests for B1, B2 and B6 [Biolab]
  
  This test measures the B1 (ETK activation), B2 (EGR activation) and B6 (EGOT activation). Results expressed as IU/gHb.



• Functional (Blood) Test for Biotin [Biolab]
  
  This test establishes the blood levels of Biotin (Vitamin H or B7). The Biotin test measures levels of two acids, 3-hydroxyisovaleric acid and 4-hydroxyisovaleric acid. A high level of 3 (i.e. over 6.7 micro mol/l) in the presence of normal levels of 2 (i.e. 2-19 micro mol/l) indicates a biotin deficiency. Biotin is not measured directly.



• Functional (Blood) Test - MMA (B12) [Biolab]
  
  This quantitative blood test establishes the blood levels of Vitamin B12.



• Direct Measurement (Blood) - Coenzyme Q10 (serum) [Biolab]
  
  This is a blood serum test to measure the levels of Coenzyme Q10, a metabolite in mitochondrial function and energy production.



• Biochemistry Pathology Report [Biolab]
  
  This is a quantitative blood test to establish levels of key amino acids, glucose, cholesterol, and specific nutritional elements.



• Haematology & Biochemistry with Electrolytes Pathology Report [Doctor's Laboratory]
  
  This is a quantitative blood test to establish levels of key nutritional metal elements, amino acids, enzymes, glucose, cholesterol, and various physical blood parameters. A low platelet and lymphocyte count can indicate either insufficient nutrition (or nutrients reaching the blood stream) or either the presence of toxins or a virus. An elevated Eosinophil (white cell) count may indicate the presence of parasites.




Immunology Tests:



• Immunology Profile Pathology Report [Doctor's Laboratory]
  
  This is a quantitative blood test to establish a variety of immunology and special pathology parameters.



• Urinary Pterins [Laboratoire Philippe Auguste]

The Urinary Pterins Test as its name suggests is a quantitative urine test for three types of Pterin. These are markers of neuroinflammation and cellular immune system response and inflammation. The test is a.k.a. Urinary Neopterine Profile.

Neopterin is a sensitive marker of cellular mediated immunity. Reduced levels reflect cellular immunity weakening. Increased levels are positively correlated with infectious, inflammatory, immune system dysfunction or neoplastic disease evolution. Excessive Neopterin may indeed impact the Nitric Oxide pathway in the body (e.g. excessive peroxynitrite formation and oxidative stress).

Neuroinflammation is largely cytokine dependent. Neopterin, a central plate form and a common final pathway in the production and activity of cytokines, is generally regarded as a useful index of inflammation response associated with immune activation. Neopterin is secreted by the monocytes-macrophages stimulated by interferon gamma and evaluates the Th1 lymphocytes immunse response. It is a catabolic product of Guanosine Triphosphate (GTP), a purine nucleotide.

Tetrahydrobiopterin (BH4), a.k.a. Reduced Biopterin. is synthsised through the same teleonomic pathway as Neopterin. BH4 is the cellular protection or antidote to Neopterin. It helps to alleviate the oxidative damage caused by Neopterin induced immune activation. When BH4 is oxidised, by Neopterin, it forms Biopterin (a.k.a. Oxidised Biopterin or 'Box'). Biopterin is the coenzyme oxidised degradation product of Tetrahydrobiopterin (BH4).

If Neopterin is constantly increased, then there is a possibility that BH4 levels are inadequate. The extent of differential between these two Pterins could be considered to be an index of deleterious consequences of cellular inflammation. Decreased Biopterin relative to Neopterin might suggest increased oxidative damaged caused by immune activation (in addition to the original cause of the immune system activation).

The parameters measured in the Urinary Pterins Test are:


• Neopterine (NEO)
• 
  
• Oxidised Biopterin (Box)


• Tetrahydrobiopterin (BH4 or Reduced Biopterin)

The following ratio is calculated on the test report to compare the amount of Neopterin to the amount of reduced and oxidised Biopterin:


• (BH4 + Box)/Neopterin




Chemical Sensitivity Tests:



• Lymphocyte Chemical Sensitivity - Electrical Sensitivity [Acumen]
  
  This is a quantitative test to detect lymphocyte sensitivity to a variety of organic toxins and heavy metals. For more information, please see the test description in the Liver Function and Toxicity test section above.



• MELISA Test [MELISA]
  
  This is a qualitative test to detect lymphocyte sensitivity to a variety of heavy metals. For more information, please see the test description in the Liver Function and Toxicity test section above.



• Immunology Testing [Breakspear Medical Group]
  
  This is a semi-quantitative programme of skin testing for an allergic response to a small number of mainly organic chemical compounds. Please see the section below on Immunology Testing for more information.




Food Allergy and Intolerance Tests:



• Lactose, Lactulose and Sucrose Breath Test [Breakspear Medical Group]
  
  This is a quantitative breath test to determine whether specific food intolerances exist, specifically Lactose (or Lactulose) Intolerance and Fructose Malabsorption, by measuring the Hydrogen concentration in the breath.
  
  In patients where these sugars are not either properly digested (in the case of Lactose on account of a 'deficiency' in the Lactase enzyme) nor absorbed (in the case of Fructose), these sugars will largely pass through the digestive tract and be fermented by bacteria, into Short Chain Fatty Acids (SCFAs) such as Butyric acid, Propionic acid and Acetic Acid, but also the gases hydrogen, carbon dioxide and methane. Only bacterial fermentation of carbohydrates produces these byproducts in the colon, primarily by anaerobic bacteria. A proportion of these gases will be absorbed into the blood stream from the GI tract, and are transported by the heart to the lungs. Here a proportion of these gases passes through the alveolar membrane and is expelled out of the lungs where the Hydrogen concentration can be measured.
  
  The patient is required to avoid any complex (slow digesting) carbohydrates for 24 hours prior to the test (including beans, bran etc.) and also to fast from 12am on the night before the test. The reason for this is explained below.
  
  At the start of the test, the patient's Hydrogen breath level is measured by having him blow into a Hydrogen meter, in order to establish a baseline H2 breath level. The patient immediately then consumes a small, measured amount of either Lactose, Lactulose or Sucrose, stirred in a glass of water (depending on what type of intolerance/malabsorption is being tested for). The patient is then monitored every 20 minutes and at each interval the patient breathes into a Hydrogen gas meter. This is continued for 2 hours. This concludes the test.
  
  If at any point during the test the patient's breath level of Hydrogen goes up significantly, the specific condition can be diagnosed. If there is little change in the H2 breath level, then the diagnosis is negative (i.e. the patient is not intolerant to that particular type of sugar.)
  
  Sucrose is used in order to test for Fructose Malabsorption as Sucrose is broken down by Sucrase in the digestive tract into Glucose and Fructose.
  
  Measuring Hydrogen levels is also an indicator of whether an individual has been eating or fasting during the testing period.
  
  
  • For non-fasting individuals, the H2 breath level is high early in the morning. H2 accumulates in the blood on account of reduced motility during sleep, and food is exposed to bacterial fermentation for longer. Reduced breathing rates (hypoventilation) during sleep also decreases the amount expelled through the lungs and thus the blood concentration and alveolar air concentration can creep up. H2 breath levels tend to fall during early afternoon, then increases again during mid-afternoon, after the carbohydrates consumed at lunchtime have reached the colon. H2 breath levels gradually decrease thereafter, until after one's dinner in the evening.
  
  
  • For fasting individuals, H2 breath levels fall gradually during the entire day, which is why the Lactose, Lactulose and Sucrose Breath Test is performed in controlled conditions, the patient having fasted prior and only consuming a controlled amount of a specific sugar type, in order to monitor the effects.
  
  It is beneficial to measure both methane and hydrogen levels in order to gain a full picture, but it is not strictly necessary. Methanogenic bacteria convert hydrogen to methane in the colon (small intestine). When disaccharides (i.e. lactose, sucrose) are metabolised/fermented by bacteria, one of three processes can occur: Hydrogen is produced; Methane is produced or both Hydrogen and Methane are produced. However, in an individual who is not able to digest/absorb Lactose or Sucrose effectively, the H2 levels will generally spike enormously compared to a person who is able to digest/absorb these sugars effectively; however measuring both gases will of course increase the accuracy of the test.



• Red Blood Cell Fructose-6-Phosphate (F6P) [Acumen]
  
  This quantitative blood test is a measure of the Fructose-6-Phosphate in one's blood. It is used to detect for an excessive level of Fructose intake and also any potential problems associated with Glycolysis (the conversion of Glucose into Pyruvate). This method of Fructose usage is found mainly in the muscle cells (as opposed to Liver cells that produce Fructose-1-Phosphate).
  
  Fructose-6-Phosphate (F6P) is produced from Fructose, and is utilised in the Glycolysis pathway, to produce Pyruvate from Glucose. Excessive Fructose intake leads to high F6P levels in the cells. If the Fructose availability far exceeds the Glucose supply, then metabolic issues arise as the control mechanisms that apply to Glucose are essentially bypassed or lifted. Excessive fructose intake tends to inhibit Glycolysis and Gluconeogensis, albeit in a slightly different manner to Hereditary Fructose Intolerance (HFI), a hereditary deficiency in the liver enzyme Aldolase-B that is involved in Fructose Metabolism. Please note that this is not a blood test for Fructose-1-Phosphate (F1P), levels of which tend to build up in HFI patients.
  
  Excessive Fructose intake can also deplete Short-Chain Essential Fatty Acids even before blood sugar levels drop significantly. The liver uses the SCFAs Acetate, Proprionate and Butyrate for the production of Glucose to try to avert Hypoglycaemia.
  
  The liver converts Fructose into Glucose in a series of enzymatically controlled steps known as Glycolysis. If any of the enzymes involved in Glycolysis are deficient, then the liver is no longer able to produce Glucose from Fructose and one of the intermediary products where the bottleneck is will build up to dangerous levels. In the case of HFI, a deficiency in the Aldolase-B enzyme means that its substrate, Fructose-6-Phosphate, builds up in the liver and kidneys and has a variety of adverse effects on the body. The Fructose-6-Phosphate (F6P) levels can be detected in the blood. The blood sample is taken 3 hours after food was last consumed. A high red cell Fructose-6-Phosphate reading is indicative of either Hereditary Fructose Intolerance or excessive Fructose intake. Both problems stress the same pathways. A concurrent SCFA test detailed below is also recommended in order to demonstrate any tendency towards Hypoglycaemia and LDH isoenzymes will show a shift to the liver pattern if Fructose-1-Phosphate levels build up (c/f HFI) and also inhibit Glycolysis and/or Gluconeogenesis.
  
  According to Acumen, F6P it is a good integrating measure is unlikely to have huge hour-to-hour or day-to-day variation, unlike F1P levels that tend to vary a great deal throughout the day and which are much more recent-diet-dependent.



• Short-Chain Fatty Acids (SCFAs) in Blood Plasma [Acumen]
  
  Repeated from Liver Function section above:
  
  This quantitative blood test is a measure of the Acetate, Propionate and Butyrate - Short-Chain Fatty Acids (SCFAs) - in blood plasma. SCFAs are produced in the colon by the bacterial fermentation of dietary fibre, which helps to keep down the stool pH to suppress dysbiotic and pathogenic microogranism overgrowth.
  
  However, greatly elevated levels of these SCFAs is an indicator of Fructose Malabsorption. Unabsorbed fructose osmotically reduces the absorption of water and is metabolised by the normal colonic bacteria to SCFAs and the gases Hydrogen, Carbon Dioxide and Methoane. These SCFAs and gases are absorbed into the bloodstream, and thus elevated SCFA levels can be observed in the blood plasma.
  
  The reverse pattern is observed in the case of Hereditary Fructose Intolerance (HFI) and other genetic liver enzyme deficiencies of the Fructose metabolic pathway. HFI is a genetic condition whereby a liver enzyme deficiency prevents normal fructose metabolism and gluconeogenesis occurring in the liver. Inhibition of gluconeogenesis results in lactic acidosis as the cells underogo anaerobic respiration in the absence of glucose (i.e. Hypoglycaemia). The liver may try to compensate by producing glucose from the SCFAs Acetate, Propionate and Butyrate that are produced by the bacterial fermentation of dietary fibre. Rapid depletion of SCFAs in blood plasma is associated with HFI and can be detected with this blood test.
  
  The SCFA blood sample is taken 3 hours after food was last consumed. The Fructose-6-Phosphate test is usually performed in parallel to see if excessive Fructose intake is implicated in any way.



• Uric Acid in Blood Plasma [Breakspear Medical Group]
  
  This is a quantitative blood test to measure the Uric acid levels in the blood plasma, as an indicator of Hereditary Fructose Intolerance (HFI). Please see the Food Allergy page for more information.



• Lymphocyte Proliferation Test for Fructose [Breakspear Medical Group]
  
  This is a qualitative blood test to measure the ratio of white blood cell (lymphocyte) growth on a low glucose medium compared to that on a low glucose/high fructose medium. Values below the reference for low glucose only reflect a metabolic intolerance to excess fructose. Please see the Food Allergy page for more information.



• Food Scan 113 Food Intolerance Test [YorkTest Laboratories]
  
  This is an arguably semi-quantitative blood test for immune system mediated Food Intolerances, specifically IgG-mediated. Its purpose is to examine the levels of Immunoglobulin/antibody IgG that correspond to a variety of food types (113 in total). Food intolerance is where the body does not produce sufficient enzymes of a specific type to digest certain food types, resulting in very slow digestion of these foods, which can 'rot' in the digestive tract. The Food Scan 113 does NOT measure IgE reactions to any of these food types which typically represent classical allergic food responses (e.g. skin rashes, shortness of breath etc.) Food allergies are usually well known by the patient, whereas food intolerances can often go unnoticed, but manifest themselves as general gut complaints such as Irritable Bowel Syndrome (IBS). One can be intolerant of a particular food type but not allergic to it, or allergic but not intolerant to it.
  
  Food Scan 113 is a pin prick test and can be performed at home; and ordered directly from the YorkTest Laboratories web site without necessarily a practitioner referral. It is the only food intolerance test endorsed by Allergy UK (to date). A small blood sample is collected and tested against a list of 113 food items, and the immune system response graded between 0 and 4 (integer rating only). A complete list of food items/parameters tested can be seen here. A sample report can be found http://www.yorktest.com/downloads/FoodScan_113_example_result.pdf. A vegetarian version, excluding all the meat products, is also available, at the same price, covering 113 items/parameters, called 'Vegetarian FoodScan Food Intolerance Test'. The YorkTest allergy tests are merely a diagnostic tool to formulate an elimination diet to avoid those foods that provoke an allergic reaction (at the time of testing), and not to actually 'treat' one's food allergies per se.



• Gluten, Dietary Yeast, Cow's MIlk, Chicken Egg and Soy Sensitivity Tests [EnteroLab]
  
  This is a set of quantitative stool tests to examine the number of IgA antibodies in the colon produced in response to historical consumption of the above food types (if eaten regularly within last 1-2 years). IgA is a protective antibody/immunoglobulin and those with food intolerances tend to have very low levels of this antibody corresponding to a particular food type they have an intolerance to. Low IgA levels generally then correspond to higher levels of Lymphocyte activity in response to the presence of these food types, causing the symptoms of gut/bodily inflammation and food intolerance. Antibody test values range from a positive value of 10 to as high as 350 units. The average positive value is approximately 45 units.
  
  IgA Sensivity Stool Tests include:
  
  
  • Gluten Sensitivity - Fecal anti-gliadin IgA antibody
  
  
  • Cow's Milk Protein (Casein) Sensitivity - Fecal anti-casein IgA antibody
  
  
  • Chicken Egg (Ovalbumin) Protein Sensitivity - Fecal anti-ovalbumin IgA antibody
  
  
  • Dietary Yeast Sensitivity - Fecal anti-Saccharomyces cerevisiae IgA antibody
  
  
  • Soy Sensitivity - Fecal anti-Soy Protein IgA antibody
  
  
  • Tissue Transglutaminase Sensitivity - Fecal anti-tissue transglutaminase IgA antibody. A measure of the reaction of the body's immune system response to the tissue transglutaminase enzyme produced by the body when Gliadin/Gluten is ingested (c/f mechanism of Celiac Disease)

  Other Sensitivity Stool Tests include:
  
  
  • Acute/Chronic Colitis - tests for Lactoferrin protein emitted from the inflammatory White Blood Cells called Neutrophils
  
  
  • Intestinal Malabsorption/Intestinal Damage - Quantitative fecal fat microscopy - a measure of malabsorption of dietary nutrients caused by damage of small intestine and/or lack of enzyme production by pancreas.

  Enterolab also offers genetic testing to ascertain one's predisposition to gluten intolerance - to identify the presence of the responsible HLA-DQ gene.
  
  
  • Gene Test for Gluten Sensitivity/Celiac Sprue - HLA-DQ testing from swab of inside of mouth - to detect for presence of one or more genes associated with (predisposition to) gluten sensitivity, celiac sprue and other autoimmune syndromes. This test detects the presence of the locus type HLA-DQB1*0201.
    
    Please see the Food Allergy Testing section for more information on genetic testing for Celiac Disease.

  All of the above tests can be ordered in two panels, the 'Gluten Sensitivity Stool and Gene Panel Complete' and the 'Egg, Yeast and Soy Sensitivity Stool Panel'.



• Immunology Testing [Breakspear Medical Group]
  
  This is a semi-quantitative programme of immunology skin (subcutaneous) testing and treatment. It is designed to test and treat both food and chemical allergies, intolerances and sensitivities.
  
  The first step is to challenge the body in the diagnostic phase. Intradermal skin injections (usually below first layer(s) of skin) of a vaccine corresponding to the antigen being tested for are performed. As the body reacts to the initial concentration of the vaccine, a bump or wheal appears at the injection site. If the wheal is still active after 10 minutes, a sequentially lower concentration is tried and the process repeated until the wheal appears 'satisfactory' after the 10 minute waiting period. The first vaccine to be tested is Histamine, followed by one antigen vaccine at a time from the list that has been recommended for the patient to try. Each sequentially lower concentration of the vaccine is a 50% dilution of the previous higher concentration, and is assigned a higher number. e.g. all antigen vaccines are started at an equivalent concentration known as '3', and the next dilution tried is a '4' (which is 50% of the concentration of the '3'). On each occasion, 0.01ml is injected under the skin. Concentrations up to '36' are available. The skin testing for that particular antigen/parameter stops when the satisfactory wheal is obtained - the next step is to inject 0.05ml under the skin of the next lower concentration, which forms the basis of the actual remedial neutralisation vaccine prepared for the patient at the end of the testing. One then moves on to test the next parameter.
  
  Once one starts testing a particular parameter, it is normally insisted that one finishes it (i.e. reaches the end point) and finishes the testing for the day by using the 0.05ml concentration of the end point concentration (the neutralisation vaccine) for that parameter, in order to obtain a normal immune system response for that parameter prior to leaving for the day. In general, one can test up to around 3 or 4 different parameters or items per half day. The immunology testing is performed in 3 hour blocks, between 9am and 12pm. and 1 and 4pm. It is recommended to wear a short sleeved T-shirt for the testing. Mobile phones (in transmit/receive mode) and new magazines are not permitted in the testing area on account of possible sensitivies with some patients. A nurse may be responsible for several patients and patients who are there for immunology testing are normally seated in one large room, the nurses using digital timers to keep track of each patient, recording the results as they go along. One is not allowed to eat during the testing, take any supplements nor drink anything apart from water. One can eat before the testing, but one should avoid eating a particular food type within 2 hours of testing that one is to test that day. One may wish to eat a different breakfast or lunch on that particular day instead.
  
  The actual parameters/antigens that one is to test for is normally determined by a discussion with the doctor and the patient. Chemical toxin sensitivies from a narrow but effective cross section can be ascertained from a Lymphocyte Sensitivity Test (see the Chemical Allergy section above. Otherwise a discussion of a patient's symptoms may reveal what particular foods are causing noticeable allergic responses. Some foods may be very mildy allergic and the patient may not be aware of the difference in sensation in the gut after consumption which might be quite subtle. In general, it is recommended to test those foods which one consumes regularly plus those which one knows one has a problem with but tends to avoid. It may be more sensible in the short term at least to target those chemical toxins in the body that are continually causing a problem plus those foods that one is perhaps only mildly allergic to, rather than focussing on one's main allergies if one avoids them totally. However in the long term it may well be worth testing for the latter.
  
  One may choose to only do half day's testing at a time on account of fatigue etc. The quicker one gets all the initial testing days out of the way the better however so one can get on with the actual treatment phase. However, during the testing phase, some people experience adverse symptoms such as dizziness, headaches, general malaise or even nausea, with certain types of parameter/item (that they are particularly sensitive to), as one is provoking the body each time with each parameter/item. This is particularly the case with items that one can only tolerate a very low concentration of (e.g. in the 30s) - having started the injections during testing at '3'! Clearly one needs to balance the amount of testing one does per day or per week against one's energy levels/reserves and use one's common sense.
  
  Although it is recommended to choose a broad cross section of food or chemical types, the actual similiarities between like foods may not be that large, depending on the antigens in questions. There are 500 antigen vaccine parameters to choose from (mainly foods and supplements, but some chemical toxins, preservatives and animal danders also), and custom vaccines/parameters can be made up for special requirements, but at a cost. There is of course a certain element of guesswork involved in determining what exact parameters one should test for, and it depends on the general symptoms and test results of allergic responses of that patient in general, and a degree of common sense is required. Some patients are much more allergic than others. It may perhaps help to use a food allergy blood test such as the YorkTest Laboratories test described above prior to commencing this Immunology Testing programme. It is also possible that Applied Kinesiology or Muscle Testing can ascertain which food types or chemicals the body is allergic to at any point in time. How this Immunology Testing programme differs is that it is not geared towards food type avoidance but long term treatment. Breakspear has been conducting this programme since the late 1980s and has treated over 3 million patients worldwide. It is the only licensed laboratory in the UK to produce such vaccines.
  
  Once the diagnostic phase is complete and all parameters have been tested, then the neutralisation concentrations for each parameter are communicated to the vaccine laboratory which then swiftly prepares the vaccine cocktail(s) for the patient. Each vaccine cocktail vial can contain up to a maximum of 25 parameters. If one has tested for more than 25 parameters, then one needs to use 2+ vaccine cocktails. The vaccine cocktail is then injected once daily (usually), subcutaneously (slightly deeper than with the vaccine testing) but not as deep as to be Intramuscular (IM). 0.05ml of the vaccine cocktail is injected at once. One alternates injection sites on the body so as to avoid skin hardening. Depending on the injection site and one's amount of body fat, one may choose to avoid certain suggested injection sites or indeed not push the needle all the way in, i.e. use one' discretion. The vaccine cocktails, as the antigen vaccines described above, contain no preservatives and should be kept frozen in the freezer when not in use, and only defrosted immediately prior to use and then refrozen again. For convenience one may wish to transfer 1ml of the vaccine cocktail into a separate rubber top sealed test tube, which can be more easily thawed out and refrozen each day (containing a much smaller volume of liquid). The vaccine cocktail tube has a sealed rubber top which is never removed and the vaccine is drawn out by sticking the needle through the rubber top into the inverted tube. This is to help keep the tubes sterile and prolong their frozen shelf-life. Vaccines can be transported with one on holiday if one brings along a doctor's note and stores the vaccine cocktails in padded envelope with a ice pack or similar. Many patients report feeling significantly better after the first day of treatment or sometimes up to 2 weeks after commencement of the treatment programme. These are probably those with the most severe allergies who have effectively targetted those antigens/items.
  
  The end points of the various antigen vaccines in the vaccine cocktail do not always go down in concentration with daily injection as the immune system gets used to them and normalises its response to them. The end points can go up or stay the same. In general, retesting is recommended every 3 months. Returning for retesting is recommended early than this if the patient starts to experience adverse symptoms immediately after the injections, including headaches, irritation around the injection site, etc. These are signs that one or more of the item endpoints in the vaccine cocktail have shifted (i.e. higher numbers of lower concentrations now tolerated). A friend of BlackSpy found that after 3 months of taking her vaccine cocktails, the endpoints of those foods she had consumed regularly during that period had remained the same, and the endpoints of those foods she had avoided for these 3 months had gone up (i.e. lower tolerance). There are clearly many factors involved, and the success in some patients may depend on what other biochemical or other issues need addressing, to treat the root cause of the excessive immune response, if it is just not a case of 'shifted conditioned response'.
  
  Retesting is much quicker than the original testing phase as one does not have to start at '3' for each vaccine but can start at the number preceding the endpoint for each vaccine parameter. This may be a function of stress levels or other factors affecting the immune system. In addition, if one does not take the vaccine cocktails consistently every day, then the endpoints may similarly be subject to change. In most cases however the vaccine cocktails are effective and do not have to be changed several times a week! Whilst some patients do benefit greatly from such testing and treatment, others do not notice much difference. This may be because the bulk of their bodily inflammation is on account of other causes, i.e. peroxynitrite-based inflammation instigated or exacerbated by the presence of excessive heavy metal toxicity or an infection, or perhaps excessive stress or regular overexertion. In such cases one may be better off focussing on addressing these areas and antioxidant therapy. Clearly it depends how large a role that diet plays in the inflammatory response in a patient.
  
  In conclusion, a large number of people have benefitted from this style of allergy treatment, however some find that other approaches to allergy testing and treatment are more effective or more suitable. As with most types of treatment.
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• Laboratory Testing Considerations:
  
  Clearly every type of test has its limitations and requires interpretation by a skilled medical practitioner:
  
  Hair analysis provides information on the toxic elements and nutrients that are able to be absorbed from the hair folicle into the hair fibres themselves. Hair folicle nutrient and toxic element levels do not necessarily correlate to those found in other tissues and the blood stream and provide historical data (like the rings in tree bark) rather than a snap shot of the time of sample collection.
  
  Urine tests provide indirect information about what was once in the blood, e.g. amino acids and wasted minerals and vitamins, (although the blood may contain amino acids and nutrients that do not appear (in the same concentrations or at all) in the urine). Urine is also tainted with other waste products. Urine amino acid levels are usually representative of the blood levels and reflect dietary uptake and metabolism, as well as excretion of these amino acids. However, a number of factors must be taken into consideration, as the urine levels may not necessarily correspond directly to the blood or tissue levels. For example, abnormal renal clearance, loss of urine during the collection period, decay or spoilage of the urine sample, and the presence of blood in the urine could cause the sample to be unrepresentative. However, the possibility of such problems can be judged from analytical measurements (metabolic markers for urine representativeness.)
  
  Blood tests are better, and provide a snap shot of what nutrients or toxic elements are in the blood or the state of the blood cells. Blood tests do not necessarily provide information about the tissues or fat cells, where many toxins may accumulate.
  
  It should be remembered that certain compounds do not cross the blood-brain barrier effectively (e.g. Choline), and so whilst they may be present in high concentrations in the rest of the body (e.g. as the neurotransmitter Acetyl-Choline), the levels of these compounds in the brain, and those made from these compounds, can be quite low. In addition, some compounds are only produced intracellularly and tend not to be circulated around the body, and any dietary intake may be directly absorbed and utilised, and so are hard to measure directly through blood or urine analysis (e.g. L-Carnitine). Also, hormone tests, whether performed through saliva, blood or urine, do not always reflect the cellular levels if the cells are absorbing the hormones as quickly as they are being produced.
  
  A biopsy can provide a full picture of what is actually going on in the tissues themselves (e.g. a fat biopsy), although taking a biopsy is a rather drastic measure, and clearly only certain bodily parts or tissues are conducive to biopsy in live specimens!
  
  In the case of toxicity, and neurotoxins in particular, one can gauge to a reasonable extent what is going on by looking at the blood (as described above). In addition, by following detoxification protocols such as taking additional phospholipids and FIR saunas, one can gauge oneself how much more is necessary and how many more toxins there are in the tissues and bones by simply continuing the regime and increasing the dosage/duration over time and observing the symptoms (if any). So one can indirectly 'measure' toxicity without having to use the scalpel. In any case, the information one might gain from a fat biopsy would only tell you to continue the detoxification protocol in any case.
  
  Minerals levels are difficult to measure in a meaningful manner. Each sample for each specific mineral ideally needs to be a different source, e.g. red blood cell magnesium levels; or white blood cell zinc levels. Most mineral tests test for a variety of mineral sources from one place, which does not tell you anything necessarily about the mineral levels in the critical places where those minerals are most heavily utilised. In addition, one's mineral levels according to a particular type of test may be considered to be 'normal' for the population as a whole, but you could still have abnormal organic and amino metabolite results even though your levels were ÒnormalÓ. This is why in many cases, deducing what mineral and vitamin levels are inadequate or deficient based on the metabolic by-products that collect in the urine (e.g. amino acids or organic acids) may be a useful diagnostic tool. Measurement of these by-products in the blood and saliva is also possible. For example, BlackSpy had had a hair mineral analysis test performed, and it showed that Magnesium levels were virtually normal (in the hair). But an amino acid profile showed that Asparagine was very low indicating that Magnesium was deficient in the tissues.
  
  For this reason, muscle testing, or Applied Kinesiological Testing, may be used in conjunction with laboratory tests, to partially offset the inherent problems and weakness of each specific test, and also to further clarify the picture or corroborate the results.
  
  Your consultant should advise what is necessary. It is entirely up to their discretion as to the general order of tests, and some may recommend some of the above tests ahead/instead of a hair mineral analysis or live blood microscopy. The above list is be no means comprehensive and one should refer to the respective laboratory's web site for a full list of tests offered. Some tests will be highly relevant in your case and others much less so.
  
  Web sites to the above laboratories can be found on the Links page in the Laboratories section, which are sorted by country. Do not feel that you have to stick to local laboratories, as it is quite common to submit samples from UK or mainland Europe patients to US laboratories, for example. Many large laboratories have agents in each respective country that handle and forward the samples onto the main lab, or are licensed and approved to carry out the testing locally. The above list is by no means comprehensive, but contains some of the tests that BlackSpy and his associates have found useful. Please visit each laboratory's web site for a complete list of tests offered and for high level technical information. In particular, BlackSpy highly rates Genova Diagnostics, Doctor's Data, The Doctor's Laboratory (TDL) and Acumen. Please familiarise yourself with the laboratory's test pages and the scope of each relevant test. This will give you a good feel for what can be done and what potential paths you may go down in the course of your treatment.
  
  Some of the CFS information or support group web sites on the links page may also list some tests. Some of these are listed below.
  
  The NHS web site provides a list of forms of allergy testing.
  
  http://www.nhs.uk/Livewell/Allergies/Pages/Whichallergytest.aspx
  
  Which? magazine in the UK has claimed that the IgG (antibody) blood analyses conducted by YorkTest Laboratories and Cambridge Nutritional Sciences produced significantly different results for the same blood sample, and as such claims that food allergy testing is often an unproven science.
  
  The Environmental Illness Resource's web site shown below also contains a brief summary of many of the above tests.
  
  www.ei-resource.org/labtests.asp Dr Sarah Myhill, who has been working with CFS patients since the 1980s, has a list of tests that she uses with her patients on her web site - including BioLab, The Doctor's Laboratory, Genova Diagnostics, Acumen and many others.
  
  www.drmyhill.co.uk/tests.cfm
  
  BeatCFSandFMS.org's web site features a series of tests that 'George' had performed between 1998 and 1999. Some of the nested links no longer work and some of the tests and laboratories have changed, but the pages are interesting for illustrative purposes.
  
  www.beatcfsandfms.org/html/GeorgesTests.html
  
  www.beatcfsandfms.org/html/GeorgesTests_M_.html
  
  Further tests will be added to this Identification page over time. Thank you for your patience.
  
  

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Neurophysiological Tests:

The following mainly Neurophysiological tests of Autonomic Function are conducted by Dr Peter Julu of Breakspear Medical Group, based at Breakspear Hospital in Hemel Hempstead in the UK. Related topics about cardiac and oxygenation functions can be found on the Cardiac page.

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Autonomic Profiling and Quantitative Inotropic Fatigability Test (QIFT) [Breakspear Medical Group]

The Quantitative Inotropic Fatigability Test (QIFT) is a test to measure a set of cardiovascular reflexes controlled in the brainstem, and both parasympathetic (rest and digest) function and sympathic (fight or flight) function, with a view to identifying any possible dysautonomia, Any abnormalities, such as Abnormal Spontaneous Brainstem Activation, issues with maintenance of blood pressure (baroreflex function), cardiac arrhythmia and/or thermoregulation problems can be detected, which may be a contributary factor for some of the fatigue, cardiac and oxygenation problems in those with CFS, ME or Fibromyalgia.

The QIFT test is useful in that it provides physiological and neurological evidence of the problems in inotropic function, fatigability and baroreflex failure, as opposed to examining biochemical tests or evidence or even psychological explanations or factors. The QIFT test is described below, and also on Breakspear Medical Group's web site here.

The tests of the QIFT are designed to stimulate the receptors of the autonomic system either directly or indirectly, to produce a set of unconscious cardiovascular reflexes that can be measured. The tests of the QIFT include a set of standardised exercises or manoeuvres optimised to stimulate the receptors or direct manipulation of the receptors themselves, in order to examine the autonomic nervous system. Standardisation allows comparison with the normal level/quality of cardiovascular reflex expected. These receptors are also known as target-organs and are located in 4 main areas: the brainstem, the large blood vessels including the heart, deep inside the body and in the skin (superficial).

The patient should only sip water during the test. It is advisable to be hydrated prior to the commencement of the test, but not excessively so, because it is not really possible to visit the toilet for the first 90 minue or 2 hour phase of the test as one is hooked up to various pieces of equipment. Being strongly in need of the toilet during the test may also affect the results as it involves increased muscular effort, even during rest.

The patient should desist from the consumption of caffeine prior to the commencement of the test, as it will increase the patient's heart beat. The polyphenols in black and green tea are also inotropic substances, that strengthen the heart's action (during exercise), and so may affect the test results also (which may show up as a higher than normal inotropic response during the isometric exercise). The consumption of green or black tea, or supplements containing these extracts, prior to the assessment or even within a day or so or the assessment. In general, however, one should note that inotropic response tends to be lower in those with CFS.

The QIFT test lasts approximately 2.5 hours and is held in a laboratory at 24C. The test is performed in two halves, which are described below.

• Oxygenation, Breathing, Heart Rate and Blood Pressure Tests
  
  The first half of the QIFT test consists of direct measurement of continuous breathing movements, pulse (heart rate or HR), the ECG R-R intervals (the elapsed time between two consecutive R waves in the electrocardiogram - each wave representing a heart beat), systolic blood pressure (SBP), diastolic blood pressure (DBP) - and tissue O2 and CO2 levels if conducted alongside the Transcutaneous Gases test described below) - in conjunction with a number of 'exercises' or manipulations of the autonomic nervous system.
  
  The patient is monitored using a small finger appliance, a number of sensor pads placed around the thorax and a special belt around the chest is used to monitor continuous breathing movements.
  
  An electrocardiogram, a thoracic interpretation of electrical activity of the heart over time, is monitored continuously throughout the duration of the autonomic examination - using the the Neuroscope method, created by Medifit Instruments Ltd. Whilst the neurologist examines the data as the test goes on, the data is also saved (with appropriate electronic markers placed into the data to signify the different phases of the test) so it can be examined in further detail after the event. Interpretation of test data is based on a normal range of values and patterns that have been obtained using standardised procedures to minimise unnecessary variances.
  
  The body is monitored in a variety of bodily positions, each posture or change in posture, and the response of the heart, has a clinical significance. The body undergoes a variety of physiological changes and adaptations, instigated by various receptors in the body, following posture changes, to properly regulate our blood pressure, heat rate and physiological requirements.
  
  
  • Supine Position -reclining horizontally
  
  
  • Head tilted backwards
  
  
  • Sitting up straight
  
  
  • Standing up

A change in the mean SBP of more than 25mmHg suggests orthostatic instability (a.k.a. orthostasis or postural cardiac instability), often associated with poor inotropic (strengthening of cardiac muscle action) response. Whilst orthostatic hypotension may not be present, other forms of orthostatic maladaptation may be present, including poor BP stability.

A sustained drop in DBP by 10mmHg or more within 3 minutes of having assumed an erect posture in comparison with the level in a horizontal posture, is an indication of orthostatic hypotension (a.k.a. postural hypotension - a sudden drop of blood pressure when a person stands up, a 'head rush'). When a healthy person stands up, the blood pressure increases hugely momentarily, but then drops down again 'like a stone' to a normal level. This reflex is designed to preserve blood flow into the brain and to maintain consciousness. An example of very poor control of BP when standing up, would follow the usual pattern of a big increase in BP followed by a sharp drop in BP, but then a period of oscillation of BP, fluctuating, until it eventually settles down.

O2 levels are intended to be greater when one is sitting up or standing up, as opposed to reclining in the supine position - to reflect levels of cellular activity, energy expenditure, relative alertness and also the blood pressure requirements of the respective postures. An excessive drop in what is effectively tissue O2 levels, particularly evident in dysautonomia cases, when lying down, is evidence of poor oxygen diffusion and perhaps also poor BP and HR regulation.

The presence of tachypnoea, abnormally rapid breathing, can be detected on the screen with data fed from the breathing belt.

Various exercises are performed, to test specific types of cardiac response, either parasympathetic or sympathetic.

The first segment of exercises are measures of parasympathetic function (rest and digest), with the exception of the third exercise which affects both parasympathic and sympathetic functions. Vagal tone, a.k.a. parasympathetic nervous system tone, is the effect producedon the heart when only the parasympathetic (rest and digest) nerve fibres (carried in the Vagus nerve - follows the jugular vein) are controlling the heart rate. The parasympathetic nerve fibres slow the heart rate down from approximately 70bpm to 60bpm. Vagal tone is measured according to a medical scale known as the Linear Vagal Scale (LVS).

• Deep Breathing Exercise - this is a 10 second cycle of deep inhalations and exhalations. This strengthens the parasympathetic nerve signals to slow the heart rate down. The above parameters are measured before, during and after the deep breath. It is used to stimulate the target-organs inside the brain stem to produce a measurable cardiovascular reflex, in this case, a drop in heart rate. During deep breathing we expect to see a significant rise in O2 levels and a significant drop in CO2 levels. A late and slight change in these gas levels in the deep breathing exercise is seen as a sign of poor gas diffusion in the tissues.

The second segment of exercises are primarily measures of sympathetic function (fight or flight response) and also parasympathetic function (rest and digest). These tests are designed to stimulate a variety of target-organs. The carotid massage exercise stimulates the parasympathetic function whereas the Sustained Isometric Exercise abolishes the parasympathetic function.

• Carotid Massage - Manual manipulation of the carotid artery in the throat by the neurologist. This artery is pressed by by the neurologist's finger for a specified number of seconds. One side of the neck is 'massaged' in this manner at a time. The massaging is the direct stimulation of the target-organs in the jugular vein. Carotid massage influences both sympathetic and parasympathetic mechanisms. Cartotid massage has a cardioinhibitory effect, a brainstem response that can be measured in the form of increased cardiac vagal tone (decreased heart rate), i.e. a measurement of cardiodepressor function. Carotid massage is also used to elicit a vasodepressor effect (on baroreflex function) measured as a decrease in SBP, but little change in HR. This response occurs due to vasodilation, probably as a result of a withdrawal of sympathetic nervous system tone. For example, there may be a normal cardiodepressor effect but failure of the vasodepressor effect of the carotid reflex.


• Sustained Isometric Exercise - performed using a stiff hand gripper pressed together in one hand for 3 minutes. One arm is exercised at a time, which a short break in between. Recordings in the third minute of the isometric exercise are compared with rest levels immediately prior to commencing the exercise in the same posture (for each of the two parts of the exercise - i.e. for each arm). This sustained isometric exercise is used to abolish the parasympathetic tone in order to assess the sympathetic tone, i.e. to withdraw/abolish the parasympathetic negative feedback control on the cardiovascular system so that the sympathetic cardioaccelerator function in the cardiac muscle and sympathetic vasoconstrictor response (and general level of control) of the blood vessels in the skeletal muscles can be assessed. The presence of central gain of the baroreflex system (i.e. excessive baroreflex response (BP increase) to exercise) can be assessed (if present). The mixture of sympathetic and parasympathetic target-organs can be assessed independently. These target-organs are located in the large blood vessels including the heart and also deep inside the body. HR (R-R interval) is used as a measure of sympathetic activity in the heart muscle. The gradient of the rise in DBP rise in the ejection phase of the cardiac cycle is used an an index of beat-to-beat left ventricular inotropic function. Sustained exercise involves the adrenaline pathway. This test is a useful measure of inotropic response during sustained exercise, which may be inadequate or even higher than normal. Any inotropic substances consumed prior to the test or indeed recently, e.g. black or green tea, may well give a falsely elevated inotropic response during this isometric exercise test, as discussed above.

The third segment of exercises are primarily measures of sympathetic function (fight or flight response). These tests are designed to stimulate the target-organs deep inside the body.

• Single Respiratory Gasp - this induces sympathetic Emotional Sudomotor Function (ESF) effects, shown by changes in skin response, e.g. sweating of the palms of hands and soles of feet. This can be measured by the Galvanic Skin Response (GSR), a measure of measuring electrical resistance of the skin between two points (on the palm of the hand usually). This test is optional and was not performed with BlackSpy.


• Valsalva manoeuvre - performed by blowing against a high resistance tube at an even rate for a predefined length of time. The subject sits upright, without moving his legs, whilst leaning forwards slightly. This ejects blood out of the heart over a period of around 10 seconds by greatly increasing intrathoracic pressure, thereby impeding venous return of blood into the right atrium. The Valsalva manoeuvre tells us what the body is doing to compensate for the insufficient blood returning to the heart when the intrathoracic pressure is raised. The major organs of the abdomen constrict in order to push blood back into the thorax.
  
  The three phases of the Valsalva manoeuvre are described below. All 3 phases occur whilst the patient is blowing against an obstruction or resistance. The return to more cardiac and circulatory function occurs after the Valsalva manoeuvre has been stopped (i.e. after Phase IIi has ended).
  
  
  • Phase I - there is an initial rise in BP on account of the pressure on the great blood vessels in the thorax.
  
  
  • Phase IIe - the early, sharp drop in SBP and DBP on account of a sustained reduction in the venous return of blood caused by the positive intra-thoracid pressure.
  
  
  • Phase IIi is the recovery of both the SBP and DBP (bounce back of BP) against the positive intrathoracic pressure being applied by the Valsalva manoeuvre. This rise in BP is caused by the sympathetic mobilisation of a reserved volume of blood ('auto-transfusion') from the splanchic vascular bed, stimulated by the crisis of reduced blood volume in the heart. The Inferior Vena Cava (IVC) - the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart) -carries more than 2/3rds of the venous return, but venous return from the lower limbs is dependent largely on the muscle pump effect. If the BP rises too high, it is an indication of the adrenaline system being too active (potentially an allergic response).

The standardised Valsalva manoeuvre is therefore use to mechanically reduce the volume of blood returning to the heart so that the sympathetically mediated reflex 'auto-transfusion' can be initiated and examined in a controlled manner. The Valsalva manoeuvre allows us therefore to assess the sympathetic adrenergic function in the splanchnic vascular bed - to assess the BP responses in each part of the Valsalva manoeuvre and afterwards when normal venous blood flow to the heart returns. Adrenergic function describes those receptors that are the targets of catecholamines, the stress hormones. The splanchic nerves are those of the organs of the thorax or abdomen. The pulmonary vascular bed describes the blood vessels of the lungs. Phase IIi is a measure of the splanchnic sympathetic tone of the deep organs of the sympathetic division of the autonomic nervous system, which may be normal, or perhaps raised, for example. If raised, it may be an indicator of increased immuen activity in the patient and often consistent with the presence of ASBAs and may cause dysmotility (abnormal or uncoordinated muscle movement of peristalsis) in the gut.

If the legs are not moved during the Valsalva manoeuvre, which are a large reservoir of blood volume, then one can specifically measure the compensatory mechanism in the abdomen (a.k.a. 'reflex autotransfusion' (Keele, et al., 1982) - i.e. a reflex to give oneself one's own blood). In Phase IIi, the reserves of blood in the organs of the splanchic bed are employed to provide an emergency venous flow of blood to the heart. These organs contain the wider blood vessels of the liver, spleen and kidney, that are used for filtering blood and thus contain a large amount of blood that can be utilised for other purposes in an emergency. These organs squeeze the blood out which is the pushed back into the heart as venous blood return, causing the SBP and DBP to rise again.

The patient leans forwards slightly in order to exclude any possible contribution to the blood flow from the vasoconstrction of muscle-pump effect in the lower limbs to the recovery of the SBP and DBP, allowing the neurologist to assess the splanchnic sympathetic adrenergic function selectively.

The gradient of BP rise during the ejection of blood from the heart provides us with information about the function of the heart ventricles (i.e. inotropic function - the alteration of the force or energy of cardiac muscular contractions). The longest ECG R-R interval occurs after the Valsalva manoeuvre, in contrast to the shortest R-R interval during the Valsalva manoeuvre.

As well as examining the abnormalities in blood pressure, breathing, heart rate and oxygenation level maintenance and patterns, and which body positions or exercises they are particularly unstable or abnormal, it is possible to infer the extent of Abnormal Spontaneous Brainstem Activation (ASBAs), which is manifested as sporadic and random fluctuations in blood pressure and pulse rate. The brainstem controls all the involuntary body functions (breathing and heart rate.) Severe abnormalities in BP and HR maintenance can have a huge impact on fatigability and energy levels.


• Cold Water Challenge
  
  The second half of the QIFT involves the assessment of Thermoregulatory Vasomotor Function (TVF) in the skin using a cold water challenge. This measures the effects of temperature on the skin and the regulation of corresponding blood vessels in all four limbs. It could be considered part of the sympathetic (fight or flight) response of the body. The cold challenge is used to specifically elicit the thermoregulatory vasoconstrictor reflex of the sympathetic system from the target-organs in the skin. Whilst only the extremities of the four limbs are monitored, it could be assumed that whatever pattern is observed in the extremities in terms of thermoregulation also applies to a large extent in the core of the body. TVF can be manifested in a number of ways, for example poor management of body temperature, temperature sensitivity (e.g. to wind or drafts) etc.
  
  Waterproof sensors (attached to a four channel laser Doppler flow meter (by Moor Instruments Ltd) are used to measure skin blood flow are placed on the extremities of all four limbs, i.e. the backs of the hands and feet. The effect on the blood flow in all 4 limbs are monitored during the test.
  
  
  • The right hand is first immersed in warm water (40C) for 2 minutes to maximise vasodilation
  • It is then immediately plunged into a tub of cold water (10C) for 2 minutes to evoke vasoconstruction
  • The cooled hand is then immediately reimmersed in the warm water (40C) for 2 minutes (i.e. re-warming)
  • After a couple of minutes break the experiment is repeated on the other hand (the left hand)

A normal response is a simultaneous decrease in blood flow to all 4 limbs when only one hand is rapidly cooled (the cooling phase), and a simultaneous return to baseline in all 4 limbs upon warming the hand in question (the re-warming phase). Abnormalities in thermoregulation (i.e. TVF) can be identified in this manner, which may include little or no response upon cooling or rewarming, or even the opposite expected response (i.e. increase in blood circulation when it should be decreasing, etc.).

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Transcutaneous Gases Test [BreakSpear Medical Group]

The balance between carbon dioxide and oxygen in the soft tissues of the body is critical to normal cellular functioning. Too much CO2 in the blood and cells may result in acidosis (contributing to fatigue) and too little CO2 in alkalosis (stimulating abnormal responses from the brainstem). Low levels of oxygen in the tissues can result in hypoxia and all round fatigue. Low oxygenation levels may stem from incorrect breathing techniques but more frequently the problem lies in oxygen transport and perfusion.

Pulse Oximeters are routinely used in hospitals to measure a patient's haemoglobin oxygen saturation levels in the Red Blood Cells. These are small and inexpensive devices that use Infrared light and are placed over the finger. However, they tell us nothing about how much oxygen is actually getting out of the blood and into the tissues where it is needed, i.e. the oxygen perfusion, nor does it tell us anything about the amount of haemoglobin in the blood, nor relative levels of carbon dioxide. In CFS patients it is not infrequently noted that blood oxygen levels are high but tissue oxygen levels are low.

http://en.wikipedia.org/wiki/Pulse_oximeter

It is difficult to measure the oxygen and carbon dioxide levels inside the tissues themselves, however it is much easier to measure the amount of O2 and CO2 that moves through the tissues and out through the skin. This can be measured using sensors placed on the various parts of the skin on the body. These readings are directly proportional to the partial pressures of oxygen and carbon dioxide found in the peripheral tissues, also known as the Nutritive Circulation. This is the essence of the Transcutaneous Gases test.

Each sensor has two membranes, one sensitive to CO2 only and the other membrane sensitive to O2 only. A small plastic cup is applied to the skin next to the liver, where the skin is generally warm. The cup is filled with a special fluid that readily dissolves both oxygen and carbon dioxide. The sensor with the two membranes is then screwed firmly into the cup. Oxygen and carbon dioxide escape from the skin and dissolve into the fluid. The dissolved gases are then detected by the sensor. CO2 is detected by the change in the pH (hydrogen ion concentration). O2 is detected by its magnetic property which increases with its concentration. Both O2 and CO2 concentrations can be measured simultaneously in real-time and in a healthy individual these concentrations mirror the concentration in the capillary blood. This concentration is similar to mixed arterial and venous blood.

The Transcutaneous Gases test can be conducted in isolation, with the patient lying on his back, resting and with the patient taking deep breaths. However the test is usually conducted in conjunction with the (first half of the) QIFT test, described above, being run simultaneously, i.e. the O2 and CO2 values being recorded during all of the exercises and body positions of the QIFT test, the results being viewed/displayed/recorded in parallel to the cardiac readings, to provide a much clearer overall picture of what is going on in the body.

O2 levels are intended to be greater when one is sitting up or standing up, as opposed to reclining in the supine position - to reflect levels of cellular activity, energy expenditure, relative alertness and also the blood pressure requirements of the respective postures. An excessive drop in what is effectively tissue O2 levels, particularly evident in dysautonomia cases, when lying down, is evidence of poor oxygen diffusion and perhaps also poor BP and HR regulation.

During exercise, O2 levels are also meant to immediately increase. In some patients, the O2 levels are slow to increase, but do eventually reach the levels required. This may be experienced in the initial phase of the exercise being particularly hard but getting easier once the body's O2 levels have caught up with requirements/expenditure. However, there may be other issues present, including mitochondrial inefficiency, meaning that after the brief period of exercise, the patient ends up exhausted in any case.

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2,3-BiPhosphoGlycerate (2,3-BPG) and BPG Mutase Test [Breakspear Medical Group]

This is a quantitative blood test for 2,3-BiPhosphoGlycerate (2,3-BPG) and the BPG Mutase (BPGM) enzyme. These two compounds are examined briefly below.

2,3-BiPhosphoGlycerate (2,3-BPG or BPG for short), a.k.a. 2,3-DiPhosphoGlycerate (2,3-DPG), is the chemical compound that encourages the release of partially deoxygenated hemoglobin (deoxyhemoglobin), to ensure as much oxygen is released from the red blood cells (RBCs) as possible. 2,3-BPG shifts the equilibrium of haemoglobin to the deoxy-state. 2,3-BPG binds with high affinity to haemoglobin, displacing and releasing some of the remaining oxygen from the semi-deoxygenated RBCs, which then passes out of the capillaries and into the surrounding cells. 2,3-BPG selectively binds to the deoxyhemoglobin, making it harder for oxygen to bind with the hemoglobin and more likely to be released to the surrounding tissues.

2,3-BPG is generated from inside Red Blood Cells. Bisphosphoglycerate mutase (BPGM) is an enzyme responsible for the catalytic synthesis of 2,3-BPG from 1,3-BPG. BPGM has also both mutase and a phosphatase function which are less pronounced that its effect as a catalyst in 2-3-BPG synthesis. BPGM is unique to erythrocytes (Red Blood Cells or RBCs) and placental cells,i.e. those cells that contain haemoglobin. 1,3-BPG is an intermediate formed in Glycolysis (the metabolic process of converting glucose in pyruvate (examined on the Food Intolerance page with respect to Fructose metabolism and Fructose intolerance).

2,3-BPG levels are not altered dynamically as the blood circulates around the body (from the lungs to the tissues), but tend to be fairly constant in a given individual, depending on physiological adaptation. High levels of 2,3-DPG create a decreased affinity for O2 in the hemoglobin, and shift the Oxygen-Hemoglobin Dissociation Curve to the right so that a higher partial pressure of O2 is required to achieve the same level of O2 saturation in the Hemoglobin. However, higher 2,3-BPG levels also ensure that hemoglobin loses more of the O2 that it is carrying at the capillaries (i.e. when hemoglobin is in the deoxy-state). Conversely, lower 2,3-BPG levels result in an increased affinity for O2 in the hemoglobin, i.e. a leftward shift in the Oxygen-Hemoglobin Dissociation Curve, and lower partial pressure of O2 required to achieve the same level of O2 saturation in the Hemoglobin, but that there is less tissue perfusion and delivery of O2 to the tissues as less of the RBC's Oxygen i delivered in the capillaries (i.e. more is retained).

Low 2,3-BPG levels are usually observed in patients with Septic Shock and Hypophosphatemia, the latter which can be caused by respiratory alkalosis (in the RBCs). However, Dr Peter Julu theorises that low 2,3-BPG levels in some CFS patients may also result in similar patterns of low oxygen perfusion into the tissues, and may mean that the enzyme BPG mutase may not be functioning inefficiently (i.e. not producing enough 2,3-BPG) or there is not enough 1,3-BPG available (from Glycolysis), despite sufficient oxygen levels in the red blood cells. This can set the body up for an oxygen-deficient state (i.e. anoxia). Some parallels could be drawn between Hypophosphatemia and CFS in that in both conditions, a lack of ATP (a source of phosphate) could be a contributary factor.

Elevated 2,3-BPG levels may indicate that tissue anoxia has been present for a significant period of time and that the body is trying to compensate (with higher levels of BPG mutase). This would presumably signify an improvement in oxygen diffusion but a decrease in overall oxygen saturation (higher partial pressures of O2 being required).

Please see the Cardiac and Oxygenation Insufficiency page for more information.

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Vascular Endothelial Growth Factor (VEGF) Test [Breakspear Medical Group]

Besides low 2,3-BPG levels above, another possible reason for low tissue oxygenation levels could be the clogging up of the basement membrane on the outside of the capillaries with immunoglobulins, from excessive allergic responses. One of the body's responses to this anoxic (oxygen deficient) tissue environment and poor circulation and/or oxygen transport capability is for capillaries to 'bud' to produce additional capillaries to try to increase the local circulation of blood around the tissues, in order to encourage more oxygen to be released into the tissues (in combination with attempts to boost 2,3-BPG levels, which is often not possible). This 'capillary budding' involves a compound known as Vascular Endothelial Growth Factor (VEGF). VEGF is a chemical signal produced by cells to instigate the growth of new capillaries around them.

http://en.wikipedia.org/wiki/Vascular_endothelial_growth_factor

'Vascular endothelial growth factor (VEGF) a sub-family of growth factors, more specifically of platelet-derived growth factor family of cystine-knot growth factors. They are important signaling proteins involved in both vasculogenesis (the de novo formation of the embryonic circulatory system) and angiogenesis (the growth of blood vessels from pre-existing vasculature).'

The VEGF blood test is used to measure the VEGF levels to determine whether capillary 'budding' is taking place, which would be one indicator of an anoxic or low oxygen environment.

Please see the Cardiac and Oxygenation Insufficiency page for more information.

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Basal Body Temperature Measurement:





Basal (waking) body temperature can provide a good indication of endocrine system health, and can be one of many way of identifying issues and measuring one's progress during treatment. The sensor of an electronic thermometer can be placed deep in the arm pit upon the moment of waking in the morning and held there (bring your upper arm onto your side to hold it in there and to keep maximum contact area) until a final peak temperature is reached, which can take up to 5 minutes (alternatively you can insert a regular thermometer into your rectum if you prefer!) Take readings every day for a couple of weeks. Use a chart (a graph) where temperature is on the vertical axis (e.g. 94.0F - 99.0F or 34.5C to 37.2C). Each 'square' or unit on the vertical axis should correspond to a tenth of a degree. This axis does not have to reach zero ;-) unless you have want to be frozen for medical research! The horizontal axis is the date, each square represents a day. Notice any changes in your dietary or supplement/treatment regime and the effect they have on your basal body temperature. The optimal basal temperature can be in the range 97.6F to 98.2F or 36.5C to 36.8C.

A consistently low basal body temperature is usually indicative of hypothyroidism (low thyroid function). An unstable basal body temperature is usually indicative of adrenal dysfunction and low adrenal gland activity. Unstable and low temperatures usually indicates both low adrenal and thyroid activity. Please note that measuring basal body temperature is different from measuring daytime body temperature, which is usually higher (as the metabolic rate increases slightly when we are awake), with its optimal range in a healthy person at around 98.6F to 98.8F or 37.0C to 37.1C. See the Hormonal Dysfunction page for more information.

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Applied Kinesiological / Muscle Testing:



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Overview:

There are many types of kinesiological testing. What we are interested here as a diagnostic method is Applied Kinesiology (AK), also referred to as muscle testing or muscle strength testing. AK testing can be used to determine how the body reacts to certain substances, be they food, supplements, toxins or micro-organisms, as either strength or weakness. In addition, AK testing can be used to determine what your body requires at a precise moment in time. AK testing is a form of strength testing, where the practitioner will move your arms and legs into different positions, to see that the body is responding and processing information correctly, then will use your right arm to apply pressure and notice the strength response, whilst placing a number of small samples of substances in small glass jars one at a time in the vicinity of your body. He may also help you form a number of finger positions to deduce dosage and frequency when it comes to supplements the body requires.

• The body may also give a positive yes answer "I need that", "I can use that" or "I strongly want that". In such a case, the practitioner may increase the dosage slowly in the sample container and note the response of the body until it says no, which is normally the dosage of that particular supplement that the body requires at that point in time (which usually changes over time). The practitioner can also determine the number of times a day the body requires that dosage.


• A possible positive/certain answer the body may give be a strong 'allergic' reaction, which isn't a literal allergic reaction, but a strong 'no' from the body. Another possible answer is a strong 'yes', meaning yes I require that very strongly. Examples may include a sample of a heavy metal, a supplement that does not agree with the body or a food that the body is allergic to.


• The body may give a don't know answer or neutral answer "I don't know what to do with that" or "I don't know how to process that". This may be because one is not asking the question in the right way, as the body is not able to recall any 'memory' associated with that question. It may be necessary to ask the 'question' in another way, i.e. investigated another pathway in the body and be more specific.


• The body may give an answer "I don't care" which is a non-kinetic response meaning that it regards the item as neutral, not particularly what it wants biochemically, but not what it doesn't want either. It would treat the item in question as 'food' or 'nutrition'. Of course hitting the body with too many neutral supplements might potentially confuse it, if these items are targetting vastly different goals.


• The body may give a kinetic response "I can't use that now" which is slightly different from above. This would take the form of a kinetic response with the eyes open but no change with the eyes closed (normally you expect weakness or a non-kinetic response with the eyes closed). Such an item should be avoided as it will not be effectively utilised by the body (as it should be), although it may provide some biochemical benefit, but that it will likely confuse the body with 'noise', cause some imbalance in some system in the body, and reduce the ability of the body to effectively communicate with itself (to do the critical jobs in hand). The body is only able to process the 'signature' or 'information' from so many supplements at once. If it is a drug or other medicine that the person really needs, it is possible to balance it out in some way, but if it is a supplement, then the normal course of action is to simply forget it and leave it out, as there are alternatives.

By moving the left arm into a variety of different positions, the practitioner can determine whether the body requires nutritional, electro-magnetic, kinesiological or structural input. Structural input may be craniosacral therapy or another structural input. Electro-magnetic could be homeopathic or energetic therapy. Once the practitioner has determined what area he needs to work on, he can test a variety of supplements if it is nutritional, for example, and see what the body responds to and what it doesn't respond to, based on a set of samples of good quality products and ideas he has about what it likely to be the kind of the thing the body might need, based on your past history of treatment and your current symptoms and laboratory test results. The practitioner can also work on a particular set of pathways (or processes/functions) rather to a particular set of glands or organ in order to determine what process is blocked and what supplement to use to treat it with. The number of types of treatment that can be tested (e.g. energetic or electro-magnetic) is going to be restricted to what the practitioner knows and what tools/remedies are available.

• The body sometimes loses clarity/memory and goes into a state where it will give no answers ("I don't know the answer to that question!"), even if you put something that just a moment ago gave a strong positive or negative response, in which case the practitioner must follow a sequence of procedures to get the body responding again. A loss of clarify may also result in unequally lengthed arms (allegedly) temporarily. These loses of clarity are effectively temporary blockages in the energy system, and the more times the body loses clarity during an AK session, the more energy the body will likely lose in the process. However, performing this procedure at the start of a session, if the body is not providing any answers, has been reported by many patients, including BlackSpy, as feeling a little like a mild acupuncture session and can be highly energising (provided the body is not pressed for too much information and reset too many times thereafter as this may have the reverse effect, of draining the body's energy). The difference between AK and Kinesiology on the whole is that the AK practitioner is using Kinesiology to determine something, whereas the Kinesiology practitioner uses Kinesiology as the end in itself, a method of treating a person and removing an energetic blockage.


• At some point during the testing, the body will lose all clarity and will not respond to further testing and will not provide any further answers, at which point the testing is finished for the day.


• AK testing for a particular supplement that the body wants can determine the dosage needed at the time of testing and for the rest of the day, and that is how a daily dosage is determined. However, if you have already taken a quantity of that supplement earlier in the day, then that needs to be taken into consideration when communicating the dosage to the patient. A practitioner will often check to see if the body still wants a particular core supplement that you have been taking for a while, to determine if the dosage needs to go up or down, for example.

No two AK sessions are exactly the same and precise effects on the body and the route taken to obtain results may vary betweens sessions and between people. However, the results or outcome if performed correctly are usually the same. AK testing is a type of testing using the 'body intelligence'.

If you don't ask the right question in the right way, you may not get an answer back or at least the answer you were after. For example, you may ask the body about a certain substance and it may give the answer that it is 'balanced', but if you did not ask specifically about a possible immune-modulated allergic reaction to that substance, then the body may not tell you.

It is recommended that you find a consultant who is proficient in Applied Kinesiological testing. This type of testing is a valid form of test in itself as well as the laboratory tests described above, and is extremely important to effectively adjust and tailor the approach effectively, rather than just by guessing supplements and quantities. BlackSpy's view is that one should not however rely on AK testing alone, but as a form of fine tuning in one's treatment programme. It should not really be used to determine primary causes and problems, and this should be obtained from both qualitative and quantitative laboratory testing and microscopy work. A wide variety of tests are available to measure one's progress. There are also other types of muscle testing or bio-feedback type testing to determine what the body needs, what the body is allergic to, and what problems you have.

Wikipedia's definition of Applied Kinesiology can be found at the link below.

http://en.wikipedia.org/wiki/Applied_kinesiology

A brief overview of the more basic type of kinesiological testing can be found at Cancer Remission web site below. Please note that many of the pathways tested and supplements test for are not necessarily 'good' or 'bad' intrinsically, but what the body requires at any point in time may change.

www.cancerremission.com/TestingDetails.html

Please see the two sections below for BlackSpy's views and experiences on the limitations of AK testing.

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Benefits of Applied Kinesiology/Muscle Testing:



From BlackSpy's limited experience, Applied Kinesiology testing seems to be very useful as part of a wider testing and identification programme. It appears to be very useful in determing a brand and type of supplement to take, and fine tuning dosage requirements for a condition identified by other means, e.g. laboratory testing. It also appears to be quite useful in determining the requirements of the most chronic mineral and vitamin deficiencies, digestive system support and adrenal gland support. It can also be useful in determining the presence of significant numbers of harmful micro-organisms, although BlackSpy would not personally rely on this method alone to determine this. It does not appear to be so useful in determining toxicity levels and the approach for a detoxification programme. It also does not appear to be so useful in determine mitochondrial dysfunction or electromagnetic deficiencies. This may perhaps vary according to the practitioner, but BlackSpy prefers other test methods in these areas for these conditions.

If when you start seeing your practitioner and the body is totally confused, then it may only provide a few answers in initial AK/muscle testing sessions, e.g. a couple of different supplements in small dosages, even if you intuitively know the body 'should' require higher dosages or a number of other supplements, from examining your lab test results or just from intuition/common sense. However, just because your body 'should' require higher dosages or additional compounds, that doesn't mean that it can utilise them. The body may choose a lower dosage supplement, e.g. 250mg Acetyl-L-Carnitine compared with a 500mg version from the same manufacturer. Taking the higher dosage may result in the body being overloading with 'information' or not being able to utilise it as well. However, as one progresses with treatment, stops doing treatments or taking supplements that are confusing the body (being 'overzealous' and forcing the body to jump through hoops of your choosing), i.e. not what it requires at that point in time, then the body may start to give more answers and know better what it wants and be better able to utilise high dosages or other compounds that are technically required by the body in its current condition. The more you work with the body, the more it tends to best respond in order to climb out of the hole that has been dug. The more you work against the body and force it to do things that it doesn't actually require (as opposed to theoretically require according to someone's opinion or some lab results), the less effecively it will utilise what you throw at it and the less things it can actually utilise (effectively) as it becomes so 'confused'. Chopping and changing supplements and regimes regularly can result in biochemical chaos and energetic/other confusion.

If one is to see one's practitioner once a month, there are so many changes in the body's pattern, dosage changes and slightly different ways of addressing the same problem that may be needed, that muscle testing really is invaluable. To intelligently arrive at the same result at the end of each appointment would require a wide range of testing of numerous parameters, involving multiple urine tests and blood tests each month, which would not be practical. Most practitioners who rely on laboratory tests alone tend to stick to one or two parameters to closely monitor and leave other parameters to intuition, based on changes symptoms reported alone. Of course, AK practitioners should also use laboratory tests, but may not repeat lab tests more than every 6 months or so, depending on the what they are. Some patients resort to trial and error based on what they think will work, from test results, things they've noticed or what they've read on the internet. This can be very disruptive on the body and very taxing, as the errors tend to unbalance one's whole functioning, and the tendency is to keep retrying and making errors until one finally arrives at what one believes is the right balance (which may not necessarily be the case, only that which does not cause noticeable harm or disruption in the short term). AK testing can help avoid all this experimentation and arrive at an optimal and consistent regime.

AK testing when utilising other disciplines such as craniosacral therapy, homeopathy etc. can be a useful treatment in itself, to 'unconfuse' the body and get it to function better and communicate to itself better internally (in terms of nervous system function etc.) BlackSpy has found that his energy levels increase after an AK testing session, even with all the logistics of getting to see the consultant are taken into consideration. Yes these are tiring, but the overall effect is a positive one for the body. back to top

 
Potential Problems and Pitfalls of Applied Kinesiology/Muscle Testing:

The results of an AK testing session must be interpreted correctly in order to be meaningful. A failure to do this by either you or your consultant can provide less benefit than you would otherwise gain. Sometimes the result of the testing is correct but you may be wrong! Let's say your practitioner tested you for 2 Betaine HCl capsules with each meal. But your experience tells you that this isn't enough as you still have pungent wind frequently and trouble digesting protein. However, you may be overeating at meal times, such that if you ate a little less at each meal, but perhaps ate more often, then your Betaine HCl requirement would decrease and your digestion would improve. Does this mean that AK is rubbish? BlackSpy does not think so, but believes that it has its limitations. However, make up your own mind and choose the style of testing that you feel most comfortable with.

Sometimes muscle testing provides a dosage that seems minimalist and often totally insufficient. Specific examples from BlackSpy's experience include 5-HTP dosages, which always seemed to be barely enough to ensure a proper night's sleep; and also mineral supplementation whilst using a demineralising chelating agent (for Lead detoxification), specifically EDTA. The mineral regime was perfectly fine if no chelation was being carried out, but because EDTA tends to remove nutritional and trace minerals as well as heavy metals, then the actual requirement would be greater than the 'normal' amount of mineral supplements. As to how one is supposed to draw this distinction with AK testing, BlackSpy does not know, but it is one failing of AK testing. Another example is either antioxidant or blood pressure lowering herbs to help with cardiac support. Whilst the general antioxidant regime was geared more to free radical proliferation, the suggested regime on several occasions (but not all) was not quite sufficient for cardiac support. On those occasions it was, the benefit came more from assisting mitochondrial function and body balance in general so the heart was not under pressure in the first place.

It is difficult to determine complex schedules of supplementation with AK testing. For example, cases where a couple of weeks on and a couple of weeks off are required. One example would be chelating and mobilising agents as part of a heavy metal detoxification programme. This was not such an issue with EDTA, as the dosage determined in BlackSpy's case was 3 Detoxamin for Kids suppositories per week, which worked out fine. However some examples of problematic cases are listed below.

• Lipoic acid (ALA) - is a mobiliser of heavy metals, and many would argue should be taken daily (dosed throughout the day and night) for up to 2 weeks, with a couple of weeks off after that, to ensure that heavy metal levels do not accumulate too high in the body. This is not really possible to determine with AK testing, where the answer you might get is twice a day for example. BlackSpy was once dosed high strength ALA daily for a number of months (600mg of ALAMax CR, twice a day), and after 5-6 months, he started getting symptoms of cumulative heavy metal toxicity and was unable to take the dosage any longer. He had a break of a week and started again with a lower dosage (starting off on 50mg every 6 hours and slowly increasing), and was ok with that for a month, but kept getting worse neurological symptoms (including visual and cognitive problems). His level of inflammation also increased. He had to stop taking it in the end. 2 weeks before this he was tested as requiring 150mg 6 times a day, which was still too high. Trying to 'achieve' this dosage over a few weeks was one contributary factor to having to stop completely. It was only a month later that the ALA tested negatively. Clearly one could have overriden this with some common sense and stopped much earlier, or adapted the regime to prevent this problem occurring in the first place.


• Changing Chelating Agents - Whilst the EDTA dosing and scheduling was perfectly fine initially, on account of the build up of Mercury because of the ALA supplementation regime, BlackSpy felt a change of chelator from EDTA (best for Lead) to a chelator such as OSR (best for Mercury) might be in order, but it took nearly 3 months for the body to actually response positively to OSR. If BlackSpy had taken it earlier, it might have helped avert this excessive build up of Mercury also, but who can say if it would have worked optimally with the body. An AK purist might also have difficulty in relating sensible precautionary measures for Mercury Amalgam Filling removal, as most of the substances involved would test neutrally before the dental procedure, so would not interest the AK practitioner but would of course be of extreme interest to the patient!


• Other mobilising agents - Humate - After BlackSpy had been off Lipoic Acid for 3 months, and had been on OSR for 2 months to remove some of the moblised Mercury, he still hadn't cleared all the excess Mercury and still had symptoms of inflammation, but he muscle tested for a probiotic Primal Defense by Garden of Life. This contains 285mg of Humate, which is a mobilising agent for heavy metals. Whilst the body may have required the 'Soil-Based Organism' (a.k.a. Homeostatic Soil Organism) Bacillus subtilis, it was not really appropriate for it to be given any Mercury mobilisers at that time still.

AK testing has also established a dosage for a multi-vitamin, mineral and antioxidant supplement such as Thorne Research's MediClear. However, this contained Rice Bran, which BlackSpy was allergic to. BlackSpy would get a very mild sore throat after consuming it (i.e. an IgE food allergy). Generally, it is recommended to avoid any foods completely that give one such a reaction (as it upregulates the whole inflammatory condition of the body), but here the practitioner was recommending it (in a small dosage) - not because of the rice bran but its other ingredients. Any more than the suggested dosage and BlackSpy's sore throat symptoms were much worse. AK testing established a dosage which was just about tolerable. However, one may wonder whether it is satisfactory in this respect as BlackSpy would have preferred for multiple reasons to have taken something or several supplements with the same ingredients but with no allergic effect, which would have helped with lowering his overall level of inflammation, whilst having the same benefits.

AK testing thus in certain instances provides a theoretical 'optimal' regime for the body from an AK perspective, rather than a functional and fully workable regime. The AK-derived regime may be optimised and balanced from an AK perspective, but this may not necessarily be optimal for one's overall recovery. In certain instances, particularly concerning long term mobilising agent use, one simply may not be asking enough 'questions', or is able to do so, so that one cannot simply equate the AK answer with what the body really wants or what is best for the body from all perspectives.

There may be an attitude amongst AK testing purists that AK testing always gives the right answer, and if not, and there is some problem with the treatment regime determined, then it is not their fault as they were just relaying back to the patient what the body told them. In this sense there may be a total denial of accountability, a doctor telling you what to take, then denying any responsibility for if it works or not, or if it does more harm than good. This type of attitude is not really what one expects from a practitioner, as one is paying them for them to use their brain and not slavishly follow the testing results (which in a metaphoric sense would be like having a trained monkey as your doctor).One expects the practitioner to sanity check the regime and pay attention to reported symptoms and how they change over time; and look to cross checking with regular laboratory testing.

Supplements that provide no muscle testing response, i.e. provide a neutral or 'food' answer, from an AK perspective, could be interpreted as meaning 'you can take it if you like, it won't make any difference'. Some practitioners interpret this as meaning 'you can take as much as you like, it is of no consequence'. The latter answer is not quite right however, as it really means 'from an AK perspective'. Whilst a particular supplement may not be optimised or functional from an AK perspective, that is not to say that it will not still perform a biochemical role in the body, and that too much may still cause imbalance, disrupt the body or in the case of certain detoxification supplements, make one extremely ill if one takes more than a small amount. Always take such suggestions or advice with a pinch of salt. BlackSpy was once told that he could take as much Cilantro as he wanted, it wouldn't make any difference. This was based on a lack of awareness of the poweful heavy metal mobilising properties of Cilantro, and at the time (after removing a Mercury Amalgam Filling) made him extremely ill (even more ill) and was the last thing he should have been doing.

Some patients may feel that AK or muscle testing sessions are 'rigged' in that the practitioner may be 'cheating' my faking a response from the body to prove what he wanted to be proven, i.e. simply making it up. BlackSpy's AK practitioner denied that this was the case, even though it did feel like it at times. However, it is objectively very difficult for the patient in this posture and with the practitioner holding their arm up at a certain angle to judge this. It may well be the case for less reputable or 'shifty' practitioners.

It would appear from BlackSpy's experiences that at certain points in his condition, that there was a honeymoon period after a consultant where his body had been energetically 'reset' by the AK practitioner, and where the body responded well to the prescribed regimen, and to the minimalist and targetted supplement regime. However, after this honeymoon period was over (likely a result of overdoing it physically/mentally or perhaps having gotten carried away with too many additional supplements and put the body into a confused state again), or when the energy boost from the session had worn off (similar to how the up-beat effect of an acupuncture or other energetic seession wears off after a few days), the body did on a number of occasions did not respond so well to the supplements and see that level of expected or previous progress. In these cases, BlackSpy wonders whether another AK session to reset the body again and re-test the previously prescribed supplement regime, would have fixed this problem, or whether this signified that the supplement approach did not really work or would only work if one hadn't overdone it and become unresponsive and much worse physically; thus requiring a different type of treatment approach. This may be exaccerbated when a patient is so ill that he has to physically recover from appointments for a few days or even weeks, when the whole logistical experience of the appointment negates (most of) the actual benefit the appointment brings (the net effect being slight progress but not as much as had been anticipated by either party). Is it in a sense like having acupuncture once a month but without taking any Chinese herbs in the interim to build on the acupuncture treatments? When it doesn't work, that is? This is probably something the individual must figure out for himself.

You or your practitioner may chose in specific areas to override your 'body intelligence' or what it has been determined that your body thinks it needs at a certain point in time. For example, if you have very poorly functioning adrenal glands, and your body is clearly signifying it wants supplementation to stimulate these, but over several months such supplementation is not making any progress, and your body is signifying that it does not want certain detoxification supplements (assuming you have a toxicity issue here), then you or your practitioner may choose to override the body's requests temporarily in this area and begin detoxification whilst still supporting the adrenal glands. In certain instances, the adrenal glands will not recover until sufficient toxins are removed from the body and stress levels are lower. However, if you do override the 'body intelligence' and use your common sense, you will occasionally get it wrong! And you have to accept the consequences.

So it is wise to regularly review your approach and not to feel locked into anything for the sake of it. Sometimes the body is so confused, that it may not understand the process and order of treatments that will be most effective. Throwing too much at your body may be detrimental or at best ineffective, as opposed to focussing on what the body most needs, and being disciplined enough to stick to that. The vast majority of the time, Applied Kinesiological testing gets the right answers however, and part of the process involves 'resetting' the body's responses if it does not provide a positive answer. So whether this rare type of problem scenario lies in the body's answer, the interpretation or the practitioner is a philosophical matter. This is really the practitioner's job to figure all this out, not yours! However...

The whole point of AK is to listen to feedback, so one has to listen to the feedback of the actual progress and how the patient is feeling (in addition to regular test results), not just slavishly follow applied kinesiological tests to guide treatment in its entirety. In other words common sense, wisdom and a wider awareness of protocols and perspective is required. Being locked into any one approach rigidly is rarely a good thing.

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Applied Kinesiology and Supplements:

When a patient or practitioner becomes aware of a particular problem, there are a large array of supplement types, manufacturers, formats and so on to choose from for that particular application; which are all theoretically (and on paper) the right tools for the job. Many practitioners stick to a certain brand for all patients, or a fixed combination of herbs or antioxidants for example, to address a certain classification of problem. However, this does not take into account the relative properties of the supplements and how they affect the body on an energetic level. Progress may be affected depending on which set of supplements one takes. This is likely to be different for each individual at a given point in them. Some may be helpful, some of limited benefit, and some cause more bodily confusion or imbalance than do good.

Remember that not all supplements are created equal. Your body can probably utilise some types/forms/brands better than others, and many your body is actually subtly allergic to, and which won't do you any good at all, and will just waste your money. This is usually true of cheaper brands. However, certain types of supplement may not be effectively utilised by your body at any one point in time. A good naturopath should be able to determine what works best for you, what your body needs, kinesiologically. This may sound strange, but it does work. Black Spy was highly sceptical at first about Applied Kinesiology. AK testing of supplements again is a skill that an individual practitioner will have, and they may be excellent at it, average, below average or awful! Certain brands tend to agree with the vast majority of patients for the vast majority of the time. An example of some high quality, non-allergenic supplement brands includes Nutri, Metagenics, Vital Nutrients, Jarrow Formulas, Thorne Research, Nutri-West, BioCare, etc. Nutri capsules are quite fragile and have a habit of breaking in the jar. Other brands tend to show an allergic reaction to the body nearly all of the time with all patients, such as Solgar or Holland and Barrett. But it is clearly dependent on the individual. 'Out of the box' supplements tailored (and marketed) by their manufacturers for specific health problems are not always effective (and are often self-prescribed). They may not provide the constituent ingredients in the right ratios, in the required concentrations and of the right quality for that individual. In specific cases, you may need to overrule the AK test result about a specific supplement and use your common sense. But as a general rule it is extremely useful.

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Bio-Resonance Testing:

Applied Kinesiology (AK) is a form of bio-resonance testing. There are other forms of bio-resonance testing available and vary according to the naturopathic practitioner. Some forms use mechanical or electronic devices. Bio-resonance testing may require the presence of the patient whereas others may only require a spot of blood taken from the patient's finger (perhaps akin to AK testing but on a blood spot rather than an actual patient).

Links to various electronic bio-resonance or bio-feedback devices can be found on the Links page, including VIBE, QXCI, VEGA, Rife and others. These operate on the basis of detecting deficiencies in the patient who holds two metal cylinders, linked up to the machine. They incorporate a software algorhythm that determines the diagnosis. Some even claim to use the sessions on the devices as a form of treatment.

Bio-resonance testing in general can determine potential issues with a patient including mitochondrial dysfunction, toxicity, adrenal issues, electromagnetic imbalances, emotional imbalance etc.

BlackSpy personally recommends using the skill, training and awareness of a practitioner in an accepted discipline such as that described in the previous section on Applied Kinesiology testing, as opposed to using a consultant with a programmed electronic bio-feedback device with clearly less ability and sensitivity. Such devices rely on the skill of the algorhythm that the devices are programmed with. Whilst they may well correctly diagnose a need or deficiency, the practitioner then usually takes this information, and picks an off-the-shelf supplement to give to the patient, which may or may not be optimised for that particular patient (in terms of brand or format or otherwise). In addition, many unskilled and sometimes slightly clueless practitioners come to rely on such devices too heavily to make up for actual talent and ability, and years of training and practice. One good thing one can say about using such a method of diagnosis however is that it is perhaps quicker and more efficient than using AK testing alone, where the practitioner has to figure out and ask the right questions of the body to obtain the right answers - but in the process of doing so may involve assisting the body to gain memory which can be a good, energising thing. However, the choice of practitioner and testing style you choose is up to you of course.

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