2011_dicken_weatherby_presentation.pdf

“Foundations of Functional Blood Chemistry Analysis” – Gi & Liver MarkersDr. Dicken Weatherby, Naturopathic Physician

© Weatherby & Associates, LLChttp://www.FMTown.com http://www.BloodChemistryAnalysis.com 1

Functional Blood ChemistryFunctional Blood Chemistry & CBC Analysis

Introduction, GI, Hepato‐Biliary & Liver D f ti M kDysfunction Markers

How do we typically gather data f i ?from our patients?

• Intake form• History• Physical Exam• Tests run in office

l– Routine urinalysis– Other tests (pregnancy test, strep throat etc..)

• Out‐sourced labs– Blood Chemistry and CBC– Other tests (hormone panels, saliva testing, hair analysis etc..)

Functional Diagnostic Assessments

Primary and Advanced

Primary FDM Assessments• Functional history• Physical examination• In-office tests• Functional blood chemistry analysis



Advanced FDM Assessments• Stool• Saliva• Blood• Hair• Urine

Blood Testing What You Need To Know

Blood Testing Is One of The Most Important Assessment ToolsMost Important Assessment Tools for the Identification of Functional

Disorders and for Disease Prevention

Purpose of Functional Blood Chemistry Analysis:To Help Answer These Questions…p Q

• Is there a dysfunction in this patient? If so, WHERE IS IT?

• What are the sources or CAUSES of the dysfunction?

• What INDIVIDUALIZED treatments are needed?

• When has function been RESTORED

Reasons to Do Regular Blood Testing• Health conditions change quickly

• To catch dysfunctions that are easy to correct if caught in time

• To screen for prescription drug related issuesp p g

• To screen for supplement related issues



Blood Chem & CBC Analysis‐The Standard ApproachThe Standard Approach

• The problem with “Normal Reference Ranges”• “Average” rather than “optimal”• Examples:

Total cholesterol– Total cholesterol– Homocysteine

• The Importance of Maintaining Youthful Blood Test Results

Blood Chem & CBC Analysis‐Th F i l A hThe Functional Approach

• Oriented around changes in physiology and not pathology.

b d i l h i l• Ranges based on optimal physiology

• Use of tighter ranges

Where do these optimal f ?ranges come from?

• “Normal” ranges 20 to 30 years ago.

• Biochemical Biopsy

• Research• Research

• “Old Time Docs”

• Clinical observations

Some Other PointsSome Other Points

• Patterns and trends• Fitting Functional Blood Chemistry Analysis into your practicey p

• Can I review blood tests?• Where to start?



The Functional Diagnosis Hierarchyh ll i

1. The organs of the GI (digestion, absorption, mucosal barrier)

2. The gallbladder3. Adequate detoxification and

elimination (liver kidneys and

6. Kidney and Bladder7. Adrenals8. Thyroid9. Sex Hormones10 C di l S

Assess The Following:

elimination (liver, kidneys, and large bowel)

4. Optimal nutrient levels: tissue minerals , vitamins, and EFAs

5. Blood Sugar Regulation & Oxidative Stress

10. Cardiovascular System11. Inflammation12. The Immune System

Today’s Focus: Markers ForG I Dysfunctions Liver & Gallbladder DysfunctionsG.I. Dysfunctions Liver & Gallbladder Dysfunctions

1. Liver Congestion (fatty liver)2. Biliary Insufficiency3. Biliary Stasis4. Biliary Obstruction

1. Hypochlorhydria2. Atrophic Gastritis3. H. pylori4. Dysbiosis

5. Fatty Acid Insufficiency6. Alcohol Use7. Oxidative Stress8. Detoxification Issues

5. Pancreatic Insufficiency6. Leaky Gut Syndrome7. Parasites8. Protein Deficiency

Gastrointestinal Markers

Gastrointestinal Markers: Reference Ranges

Optimal RangeTotal Protein 6.9 – 7.4Globulin 2.4 – 2.8BUN 10 – 16Creatinine 0.8 – 1.1Phosphorous 3.0 – 4.0Eosinophils 0 – 3%



Element Background

• Total serum protein• Total Serum Globulin• BUNBUN• Eosinophils

Total Protein – Clinical ImplicationsHIGH

Dehydration Liver/Biliary Dysfunction

LOWHypochlorhydriaProtein deficiencyMalnutritionPoor protein breakdownAmino acid needAmino acid needDigestive dysfunction and/or inflammationLiver dysfunction

Globulin – Clinical ImplicationsHIGH

Hypochlorhydria

Liver cell damage

Oxidative stress

LOW

Digestive dysfunction and/or inflammation

Immune insufficiencyOxidative stress

Heavy metal toxicity

Immune insufficiency

BUN‐ Clinical ImplicationsHIGH LOWHIGH

Renal diseaseRenal insufficiencyDehydrationHypochlorhydria

Diet‐ excessive protein intake

LOW Diet‐ low protein

MalabsorptionPancreatic insufficiencyLiver dysfunctionp

Adrenal hyperfunctionDysbiosis

Edema Anterior pituitary dysfunction



Gastrointestinal Dysfunction1 H hl h d i1. Hypochlorhydria

2. Digestive dysfunction/Gastric inflammation

3. Dysbiosis

4 Pancreatic insufficiency4. Pancreatic insufficiency

5. Parasites

6. Protein deficiency or impaired protein digestion

Hypochlorhydria ‐ Causes• Aging

• Stress

• Carbohydrates

• Zinc and Thiamine Deficiency

• Drugs

• Lack of protein in diet

Hypochlorhydria ‐ Effects• Poor digestion

• Pancreatic insufficiency

• Reduced absorption of nutrients

N t i t d fi i i• Nutrient deficiencies

• Increased bacterial infections

• H. pylori infections and ulcers

Hypochlorhydria – S/SX• Gas belching bloating• Gas, belching, bloating

• Heartburn

• Nail problems

• Hair loss

• Dermatological problems: Acne rosaceaDermatological problems: Acne rosacea

• Iron deficiency anemia

• Asthma

• Intestinal parasites



Hypochlorhydria ‐ Pattern( )• An increased total globulin (>2.8)

• Normal or decreased total protein (<6.9) and/or albumin (<4.0)

• Increased BUN (>16)• Decreased serum phosphorous (<3.0)• Other values• Other values

– Gastrin– MCV– Calcium– Iron– Alk phos

Functional Testing for Hypochlorhydria

• Functional Physical Exam• Functional Urinalysis

–Urine indicanUrine indican–Urine sediment–Urine calcium

Physical Exam Findings for HypochlorhydriaHypochlorhydria

• Nutritional Physical Findings– Adult acne– Dilated capillaries on nose and face– Dandruff

Soft poor growth of fingernails– Soft, poor growth of fingernails– Brittle and splitting nails

• Functional Physical Exam Findings– HCL & Pancreatic Enzyme Points– Chapman’s Reflex

The HCL Point



The Enzyme Point Upper GI Chapman’s Reflex

Helicobacter pylori

H. Pylori ‐ Symptoms• The symptoms of an H. pylori infection include:

– Discomfort in the upper GI especially upper left quadrant discomfort

– Bloatingg–Nausea–Maybe even vomiting.



H. Pylori Pattern• An increased or decreased total globulin (>2.8 or < 2.4)• Increased or decreased total protein (<6.9 or > 7.4)• Increased or Decreased BUN (< 10 or >16)• decreased serum phosphorous (<3.0)• IncreasedWBC count (>7 5)• Increased WBC count (>7.5)• Increased Neutrophils (>60)• Decreased Lymphocytes (<24)• Normal or Increased Monocytes (N or >7)

H. Pylori ‐ Advanced FDM Testing

• Blood test to measure H. pylori antibodies

• Breath test

• The H. pylori stool antigen test

• CDSA

• Allopathic Testing– Endoscopy with tissue biopsy

A hi G i iAtrophic Gastritis

Gastric Inflammation

Atrophic Gastritis ‐ Gastric Inflammation• Causes

– Pain killers (Aspirin, NSAIDS etc.)– Alcohol– Stress– Hypochlorhydria

• Common symptomsCommon symptoms– Epigastric pain– Poor appetite– Heartburn

• Long Term Effects



Atrophic Gastritis ‐ Patternp

Decreased protein (<6.9), Decreased total globulin (<2.4), Decreased serum phosphorus (<3.00), Increased BUN (>16), Decreased Creatinine (<0.9)Chronic versus Acute

Dysbiosis• Background

• Common Causes

S t• Symptoms

• Finding on Chem. Screen: Increased BUN (>16)

Other GI Dysfunctionsl b l• Intestinal Hyperpermeability

– Definition

– Common Causes

P tt– Pattern• An increased Alkaline (>100),• Serum Uric acid (>5.9)• Serum gastrin levels may also be elevated.

Other GI DysfunctionsP i I ffi i• Pancreatic Insufficiency– Decreased BUN (<10), – Elevated GGT (>30) – Decreased WBC count (<5.0)Decreased WBC count ( 5.0)

• Intestinal Parasites– Increased eosinophil count (>3)



Protein Malnutrition and DeficiencyExpect to see the following: Decreased BUN (<10) Creatinine (<0.8) T t l P t i (<6 9) Total Protein (<6.9)

Review diet and consider hypochlorhydriasupport

Liver and Gallbladder Markers

SGOT/AST SGPT/ALT & GGTPSGOT/AST, SGPT/ALT & GGTPGetting the Most from the

Liver Panel

Liver Panel‐ Reference RangesTest Standard

Reference ValueOptimal Value

Alarm Ranges

SGOT/AST

0 – 40 U/L 10 – 30 > 100

SGPT/ 0 45 U/L 10 30 > 100SGPT/ALT

0 – 45 U/L 10 – 30 > 100

GGTP 0 – 85 U/L 10 – 30 >100



AST, ALT & GGTP‐ LocationSGOT/AST SGPT/ALT GGTP

Skeletal muscle Heart Liver

Liver Skeletal muscle Heart

Liver/Gall bladder

Prostate

Kidney Lungs

Kidney Pancreas

Liver Dysfunction• A moderate rise in SGPT/ALT can alert us to functional problems within the liver: – Developing liver dysfunction– Liver congestion (fatty liver)– Detoxification/ Oxidative stress issues– Conjugation problems– Liver cell damage

Fatty Liver ‐ Causes• Diet: fiber deficient diet, trans fatty acids, refined foods, excessive calories

• Free radical exposure and oxidative stress• Obesity• Excessive alcohol consumptionExcessive alcohol consumption• Prescription drugs (e.g. steroids)• Iron overload• Solvent exposure

Fatty Liver –l lEarly Development Pattern

Early development of fatty liver is possible if:• SGPT/ALT is decreased (<10) with • Decreased albumin (<4.0 or 40)

I d t t l h l t l ( 180 4 66)• Increased total cholesterol (> 180 or >4.66), • Increased LDL (>100 or >2.6 ) • Increased triglycerides (>80 or >0.90)• Decreased HDL (<55 or <1.42)



Fatty Liver‐ Late Stage• SGPT/ALT is increased above the SGOT/AST and GGTP levels

• SGPT/ALT may be elevated as much as 4 times the upper limit of normalthe upper limit of normal.

• LDH elevated >240• Alk Phos elevated >140

Gallbladder and Liver Markers

Getting to the Bottom of Your Patients’ Gallbladder and Liver Dysfunctions

Gallbladder Function‐ Reference RangesOptimal Range

GGTP 10 – 30

Alk Phos 70 – 100

Bilirubin- total 0.1 – 1.2 or 1.7 – 20.5 mmol/LBilirubin- direct 0 – 0.2 or 0.0 – 3.4 mmol/L

GGTP – Clinical ImplicationsHIGH

Dysfunction located outside the liver and inside the biliary treeBiliary stasis/insufficiencyBiliary obstructionLiver cell damageLiver cell damage

Alcoholism (GGTP production induced by alcohol) Acute/chronic Pancreatitis

Pancreatic insufficiency Obesity (elevated as high as 50%)



Alk Phos ‐ Clinical ImplicationsHIGHHIGH

Biliary obstructionLiver cell damage

Bone: loss/increased turnover or bone growth and/or repairand/or repairLeaky gut syndrome

Herpes zosterMetastatic carcinoma of the bone

Total Bili – Clinical ImplicationsHIGH

Biliary stasisBiliary tract obstruction or calculiOxidative stressThymus dysfunctionThymus dysfunctionLiver dysfunctionRBC hemolysisGilbert’s syndrome

Hepato‐Biliary Dysfunction

Biliary Insufficiency and Stasis

Biliary DysfunctionBiliary Dysfunction• Biliary insufficiency

• Biliary stasisBiliary stasis



Biliary Insufficiency ‐ CausesBiliary Insufficiency Causes• Changes in metabolism • Diseases affecting function• Diseases that reduce levels of hepatocytes

Biliary Stasis ‐CausesBiliary Stasis Causes• Supersaturation of the bile • Decrease in bile acid formation• Decrease in phosphatidylcholine secretion

Biliary Insufficiency & Stasis ‐ PatternBiliary Insufficiency & Stasis Pattern• Pattern for both:

– GGT >30, – Bilirubin >1.2 or 20.5 mmol/L,– Alk phos > 100

• Complications

Biliary Dysfunction: S/Sxs• Pain between shoulder blades• Stomach upset by greasy foods• Loose, bulky and offensive

stools• Greasy or shiny stools

• Light or clay colored stools• Dry skin, itchy feet or skin peels

on feet • Headache over eyes• History of gallbladder attacks y y

• Nausea• Sea, car, airplane or motion

sickness• History of morning sickness

y g• Bitter taste in mouth, especially

after meals• Dark orange urine



Biliary Dysfunction: PE• Nutritional Physical Exam Findings• Functional Physical Exam Findings

– Check for a positive Murphy’s sign – Check chronic gallbladder sign– Check Liver Reflex Point– Check for tenderness in the Chapman reflex for the liver‐

gallbladder • Functional Urinalysis

– Increased urinary sediment levels

Liver Reflex Point

Chapman’s Liver/GB Point Early Biliary Obstruction ‐ PatternEarly Biliary Obstruction Pattern

• Elevated total bilirubin (>1.2 or >20.5 mmol/L) • Increased GGTP (>30),

/• Increased SGPT/ALT (>30),• Increased alk phos (>100) and/or • Increased LDH (>200).



Extrahepatic Biliary Obstruction ‐P ttPattern

• GGTP (>85)

• Alk Phos (>140)

• Normal or increased SGOT/AST (>55)

• Normal or increased SGPT/ALT (>55)

Additional Patterns• Alcohol Use

– Increased GGT (>30) with– Increased Triglycerides (>110 or >0.9 mmol/L)– May see elevated SGOT/AST and SGPT/ALT levels (>30), but y / / ( ),the GGTP will usually be higher.

• Fatty Acid Insufficiency– Decreased triglycerides (<70 or < 0.79 mmol/L) and/or– Decreased total cholesterol (<160 or < 4.14 mmol/L)

AlbuminAlbumin

i f i d id iLiver Dysfunction and Oxidative Stress

O idati e Stress Reference RangesOxidative Stress‐ Reference RangesOptimal Range

Cholesterol 160 – 180 or 4.14 – 4.66 mmol/L

Albumin 4.0 – 5.0



Albumin – Clinical ImplicationsLOW

Liver dysfunctionOxidative stressHypochlorhydriaVitamin C needEdemaDigestive dysfunction

Oxidative Stress

• Chem. screen as an assessment of oxidative burden

• Cholesterol as an antioxidantCholesterol as an antioxidant

• RBC Hemolysis and Oxidative Stress

Oxidative Stress Pattern Total cholesterol level suddenly below its historical level

and seen with: Decreased albumin (<4.0) Decreased platelet level (<150) Decreased lymphocyte count (<20)y p y ( ) Increased total globulin (>2.8 or 28) Increased Uric acid level (>5.9 or >351 men and >5.5 or 327

women) May also see increased Ferritin, bilirubin and LDL levels

Uric Acid

Poor Detoxification



Poor Detoxification‐ Reference RangesOptimal Value

Uric acid Males: 3.5 – 5.9 or 208 – 351 mmol/L

Females: 3 0 5 5 or 178 327 mmol/LFemales: 3.0 – 5.5 or 178 – 327 mmol/L

Poor Detox ‐ Pattern• Poor detoxification associated with:

– Decreased uric acid level (♀ <3.0 or <178 mmol/L, ♂< 3.5 or < 208 mmol/L)

– Normal MCV (82 – 89.9)

– Normal MCH (28 – 31.9)

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2011_dicken_weatherby_presentation.pdf

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