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Last blog, we discussed sleep apnea, which can have dramatic affects on sleep quality. In this post, I discuss circadian rhythm. Diagnostically, the field of sleep medicine has made huge advances. Less than a decade ago, if you wanted to understand your sleep patterns, it required an overnight stay at the hospital for polysomnography. Now, you can monitor your sleep with a high degree of detail through rings, watches, bedside devices, and more. These devices tells us the proportion of time a person spends in light, deep, or REM sleep. REM is important for memory consolidation and processing. Deep sleep is when  growth hormone is released and repair happens.

Circadian rhythms are set in response to cues from our natural environment. Until very, very recently, our ancestors rose with the dawn and fell asleep soon after dark. There simply weren’t other options! The affect of artificial blue light from devices and screens has been well researched. Melatonin is produced in the pineal gland and is regulated by light-dark cycles perceived by photoreceptors in the retina. Melatonin makes us feel sleepy and keeps us in deep sleep. It is also a powerful antioxidant that plays a role in clearing toxic metabolites out of the brain through the glymphatic system.

Taking melatonin can be part of resetting circadian rhythm, but it isn’t the only strategy. We like sustained release melatonin supplements in fairly small doses – 1-3mg. Research studies have show that achieving deep sleep with melatonin in not dose dependent (at least not in a systematic way). Studies have also shown that regular melatonin use does not block natural production[i]. Ideally, melatonin in taken 2 hours before your desired sleep time, in combination with the practices below.

Resetting internal circadian rhythms starts with increasing (or mimicking) exposure to natural light cues. Melatonin is maximally released in the dark. Studies have show that light exposure between 12am-4am (the normal hours of melatonin production) will inhibit production for the rest of that sleep cycle. (Tip: put your devices in another room so those errant middle of the night disturbances from insomniac friends don’t ruin your sleep!)

Of course, following the circadian rhythm, darkness at night is followed by bright light exposure in the morning. Exposure to bright (10,000 lux) light in the morning triggers a phase shift in melatonin production, meaning it will begin to release earlier that evening. If you have a bad night’s sleep, one of the best things you can do is to take a morning walk in the bright sunlight for 30 minutes. If that doesn’t work in your schedule, consider a full-spectrum light box that emits at least 10,000 lux. I recall when I lived in Seattle and struggled against seasonal affective disorder myself. I had an elaborate system of self-care that included a full-spectrum light on a “Dawn simulator” timer that could be programmed to gradually brighten over 30 minutes for a gentle, full light awakening. It made a huge difference (at least until I walked into the pitch-dark hallway and remembered reality!) We sometimes forget to talk about light boxes as part of sleep disorders here in sunny San Diego but for many people who work indoors, insufficient exposure to high lux full-spectrum light is an easy problem to fix.

[i] Anderson-Ross, K. Sleep, the emerging science and its clinical applications. NDNR Mar 2018

Many of the people who come to see me at my clinic are what I consider excellent “do-ers.” They follow the latest diet rigorously, they take complex regimens of supplements (which I often pare back), and are excellent at applying discipline and restraint in pursuit of wellness. There are, however, other domains of wellness that are equally important and the way we pursue them is both pleasurable and flexible.

This diagram illustrates some of the other domains of well-being beyond physical health, which in turn, have meaningful effects on well-being and physical health. For example, a gratitude practice can make your brain more flexible and resilient. A 2016 study measured brain response and neural activity by fMRI. Subjects were taught to keep a gratitude journal, and then 3 months later, asked to engage in a “pay it forward” activity while in the fMRI. Those that practiced gratitude regularly had greater levels of positive brain activity, especially in the prefrontal cortex – an area involved in higher level thinking.

Another important “non-physical” domain of wellness is community and connection. These are especially relevant this year, as we navigate the new world order of minimizing our in-person social interactions. However, there can be silver linings – fewer friendships provide opportunity for quality over quantity and deeper, more meaningful connections. Science supports the value of connection (not surprisingly). A recent meta-analysis found that social connections protect against chronic stress and increase resilience to the endocrine imbalances that come from stress.

The diagram comes from a colleague’s project, in beta mode currently, that seeks to leverage happiness to boost healthfulness. Nola.com seeks to leverage artificial intelligence to learn what makes you happy, and then provide reminders to keep those things in your life, thus resulting in measurable health benefits such as lower blood pressure and less depression and anxiety.

So, balance out the “do-ing” of your wellness plan with a little more pleasure. Share a delicious meal with someone you care about. Laugh more. Practice gratitude. Volunteer. Do something for someone else. Whatever makes you happy (within reason!) – do it and enjoy knowing you are doing good for your health!

Every successful journey needs a good map, so your road to good health needs the data to ensure you will reach your destination.Think of it this way: If you don’t know the root cause of a problem, you don’t know the best starting point and route to follow. A thorough evaluation of your overall health is essential to plot your road to success.

Conventional medicine typically focuses on just one aspect of that journey. Testing is narrow in scope and focuses on a specific symptom, so any treatment plan lacks the complete data necessary for a holistic approach to healing.

In contrast, functional lab testing has the ability to look at the entire body. That’s because our health isn’t a collection of siloed processes, but rather a complex network. Examining your overall health allows your healthcare provider – and yourself – to take a step back and look at the big picture. A treatment plan is therefore comprehensive instead of merely focusing on getting rid of one symptom.

What Is Functional Lab Testing?

Just as the name implies, functional lab testing aims to determine how your body is functioning as a unit. Most common tests could involve:

• Blood tests

• Saliva tests

• Stool samples

• Urine samples

The data gathered through these tests helps determine the impact of nutrition, stress, environment, hormones, genetics and more on your body. It can also assess the state of your microbiome – the bacteria in your gut. As a result, you have more information to determine the underlying causes of any health issue.

Key Functional Tests

An integrative healthcare practitioner will determine the best tests for you, since there’s no set formula for testing. Some of the most common and informative tests include:

Hormone panel

The impact of your hormone levels on your overall health – both physical and mental – is far-reaching and often underestimated. Unbalanced levels of cortisol, DHEA, progesterone, testosterone, estrogen, androgens, insulin and thyroid hormones can all impact your wellbeing in ways that can be difficult to diagnose through standard tests. Debilitating symptoms like weight problems, mood issues, and fatigue can continue unnecessarily without targeted hormone testing.

It’s often important to have a complete panel, instead of focusing on one, since you want to see the balance of different hormones, like estrogen and progesterone. Hormone testing can be done by blood tests or saliva tests.

Gut health assessments

This is another frequently overlooked function with broad implications on your health. In fact, science is only now starting to recognize that your gut health greatly impacts a broad range of common health issues, including depression, obesity, and diabetes. Even your cardiovascular health is impacted by the microbiome. Modern lifestyles and diets harm your gut by disturbing the delicate balance of bacteria, leading to inflammation and malabsorption of essential nutrients. Tests to gage your gut health include:

• Stool analysis: These tests can uncover issues with malabsorption, which could be caused by damage to the intestine, or conditions like celiac, Crohn’s disease, or autoimmune disorders.

• SIBO breath test: SIBO stands for small intestinal bacterial overgrowth. By measuring the amount of hydrogen in your breath after consuming sugar, it can gage the amount of bacteria in your small intestine, and your ability to digest certain sugars, such as lactose.

• Zonulin antibody testing: Zonulin is a protein that helps maintain the correct degree of permeability in your gut. Testing for zonulin antibodies can help diagnose leaky gut syndrome. Testing for antibodies generally gives more accurate results than testing zonulin levels.

Food sensitivity assessments

Sensitivities to certain foods can have a profound impact on your overall health, but they’re notoriously difficult to diagnose on your own, in part because there is a wide range of possible reactions. It’s best to work with a healthcare practitioner. Tests that can hone in on possible sensitivities include elimination diets with careful records and blood tests evaluating factors such as immunoglobulin G (IgG) antibodies.

Tests for inflammation markers

Inflammation is often a sign that something is amiss in your body, but most standard checkups don’t evaluate for signs of inflammation. Markets to test include:

• C-reactive protein

• Homocysteine

• Ferritin

Elevated inflammation markers don’t necessarily tell you what’s causing problems, but they are definitely a sign to do more testing – and that information can be invaluable. One study found that people with elevated levels of c-reactive protein have an increased risk of heart attack, by as much as three times.

Detox testing

Exposure to toxic substances such as heavy metals, molds or pesticides is another impact to our health, particularly with regards to autoimmune disorders and digestive issues. But, despite the risks, testing for exposure is often overlooked. Methylation is the complex process that removes toxins from your body, and some people have a genetic variation that impacts this process, putting them at greater risk for high levels of toxins. MTHFR genetic testing is one test that can indicate if your body’s detox processes are working as they should.

In addition, heavy metal testing examines the levels of possibly toxic substances like mercury, lead, and cadmium.

Mold has also been a hidden cause of many “mystery illnesses” but is rarely checked in conventional medicine. Symptoms of mold exposure are not always the obvious ones like sneezing or itchy and watery eyes, they can include cognitive impairment, depression, sleep disturbance, brain fog, digestive complaints and more!

Nutrient levels

Deficiencies in essential nutrients can lead to many health issues. Common symptoms include unexplained fatigue, brain fog, mood disorders, and more. It’s important to check your levels regularly, since they can change easily depending on what else is going on in your life – even if your diet remains the same, stress can affect levels of many nutrients, including magnesium and iron. It’s important to review your results with a qualified practitioner, as many holistic practitioners use different standards than conventional medicine does.

Metabolic testing

No matter how good your diet is, a problem with how you metabolize nutrients can lead to health issues.

• HgA1c

• Fasting glucose

• Insulin

• Lipid panel

One important factor in these tests is that they can spot potential issues before they become problems. For example, monitoring HgA1c and glucose levels can help diagnose insulin sensitivity before you develop prediabetes or diabetes. A holistic practice will watch for trends in order to suggest changes before a problem develops.

Interpreting Results

Numbers can tell a story, but they need to be interpreted properly. Just looking at the numbers from testing and only reacting if they fall out of “normal” range can lead to missing the point of the story. After all, the goal for testing should be to determine all of the factors influencing your health, and to determine if you can improve any aspect for optimum health. Aiming for so-called normal ranges will detect the presence of disease, but may not prevent disease from developing. Looking at optimal levels, and using functional tests, can help ensure optimal wellbeing and help prevent disease..

Functional testing helps determine the underlying cause of health problems, and will help you develop a roadmap to a healthier you. Contact us to get started!

Sources

Blottière HM, Doré J. Impact des nouveaux outils de métagénomique sur notre connaissance du microbiote intestinal et de son rôle en santé humaine – Enjeux diagnostiques et thérapeutiques [Impact of newly developed metagenomic tools on our knowledge of the gut microbiota and its role in human health: diagnostic and therapeutic issues]. Med Sci (Paris). 2016 Nov;32(11):944-951. French. doi: 10.1051/medsci/20163211009. Epub 2016 Dec 23. PMID: 28008834.

Aron-Wisnewsky J, Clément K. The gut microbiome, diet, and links to cardiometabolic and chronic disorders. Nat Rev Nephrol. 2016 Mar;12(3):169-81. doi: 10.1038/nrneph.2015.191. Epub 2015 Nov 30. PMID: 26616538.

Vojdani A, Vojdani E, Kharrazian D. Fluctuation of zonulin levels in blood vs stability of antibodies. World J Gastroenterol. 2017;23(31):5669-5679. doi:10.3748/wjg.v23.i31.5669

Ridker PM. Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke. Circulation. 2003 Sep 23;108(12):e81-5. doi: 10.1161/01.CIR.0000093381.57779.67. PMID: 14504253.

Lopresti AL. The Effects of Psychological and Environmental Stress on Micronutrient Concentrations in the Body: A Review of the Evidence. Adv Nutr. 2020;11(1):103-112. doi:10.1093/advances/nmz082