What kind of testing should I have done for my mental health concerns?
Patients often ask Dr. Cain about certain lab tests, their value and whether or not she recommends them in clinical practice. Below Dr. Cain describes some of the most popular tests and their clinical efficacy.
Laboratory testing for mental health. Learn what laboratory testing you should have done to help you get to the root cause of your mental health concerns.
Dr. Cain selects laboratory testing based on peer-reviewed research of their accuracy and usefulness in the diagnosis and management of patient care. She recommends lab work on a case-by-case basis.
Below is a quick explanation of some of the tests that Dr. Cain is more frequently asked about and their efficacy in clinical practice.
Laboratory Topics:Nutritional Testing
Dr. Cain does not recommend generalized nutritional testing, like the one you may see in the link below. http://www.riordanclinic.org/forms/lab/SampleReport.pdf
These types of testing have no proven clinical value evidenced by case controlled studies.
It is difficult to accurately test nutrients in the body because the blood does not necessarily provide information about the nutritional status of the enzyme systems, tissues or other areas of the body, like bone marrow. It only evaluates the “nutritional status” of the blood at the moment that test was conducted.
Moreover, a blood test may remain normal even in “deficiency states.” For example, a patient may often have a normal serum iron (iron in the blood), but significantly low ferritin which looks at levels of iron that is stored in the tissues. Another example is serum vitamin B12. Often times patients have normal B12 levels, but upon testing methylmalonic acid (a more accurate test for vitamin B12), we are able to diagnose severe nutritional deficiencies.
There is clinical evidence that deficiencies in certain nutrients can cause illness in patients. For example: Thiamine (vitamin B1) deficiency is linked to Wernicke-Korsakoff syndrome, vitamin C deficiency may be linked to scurvy, and iron deficiency is seen in anemia. There are laboratory tests that have been designed to evaluate for certain nutritional deficiencies, for example iron deficiency may be tested with serum iron, ferritin, total iron binding capacity and Transferrin saturation index. Therefore with respect to this, Dr. Cain may order tests selectively based on your clinical presentation, individualizing your care, but does not recommend generalized nutritional tests like the one in the link above.
There is an undeniable link between what you eat and your resulting health. For example, many of us have heard of people who are exposed to peanuts going into anaphylactic shock, or a child who has a sensitivity to milk developing recurrent otitis media or eczema. Respectively, food sensitivity testing is becoming quite popular in alternative medicine. Food allergy tests are typically broken down into three components:
- IgE: Allergic reactions manifest clinically as anaphylaxis
- IgG: Delayed hypersensitivity reactions
- IgA: Delayed hypersensitivity reactions
The test is done by collecting serum (blood) from the patient and evaluating the specimen for immunoglobulins (IgG, IgA and IgE commonly). The immunoglobulins are part of the person’s immune system and the rationale is that more immunoglobulins found in the serum gives indication of a person’s relative reactivity to that particular food.
However there are many factors that can cause false positives and false negatives, rendering these tests as informative but nothing to “hang your hat on.” For example, a false negative in celiac disease blood testing may be seen in patients who stop consuming wheat/gluten before their test . False positives are seen in patients who have over 10-12 positive food allergies, and have what is called leaky gut. This means that foods that are not true allergies, may show up on the panel as foods to avoided.
There are also the additional concerns with lab errors and laboratory accuracy.
If you send the same blood sample to three different labs, often times you will get three different sets of allergy results. In a double-blind controlled study, positive cytotoxic tests were frequently obtained to foods that produced no clinical symptoms and negative reactions were obtained to foods that did produce symptoms . Another double-blind study found the test results varied from day to day .
The most accurate way to determine if you are sensitive to a food, is by doing an “Elimination and Reintroduction Challenge.” Dr. Cain prefers to use this method for diagnosis of food sensitivities, and will only run a food panel only on an “as needed basis.” Even if she runs these tests, does not use this to “diagnose” food allergies.
- The Celiac Foundation: Retrieved from http://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/ on February 16, 14
- Benson TE, Arkins JA. Cytotoxic testing for food allergy: Evaluations of reproducibility and correlation. Journal of Allergy and Clinical Immunology 58:471-476, 1976.
- Lehman CW. The leukocytic food allergy test: A study of its reliability and reproducibility. Effect of diet and sublingual food drops on this test. A double-blind study of sublingual provocative food testing: A study of its efficacy. Annals of Allergy 45:150-158, 1980.
There is no formal laboratory test known as the “Urinary Neurotransmitter Test.” However many doctors are selling urinary monoamine assays under the “spot baseline urinary neurotransmitter testing marketing model.” This test is conducted by taking a sample of urine, and then evaluating it for levels of monoamines (serotonin, dopamine, epinephrine and norepinephrine). The claims are that these monoamines give clinical information about the levels of these neurotransmitters in the brain, and use this to justify supplementation or drug prescriptions.
However, the monoamines found in the urine have not, do not and will not function exclusively as neurotransmitters.
Though they do function as neurotransmitters, as monoamines they are also involved in many major regulatory, autocrine and paracrine functions all over the body besides the brain and central nervous system.
So when we see them in the urine we have no idea where they came from and whether or not they have acted as neurotransmitters.
In the article: Validity of urinary monoamine assay sales under the “spot baseline urinary neurotransmitter testing marketing model,” Authors Hinz, Stein, and Ucini provide a detailed analysis of why there is no clinical efficacy to these tests. Some of their key points are listed below: 
- There are over 100 research studies supporting that most monoamines do not cross the blood brain barrier, they stay in the central nervous system. Serotonin, dopamine, epinephrine and norepinephrine do not cross the blood–brain barrier, so if you measure the peripheral levels of these they did not come from the central nervous system.
- There are also no transport cations of monoamines from the CNS to the PNS, and even there were it would still be mixing with the NT already existing in the PNS and we can’t measure what came from where.
- Monoamines exist in two states, the endogenous state which is the day-to-day state and the competitive inhibition state which occurs when significant amounts of both serotonin and dopamine amino acid precursors are being taken simultaneously.
- Monoamines are not produced exclusively in the central nervous system, and in fact are produced elsewhere in the body. For example: Most of the serotonin or dopamine found in the urine is made or synthesized in the kidney, not the brain.
With respect to the research, Dr. Cain does not recommend neurotransmitter testing in her clinical practice.
4) Hinz M, Stein A, Uncini T.. Validity of urinary monoamine assay sales under the “spot baseline urinary neurotransmitter testing marketing model”. Int J Nephrol Renovasc Dis. 2011;4:101-13. doi: 10.2147/IJNRD.S22783. Epub 2011 Jul 20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21912487
Some clinicians are claiming to use hair analysis for assessment and diagnosis of neurotransmitter imbalances, mineral/ nutrient status and more.
However, according to research, hair analysis is only medically indicated for old or past exposure to cadmium, lead and arsenic. Though these toxicities may be implicated in certain physiological and psychological conditions, these are not typically a part of Dr. Cain’s routine screening. She may order these tests if your clinical presentation justifies analysis of these metals in assessing your health concerns.
There is no peer reviewed clinical research suggesting that hair analysis is an accurate method for testing for anything beyond the aforementioned.
Neurotransmitter testing and the hair: The key elements to consider are: Where are neurotransmitters eliminated from the body, and are these eliminatory organs reflective of the levels of neurotransmitters in the body or the excretion rate?
Neurotransmitters are typically eliminated by the kidneys through the urine, not the hair. Please also see the above comments on the accuracy of using urine testing for central nervous system neurotransmitters.
Mineral testing and the hair: With respect to mineral analysis as diagnosed by hair, the results of measuring metal concentrations in hair even do not generally correlate with those obtained in blood and urine. There are significant issues with these tests including :
1)Contamination by sweat  2)Environmental contamination  3)Influence of previous beauty treatments  4)Critical dependence upon location of the hair sample  5)Paradoxic values depending upon the rate of hair growth  6)Lack of clear definition of a normal range  7)Variable eliminatory processes by the individual 
5) Richard S. Rivlin, M.D. Misuse of hair analysis for nutritional assessment. The American Journal of Medicine Volume 75, Issue 3, September 1983, Pages 489–493. Retrieved from http://www.sciencedirect.com/science/article/pii/0002934383903558 on February 16, 14.
6) Liuzzi, J.P., Bobo, J.A., McMahon, R.J. & Cousins R.J. Zinc Transporters 1, 2 and 4 Are Differentially Expressed and Localized in Rats during Pregnancy and Lactation. 2003 The American Society for Nutritional Sciences.