Functional Lab
Testing Guide .
© 2022, 2024 Integrative Nutrition, LLC
Functional Lab Testing Guide .
How can healthcare honor the bio-individuality of clients seeking to improve or
maintain their health? While the options used to be less available, there are now many
approaches and practices founded in addressing an individual’s unique health needs.
One practice is through functional lab testing, where functional providers work
together with their clients using data points, or biomarkers, to uncover and address
the root cause(s) of an imbalance. A functional medicine approach considers how the
body’s systems are interconnected and emphasizes a client’s complete health story
and lab results in testing, diagnosis, and treatment.
WHAT IS FUNCTIONAL LAB TESTING?
Functional lab testing is a comprehensive clinical tool used in functional medicine
to better understand the symptoms and dysfunctions that clients experience.
Though sometimes helpful in making a diagnosis, functional lab testing is more
about collecting information about what’s going on in the various body systems and
interpreting this information to determine how well a client’s body is working. These
tests can often be done by a client at home and sent directly to the lab and therefore
are used extensively by many nonphysician providers.
Functional labs seek to identify the root causes of a symptom and thus provide
valuable insight and information beneficial for healing. They are key players in early
detection, before an imbalance becomes a pathological disease.
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A conventional approach to lab testing, on the other hand, is geared toward
identifying pathology and disease. Conventional lab tests may provide acceptable
lab ranges, whereas functional lab tests are more narrow and provide optimal
ranges. An optimal range is a specific window that, ideally, a functional lab result
falls within if a client is experiencing optimal health. Any test result outside this
range may be considered suboptimal and present a red flag to the practitioner that
indicates some dysfunction is taking place.
Approaches to Lab Testing
Conventional Approach Functional Approach
Identify pathology and disease. Predict and assess dysfunction.
BENEFITS OF FUNCTIONAL LAB TESTING
Because functional lab tests look at optimal ranges, they can help provide validation
for those who’ve been searching for answers to their unexplained symptoms. Many
people have what are considered “normal” results in routine or conventional lab work,
but discover through functional lab testing that their symptoms may be indicative of
an underlying issue.
Functional lab testing is also beneficial because it can observe trends and detect
potential issues early. For example, the conventional lab range for fasting insulin
is wide (2.6–24.9 mcIU/mL), while the functional lab range is much narrower (3–8
mcIU/mL). Referencing this optimal range may help catch insulin resistance and the
risk for diabetes early on.
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Functional lab testing comes from a holistic perspective. When interpreting lab
test results, a practitioner accounts for the patient’s story, their symptoms, and the
relationship between results and other markers to make the best assessment for
their client. The ultimate goal is for the results of functional lab testing to pinpoint
problem areas and guide treatment recommendations that target the root cause of
the issue rather than simply treating the symptom.
TYPES OF FUNCTIONAL LAB TESTS
Functional healthcare providers utilize both basic (routine) and specialty lab tests to
help them see the full picture of their client’s health.
Basic Tests
Basic lab tests are thought of as the foundational assessments that analyze organ
function. These tests may be routine and can be used with both a conventional and
functional approach, the difference simply being the ranges referenced to interpret
the results.
Some common basic labs include:
• Basic metabolic panel • Hemoglobin A1C
• Complete blood count • Lipid panel
• Fasting glucose • Urinalysis
• Fasting insulin • 25-hydroxy vitamin D test
A functional health practitioner might consider the context of two or more basic lab
tests together to gain a more complete understanding of what’s going on with the
client. And unlike the conventional approach, a functional approach often has more
rigorous standards when determining the meaning behind lab test results.
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For example, the essential nutrient vitamin D can be easily tested for through a basic
blood test called the 25-hydroxy vitamin D test. The following table demonstrates
how results for this test might be interpreted conventionally and functionally.
25-Hydroxy Vitamin D Test
Conventional Range
Low <30 ng/mL
Normal 30–50 ng/mL
High >50 ng/mL
Functional Range
Clinically Deficient <30 ng/mL
Sufficient 30–45 ng/mL
Optimal 45–80 ng/mL
Potentially Harmful >80 ng/mL
Note: Results are measured in nanograms per milliliter (ng/mL). Reference
ranges can vary, depending on testing laboratories and expert opinions.
By conventional standards, a vitamin D level of 32 ng/mL might be overlooked when
investigating the root cause of a health concern, while in a functional medicine
practice, it would more likely be addressed in support of optimal health and healing.
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Specialty Tests
Specialty lab tests are advanced tests that go beyond the standards of routine labs.
While conventional medicine providers may order some of the assessments listed below,
most often these are ordered and interpreted specifically by functional healthcare
providers to see a more complete representation of the underlying physiology.
Some common specialty labs include:1
• Environmental toxin test: This urine test is used to assess exposure to many
environmental pollutants, such as pesticides, herbicides, plastics, solvents. High
levels of exposure to these pollutants can lead to chronic health symptoms.
• Genetic test: This can be used to identify predetermined genetic variants and
potential health risks that can be addressed before they create an issue. Of the
many types of genetic tests available, some are focused and target a specific
genetic variant, such as for the MTHFR gene, while others are broad and examine
an individual’s entire genome. Results from genetic testing can inform lifestyle
interventions and help clients understand their unique predispositions.
• Heavy metal test: This urine test analyzes a sample for an overload of heavy
metals, such as lead, mercury, arsenic, or cadmium. High levels of heavy metals
can create toxicity and present as symptoms that generally would be challenging
to pinpoint a cause for, including fatigue, headaches, nausea, or irritability.
• Hormone test: This test (urine or saliva) demonstrates neuroendocrine health
and includes insight on a client’s stress response, adrenal and sex hormone
production, hormone metabolism, and liver pathways. It might be ordered for
someone with ongoing fatigue or irregular menstrual cycles.
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• IgG food sensitivity test: Unlike a food allergy test, a food sensitivity test
specifically measures the immune system’s IgG antibody reactivity to different
foods. Some practitioners also use this test to assess gut permeability, since food
particles that have leaked into the bloodstream can trigger an immune response.
• Inflammation test: Various markers of inflammation can be tested, including
C-reactive protein (CRP), specific cytokine levels, and homocysteine levels (which
can specifically indicate the risk for cardiovascular disease).
• Mycotoxin test: Assessing for a variety of mycotoxins (chemicals found in
mold) is one way to determine if mold toxicity exists in the body and can be
done via blood or urine.
• Organic acids test (OAT): This urine test evaluates the acidic compounds
excreted as the products of metabolism. It has functional markers for
microorganisms, like intestinal yeast and bacteria; vitamin and mineral levels;
oxalates; oxidative stress; and neurotransmitter levels.2
• Small intestinal bacterial overgrowth (SIBO) breath test: This test is
recommended if there’s suspected overgrowth of bacteria in the small bowel
or small intestine, which if left untreated, can lead to malabsorption issues and
nutritional deficiencies. These tests are noninvasive and include the lactulose
and glucose hydrogen breath tests: LHBT, GHBT, and C-D-xylose.
• Stool test: This test examines digestion and absorption, inflammation and immune
function, the presence of pathogens, and the diversity of the gut microbiome. It
may be used regardless of whether a client presents with GI symptoms as the gut
has such an overwhelming influence on other body systems.
• Thyroid test: Functional providers investigate beyond the standard testing for
thyroid-stimulating hormone (TSH) and often include a full thyroid panel that
tests for thyroid antibodies and hormones like T4, free T4, T3, free T3, and
reverse T3 to thoroughly assess thyroid function.
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FUNCTIONAL LAB TESTING CONSIDERATIONS
Functional medicine takes a personalized approach to testing and treating clients,
though not every client will be an appropriate candidate. For instance, if a client is
not consistently addressing their primary and secondary food, it’s typically best
for them to further explore these important aspects of health before opting for
functional lab testing.
Here are some ideal candidates for functional lab testing:
• Clients who’ve already done the basics: They’re applying healthy habits but are
still not feeling their best.
• Clients who’ve exhausted other options: They may have “normal” lab work and have
been deemed healthy by their doctor but are experiencing ongoing symptoms.
• Clients who are motivated by data: They need tangible evidence to feel validated,
hold themselves accountable, or connect the dots between health issues.
Because functional lab tests can be an expensive investment and are usually not
covered by health insurance, an experienced functional practitioner can discern which
tests are necessary to effectively address dysfunction. A functional medicine provider
will take the details of a client’s health story and symptoms into consideration when
strategizing which tests to order. It’s also most valuable to have a trained professional
analyze and address the lab results as this may affect the treatment approach.
A HEALTH COACH’S ROLE
While it’s not within a Health Coach’s scope of practice to recommend, order, or
interpret results of functional lab tests, there may be some exceptions for coaches
working closely with and under the guidance of functional health providers. For
instance, in some functional medicine practices, Health Coaches may receive training
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and supervision that gives them the ability to order and review food sensitivity tests
to guide their clients in implementing an appropriate food plan. More commonly, the
Health Coach supports the treatment plan after the ordering practitioner provides
a summary of the results. For example, if a lab test shows a client’s adrenal glands
require support, the coach would be given that information and asked to work with
the client to develop lifestyle treatment goals around sleep and stress management.
Health Coaches can always help empower clients to talk to their health providers
about available lab testing that may be appropriate for them, based on their unique
health needs. Health Coaches should refer clients to trusted practitioners who are
qualified to address areas outside the health coaching scope of practice.
Upon receiving the results of functional lab tests, many times clients receive a
course of action to implement. Health Coaches can hold space for clients as they
navigate their test results and assist with any behavior changes needed, offering
support, education, and motivation as they make lifestyle changes according to
the instructions given by their functional health provider. Overall, a Health Coach’s
responsibility within this setting is to encourage clients to play an active role and
engage in their own health journey.
THE EXPANDING FIELD OF FUNCTIONAL MEDICINE
Improving health while honoring bio-individuality is a standard focus of functional
medicine. As this field continues to expand, functional lab testing is becoming more
and more available as a tool to gather detailed information about one’s health. The
functional approach to lab testing is one way to support holistic well-being, so it’s
helpful for Health Coaches to understand the foundations of this practice.
Health Coaches who wish to help clients find a functional medicine practitioner
to order and interpret functional lab tests can search the online directory from
the Institute for Functional Medicine: IFM.org.
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FOOTNOTES
1| Cole, W. (n.d.). These are the 6 labs you need to run if you are feeling off.
Dr. Will Cole. Retrieved from drwillcole.com/functional-medicine/these-are-the
-6-labs-you-need-to-run-if-you-are-feeling-off
2| Organic acids test. (2023). Mosaic DX. Retrieved from mosaicdx.com/test
/organic-acids-test
