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Diagnosis Misconceptions

We recently had an inquiry as to the methods of diagnosing blood brain barrier (BBB) issues. This person was upset with us because we could not give them a procedure code (CPT) for a specific blood test for that problem. I had suggested a GABA challenge as a way to get an idea of the presence and extent of a BBB breakdown. The person felt that if there were not specific test then how could we comment on it at all.

The illustrates the misconception of how a diagnosis is made. The goal of diagnostic testing is to find an objective measure or biomarker to: Help direct treatment Meaningfully measure the effects of treatment.

Biomarkers are objective, measurable characteristics that are indicators of physiological and/or pathological states or responses to intervention.

Biomarkers are in two categories: DIAGNOSTIC like a throat culture for strep FUNCTIONAL such as cholesterol blood levels

In a few diseases or conditions, a specific lab test for a biomarker is in itself diagnostic and if you have that result, you have the disease and if you have that disease you will have that specific lab result. An example is Down Syndrome. If you test positive for trisomy 21 then you have Down Syndrome and if you have Down Syndrome, you have trisomy 21. According to most experts, if you have an increased visual evoked potential time you have multiple sclerosis and if you have multiple sclerosis, you have increased visual evoked potential times. Cancer diagnosis is made by looking for specific traits on a biopsy in most cases. If you have a certain kind of cancer, you can expect specific histological traits and if you have those specific histological traits you have that type of cancer.

Most diagnoses are not made like that. A rheumatologist will look for rheumatoid factor in helping diagnose rheumatoid arthritis but will use a combination of tests to arrive at a diagnosis as an elevated rheumatoid factor in itself is not diagnostic.

Certain blood profiles indicate an elevated risk of heart disease but a good diagnostician will want an array of tests before arriving at a heart disease diagnosis.

You might be experiencing depression but as real as your experience is, you will not find a specific lab test that will distinguish between depression and other issues. This has been the biggest complaint with using urinary neurotransmitter testing as an aid to diagnosis. Clinicians fail to realize that you need a combination of history, exam and lab testing to help arrive at a meaningful diagnosis in order to direct treatment and help in measuring treatment outcomes.

As always, we measure, treat and re-measure. Sounds simple enough.

So when it comes to blood brain barrier problems, we do not have specific biomarkers that are diagnostic. Rather we rely on functional biomarkers along with clinical history to arrive at a diagnosis. We can still use these functional biomarkers the same way a cardiologist would look at triglyceride and LDL cholesterol levels to help determine risk and progress.

What are good indicators of blood brain barrier and intestinal barrier problems? The reason I put these two together because you probably cannot have one without the other.

First we want to consider the clinical history. A person with many food sensitivities and who is experiencing brain fog and some memory problems should be considered at high risk for barrier issues.

We can use Cyrex Labs Array 2 to test for zonulin for example. We also look at IgA, IgG and even IgE testing to give an idea of antibody activity in the blood. We can imply that a healthy intestinal barrier won't be letting that many proteins into the blood where the immune system has to be on such high alert.

And of course, the GABA challenge is a subjective test but still gives us some information about the size of biochemicals that have direct access to the brain.

In summary, most diagnoses are made from a functional point of view. In some cases you can rely on the specific diagnostic biomarkers but not usually.

It takes work to piece together information to come up with a meaningful diagnosis along with effective and directed treatment. That has always been our goal at Schlenger Chiropractic and now