Lab Testing 101: Which Labs to Order First

Hello everybody, Dr. Dan Kish here, and I am speaking to you today about lab testing 101. What lab tests should you start to order first? Very straightforward topic, and we want to impact your life. Our goals here are to get you starting to order labs, learning how to start a functional medicine practice. A successful functional medicine practice requires you have a ton of labs, and the first set of lab kits is the hardest. Promise, it gets easier after a little while.

So, in this class, I want to tell you what are the three essential kits that you need to order. You don't have to order all three, just pick one of them, okay? But you could order all three if you want. And how to, uh, get your mind around how to explain this to patients so you can get this started. And then we'll talk a little bit about matching the right test with the right patient so you get the right fit, because it's very easy to order a great test on the wrong person, and then the results are not so great. And there are so many different roadblocks to this. We're trying to overcome that. We have developed a whole series of different things for you all to get started because the goal here again is just to get you to order your first lab. I'll talk a little bit about my background, we'll get into the lecture slides, and then we'll have time at the end for any questions you guys may have.

So, I am Dr. Dan Kish. I've been in the functional medicine space since 1992. I've trained thousands and thousands of practitioners in how to start successful practices. I've worked with the Mayo Clinic. In fact, a whole group of Mayo Clinic doctors took my training program quite a few years ago. We did a research study together. I'm working right now with Dr. Richard Lord, who's the premier lab scientist in our industry. He's been retired for a long time, but he's really quite a character, and he and I have developed a lot of course content over the last 10 or 12 years. I'm IFM certified. I actually practice, have been for a long time, but primarily I'm really focused on teaching and getting doctors up to speed on how to do these tests. And one of the things that my team and I realized a year or so ago is that a lot of people new to the field don't know exactly how to get started. And so we've developed this whole series of courses specifically for you who want to know how to get started. And so, in addition to what we're doing right now, this free webinar we're doing right now, we have also offered this group, you this class called "Getting Started with Functional Medicine Labs." It's a four-week course. It's, I think it's free. Yeah, it's free. See the free thing there? It's $1,000 worth of material that we put together, and we're just offering it to you guys so you can get started with your testing. So you can scan that QR code, you can use the code SUPERCHARGE23, and it'll drop the price down from a thousand bucks to free. And then you can get in there, and I'll show you at the end of this call what's in that class. You can see, you know, all the, basically, it's a series of dialogues and scripts and techniques for explaining to patients why these labs are important so patients start to do the labs, okay? There's, it's broken out. There's three different sections within this one class. There's one on adrenals, one on GI, and one on organic acids. We're not expecting you to do all three. We're expecting you to pick one. You can do all three, they're all three available to you, but I would probably pick one and start with it. And in a month, if you listen to that class and you come to, we're going to have a few live calls as part of the course too. You come to the live calls, listen to that class, at the end of the month, you'll be able to get patients to do an adrenal lab or a GI lab or organic acids, whichever portion of the course that you choose, okay? It's a technique that we've used with hundreds and hundreds of doctors. It's easy to learn. It'll give you all the information that you need to get started, okay? Again, so you can scan that QR code and hopefully you guys can all sign up for that class too. That gets you over the hump, I promise. I promise once you've done that.

So, you know, one of the issues that is that we're mission-driven healers, aren't we all? You know, and that we're struggling, you know, with the challenges of this current health system, and we're trying to find a solution. And we're trying to move away from just doing an acupuncture practice or just doing chiropractic, or maybe you're just in primary care, you want to add functional medicine as a component to what you're doing. And in order to do that, you have to figure out how to order labs. And then there's a little bit of a conundrum because there's a roadblock here where you want to get started doing a functional medicine practice, but how do you get started to ordering your labs when you haven't ordered the labs? You don't know how to interpret them yet, right? So there's a pretty big roadblock. And the first step is to just learn how to dialogue with a patient so you can explain to them the value and the purpose of the lab. And then there are people like me to rely upon, and the lab companies themselves to help you interpret the test once you get it ordered. That's the second sort of phase. And I see this as a superpower because once you learn how to interpret labs at a really high level, it's just amazing the kinds of things that you can identify and help people with. It's just incredible. But in order to even get started with that project, you need to figure out, you need to be basically a matchmaker. You need to understand the importance of the information that is gathered in each test, and then figure out the history and the symptoms of a given patient, and then be able to connect those two. And I call that the condition description technique. You're taking the condition that they're experiencing, their chief complaints, and describing why these labs are so relevant for them. And that's what the month-long free class has, okay? It has this one here that you can scan your QR code. This one has condition description technique drills and practices and lessons that you learn in a month, and then you practice them on your patients, and a month later, you'll be able to do this, okay? No problem. But you need to have that to develop the superpower. You need a little bit of a head start to make that happen, and that's what that course is.

So, there are four steps that you have to get in order to order labs. You have to, obviously, understand what your patient needs are. Figure out which of these three essential labs that we're about to talk about are the best fit. So just pick one in the beginning and get one test ordered. Really shooting for one test ordered by each one of you, just to get the ball rolling. Then you're going to educate your patient as to the value and purpose of the test. Now that you've determined which one you want them to do, now they are excited about it. And then you can interpret the lab, design and protocol. So again, in that one month free class that we're doing, we have a session at the end of that class for lab interpretation. So if you order your first lab now, adrenal, GI, or organic acids, by the time you're enrolled in that class and we're at the end of that class, that lab will be back, and I will one-on-one step you through that interpretation in the last of those live calls. So we're going to actually have people submitting the labs that they order. I'll interpret that first lab for you, I'll give you the protocol, so you don't have to worry about that first test. Take all the stress away, okay? And by the way, that was done for me 30 years ago when I ordered my first test. I called the lab, well, my second test, I should say. My second test, I called the lab, and Dr. Timman spent, you know, four or five hours on the phone with me describing what I was supposed to do about that case, and I was hooked after that, completely hooked on lab testing ever since that day, okay? So I want to try to offer that same experience to you guys so you don't have that nervousness about interpreting the test. It's a horrible feeling, I understand that.

So, step one, understanding your patients. You've got to listen to them. You know, not too much. If you listen for hours, you're just going to get confused. But, you know, 10 or 15 minutes about what are they experiencing? What's their problem? Is it fatigue? Is it GI issues? Is it sleep and anxiety? And again, with these first three tests, we're looking at adrenals, GI, and organic acids. So we're looking at fatigue, GI issues, and sleep and anxiety type problems. You then want to match your listening skills and the understanding of your patient challenges with the right lab. So, okay, this person is having this moment, I'm going to do this lab. And then once you get the category right, it's confusing. So I don't want to tell you exactly which kit to get because if you look at any of these lab companies' websites, they might have like 10 different labs for adrenal and 16 different GI tests. It's absolutely overwhelming. So I'm going to tell you exactly which one in a second here, okay? And then you're going to talk to your patient about why that's so important so they get super excited about doing it. So in the beginning, in the beginning, to me, is the first year or so of doing this. Just pick from the three basic tests. Don't order a super complex advanced lab kit when you're just getting started. You know, designing and then applying an advanced protocol based on a complex test for a complex patient is incredibly difficult. You think about any other subject area that we learn about, like my best friend Matt is a carpenter. His first job was changing a disposal in someone's house. Now he can build a house from the ground up, you know? But he didn't start with his first job saying, "Hey, I could build you a house over there." No, we, we start simple, and then you add to your skill set. It's the same thing in functional medicine, okay? You want to start simple.

And here we are. Figure out how to talk to your patients to decide which of these three tests to start with. Either adrenals, especially if they have fatigue as their major symptom. A GI test if they have GI symptoms, functional GI disorders. We'll explain that a little more in detail in a second, as their main symptom. Or organic acids if they have symptoms around sleeping and anxiety and mood. That would be more like maybe neurotransmitters, and you'll see the neurotransmitter markers on organic acids. So again, adrenals for fatigue, GI for GI problems, and organic acids if it's more like sleep, anxiety, and low mood. So you have three different options there. And then you want to match the patient with the right test. So first of all, pick a patient you're comfortable with. You know, find someone that's easy, that's comfortable, that you're maybe already familiar with, or a new patient that just seems really open to this kind of work. And keep it to fatigue and GI upset and mood issues. And then select one of the basic test kits, okay? I'll, I'll go over the exact labs in one second. I'll show you that. And then, when the interpretation thing comes, you can join the free call in the free class that we just showed you the QR code, and I'll interpret the lab for you in that class, so you don't have to worry about the interpretation part, okay?

So, the second step, determining which labs are the best fit. So you can definitely order the right test on the wrong person. So you don't want to start with your most severely chronically ill patient. Everybody that's, every, I used to work at one of these labs. I used to have 500 accounts that were directly under me, and I had to service all these accounts as, like I was, like the, I don't know what you call it, customer service, but it's also helping with interpretations. Every single one of my clients back then, and this was in the '90s, would order the first adrenal lab on the most complex patient in their practice. And of course, you're not going to be able to fix their super complex people if you're just getting started. So choosing the right patient is super important. And not going, and everyone's intuitive first move is to think of the patient that they have never helped, or the patient that's been to 10 doctors and was never helped, and wanting to start there. That just doesn't work well. You'll have bad outcomes because you don't have the experience yet to know how to navigate a really complex case. So you want you to start simple, pick the right person, okay? And then pick the right test. And you can do all, there's all kinds of different ways you can mess this up. We would not dwell on the negative, that's true, with the positive, okay?

So, starting with adrenals. It's easy to start with adrenals first. Pretty much everybody is stressed. It's not that expensive, and it's easy to do because it's just a bunch of saliva samples. And people, if you design a good adrenal program, and I will help you with that, okay, in that other course, then it makes a really big difference. People are going to feel better, they're going to sleep better, they're going to have more energy, they're just going to have a little more zest for life. They're going to recover from exercise easier, their blood sugar gets more stable. Lots of really good things happen with adrenals. So that's a nice place to start because you get this positive reinforcement with a person feeling better. Patient feels like, "Oh, this is really helping." That's a good thing. So amongst the different adrenal lab kits, the most popular and very easy to do is called the DUTCH Complete, okay? And that's from Precision Analytical Lab. The DUTCH Complete. So you're going to go to your Rupa portal and type in DUTCH Complete, click buy, done. You could test yourself, you could test an easy-to-test patient, but that is a standard, great starting test for the adrenals, complete, okay? Immediately, boom, done. So you want to test people that have stress-related fatigue, and not people that have some intense autoimmune disorder or Lyme disease or mold exposure or something that's just horrible and complex. So what's an example of stress-related fatigue? The obvious one is somebody that just had a baby. They were fine before, now they haven't slept in six months. You know, I didn't, my son did, didn't sleep through the night until he was five years old, so I had four and a half years of complete sleep deprivation. You get pretty tired after a while. But it, what, you know, but that's stress related to something identifiable, not a chronic illness kind of problem. You might also have someone who's just going through a divorce, or someone in their family died, or they started graduate school, they just finished medical school, or something like that, you know, where they've been going, they're basically a healthy person but under a lot of stress that caused fatigue. And that's, that's the group that the adrenal programs work the absolute best for, okay? I mean, we test everybody, but these, this is the group that you could really kind of hone in on.

Now, if you want to start with a GI test, totally great. It's only functional GI disorders. So you don't want to test somebody with, you know, advanced Crohn's disease or ulcerative colitis, or somebody that's in and out of the ER all the time, or someone on, with a GI disorder and they're on all kinds of medications. So a functional GI disorder means that it's low-grade. It's like a heartburn, constipation, diarrhea kind of thing, right? They're bloated all the time. Those kinds of problems. And GI testing is great. It's fun because you're usually going to find something wrong that the person had no idea about, and you'll be able to knock out these low-level functional GI disorders most of the time. Not 100%, but most of the time. If you pick a really hard patient, it's going to be hard. Easy patient with, you know, lighter weight problems, it's going to work really well, and they'll be super happy that their all their bloating and heartburn is gone. I mean, that's a really great victory for somebody, you know? Um, and there are different kinds of stool tests. Um, there's some that are either three or four stool samples. I would definitely not do that for your first one. I would do a single sample stool kit. So it's one stool test. That's enough to get someone to do, right? It's hard to get people to do stool testing. And so if you're going to do that, the simple, easy, great place to start for GI testing, a very popular test, it's called a GI-MAP. You probably have heard about it. It's one stool sample for one day. It's a great workup. It's a Diagnostic Solutions Lab. I know Tony and David, who are the two people that started that lab, really well. In fact, I've known them both for almost 30 years, and it's a great test. Couldn't do better. Single sample, lots of data, super popular, and, um, easy to do, okay? Then who do you want to test? As I said, functional GI disorders. So someone that's going to feel dramatically better with some diet changes and a lab-based supplement program. And it's so important to have your confidence built in that first few months and those first few tests that you want to work on people that are going to get better so you can see how effective this stuff is when you're, as you're putting your skill sets together and you're learning all these different tools. So again, heartburn, bloating, gas, people that get upset when they eat tomatoes or GI upset, your salsa makes them feel not so great, you know, but it used to be fine. Um, one group that always works really well for these tests, if you happen to have someone in your practice like this, is somebody that went gluten-free and it helped them a lot, but they still have GI issues that haven't really resolved. That group always does great on these tests. That's like almost 100% sure you're going to help, okay? Um, you may have somebody that has been on antibiotics a lot in the past, that kind of thing. But super simple.

DUTCH test for adrenals, GI-MAP if you want to do a GI test. Now, this is the most complex, but some of you may want to start with organic acids. I'm okay with that. Sometimes it's called a metabolomics test. This would be more for brain or metabolic problems. So that could be focus, mood, sleep issues, anxiety, depression, but not diagnosed depression, like, you know, I'm clinically depressed, just a mild depression, low mood kind of situation. Now, it's a little more expensive than an adrenal test. You get a ton of data, so it's worth it, you know? Um, it's easy to do. It's just a urine sample. There's no blood draw, okay? There's no stool sample, and a lot of times people have pushback pretty hard on this stool testing. So that may be a hard place to start, just so you know. Um, and the brain support, this is why this is just so great, is that people feel better like within a couple of days, sometimes. Sometimes it takes a few weeks, but a good brain program based on organic acids, people are going to feel the difference significantly, and it's not going to take too long. So in this category of organic acids, the most popular test, easy to do, is by a company called Mosaic Lab. They used to be known as Great Plains Lab, and it's called the OAT test for Organic Acids Test, or OAT, okay? So DUTCH test for adrenals, GI-MAP for GI, and an OAT test from Mosaic or Great Plains for organic acids. Now, if you want to do organic acids, again, I would find mild neurotransmitter problems, nothing too crazy over the top, like they don't sleep well or they have focus concentration problems, things like that, okay? Something that's going to get better pretty quickly.

Now, we have on this list here, and you might want to take a little snapshot of this, okay? So we have on this list the, the easy-to-do first recommended test that I laid out, and I just want to show you this so it's really super clear because this is exactly what you need to order your first test, all in one slide. Uh, let me circle here. So, and I mentioned already DUTCH Complete, but hey, maybe for some reason you want to do a salivary test, more power to you. Adrenal Stress Profile from Genova or the Adrenal Function Profile from Doctor's Data. These are all rough equivalents, let's say, as an ENT level adrenal test, depending on what lab company you wanted to use. Again, for the GI microbiome, I'm suggesting GI-MAP. Hey, if you have a Genova, you know, you really like Genova as I do, you could do a GI Effects or a GI 360 from Doctor's Data. So you have a couple options there. And then for organic acids, the OAT test is the most popular. You could also do a Neuro-Hormone or Metabolomics from Genova or an Ometrix test. So I just want to give you some variety in case you have a favorite lab that you, uh, want to order from, okay? But DUTCH, GI-MAP, and OAT, those are, you can't go wrong with those three.

So again, I've developed this whole additional free training. It's crazy and in-depth, and it'll teach you how to get this whole ball rolling. And we've tried this with all kinds of practitioners for many, many years, and it works really well. Works really well. Oh, and then we're also, I'm offering a free interpretation session for any of you that are ordering your first Rupa tests. We'll have this group call that's coming up in a month or so, and if that doesn't work for you, we can do a one-on-one call. We're going to make sure that if you order your first Rupa test, I'll be there to help you interpret it however that has to happen. I'm going to make it happen.

Step three, educating your patient. Okay, so now we're getting into, like, the details again. This is covered in much more, uh, explicitly in the month-long class, but I just want to introduce you to the subject area now so you get a general sense of what we're talking about. So why do you do lab testing in the first place? Well, labs are going to provide a window into the root cause of your patients' problems, and it's going to allow you to develop a personalized program. So you can not just have a generic liver detox protocol that you give to everyone, but when it's personalized or individualized based on their individual biochemistry, based on their genetics, on their environmental stressors, and all that. And then you could just do a gut cleanse program and just guess. But the whole point of this is that you might have an H. pylori program that's completely different from a Giardia program or a yeast program. So doing the test allows you to hone in on exactly what you want to do for a GI issue, or what stage of their adrenals they're in, or what's happening with their brain on their organic acids. Is it inflamed? Or are they stressed? You know, there's all these different variables, and the test just gets you right to the punchline so you're doing the right thing and you can be much more specific and much more effective with your programs. So once you educate patients about that, if you do a good job on it, they're going to be motivated and want to do the test. Once they've done the test, why is that so important? Well, once the labs come back, that's what motivates them to do the supplement program. And when they're buying all those supplements, that motivates them to make the lifestyle changes. As a simple example, if you have somebody and their main problem really is that they drink too much caffeine and too much alcohol, and that's actually their main problem, so you run, uh, organic acids on them, you're like, "Whoa, your liver pathways don't look very good." And you sell them a whole bunch of liver support supplements, all. And then you say, "Hey, part of this program is you need to stop the caffeine and stop the alcohol for a few months." It's the lifestyle change combined with the supplement program that make them better. But you're able to make that lifestyle change recommendation because of the information you got on the lab. So the labs really help you with a more in-depth and more, um, more generally accepted by the patient, also lifestyle change recommendations. And without that, without the labs, I don't even know what we're doing, right? We're just kind of lifestyle coaching, but you're not sure exactly what to tell them, and maybe you're recommending supplements, but you're not sure exactly which ones. And so not only is the program not as effective, but you know, people just don't take them as seriously as they do when there's a test. Now, not everybody just jumps up and wants to buy a test. Some people are going to look at you and go, "That's really expensive. Why won't my health insurance pay for it?" Or something like that, you know? And then other people are going to say, "Well, I don't really want to do the test. And, you know, can I just take what you gave my best friend because that worked for them?" So you, you have to have, you know, some, uh, prepared the person so you can say, "Well, actually, these are individualized programs. They're based on the lab. So just because Susie got better from doing that N-acetylcysteine doesn't mean it's going to make any difference for you. I don't really know. We have to do the testing so we can see." And then for the labs too expensive folks, that's all covered in the month-long class. We talk about this concept called "value" and how you can actually convince people that the labs are worth it.

Well, okay, we had, I had a conference that I went to, this a while ago now, seven or eight years ago maybe, and it was in Columbus, Ohio, and I was teaching a class. It was actually a class on the GI-MAP. I was doing a little tour and teaching all these courses on GI-MAP that year. And this doctor came up to me, and she was the head of a large medical group, and she had a bunch of doctors working under her. And she said, "I don't know if you, what you do in this, in this mentorship class that you teach, Kish, but we call Jennifer over there a lab whisperer." And I started laughing because I never heard that before. I like, "Whoa, lab whisperer?" And this is Jennifer's boss, right? Jennifer was an MD, her boss was an MD. And the boss is saying, "Yeah, I don't know what you do in your classes, but everybody that comes out of Jennifer's office orders all the labs." And we start to call her the lab whisperer. None of my other associates are doing that. And I was like, "My gosh, Jennifer's got like some amazing thing. I don't know what this is." So at the next break, I ran over to Jennifer. I was like, "What's going on?" Like, and she's like, "What are you talking about?" And she said, "I just do what you taught us in class." And really, she's like, "Yeah, that's all it really takes." And when that happened, when that moment happened, I realized anybody can learn this. It's not very hard. And it's not intuitively obvious. None of the other doctors in that clinic had learned how to do this. It's something that eventually people figure out, but it could take five or 10 years, and you can learn it in 30 days. So what the heck? And it used to be a thousand bucks, but now it's not even, doesn't even cost you anything. The class is free, okay? So we're really trying to push the needle here on getting you guys to order your first labs. That's really what we want. And once you do, the success rate of patients that have purchased a lab is just so great because you're going to interpret it. I'll help you interpret it. You know, it's not that hard once you get this whole thing rolling.

Now, the lab interpretation skills development. This is just general advice, unsolicited advice. No one asked me because you guys can't talk because you're all on mute right now. But I'm just going to give you this general advice because I really have seen thousands of practices set up, I've seen hundreds of them fall apart completely, and I don't want that to happen to you. I want you to be really, really successful. So in the beginning, first six months or year of doing this, just focus on the three essential types of labs. This is a body systems approach: hormones, GI, and metabolic. Just get the book knowledge required to understand those labs. Get some clinical experience in those labs. Get, you know, 20 people tested on adrenals or 20 people with GI. Just get that under your belt. And then as soon as you're like, "Wow, you know, I can, I think I kind of got this now." Once you've got the protocols down and you understand how to do the basics, then you can get into mold or cognitive decline or complex cancer workups or autism or whatever the heck you want. But you'll have that foundation in place. And a lot of people don't do it this way. They jump right into the complex stuff and they never have a strong foundation, and it's just not a good way to build the practice.

And then timelines. I have a one-year mentorship program, which is kind of our flagship course. We had one doctor go through that entire training program in about six weeks. For most people, that's not really realistic. If you have kids, if you have a job, you know, or you have friends perhaps, it usually takes people about six months to a year to get comfortable with these three essential tests: adrenals, GI, and organic acids. You've got to learn how to interpret them. It takes a little while. You've got to apply it. You've got to watch those people get better. This whole thing drags out over a longer period of time than you would think. But once you've got 20 successful cases under your belt, you'll be like awesome at this, okay? It takes a little bit of time. So I just, you know, it's not like you can do a weekend workshop and then have this all figured out. It's just not realistic. In fact, that's why I made my mentorship a year-long course.

All right, so now I'm going to wrap it up in a moment, and we'll have time for questions if anyone has a question. And here's the QR code again. So if this approach makes sense to you, you want to learn how to recommend adrenal and GI and organic acids tests, grab a snapshot of this with your phone, get the QR code, jot down somewhere SUPERCHARGE23, SUPERCHARGE23. That'll knock the price down from a grand to zero, okay? And when you get in there, we're going to have a couple of live calls where we're going to be able to talk about this stuff. And you're going to, in a second live call, you're going to be able to present a lab that you're about to order, okay?

And here's our measure for success thing. Set up a group account. Most of you probably already have one, that's fine. And order just one test. One of these three. Either adrenals, if there's fatigue. You can do it on yourself too, obviously. Uh, GI test if there's GI symptoms or you're just kind of curious about your microbiome. And organic acids if you want to focus on like brain and metabolism, okay? So adrenals for fatigue, GI for GI issues, and organic acids for brain or metabolic type problems. Just one test is enough. It's plenty to keep you busy for a little while. If you're super ambitious, if you are like an AP student all through high school, always got straight A's, then you could do all three tests. But that's, we're just trying to shoot for one, you know, one of these. And it doesn't even matter which one. Just pick one that makes the most sense. If you want me to pick for you, I don't know. I think the most interesting one really is organic acids, but it's also the most complicated. So I'd probably start with an adrenal test if I were you. But all right.

So again, this class is coming up. It's starting like now, this week, I think. Is this this week? Yeah, starting this week, okay? So scan the QR code, you can get into that course, you can start to get into that material. We'll have a live call on, uh, November the 9th, which is a couple days away, and we'll do an orientation. And then you guys can get into that curriculum. Pick again, as three different subjects: adrenals, GI, and organic acids. Pick one of those modules, get into it, practice it, and you'll have, you know, you'll have the stuff figured out. And in, in one month, maybe two months, you can become a lab whisperer in adrenals or GI or organic acid. And once you tackle one, the other, the second one's going to be