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October 3, 2024

The 10 Most Commonly Ordered Lab Tests For Naturopathic Doctors

Why This Was Updated?

Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
Medically Reviewed by

As more individuals seek alternatives to the conventional allopathic healthcare model, naturopathic doctors (NDs) stand out as champions of natural healing. Rooted in the philosophy of treating the whole person – body, mind, and spirit – naturopathic medicine focuses on uncovering the underlying causes of illness rather than merely addressing symptoms. 

Lab testing is a highly valued tool among NDs because the results offer invaluable insights into a patient's health and guide effective treatment strategies. By utilizing labs, practitioners can delve deeper into the complexities of an individual's condition, gaining a comprehensive understanding of the body as a whole and the reasons behind their symptoms.

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Understanding Lab Testing in Naturopathic Medicine

Many patients seek help from NDs for chronic issues that often stem from functional imbalances not always detectable in routine testing, such as: 

Wellness optimization and preventive health are also key focuses in naturopathic medicine, with NDs striving to identify early signs of imbalance before they manifest as disease.

Laboratory tests offer NDs objective data to support their evidence-based, clinical decision-making in disease diagnosis and management. Their results provide objective data to support a holistic and personalized approach to healthcare, motivating patients to take responsibility for their health along the way. 

Naturopathic doctors utilize a broad array of specialty lab tests, emphasizing functional assessments rather than solely diagnostic ones. NDs interpret results within an optimal range to identify early-stage dysfunction before it progresses to pathologic disease. (21)

‍Evidence suggests that patients who engage in integrative, holistic care, including naturopathic approaches, report improved health outcomes. 

For example, one study found that patients with cardiovascular disease risk factors who received naturopathic care saw significant improvements in their blood pressure and lipid profiles. 

Another study demonstrated improvements in the symptoms and quality of life of patients diagnosed with moderate-to-severe anxiety.

Top 10 Commonly Ordered Lab Tests

NDs rely upon the following lab tests to provide integrative, personalized, and evidence-based healthcare.

Comprehensive Metabolic Panel (CMP)

A CMP is a blood test that provides valuable information about your body's chemical balance and metabolism. 

The CMP includes the following biomarkers:

An ND may order a CMP for one of the following reasons:

The results from a CMP can provide insight into various health conditions:

  • Abnormal liver function tests (e.g., elevated ALT, AST) may indicate liver disease or damage
  • Elevated BUN and creatinine levels suggest impaired kidney function or kidney disease
  • Electrolyte imbalances (e.g., abnormal sodium or potassium levels) can affect heart rhythm and muscle function
  • High glucose levels may indicate prediabetes or diabetes

Order a CMP with one of these tests:

Thyroid Panel

The thyroid is a butterfly-shaped endocrine gland in the front of the neck. It produces hormones that regulate the body's metabolism.

Thyroid-stimulating hormone (TSH) is the recommended screening test for thyroid function. However, studies show that approximately 7% of thyroid dysfunction cases can be missed when measuring TSH alone, prompting NDs to order a complete thyroid panel for a more comprehensive assessment. (25)

NDs order thyroid panels that include (at minimum):

 A thyroid panel may be ordered in the following situations (25): 

  • Symptoms of hypothyroidism (e.g., fatigue, weight gain, depression)
  • Symptoms of hyperthyroidism (e.g., weight loss, anxiety, rapid heartbeat)
  • Monitoring patients with known thyroid disorders
  • Evaluating abnormal TSH results to determine the cause of thyroid dysfunction
  • Assessing autoimmune conditions affecting the thyroid

Common patterns measured with a thyroid panel include:

  • Optimal TSH, free T3, and free T4 levels indicate normal thyroid function
  • High TSH levels with low T3 and T4 are diagnostic for hypothyroidism
  • Low TSH levels with high T3 and T4 are diagnostic for hyperthyroidism 
  • The presence of thyroid antibodies indicates thyroid autoimmunity that can lead to Hashimoto's thyroiditis or Graves' disease

Order a thyroid panel with one of these tests:

Vitamin D Levels

Vitamin D is a fat-soluble vitamin with important roles in calcium metabolism, bone health, and immune function. It is synthesized in the skin upon exposure to sunlight and can also be obtained in small amounts from the diet.

Vitamin D exists in several forms, primarily as calcidiol (25-hydroxyvitamin D) and calcitriol (1,25-dihydroxyvitamin D), both of which can be measured in blood. Calcidiol is preferred for assessing vitamin D status due to its longer half-life, making it a more reliable indicator of vitamin D stores. (91) 

Deficiency and insufficiency of vitamin D can lead to various health issues, including:

 Despite its immense importance for human health, half the global population is vitamin D insufficient, and another 1 billion people are frankly deficient (83). 

The Endocrine Society established the following reference ranges for vitamin D:

  • Deficiency: ≤ 20 ng/mL
  • Insufficiency: 20–30 ng/mL
  • Normal: ≥ 30 ng/mL

However, given research suggesting that higher vitamin D levels are associated with a lower risk of some diseases, NDs prefer their patients' vitamin D levels to be within a more optimal range of  40-70 ng/mL.

Order vitamin D with one of these tests:

Iron Panel

Iron is essential for the body, primarily for its role in hemoglobin synthesis. Iron deficiency can impair oxygen transport, leading to symptoms like fatigue, weakness, pale skin, and shortness of breath.  

Excess iron can catalyze the formation of highly reactive free radicals, which causes oxidative stress, tissue injury, and organ damage.

An iron panel includes the following tests:

  • Ferritin: Measures the stored form of iron in the body, providing insight into overall iron reserves.
  • Serum iron: Measures the amount of circulating iron in the blood.
  • Total iron-binding capacity (TIBC): Indicates the total capacity of transferrin (the main protein that transports iron) to bind iron.
  • Transferrin saturation: Calculated by dividing serum iron by TIBC, it reflects the percentage of transferrin saturated with iron.
  • Unsaturated iron-binding capacity (UIBC): Measures the portion of transferrin not saturated with iron, indicating how much more iron can be carried in the blood.

NDs order iron panels:

  • To diagnose iron deficiency anemia
  • To diagnose iron overload conditions, such as hemochromatosis
  • To investigate symptoms suggestive of anemia
  • To screen for iron deficiency in at-risk populations (e.g., pregnant women and individuals with heavy menstrual bleeding).
  • To monitor patients undergoing treatment for known iron disorders or those receiving iron supplementation.

Common patterns measured on iron panels include: 

  • Low ferritin, low serum iron, low transferrin saturation, and high TIBC diagnostic for iron deficiency (16) 
  • High ferritin, high serum iron, high transferrin saturation, and low TIBC diagnostic for iron overload (81) 

Create an iron panel by ordering these tests:

Hormone Panels

Hormones are chemical messengers made and secreted into the bloodstream by endocrine glands, including the thyroid, pancreas, adrenal glands, ovaries, and testes. They control hundreds of bodily processes, so when imbalances occur, they can cause body-wide symptoms, including: 

Sex Hormones

The primary sex (reproductive) hormones include estrogen, progesterone, and testosterone. These hormones are produced primarily by the ovaries (in people assigned female at birth) and the testes (in people assigned male at birth) and are responsible for regulating bodily functions related to sexuality and reproduction. (80)

Common sex hormone imbalances in women are androgen excess, estrogen dominance, and progesterone deficiency. These can lead to symptoms like:

  • Acne
  • Hair loss
  • Irregular menstrual cycles
  • Hot flashes
  • Excess body hair
  • Vaginal atrophy and pain with sex

Low testosterone is a common health concern among men, leading to the following symptoms:

  • Erectile dysfunction
  • Low libido
  • Depression
  • Loss of muscle mass
  • Enlarged breast tissue

Order a hormone panel with one of these tests:

Adrenal Function

The adrenal glands are triangle-shaped glands that sit on top of the kidneys and are responsible for making a variety of hormones, including:

Chronic stress-induced inflammation has been identified as an underlying factor involved in the development of cardiometabolic disease, depression, and immune dysfunction. Therefore, NDs frequently measure cortisol and DHEA with salivary and urinary tests to assess how stress affects adrenal function. 

Assess adrenal function with one of these tests:

Comprehensive Stool Analysis

Research increasingly highlights the significance of gastrointestinal health as a cornerstone for systemic health, with various axes connecting gut function to multiple body systems, including the thyroid, skin, joints, immune system, and nervous system. 

This understanding aligns with the root-cause approach to healthcare, which is why NDs prioritize gut health as a primary driver of disease. Comprehensive stool analysis (CSA) plays a crucial role in this assessment by evaluating three critical areas of gastrointestinal health and function: 

Malabsorption, dysbiosis (an imbalance in gut bacteria), and intestinal inflammation have been linked to systemic diseases.

Order a CSA with one of these tests:

Food Sensitivity and Allergy Testing

Food sensitivity and allergy testing help identify individual reactions to foods that may contribute to various health issues. 

  • Food Allergy: Involves an immune system response mediated by immunoglobulin E (IgE) antibodies, leading to immediate and potentially life-threatening reactions, such as anaphylaxis, hives, or difficulty breathing.
  • Food Sensitivity: Involves a delayed immune response mediated by immunoglobulin G (IgG) antibodies, resulting in non-life-threatening symptoms such as bloating, digestive upset, fatigue, and skin reactions that may develop hours or days after consuming the offending food.

Testing for food sensitivities and allergies is warranted in cases of (14, 75):  

  • Chronic gastrointestinal symptoms
  • Allergy symptoms
  • Skin conditions
  • Fatigue
  • Low mood
  • Autoimmune diseases
  • Headaches

NDs utilize food sensitivity and allergy test results to personalize dietary and nutritional recommendations. By identifying specific foods that trigger adverse reactions, NDs can develop tailored elimination diets or suggest alternative foods that support the patient's overall health. 

Order a food sensitivity or allergy panel with one of these tests:

Nutrient Deficiency Panels

According to the World Health Organization, over 2 billion people have nutrient deficiencies that can contribute to disease development. 

The Standard American Diet (SAD) is devoid of essential vitamins and minerals, increasing the risk of nutrient deficiencies. The National Health and Nutrition Examination Surveys (NHANES) data revealed that 31% of Americans are at risk of at least one vitamin deficiency. 

Nutrient deficiencies can produce many symptoms that overlap, making pinpointing specific deficiencies challenging without thorough testing. For example, fatigue is a common symptom that can arise from both iron and vitamin B12 deficiency.

This is why NDs frequently use comprehensive micronutrient tests, which screen for deficiencies in vitamins, minerals, antioxidants, amino acids, and fatty acids. These tests employ methods that offer a better representation of long-term nutrient status compared to those that only measure short-term circulating levels.

Order a micronutrient test with one of these tests:

Oxidative Stress and Antioxidant Status

​​Oxidative stress refers to an imbalance between the production of reactive oxygen and nitrogen species (RONS) and the body's ability to neutralize these harmful compounds with antioxidants. Increased oxidative stress and reductions in antioxidant defenses play a significant role in advanced aging and chronic disease, as they contribute to cellular damage and inflammation.

Elevated markers of oxidative damage, such as 8-hydroxy-2-deoxyguanosine (8-OHdG), are associated with increased oxidative stress and inflammation. Low levels of antioxidants, such as vitamin C or glutathione, impair the body's ability to neutralize reactive oxygen and nitrogen species (RONS), thereby increasing the risk of oxidative stress.

Assess oxidative stress and antioxidant status with one of these tests:

Inflammatory Markers

Chronic inflammation increases the risk of disease and is attributed to 50% of all deaths. Fighting inflammation is a core principle of preventing, treating, and reversing disease. 

The routine measurement of inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), is becoming increasingly more commonplace in the primary care setting for diagnosing and monitoring:

  • Arthritis
  • Autoimmune disease
  • Cancer
  • Cardiovascular disease
  • Infections

Inflammatory markers can help quantify the degree of systemic inflammation and calculate the disease risk. For example, there is a correlation between cardiovascular risk and elevated high-sensitivity CRP (hs-CRP):

  • Low Risk: hs-CRP < 1 mg/dL
  • Moderate Risk: hs-CRP 1-3 mg/dL
  • High Risk: hs-CRP > 3 mg/dL

Measure inflammatory markers through Rupa Health with one of these tests:

Factors Influencing Lab Test Orders by NDs

NDs practice medicine under a framework guided by these six principles:

  1. First, Do No Harm: use the most natural and least invasive therapies possible to minimize danger to the patient
  2. The Healing Power of Nature: nature assists the healing process, and the body holds the wisdom to heal itself
  3. Identify and Treat the Cause: identify underlying causes of illness and remove obstacles to cure instead of focusing on symptom suppression
  4. Doctor as Teacher: NDs support and empower their patients in learning to optimize health
  5. Treat the Whole Person: a holistic approach  to healing realizes that every body system is interconnected
  6. Prevention: focus on health, wellness, and disease prevention 

Lab tests align with these principles by supporting the goal of identifying and addressing the root cause of disease rather than merely treating symptoms. This diagnostic approach complements the naturopathic focus on prevention and whole-person care.

Other factors that influence lab test ordering by NDs include:

  • The potential of the test to change the course of clinical decision-making
  • Patient history and symptoms
  • Holistic and personalized approach to healthcare
  • The patient's socioeconomic status

Best Practices for Ordering and Interpreting Lab Tests in Naturopathy

Testing inaccuracy poses significant risks to patients and healthcare systems, leading to potentially stressful, costly, and even dangerous consequences. Prioritizing accurate testing through reputable companies that utilize standardized testing methods minimizes the risk of testing errors.

As a patient, has your doctor ever told you that nothing is wrong because your test results are normal despite having symptoms that say otherwise? NDs don't look at lab numbers in isolation; they consider each patient's unique health history alongside lab values to differentiate between "normal" and "optimal." This holistic approach to lab interpretation enables NDs to identify functional imbalances that may contribute to symptoms, even if they are not immediately apparent.

NDs also use lab test interpretation as an opportunity to educate and empower patients in their healthcare journey. Appointment times are often longer than expected from a conventional medical doctor's office. This allows the time to open a dialogue about what results mean for the patient's health and discuss next steps – whether that involves lifestyle/diet modifications, natural supplements, prescription medications, or further testing.

Common Challenges and Solutions in Lab Testing for NDs

NDs may face several challenges regarding lab testing, which can impact patient care and treatment outcomes.

One common issue is patient non-compliance or lack of follow-up. Patients may not complete recommended tests due to fear, confusion, or financial constraints. To address this, NDs can:

  • Clearly explain the purpose and benefits of each test 
  • Provide easy-to-follow instructions for specimen collection
  • Offer flexible scheduling for lab work and follow-up consultations
  • Use digital health tools like reminders or apps to track testing schedules and follow-up appointments

Many tests yield intricate data that can be difficult to interpret without specialized training. Tips to overcome this include:

  • Seek out continuing education resources for interpreting and applying complex results to clinical practice
  • Take advantage of the educational interpretative resources many laboratory companies offer to assist providers
  • Use clinical judgment to prioritize key findings and integrate them into a holistic treatment plan
  • Collaborate with other healthcare professionals to discuss complex or unfamiliar results

The cost of tests and lack of insurance coverage can deter patients from pursuing necessary diagnostics.

  • Insurance coverage for functional medicine varies by state, provider, and lab company. Always encourage patients to check their lab benefits before paying out-of-pocket costs.
  • Use cash-pay labs as an alternative to insurance-based labs to improve affordability when insurance does not deem a lab "medically necessary"
  • Order labs through Rupa Health, which provides patients with access to labs for the wholesale price, with an additional 7% ordering fee

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Conclusion

  • Lab testing enhances holistic healthcare through informed testing. By utilizing comprehensive and functional lab tests, naturopathic doctors can uncover underlying imbalances and health concerns that may not be evident through conventional diagnostics. 
  • Lab results support the creation of personalized treatment plans tailored to each individual's unique health needs, ultimately promoting preventive health strategies that aim to optimize wellness and longevity.
  • By embracing a commitment to lifelong learning and staying up-to-date on advancements in lab testing, NDs can enhance their practice, empower their patients, and contribute to a healthcare model that prioritizes individualized care and disease prevention.

Further Reading

Check out these additional resources relevant to this topic:

Naturopathic Associations

American Association of Naturopathic Physicians 

Association of Accredited Naturopathic Medical Colleges 

Rupa Magazine

How to Become a Naturopathic Doctor 

A Beginner's Guide To Functional Medicine Lab Testing

Lab Test Ordering Access by State: The Ultimate Guide

How To Choose The Right Functional Medicine Lab Tests For Your Patient's Health Concerns 

Rupa Health Live & Free Classes

Lab Testing 101: Which Labs to Order First 

Uncovering the Hidden Intelligence in the CMP and CBC 

Thyroid, GastroIntestinal Tract and Forgotten Lab Tests

Supercharge Your Hormone Balancing Expertise With HuMap™!

GI MAP vs GI Effects: Stool Test Showdown  

Food Allergy Testing: An Integral Part of the Functional Workup

The NutrEval: The Intersection of Micronutrient Testing and Cellular Health 

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
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Lab Tests in This Article

Oxidative Stress 2.0 Urine
 by 
Genova Diagnostics
Urine
The Oxidative Stress Analysis 2.0 evaluates two oxidative tissue damage markers. Oxidative stress underlies many common chronic diseases; balance is crucial for slowing or stopping degenerative processes. The Oxidative Stress Analysis 2.0 can indicate the need for dietary and/or lifestyle modification, which can help minimize further oxidative damage. This test cannot be ordered for patients under two years of age.
C-Reactive Protein, Inflammation (CRP)
 by 
Access Med Labs
Serum
This is a single-marker test measuring C-reactive protein (CRP). It is used to test for inflammation, infections, and neoplastic diseases.
C-Reactive Protein, Inflammation (CRP)
 by 
Access Labcorp Draw
Serum
This is a single-marker test measuring C-reactive protein (CRP). It is used to test for inflammation, infections, and neoplastic diseases.
Redox/Antioxidant Protection Assay
 by 
Cell Science Systems
Whole Blood
The Redox/Antioxidant Protection Assay measures the overall antioxidant function of a patient's immune system. It also determines specific antioxidants that may be beneficial to improve a patient's antioxidant function.
Organic Acids (OAT)
 by 
Mosaic Diagnostics (formerly Great Plains)
Urine
The Organic Acids Test (OAT) provides a comprehensive metabolic analysis of a patient's overall health, including intestinal yeast and bacteria, vitamin and mineral levels, oxidative stress, neurotransmitter levels, and oxalates.

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