It’s not uncommon for people with chronic symptoms to have normal test results. This experience can be quite frustrating, as many of you might know, given that abnormal test results often indicate what you can do to resolve your symptoms, whether that’s taking vitamin B12 to address a vitamin B12 deficiency, or eliminating foods high in oxalate from your diet, to address oxalate toxicity. Abnormal test results also provide validation that your symptoms, however unusual, are real. That they’re not in your head. That you’re not just making them up.
But when all of your test results are normal, it can be totally disorienting. You don’t know why your symptoms developed, and you don’t have objective data that validates how terrible you feel, and so it becomes difficult to maintain the motivation necessary to move forward and continue seeking answers.
Without abnormal test results, your practitioners don’t know how to help, and some of them might even imply that your symptoms are insignificant, because you don’t meet the criteria for a diagnosis. They might tell you to come back for more tests if your condition worsens, and maybe then you’ll meet the criteria for a diagnosis, at which point they can provide treatment.
Doing nothing, of course, isn’t an effective strategy. Yet, too often, people with chronic illness, with normal test results, are told to do just that. To wait. To allow the passage of time to reveal whether your health continues to decline, and, if it does, to try some heroic measure at that point.
So, why are normal test results so common amongst people with chronic illness? And what can people do to access tests that can move them forward, rather than hold them back?
To answer these questions, I think it’s important to distinguish between two categories of biomarker tests: conventional tests and specialty tests.
Conventional tests
Conventional tests are used to evaluate whether someone meets the criteria for a disease diagnosis. These tests measure biomarkers that can indicate the presence of a disease process in the body, but don’t measure biomarkers that can indicate why a disease process is occurring. The objective of conventional tests is to answer the “what” question—“what disease?”—which is certainly an important question to know the answer to, if indeed some disease process is occurring that can be halted or reversed.
Let’s say, for example, that you develop chronic joint pain, and you go to your practitioner for help. If your practitioner opts for conventional tests—which most conventional practitioners are likely to do, as these are the tests they were trained to use—they might order rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) to evaluate whether you have rheumatoid arthritis, an autoimmune disease in which your immune system inappropriately targets your own tissue, causing significant pain and inflammation in your joints.
If these biomarkers show autoimmune activity, your practitioner would diagnose you with rheumatoid arthritis, and would then, per the medical guidelines, prescribe medication to help you manage, but not reverse, the disease.
If, however, these biomarkers didn’t show autoimmune activity—if your results were normal—then your practitioner wouldn’t diagnose you with rheumatoid arthritis, wouldn’t prescribe medication, and you might be encouraged to come back for the same tests in the future if your joint pain worsens.
Your practitioner, in this case, used conventional tests to evaluate whether you have rheumatoid arthritis, and it’s important to have these tests conducted to know if you do or don’t have the disease. But, whether your results are abnormal or normal, the helpfulness of the results is limited to informing whether you have the disease or don’t have the disease. The results, if abnormal, don’t indicate why the disease developed, or, if normal, don’t indicate why your joint pain, not attributed to rheumatoid arthritis, developed.
This is where specialty tests come in.
Specialty tests
Specialty tests, in contrast to conventional tests, are used to investigate the causes of symptoms. These tests measure biomarkers that can indicate the presence of specific causal factors, such as infections, toxicities, deficiencies, and imbalances, that are often implicated in the development of chronic symptoms. The objective of specialty tests is to answer the “why” question—“why did symptoms develop?”—which, for people with chronic illness, is a critically important question to know the answer to, given that resolving chronic symptoms requires addressing the causes, or the reasons why physiological function was compromised.
Let’s go back to the same example, in which you hypothetically have chronic joint pain, and you go to your practitioner. This time, however, your practitioner opts for specialty tests, to investigate the causes of your symptoms, and not just whether you meet the criteria for a disease diagnosis. They might order a quantitative polymerase chain reaction (qPCR) stool analysis, to test for parasites, bacteria, fungi, and viruses, and a food sensitivity test, if they suspect that there are foods in your diet that you have an immune reaction to.
If, say, the qPCR stool analysis shows an overgrowth of Helicobacter pylori, a bacterium that colonizes the stomach and, in cases of significant overgrowth, can cause joint inflammation and pain, your practitioner would create a protocol for you to address the infection.
If the food sensitivity test shows an IgG antibody reaction to gluten, a protein found in wheat, barley, and rye that can cause innumerable symptoms, including joint pain, your practitioner would also recommend that you transition to a gluten-free diet to eliminate exposure to gluten.
In this case, your practitioner used specialty tests to investigate why your joint pain developed, testing for parasites, bacteria, fungi, and viruses, and food sensitivities. The results revealed the causes of your joint pain—Helicobacter pylori and gluten sensitivity—and provided the actionable information you needed to recover your health.
Normal test results don’t indicate that everything is normal
Normal test results, for people with chronic illness, don’t indicate that everything is normal. They indicate that the right tests haven’t been conducted yet.
When conventional tests are used, it’s common for people with chronic illness to have normal results, despite their symptoms, because conventional tests aren’t designed to investigate why symptoms developed, but rather to evaluate whether a disease diagnosis can be made. And most people with complex chronic illness don’t qualify for a disease diagnosis.
When specialty tests are used, it’s uncommon for people with chronic illness to have normal results, because all symptoms have causes, and specialty tests can test for most of these causes. There are almost always abnormal factors present that provide insight into why symptoms developed, and identifying these factors is often a precondition to resolving your symptoms and getting your life back.
If you’re interested in investigating the causes of your symptoms with specialty tests, you can schedule a call to learn more about Quantify membership and how we can help you to get the data you need to resolve your symptoms and optimize your health.