Laboratory tests

Laboratory tests can compliment symptom reports to provide a more complete clinical picture of patients' progress on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP).

Patients who progress on the MP typically experience immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed.. Immunopathology is caused largely by cytokinesAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. generated by the immune response and endotoxins released from dying bacteria. Occasionally, immunopathology will consist of an abnormal lab value such as elevated creatinine, elevated liver enzymes, or low white blood count. This is due to the occurrence of subclinical bacterial inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. that has been revealed by olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. 's (Benicar) activation of the immune system.

The levels of the two most important vitamin D metabolites, 25-DThe vitamin D metabolite widely (and erroneously) considered best indicator of vitamin D "deficiency." Inactivates the Vitamin D Nuclear Receptor. Produced by hydroxylation of vitamin D3 in the liver. and 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol., can be interpreted using the Vitamin D Metabolite Calculator. A periodic assessment of a patient's serum 25-D level, which is inversely correlated with immune function, is strongly recommended – especially as it declines below 20 ng/ml. Testing 1,25-D as a measure of inflammation is only useful before taking olmesartan.

Baseline inflammatory marker tests such as a complete blood count (CBC) along with a comprehensive metabolic panel (CMP) should also be ordered prior to introducing olmesartan to provide the best possible measure of chronic inflammation in the patient prior to treatment.

Under many circumstances, some laboratory tests can be considered non-essential. Patient and doctor should discuss the decision to perform these tests based on the individual patient's clinical picture and any economic concerns. Every test should be interpreted by the physician in the relevant clinical context.

Short of trying the Marshall Protocol itself (i.e. a therapeutic probeA brief trial of the Marshall Protocol to see if it will generate an immunopathological response. The "gold standard" for testing whether a patient is a good candidate for the MP.), the most valid way to determine if the MP is applicable to a patient is by measuring serum levels of two key vitamin D metabolites: 25-D and 1,25-D. 25-D is a measure of innate immune function with higher levels suggesting active immunosuppression. 1,25-D is a measure of inflammation.

Contextual interpretation of a patient's 25-D and 1,25-D results are available using the vitamin D metabolite calculator. Relevant instructions for testing the vitamin D metabolites, including the freezing of samples, should be closely followed.

• Test 25-D before starting the MP and intermittently thereafter – Patients should ask their physicians to order a baseline 25-D test prior to beginning olmesartan. Marshall Protocol patients whose 25-D is above 20 ng/ml should continue to be tested every three months. This allows the doctor and the patient to anticipate a possible increase in immunopathology, which corresponds to a 25-D level of 20 ng/ml or below. Intermittent testing (once every six months or longer) can continue thereafter to verify a patient is continuing to successfully avoid food containing vitamin D.
• Test 1,25-D only before beginning the MP – Because olmesartan activates the nuclear receptorIntracellular receptor proteins that bind to hydrophobic signal molecules (such as steroid and thyroid hormones) or intracellular metabolites and are thus activated to bind to specific DNA sequences which affects transcription. which limits concentrations of 1,25-D, the patient's level of 1,25-D after beginning the MP is not relevant. The 1,25-D test can sometimes be rather expensive.

• complete blood count (CBC) – A test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood. Widely used for regular checkups.
  • electrolytes – sodium, potassium, etc.
  • kidney function – see above
  • lipid profile – Many observations that conflict with the LDL receptor hypothesis (i.e. high LDL cholesterol is the most important cause of atherosclerosis), may be explained by the idea that high serum cholesterol and/or high LDL is protective against infection and atherosclerosis.²
  • liver function –
  • other measures of inflammation – Several other measures may wax and wane with immunopathology including ACE (angiotensin-converting enzyme), C-reactive protein, and ESR
• antibodies and cytokines – Expected to increase with immunopathology. (See right.)
• bone density – The primary tool for measuring bone density is a DEXA (also known as DXA) scan. DEXA may provide evidence that treatment is reversing Th1 disease related bone loss such as the kind observed in osteoporosis and osteopenia. Results usually do not change course of treatment.
• colonoscopy – Endoscopic examination of the colon and the distal part of the small bowel with a small camera on a flexible tube. May provide reassurance when fearful of malignancy, but can expose patient to greater infection due to difficulties in sterilizing equipment. Results usually do not change course of treatment.
• imaging tests – Includes x-ray, magnetic resonance imaging (MRI), and computed tomography (CT Scan). Significant level of interpretation required to determine meaning of resulting image. Exposes patient with chronic inflammation to additional radiation, possibly increasing the risk of cancer. Results tend not to change course of treatment.
• lung function – For patients with lung involvement, tests of pulmonary function may temporarily decline on the MP, but are expected to improve over time.
• thyroid function – It is common for patients suffering from chronic diseases to have low levels of thyroid hormones.

Patients should remember they are the most important member of their health care team. Making sure you know what is in your medical records means that they are able to follow-up on questions and in some cases, verify accuracy. A doctor's office personnel can read you the exact numbers with measurements over the phone but patients should get a printed copy of all lab results.

Patients may need to sign a release of information form. Call the clinic's “Release of Information Office” or Medical Records to find out what their procedure is to obtain medical records. A patient should be able to do this all via the phone and mail. Once a signed release form is on file, patients can often just call them and have them mail you copies of the doctor's clinic note and test results after each visit.

It is best to always ask for copies of your lab reports, x-rays reports, clinic notes, etc. A proactive patient knows exactly what is in his/her medical record.