This article is the transcript of a conversation between Dr Richard Shames, highly respected endocrinologist and Canary Club advisor and Dr. David Zava, the founder and CEO of ZRT Laboratory. In this conversation they discuss Saliva Tests, testing information and its impact on patients and patient self empowerment.
RS: Dr. Zava, the number of activities you have been involved in, in recent years, leads one to think you are a very innovative person. How did you come by this quality originally?
DZ: A lot of hard work and perseverance. I have always been a scientist. Ever since I was a young child I was thinking science, reading articles in Scientific American I only half understood. Science is my life and passion.
RS: It does seem to be an innate curiosity, perhaps, or thinking outside the box. Have you had other occasions where you had to think in wider terms than your colleagues?
DZ: All creative thinking comes from outside the box. Throughout my professional career I have encountered people telling me “it can’t be done” at the same time I am doing it. Saliva testing is no exception and the blood spot testing is the same story.
RS: That’s right. the new lab kit that you have developed with this kind of perseverance and thinking outside the box has been very helpful in my practice.
DZ: I combined the technology of the saliva and blood spot testing into one kit because it allows one to test for the sex hormones (estradiol, progesterone, and testosterone), the adrenal hormones (DHEA and cortisol), and the thyroid hormones (T4, T3, TSH, TPO) all at the same time, and to evaluate these hormones in concert with a self-assessment of symptoms associated with both deficiencies and excesses of each of the hormones. Dr. Shames has written a great book describing the intricate interplay of all these hormones, much like a symphony. When one of these hormones is “off” it can make the beautiful music of wellbeing go sour.
RS: How did you know John Lee, who has passed away recently?
DZ: Dr. Lee was a clinical innovator and he lived close to me in the Bay Area of California. He had written his first book on progesterone and it was becoming a best seller because it was giving women answers to questions they weren’t getting from their doctors. John gave a lecture in Oakland on women’s health in the mid 90’s and I was one of the few males there in a crowd of some 5000. I met John there and invited him to my laboratory where I was doing breast cancer research. He dropped by one day, saw I was developing methods (saliva) to look at the level of hormones women were exposed to in OTC products. I had tested OTC creams for progesterone content. When John saw the list he asked if he could have it for his first book on progesterone in post menopausal women. John knew I was interested in putting some of my thoughts together regarding breast cancer, so he invited me to write a third book on hormones and breast cancer, which we published in 2002.
RS: It has been said by a number of practitioners that they have more confidence in your Blood Spot analyses of thyroid than in the regular thyroid tests. Could you explain why they might feel that way?
DZ: One of the reasons is that, conventionally, practitioners tend to test what insurance will cover, which means TSH only. By itself this is a pretty useless test in most cases. I’m sure most practitioners have seen many patients with clear thyroid deficiency symptoms with a normal TSH. We see it more often than not. TSH is not a good marker for thyroid dysfunction. That’s why it is important to look at T4, T3, TSH, and TPO in concert with the sex and adrenal hormones. Sometimes you will see people with perfectly normal thyroids but severe thyroid deficiency symptoms. Dr. Shames describes why this is so quite eloquently in his latest book. The thyroid doesn’t work alone in the cells of the body. It requires a team of other hormones, one of the most important of which is cortisol. If cortisol is too low or too high, caused by some kind of emotional, physical, chemical, or microbial stressor, it could cause your thyroid hormone to work less efficiently in the tissues. Measuring the thyroids is only one piece of the puzzle. This is why it is so important to know what your other hormones are doing, to know what hormones or medications you are taking that may interfere with the thyroid hormone that’s in your body, and to know what stressors you perceive. This is the basis of our Combo kit, it takes all of these parameters into consideration.
RS: When you were at a conference for the Professional Compounding Centers of America talking about your new technology, there was a member of the audience that said, “This is a fabulous idea of having a dried specimen”. The reason TSH values are often incorrect is that they sit around as a liquid for hours and hours and degrading. How big a factor is that?
DZ: TSH will degrade some, but it’s not particularly problematic as regards stability in whole blood. What I like about the finger-prick blood spot is that it gives values equivalent to blood drawn from the arm. Blood draws can be quite time consuming when you consider you need to go to a drawing station and wait around for someone to draw your blood. All the reference ranges are based on morning sampling and it’s not always easy to get to the blood drawing station through morning traffic without a little stress. Stress alters hormone levels. Practitioners often draw blood in their offices when the patient is available, which is not always the optimal time. Finger-prick blood spot draws can be done at home at the appropriate time with much less stress. When you put a few drops of blood from your finger onto the filter paper, it dries within about 15 minutes. What I find amazing is that the hormones in that dried specimen are very stable at room temperature or even warmer for at least a month, allowing for great latitude in shipping to the testing laboratory. Dried blood can be mailed without taking the same precautions as with liquid blood because the pathogens that potentially cause infections, such as the AIDS virus, are destroyed in the drying process. That’s a big plus for the lab staff that handles the dried blood specimens.
RS: And is there anything about capillary blood that is of greater benefit than venous blood that is always used for regular blood tests?
DZ: When hormones are produced within the body (endogenous) the capillary blood values are very similar to blood hormone values from conventional serum testing, where blood is drawn from the arm. When hormones are used topically, as with topical progesterone creams in women and topical testosterone gels or creams in men, there is much less equivalence. The capillary blood from the finger, as well as the hormones in saliva that are derived from capillary blood, contain much more hormone than the venous blood drawn from the arm that is returning to the heart. The capillary blood, drawn from the finger, or tested indirectly in saliva, is reflective of what is being delivered to the tissues. Venous blood grossly underestimates hormone delivered to tissues when the hormone is used topically.
RS: Right. So this is another innovation. Now, what is the purpose of putting a special kit together for thyroid, adrenal and sex hormones?
DZ: As I said earlier the sex hormones, adrenal hormones, and thyroid hormones work in concert with one another and to understand how thyroid hormones are functioning in the body one must know how the sex and adrenal hormones are doing. This is why we developed the Combo kit-it allows a simple means to test for the three types of hormones. If your sex hormones are out of balance, say your Estrogen is too high, it blocks the thyroid; Progesterone too low and thyroid function is not good; if the adrenal hormones, particularly cortisol is too high or it’s too low then thyroid hormones will not function as efficiently at the cell level.
RS: You have something else that is innovative on the report that you have on this particular test kit or on all your test kits. You have a list of symptoms that the patients can answer as a questionnaire and then somehow that comes out as a bar graph of what their most likely hormone difficulty is. How did you develop that?
DZ: The reason I developed the symptom profile is that practitioners would call me up and say “well, we have a hormone test result and I don’t know what it means”. I would ask them “what kind of symptoms do they have?” For convenience to the practitioner and patient, I developed a list of the most common symptoms of deficiency and excess of each of the hormones we were testing and put them on a form such that the patient could report them as none, mild, moderate, or severe.
RS: Right, exactly. The symptom correlation has been very helpful in my practice. I find in addition to the objective findings from the actual test of the body fluid there is this correlation that is quite useful and what I am wondering is how did you come up with the correlation of the diagnoses with which particular symptoms. Is there a computer rubric that handles that, how did you develop it?
DZ: We call that our Artificial Intelligence, or AI. Basically, five to six years ago as we looked at results and we would say this person has cold body temperature, they have depression, they have fatigue, mostly in the evening, they have a number of symptoms associated with thyroid deficiency and those were listed and quantified. The Artificial Intelligence takes the actual lab numbers and says you have low thyroid, then it takes a look at the symptoms and says you have low thyroid symptoms, so basically you have a match. When you have a match you know clinically that you really have got something. If you don’t have a match you are less likely to move forward. Say the person doesn’t have a low thyroid level and yet they have symptoms of thyroid deficiency. You might want to look at the adrenal glands first before you start treating with thyroid hormones. These symptoms are reported back to the practitioner to help them see what their patients were complaining about and if it was related to their hormone profile in any way. When a patient retests, the report also looks at their previous hormone levels as well as their past and current symptoms to see if improvements were made with whatever treatment regimen was implemented. If I had to pick anything I have done as “the most” creative, it would be the AI. It’s very powerful and growing with each new scientific and clinical study.
RS: Dr. Zava, tell me what kind of person would most likely benefit from this new type of technology?
DZ: Everybody with hormone-related symptoms. What I like about the test report is that it has relevant and useful information that makes a lot more sense to the patient. They now have information because they can look at the symptoms and say “yes, I have these symptoms”; they can look at what hormones they are taking, they can look at their test results because everybody likes to be self-educated about their own health. It shouldn’t be a secret to the person who has these kinds of problems. They are going to the doctor to get help and they need to be working hand in hand. This empowers the patient and the doctor to get to the source of the problem a lot faster.
DZ: That’s the reason I developed these types of systems; because it does help. Also when you treat with a hormone - let’s say you treat with thyroid - you can see that their thyroid levels are going up or changing, or their thyroid symptoms are beginning to wane. If they don’t, you need another course of action. You have not only the lab test numbers to see if things are changing, you also have the symptoms profile. The symptoms of thyroid deficiency one would expect would start to get better over time with thyroid therapy. If they don’t maybe it is severe stress that the person has from taking care of a sick parent or sick child; maybe their cortisol levels are high. Under these stress situations, the thyroid hormone is unlikely to function optimally at the tissue level. It’s like trying to turn on a light switch in a room and the switch is defective.
RS: That’s a good point Dr. Zava. You have turned on the light for a great many practitioners as well as a great many patients. It is a pleasure to have these insights.
You can find out more about Dr. Richard Shames and the extraordinary work he is doing with hormone imbalance at www.THYROIDPOWER.com