Dr. Holland's comprehensive lab guide
The Hidden Drivers Lab Guide
A reference guide to the labs and assessments used to look for the hidden drivers behind persistent symptoms, organized by body system. Enter your details below and we will send it straight to your inbox.
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Core energy pillars
Start here. These five systems are the foundation of energy production and stress resilience, so they are often the first place to look.
Adrenals / HPA Axis
Morning cortisol, DHEA-S, 4-point salivary cortisol curve, ACTH when indicated
Thyroid
TSH, free T4, total T4, free T3, total T3, reverse T3, FT3:RT3 ratio, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb)
Gastrointestinal System
CBC with differential, CMP, iron panel with ferritin, vitamin B12, folate, magnesium, CRP, celiac panel. Comprehensive stool analysis when indicated: microbiome, short-chain fatty acids, calprotectin, secretory IgA, pancreatic elastase, parasites, and pathogens
Detoxification System
Liver enzymes (ALT, AST, GGT), kidney function (creatinine, eGFR), ADH, red blood cell glutathione, red blood cell magnesium
Immune System
ANA, CBC with differential, WBC, immunoglobulins (IgG, IgA, IgM, IgE), lymphocyte subsets (CD3, CD4, CD8, CD19, NK cells), NK cell count and function, complement C3 and C4, CRP, total protein and globulin, vitamin D, vitamin A
Cellular health and communication
Mitochondrial & Cellular Health
Carnitine (free and total), CK, lactic acid, LDH, organic acids test (OAT), pyruvic acid, 8-OHdG, genomic testing when indicated
Nervous System
Clinical assessment of autonomic function, sleep, stress response, and neurological symptoms
Hormones
Estradiol, progesterone, testosterone (total and free), SHBG, DHEA-S, LH, FSH, prolactin
Hidden infections
Epstein-Barr Virus (EBV)
EBV viral capsid antigen (VCA) IgM and IgG, EBV nuclear antigen (EBNA) IgG, early antigen (EA) IgG; EBV DNA PCR when clinically indicated
Lyme Disease
Indirect testing: ELISA/EIA, Western blot (IgM/IgG), immunofluorescent antibody (IFA), immunoblots.
Direct testing: PCR (DNA), FISH (RNA), Nanotrap urine antigen testing.
Immune function markers: C3a, C4a, CD57, TGF-β1.
Inflammatory markers: ANA, CRP.
Other Tick-Borne Infections
Testing for Babesia, Bartonella, Anaplasma, Ehrlichia, Rickettsia, and other vector-borne pathogens based on symptoms and exposure history
Other Viral Infections
HSV-1 (HHV-1), HSV-2 (HHV-2), HHV-6A and HHV-6B, CMV, Coxsackievirus A and B, VZV, EBV and Parvovirus. Pathogen - specific antibody, antigen, or nucleic acid testing, as clinically indicated.
Long COVID-19 / Spikeopathy assessment
SARS-CoV-2 semi-quantitative total antibody, spike (S-protein) - Consider results alongside symptom history, infection and vaccination history, and other clinical findings.
Section 4: Labs and Assessments
Hidden toxins
Mold & Mycotoxins
Screening: Mold IQ symptom questionnaire, exposure history, visual contrast sensitivity (VCS) screening.
Urine mycotoxin testing: Urinary mycotoxin panel.
Serum mycotoxin antibody testing: Mycotoxin IgG and IgE antibodies.
Organic acids testing: Urinary organic acids test (OAT), including fungal metabolites when colonization is suspected.
CIRS panel: HLA-DR/DQ, C4a, TGF-β1, MMP-9, MSH, VEGF, VIP, ADH, serum osmolality, ACTH, cortisol, leptin, T-regulatory cells (Tregs), anti-gliadin antibodies (AGA), anticardiolipin antibodies (ACLA), von Willebrand factor/profile (vWF), C3a, lipase.
Additional assessments: MARCoNS nasal culture; home moisture and mold assessment.
Heavy Metals
Urine heavy metal testing
Glyphosate
Urinary glyphosate testing
Other Environmental Toxins
Exposure history and targeted testing based on suspected pesticides, solvents, chemicals, or other environmental contaminants
Clinical note
This table is a reference meant to be used for your individualized assessment. This is not a recommendation to order every test. Testing should be selected and interpreted in the context of your symptoms, exposure history, and clinical presentation.
This guide offers general wellness information and is not medical advice.