At one time, this page had a focus on Lyme and co-infection testing. Over time, we have a better understanding that testing for "Lyme" goes far beyond just testing for vector-borne infections. Thus, as of 2025, this page has been broadened in focus to include my current thoughts on testing for complex, chronic illness.
Lyme and Co-infection Testing
IGeneX
IGeneX continues to be the recognized leader in the vector-borne disease testing space. Their ImmunoBlots go far beyond the Western Blots that we relied on for many years. Not only that, but ImmunoBlots are now available for Lyme Borrelia, TBRF Borrelia, Bartonella, and Babesia.
It is important to note that if you are looking for Borrelia, you ideally would test for both Lyme Borrelia and TBRF Borrelia. These are two separate ImmunoBlots unfortunately, and TBRF Borrelia is becoming highly prevalent and presents with a condition very similar to Lyme disease. Testing only for Lyme Borrelia is not painting the full picture.
Ideally, one would use both direct and indirect testing methods for both Borrelia and for co-infections like Bartonella and Babesia. Their Tick-Borne Disease Panels look at the potential for these infections from different lenses such as an ImmunoBlot (indirect) and a FISH (direct). Panel TBD61BL offers an ImmunoBlot for Lyme, TBRF, Bartonella, and Babesia as well as FISH testing for Bartonella and Babesia; among other testing methods.
Vibrant Wellness
Vibrant Wellness
My observation has been that they generally find many IgG positives, very few IgM, and I have yet to see a positive PCR. So, when you get back several IgG positives, the problem becomes whether or not the doctor will consider that "past immune memory" or if they will accept those as an indication that treatment may be appropriate if symptoms are present.
I know of several practitioners that love this panel and others that dismiss it for having too many positives. I would first confirm that the doctor will accept Vibrant as valid before ordering it. The cost is lower than IGeneX.
DNA Connexions
DNA Connexions tests for 11 tick-borne pathogens and is a direct test. One advantage is that it uses a urine sample and does not require a blood draw.
This test is often best done with some type of provocation prior to the collection such as exercise, massage, or other body work to mobilize the microbes out of tissue and into the urine; this helps to minimize false negative results.
Similar to the comments above, I have heard of practitioners that love this test and use it regularly and others that dismiss it due to the high numbers of positives. It's ironic that the tests that commonly find evidence of these pathogens are often dismissed. For so many years, the problem was finding a test that could find these organisms, and now, the tests that do are often not used.
Arminlabs / Infectolab Americas
While ArminLabs has several tests that are immunoglobulin / B-cell tests in the realm of vector-borne infections, there are numerous options for testing currently within the US that are similar.
With T-cell testing, as much as I love this approach as a primary tool for exploring viruses, I'm less convinced for vector-borne infections. Testing appears to be species-specific. If, for example, you are testing for Bartonella, the test is for Bartonella henselae. What if you have a different type of Bartonella within the genus that is then missed?
Same with Babesia? Most are Babesia microti; more recently, Babesia duncani has been added by Infectolab but not by Arminlabs. Until we understand more about how likely these tests are to pick-up other species within the genus being tested, I don't view these as primary tools for Lyme and co-infections. But for viruses, read on....
Other Testing Options
Other labs of note in the Lyme and co-infection testing arena include:
- TLab is another emerging option for testing for Bartonella and Babesia from Robert Mozayeni, MD, a leader in the diagnosis and treatment of Lyme-related co-infections. For many years, the use of microscopy has been discounted in medicine. TLab is using advanced microscopic imaging in their testing assays. They offer RNA FISH testing for Borrelia, Bartonella, and Babesia.
- Galaxy Diagnostics which is well-known for their work in the realm of Bartonella but offers testing for other vector-borne infections as well
- Medical Diagnostics Lab (MDL) is another commonly used lab
Co-Infections
- Co-infections are the RULE, not an exception
- The average child with Lyme has 2-5 co-infections with an average of 3.
- Treatment of co-infections is required and often, they must be treated before or concurrent with the Borrelia treatment itself.
- If you don't test for and treat co-infections, you are not putting yourself in a good position for healing.
- Almost everyone with chronic Lyme likely has 1 or more co-infections.
- More and more, Bartonella and Babesia are commonly found together and less commonly occur on their own.
- Co-infections require DIFFERENT treatments in many cases. Do not assume that you are covering them with only the Lyme treatment.
- Co-infection testing is often unreliable and may need to be repeated over time. It took 4 months for my Bartonella to appear and almost 8 for Babesia to finally appear, but they were there. While many years have passed since my initial testing and testing options have notably improved, don't assume a negative test is proof of absence of infection.
- If you think you only have Borrelia, odds are you have not looked closely enough. And if I had to bet, you (and I) have numerous co-infections.
Mold and Mycotoxin Testing
Urine mycotoxin testing is greatly debated. I personally find it a very helpful tool.
There is an argument that mycotoxins are normal excretion and should be found in the urine. That is certainly true. However, high levels of urine mycotoxins being observed in the urine lead me to ask "why are they there?". Are they coming from the diet? Are they coming from the external environment? Are they coming from fungal colonization inside the body itself? Whatever the source, high levels are not believed to be normal and are not believed to be solely from dietary exposure. Thus, when these results are elevated, it is an indication that a deeper dive may be appropriate.
RealTime Labs
RealTime Labs is my personal favorite and that of my mentor, Neil Nathan, MD. When testing urine mycotoxins with RealTime, a provocation may be used with liposomal glutathione for up to 7 days, and binders should be stopped for 3 days prior to the urine collection. If someone starts glutathione as a provocation and feels worse after a couple of days, then you would generally stop the provocation and perform the collection.
Note that if you are sensitive and believe you may have to stop the glutathione early, you will want to plan such that you have still stopped binders for 3 days prior to the collection. If you do not tolerate glutathione, the provocation should likely be skipped. Other forms of provocation such as a hot bath, hot tub, sauna, or exercise can also be used with or without the glutathione provocation.
Vibrant Wellness
Vibrant Wellness offers a Mycotoxins Test. It breaks down mycotoxins into specific mycotoxins as compared to RealTime which reports on 5 groups of mycotoxins. A provocation with glutathione should not be done with Vibrant as it may lead to false negative results. Other non-glutathione forms of provocation as mentioned above may still be appropriate. Binders should still be stopped for at least 3 days before the urine collection.
Personally, if I were doing this test, I prefer the Total Tox Burden panel which includes heavy metals, environmental chemicals, and mycotoxins.
NOTE: I do not recommend the MycoTOX from Mosaic Diagnostics at this time. My observation, and that of others, is that it is not very sensitive.
Other Testing Options
- MyMycoLab offers mycotoxin antibody testing which I have discussed here and in a podcast with Dr. Campbell. One potential advantage is that if IgE is elevated, that likely represents a current exposure. This is an indirect test where the urine mycotoxin tests are direct tests. Both have advantages and disadvantages in my opinion, and using a combination of both may paint a fuller picture.
- Shoemaker biotoxin testing with tools such as VCS, C4a, TGFb1, MSH, MMP9 and others can provide insights around inflammation and the potential for CIRS, but they are not specific to mold or any other causation
- The GENIE test may provide insights into CIRS causation with factors such as mold/mycotoxins, Actinobacteria, endotoxins, etc. This was discussed in detail in a great podcast episode with Dr. Shoemaker.
Environmental/Building Testing
While self-testing may be a reasonable place to start, the ideal scenario is to work with a professional IEP (Indoor Environmental Professional) who works exclusively with medically-hypersensitive patients. A good place to look for an IEP is ISEAI.org.
EnviroBiomics, Inc
EnviroBiomics, Inc offers a number of panels for self-testing exploration of the external environment. I do not recommend doing a HERTSMI-2 and generally suggest doing a full ERMI.
More recently, based on newer focus within the Shoemaker community, it may be prudent to also do Actinobacteria and Endotoxin testing in addition to the ERMI.
If you want to do the ERMI alone, that is panel #1. If you want to additionally explore Actino + Endo, consider panel #8.
ImmunoLytics
ImmunoLytics offers plate and swab testing. Their plate testing can be a useful option for having a visual indicator of mold growth. It is inexpensive in comparison to other tests as you can purchase several plates at a low cost and then add the interpretation from the lab if needed.
Sadly, mold plates often entirely miss Stachybotrys and Chaetomium. So while these are a helpful adjunct, they do not, in my opinion, take the place of an ERMI. They can be another lens, however, from which to assess the environment alongside an ERMI.
Hypercoagulation Testing
Labcorp
As discussed in my podcast with Ruth Kriz, APRN on hypercoagulation, Labcorp offers her comprehensive coagulation panel using test code 505443. I cannot stress enough how often I think this issue is missed and how critical it is for this test to be performed in those dealing with Lyme, mold, long COVID, and other chronic conditions.
Labcorp Test Code: 505443 (order only from Labcorp)
Hypercoag Reflexive3 Panel
- Fibrinogen Activity
- Prothrombin Fragment 1+2
- Thrombin Antithrombin Complex
- Alpha-2 Antiplasmin
- Activated Protein C Resistance w/reflex to Factor V Leiden
- PAI-1 Activity w/reflex to PAI-1 4G/5G Polymorphism
- Lipoprotein (a)
- Homocysteine
- Protein S Activity
- Factor II Gene Mutation (Prothrombin G20210A)
See the detailed notes on ordering in the Show Notes of our conversation.
Viral Testing
Arminlabs / Infectolab Americas
In my opinion, T-cell based testing shines when looking at chronic viral activation. Testing for EBV using IgM/IgG is generally not significantly beneficial, and IgG is often dismissed as "past memory". In my experience, chronic viruses are a significant contributor to chronic illness and often need to be treated. Enter T-cell testing....
T-cell testing gives you an indication as to whether or not your immune system has been engaged with these viruses in the last 2-3 months. It is also an excellent tool to assess the benefit of the treatments being used.
Common herpetic viruses that I would look for include: EBV, HSV-1, HSV-2, HHV-6, CMV, and Varicella. There are also T-cell based tests for COVID.
At Arminlabs, these are generally going to be the EliSpot tests; at InfectoLab, these are listed as IFN-γ and IL-2.
ArminLabs also has some non-T-cell based testing for other viruses which may also be helpful such as testing for Coxsackievirus.
COVID Testing
Radiance Diagnostics
Based on the work of Bruce Patterson, MD, Radiance Diagnostics offers the COVID-19 Long Hauler Test by Flow Cytometry. This panel can be very helpful for distinguishing Long COVID from Post-Vax from chronic Lyme disease.
Labcorp
Given the toxicity of the spike protein, more recently, testing is being done for spike protein antibodies (not SARS-CoV2 antibodies which can also be done) at Labcorp. The test code is 164090.
Environmental Toxicity Testing
Vibrant Wellness
Vibrant Wellness offers the Total Tox Burden panel which includes heavy metals, environmental chemicals, and mycotoxins. With the numerous environmental toxins we are exposed to in modern times, a comprehensive panel and daily detoxification are keys to health optimization.
Mosaic Diagnostics
Mosaic Diagnostics offers the ToxDetect Profile which looks at a broad number of different types of chemicals and environmental toxins. It does not test for heavy metals, but they offer an Essential Nutrients and Toxic Elements Test which would round out this exploration. As a reminder, I sadly cannot recommend their mycotoxin testing.
Parasite Testing
ParaWellness Research
Other than various forms of energetic testing, the only test that I have consistently found helpful for testing for parasites is from ParaWellness Research. Dr. d'Angelo was one of my first podcast guests. If you decide to run his panel, check the "diarrhea" box on the intake form as it leads to more extensive testing done at the same cost.
GI Microbiome Testing
Genova Diagnostics
GI Effects from Genova Diagnostics is a comprehensive gut health assessment looking at maldigestion, inflammation, dysbiosis, metabolic imbalance, microbial dysbiosis, and more.
Vibrant Wellness
Vibrant Wellness offers the Gut Zoomer. The panel looks at commensals, pathogens, inflammation, digestion, immune balance, gut antibodies, malabsorption, GI metabolites, diversity, and more.
Diagnostic Solutions Laboratory
Diagnostic Solutions Laboratory offers the GI-MAP or GI Microbial Assay Plus. This assay uses qPCR to detect the presence of various microbes.
Organic Acids Testing
While organic acids testing is not perfect, it can provide highly valuable insights into many different aspects of how the body is functioning as we as potential infections, toxicants, etc. that may be present.
It is worth noting that while fungal metabolites may be an indicator of fungal colonization, this is not black and white and should not be used to rule out the potential for fungal colonization in the body.
Mosaic Diagnostics
Mosaic Diagnostics offers the best known Organic Acids Test in the world. While others have emerged on the scene, many practitioners are far more familiar with interpreting the OAT from Mosaic. It is the OG of OATs!
Vibrant Wellness
Vibrant Wellness offers the Organic Acids Test. I personally found the pattern of elevated fungal metabolites very relevant in my own health journey.
Micronutrient Testing
I place more value on nutrient deficiencies now than I did in the past. It can be important to know if one is deficient in certain nutrients and to then replete those nutrients to optimize body function.
Vibrant Wellness
Vibrant Wellness offers the Micronutrient Panel. I have done this one a couple of times in recent years and found the information helpful in adjusting my supplement regime. Their panel measures both extracellular and intracellular levels of essential nutrients.
Genova Diagnostics
Genova Diagnostics has the well-known NutrEval for assessing nutrient deficiencies.
