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Optimal vs Normal: Reading your annual labs

“Your cholesterol is high, so we sent a prescription to the pharmacy.” We can discuss it next year”

The receptionist sends an email that says, “Everything on your labs looks fine. The doctor says to try harder to eat right and exercise.” But you are exhausted no matter how much you sleep, your hair is falling out, and you can’t seem to get your weight to budge. And what does eat right mean, exactly?

You tell your doctor you are worried about diabetes risk, and ask for a more comprehensive blood evaluation, but the doctor won’t order any more tests because, “Your fasting glucose is fine.”

  • Some doctors are often inadequately or inappropriately trained on some labs, “I don’t know how to interpret that XYZ lab, so I won’t order it.”

  • Some Doctors are not up to date on recent developments in lab interpretation since they graduated from Med School many years prior.

  • Some are given motivation by insurance companies to treat in specific ways through billing guidelines

**** Disclaimer: I am NOT a doctor, this is for educational purposes only. Material is not intended to diagnose or treat any disease. These are my suggestions based on years in my practice and working with people who do not feel optimal. My training is in functional blood chemistry.

1.  What Are Reference Intervals?

Reference interval reflects the range of results of 95% of the population. Reference range data is drawn from a group of people that have taken a specific test. While an effort is generally made to remove the data of those with known illnesses, that is not always possible. This is due to the reality that the general population is rife with undiagnosed medical issues. This is not optimal.

Not all ranges are determined by calculating the 95% reference interval, some are determined by consensus. This means a medical governing body has set the range, so it’s not exclusively based on population statistics. Blood Glucose and Lipid recommendations are examples of this type.

“Everything in range is good,” assumption is far from reality. Reference ranges are a reflection of the health of a society. Less than 12% of the US population qualifies as metabolically healthy, and yet, for the majority of that unhealthy 88%, this fact would not disqualify them from being included in the reference ranges.

2. Items that affect your lab results

There are a variety of substances and actions that can obscure or change your test results, causing the results to be incorrect or misleading.

  • Biotin:  Biotin is vitamin B-7, and it interferes with several blood tests, including SHBG, thyroid, progesterone, B-12, and others.

  • Creatine: This can artificially elevate creatine and GFR results.

  • Iron: If you are looking at ferritin or iron levels, the general advice is to discontinue the use of any iron supplements for 5 days before the test.

  • Illness & Exertion: If you’ve been ill or had an injury or infection before the testing, this could cause your inflammation markers to be extremely elevated.  Additionally, hard exercise too close to the day of the test could have a similar effect.  

  • Dehydration: Aside from making the blood draw itself difficult, tests are based on blood concentration, which means if you are dehydrated, levels can look artificially high due to low blood volume.

The reference range is based on the average American, and the average American is not eating a healthy diet. An improved diet will improve blood markers.

3.  How To Prep For Your Labs: 

Do not eat or drink anything except water, this includes no coffee, in the 12 to 14 hours before your test. There is a downside to allowing some tests to be done when not fasted. If you regularly work out in the mornings, I suggest skipping your workout on the day of the draw. A workout, especially a hard one, can artificially elevate some lab results.

4. Annual Labs to request

  • A1C – related to glucose

  • B-12 – vitamin

  • CBC w/Diff – blood cell health

  • CMP – metabolic panel

  • D-25 – vitamin

  • DHEA-S – sex hormone

  • ESR – related to hormone

  • Fasting Insulin – baseline insulin

  • Ferritin – related to iron

  • hsCRP – related to inflammation

  • Iron – mineral

  • Lipid Panel – cholesterol

  • Magnesium – electrolyte

  • TSH – thyroid stimulating hormone

A. Tests Within the CMP

Glucose: A1C only gives us an estimate for our average blood glucose and does not show us the highs and lows, and the direct cause and effect of meal choices to our resulting glucose levels. Our body’s ability to regulate blood glucose is essential, as excess glucose levels are actually toxic to tissues and organs.

What happens when your blood glucose is too low? Glucagon signals the release of more glucose.  Too high? Insulin signals the storage of glucose and turns down the release of your body’s store of glycogen (the name for stored glucose).

  • Baseline glucose in the morning should be in a healthy range 60-90

  • Average Blood Glucose Level should be 80-110

B. CBC w/Differential

Red blood cell count is the measure of the RBC (red blood cell) density within a sample. The Hemoglobin in RBCs carries oxygen to tissues and organs. RBCs also help transport carbon dioxide out of the body. Low RBCs can suggest anemia or other problems.

Hemoglobin is a protein molecule that is tasked with oxygen and carbon dioxide transport. Hemoglobin is what makes blood red.

Hematocrit is a measure of the volume percent of RBCs in the blood. While this percentage being off might indicate a health issue, it often points to an over or under-hydration issue as this affects the concentration of RBCs in blood volume.

Mean Corpuscular Volume (MCV) is a measure of the size of your RBCs. This can point to certain blood disorders or nutrient deficiencies, especially folic acid and vitamin B-12, and possible iron.

Mean Corpuscular Hemoglobin (MCH) measures the amount of hemoglobin within a single Red Blood Cell. Out-of-range results often point to anemia.

Mean Corpuscular Hemoglobin Concentration (MCHC) is similar to MCH but looks at the average concentration of hemoglobin. In addition to MCH, MCHC is also looked at to evaluate anemia or other blood disorders.


White Blood Cells (WBC)

C. What’s In a Basic Lipid Panel?

  1. LDL: Low-Density Lipoprotein. These have a larger proportion of cholesterol to protein, making them less dense.  LDL is the package that carries cholesterol (and many other useful things) to the cells for use. 

  2. HDL: High-Density Lipoprotein. These have a larger proportion of protein to cholesterol, making them denser. HDL is the package that returns cholesterol to the liver for recycling. 

  3. Total Cholesterol: This is a calculation of your HDL, LDL, and VLDL (Very Low-Density Lipoprotein).  It’s not extremely useful.

  4. Triglycerides: Trigs, are named for their structure, three fatty acids with a glycerol backbone.  Triglycerides are the main lipid in the blood, and if they are at exceedingly high levels in a sample, they can give it surprisingly cloudy or milky appearance.

The primary driver of chronic high triglycerides is consumption of too much energy, especially in the form of carbohydrates/sugars.  High triglycerides are correlated to one of the biggest threats to your good health, Metabolic Syndrome.

To get a good picture of metabolic health you’ll want to know your trigs and HDL.  A basic Lipid Panel in isolation is insufficient to seriously evaluate cardiovascular heal.

D. Other tests

5. Other symptoms

Often people know they don’t feel well, but don’t know the cause. 

Fatigue: Feeling exhausted; a general malaise; can’t quite wake up; constantly wanting a nap; feeling overwhelmed by activity and generally weak; as well as feeling under-fueled

  • Anxiety: Unexplained emotional fluctuations; mood changes; sadness that don’t fit your circumstances

  • Unexplained Weight Change: Inability to lose or gain weight when trying to, or sudden weight gain or loss when not trying to.

  • Confusion: Often described as brain fog and/or forgetfulness

  • Low Libido: A general reduction of the sex drive

  • Headaches: frequent low-level headaches to chronic migraines

  • Hair Loss: Sudden intense shedding of hair

  • Bodily Aches and Pains: Both due to known and unknown causes

  • Frequent Infections: A tendency towards repeated infections

  • Sleep Disturbances

 Symptoms & Testing ideas

Keep Moving Forward 😊 Sarah

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