When Normal Isn’t Normal
I know that some of you are like me. You rarely go to the doctor, you read up on all of the latest health information which is easily done online and you work to relieve what ails you on your own and most of the time you can. So when you finally go to the doctor because something clearly isn’t right and you’re sick and tired from functioning at less than you’re used to, you’re ready to face the music and find out what’s wrong!
Then Your Doctor Looks at Your Blood Work and Says, “Everything’s normal!”
Now, which response do you have?! Is this when you simply cock your head sideways like your dog taught you to do, look puzzled and walk out? Or are you the one who feels totally demoralized, insulted and frustrated but find the energy to pull up your tired boot straps and march off to the next practitioner? Or, are you the one who wants to scream “are you out of your mind!? I wouldn’t be here if everything was normal, those blood tests might say I’m normal but I don’t feel normal, that’s why I’m here!”……..but you don’t and so you leave the office seething, never to return again!?
I’ve had this frustrating experience myself and it was only later in my training as a nutritionist that I understood what my doctor might have missed. Part of a comprehensive assessment in my office is to read through all of your previous test results, whether those are operative or radiology reports, blood test results or gastrointestinal studies. I don’t order these tests, I simply read through all of the results looking for puzzle pieces that may fit into the empty spaces of your unresolved health issue.
Drawing your blood and measuring all of the different values follows a strict protocol and we all rely on the lab techs to do that correctly. A computer will ‘read’ your test results and mark a value as high or low if that value falls outside of the laboratory’s reference range. A busy practitioner will look for those computer scored high’s and low’s and leave it at that but the true artistry of interpreting your blood work to see if it tells a deeper story about your health comes from taking the time to assess your results while keeping the following principles in mind:
1. What is Normal? Who is normal? Who were all the people who got tested LONG ago to decide on what normal would be for any particular lab reference range? Were they normal? (Notice that we have seen accepted normal ranges for cholesterol change 2 times over the last 10 – 15 yrs). What may be considered normal by the lab’s reference range may not be normal at all for someone who has their own unique chemistry, genetics and function. Do current lab reference ranges coincide with up to date research and cutting edge science?
2. Optimal Ranges vs. Lab Ranges: There are optimal ranges for any value that may or may not match the lab’s established reference range. What is high normal or low normal and yet still very normal for one person may be entirely too high or low for another person and may actually be a clue about what is destabilizing their chemistry and therefore their health. Everyone’s chemistry has a different window or threshold of ‘normal’ function. One of your lab values may be within the reference range yet is out- side the optimal range. This may, in fact, be suboptimal function for you!
3. A Blood Test is A Snap Shot: Each blood value speaks to the status of particular physiology going on in the body which is actually a dynamic process in a living being. Even if a particular blood value has a very narrow range of accepted normal there is still a fluctuating aspect of that value since it comes from the blood of a living person who’s body’s chemistry is always in a state of change, diurnal rhythm or dynamic balance. A blood test is like a snap shot of a moment in time, was that blood value possibly on its way up or on its way down at the moment blood was drawn? A momentary snap shot doesn’t give us the long term perspective of a blood value that can change day to day or even hourly.
4. Patterns: Even if all blood values are scored as normal by the lab’s computer there can be patterns that exist among these high and low normal values. It’s critical that time is taken to look for patterns since these can sometimes be the only indicator that a particular dysfunction is occurring and can even be the best method for early detection of health issues. Isn’t it better to catch a condition in it’s earliest phase before one’s health begins to change or fail?
Examples of ‘Normal’ When You Don’t Feel Normal!
Fasting glucose: This could be quite optimal at 87 or even considered normal at 99, it still says nothing about if your ability to process carbohydrates is working correctly or if your longer term storage of glucose in your blood is too high.
Hemoglobin A1-C: This tells you about longer term storage of sugar in your blood and is normal up to 5.6%. Diabetic levels are at 7.0%. So what’s going on with you if you are at 5.9% or 6.4%? The range between 5.6 and diabetic is one of insulin resistance and proper counseling to lower this value is critical to avoid cardiovascular and other degenerative disease and yet your doctor may not be aware of this.
MCV: this stands for Mean Corpuscular Volume which just means the average size of your red blood cell. Low iron pulls this value down and low B12 pulls this value up. What if you have both low iron AND low B12 (not uncommon), this value will stay right in the middle at an optimal normal range. What does your doctor do then?
Serum Iron: many practitioners rely on this to find out about your iron level. But this is a very transient value, it even changes with what you ate the day before, if you took iron supplements or even cooked in iron cookware! Longer term iron storage is most important to look at your iron level and is seen with a value called ferritin.
TSH: this is Thyroid Stimulating Hormone, the value that indicates how much your brain is telling your thyroid what to do. There is so much confusion and consistent lack of correlation of this value with how the patient actually feels, that like Cholesterol, TSH has been assigned a new (narrower) reference range and yet that range is not yet used by all labs. And even more confoudning, this value could be low indicating a high thyroid problem when in fact the patient has a low thyroid problem. How confusing is that?
Vitamin D: has a very wide ‘normal’ range of 32 – 100. So your result could be at 35 and be considered normal and you might not be advised to take Vitamin D3 supplementation. Most research advises Vitamin D to be in the 50’s, 60’s and 70’s particularly for adequate immune balance.
Vitamin B12: if investigated, a serum B12 is often drawn which has a Grand Canyon wide reference range of 211 – 946! Cutting edge research shows that clinical signs and symptoms of low B12 can be present when serum B12 is in the ‘normal’ range of 250. More acceptable ranges for serum B12 by those who study it are up in the 500’s and 600‘s. Furthermore, serum B12 is actually not the most sensitive marker for low B12, a value called Methylmalonic is most sensitive.
Morning Cortisol: this would be ordered to assess adrenal function. While it’s great that your adrenal glands are being given attention at all, cortisol functions in a diurnal rhythm and only by taking sequential cortisol samples (4 in one day), would you find out your total production for the day but also if your pattern or rhythm of output is as it should be.
These are only a few of many, many blood test results that if read as normal may lead your practitioner to tell you that you’re fine. Misinterpretation of blood work is only one aspect of why perhaps no one is fixing your health, there may be many more reasons that I’m not discussing for this article. Blood work is basic though and although the blood draw and chemistry calculations that lead to your results are hard science, the interpretation of your results is much more an art than a science!