Your Labs: Normal v. Optimal
Years ago, I remember getting those postcards in the mail a couple weeks after my annual physical that read:
"All looks good. See you next year!"
Wait, what? All good? I would then proceed to call back to my primary care physician's office, get put on hold, finally reach someone and ask for a copy of my results. Then they would arrive in the mail a week later.
I was still left with a multitude of questions.
What looks good? What looks REALLY good? And more importantly, what looks so-so so I can work on that?
Where can I improve my health? How do these results trend with my prior results?
I never felt like labs were like pass/fail grades, either "good" or "bad." There must be some gradient of health and areas where I could improve.
ROUTINE LABS TELL A BIG STORY
Your blood has a lot to tell you about the state of your health. If you've had an annual physical, you've most likely had labs that included a blood chemistry panel and complete blood count (CBC). These two collections of tests are the most commonly ordered medical lab tests worldwide.
These blood tests, which are an integral part of Western clinical medicine, are used to aid in the diagnostic decision-making process. Individuals understand and are educated that blood testing is the "norm" for health assessment.
However, many people start to feel unwell long before a traditional blood test sheds the light on a "diagnosis". More often than not, individuals are told by their physician that "everything on your blood test looks normal."
(In fact, I did have major issues with anemia, failure to diagnose celiac disease as well as pernicious anemia - and there were signs in my blood work for decades before an official diagnosis! More about my journey here.)
"NORMAL" IS NOT OPTIMAL
Most patients who feel "unwell" will come out "normal" on a blood test. Clinical experience suggests that these people are by no means "normal" and are a far cry from being functionally optimal. They may not yet have progressed to a known disease state but they are what we call dysfunctional. This means that their physiological systems are no longer functioning properly and they are starting to feel unwell. But there is no formal diagnosis.
The issue is not that the blood test is a poor diagnostic tool, in fact, far from it. The issue is that the references ranges used on a traditional lab test are based on statistics. Reference ranges represent about 95% of the population and as long as your lab value falls into that range, most likely you will be told you are "normal".
However reference ranges do not represent good health or optimal physiological function. Most "normal" ranges are too broad to adequately detect health problems before they become an actual diagnosis. Normal ranges are simply not useful for detecting the emergence of dysfunction.
THE FUNCTIONAL APPROACH
The functional approach to laboratory analysis is oriented around changes in physiology and not pathology. In functional medicine, we use ranges that are based on optimal physiology and not the "normal" population.
This results in what is called a tighter "Functional Physiological Range". This allows functional medicine-trained practitioners to evaluate the area within the "Normal" range which indicates that something is not quite right in the physiological systems associated with this biomarker.
What this does is help clients with changes in physiological "function". We can identify the factors that obstruct our clients from achieving optimal physiological, biochemical, and metabolic functioning in their bodies.
WHAT DIRECTION IS YOUR HEALTH HEADING?
Another thing that separates a functional approach from the traditional approach is this - we are not simply looking at one individual biomarker at a time in a linear report of the data. Rather, we use trend analysis between the individual biomarkers to discover otherwise hidden trend towards or away from a functional health optimal. The direction matters! I try to look at two to three years of laboratory data at a time.
EXPLORING MARKERS TOGETHER
One more thing that makes a functional approach to laboratory results more powerful is by exploring markers together. Everything in our body is interconnected. Well, so are our individual markers within our blood chemistry. Ratios between markers matter.
Take triglycerides and HDL for example.
Your TG:HDL ratio is calculated on a fasting lipid profile. Simply take the Triglyceride and divide by the HDL. The closer to one, the better. For example: TG = 120 mg/dL and HDL=40 mg/dL. 120 / 40 = 3.0, and indicates an elevated risk of heart attack and stroke.
No only does a functional approach look at traditional ratios, we also look at markers together to tell a story of whether someone has opportunities to reach optimal health.
VITAL PART OF OPTIMAL HEALTH
In closing, blood testing is no longer simply a part of disease or injury management. It’s a vital component of a comprehensive optimal health work up and plays a vital role in uncovering hidden health trends, comprehensive health promotion and disease prevention.