Tag Archives: preventive

“My lab tests are normal” (…or are they?)

Cindy* sits across my small round table during our first visit together.  She has hit a brick wall.  Last week, she submitted to my office her intake forms and previous medical records, which consist of lab test after lab test.  These are isolated individual tests, taken on different days (or even months), never all at the same time.  Some of the tests are repeated several times.

Cindy shrugs, throwing her hands in the air.  “I don’t know what to do.  They look at me like I’m crazy.  They tell me my labs are normal.  And yet–well, you’ve seen my questionnaires.  I’m a mess!”

So her lab tests were “normal”, eh?  Let’s see about that….

First, let’s talk about the blood test process.  After the doctor or nurse takes your blood, they send it to a lab, telling that lab to run various tests on it.  The lab analyzes the blood sample and determines the results of the tests ordered.  These test results are reported back to the doctor in the form of a number.  Some of those numbers are familiar–for example, a cholesterol of 183, triglycerides of 132, or a blood sugar/blood glucose of 94.  If you have a thyroid issue, you may also know your TSH level.  The lab will compare your number results with what is called a “reference range” – a “normal” range.

Next, it’s important to understand what “normal” means.  The conventional medical system only recognizes two states of health: either you have a disease or you don’t.  If they can’t establish the presence of a disease, the doctor tells you you’re “normal” or “fine”.

The problem is, the regular definition of “normal” (and the “normal range” used by the labs to determine whether you’re sick or not) isn’t based on good health or healthy function.  It’s based on that “normal range” we talked about earlier.  How are those ranges determined?

By statistics.  The large national lab companies are responsible for setting their own reference ranges.  To do this, they compile the test results of the samples submitted, established an average, and compare the results to the corresponding patients. Every so often, as the general health of the population shifts and the average number values change, these laboratories will adjust their average ranges accordingly.

Look around you; 60% of the population is overweight and 20% of the population has developed diabetes.  About 73% of the population is taking at least one medication.  Cholesterol problems, hormone imbalances, and digestive issues abound.  Alzheimer’s Disease and autoimmune disorders are skyrocketing.

Do you really want to be compared to those around you?
Do you really want your “normal” range to be based on those people?

Also, it’s important to understand that these labs do this on a regional basis.  This means that a patient in South Carolina and a patient in Utah may have the same fasting blood sugar levels, but get labeled “normal” in South Carolina, while the lab in Utah would “flag” the result as abnormal.  The South Carolina patient’s doctor would tell that patient he or she is “fine”, while the Utah patient’s doctor will make recommendations for preventing diabetes.

One huge problem is that in gathering these statistics, labs fail to take prescription drugs into account when establishing normal ranges.  Medications, by definition, artificially manipulate the body’s function, altering its chemistry.  Because of this, it’s important to consider their effects when determining what’s “normal” and what’s not and yet, this is not done.  As a result, people undergoing thyroid testing get lumped in with people taking thyroid medications, and people undergoing a blood sugar screening get lumped in with those taking insulin.

Do you want to be lumped in with people taking loads of medications?  Do you think that these “normal” ranges can be fully trusted?

Now…when most doctors get these results back, they scan them, looking for abnormal results.  If any test result falls out of range, the lab highlights it, usually in bold, stating “high” or “low” off to the side.  Most doctors, lacking the time to fully investigate these results, quickly scan each line item.  Anything not flagged in “pathological” (disease) range is passed over without a second thought.

So, back to Cindy.  When she hands me the printouts from her previous lab tests, I, too, scan for the lab’s flags.  However, that’s just the tip of the iceberg; I usually find many more abnormal results that lie outside of healthy range, but not yet far enough advanced for the lab to flag the result as “abnormal”.  It’s not that I run different tests, it’s that I use “functional ranges”, which are much tighter and designed for healthy function.

For example, a good healthy functional range for fasting blood sugar is about 85-100.  The lab’s established reference range is often 65-110. If Cindy has a fasting blood sugar of 77 , she begins to lose optimal function, and yet most doctors will tell her she’s “fine” because the lab won’t highlight her result as “abnormal” until she reaches 64.  By the time her blood sugar falls that far, she has lost a lot of function!  She probably started feeling dizzy and lightheaded around 79.

Is Cindy hypoglycemic at 77?  Nope, she’s what we call “functionally hypoglycemic”, because she falls below the lower functional blood sugar limit of 85.  When she gets to 64, we can officially call it true hypoglycemia.  But why wait until then?  Someone with blood sugar in the 70s can certainly have hypoglycemic symptoms and can still benefit from a blood sugar stabilizing plan.

That’s what Functional Medicine is all about, folks: good function.  It’s about catching health issues early, identifying breakdowns in proper function before they become established diseases.

Of course, once they do, it’s not impossible to turn it around.  But if you’ve got a train starting to travel in the wrong direction, picking up speed second by second, isn’t it easier to get it stopped and turned around before it reaches full speed?  True health works exactly the same way. 🙂

*real patient, but not her real name


Does my health insurance cover Functional Medicine?

That’s a great question.  In fact, that’s one of the first and most common questions people ask.  This is understandable; after all, chances are you’re paying good money for your premiums, not to mention deductibles and co-pays.  Your employer has no doubt touted the benefits of each plan, which seems generous at the time.

So where does Functional Medicine fit in?  The short answer is, I recommend that you first carefully review your policy, checking for any reference to “preventive” services, or possibly “nutritional counseling”.  When in doubt, it’s best call your insurance company directly and ask them if any of these types of service are covered under your plan.

To understand the long answer, we must first make an introductory foray into the world of so-called “health” insurance.  The first thing that you should know about health insurance is that the term is a misnomer; your health insurance company (be it Blue Cross Blue Shield, Aetna, Cigna, Humana, or worse, United Healthcare) has not made your health their top priority.  How can this be?

Well, let’s do a little research (I love research).  Quick Google searches show that the first Blue Cross plan was introduced in 1939.  Humana was founded in 1961.  United Healthcare is the new kid on the block, formed in 1977.  And the elder of the insurance companies?  Aetna has been around since 1853.

Since insurance companies are private corporations, this may go without saying, but it’s worth highlighting here: in order to survive, health insurance companies must turn a profit.  This is true of any company, family/household, or individual.  You must make more than you spend.  By definition, this means that they must take in (revenue) more than they pay out (expenses).  This means that their customers (that’s you) must pay more in premiums (as well as deductibles and co-pays) than they pay back out on your behalf (in the form of benefits, or covered services).

Functional Medicine itself requires the doctor to spend an enormous amount of energy behind the scenes between your appointments.  This time spent on your behalf includes deeply interpreting lab results and putting them together, attempting to find the underlying common cause or causes of the problem.  This may also take research and review of the newest published studies as they come hot off the presses.  No other healthcare discipline goes this far or invests this amount of time on each patient.

Since these doctors only have so many hours in a day, they’d rather devote that time to your case, (researching and reviewing your case, preparing information and treatment plans, and answering your questions), than wrangling with insurance bureaucrats, none of whom have any medical training themselves and thus lack the understanding that Functional Medicine doctors have.  Most Functional Medicine doctors would love to provide the convenience and assistance of filing insurance for their patients, but with the time and energy constraints, they find that they can’t do both well.  The bad news is, they don’t file your insurance for you and they furnish you with the receipt to submit instead.  The good news, though, is the most important: they’re not bound by their arbitrary rules, and their time can be spent where it counts–devoted to YOU.

So, about that receipt I just mentioned… Yes, most Functional Medicine doctors will provide a descriptive receipt upon request.  Depending on your insurance company, they may accept that receipt and perhaps reimburse you for part of the out-of-pocket investment you made.  I can never guarantee this, as insurance companies are like water, always changing and tough to get a firm grasp of.  Sometimes they will want codes, and this is where things get sticky…

The codes the insurance company likes to have essentially reduce you to a Dewey Decimal-like system of numbers.  Every established disease (official diagnosis) has a 4- or 5-digit number, in the form of “123.45”.  Each recognized type of treatment has a 5-digit code, too, in the form of 12345.  Although the two numbering systems are different, each recognized disease corresponds with its appropriate avenues of treatment, and vice versa.

So what’s the problem?  The difficulty arises in that these coding systems are old and outdated.  They fail to consider dysfunction (i.e. breakdowns in healthy functions or processes, the earliest signs of disease) and they also usually neglect to include contemporary health issues.  In other words, there is a language barrier between Functional Medicine and health insurance, especially considering that health insurance is actually structured around–and oriented toward–conventional medicine, which intervenes only when the dysfunction has advanced for years to decades, resulting in a blatantly recognizable, established disease condition.

The common scenario is this: you start to feel that something’s not quite right.  You visit your conventional/regular doctor, who runs the blood tests and, after scanning them quickly, says “everything is normal”.  You know that it’s not, but now they’re hinting that it’s all in your head.  Meanwhile, your health does slide further and further away from healthy ranges, toward the outlying borders of “normal” and eventually it does cross into “abnormal” territory.  This may be years later, and by then it may or may not be too late to effectively use natural methods.  But the insurance company now has a number it can assign you, a little numeric box it can neatly put you into.  They’re happy, they’ve been satisfied.  But what about you?

That’s where Functional Medicine comes in, and hopefully you’ll be able to see a Functionally-oriented doctor before you reach the disease point.  With any luck, your insurance company will cover at least part of the tab.  If they do, look at it as a secondary bonus, and if they don’t, simply consider it part of the cost of living.  After all, when owning a vehicle, we understand that if we don’t invest in maintenance, the car breaks down and stops working.  We must pay for regular oil changes, state-mandated vehicle inspections, license plate tags/stickers, brake pads (which are actually designed to wear out!), tires, and many more.  Why give your body any less?  Make your health your top priority, even if it’s not your insurance company’s.  Why?  Because you only have one body, and it only treats you as well as you have treated it.  We’re a product of the decisions we have made every day.  Up until now, people have relied on their insurance coverage for any kind of medical care.  But if we want a different result, we may have to consider a different approach…whether an out-of-touch insurance company thinks it’s medically necessary or not 🙂