Tag Archives: reference range

“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

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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 🙂

What Functional Medicine is NOT, Part 2:

In the last post, I brought up a few myths that I frequently come across and dissected them.  As I mentioned before, when different practitioners use the same term (in this case Functional Medicine) to mean various things (such as nutrition, bioidentical hormones, or fad diets), this confuses people.  People are just starting to find out about Functional Medicine as it is, and many people aren’t exactly sure what it means.  And who can blame them?  It seems as though there is too wide a variety and not enough consistency, and people aren’t sure where to turn or who to trust.  I thought I’d help sort things out.

Since the last post got longer than I expected, I decided to split it into two parts.  Here is the second part…

Truth #5: Functional Medicine is not a scam, voodoo witch-doctor healing, or old wives’ tales.  The Institute for Functional Medicine (IFM) has published an authoritative textbook that covers nearly all aspects of true Functional Medicine.  The author page boasts an enormous amount of inter-disciplinary collaboration, meaning that Medical Doctors, PhDs, Doctors of Chiropractic, Doctors of Osteopathy, Naturopathic Doctors, Certified Clinical Nutritionists, Dentists, Massage Therapists, Physical Therapists, people with Masters degrees including Masters in Public Health, and Acupuncturists have all worked together to produce this resourceful body of knowledge.  The book cites numerous solid references to genuine studies published in standard, respected peer-reviewed journals across the world.

And that’s just the textbook that many of us use.  In addition, there are classes affiliated with educational institutions that are recognized and accredited by the US Department of Education.  There are cutting-edge authoritative books written for the public by esteemed authors such as Datis Kharrazian, whose protocols I follow (with a few modifications for individual needs and sensitivities), which by itself cites over 600 genuine references.

True Functional Medicine bases their holistic treatment approaches on diagnostic lab test results ordered through standard blood laboratories (the same ones that any hospital or conventional doctors would use), and other CLIA-certified specialty laboratories.  The reference ranges used to interpret lab work are narrower than these labs have set, but are nonetheless based on respected organizations such as the American Endocrine Society and the Vitamin D Council.

Truth #6: Functional Medicine has nothing to do with muscle testing or AK.  Some practitioners utilize “muscle testing”, also known as Applied Kinesiology (AK).  This involves having you hold your arm out, resisting the practitioner’s attempts to push/pull your arm in a certain direction (or directions).  Once he or she establishes that the muscle group s/he’ll use for testing is working properly, s/he’ll have you touch certain points on your body, make certain movements, hold certain positions, or hold certain objects.  These practitioners claim that the results of this “testing” can show if you have a liver problem or adrenal issue.

I have several significant problems with this.  First, the test itself may not be accurate or reliable.  Not only is it incredibly vulnerable to practitioner manipulation (whether he or she is aware of their influence or not), but the scientific research has not been done to back up the validity of this so-called testing.  Not only that, but even if its results are accurate (and let’s say the test really is valid for adrenal dysfunction), there are multiple kinds of dysfunction.  There is overactivity, underactivity, and normal activity but in a chaotic rhythm.  Muscle testing can’t reliably break things down that far, and it certainly can’t quantify it into objective numbers like real lab testing can.

Truth #7: Functional Medicine is a real, recognized form of medicine, not something the alternative medical community made up.  Functional Medicine is not a “chiropractic thing”; in fact, it’s not specific to any single healthcare discipline.  It’s definitely not a fly-by-night approach to be considered second to conventional medicine, with conventional medicine holding the ultimate authority, from whom everyone else (patients and other practitioners) must seek approval.  Functional Medicine, in most situations, can very well be regarded on an equal playing field as any medication-based approach, and Functional Medicine doctors are every bit as knowledgeable in their approach as (and sometimes even moreso than) conventional practitioners who have not studied this approach.

Functional Medicine is indeed a medical subspecialty; its non-pharmaceutical approach allows any non-drug practitioners, including Naturopathic Doctors (in states that license them–of which Texas, where I live, is not one), Doctors of Chiropractic, and others to practice.  Essentially, as long as the practitioner is licensed in the state in which they practice, and their license covers the ordering of diagnostic lab testing, then they may also legally interpret the results and offer a Functional Medicine approach.

I hope that clears up some of the confusion out there. 🙂

Testing, testing: Lab testing and Functional Medicine

A Revolution in Advanced Clinical Nutrition…

A segment of Clinical Nutrition began to evolve considerably–quietly–about 30 years ago.  Now, it has bloomed into a full-fledged, legitimate medical subspecialty.  We now know much more about the mechanisms behind chronic disorders than we did even 10 years ago.  We also now realize that pharmaceutical medications, while necessary at times, don’t usually offer much in terms of resolution or long-term relief/improvement for these conditions.  Irregular blood sugar, autoimmune disorders, nutrient malabsorption, gastrointestinal microbes, inefficient liver detoxification, and adrenal fatigue don’t necessarily respond all that well to medications.

Since many of these disorders mimic each other (sometimes very closely), it can be difficult to determine exactly what’s going on using symptoms alone.  This can pose a problem, because if there is any hope in making progress or getting relief, the right treatment approach must be followed.

For example, let’s say Betty has fatigue.  The first remedy that come to mind might be caffeine pills.  It sounds logical; if she’s tired, the idea of a stimulant probably appeals to her.  If she doesn’t like the concept of chemical stimulants, she might opt for a more natural route; a naturopath or herbalist may suggest Ginseng or something similar.  Functional Medicine, on the other hand, asks why she is tired, and considers all the possibilities.  Fatigue is a common symptom, with many causes – maybe her adrenal glands aren’t producing enough cortisol.  Maybe her thyroid gland isn’t producing enough T4, or maybe she has a sluggish liver or gastrointestinal tract and can’t convert inactive thyroid hormone (T4) to active thyroid hormone her body can use (T3).  Maybe she’s got a lingering virus.  Maybe her energy is being diverted toward immune system activity because she has seasonal allergies.  Maybe her blood cells aren’t carrying enough oxygen.  Maybe she’s got candidiasis (overgrowth of candida albicans, a problematic yeast); maybe she’s fighting a bacterial infection.  Maybe she she has a food intolerance (these can make people profoundly drowsy).  Or maybe she has low blood sugar.

Each of these possibilities is a completely different problem.  Ten people with fatigue may all share the same symptom, but have completely different reasons for feeling the fatigue.  If the underlying reason isn’t investigated, and the person assumes they have adrenal fatigue when really they have a low thyroid, and they begin taking herbs that boost adrenal function, then they’ve missed the thyroid issue and they fail to correct the problem…and the problem remains.  This begins to illuminate the reason why lab testing is crucial.

As I mentioned before, when most doctors order lab testing, they tend to stick only with what insurance covers.  What you may not realize is that the testing insurance will cover is bare-bones, hardly scratching the surface of what’s actually going on.  Essentially, it’s a screening tool for basic disease and that’s really about it.  The limited tests that are ordered and the way in which the results are interpreted does not do much of anything to accurately assess someone’s actual baseline health.

This is not to “bash” the medical profession at all or paint some kind of “us versus them” polarized picture that illustrates that Functional Medicine is everything while conventional medicine has no place.  Indeed, some of those basic disease screenings can be highly appropriate and unquestionably warranted.  However, those basic screenings are sorely limited in their ability to comprehensively assess someone’s genuine health, wellbeing, and quality of life.  And that is where Functional Medicine has a chance to shine…

Functional Medicine doctors will order comprehensive testing that evaluates multiple areas of body chemistry and multiple important functions that are hardly ever touched on in hospitals or regular clinics.  When we order testing a patient has never had, we find things other doctors have never found.  A good Functional Medicine practitioner will evaluate (at minimum) several areas during routine testing:

  • Nutrient metabolism
  • Cellular energy production
  • Oxygen delivery
  • Inflammation markers
  • Organ and gland functions
  • Infection screening
  • Status of certain nutrients
  • Blood sugar consistency, long and short-term
  • Intestinal microbes, beneficial and hazardous
  • Adrenal stress
  • Central Nervous System state

Another important tenet of Functional Medicine pertains to how the lab testing is interpreted.  Most doctors simply scan the lab test results, looking for anything that the lab has “flagged” as abnormal.  In order for a result to show up as abnormal, it must fall outside of the “normal” or “reference” range.  These ranges are set based on statistics.  They vary by lab and even by region.  Look around you; you’re being compared to your neighbors, your friends, family, and co-workers.  How healthy are they?  I don’t know about you, but being “normal” compared to everyone else isn’t exactly reassuring.

What Functional Medicine doctors do is look closer at the lab test results.  They are familiar with what healthy ranges look like and where a person’s body chemistry should be.  These doctors will find literally a dozen or so dysfunctional/abnormal results that labs and conventionally-practicing doctors will flat-out miss.

Many Functional Medicine doctors take yet one more step further, to analyze patterns between these abnormal results, to attempt to find a common denominator, because often, various dysfunctions are related.  It is indeed entirely possible that a person may have multiple dysfunctional processes happening at once, and it’s also possible that multiple symptoms may stem from one underlying disorder.  Functional Medicine practitioners spend a tremendous amount of time behind the scenes pouring over lab test results and conducting any necessary research.

In short, the rabbit hole that is human physiology can go far deeper than expected; Functional Medicine is the only discipline to ever rise to the challenge.

What is Functional Medicine?

The short answer is, Functional Medicine is the future of medicine, if we are to get well and stay well as a society.  It’s the direction in which regular medicine should have gone.  It should be used as the primary method of treatment, especially in cases that are not acute, infectious, catastrophic, life-threatening, or other emergencies.

The long answer is, the definition of Functional Medicine largely depends on who you talk to.

  • The Institute of Functional Medicine, arguably the leader and Gold Standard of the field, describes a science-based, patient-centered form of healthcare that recognizes biochemical individuality and favors active prevention.
  • A talented colleague of mine defines Functional Medicine as a complete lifestyle-modification program that evaluates physiology using extensive diagnostic lab testing and then corrects any imbalances found by applying specific, individually unique combinations of neuro-metabolic therapies.
  • Another talented colleague of mine mentions looking at everything (hormone balance, nutrient metabolism, immune system, and a plethora of other categories) all at the same time, leaving no stone unturned

Functional Medicine really is “all that” – in terms of the explanations given above, as well as being Just That Cool.

When I explain it, Functional Medicine can take on a few different personas that all relate back to the same Big Idea.  Various descriptions are as follows…

  • A highly-advanced version of Clinical Nutrition, taken to another level as practiced by a doctor, that bases its herbal and nutritional plans on comprehensive lab testing
  • A third type of healthcare that is separate from both conventional and alternative medicine branches we’re already familiar with, that utilizes the best of both worlds
  • An emerging medical subspecialty that combines conventional testing and natural therapies
  • A logical, scientific alternative for those looking for natural or holistic healthcare, perfect for those who don’t know where to turn or who to trust.
  • A scientific-yet-holistic of looking at the functions of the body and how they are inter-connected, identifying dysfunctions in key areas using lab tests, and then correcting them with a comprehensive lifestyle modification plan.

That last one is my favorite (couldn’t you tell?)

Functional Medicine really shines with chronic, complex disorders, especially the degenerative and/or mysterious.  I can say it is definitely worth the effort, commitment, and investment!  Most Functional Medicine practitioners know firsthand; many of the best doctors got involved with the field because of their incredible experiences.

We’re a product of the choices we have made every day.  Every day we have another chance to stay on our current path or choose something different.  What are you waiting for? 🙂