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