When you see your Primary Care Physician (PCP) for your annual checkup and you have blood collected. The Big Myth about Lab Results.
This article is adapted from Tracy Harrison, a very knowledgeable scientist and health coach. “You may have run into these myths, these assumptions that really shapes the framework of the vast majority of primary care interactions we have. So as long as the lab value was within the reference range, it’s fine. It doesn’t really merit any attention. It’s “WNL” -it’s within normal limits. It doesn’t need investigation, it doesn’t need attention, and it certainly doesn’t need treatment. I think we all know already, that this is a common one and it could not be further from the truth. It’s a fact that the reference range is not a target range. You might be shocked at how many people, really intelligent people, have just been misled or misinformed to believe that the normal range is the healthy range. It’s a good place to be. As long as they’re inside of it, phew, they’re not going to get sick. They’re good. They’re doing great. They should just keep doing whatever they’ve been doing in terms of lifestyle choice.”
When you have an epidemic, chronic disease dynamic going on in your culture, the last thing in the world you want to be is normal.
But in fact, the reference range is very seldom an optimal range. It is actually using the word normal not to mean fine, healthy, good. I’m using the word normal to mean a statistical norm or the average. Reference range simply represents two standard deviations of what the actual reference population has. When you have an epidemic, chronic disease dynamic going on in your culture, the last thing in the world you want to be is normal. I’ve shared with all of you, I know in prior discussions I really disliked the word fine, because we use “fine “as a shield, as a throw away response to the question of how are you? That is not really accurate or thought through. It’s not a thoughtful response. Many of the people in our practice are lurking behind the label of “fine” and they’re not really well at all. They have perhaps become so adapted to various clusters of symptoms or states of dis-ease, that it’s their normal.
As long as their health sucks in the same general way on a day over day basis, they feel normal. It’s what is normal to them. It’s what is average to them. Right now in society, we are having to get used to the idea of a new normal, or really a new abnormal. Did you think you were a bank robber the first time you walked into the grocery store wearing a mask?
So we have an opportunity to educate folks about aiming for a higher good, about moving beyond the conventional medical goal of finding a disease. If all you have is a hammer, you tend to find nails, you tend to find things to diagnose, you tend to find things to treat. But if your goal is to maximize health, you will respond organically in a completely different way. Sometimes on lab report sheets, ranges are stated as target values. The majority of the time they are stated as statistical ranges. I think one of the worst things is that it is often not labeled one way or another. So perhaps it’s no surprise that the average patient is quite confused because they are looking for standardization, they’re looking for it to work the same way all the time and it of course doesn’t.
So we just take a simple example here. Brad, 39 year-old man struggling with energy crashes in between meals. Struggling increasingly with less muscle mass despite working out on a regular basis. He’s picked up eight pounds, which he feels is largely around his midsection. Depressed that he’s had to move two notches out on his belt over the past year. And has started to struggle with some hypertension – was surprised to learn about that in his most recent annual physical visit. What interconnectedness comes to mind? We have an epidemic of insulin resistance and various stages of metabolic dysfunction and changes in blood sugar and in insulin can have a downstream effect on sex hormones like testosterone for a man, and start to cause some of these classic symptoms. His most recent fasting glucose result was a 95 and indeed he was told he was fine. The following year, this same fasting glucose was up to 101. OH, it’s finally up outside of the reference range so that finally triggered a reaction from his primary care physician. Hemoglobin A1C was run for the first time, 5. 8%. And of course, what does he say? “I don’t know what happened. I just suddenly got pre-diabetes.”
No one suddenly gets prediabetes.
In fact, when metabolic dysfunction progresses to the point where blood sugar is increasing, whether it’s marked against the threshold of prediabetes or official type two diabetes, is really a sort of an immaterial division. It’s still later stages of metabolic dysfunction. There was an opportunity missed to inform Brad over a year ago when his fasting glucose was 95 or I bet probably two years ago when his fasting glucose was 92 or maybe the year before when his fasting glucose was 90. There was an opportunity to start to educate him then that there was an opportunity for him to change his future, to change his prognosis by simply making other choices. Sometimes people continue down a disease progression because they just don’t want to make lifestyle change or they can’t figure out a way to do it. It’s a travesty for so many people who don’t change their lifestyle because they don’t know it’s an issue. We should wait so long to engage. The longer we let things go on, the harder it seems to change. Let’s not wait for dis-ease to become severe enough to diagnose it when already usually quite a bit of damage has been done, Or in the case of metabolic dysfunction when the imbalance has likely been at play for several years, if not a decade beforehand. (end of abridged article.)
Note from Garey: Tracy is my mentor and teacher at the School of Applied Functional Medicine. Here is my take-away. If you are at the upper limit but within range or at the lower limit and still within range, understand there may be a dysfunction at play here and an more detailed examination may be in order. Not to prescribe a medication but to examine, lifestyle choices, food quality choices, mental and emotional stress levels and ensuring you have a higher level goal in mind for your health. Don’t wait until you are out of range and a medication becomes the go to prescription. Most of what we experience as illness or lack of energy and sleep or gut disorders, heart risk factors and endocrine disorders are basically self-inflicted. We can avoid a lot of this by course correcting as we move along in life.
The really great thing in all of this is that the body is very forgiving and within weeks or months of making a pivot to the good, the body responds quickly. Said another way, we can dish out a lot of abuse and neglect on our bodies, but once we make a decision to take a stand to “level up,” the body will meet you and surprise you with speedy improvements! If you’d like to go over your annual physical blood test result with a functional medicine health coach, fill up this form.
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