There is a significant difference between normal lab results and optimal health. Hearing your doctor say your labs are normal may not be the goal for which you should strive.
Reference ranges are not reliable.
Do you know how reference ranges are calculated in medical labs? They represent a bell curve created by the data collection of all test results. That means they include the results of even the sickest of patients. It is far from ideal to be in the middle of the range compared to a population that consists of the unhealthy.
Different lab companies will have different ranges for a specific test. Although the measured levels will be the same, ranges will vary according to the population that uses that lab for a particular test. What is in range for one lab may be way out of range for another. One clear example of this is hormone levels. Quest Diagnostics is a lab company that is used by all types of practitioners across all fields of medicine. Their reference range for testosterone in a menopausal female is from 4 to 45 (ng/dL). Vibrant America’s range for the same patient is 4 to 312 (ng/dL). This is because many Functional Medicine practitioners use Vibrant America, and often their patients are on bio-identical hormone replacement therapy.
Lab ranges are always changing. A current example of this is Vitamin D3 levels. Before the pandemic in 2020, most lab companies used 30-100 (ng/mL) for the range of Vitamin D3. Since so many people began taking Vitamin D3 to stay healthy, the reference range at Quest Diagnostics has recently changed. It is now 30-150 (ng/mL). The reference range has nothing to do with what is optimal for your health but what is most common.
Relation is important.
Often, markers are looked at individually, but the relationship between markers is most important. One example of this is complete thyroid testing. Our thyroid produces T4 and a small amount of T3, the active thyroid hormone our body uses. We convert T4 into more T3, and Reverse T3 is created as a byproduct. Reverse T3 mimics T3 but is inactive and blocks the T3 receptors. So, if T3 is on the low end of the normal range and Reverse T3 is on the high end, nothing is flagged as unusual, and labs will look fine. But, since these hormones oppose each other in their actions, the net effect will be functional hypothyroidism (low thyroid) even though their thyroid parameters are “normal.” The body may be producing enough T3 but cannot use it. This would be easily missed if the relationship between markers wasn’t considered.
An additional example of the importance of results in relation to one another is the counterbalance between Estradiol (a form of estrogen) and Progesterone. A female experiencing some, or all, of the symptoms of estrogen dominance, may have normal labs. She may have weight gain, PMS, breast tenderness, heavy and painful periods, cyclical migraines, acne, mood changes, or other symptoms. At the same time, her labs are “normal.” If her Estradiol on the higher end of normal and Progesterone on the lower end of normal, she will likely be told by her physician that her hormones are fine and not the cause of her problem. But she is actually estrogen dominant. And worse, unopposed estrogen levels can contribute to other more serious health issues like uterine fibroids, endometriosis, autoimmune conditions, and cancers.
So many patients are told their labs are normal, even when they know they aren’t feeling right. Either their lab work is missing important parameters, or physicians aren’t differentiating between truly optimal results and “normal” results. My labs were always normal when I was at my worst with autoimmunity. It is an all-too-common challenge for those with chronic illnesses.
Hopefully, you are healthy and focused on optimizing! The results we should be looking for are optimal. Being in the middle of the bell curve of the unhealthy population at large is not acceptable. And it is certainly not leading to the path of prevention and longevity.
Luckily, looking at your labs through the lens of optimal rather than just within the reference range and having the right physician who orders all of the appropriate tests and considers them in relation to one another can be life-changing. It can mean finding the underlying causes of your symptoms or preventing potential health decline.
It is time to strive for excellence!