As a clinical nutritionist in the state of Michigan, I have no access to ordering blood work tests for my clients and instead I need to rely solely on the client's physician to run the appropriate tests each year so I can help monitor the health status of my
Even more frustrating was that as a patient (before becoming a clinical nutritionist) I had blood work done yearly, and my doctors would tell me my blood work was good but I had NO IDEA what any of the numbers actually meant. What the heck is Alk Phos? Or MCV? Or any of the other numbers for that matter? And why are they important to check? In order to empower us as patients, it is ESSENTIAL that you understand what your blood work means.
Now that I know what the numbers actually mean, I have been very disappointed in the lack of blood work and testing that is run on a yearly basis. When blood work is run, it usually is only a scattering of numbers that hardly paints a picture as to what is happening in that client's body. And I almost NEVER see certain tests that I think are vital to everyone regardless of age, condition, etc such as stool tests.
Below you will find the tests needed to see the total picture of health (or at least as close as we can get right now) along with the optimum functional ranges in which your number should fall. There is a difference between the reference ranges you will see on the blood work from your doctor's office and what functional health practitioners see as optimum ranges. The reason for this is that most blood draw labs create their own reference ranges based on the tons of results from the folks who come into the lab and get their blood work done. However, the ranges become skewed as folks with medical conditions and diseases are more likely to get their blood drawn more often.
This means that the ranges we consider "normal" or "healthy" are actually not ranges established from a healthy population.
These conventional ranges are also very broad in that if you are out of range, you
either have an established disease or are well on your way to having an established disease. They detect the disease when it is full-blown. In conventional medicine, the paradigm is "let's wait until you have developed a serious disease and then we can use drugs and surgery to treat it." At this point of a disease, it can be very challenging to use lifestyle changes, nutrition, etc to treat it.
Using functional optimum lab ranges, we are comparing our blood work to that of a healthy population. The ranges are also much smaller so that if a number falls out of range, it is indicative of the beginning development of a more serious condition.
Functional lab ranges detect imbalances before a disease actually occurs. When we look for patterns of numbers falling out of the functional range, we can start to see a disease forming before it becomes a full-fledged illness that needs medication. At this stage, the client can much more easily use lifestyle changes and nutrition to help heal the body and reverse what ever condition is beginning.
My goal here is to empower you to understand your blood work and help recognize patterns indicative of dysfunction or disease before they are full-blown.
Glucose (70-90 mg/dL) and HbA1C (<4.5%): early detection of blood sugar dysregulation and prediabetes.
Triglycerides (70-110 mg/dl): indicative of excessive sugar, fructose, alcohol or hydrogenated fat consumption and blood sugar dysregulation. Serum triglyceride
removal is a function of both the liver and muscle tissue so exercise and liver health are an essential component of optimum triglyceride levels.
Total Cholesterol (150-220 mg/dL): Cholesterol is found in every cell of the human body and is needed in order to make sex hormones (estrogen, progesterone, testosterone, cortisol, etc) and is needed to synthesize vitamin D from sunlight. Total cholesterol really is not a very important indicator of cardiovascular health as we once thought and instead, triglycerides, LDL and HDL are starting to paint a better picture of cardiovascular health. Make note: a diet high in sugar, processed carbs, alcohol and hydrogenated fats are more likely to cause elevated cholesterol than consuming dietary fat.
LDL (<120 mg/dL) and HDL (>55 mg/dL): Act as "cars" that transport cholesterol throughout the body in the blood. Recent studies are showing that the more important marker of in the development of cardiovascular disease is the number of LDL particles in the blood. LDL particles are denser than HDL particles. Picture LDL particles as baseballs and HDL particles as beach balls. Both types of particles are carrying cholesterol through the blood vessels. When you have lots of LDL, that means lots of baseballs crashing into the fragile blood vessel walls. This is what helps initiate a build
up of LDL and plaque. Unlike LDL "baseballs", HDL "beachballs" just gently bounce off the walls and do not damage the arteries which is why HDL is considered "good cholesterol." This is a very simplified version of what happens but I hope it gives you some insight as to why LDL particle number/concentration is important. More baseballs in the blood stream leads to the potential for more damage to the blood vessels. Unfortunately, the LDL that doctors most often test is not the particle number (LDL-P: <1,000) so it is not as helpful in painting a picture as to what is happening in the blood vessels.
BUN (10-16 mg/dL) and creatinine (0.8-1.1 mg/dL): Tests that help measure kidney function
Potassium (4.0-4.5 mEq/L), Sodium (135-142 mEq/L), Chloride (100-106 mEq/L), CO2 (25-30 mEq/L): electrolytes important to view in relationship to each other. When out of range, it can be indicative of several things including adrenal dysregulation, dehydration and/or imbalanced pH levels.
Anion Gap (7-12 mEq/L): a measurement of the comparison of sodium and potassium to CO2 and chloride. Helps to determine a general measurement of tissue alkalinity or acidity.
Total Protein (6.9 - 7.4 g/dL), Albumin (4.0-5.0 g/dL), Globulin (2.4-2.8 g/dL): When
these numbers are low compared to the functional range, it is a good indicator that your body is low in stomach acid and further testing in this area is needed. This is especially true if you are consuming adequate protein but the numbers are still low. Appropriate stomach acid levels are essential to breaking down food and absorbing nutrients and reducing digestive inflammation so optimizing stomach acid is a key component of health.
Calcium (9.2-10.0 mg/dL): when calcium is out of range it is usually indicative of something besides too little dietary calcium since the body has a huge reserve of calcium in the bones to help keep serum calcium levels optimum. When serum calcium is outside of the optimum range, also look at these things that are needed for proper calcium blood levels and proper calcium balance in the body: adequate stomach acid, vitamin D levels, vitamin K2 levels, appropriate levels of magnesium and phosphorus, hormone imbalance (ie: parathyroid hormone).
Phosphorus (3.0-4.0 mg/dL): levels are closely tied with calcium so look at the two numbers in relation to each other. Like calcium, if numbers are out of range look to things like hormone imbalances and digestive insufficiency.
Magnesium: behind potassium, magnesium is the body's second most common intracellular cation. This means that because most magnesium is found inside of the cell, blood levels are not a great measurement of your body's magnesium status. If concerned with magnesium levels (ie: muscle cramping, heart dysrhythmia, chronic constipation, etc), then get an RBC magnesium assessment as red blood cells contain 2-3 times the concentration of magnesium found in the blood and will be a better indicator as to the body's magnesium levels.
Alkaline Phosphatase (70-100 UL), AST (10-30 U/L), ALT (10-30 U/L), GGTP (10-30 U/L): All of these markers can paint a picture as to liver and gallbladder health. In general, numbers that run high outside of the functional range can indicate liver/gallbladder dysfunction or inflammation and numbers that run low outside of the functional range can indicate the need for various nutrients such as zinc, B6, magnesium, etc.
CBC: This measures levels of immune cells such as WBC, neutrophils, eosinophils,
basophils, monocytes, lymphocytes. When outside the reference range, this can be indicative of the body fighting either an acute infection such as a cold or a chronic infection. Chronic infections are depleting on the body so if a chronic infection is possible, it is essential to get to the root cause.
Markers for anemia: Total Serum Iron (50-100 mcg/L), Serum Ferritin (men: 33-236 ng/ml, pre menopausal women: 10-122 ng/ml, post menopausal women: 10-263 ng/ml), Total Iron Binding Capacity (250-350 mcg/dL), % Transferrin Saturation (20-35%), reticulocyte count (0.5-1%), hematocrit (males: 40-48%, females: 37-44%), hemoglobin (males: 14.0-15.0 g/dl), MCV (82.0-89.9), MCH (28-31.9 pg), MCHC (32.0-35.0 g/dl), RDW (<13%). Because anemia can be due to several things including reduced iron consumption, low stomach acid, reduced levels of B12, folic acid, copper, B6, it is important to run several markers for anemia status to indicate the level of anemia
along with the primary driving factor such as a nutrient deficiency. This is an instance where I almost never see a full panel of numbers run and instead clients with low iron are often supplemented with iron pills even though the anemia may be due to low stomach acid. Nutrient deficiencies that can be tested in anemia include B12, B6, B9, zinc, copper.
Thyroid Health: TSH (1.4-2.2), free t4 (1.0-1.5), free t3 (3.0-4.5), reverse t3 (90-350), thyroid antibodies (TGab <4, TPOab <35), t3 uptake (females 28-35%, males 32-38%), TBG (1.1-2.1), total t3 (100-280), total t4 (5.4-11.5). As you can see, dysfunction in the thyroid is dependent on a lot more than just TSH numbers. When we see a full thyroid panel, we can start to see where the thyroid dysfunction is occurring, which is especially helpful in clients with hypothyroid symptoms but normal TSH and free t4 numbers. Other things that impact thyroid health are iodine, selenium, circadian rhythm function and stressors.
Markers for inflammation: LDH (140-200), ANA (<4%), ESR (Males: <5 mm/hour
Females: <10 mm/hour), homocysteine (<7), hs-CRP (<0.5), vitamin D (40-60+ as long as vitamins K2 and A status are also optimized)
Tests for digestive dysfunction that I usually only see functional medical practitioners run but I think these tests are extremely important: Heidelberg pH Test (tests for levels of stomach acid), food sensitivity testing (food sensitivities contribute to digestive inflammation and overall inflammation. Cyrex Labs has the most accurate tests), Comprehensive Stool Analysis (I like Doctor's Data laboratory. This type of test gives insight into the health of gut bacteria, the presence of pathogens and parasites, the appropriate breakdown and
absorption of food as well as markers of digestive inflammation). The stool analysis can also test for leaky gut/intestinal permeability which also drives up whole body inflammation levels and can be seen in several conditions from autoimmunity, to skin conditions such as eczema, to depression and anxiety (as 90% of serotonin is actually produced in the gut, not the brain).
Tests for hormone balance: I really like the DUTCH dried urine hormone test from Precision Analytical. Urine and saliva are the best means to test hormone status as these fluids show levels of bioavailable hormones. When testing hormone levels in the blood, these hormones are often bound to transporters which makes them unavailable for immediate use in the body. Therefore, it is possible to have blood hormone levels "in range" but to have symptoms of hormone imbalance since this measurement is not indicative of hormones immediately available for use. The DUTCH test is great for testing imbalances in sex hormones and adrenal hormones which I often see in clients as they go through mid-life changes along with those under constant stress. The DUTCH test is best since it measures dried urine levels of both hormones and their precursors and metabolites to get a very comprehensive picture as to what is happening in the body.