“My Lab Tests Are Normal, So Why Do I Still Feel Horrible?”
One of the most common questions that we get here is “my doctor says my lab tests all look normal, so why do I still feel horrible?”
There are two main reasons for this.
One– laboratory reference ranges versus functional medicine reference ranges.
Most doctors (and laboratories), when assessing blood chemistry, look at what is called a “standard laboratory reference range”. This is based on an average of people who are getting their blood tested, both sick and healthy. Therefore, when one patient is comparing their results to this standard laboratory reference range, really what they are doing is seeing how sick they are compared to a population who is both healthy and sick. This is kind of like going to McDonald’s and seeing that compared to the people in there, you’re in pretty good shape. If you go to a gym where there tend to be more healthy people, unfortunately, we tend to notice how out of shape we can be. While humbling, it is a more honest assessment of our physical fitness.
Functional medicine blood chemistry reference ranges are like the people at the gym—it’s an average of the blood chemistry levels taken from people who are healthy. By comparing our values to these, we tend to notice how out of shape we can be. What often happens with patients who are symptomatic, is that they are within the standard laboratory reference ranges, but are outside the functional medicine reference ranges.
In our office, we use functional medicine blood chemistry reference ranges. We also refer to the standard laboratory reference ranges so that we can show our patients the difference between the two. Patients love seeing the black-and-white the difference. Just this morning I saw a patient whose main complaints were chronic fatigue and fibromyalgia. Her previous labs showed no problems. But when I ran a functional medicine blood chemistry panel on her, guess what? It showed that she was hypothyroid, and had marked inflammation! No wonder she felt horrible!
Two-Insurance-based medicine versus patient-based medicine.
Let’s acknowledge the elephant in the room right now. Who is in charge of healthcare? Is it the doctors? Who pays them? If you answered insurance companies, you’re right! And guess what, insurance companies make their money by cutting our benefits and doctors’ pay. And how do they do that? By telling doctors and patients what they will and will not cover, or just by flat out not covering something but they said they would. We’ve all either experienced this or have heard of somebody who has. Right now, insurance companies are covering less and less laboratory testing, which leaves us as patients hung out to dry. Almost all patients that I’ve seen come into my office do not have comprehensive laboratory panels run on them to see what their real problem is. This is the second reason why many patients are told that their laboratory tests are normal even though they still feel horrible. The right laboratory tests were not run! In my previous example of the patient who felt terrible but was told they were normal and had fibromyalgia and chronic fatigue, the previous tests done by the hospital did not check for inflammatory markers such as ferritin, HS-CRP, and homocysteine. The tests also did not take into account functional medicine blood chemistry lab values which, if used, would’ve shown that she was borderline hypothyroid! Once we put these all together, the picture became clear—both to me and to the patient—much to my patient’s satisfaction. By the way, yes, she is feeling much better.
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Yours in health,