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The following paragraph is from a handout I saw in the office of Ben Gonzales, M.D.:

Everything is Normal” … said the doctor to you. You went to your doctor because you haven’t been feeling yourself in a while. Something is not quite right. You feel a bit “off” but can’t quite put your finger on it. You may be gaining weight despite working out and eating right, your energy levels have been dropping, sex drive is decreasing or you simply are losing your ability to focus. Yes, you have the usual and may be unusual stresses at home, job, financially, relationships perhaps. Your sleep patterns are changing and you do not know why. The doctor did an exam, got some basic labs and tells you, “Everything is normal” But you don’t feel normal. What is “normal” when it comes to labs? Why is it that results vary in “normal ranges” from lab to lab?

Or, maybe it is the opposite scenario, as described below an excerpt from Labs Online website:

Your test was out of the normal range,” your doctor says to you, handing you a sheet of paper with a set of test results, numbers on a page. Your heart starts to race in fear that you are really sick. But what does this statement mean, “Out of the normal range”? Is it cause for concern?

Doctors may use the words “normal” informally, but labs these days more often than not use the word reference range.

For example, blood work for Cholesterol may look like this:

(If the figure is legible, just click on it)

Figure

In this above example, Total Cholesterol, Triglycerides, HDL, VLDL are all within their corresponding Reference Ranges. While LDL Cholesterol, which is a calculated value from other measurements is outside the range, marked here with bold font and also with letter H (for High) in the next to the reference range.

First of all, where do these Normal or Reference Ranges come from and what does it mean to be within the range or outside the range – doctors and you may refer to as Normal or Not-Normal after a quick review of the lab results?

For some tests, guidance may come from National Institute of Health (NIH) or some expert panel of the corresponding physician’s association. For example, in the case of Cholesterol, the reference range is taken from the NIH Heart, Lung, and Blood Institute publication called Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, or Adult Test Panel III or ATP III. NIH has developed this publication by organizing expert panels of medical professionals and researcher to review all the literature and then develop recommendations.

For some other tests, ranges are derived by collecting data for a large enough group of people and then performing some statistical analysis to derive what is “normal” for them

The first step in determining a given reference range is usually to define the population to which the reference range will apply, for example, healthy females between 20 and 30 years old. A large enough number of individuals from this category are tested for a specific laboratory test. The results are then averaged and a range (plus or minus 2 standard deviations of the average) of normal values is established.

And that becomes the reference range, based on which, you may be told “Everything is normal” or the opposite of it.

So, given this background, what should you be watching out for or questioning in this process? Here are some questions to ask, that may lead you to dig further into your labs:

  1. Does the lab data correspond to how I feel?
  2. Do I belong to the category from which the reference range was derived?
  3. What is the optimal range, not just normal range?

There is an intriguing story of a woman who during her pregnancy felt awful but her doctor kept telling her that everything was normal and she even had a miscarriage. She eventually figured out that she was suffering from Hypothyroid and found the right doctor to work with, thus totally transforming her life. She became a crusader in educating women on this thyroid issue and launched HypothyroidMom website.

Then there is even a bigger question: Are the lab tests that are being used for screening issues the right tests?

Dr. Gonzalez in his flier concludes:

Many basic labs are left out in an initial general physical workup. Understanding what labs to obtain in evaluating your physiologic function is not a basic skill seen in many primary care clinics. Again, simply because most clinics are looking for disease results in your labs, not optimal results as they relate to your long term good health. This is an issue in our current health care system. Finding a provider who understands optimal ranges in your labs and how nutrition fits into managing your health can be challenging. Seek that provider.

Because everything may not be “normal”.”

In my next post I will share some more information about what are some overlooked labs that your primary physician may be reluctant to order but are these days considered vital for managing optimal health.

So, what are your experience on this subject.

I would love to hear and learn.

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