“My doctor said my blood work is fine,” or “I think they checked my thyroid and said it was okay,” said many a new patient. Nine times out of 10, the same thing will be discovered: Not only was the blood work not quite fine, but not enough tests were actually performed to make such a claim.
Standard Blood Tests
What is usually tested is a complete blood count (CBC), a complete metabolic profile (CMP) and a basic lipid panel. Sometimes, there will be a vitamin D test, a urinalysis, a vitamin B12 test and a folic acid test. Occasionally, there will be a thyroid test, generally consisting of a TSH (thyroid-stimulating hormone) test. If you are lucky, either T4 or T3 uptake is tested as well, but generally not.
Complete Blood Count (CBC)
Let’s review these tests. The CBC checks our blood for the types of red and white blood cells, their size and shape, hemoglobin, and other detailed data on their appearance and function. These tests are for a reason, and their reference ranges are as well. What is beyond shocking to me is how often some of the “M tests” are out of range, and no one says anything about it. The M tests check the size, shape, volume, color and other physical values of our red blood cells. These give enormous insight into the health of our blood production systems and gives an idea if there are any anemias (iron-deficiency anemia is just one type) or other blood-related problems in the body. Some of these tests are called MCV, MCHC and MPV. If these values are out of range, it suggests things like young, immature blood or irregularly shaped blood. Sound important? Besides just an anemia, they can suggest issues of the spleen, liver and kidney far more often than the bone marrow, as you might think.
Complete Metabolic Profile (CMP)
The CMP tests some of the chemicals and a few minerals/electrolytes in the blood. Again, here there are some things ignored quite often. Take glucose for example. There is the standard range of up to 99 or 100 being considered okay, but have you ever wondered what values extremely healthy individuals have? Most of my patients that have worked with me for at least a few months find their glucose values to hover around 80 to 90, not 95 to 105, as many seem to have. Another test is calcium. This one is fascinating to me. For all the comments about healthy bones and calcium supplementation, it is extremely uncommon to see calcium levels out of range! So, why are our bones in general weakening? Honestly, this is a whole article unto itself, but for whatever reason—and there are many—the body is consuming or destroying the bones as a result of other imbalances, such as chronic systemic inflammation; long-term digestive problems, especially with the use of acid blockers and reducers; or hormone imbalances. Almost never is it calcium deficiency, as virtually all research shows. Vitamin D, which is sometimes tested, has been said to be deficient in more than 90 percent of the U.S. population, despite those that work outdoors and sunbathe regularly. That is also beyond the scope of this article.
Some of the other minerals tested are also often out of range. Sodium, potassium, carbon dioxide and chloride are all very important electrolyte minerals in the body. They have a very specific and defined range that they are required to be in. While low potassium may be dealt with by consuming bananas regularly, why is that for most of our life that was not necessary? It’s because we are missing the big picture. These imbalances are really showing us that our bodies, or more specifically, some of our organs, are not functioning quite the same as when we were younger. Maybe they need a little help and repair? These electrolytes are mostly managed by our kidneys, adrenal glands, liver, and even our lungs. How often have those been discussed when observing a mineral or chemical imbalance on your blood work? Perhaps if the CMP values for ALT, AST or alkaline phosphatase were out of range, you heard your liver referenced. If you have seen high liver enzymes, as those three are sometimes referred to, what was the action step? An ultrasound? Maybe they found nothing. Then what? Maybe they found fatty streaks on the liver or gallstones? Now what? Did those values drop? Was there treatment? There are ways to get those values down to repair the source of the problem. It is not removing your gallbladder, sorry.
Basic Lipid Panel
Lipid panels are interesting as well. Cholesterol, cholesterol, cholesterol—it seems to be all that matters. Actually, it probably matters less than you think. The ranges for cholesterol seem to have moved down over the past 40 years, despite heart attack rates rising over that same time. Yes, death rates have plummeted thanks to the miracle of modern CPR (cardiopulmonary resuscitation) and surgical life-saving techniques by more than 75 percent, but the incidence did not drop; it has actually increased over that time. Then there are triglycerides. Not the same as cholesterol at all. Triglycerides are really just fat. Cholesterol is actually a steroid—very different. High triglycerides are a sign that fat is not being processed appropriately, usually a digestive or liver issue. Those same reasons can cause high cholesterol as well, but not always. Isn’t it funny how they give prescription fish oil for high triglycerides now? Fat lowers fat?
My favorite part about cholesterol is the nonsense of good and bad cholesterol. As far as I can tell, there is only one structure for cholesterol. High- and low-density lipoproteins (HDL and LDL) are containers and markers that actually carry cholesterol and other lipids. It is actually a bus made of protein that carries passengers made out of mostly cholesterol. All cholesterol is the same. It is the type and destination of the buses that are different. Some of those buses are for great things, like hormone production and healing, while other buses are for damage and constant repair or inflammation. The problem isn’t the cholesterol, it’s the body’s need for cholesterol. If every day your body is inflamed, it will constantly fill buses with cholesterol with a destination of your arteries and to repair tissues. If every day your body is humming along well, those cholesterol passengers will get on the hormone and growth bus. Maybe the problem isn’t just too much cholesterol but rather the inflammation and damage requiring large amounts of cholesterol for repair.
Expanded Blood Work
Now I will review much of the more expanded bloodwork that virtually every blood lab performs and that all of your doctors learned in school but for some reason do not test in most cases. After helping people for more than a decade, it is apparent that over 80 percent of all laboratory work patients bring from other doctors is grossly lacking and incomplete.
Thyroid tests are likely the most commonly under-tested set of evaluations. While many that know they have a thyroid problem believe they have been tested appropriately, it is generally not so. The most common thyroid problem sounds exotic, Hashimoto’s thyroiditis. This is by far what most people with a thyroid issue have. The hallmark of Hashimoto’s is that it is an autoimmune disease, which means the immune system is attacking thyroid-related compounds. Fundamentally, it is not a problem arising from a malfunction of the thyroid itself or its many feedback systems. There are two blood tests required for accurate diagnosis: thyroperoxidase antibodies and thyroglobulin antibodies. A person with Hashimoto’s may have one or both of these antibodies. These antibodies are important not only to diagnose Hashimoto’s but also to know how to treat it. Those with lower antibody levels tend to have reasonable response to medical intervention, such as Synthroid or its generic, levothyroxine. Those with very high antibody levels seem to have very poor response to prescription despite their TSH (thyroid-stimulating hormone) levels appearing normal. In fact, many have a worsening of symptoms and even the disease process by adding synthetic thyroid hormones in to a highly inflamed system.
Anti-Nuclear Antibodies (ANA)
Those with varied symptoms, such as joint pains, stiffness, fatigue, brain fog and digestive discomfort, should have some very important testing. ANA, or anti-nuclear antibodies, is a general test for most autoimmune conditions. If it is positive, the lab will automatically perform a series of advanced tests to determine more information. Other inflammatory tests include: ESR, CRP, hsCRP, homocysteine, C3a, C4a, and anti-cardiolipin antibodies. Some measure general inflammation levels, while others are more specific to the heart or specific autoimmune processes, and should be potentially checked depending on the complete symptomology of the patient.
Testing for Viruses
Many patients actually have chronic viruses or other pathogens affecting them long term. For whatever reason, in the U.S. talking about parasites is taboo, but the rest of the world checks for and treats these issues more regularly. A few seemingly benign viruses actually can come back later in life with some serious effects. Many have heard of “mono,” or mononucleosis, a disease generally first experienced as a teenager. Just like chicken pox, also called herpes zoster, mono is a herpes-type virus called the Epstein-Barr virus (EBV). And just like with chicken pox, it can come back later in life and be quite persistent, lasting months to even years. Chronic Epstein-Barr infections are implicated in autoimmune diseases like Hashimoto’s and Lupus and even in lymphoma. Often these viral infections come with friends, such as HHV6, CMV and parvovirus, which all act like Epstein-Barr and can reactivate later in life. When testing for these viruses, using EBV as an example, one must test multiple antibodies and see how high the levels are. Many doctors ignore this, only paying attention to the acute type test for the initial infection of mono.
Vitamin levels are quite important as well. There are so many tests available, from the various B-type vitamins to vitamins C, D, E and others. Vitamin D is likely the most interesting, as there are advanced tests showing the difference between vitamin D3 and D2 levels. The body only utilizes D3, so if you are on the prescription 50,000 IU of D2, it is important to know that it is being converted to D3. Many minerals and heavy metals can be analyzed as well, depending on the situation.
Hormone testing is one of the most important and interesting of all the testing areas. Our hormones do not just include estrogen, testosterone and thyroid hormones. Knowing our cortisol levels, for example, might give us an idea of why we are gaining weight, having high sugar levels, healing slowly, and even not sleeping through the night. When it comes to females, there are actually three major estrogens and they all have different importance and tendencies to cause different issues when out of balance. Being that testosterone turns into estrogen in both men and women, both types of tests are required to have a better understanding of what the body is doing. Even testosterone has a few forms, including DHT (dihydrotestosterone), which is many times more powerful than the standard testosterone and has a tendency to cause hair loss on the head but hair growth on the body and face—important to understand in both men and women, especially those with polycystic ovary syndrome.
Many of the tests discussed are just a few of what I consider standard testing, while a few we only use in special occasions. We don’t do these tests necessarily repeatedly on a patient every few months or even years, but don’t you want to know where your base levels are? Call us at 631-462-0801 to learn more about our full panel of bloodwork and report of findings.
Functional Medicine is All About You.
Wellness is not just the absence of disease, but a daily feeling of health and well-being. Functional medicine provides the body with balance and strength from the inside out by healing the root causes of disease to foster your true vitality.
At Pollack Wellness, we strive to bring a supportive and personalized approach to all of our patient relationships. Meet with our wellness center team today and choose one of the best functional medicine doctors in New York to partner with you on your path to wellness. Call now to experience our proactive approach to healing!