Why Your Lab Work Came Back “Normal,” and You Feel Terrible
What does it mean to be normal?
The day is here. It’s your son’s birthday, and his wish is that you play hide and seek with him. You see the smile light up his face as he asks you, “Are we still gonna play?” You’d love to, except for the fact that your back is killing you, you feel bloated, and you’re so fatigued walking down the stairs that it feels like doing an Ironman triathlon. Naturally, you think it might be time to have a check-in with your doctor.
Your doctor orders some labs and you’re excited that you will finally know what’s going on with you! Then, you hear this sentence: “It looks like everything checks out. All your numbers came back normal.” You’ve never been more confused. How on earth could you be feeling like this and still have normal blood markers? Surely something has to be off.
Let me first say it’s entirely common to have symptoms of fatigue, brain fog, constipation, bloating, or joint pain, while still having lab values in the “normal range.” In today’s article, we’re going to explore what leads to this confusion, what lab companies mean by “normal,” and why your numbers don’t match your symptoms.
The Idea of Normal
To identify where medical ranges come from, let’s return to high school math, sorry non-math enthusiasts. Remember standard deviation? It basically says that, for a given set of values, ⅔ of people (67%) will fall within 1 standard deviation of the mean or average. 95% of people will fall within 2 standard deviations of the mean. Lab values are determined based on ranges 2 standard deviations (95%) on either side of the mean.
Okay, so where does the mean come from?
It comes from the people living in your area, visiting that same lab. Essentially your lab ranges are calculated based on the average of the people around you. Let’s take blood sugar for example. You get a blood sugar test done as a part of your yearly check up, the value comes back as 90 mg/dL (disregard the metric, just keep the absolute numbers in mind). The lab range says 65–99 mg/dL, yay you made it in! KEY POINT: This means that 95% of the people in your area have an average blood sugar value somewhere between 65 and 99. So your value is “normal” based on your area.
Now, let me ask you this, would you say there are towns, areas, or cities that are “healthier” than others? Is cold-brewed coffee the greatest creation ever? You bet! What’s the health of the average American like? I think we agree it could use some improvement.
Let’s say you live in a generally unhealthy area, but personally, you like working on your health, so you eat a fairly high protein diet and exercise quite frequently. Now, if you were to go get lab work done, do you think your numbers would look like everyone else eating the standard American diet and not exercising? Of course not.
Because your lifestyle is so different from those around you, you’re likely going to have numbers that are outside the “normal range.” For example, Blood Urea Nitrogen (BUN) is a common lab run to assess kidney function. In people such as yourself who like protein and exercise, this number may come back above the normal range, but this is a normal phenomenon. If you were to have a traditional practitioner look at your numbers, they would think you’d have some sort of kidney damage, especially if all your other kidney markers look good. Scenarios like this take a practitioner who’s skilled in looking at lab work differently.
What’s Optimal?
If you’ve been to any functional, natural, and/or integrative practitioner, they’ve likely mentioned the concept of “functional” or “optimal ranges” with you. The idea is that the standard medical ranges capture too much of the average American, and the ranges should be different for those looking to improve their health. I’m a huge fan of this approach, however, I’ve seen some functional providers take a cookie-cutter approach to looking at lab work. They take the standard medical ranges, and just make them more narrow and call that their “functional range.” It’s too simple in many cases.
For markers such as blood sugar, that’s generally an okay approach, but remember what happens to BUN (kidney marker) if you eat high protein and exercise. It reads above the normal range. So just narrowing the range isn’t really capturing the optimal range, rather the optimal range should be calculated differently from test to test. Next time you visit a functional provider, ask them where their ranges come from. If they can’t provide you with an answer, that’s a problem.
From my experience, having levels fall outside the functional range is a reason for practitioners to recommend supplements to improve that marker level. It can be used to scare people into thinking that they need certain supplements, rather than educating them on why the lab marker is or could be non-optimal. For example, if your blood glucose (sugar) falls outside the functional range, recommendations may include berberine, bitter melon, glycine, L-alanine, or cinnamon extract. This approach is along the same line of thinking as traditional medicine. If you have y condition, give x solution. In reality, your blood sugar levels might be fine. It may be as simple as you just had a stressful morning the day you got blood drawn. It’s important to look at the big picture and not just one piece of the puzzle.
The human body is so complex that thinking we can identify the possible cause of any symptom-based on a lab value is laughable. For example, there is no blood marker for happiness, sadness, or fear. Do you think those feelings influence your symptoms? Human thoughts and emotions play such a large role in determining how we feel, yet are incredibly difficult to quantify.
Evidence-Informed Approach
“Many doctors use lab work to look for disease, however, at The HIVE Natural Health Center, we use lab work to look for health.”
Don’t get me wrong, I love the field of functional and natural health, I just think some practitioners are so busy they don’t have time to fact-check where the functional ranges come from. Oftentimes, they are put forward by supplement companies, as a means for practitioners to sell more of their stuff, which is kind of a genius, but misguided approach. The right approach would be to use lab numbers associated with health from the latest research, the practitioner’s clinical experience, and what the patient is comfortable with.
Many doctors use lab work to look for disease, however, at The HIVE Natural Health Center, we use lab work to look for health. We use lab values from the latest health data, along with values we’ve personally found that have been associated with better health in our patients. We don’t treat your health and livelihood with a cookie-cutter approach, we treat you as the unique individual you are.
Next time you get lab work done, remember, lab numbers don’t dictate your symptoms, and your symptoms are not dictated by lab numbers. Or, as one of my mentors puts it: “Treat the patient, not the lab value.”
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As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
