By Dr. Justin Marchegiani
I see patients all the time in my practice that tell me they don’t feel right, yet their medical doctor tells them their lab tests are normal. The typical response from the average medical doctor will be something like this: “It’s all in your head. You may benefit from taking an antidepressant.” Or if you’re a woman, it may be blamed on female hormone issues, and the next solution may be to go on a birth control pill to help normalize your cycle.
Intuitively, people know something’s wrong even if their lab tests aren’t totally in the red. The most common response I hear in my practice—
“My lab tests are normal, but I still don’t feel well!”
The problem with this scenario is there are physiological, biochemical, and hormonal explanations for why patients feel the way they do. Conventional medicine typically gives these patients no answers and worst of all, can sometimes make them feel as if they’re making it up.
In the world of functional medicine, we tend to look at things differently than your conventional medical doctor. Most lab tests have originated to include 95% of the population into the normal values. So if your medical doctor tells you your labs look fine, that just means you fit into that 95% category, or two standard deviations away from the mean if you are into statistics.
Anyone that has walked around an airport for just a little bit of time will be able to tell you 95% of the population doesn’t fit into the healthy category. Conventional medicine makes a massive assumption that the absence of disease is health. This is like saying the absence of being poor on the street means you’re rich! I hope my analogies help drive the point home that these assumptions are absurd!
Why the Answers to Symptoms Get Missed by Conventional Lab Testing
As society gets sicker and sicker and sicker, we know the reference ranges get wider, and wider, and wider. So if you are someone that may have been healthy to begin with, and then have a sudden drop in your health, you may still fall within that normal reference range. Thus, being told nothing is wrong.
It’s really not your medical doctor’s fault. Conventional medicine trains physicians to look for pathologies or disease, and this is a good thing. Where this paradigm falls short is when you aren’t sick enough to fall into the category of being diagnosed with a disease. So what do you do next?
Essentially, conventional medicine is saying, “Go home, continue doing what you’re doing, get sicker, and then maybe we’ll be able to diagnose you with something in a few years.” Intuitively, that doesn’t sound right to me. We need to look at things in a more sensitive way so we can pick up this slow and steady breakdown before it becomes a major problem.
Your body is designed to adapt to stress. Maladaptation is the number-one sign that your health is starting to decline. If your body loses the ability to adapt to the various stressors in your life, you will eventually come down with some type of disease. The goal of functional medicine is to figure out where the underlying stressors are coming from. Using specific lab markers that are sensitive, we can chart your overall health function on a spectrum so as we start incorporating treatments, we have objective and subjective markers of improvement.
Functional medicine can look at the exact same labs and potentially pick up subtle things that conventional medicine may not. Click here to get your labs assessed.
Thyroid Lab Testing and the Inadequate TSH Test
Most people have low thyroid symptoms even though their thyroid lab tests are normal! The standard panels that are looked at are typically a TSH test (a brain hormone) and T4 test (a storage thyroid hormone). It always bothers me that conventional doctors very rarely look at the active thyroid hormone (T3) to assess a thyroid problem. Especially since the research over time has shown that TSH testing isn’t the best to assess thyroid function. If TSH is elevated, it’s a surefire sign of thyroid dysfunction, but it’s a marker that tends to elevate late in the game.
Above are the markers that I commonly run on my patients to assess which pattern of thyroid dysfunction they have. Thyroid antibodies are also looked at to assess if there is an autoimmune disease at play. Most conventional physicians totally ignore thyroid antibody testing completely because it doesn’t change the conventional treatment; Synthroid will be given either way. Knowing whether or not a patient has an autoimmune thyroid disease (Hashimoto’s thyroiditis) can make all the difference in the world.
When we are dealing with Hashimoto’s, it’s the immune system that is out of balance. It is destroying the thyroid gland. It doesn’t make sense to put all of our focus on the thyroid gland if the immune system is attacking it daily. Some people with Hashimoto’s (hypothyroidism) may need thyroid hormone depending on how bad the damages is. I always recommend getting a full assessment like the one above before it is recommended. Hashimoto’s patients will typically respond better on a combination of T3 and T4, like in Nature-Throid, or a bioidentical thyroid glandular instead of a synthetic T4 medication.
Assessing the glands that help control and regulate stress is very important to your health. Your body is designed to be healthy, and part of being healthy means adapting to stress. Your adrenals are instrumental at producing hormones throughout the day that are designed to do just that.
Cortisol is secreted in a pulsatile fashion, higher in the morning and then tapering off throughout the day. Cortisol is designed to help stabilize blood sugar and help deal with stress and inflammation. The more dysfunctional our adrenals become, we start progressing into deeper stages of adrenal fatigue. This is where our brain (the master controller) isn’t able to communicate with our adrenals properly and we develop HPA axis dysfunction. This is nothing more than communication breakdown that can be fixed with proper diet, lifestyle, stress management, and a properly prescribed adrenal program (specific to your pattern of adrenal fatigue).
Blood Test Markers for Health
Looking at blood test markers from a CBC, CMP, or lipid panel can provide a pretty good idea of how the body’s systems are functioning.
When we see digestive markers, like albumin, globulin, creatinine, BUN, or serum protein, out of balance, it can tip us off that we may be dealing with some digestive inflammation, low stomach acid, leaky gut, and/or malabsorption.
We can look at markers like RBC, Hgb, Hct, MCV, MCH, MCHC, and ferritin, which are markers for an anemia. An anemia typically deals with deficiencies in certain B vitamins, like folate or B12 and/or iron. Most conventional doctors tend to miss these subtle imbalances. And they can contribute to a person’s inability to transport oxygen, create energy, and convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).
When we see blood sugar markers, like fasting blood sugar, hemoglobin A1C, or insulin, out of balance, it is a good sign there is inflammation. There are more specific markers that can be looked at, like C-reactive protein, ESR (erythrocyte sedimentation rate), fibrinogen, and a triglyceride-to-HDL ratio greater than 2.
When we assess white blood cell (WBC) function, long-term low WBC can be indicative of a chronic infection, while elevated WBC can be a sign of an acute infection. This rule is the same for the WBC’s constituents as well. Below is a list of the specific components of WBCs. We are looking at the markers below in a more sensitive range than the standard lab range, so we can pick up more subtle infections.
- Neutrophils: Potential bacterial infection including H.pylori
- Lymphocytes: Potential viral infection
- Monocytes: Potential parasitic infection and recovering from an infection
- Eosinophils: More specific for a potential parasite infection
- Basophils: Can increase due to allergies, inflammation, or parasites.
- Alkaline phosphatase: When low, a sign of zinc deficiency, which is a key immune-system nutrient
Most people who are tired and moody and have weight gain and hormone imbalances tend to have an infection! I have tested hundreds of patients, and I would say, based on my experience, over 70% have a parasite, bacteria, or fungal infection.
Yet in First World countries, it still isn’t accepted, by and large, that these infections can cause a problem. But having worked with many patients with these infections and having helped to remove the infections, I can tell you I’ve seen significant changes, and my patients will tell you the same.
These infections can cause classic GI symptoms, like bloating, gas, constipation, diarrhea, and acid reflux. These infections, at the same time, can cause symptoms that are more nuanced, like depression, hormone imbalances, fatigue, neurological issues, skin issues, and weight gain. It’s hard to connect the dots when these infections aren’t causing the typical symptoms you would see in Third World countries (distended bellies and such).
So What Do I Do Next?
If you are told that your lab tests are normal but you know something deeper is wrong, you are probably correct. Most of these problems if left alone only get worse and take more time and money to fix later on.