My Lab Tests Are Normal But I Still Have Symptoms
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.
Adrenal Testing
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.
Digestion
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.
Energy systems
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).
Inflammation
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.
Infections
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
Stool Testing
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).
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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.
If you need help getting to the bottom of your health challenges, click here!
Recommended Carbohydrate Intake For Optimal Health
Do You Know What Your Recommended Carbohydrate Intake Is?
Based on my clinical experience as a functional-medicine doctor, carbohydrate recommendations can be different for each person. If you are a healthy, insulin-sensitive CrossFitter, your body may be better adapt at utilizing glucose for fuel without any negative effects. Some individuals may fall into the category of being insulin resistant or having metabolic syndrome. These individuals have a very difficult time utilizing sugar for fuel and need to utilize a lower carbohydrate plan that allows them to burn ketones/fat for fuel. There are also many people in between on the carbohydrate spectrum! There are exceptions to every rule mentioned.
Did You Know That Carbohydrates Are Not Essential Nutrients?
Your body has no nutritional requirement for carbohydrates. It can actually make its own carbohydrates through a process known as gluconeogenesis, where your liver converts amino acids into glucose. Your body can also convert fat for energy through a process known as ketosis.
There are essential fatty acids and amino acids; these are nutrients our body cannot make and needs to take in through outside food sources. Just because your body has no essential requirement for carbohydrates doesn’t mean you should avoid carbohydrates.
When you look at the Food Guide Pyramid, you’ll see that over 60% of the recommended macronutrients come from carbohydrate sources. This begs the question, if carbohydrates are not essential, then why are such a large percent of them recommended on the Food Guide Pyramid? Food recommendations are typically made for political reasons, not necessarily scientific reasons. It’s a sad state of affairs that the lobbying efforts from massive food corporations tend to dictate what shows up on the Food Pyramid.
Carbohydrate Consumption and Reactive Hypoglycemia
When you eat carbohydrates, your pancreas responds by squirting out some insulin so your body can pull the newly broken down glucose into your cells so it can be utilized for energy. If you consume an excessive amount of carbohydrates, or consume carbohydrates that have a higher glycemic load, your pancreas will squirt out an exaggerated amount of insulin to ensure it will be taken up by the cells efficiently. In your body’s desire to utilize the glucose, it has actually dropped your blood glucose into a hypoglycemic state.
Most people live their life on these blood sugar swings from high to low. These swings put a tremendous amount of stress on your adrenal and thyroid glands. Hypothyroidism and thyroid imbalances are strongly connected with dysglycemia (swings in your blood sugar).
These ups and downs in blood sugar (dysglycemia) are a hallmark of metabolic syndrome. These swings also create extra sweet cravings—your body is hardwired to crave sweets when your blood glucose drops past a certain point. If you are always triggering your body’s fight-or-flight response with low blood sugar stress, you are telling your genes you are starving and you feel you need food in your mouth as fast as possible. This usually translates to eating some refined sugar and junk food, which sends you back on the same viscous cycle you were just on. Most people live their life this very way!
With habits like this, you will be putting significant stress on your thyroid and adrenal glands as they are required to rev up and down to buffer the hormonal roller coaster!
“Subclinical hypothyroidism is significantly associated with metabolic syndrome.“
How Many Carbohydrates Can Your Body Hold?
Your body can roughly hold about 300 to 350 g of carbohydrates in your muscles. One of the best recommendations for health is to add muscle to your body. Muscle provides structural integrity, enhances performance when moving, and also provides an additional reservoir for carbohydrates. When your carbohydrate levels are tapped off in your muscles, the next place carbohydrates are stored is in your liver. Your liver can only hold about 60 to 80 g more carbohydrates than your muscles, and it can become saturated much quicker.
After the 350 g of carbohydrates your body can hold in your muscles and liver, the remaining carbohydrates are converted to fat. Your body is very efficient at turning carbohydrates into fat and will do so if there are too many carbohydrates coming into your diet.
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How Many Carbohydrates Do You Need on a Daily Basis?
Ketosis and Fat Burning (0 to 50 g per Day)
When you keep your carbohydrate intake near 50 g per day, you’re going to enter a physiological state known as ketosis lipolysis. Most people get scared when they hear the word ketosis, confusing it for ketoacidosis, a state that type I diabetics and alcoholics with liver damage may go into.
Ketosis lipolysis is a normal state of physiology that involves primarily using fat for energy (this happens in fasting too). Fatty acids are broken down into ketones. These ketones are then used for fuel by the body and brain. Ketones also have an appetite-suppressing effect, and after a few weeks in ketosis, you will tend to lose your sweet cravings, too.
The Sweet Spot! (50 to 100 g per Day)
This is a spot I typically like to keep my carbohydrate range within; it allows me to not rely on exercise to stay lean and fit. If you have a damaged metabolism, a 0 to 50 g per day range may be where you need to live for a while. Some people also do well cycling in and out of ketosis: three or four days in a row in ketosis and one day in the sweet-spot range or higher.
Carbohydrates are primarily used for instant energy, so if you’re doing lots of exercise or you’re under higher amounts of stress, getting a little bit of extra carbohydrates from healthy sources may be beneficial.
Maintenance (100 to 150 g per Day)
Most people do well in maintaining their weight when their carbohydrates are within this range. Everyone is different, so depending on how damaged your metabolism is, this range may be too high for you. If you’re relatively lean, exercise three to four times a week, and engage in activities like CrossFit, this will be a great place for you to be. I recommend timing a good chunk of your carbohydrate intake post workout as a means to help improve recovery.
The Steady Track to Weight Gain (150 to 300 g per Day)
When your carbohydrate levels are this high on a continuous basis, especially when there is no energy output to back it up, you are starting to push your body into an insulin-resistant state. The hormone that is secreted when you eat carbohydrates is insulin, and it primarily works by pulling carbohydrates and amino acids into your muscles. Like we talked about above, when your muscles and liver are saturated with carbohydrates, the rest of those carbohydrates will be stored as fat. When your carbohydrate intake is within the 150 to 300 g per day range, it’s highly likely it will be stored as fat.
Danger, Will Robinson! (300 g per Day of Carbohydrates or More)
If you’re eating based on the Food Guide Pyramid, it’s more than likely your carbohydrate intake will be in or around this range. All you have to do is eat your bagel every morning along with your orange juice or cereal, have a sandwich for lunch with your Gatorade, and eat a nice plate of pasta for dinner, and you’ll be on your way. Most people that are eating carbohydrates at this high level tend to have insulin resistance as well as increased risk markers for inflammation and metabolic syndrome.
What Types of Carbohydrates Should I Eat?
Starchy versus Non-starchy
Starchy carbohydrates: White potatoes, sweet potatoes, winter squash, beats, yams, carrots (if cooked), butternut squash, rutabaga, spaghetti squash, turnips, pumpkin, plantains, and bananas. These carbohydrates can have higher levels of sugar along with higher levels of nutrients.
Non-starchy carbohydrates: Broccoli, spinach, kale, celery, brussels sprouts, cauliflower, zucchini, Swiss chard, spinach, asparagus, peppers, onions. These carbohydrates have the lowest level of sugar along with the highest level of nutrients.
High-Glycemic versus Low-Glycemic Carbohydrates
High glycemic: Grains, chips, candies, breads, refined sugars, cereals, junk foods, and tropical fruits (bananas, watermelons, pineapples, papaya, mangoes, and all fruit juices). Outside of the whole food fruit sources, higher glycemic carbohydrates tend to have the lowest amount of nutrients with the highest amount of sugar.
Low glycemic: Blackberries, blueberries, strawberries, huckleberries, apples, oranges. these carbohydrates, as a fruit, tend to have the lowest amount of sugar with a higher amount of nutrition.
The carbohydrates that you eat on a daily basis should be of the non-starchy variety, which are all the vegetables your mom tried to get you to eat when you were little.
There are some benefits to the intake of some of the starchy carbohydrates, but you have to make sure they are dosed according to your metabolic constitution and activity level.
When we’re looking at the glycemic index, this refers to how fast the sugar in the carbohydrates breaks down and absorbs into your bloodstream. Carbohydrates that have a higher glycemic index get absorbed and impact your blood sugar faster.
The faster the carbohydrates impact your blood sugar, the faster your insulin spikes. When you have pronounced insulin spikes, this drives down your blood sugar, creating sweet cravings just a few hours later. This is a vicious cycle that I see most people live in their entire life. Break the blood-sugar roller coaster by eating healthy proteins, fats, and the right carbohydrates for your metabolic type with each meal.
If you need help getting your blood sugar balanced, click here for more information!
References:
- http://www.marksdailyapple.com/the-primal-carbohydrate-continuum/
Healthy Digestion! How Much Fat and Protein Should I Be Eating?
By Dr. Justin Marchegiani
How much fat do I need?
Your body has specific feedback loops that are intimately tied with satiety (feeling full). It’s interesting to know that fat and protein produce specific neurochemicals that make you feel full. Some of these neurochemicals are known as peptide YY, adiponectin, leptin, Ghrelin and CCK. These chemicals have an intimate feedback loop to the appetite centers of our brain. If you eat too many of these foods you will start to feel nauseous.
If you think back to some of the famous Pringles commercials of the 1990’s where they would say, “Once you pop, you can’t stop!” Or just think back to your college days, how many times do you remember eating a whole pizza to yourself ? It’s very easy to eat foods in excess that don’t produce a neurochemical signal to your brain telling you you’re full. The food industry knows this, and that is one of the reasons why they’ve taken most fats out of the food and added refined sugar and artificial sweeteners in their place. it’s wrong to even refer to these items as food, as Michael Pollan poetically puts it, they are more like “Edible food like substances.”
When you wake up in the middle of the night craving something; do you find your self craving a grass fed steak with asparagus? Or are you craving some potato chips and Häagen-Dazs ice cream? You’ll find the underlying denominator in all these cravings is refined sugar and high glycemic carbohydrates.
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How much protein do I need?
My personal recommendations are 0.5 to 1 g per pound of body weight. Many people convolute this formula using kilogram conversions and refer to lean body mass, in my opinion this just makes it more confusing. In general the recommendations above are adequate and nearly everyone can calculate their needs within just a few seconds.
Therefore a 200 pound man would need anywhere between 100 g of protein to 200 g protein depending on activity level and particular goals. If this person were training and trying to increase their muscle mass I would recommend staying at the 1 g side.
Strength coaches such as Charles Poliquinn even go as far to recommend 2 g per pound of body-weight. For your average everyday person 0.7 grams per pound is a safe starting place, you’ll find it’s probably far more than what you’re eating currently.
The only individuals that need to worry about their protein consumption are people who have kidney damage or kidney disease. Proteins do not create kidney damage on a healthy kidney, but if your kidney is already impaired, the extra glomular filtration may be to much for the kidney to handle. Adding extra fats into your diet have a net neutral effect and can be a good alternative if you have kidney damage.
Many people ask about the acid load of protein. As long as you eat enough high quality vegetable and fruit emphasis on the vegetables, the alkalinity created from the vegetables will be more than enough to balance out the acidity of the meat proteins. The most acidic proteins are soy, grains, casein and egg whites; all other whole animal proteins provide an adequate amount of phosporus which will help neutralize it from it’s calcium leaching effects.
I recommend starting off your day with the first 30 to 60 minutes consuming at least 30 g of protein. Below are different food choices and their protein amount per 4 ounces. FYI the palm of your hand is about 3 ounces, so something slightly bigger than your palm is a good estimate.
Beef- 32 gms. Lamb- 30.2 gms.
Turkey- 32.6 gms. Chicken- 33.8 gms.
Calf liver- 24.5 gms. Venison- 34.3 gms.
Salmon- 29 gms. Scallops- 23 gms.
Shrimp- 23.7 gms. Cod- 26 gms.
Tuna – 34 gms. Sardines- 22.7 gms.
*Tofu- 9.2 gms. Egg- (1) 6 gms.
*Lentils- 1cup 17.9 gms. *Dried peas- ½ cup 6 gms
*Cottage cheese- ½ cup 14 gms. *Yogurt- 1 cup 12.9 gms.
*Kidney Bean- 1 cup 15.4 gms. *Pinto Beans- 1 cup 14 gms.
*Lima Beans- 1 cup 14.7 gms. *Black Beans- 1 cup 15.2 gms.
*Garbanzo- 1 cup 14.5 gms. *Navy Bean-1 cup 15.8 gms.
Walnuts- ¼ cup 3.81 gms. Almonds- ¼ cup 7.62 gms.
Cashews- ¼ cup 5.24 gms. Almond Butter- 2 TBSP. 7 gms.
Cashew Butter- 2 TBSP 5 gms.
*Please keep in mind that beans are two thirds starch. So for every 1 g of protein you get from beans (legumes) you end up consuming 2 g of starchy carbohydrate. This is one of the main reasons why I don’t like legumes or beans as a quality protein source. I also don’t recommend getting your protein from dairy sources like cottage cheese and yogurt. The casein proteins in these foods can create inflammation and stress the immune system. These dairy foods in their raw form are far superior to their pasteurized, homogenize and refined alternatives.
What do I do if eating all this protein and fat is causing me digestive problems?
Your stomachs main job is to digest protein. It does this by producing HCl and pepsin which help decrease the pH in your stomach. As the acidity in the stomach decreases, this provides a more favorable environment to help break down protein. As the acidic chyme (pre-broken down protein and food in the stomach) are released into the small intestine, this signals a release of bile from the gallbladder and pancreatic enzymes from the pancreas. The bile from the gallbladder is an emulsifying agent which helps break down this newly entered fat in the small intestine. If the chyme from the stomach is not acidic it will not trigger a release of bile when it enters the small intestine.
As you can see there’s an intricate domino effect occurring in our digestion processes. Healthy digestion in the stomach is the first domino that needs to fall. This domino then triggers healthy digestion in the small intestine. The next domino that falls is healthy absorption of these broken down nutrients in the small intestine and healthy bacterial fermentation and re-absorption of electrolytes in the large intestine. if one Domino doesn’t fall they can mess up the whole chain!
If you have a digestive problem the first thing I would recommend is supporting your body with hydrochloric acid, enzymes, pancreatic support and bile salts. This greatly aids in your body’s digestive abilities, which helps you to break down, utilize and assimilate all of the great food your putting your body. if your digestion is impaired it’s common to have bloating, gas, stomach burning or Gerd, belching, nausea and skin problems.
Some individuals have a gastrointestinal infection ranging from a parasite, bacteria (H-Pylori is a common one), fungus or viruses. it’s important to mention that everyone is entitled to having more than one infection, the more infections you have, the longer the recovery time.
If adding in digestive support doesn’t do the trick you should be screened for an infection either way. The goal isn’t to use natural supplements to cover up symptoms, the goal is to get to the underlying cause of the problem.
The last thing you want to do is use any type of proton pump inhibitors or acid blockers to fix the problem. This may help some of the symptoms in the beginning, but in the long run you are opening yourself up to major problems!
If you need help figuring out your diet and getting your digestion back on track, feel free and schedule a complimentary consultation by clicking here. This will at least give you the opportunity figure out the next steps you need to take to help improve your health!