In both our Longmont and Denver, Colorado offices we are often asked how and why functional blood chemistry differs from more traditional readings of blood tests. The easiest answer relies on the examination of reference ranges (what is considered low, high or normal) and viewing this information through the lense of evidence-based research that helps us parse this data.
When a patient comes in with a complaint that could be considered more of a “metabolic complaint,” we like to analyze lab work to get an entire picture of what could be going on with them. Some examples of metabolic complaints can be fatigue, inability to lose weight and constipation. Patients will often have one or two primary complaints but often secondary complaints, as well. For example, the inability to lose weight might be the primary complaint that brings a patient in to see us, but as we gather more information they may also suffer from bloating, constipation, brain fog, inability to complete tasks, or trouble falling/staying asleep at night, for example.
Patients often present for all sorts of different reasons, but ultimately they may all fall into what we call the “grey zone.” The “grey zone” is when a patient has symptoms that continue to worsen and are on their way to a disease process, but they are not so far enough along to be diagnosed with a particular disease or condition. Many of us are familiar with the term “pre-diabetes” or “pre-diabetic” – this is a terrific example of the “grey zone.” Unfortunately, unlike with diabetes, many conditions do not have a codified “pre” stage, but that doesn’t mean that it is impossible to make educated recommendations before an actual diagnosable condition or disease is present.
In our practice we have many patients that have previously visited multiple healthcare practitioners to get help only to be told they are “normal” or are just given a prescription or two to manage their symptoms. These patients continue to feel worse and are merely surviving on a day to day basis. Discouraged, they know if they continue to wait, the problem will likely get worse, but at least they will be diagnosed with something! When these patients eventually make their way into our office (often very frustrated) we assure them that this is a good thing. The reason this is a good thing is, these patients are not far enough gone yet to be diagnosed with a full-blown condition or disease. This means that far less intervention is necessary and many of these patients can heal by natural means versus using pharmaceuticals.
More often than not, these collections of symptoms are the body’s way of giving early signs that something needs to be addressed. That being the case, we always empower patients to have open conversations with all of their healthcare providers and to be honest when things are not right or not getting better. Our patients are correct when they tell us something is wrong, or not quite right. You are in your body all day, every day and know when something is wrong. Trust your intuition! We are happy to share our findings and recommendations with other healthcare providers in an integrative approach to overall health and wellness.
In treatment, in order to properly diagnose and/or treat metabolic issues and conditions we run basic labs, which we will talk about in more detail, and analyze them using evidence-based reference ranges commonly used in functional medicine. Herein lies the major difference between traditional and functional medicine: we use different numbers than the standard reference ranges, because standard reference ranges are based on population averages. It isn’t always helpful to be compared with everyone else. Although all human bodies are put together the same way, not all bodies thrive with matching chemical compositions to the rest of the world! We are all unique and our diagnostics should reflect that!
Let’s take a look at some of the tests we rely on.
Complete Blood Count (CBC)
This is a test that checks to see how well one’s immune system is functioning. We are also able to glean other important information from this test such as a vitamin B12, folic acid, or iron deficiency.
We are able to look at patterns with the white blood cells such as lymphocytes, and neutrophils, to determine if a patient has an acute or chronic infection. Lymphocytes are broken down between B and T cells. The B cells produce antibodies in order to attack invading bacteria, viruses and toxins, while the T cells destroy the body’s own cells that have themselves been taken over by viruses or have become cancerous. Neutrophils are a type of immune cell that counts itself amongst the first cell types to travel to the site of an infection. They help the immune system by both ingesting invading microorganisms while also releasing an enzyme that kills off microorganisms as well. This is all very important because during periods of high stress the immune system can weaken and old, latent viral infections can flare back up. A very common stress-reactivated viral infection is EBV (Epstein Barr Virus) a.k.a Mononucleosis. A large percent of the population are EBV carriers, but not all old EBV infections will reactivate. While EBV is just one example of a virus that can reactivate, it’s a great example of just how helpful a Complete Blood Count can be.
Another amazing marker on the CBC are Monocytes. Monocytes are a type of white blood cell created in the bone marrow that travels through the bloodstream to tissues in the body where they become macrophages. Macrophages surround and kill microorganisms, ingest foreign material and remove dead cells. Thus, Monocytes are a great marker in determining if a patient has inflammation in their system. Inflammation can lead to chronic pain and/or inability to lose/gain weight among many of its negative impacts.
Complete Metabolic Panel
The Complete Metabolic Panel is another great test in determining specifically where a patient is struggling. It gives us a snapshot into the health of the internal organs. It can also tell us a great deal about the patient’s blood sugar regulation (or dysregulation). By identifying patterns on the test we can hone in on insulin resistance (this is a major issue with difficult weight loss), hypoglycemia (low blood sugar and fatigue associated with this), or hyperglycemia (elevated blood glucose leading to diabetes). Regulating and knowing what is going on with glucose and insulin levels is incredibly important. Food is not the only thing that affects glucose (blood sugar). Stress is a huge impediment to effective glucose regulation. Glucose dysregulation can also be at play with unrelated issues like the “ Energy Crash at 3pm”, waking up all night, or having dizzy spells as well.
We are also able to identify kidney dysfunction. The Complete Metabolic Panel shows us early signs of kidney failure. The CMP generally covers BUN (which can rise when the body isn’t able to remove urea from the blood), Creatinine (a waste product of Creatine, a compound used by the muscles for energy, later filtered by the kidneys for removal) eGFR (a test designed to measure the kidneys’ filtration rates), and BUN/Creatinine ratio. All of these combine to show us a fairly complete picture of the health of the renal system.
The Complete Metabolic Panel also looks at electrolyte function. This can give us insight on hydration, breathing issues, and adrenal function.
A CMP will also provide levels for calcium and magnesium. Many patients show magnesium deficiency. With a deficiency in magnesium a patient may suffer with mood issues, leg cramps (at rest) and constipation. We also like to determine the cause of the magnesium deficiency, as to correct or support it.
The proteins section of the CMP results can help us determine digestive function. We can successfully link these numbers with symptoms. A lot of people have issues digesting because of our stressful lifestyles. Our body sees all stressors in the same way: whether you are running from a bear or you are trying to get a paper finished for a deadline, this is all stress. Since we are constantly stressed, this leads to decreased digestive function. This often leads the way to gastrointestinal infections, bloating, gas, and undigested food particles in the stool.
Utilizing a CMP we can identify early dysfunctions with the liver and gallbladder. The hepatic systems are important because they filter all of the environmental toxins we are exposed to on a daily basis. (Some estimates site exposure to about 80,000 chemicals every 7 days). These systems also help to detoxify and convert chemicals. For example, most of the conversion from T4 to T3 in the thyroid gland occurs in the liver. Thyroid health is incredibly important and often overlooked. More recently in practice, we have been finding more and more issues with the gallbladder and are able to give patients relief that do not want their gallbladder removed.
Lastly, we are able to look at a panel of iron markers. Anemia, low iron, or hemochromatosis (high iron), are all very important to diagnosis. Where you have low iron the patient will struggle with extreme fatigue, brittle nails and hair loss. If the patient has too much iron it acts as an oxidant. It is like being constantly exposed to any heavy metal. Ultimately, this can create major issues down the line, if not addressed.
We also run a full thyroid panel. Running TSH or T3 is not sufficient enough to see the entire thyroid picture. Most patients come in and tell us that their thyroid gland is normal, yet when we look at their existing labs, only a TSH has been run. TSH is only one very small part of the overall thyroid picture. We see conversion problems, autoimmune thyroid, pituitary thyroid problems, and even excess estrogens creating thyroid symptoms.
Functional blood chemistry is invaluable for both disease and condition treatment, but also diagnosis and preventative care. If you find yourself suffering needlessly in the “grey zone” we strongly recommend making an appointment with a Functional Medicine specialist.