Still Sick Even When Your Labs Are Normal? Here’s Why
When I ask my autoimmune patients whether they’ve had a particular lab test, they often say, “My doctor already checked that and it was normal.”
But how can everything be fine if you’re having symptoms? How does that make any sense?
In fact, when I repeat the test or order additional tests, the results are obviously not normal, at least according to functional medicine. So what’s happening here?
The reason for this discrepancy is that in conventional medicine, the goal of standard lab tests is to make a diagnosis that can be shared from doctor to doctor so that everyone can be on the same page. It’s just a way to label things, but it doesn’t really address or identify the underlying causes of the patient’s problems. Because of that, there’s still a lot of information we need in order to figure out the root cause of the patient’s problem, even when the patient says “all of my tests are normal.”
People are being told their labs are normal when in fact there is a lot of missing test information. Here are some of the issues that we will discuss in this blog.
- Is your doctor running the right tests?
- Did your doctor run enough tests to get the full picture?
- Is your doctor using the right specimen type for a test?
- Did your doctor interpret the lab results properly? Does he or she take into account the optimal or functional lab ranges (as opposed to the standard reference ranges)?
If you’re wondering, “can blood tests be wrong?” and “are blood tests accurate?” the answer depends on how the test is being interpreted and whether you’re given the right lab tests.
In this blog article, I’ll share with you some of the tests where conventional medicine misses the mark and the reason why you’ve been told everything is normal when you still have symptoms. I’ll discuss how to interpret blood test results such as insulin, thyroid hormone, CRP—and the findings of other lab tests—in a more accurate and comprehensive way.
What Can Routine Blood Tests Detect?
Years ago, the standard blood testing that doctors ordered had 25 to 27 different panels. It was more thorough and comprehensive. Today, standard blood testing only measures what doctors consider the most important blood tests (only about 5 panels). Most people are given a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid stimulating hormone (TSH), a lipid panel, and maybe a hemoglobin A1c (HbA1c) to measure blood glucose levels over time.
That’s it. They usually don’t look at anything else. When your doctor says your labs are normal, the first question you need to think about is, “What labs did they run? Did they do enough tests to actually get a full picture? Is there more that we could look for?”
When a doctor says, “I checked your thyroid,” most of the time they’re checking only one out of 11 thyroid markers. They’re looking at just the TSH and that’s it. If it’s anywhere in the lab range they just move on and say it’s normal.
As a functional medicine provider, I look at all the thyroid markers. We need to look at enough markers of thyroid function to get the full picture of what’s happening. We need to hone in on the reference ranges; what is an optimal lab result for thyroid function versus what’s acceptable, but not very healthy (within the lab range).
Blood Sugar Testing
Conventional doctors focus on blood sugar and ignore insulin. A lot of people will have hidden insulin resistance, because they never get their insulin levels checked. If your HbA1c or fasting glucose looked normal, doctors often never look further at insulin signaling. You’ll be told, “your tests are normal.”
Many autoimmune patients are low in vitamin D. They may have never been checked for vitamin D deficiency. A vitamin D blood test is not considered standard or necessary because insurance doesn’t deem it necessary. Other nutritional and functional lab tests fall into that category as well. It’s not helping their diagnosis, insurance doesn’t want to pay for it, and they may assume that the patient doesn’t want to pay for it out of pocket, either. So, doctors may not choose to run the test. However, they may be missing a vital piece of the patient’s puzzle.
C-Reactive Protein (CRP) and Homocysteine
High-sensitivity CRP and homocysteine are inflammation markers and they’re also cardiovascular risk markers. These are well-researched markers that will tell you if you’re at a higher risk of having a heart attack or stroke. Yet insurance doesn’t think those markers are necessary unless somebody has already had their first heart attack and stroke. This doesn’t seem wise to me. Why wait for information about heart attack or stroke risk, if you can predict it’s a problem ahead of time, and do something to stop it? People are missing really important information when tests like hs-CRP and homocysteine are overlooked.
Is a Blood Test for Cortisol Accurate?
Stress is one of the root causes of autoimmune disease, so we often look at levels of the stress hormone cortisol in our autoimmune patients. A lot of doctors will order a cortisol blood test, but blood testing for cortisol isn’t as helpful or accurate as salivary cortisol test results. Cortisol is our body’s stress hormone. Just the fact you’re getting a needle put in your arm is stress on the body and can cause the cortisol level to rise just because your body is sensing that there’s stress when you’re getting your blood drawn.
You also have to check your cortisol at different times of the day to really determine your total production and your cortisol rhythm over the course of the day. Checking throughout the day also allows you to compare it to other hormones like DHEA. It’s important that we do the right tests the right way. Not everything can come from blood work. We have to look at other types of labs like a cortisol saliva test.
When patients are having gastrointestinal problems, gastroenterologists will do a colonoscopy or a Cologuard stool test to detect evidence of blood. If the results are normal, they’ll proclaim that everything is fine. But they may miss out on other lab markers that show the person has an inflamed, leaky gut, food sensitivities, and/or microbial imbalances. It’s because they didn’t run the right tests.
Even when a gastroenterologist does a standard stool test they’re looking for specific pathogens, parasites or bacteria, such as Escherichia coli (E. Coli), Salmonella, or Clostridioides difficile (C. difficile) infection. They’re not running a whole gut microbiome test to look at the status of your good bacteria or if you have imbalanced digestion or inflammation markers. It’s not just about infection. It’s about balance with the other species. It’s about how well the patient is digesting and absorbing food and nutrients.
Food Sensitivity Testing
One single test cannot give us all the information we need. This is true for various food allergy or food sensitivity tests. Patients who suspect they have food sensitivities will go to their doctor and ask to get tested. Doctors will often do an IgE panel, a food allergy panel, and when they get back the results, they’ll say, “You’re not allergic to anything. You’re fine.” But the patient is not fine. They’re having food sensitivities or intolerances. IgE tests detect food allergies, but they miss food sensitivities. Even food sensitivity tests routinely miss the mark. Sometimes doctors will run just an IgG test, but the person is having an IgA reaction.
Different Specimen Types Give Clinicians Different Information: Blood, Saliva, Urine
You may be wondering, “Is a blood test more accurate than a urine test?” Truth is, there are different specimen types depending on what specifically we’re looking for. A good example is hormone testing. There are different specimen types for hormone testing, and there’s validity in all these different specimen types. What you’re looking for will determine what test you run.
A blood test will show the production level of the hormone, but if you’re looking for how much hormone is bioavailable, active, and used by the body, you’re going to measure it through saliva. If you’re concerned with how the body is breaking down and metabolizing these hormones—for example, making sure you’re not breaking down estrogen into the wrong form that increases cancer risk—then you need to do a urine test to see your metabolism of the hormone. There are different ways to look at hormones depending on what information you’re trying to get. A savvy practitioner should know about the different specimen types and what information they give.
Lab results are like a snapshot of what’s happening at a point in time, not of what’s happening in your body all the time. A patient’s blood sugar might be fine when they’re fasting, but if you check blood sugar five times in a row you’re going to get five different numbers. The fasting blood sugar test is not the most helpful test to check your blood sugar. Glucose monitors can be a useful tool in this regard, since they monitor glucose throughout the day.
Let Us Help You With Lab Results Interpretation
If you’re tired of being told your lab tests are normal even though you still have autoimmune symptoms, sign up for a free 15-minute discovery consultation. We’ll talk about your biggest concerns and let you know how we can help. If you come on board as a patient, we’ll order the best lab tests for autoimmune disease. Most importantly, we’ll interpret the tests in a more accurate way that gets at the root cause of why you don’t feel your best. The goal? Find out why you still have autoimmune symptoms and take steps to eliminate them for good.