This post describes the difference between conventional and functional blood labs. It also provides information about how I do Functional Medicine blood labs.
Conventional Blood Labs
When you get blood lab results from your conventional doctor, you often hear that “everything’s okay.” You don’t necessarily know what that means. Your practitioner may not explain what tests were done, or what the results mean. You don’t get copies of the labs unless you specifically ask.
Occasionally you hear that something is out of range. For example, you might hear that your “cholesterol is high” or your “thyroid is low.” You might not know exactly what that means in terms of the tests that were done and the resulting numbers.
In some cases you don’t hear anything at all, and you think that everything is fine. You usually assume that everything that is supposed to get tested did get tested.
This scenario happens too often
When you request a copy of your labs, and you find out there are markers out of range. Or you may discover that the testing was not as thorough as you thought.
When my patients tell me “I’ve already done blood work recently,” I want to know:
- WHAT markers were tested?
- WHEN were the tests done?
- WHAT were the specific results?
In many cases, women don’t know the answers to these questions. So we request a copy of the results. I often find that the testing was not sufficient. Frequently some of the results are out of range. If the tests aren’t recent, such as in the past three months, they aren’t current.
The worst-case scenario
This is when your results are dangerously out of range, and your doctor hasn’t informed you. This happened to me. During a time of health struggles, my liver enzymes were dangerously high. My doctor did labs, and didn’t notify me about my elevated liver enzymes.
The only reason I found out is because I had just started a new habit of requesting copies of all labs. I was shocked when I saw my lab results. I went to a new physician who was appalled and wanted to proceed with a liver ultrasound. We did everything possible to lower my liver enzymes, and fortunately it worked. I was able to avoid a liver ultrasound and biopsy.
Always get copies of your labs
I advise you to request a copy of your labs immediately after they are taken. It’s much easier for medical offices to provide copies at the time rather than years later. In fact, you can usually request the lab send you a copy of your results.
Keep your labs in a binder in chronological order. Or keep digital copies in a folder on your computer. Patient portals such as ours allow you to keep copies safely and privately right on the portal.
There are many reasons for doing this. When you don’t understand your labs, your practitioner should explain them. You can also research the results on your own. Keeping copies allows you to monitor lab markers over time.
You may reach a time in your life when this tracking is very important. Some patient portals will create nice graphs so you can see how markers change over time.
What is the difference between conventional and functional blood labs?
Conventional labs detect disease that is full-blown. Functional labs detect imbalances that happen before actual disease. Functional labs help prevent disease. They also help you achieve optimal health now.
Conventional lab ranges are taken from bell curves of our population. Bell curves are supposed to represent “averages” or “within normal limits.” The problem is, these curves aren’t usually based on healthy populations! Healthy people tend to get blood labs less often than sick people. Do you want to be measured according to the average ranges of sick people?
The guidelines for nutrient status match the RDI (Recommended Daily Intake). RDI standards reflect nutrients needed only to prevent actual disease. These standards are not based on what nutrients are optimal for health.
Functional ranges tend to be more narrow. They aim for optimal ranges, not just being inside a bell curve. According to Chris Kresser,
Some functional ranges come from groups such as the American Association of Clinical Chemistry (AACC). The AACC has several divisions. One of them is a division of preventative medicine. Another is a division of nutrition. Functional ranges are also established by clinicians or researchers based on extensive review of scientific literature.
What can I expect from Functional Medicine blood labs?
Expect more thorough lab markers. We do this because we are looking for patterns or trends of imbalances that are brewing. We can spot deficiencies or illnesses waiting to happen before they happen. Or, we can solve problems that your conventional practitioner wasn’t able to solve. There are many examples. Here are some of the common ones:
Instead of just testing iron in your blood, we take more complete markers. We add iron saturation, stored iron (ferritin), and other markers. We are thorough about iron because iron deficiency AND iron overload are two common and serious problems that are often not detected through conventional labs.
Conventional labs usually test only TSH (thyroid stimulating hormone) and the thyroid hormone T4. Functional labs also test the free levels of thyroid hormones. This includes free T3 which is what your cells use. It’s also important to check for thyroid autoimmunity, because it’s so common. I go into more detail on thyroid markers here.
This is a hot topic for me, because I’ve treated so many women for infertility who have not been properly assessed. We test sex hormones at the right time. This means testing progesterone ideally seven days after ovulation. I’ve had more women than I can count show up with recurrent miscarriage and low progesterone. These are young women in their late 20s and early 30s. They may have gone through assessment by their conventional doctor, or been given fertility drugs. In many of these cases we find out it’s simply a case of low progesterone, and when we add it, they are pregnant within three cycles.
I always order full thyroid panels, and panels for polycystic ovarian syndrome (for women, this is one of the most common causes for infertility).
We go beyond conventional prenatal or pregnancy panels. I want to find out if there are patterns that make you susceptible to gestational diabetes, hypothyroid, or high blood pressure. Finding out nutrient status is imperative. Pregnant women are always given iron, yet some women have iron overload. Sufficient vitamin D, only tested with a full vitamin D panel, is crucial for the baby’s development.
Perimenopause and menopause
With this special population my goal is that all women over 40 become more vibrant and healthy with each passing year. We definitely test nutrient status, and all hormones. Your adrenals have to be on par in order to produce sex hormones when your ovarian production declines. We need to assess whether or not adding bio-identical hormones in small doses makes sense for you. We want to find out if the conditions your parents developed as they got older are brewing for you. While going through this hormonal transition, it’s a great time to focus on prevention. We can detect patterns and trends that need to be reversed.
If cholesterol and lipid markers are off, we do further testing to see if your markers are dangerous or not. The latest research shows that real risk factors are measured by nonconventional markers such as LDL-P (particle number) and genetic markers Apo B and Apo A-1.
Type II diabetes, insulin resistance, metabolic syndrome, and hypoglycemia
These are part of the same spectrum of blood sugar and insulin metabolism problems. If caught early, they are reversible. These issues are so common that I always test for them on preliminary blood labs.
What else do Functional Medicine labs tell me?
One of the most important things to learn about is your potential nutrient deficiencies. There are certain nutrients that are very important to look at. This includes vitamin D. However, to get a full picture of vitamin D, we also need to look at parathyroid hormone and a marker called calcitriol.
Vitamins B12 and folate are important. Vitamin B12 deficiency is very common. Folate and homocysteine give us a first flash picture of how you are metabolizing folate from your diet and if you have enough. Folate is crucial for a biochemical process called methylation, which is happening in every cell of your body all of the time. Genetic mutations that make methylation more difficult are very common.
Is every single thing tested all at once?
No. Initial functional medicine blood panels cover basic markers. Even these basic markers are much more thorough than conventional blood panels. However, there is no reason to deeply investigate things like diabetes, cardiovascular disease risk, and methylation status unless the first panel comes back with red flags. Then we look further.
Most first panels are tailored to individual women. They are based on your health history, conditions that run in your family, your symptoms, and your age.
Complicated health conditions can require more detailed testing. Examples include screening for Lyme’s disease, rheumatoid arthritis, or other less common diseases.
What about payment?
If you have insurance that covers blood labs, your Functional Medicine labs should be covered. Some people don’t have good insurance for labs because they have a high deductible. When there is not good insurance coverage, I use a fantastic co-op that offers steep discounts on cash lab prices.
Women are thrilled to get this kind of detailed analysis. They report that they have never received such a precise and individual picture of their health. We make a personal chart that shows your lab results, compared to both functional and conventional ranges.
I welcome your questions and comments below!