Normal vs. Optimal Range: Interpreting Your Blood Work
Tell me if this sounds familiar: you go to the doctor with a specific complaint. They order blood work; everything comes back normal. The doctor sends you on your way. You’re relieved your results came back “normal,” but you don’t exactly feel “normal.” You still suspect something is off but don’t know where to turn.
In my experience, just because labs come back without any red flags doesn’t mean we’re in an optimal place health-wise, and oftentimes, we can feel it. Traditional Western medicine-practicing doctors will usually move on once labs “prove” nothing is wrong. But the truth is, health looks different on everyone. Most reference ranges for lab values are based on the current adult population—with more than half living with at least one chronic illness. By taking averages from a group that includes unhealthy individuals, are those “normal” ranges really normal at all?
So, what’s actually “normal”?
In Functional and Holistic Medicine, reference ranges are based on the average healthy population, narrowing the reference window. This makes it easier to interpret results in a way that can better help us prevent health issues by working to reverse the values that begin to move out of a truly “healthy” range. Additionally, blood work beyond the typical annual lab tests will be ordered or encouraged. While markers like cholesterol, glucose, and liver enzymes are important, there is so much we can test beyond these values that can give us a deeper and more meaningful look into your health. Hormone levels, thyroid function, adrenal gland function, nutrient status, and enzyme levels are just a few examples of the more specific blood work available
Does this mean I should switch doctors?
Not necessarily. If you have an open-minded doctor who listens to your concerns, there is no harm in getting feedback from them regarding blood work and getting a second opinion from a holistic practitioner or vice versa. Additionally, depending on the state you live in, some companies are now offering the option to order lab tests without doctor authorization. While this is a great step in the right direction toward allowing people to take charge of their personal health, the downside here is that most insurance companies will not reimburse self-ordered labs.
So how can I get additional blood work done if my routine tests came back “normal”?
Before asking your doctor for specific lab tests, be sure to express your dedication to your health and explain why you are looking for additional, targeted testing. If they disagree with the additional testing, that’s ok. Just like with therapists, sometimes it takes time to find the right general practitioner for you. There are doctors out there who listen to their patient’s needs and who are willing to work with you, for you. Once you find the right match, or if you already have a great practitioner, here are some of the tests I prefer to see with my clients:
Hormone Testing: Hormone levels can decline with stress, illness, and age (with some beginning their decline by mid-20s). Having balanced hormones is vital for energy, motivation, mood, fertility, and beyond, but they are not monitored until a problem arises in traditional Western medicine. Here are a couple of examples to illustrate the difference between those “normal” reference ranges vs. “optimal” ranges more commonly seen in functional medicine:
Lab TestNormalOptimalTestosteroneMen264-916 ng/dL> 600 ng/dLWomen20-49: 8-48 ng/dL48+: 3-41 ng/dL20-40 ng/dLEstrogen (estradiol)Men20-50: 7.2-26.5 pg/mL50+: 6.6-24.0 pg/mL>15-25 pg/mLWomen0-4.2 pg/mL1-2 pg/mL
Thyroid Labs: This is a big one. In the last 40 years, there has been a significant surge in thyroid disorders. What’s more, it is estimated that over half of those suffering have no idea where their symptoms are coming from, let alone what tests to request. This was me years ago when I was trying to get to the bottom of my symptoms that eventually turned to be a result of hypothyroidism. In fact, the most commonly ordered test to check thyroid function—thyroid-stimulating hormone or TSH—is not even the most accurate mode of detection. For these reasons, I like my patients to add tests like Free T4, Free T3, Thyroid antibodies, and Cortisol to their docket when dealing with unexplained symptoms. Range difference examples:
Lab TestNormalOptimalThyroid stimulating hormone (TSH)0.45-4.5 µIU/mL0.5-2.0 µIU/mLFree T3 (fT3)2.0-7.0 pmol/L5.0-7.0 pmol/L
Nutrient Panel: Proper nutrient status is essential to just about every function of our bodies. Things like high stress, certain medications, and excessive exercise can deplete our precious nutrient stores. Getting nutrients checked routinely is vital in maintaining optimal overall wellness and something I encourage all my clients to have done. Range difference examples:
Lab TestNormalOptimalVitamin D30-100 ng/mL50-80 ng/mLIodine34-523 mcg/L 100-300 mcg/LOmega-3 Index2.9% – 12.9%8% – 12.9%
Health is not just about the absence of disease—it’s about being able to live your life to the fullest degree and feel great doing it! Today, so many of us are made to believe that 100 percent of our personal health should be left to professionals. As a professional myself, I am here to tell you that professional help can be a wonderful tool, but you are ultimately in charge. You should feel empowered to listen to your gut, dig deeper, and get a second opinion when things feel off.
This content is for educational purposes only. It is not intended to provide medical advice. Please consult with your doctor, or licensed healthcare provider, before trying any new supplements as they may interfere with your current medications or be contraindicated for you.
Elissa Goodman is one of LA's premiere Cleanse Experts and Holistic Nutritionists focused on helping fight cancers through transformative lifestyle and diet changes. In this column, Elissa offers wisdom on nutrition, how to support a healthy immune system, and more.