If all my lab values are normal, why do I feel so bad?
The short answer is that the so called “reference range” does not reflect healthy lab values and key tests that may have revealed important information were never ordered. It is NOT all in your head and you are NOT a hypochondriac.
Flaw #1- Rigid upper and lower limits
One of the MDs that I saw when trying to solve a thyroid disorder conventionally told me flat out that if the upper limit of the reference range for TSH is 4.0, a 3.99 would not be flagged and the patient would receive no treatment. However, if the test came back at 4.01, it changes everything. A few minutes later, she told me that lab values can fluctuate by up to 5% and the time of day that the sample is taken can also make a small difference. Factor in lab error and we could be talking about a variance close to 10%. A borderline 3.9 TSH could be as high as 4.3 if re-tested.
Another consideration is that the reference range can vary from lab to lab. The widest disparity that I have seen is that of ceruloplasmin (copper binding liver protein). My lab had a reference range of 15-30 units while in others, the range is 20-45. My first test was a 17.9 and was not flagged and I would have been told that I was fine. Knowledgeable practitioners should be aware that anything under 20 is a serious deficiency and could indicate Wilson’s disease.
Flaw #2- Lab values may be “normal” but are far from optimal
You may have been tested several times and came back borderline each time but still within the “normal range.” I can pretty much guarantee that you are not feeling anywhere near your best and yes, this sub-optimal lab value really is the source or one of the sources of your problems.
Here are a few examples: The TSH lab normal is usually 0.4-4.0 but anything much over 2.0 is sub-optimal and the patient will have hypo symptoms. For a runner, it could mean up to a 5% drop in performance. Further, if a patient is below 1.0, he or she is sub-optimal on the hyper side. With Magnesium RBC, the optimal range is 6.0-6.5 versus a lab normal of 4.2-6.8. Mine has tested consistently in the upper 5s so any problems I face as a result of it are fairly negligible but if you test under 5.0, it is a serious deficiency. Again, doctors will call it normal unless it is below 4.2. Ceruloplasmin should be 30-35 so you could actually be flagged as high if you are optimal. With B-12, the story is the same. If you test below the reference range, you have a very serious deficiency and are still on the low side in the middle of the range. Optimally, you should be near the high end if not slightly over the top.
Flaw #3- Key tests were not ordered
With the thyroid, most MDs will only test T4 and TSH. At the very least, you need free T4, free T3 and reverse T3 in addition to TSH. Typically, if Magnesium is tested, it is the useless serum value rather than more informative RBC test, which measures the mineral at cellular level. If copper is tested without ceruloplasmin, the patient has no idea how much copper is bound and how much is toxic. For adrenal patients, a random blood cortisol is usually inaccurate. Rather, a saliva cortisol test is the better option and measure your values at the cellular level at different times of the day. In my case, the only lab value that was outside the reference range was an elevated homocysteine, which my doctor brushed off as no big deal. If coupled with a low SAM-e and/or folate level, it would have been a sure sign of a methylation block. B-12, B-6 and Lithium tests also would have been useful. Unfortunately, those tests were never ordered and my defective enzymes have yet to be corrected.
Flaw #4- Ignorance of ratios and correlations
In thyroid testing, hyper is diagnosed with a low TSH and an elevated T3 and T4. What if the patient has a low TSH but it’s not accompanied by elevated levels of others? Doctors usually don’t know what to do. The truth is that it’s strong evidence of adrenal fatigue.
Zinc and copper are direct antagonists of each other. It is better to be a little low in both than have one high and one low. Ideally, zinc should be 1.2-1.3 times higher than copper in the blood. Now, suppose that a patient has a Zinc level of 60 and a Copper level of 120. Both are within the normal range but copper is twice as high as zinc. If the high copper is accompanied by a low ceruloplasmin level, that’s a double whammy that indicates a deficiency of bioavailable copper combined with a toxic level of unbound. Such a patient is likely to be deemed “fine” by a conventional MD. Morley Robbins has coined the term “Mineral Denialist” to describe such doctors. To illustrate the absurdity of that line of thought, consider height and weight correlations. A reference range for an adult male would probably be 5’4”-6’4” with a weight of 120-260 lbs. It goes without saying that a patient who is 5’4” and 260 lbs is morbidly obese while 6’4” 120 is severely malnourished. A person with a severe chemical imbalance is just as sick on the inside but often appears normal.
Flaw #5- Blindly prescribe anti-depressants
If every test ordered by your MD comes back within the reference range, you will likely be prescribed SSRI anti-depressants. The big problem with this plan is that it disregards your neurotransmitter levels. A neurotransmitter screening, which will reveal your levels of serotonin in addition to dopamine, adrenaline, norepinephrine and GABA but it is almost never ordered. In my case, yes I was low in serotonin but also low in everything else. It naturally follows that a serotonin drug given to a patient with a normal serotonin but a pressing need for dopamine will be ineffective at best and potentially harmful at worst. How did I react to anti-depressants? I got some relief from anxiety but the fatigue got worse and I was prone to angry outbursts.