Everything You Need to Know About Lab Testing

When you have blood, urine, stool, or laboratory tests, you are being compared to a lot of other people. The laboratory takes thousands of results like yours and plots them on a graph to produces some sort of a “bell curve.”

The result of your lab work is all about math. If you are in the green, then you’re normal. But if you are outside the green area, you are abnormal. We don’t know what your number is supposed to be, so we just compare you to others. Some are higher than you, some are lower than you, and so we’re just comparing you to the people who do tests. But, there are problems with this method of reading results.

1. What if only abnormal people do the test? Doctors may never order a test on someone who is normal so everyone who does it is abnormal. Thus, the “normal” for that test is abnormal.
2. What if the whole population is abnormal? Do you even think this is possible? Well, think again. Right now the average person in the United States is overweight or obese and has insulin resistance, or pre-diabetes. So, the average test is going to shift the curve up and tell us that it’s “normal” to have insulin resistance.

There are “normal” ranges and optimal ranges for most tests, and they aren’t the same. Most of the time “normal” is fine and is good, but you must be careful to know which ones are not. The lab does not give the OPTIMAL range for many tests because the “science” of medicine only uses statistics.

Cholesterol tests are a special case because the “normal” ranges are not from a bell curve, but from marketing departments. Drug companies put together a panel of experts to determine what is best. Thus, almost everyone falls in the range of needing their drugs. Statistically, when total cholesterol is plotted against the death rate, low cholesterol is worse than high cholesterol levels. The optimal range, the lowest death rate, is between 180 and 220 mg/dl.[1] Again, the optimal range is different than the normal range.

Some tests are not on the bell curve, but rather on a disease state. For example, blood vitamin levels tested by a lab are given a number that is considered normal. But these numbers come from deficiency disease.

For example, vitamin B12 has a “normal” of about 200-300 ng/ml, depending on the lab.[2] What this means is that less than 5% of people will have symptoms of vitamin B12 deficiency if they are above that level. Most people who are just over the line are told they are normal when they have a small chance that they are vitamin B12 deficient.

The OPTIMAL level of vitamin B12 is 500-1000 ng/ml. This amount is enough for all the body but not so that the vitamin limits cell function in any way.[3]

There is an optimal level for almost every test, and the lab may not give it. For nutrients there is a good web site that includes optimal testing at the Linus Pauling Institute.

Since there are thousands of lab tests, I am not able to give the optimal range for each of them. For each test I often search Google (I know, cheating) to look for reliable web sites such as the Linus Pauling Institute that provide optimal ranges for vitamin levels.

Finding the cause

There are many reasons for a lab test to be abnormal. Sometimes a recent illness may produce high levels of liver enzymes that could wrongly be diagnosed as hepatitis. Most of the tests we do today tell us what is there, but not why. It is essential that you don’t base a diagnosis on a single test, but rather find out why the test is abnormal with more testing.

In the case of Hepatitis, or elevated liver enzymes, there are many different causes, including infections, toxins, deficiencies, and metabolic abnormalities. Just saying you have hepatitis isn’t useful at all – you need to know why! Most other tests are the same. Find the root cause; don’t make the mistake of treating a number.

Accuracy

The accuracy of lab tests varies. Most of the time, if there is an unexpected abnormal test it is best to repeat the test to be sure it wasn’t aberrancy. I had one patient who was doing a test for heavy metals and his aluminum level was over 50 times higher than the toxic level. Since he wasn’t completely debilitated, I decided to repeat the test and it came back normal. We believe that since he was using an underarm deodorant spray that contained aluminum some of the powder in the air settled in his open collection cup that he was using to collect his urine for the test. These tests are VERY sensitive.

Sometimes tests are abnormal but aren’t relevant. There are normal variations that put people outside of the bell curve that don’t have any health issues. I have had to calm many patients who have tests come back in the red. I explain that even though it is outside of the “normal” it isn’t a problem. This is especially true with the Complete Blood Count (CBC) that measures the cells in the blood. Some people have smaller cells, some are larger. Some have fewer platelets that are larger. Variations are common. So, the other complication of doing testing is knowing which abnormal tests are important and need further testing.

Cancer testing

The accuracy of tests is often dependent on the one who is doing it. This is a common problem in pathology. The pathologists are sitting around in the basement of a hospital looking under microscopes at cells. They look at thousands of cells looking for patterns. They ask each other if that seems more like a cancer cell, or an inflammatory cell. They confer and decide one way or the other. But their decision has a huge effect on the patient. If they decide it is cancer then the patient is given a death sentence and put through chemotherapy, radiation, surgery, and so forth. However, if they decide it is not cancer, then the patient goes home and lives a normal life. One New York Times article reported as many as 3% of samples are mixed-up or contaminated in the lab, causing false positive tests.[4]

I had a case of a high school student who came in with enlarged lymph nodes and a big spleen. He had a lymph node biopsied, which indicated he had lymphoma. A week before his first chemotherapy treatment, a classmate on his football team came down with a classic case of mononucleosis. I told the pathologist about this and sent the “lymphoma” specimen for special staining at Stanford University. It turned-out he had Mono. Had his teammate not come in to my office, the boy would have had a lifetime of cancer treatment. OOPS!

Part of the problem with our system is if a pathologist says you have cancer and you don’t, then you just get unnecessary treatment. But if the lab says you don’t have cancer but you do, then they can get in a lot of trouble. To avoid liability for themselves, they will tend to err on the side of diagnosing cancer.

Metabolic testing

I have had people tell me that they want to test for everything. This isn’t possible, because there are so many tests that could not, or should not be done. The tests of metabolism, or all the chemical reactions in the body, are multiplying almost daily. We now can test almost every reaction or enzyme, but this is very impractical.

There is one test that is available worldwide that is very useful. People often ask me if they should take vitamins, and if so, which ones. Since everyone is different in their needs, I do a test of their metabolism.

Imagine the house next door sells and you’re excited to meet the new neighbors, but you never see them. The garage opens and a car comes out with tinted windows, the garage door closes. Nobody answers when you knock – you don’t know anything about them – is it one, or a family, male or female, old or young, black or white? Then one day after they leave you see the garbage in front of the house. You go through their garbage and find out a lot of things about them, shopping, eating, mail, and habits.

The organic acids test is like this. It is a urine test of what the body is getting rid of, the garbage. We can tell a lot about what is going on inside by what is being disposed-of in the urine. The one I use is called the NUTREVAL test by Genova Diagnostics. It is available worldwide and can be ordered by your physician. One caveat to this test is that it requires some interpretation skills. If your doctor isn’t familiar with it, the lab has consultants available to discuss and help with the results.

Another metabolic test that I find very useful is the VERIDIA test. These tests are more familiar to most doctors, but they have more detailed testing that can uncover early potential problems. It also includes allergy testing, which I have found to be helpful.

Other tests

For those with stomach and intestinal issues, there are other tests that can be performed. For irritable bowel, Crohn’s disease, or other intestinal issues try the Genova stool test. It has been very useful. Most doctors don’t look at the reasons whya patient has IBS or Inflammatory Bowel Disease, instead just treating the symptoms. If you know why, and remove the cause, then the condition can resolve and there is no need for further treatment.

I also recommend some genetic testing. Either 23-and-Me or Ancestry genetic tests can be entered into Livewello and tell you a great deal about your genetic weaknesses and strengths. It is very important that you don’t fall into the same trap of treating a number. The presence of an abnormal DNA test is only about 20% of the issue. Genetic variants don’t determine what will happen to you, they only tell you of a possibility. The 80% that determines if that gene is expressed is called “epigenetics” and is determined by the environment – mostly by lifestyle. We have control over our genes and knowing where our weaknesses are can help us to choose a lifestyle that will assure we don’t get genetic diseases.

Everyone does cholesterol testing, which most often leads to a prescription for “statin” drugs. To determine the need for these I don’t just use cholesterol testing because it doesn’t correlate well with atherosclerosis. People with high cholesterol often don’t have artery disease, and most people with heart disease have normal cholesterol. The best tests to do if you have high cholesterol, before initiating treatment, are the Coronary Calcium Score, and an ultrasound of the arteries, which can be done at any radiology center that has a CT scanner and ultrasound machine. I often recommend the Lifeline Screening test for the ultrasound because it is convenient and less expensive.

Cancer tests

The screening tests for cancer were discussed in a previous issue. Basically, there is only one screening test that is beneficial. I recommend a PAP smear every 3 years until age 70. This actually lowers the risk of cervical cancer.

Ideally, tests should be determined by the need. If you have no health issues, then most testing is unnecessary. A one-time genetic test to help you make choices of how to live your life is beneficial. There may be some value to a NUTREVAL test to check your overall metabolism. Even a Veridia test taken once to be sure there are no problems looming in the future can be beneficial. But the practice of testing every year for “everything” is not useful. Even the screening tests that are recommended every year aren’t needed. If you have a problem, take care of it, and if you don’t, annual screening is unlikely to find a new one.

There are many states in the United States that allow patients to order their own testing. If you already know what you need, and how to interpret the tests, that is fine. Otherwise, I think it’s best to confer with a health practitioner who is knowledgeable in that specific testing. There is a lot of value in experience, knowing what to expect, and why.

Sources:
[1]http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/PH709_Heart/PH709_Heart5.html
[2]https://medlineplus.gov/ency/article/003705.htm
[3]https://www.jillcarnahan.com/2014/07/07/vitamin-b12-deficiency/
[4]https://www.nytimes.com/2017/06/26/health/the-lab-says-its-cancer-but-sometimes-the-lab-is-wrong.html