As clinicians, we have all met with patients who present with an exhaustive list of symptoms, only to have all of their basic blood biomarkers come back within the normal laboratory reference ranges. These patients may be experiencing physiological or functional shifts not accounted for by the wide reference ranges defined in standard lab tests.
Some practitioners take the lab data at face value and accept that there are no biological indications explaining the patient’s symptoms and attribute them to stress or other non-measurable issues. Some may prescribe something to address symptoms. This may explain why the top 25 most commonly prescribed medications are for pain, insomnia, mood problems---all of which are non-specific and chronic problems that are usually not clearly diagnosed.
Today’s healthcare model is largely focused on disease management, not prevention and the system is transforming into a single-drug for a single-ICD-9 code model of patient care. The vast complexity of human physiology is reduced to limited panels, such as chem-6 or chem-12 with a lipid panel. Results of these panels too often lead to prescriptions for cholesterol-lowering medications without first addressing any diet and lifestyle factors.
Routine blood chemistry analysis can be useful to rule out overt pathology, but it is not much help to us in dealing with patients who have complex but non-specific symptom patterns. Nor is it very helpful in guiding comprehensive prevention strategies.
Functional blood chemistry (FBC) analysis is an emerging approach that provides additional tools to help evaluate patients with complex health concerns. FBC differs from conventional blood panels in that it gives functional reference ranges that identify problems not yet pathological. It is a complement to conventional blood work in that it enables clarification of more subtle issues in those patients who suffer from lifestyle conditions associated with physiological imbalances.
When implementing FBC analysis, practitioners can use routine blood chemistry analysis to rule out overt pathology and disease and can then use functional analysis to identify more subtle issues, such as chronic, non-specific symptom patterns associated with physiological imbalances.
Practitioners who embrace the concept of FBC analysis are better able to guide their patients in making lifestyle changes, diet alterations, nutritional support, or in utilizing other non-pharmacological therapies.
Across a Spectrum
In the absence of an obvious infection or injury, it is rare for someone to go from “perfectly healthy” to seriously ill. In most cases, there is a spectrum from wellness to illness that spans years. By giving functional reference ranges that identify problems not yet pathological, FBC analysis more appropriately reflects this reality.
Laboratory ranges work in a continuum, with many shades of grey associated with shifts in physiology. The stringent black-and-white laboratory ranges associated with end-stage disease need no longer be the exclusive framework for evaluating our patients.
To illustrate how FBC works, let’s consider a case involving a 34-year-old female patient who exhibits moderate hypertension, hyperlipidemia, abnormal and painful menstrual cycles, and moderate depression. It would not be uncommon for that patient to be prescribed anti-hypertensive medications, anti-cholesterol medications, birth control pills, and an antidepressant. In fact, it may be considered poor medical practice if she wasn’t.
Now let’s take that same patient and add one more component to her case. This patient also has a fasting blood glucose of 110 mg/dl and symptoms of insulin resistance, such as fatigue after meals and sugar cravings. Let’s say the high end of the laboratory reference range for glucose used by her doctor’s lab is 115 mg/dl. This would mean that the patient‘s glucose levels are within the normal laboratory range and are not associated with disease.
She’s not “diabetic,” but her glucose level is associated with functional or physiological imbalances associated with insulin resistance. Taken together, the pattern strongly suggests she’s headed toward diabetes.
Instead of putting this patient on multiple medications that work by blocking, inhibiting, or suppressing an aspect of her human physiology, what would happen if her doctor guided her toward meaningful dietary, nutritional, and lifestyle modifications? As her insulin resistance is reduced, her hypertension and hyperlipidemia start to normalize. Her menstrual cycles start to normalize and her mood improves. She starts to feel better and avoids being misdiagnosed.
There are many people like this, who suffer from non-specific symptoms linked to physiological functional shifts not accounted for by the wide reference ranges associated with organ pathology or disease. The ability to evaluate lab work for non-disease physiological imbalances gives us an advantage in fully evaluating and ultimately helping many people.
If we want to implement the use of natural medicine and a healthy diet and lifestyle in lieu of invasive medical strategies, functional blood chemistry analysis can be a major clinical tool.
We need to learn how to more critically evaluate blood chemistry biomarkers in assessing people who suffer from lifestyle conditions associated with physiological imbalances, such as subtle thyroid imbalances, dysglycemia, electrolyte imbalances, protein imbalances, and nutritional deficiencies.
Datis Kharrazian, DC is a Diplomate of the Certification Board of Nutrition Specialists, the American Clinical Board of Nutrition, the International Board of Applied Kinesiology, and the American Board of Chiropractic Neurology. He is a member of the American College of Nutrition, the Institute for Functional Medicine, the Council of Nutrition, and the Endocrine Society. Dr. Kharrazian holds the designation of Fellow of the American Academy of Chiropractic Physicians and is also a Fellow of the American College of Functional Neurology. He is currently a professor of neuroendocrinology at the Carrick Institute for Graduate Studies and conducts educational programs for the Postgraduate Department of the University of Bridgeport.