This article was sent to me by a good friend who is working to change healthcare.
It's really impossible to take on all the flaws of current lab testing in a short article. However, articles like this give me an opportunity to remind you about shortcomings in testing and how we developed a systems approach to overcome them.
This blog is not intended to be comprehensive. Instead it just addresses some of the topics and concepts brought up in the article.
"Blood tests are one of the least invasive and cost-effective tests you can get to be proactive about managing your health. Testing centers are typically easy to find and make an appointment with. In fifteen minutes you can be in and out, having had a few vials of blood drawn in a usually pleasant setting, and be on your way. Results are often available online a week or so later."
LEWIS: Agreed. However, the BEST "test" that is completely non-invasive and costs nothing is your own "self-reported" health issues. We obtain this through a survey and a consult where you tell us your health story.
Here is a link to the blog that explains this:
"According to the Cleveland Clinic, “blood tests are an essential tool healthcare providers use to monitor your overall health or diagnose medical conditions.” But you don’t need to be under a doctor’s care to obtain blood tests. Consumer-focused companies like Grassroots Labs or Function Health can put you firmly in the driver’s seat."
"The biggest use of blood tests is to assist your doctor in making diagnosis and treatment decisions. The pharmaceutical industry relies on biomarker testing to prove its drug is doing what it claims to do better than a placebo."
LEWIS: WRONG! Blood tests should not be the primary measurement to determine treatment decisions. Blood tests answer the question "WHAT," but seldom answer the questions "HOW" and "WHY." In a pharmaceutical-driven health system, answering WHAT is adequate to treat a symptom with a drug - but I hope that is NOT what. you want.
"Limitations of Normal Ranges
The trick though is in understanding the context of all those numbers and how your results compare to the cited “normal range.” Only then can you begin to glean relevant insights to optimize your health.
For starters, even if you test 100 different biomarkers in your blood, it is barely scratching the surface of what is going on inside your infinitely complex body that is constantly working to keep you in balance and functioning well.
LEWIS: However, if you understand disease mechanisms and pathways, and understand the interrelationship between cytokines, proteins, hormones, and other biomarkers, then a short-list of biomarkers are all you need. I focus on 4 biomarkers and believe they tell at least 80% of a person's health story. They are:
Total white blood cell count
Neutrophil to lymphocyte ratio
Fasting Insulin
Erythrocyte sedimentation rate.
Of course, your metabolic values and A1C should be measured too, but much can be deduced with just those 4.
A blood test generally measures a moment in time and may be influenced by what you ate the day before, how much you exercised, if you had an argument with your spouse, or how well you slept the previous night. You are an individual. There is no such thing as a perfect score for any element being tested.
LEWIS: 99.999% of those in the medical profession do not understand physiological half-lives. When you do, then one lab test using multiple biomarkers provides a "look-back" at your health, rather than an instantaneous snapshot. For example, A1C is a 120 average for glucose. RDW is a 120 lookback at vascular inflammation and often coincides with CRP, which has a very short half life.
Regarding "perfect score," there certainly are perfect scores. It is the level of the biomarker that shows no excess all-cause early mortality. Here are a couple of examples:
Fasting Insulin between 1.5 and 3 mIU/L
Neutrophil to lymphocyte ratio of 1.1 - 1.5 with a WBC of close to 4,400 cells/microliter
Erythrocyte sedimentation rate of <3 mm/hr
An article published in the journal Heliyon last year discusses the pros and cons of biomarkers which include tests of other bodily fluids and cells such as hair—useful to test for heavy metals—and stool—useful to assess your microbiome—and sound an alert to certain cancers and other conditions. One of the clear disadvantages cited of biomarker monitoring is the difficulty of establishing what is “normal.”
LEWIS: Most of the time, you don't have to go into advanced testing if you know how to properly interpret labs and run a robust risk assessment. These labs often add substantially to cost without providing an equal amount of insight.
There is some truth to the statement about establishing "normal." However, when it comes to blood-based labs, the data on the association between early all-cause mortality hazard ratios and lab values is solid and abundant.
The reference values or normal ranges listed on your test results are typically lab-specific and are based on the test results of a subset of the population studied. The range then covers the results for 95 percent of this sample population who are deemed to be healthy. The lowest 2.5 percent and the highest 2.5 percent are considered outliers, with the rest considered normal.
The lab may adjust its range by demographics such as males/females and age groups, but this vastly oversimplifies all the elements that affect any individual biomarker for a given human.
LEWIS: OUR NATION IS MOSTLY UNHEALTHY. DO YOU REALLY WANT UNHEALTHY PEOPLE TO SET THE STANDARDS FOR YOUR HEALTH?
DO YOU SEE THE PROFOUND LACK OF SCIENCE, PRECISION, AND ACCURACY IN THE STATISTICS OF "NORMAL" RANGES? WITH THAT TYPE OF SCIENCE, THE ONLY DIRECTION OUR POPULATION CAN HEAD IS IN A LESS HEALTHY DIRECTION. THE CURVE BELOW EXPLAINS THIS.
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