Feeling unwell but blood test results are ‘normal’
Why blood testing?
Blood has a lot to tell us (GPs and practitioners) about your state of health and blood chemistry. Blood tests (Complete blood count (CBC) or specific markers, as listed below) are an integral part of Western clinical medicine and are used to aid in the diagnostic decision-making process and establish dysfunction if any. Therefore, patients understand the need for blood testing and specific markers (e.g., liver and kidney function, oral glucose tolerance test (OGTT), commonly known as fasting blood glucose, or vitamin D levels).
The issue with a blood test is that it is a snapshot of a moment in time, a bit like a polaroid picture. Once the picture is revealed, it shows what you intended to capture inside a frame. Anything outside the frame is not included (e.g., your environment, the cause(s) of dysfunction or malaise), and the picture may show someone smiling even though there was nothing to smile about at that moment. This is why blood testing needs to be included in the diagnostic decision-making process, which must also include the medical history and any other factors or symptoms you may be presenting at the time of the test (the reason why the tests were ordered in the first place).
Furthermore, many, many people start to feel unwell long before a traditional blood test reveals any sort of dysfunction and more often than not, patients may be told by their physician that everything on their blood test looks ‘normal’.
If you insist, he or she may even tell you that “it is all in your head,” as it is often the case for unexplained pain or chronic fatigue or even chronic UTIs.
"NORMAL" IS NOT OPTIMAL
Most patients who feel "unwell" have a "normal" blood test and be told that the tested markers are “within range”. However, clinical experience suggests that these individuals are not "normal" and are far from being functionally optimal. They may be in the early stages of dis-ease and are yet to progress to a known disease state, at which time it may be too late to do something about it. These individuals are what we call dysfunctional (the causes/triggering factors and mediators are pushing their body into the red zone, their physiological systems are no longer functioning properly and, as a result, they’re starting to feel un-well.
This doesn’t mean in any way that the blood test is a poor diagnostic tool, far from it.
What we know is that the ranges used on a traditional lab test are based on statistics, not on whether a certain value represents good health or optimal physiological function. Plus, they may have too wide a range to give any insight. For example, neutrophils range is from 1.5 - 10.0, erythrocyte sedimentation rate (ESR): 1.0 - 12.0 mm/hr, ferritin: (males) 25 – 350 ng/mL and (females) 10 – 300 ng/mL. In the latter, 11 may be in range, while 289 is too, but the effect on the body is not the same. Such a wide range may, therefore, give little insight if your physician is only looking at the “in-range” results and missing out on the interpretation and global diagnostic vision.
Additionally, the "normal" reference ranges are typical "averages" for a certain population rather than the optimal level required to maintain your good health. And again, most "normal" ranges are too broad to adequately detect health problems before they become pathology and are not useful for detecting the emergence of dysfunction. The physician may thus miss (or disregard) the early signs of dysfunction and may even misdiagnose you as a result.
The naturopathic, functional and integrative approaches
The functional approach to blood testing is oriented around changes in physiology (e.g., unbalances and disturbances) and not pathology.
It is thus important to rely on blood tests that are more accurate and not based on averages or the ‘normal’ population. Ranges should be based on optimal physiology. This means that more specific test ranges allow us to evaluate the area within the "normal" range that may be used to understand that something is not quite right in the physiological systems associated with specific biomarkers. We can, therefore, identify the factors that obstruct you from achieving optimal physiological, biochemical, and metabolic functioning in your body; something your regular blood test won’t reveal.
Also, it is key to take into consideration the cost of testing. While a test on the NHS may cost a few pounds, it may cost a couple of hundred pounds from a private laboratory. Laboratories have so much on the line that they have to provide excellent and reliable services and are under tremendous scrutiny. Plus, they may use the latest technology and detect biomarkers that are not on the NHS (again because of cost or because it would reveal a completely different picture that the pharma industry is not interested in — remember pills are designed to suppress the symptoms, not deal with the cause — and your functional optimal health is also of no interest).
Let’s look at the perfect example": a chicken from Tesco and a chicken from an organic farm. One may be horribly cheap (perhaps, £3-4) while the other may cost up to £18. It is still chicken but one is definitely more nutritious and also contains no nasty. Gustatively, the difference is also noticeable, even the texture. To be sold on the cheap the farmer relies on quantity and cheap feed (and also routinely give antibiotics to healthy animals to prevent disease due to overcrowded and poorly sanitary facilities). The organic farm is concerned with the well-being of the animal and give much care and attention to each animal.
Blood testing is no longer simply a part of disease or injury management. It’s a vital component of your comprehensive report and plays a vital role in uncovering hidden health trends and disease prevention, and supporting (or improving) your health and the functioning of your body.
Unhappy with your GP’s diagnosis or been told: “it is all in your head,” and you are looking to understand what is “wrong” with you, then book a consultation today.
If we believe we need to do further testing, we will discuss this with you and give you the options that are best for you.
Blood Chemistry
Blood is a unique tissue, transporting:
Nutrients
Gases
Waste products and various toxicants brought by diet and breathing (e.g., pollutants, BPA, PFAs, NO2, SO2)
Enzymes
Proteins (albumin, globulins, fibrinogen) and lipoproteins
Hormones
Blood tests allow practitioners to see a snapshot of these things travelling in the bloodstream on any given day and time. However, your body is always changing. Your age, diet, hormonal cycles, physical activity level, alcohol intake, and even a change of season can cause alterations in your body chemistry that will show up on a test result. If you add a pinch of stress or anxiety here and there and you may well fall outside of the range.
Understanding references range
As discussed, the medical reference ranges can be quite wide and you may have a normal result and still have symptoms or you may have out-of-range results and not experience symptoms.
Reference ranges are based on statistics and are usually established by collecting results from a large population and determining from the data an expected average (mean) result and expected differences from that average (standard deviation). Typically, reference ranges cover 95% of the results for a healthy population. Statistically speaking, it means 5% of people in that same population will have results that fall outside the limits.
Also, some laboratories use different ranges, so you must always refer to their ranges to evaluate whether your results are "within normal limits."
Interpreting results
A normal result does not mean optimum health. If you keep in mind that reference ranges are statistically created, there may be a lot of overlap among results from healthy people and those with diseases, especially in the early stages of a disease. If your test results are within range but feel unwell (or have for a while), there is still a chance that there could be an undetected problem.
An abnormal result does not mean you are sick. Again, any test result outside the reference range may or may not indicate a problem. Since many reference values are based on statistical ranges in healthy people, you may be one of the healthy people falling outside this range, especially if your value is close to the expected reference range. However, if you fall far outside the expected values, this will alert your healthcare provider to a possible problem.
What is a Complete Blood Count (CBC)
A full blood count measures the status of a number of different markers in the blood, which include:
The amount of haemoglobin in the blood,
The number of red blood cells (red cell count),
The percentage of blood cells as a proportion of the total blood volume (haematocrit or packed cell volume),
The volume of red blood cells (mean cell volume),
The average amount of haemoglobin in the red blood cells (known as mean cell
haemoglobin),
The number of white blood cells (white cell count),
The percentages of the different types of white blood cells (leukocyte differential count), and
The number of platelets.
The ranges and information contained within this sheet are for informational and educational purposes only.
Consult your healthcare practitioner before making any changes to your current lifestyle. The ranges featured below are nutritional ranges, they are not designed to diagnose, treat, or cure any disease. Acceptance of these ranges varies among practitioners and laboratories used — always refer to the reference ranges featured on your test result.
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HIGH:
Acute infections
Stress
Diet high in refined carbs
LOW:
Chronic infections
Leukocytic autodigestion
SLE
Some medications
Bone marrow failure
Congenital marrow aplasia (marrow doesn't develop normally). Enlarged spleen
Liver disease
Alcohol excess
Vegan/raw food diet
-
HIGH:
Viral infections
Epstein-Barr (retroviruses)
Inflammation
Systemic toxicity
Chronic lymphocytic leukaemia
LOW:
Chronic viral or bacterial infections High free radical load
Active bacterial infection Suppressed bone marrow function
-
Note: normal ranges vary with ethnicity.
HIGH:
Bacterial infection
Inflammation
LOW:
Chronic viral infection
Diseases affecting bone marrow
-
HIGH:
Recovery phase of infection
Some types of infection e.g. TB
Liver dysfunction
Intestinal parasites
BPH
Certain types of leukaemia
LOW:
Diseases affecting bone marrow
-
HIGH:
Atopy (asthma, hay fever, eczema)
Allergies
Some parasitic infections
Vasculitis
Hodgkin’s lymphoma
Bone marrow disorders
LOW:
Increased adrenal steroid production (or adrenal dysfunction)
Diseases affecting bone marrow
-
HIGH:
Infections
Inflammatory disorders
Intestinal parasites
Chronic myeloid leukaemia
LOW:
Diseases affecting bone marrow
-
HIGH:
Respiratory distress (e.g., asthma, COPD)
Excessive production (polycythaemia)
Fluid loss due to diarrhoea, dehydration, or burns
high altitude
Renal and cardiovascular dysfunction
Immune suppression
LOW:
Anaemia: iron (Fe) deficiency, B12/folate deficiency, B6 deficiency, or copper (Cu) deficiency
haemorrhage or internal bleeding
immune suppression,
Adrenal dysfunction and cortisol production dysfunction
Chronic bacterial infections
increased vitamin C requirements
-
Erythrocyte sedimentation rate (ESR) is an indirect measure of the degree of inflammation present in the body. In other words, it is a non-specific marker for inflammation. It tells you nothing about the causes of inflammation or where its located.
In addition, menstruation, pregnancy and increasing age can also raise ESR.
ESR measures the rate of fall (sedimentation) of erythrocytes in a tall, thin tube of blood. The results are reported as how many millimetres of clear plasma are present at the top of the column after one hour.
Normally, red cells fall slowly, leaving little clear plasma. Increased blood levels of certain proteins (such as fibrinogen or immunoglobulins, which are increased in inflammation) cause the red blood cells to fall more rapidly, increasing the ESR.
HIGH:
Infections
Anaemia
Kidney disease
Lymphoma, cancer
Multiple myeloma
Thyroid disease
Waldenstrom’s macroglobulinemia
Certain types of arthritis
Autoimmune conditions (e.g., Crohn's disease)
-
C-reactive protein (CRP) is a protein made by the liver and released into the blood within a few hours after tissue injury, the start of an infection, or other cause of inflammation. The test measures markedly high levels of the protein to detect diseases that cause significant inflammation.
Often increased levels are observed after trauma or a heart attack, with active or uncontrolled autoimmune disorders, and with serious bacterial infections like sepsis.
CRP versus ESR
Both biomarkers for inflammation, ESR and CRP should still be interpreted differently. CRP is a more sensitive and accurate reflection of the acute phase of inflammation than is the ESR.
In the first 24 hours of a disease process, the ESR may be normal and CRP elevated. The CRP will return to normal, within a day or so, if the focus of inflammation is eliminated. The ESR will remain elevated for several days until excess fibrinogen is removed from the serum.
-
HIGH:
Dehydration
Bleeding
haemoglobin production abnormality
Respiratory distress (lung dysfunction)
Polycythaemia (excessive RBC)
Cardiac dysfunction
immune suppression
Haemolysis (the rupturing (lysis) or destruction of red blood cells)
Liver dysfunction and/or kidney dysfunction
LOW:
Anaemia: iron (Fe) deficiency, B12/folate deficiency, B6 deficiency, or copper (Cu) deficiency
Digestive inflammation
Haemorrhage or internal bleeding
Increased vitamin C requirements
-
HIGH:
Shock
Respiratory distress
Polycythaemia
Dehydration
Overworking spleen or immune suppression
LOW:
Anaemia: iron (Fe) deficiency, B12/folate deficiency, B6 deficiency, or copper (Cu) deficiency
Digestive inflammation
Thymus hypofunction
Adrenal dysfunction
Haemorrhage or internal bleeding
Increased vitamin C requirements
-
Mean Corpuscular Volume —average red blood cell size.
HIGH:
B12/Folate deficiency anaemia
Increased vitamin C requirements
Liver disease
Under-active thyroid
Pregnancy
Excess alcohol
Some bone marrow disorders
High altitude
Elevated methylmalonic acid and homocysteine
LOW:
Iron deficiency anaemia
B6 deficiency anaemia
Longstanding inflammatory disorders (increased free radical damage
Thalassaemia
Haemorrhage or internal bleeding
Parasites
-
Mean Corpuscular Haemoglobin — the average amount of haemoglobin per red blood cell.
HIGH:
Low stomach acid
B12/Folate deficiency anaemia
RBC abnormality
LOW:
B12/folate deficiency anaemia
Iron (Fe) deficiency anaemia
Haemorrhage, internal bleeding
RBC abnormality
Heavy metal toxicity
Increased vitamin C requirements
-
Mean Corpuscular Haemoglobin Concentration — the ratio of haemoglobin mass to the volume of red cells.
HIGH:
B12/folate deficiency anaemia
Low stomach acid
LOW:
B6 deficiency anaemia
Iron (Fe) deficiency anaemia
Abnormal haemoglobin production
Haemorrhage, internal bleeding
Heavy metal toxicity
Increased vitamin C requirements
-
RBC Distribution Width — measures the differences in the volume and size of your red blood cells. Higher values mean that your red blood cells are produced in different sizes. In other words, there is some issue with red blood cell production or survival. Low values mean that your red blood cells are roughly similar in size, which is normal and desirable.
Elevated RDW helps provide a clue for a diagnosis of early nutritional deficiency such as iron, folate, or vitamin B12 deficiency as it becomes elevated earlier than other red blood cell parameters.
It aids in distinguishing between uncomplicated iron deficiency anaemia (elevated RDW, normal to low MCV) and uncomplicated heterozygous thalassaemia (normal RDW, low MCV)
It can also help distinguish between megaloblastic anaemia such as folate or vitamin B12 deficiency anaemia (elevated RDW) and other causes of macrocytosis (often normal RDW).
HIGH:
Iron (Fe) deficiency anaemia (when combined with other anaemias or in the early stages)
B12/folate deficiency anaemia
Pernicious anaemia
Haemolytic anaemia
Immune suppression
Chronic liver disease
Heart disease
Diabetes
Kidney disease
LOW:
—
-
Temporary raise can occur after significant blood loss or after physical activity or exertion, during recovery from excess alcohol consumption and vitamin B12 and folate deficiency.
HIGH:
Atherosclerosis
Cancer
Iron (Fe) deficiency anaemia
Inflammatory conditions - IBD/RA
Infectious diseases (e.g., TB)
Splenectomy (spleen removal)
OCP
Thrombocythemia
LOW:
Autoimmune thrombocytopenia
Viral infections
Certain drugs, such as aspirin and ibuprofen, and some antibiotics
Heparin-induced thrombocytopenia
Leukaemia
Aplastic anaemia
Long-term bleeding problems (e.g., chronic bleeding from stomach ulcers)
Sepsis
Cirrhosis
Chemotherapy or radiation therapy
Exposure to toxic chemicals (e.g., pesticides, arsenic or benzene)
-
Note: ferritin levels below 50mcg/L are associated with telogen effluvium (diffuse hair loss) in women.
HIGH:
Haemochromatosis
Inflammatory conditions
Liver disease
LOW:
Long-term iron deficiency.
Low protein intake and levels as observed in some cases of malnutrition.
-
-
The above range varies immensely between laboratories in the UK.
Serum B12 testing is often used to confirm B12 deficiency anaemia because a full blood count alone cannot easily differentiate between folate deficiency and B12 deficiency. There is an increased risk of clinical symptoms of insufficiency below 300ng/L.
Many people experience signs of B12 deficiency with normal B12 serum.
-
Methyl Malonic Acid gives an indication of how B12 is used as a coenzyme in cell metabolism.
High MMA levels indicate low B12 status
-
Blood tests for vitamin D measure 25-OH vitamin D. Some tests measure vitamin D in nmol/L others use ng/mL.
Research has generally shown that parathyroid hormone is maximally suppressed at 40 ng/ml or higher
The human body is usually unable to achieve 25(OH)D levels above 100 ng/ml on UVB exposure alone.
Toxicity can thus occur following excessive supplementation.
-
Standard NHS blood tests measure TSH and T4
• TSH reference range 0.4-4.0 mIU/L
• Total T4 reference range 10-22pmol/L
• Free T4 reference range 58-154nmol/L
Optimal thyroid function is TSH of 1.0-2.0mIU/L
NHS panels do not pick up sub-clinical hypothyroidism caused by poor conversion of T4-T3 or excessive production of reverse T3.
-
An “A” in front of a blood marker indicates abnormal (either high or low)