Reframing the Healthcare Trend of Functional Lab Testing with a Functional Medicine Nutritionist
Posted by Andrea Nakayama
Functional lab testing has become a wild healthcare trend that can all too often be misused and misunderstood. As a result, patients are spending unnecessary dollars on lab tests that may not be issued at the appropriate time or for the right reasons. Even worse, this overemphasis on testing has coaches and clinicians clamoring to access labs that they don’t even know how to properly utilize in clinical practice.
Before we move forward, if you haven’t read my previous two blogs on lab testing, please go back and do so now (A Functional Nutrition Approach to Lab Testing and Functional vs. Pathological) so that we’re on the same page.
Timeliness of lab testing and assessment is crucial
I’d like to share a key factor for interpreting labs that I hope will calm your nerves about ordering labs, reading labs, and knowing the latest and greatest in using lab work in your practice.
When you look at someone’s serum (blood) lab results, you’re literally just looking at a snapshot of one point in time. That point in time? For most serum labs it’s the time when the lab was drawn. That’s it! It makes sense when you think about it, right?
Lab results are a snapshot of your clients health at that moment
Blood is circulating through the body all the time. It provides the body with nutrition, oxygen, and waste removal. Blood is mostly liquid, with different types of cells and proteins suspended in it. These cells make blood thicker than water.
When we get a blood draw, fluid is removed from the body and captured in a tube (or tubes, as the case may be). Those tubes get sent to a laboratory for dissection and analysis. This can happen in a number of ways, depending on what’s being measured.
It then stands to reason that those lab markers that you see on the printed or electronic report represent the moment when the blood was removed from the body by the phlebotomist and secured in those special blood collection tubes.
It’s almost like time has stopped and you get to survey the internal terrain!
Be aware of changes in lab results due to foods and medications
If the blood was drawn Tuesday morning at 8am, then that marker is an indicator of the state of the blood on that Tuesday morning at 8am. If you ate a bacon and egg breakfast with coffee at 7am before heading to the lab draw, then some of your blood markers will likely look different than if you showed up for the phlebotomy appointment fasting.
Similarly, if your client or patient takes medication, and they are being tested to monitor their dosing of that medication, you’ll want to check with the prescriber whether or not the blood should be drawn before or after taking their meds for their analysis. Their decision should depend on both the absorption and clearance (ie. “half life”) of the prescription in question. That’s because the presence of the medication in the bloodstream (which can be absorbed at different rates, depending on various factors, and perhaps a discussion for a different blog post) can alter the understanding of medication need and dosing because the results are, again, representative of that one snapshot in time. Therefore, the use or elimination of that medication could influence the lab results.
Why is the half life of a drug important?
“Half life” is the time required for a medication’s active compounds to reduce to half of their initial value. As a Functional Medicine Nutritionist, I’d be remiss not to remind you that even half life is bioindividual!
While we may understand a drug’s half life in the laboratory in relation to hours, days or even weeks, in some instances a person’s potential for clearance (and the function of their detoxification pathways) may either slow down or speed up what the literature lists as the pharmaceutical’s half life.
Labs on thyroid medication
Let’s use thyroid medication as an example here. The question of whether or not to take thyroid medication before a blood draw comes up so often in our practice at the Functional Nutrition Alliance Clinic that it serves as a good example for my “point in time” objective while also answering a common inquiry.
First, it’s important to know that there are two primary thyroid hormones: T4 (thyroxine) and T3 (triiodothyronine). We need them both. T4 hormone has a longer half life than T3 hormone.
T4 half life = ~5-9 days
T3 half life = ~1 day
This means it takes longer to clear T4 from the body than it does to clear T3. If you take supplemental T4, it will be like a slow and steady pump of hormone whereas T3 works in shorter spurts.
Because T4 has a fairly long half life, we’d have to go quite some time without thyroid medication to see a pure reading of total or free T4 values in blood work that are not representative of the exogenous support. I do not recommend this as it imposes undue pressure on the body.
Bottom line: Do not eliminate solitary T4 supplementation (like Synthroid, Levoxyl or any of the other T4 hormone supplements) just for lab testing.
But since the half life of T3 is much shorter, it can be helpful to give it a short beat for testing and the calibration of dosing. Supplemental T3, in the form of a desiccated thyroid replacement such as Armour, Nature-Throid, or a compounded T4/T3, as well as isolated T3 in its synthetic form in Cytomel – are all going to alter the blood levels of total and free T3 (↑) and TSH (↓) taken in a serum thyroid panel shortly after the medication is ingested. This is why I typically ask clients to avoid taking their T3 inclusive thyroid replacement until after the labs have been drawn, so as not to skew the interpretation of the results that are informing their medication dosing.
Bottom line: Do eliminate T3 inclusive supplementation on the morning of lab testing.
Personally, I take a small pill box with me to my early morning lab draw and pop my compounded thyroid medication right after the blood has been taken. I mark the time and start planning for my delayed breakfast 30 minutes later!
A lab draw is true, but partial when assessing functionally
If your head is spinning as you read this, please take a deep breath. It’s important to know that a lab draw is only one part of the healthcare equation. There’s so much to address, with or without labs! And whether or not you are the one ordering those labs is not critical. Just getting comfortable looking at serum labs is more foundational than either being the one to order them or having any next-step fancy, expensive, or trendy lab reports.
In fact, the true value of a Functional Nutritionist may come from knowing the situation in which the blood was drawn, and how that might influence your next step recommendations for that client or patient, rather than those other factors!
Factors to ponder through a functional lens
Your first takeaway is that a serum lab draw can be influenced by many factors. Those include:
- food consumed before the lab draw
- hydration levels
- sleep or stress the night before and day of the lab draw
- medication taken (or not)
- the individual’s absorption and metabolization of their medication(s)
- and so much more
An even better takeaway, and the entire direction of this blog post, is that we don’t want to get too alarmed by one set of labs! At least not when we’re looking at functional ranges (although there’s a caveat here, which I’ll speak to at the end of this blog).
This is where tracking comes in. Track is the ‘T’ in the ART of the practice!
Why health trackers are important
Trackers are actually the latest trend in healthcare that we all need to pay heed to. In fact wearable trackers like FitBit and Amazfit and so many others are trending for good reason. Tracking refers to the collection and analysis of various data points related to health and health outcomes. And tracking allows us to see the trend instead of just focusing on one piece of data alone. These types of trends help us to create context and paint a picture, which is what analyzing labs from a functional perspective is all about. We can easily apply that trend of tracking to functional lab test analysis, and it doesn’t need to be fancy!
Trackers help us to get out of the impulse to diagnose (which is not what functional lab ranges are for anyway), and into the opportunity to get curious!
Is the lab result a fluke, trend, or determinant?
If we see something out of Functional range on a client’s lab report, we remind ourselves of three very important things:
- This is just a snapshot in time! And so many things can influence that moment in time from a bacon and egg breakfast to medications taken.
- It’s not our job to diagnose. Yes, you’ll hear or see me say it again and again…. diagnosing is not your job, unless, of course, it is! And you know who you are. As Functional Nutrition Counselors we’re using labs to help us see the full picture more clearly and assess where we can help to “fine-tune the dial” and nourish the physiological terrain.
- We can use these markers as an opportunity to ask questions – questions for our clients and questions for ourselves!
Questions for our clients or patients may be things like:
- What was happening when this lab was drawn?
- Were you fasting?
- If you’d eaten, when was the last time you ate and can you remember what it was?
- Were you fighting a cold or experiencing anything unusual that day?
- How did you sleep the night before?
- Were you under any particular stress that day?
- Did you take any medications or supplements or drink any water prior to the lab draw?
- What’s the experience for you of having your blood drawn?
Tracking allows us to watch a number, to see how that number trends over time, and to place any changes in the numbers into context. This leads to the questions we may ask ourselves as we review the trend:
- Why did this level change (going up or down)?
- When did it change or shift?
- Can I correlate that change to anything in their Functional Timeline and health history?
- Where do we want this level to be, and what steps might we take to help it get there?
- How can I continue to track this information over time, and how often do I want to be gathering more data or information?
Tracking is also a great way to bring our clients and patients into the process, reviewing their own blood work as well! When we are looking at lab trackers like those available for download above, we can talk someone off the ledge of panic and worry that can often occur when they see an elevated or depressed marker on their lab report. Afterall, an odd looking number may just be a fluke!
As Functional Nutritionists and Functional Nutrition Counselors, we want to put labs into context, for ourselves and also for our clients or patients. We consider the history of their signs and symptoms. We help to make lab tracking a part of their tracking practices. And we work with Functional empathy to tie what we’re seeing in the Lab Tracker to their goals.
When we embrace the art of looking at clues and patterns in data, as opposed to the latest fad, we reframe the importance of truly looking at trends.
P.S. I did mention a caveat up above… When you see something out of pathological range on a lab report, be sure to ask your client (with curiosity, not anxiety), if they’ve spoken to their ordering physician about that number or numbers. If they have not, this is a good time to encourage them to ask for some clarity from their doctor. While it may be nothing – just a fluke or something the doc isn’t concerned about – it’s always a good idea to be partnering with a practitioner who is able to diagnose and keep an eye on those values from their unique lens. Your reminder to advocate for that communication between doctor and patients sets you up as a true guide and therapeutic partner.
Learn more about understanding labs with Full Body Systems
For deeper insight into helping serve your clients’ and patients’ needs, along with tools to help you navigate the process of reading, and assessing lab results, be sure to visit the Full Body Systems program course page, or schedule a convenient time to speak with an Admissions Advisor.
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