How can my blood work be normal when I feel so bad....

A significant part of my job as a Naturopathic Doctor is helping people with lab tests. This consists of the interpretation of results as well as making patients aware of what further testing may be necessary or helpful for their case.

I regularly see new patients who are experiencing numerous symptoms and they’ll often say that their doctor ran tons of blood work and everything came back normal but they’re still not feeling well. In this post, I will take you through the numerous reasons why this can happen.

• The testing was not extensive enough. In many cases they only run a CBC (complete blood count). While the name may suggest otherwise, a complete blood count is not a definitive diagnostic test; it certainly does not check for everything possible that could be happening in the body. Conditions that it may reveal include: anemia, certain types of cancer, some infections, and inflammation. If you are experiencing a long list of symptoms with no answers, it is likely that you need more comprehensive testing.

• The reference range. This is where things can get tricky. Reference ranges are developed by taking a sample of the “normal” population, testing that subset, and then finding the average range (minus one or two standard deviations). This does not necessarily mean it is the range at which you will feel your best or function optimally. Specific areas where I find this to be a problem are with thyroid testing, ferritin (iron stores), vitamin B12, and vitamin D.

• Some issues won’t be revealed through the standard lab testing. Hormones are a good example of this. Standard labs will not detect subtle hormonal imbalances, yet they can still have a significant impact on how you feel. The most common way to test hormones is via the blood (serum). While this may be accurate for some hormones, saliva is the way to go in other cases. Sex hormones are an example of this. Saliva measures the “free” sex hormones (biologically active), whereas serum primarily measures “bound” sex hormones (not active). Then why aren’t doctors measuring saliva? Several reasons: it is a newer technology and therefore less accepted by the medical community (serum has always been the standard), fewer insurance companies will cover it, and serum testing is more widely used and therefore readily available through hospitals and labs. Keep note that multiple private labs are offering salivary testing.

• Some concerns won’t be revealed in ANY labs. While they can be extremely helpful and 100% necessary in some cases, lab results are not the “be-all end-all” of every single case. Medicine is an ever-evolving field and to put it simply; there does not exist a lab test for every facet of health as it relates to the physical body. If you are clearly suffering and that is not reflected in your lab reports it does not mean that the case is closed. Listen to your body. A prime example of this would be for thyroid function. Thyroid physiology is very complex and there are several possible scenarios where the thyroid may not be functioning appropriately and a person is exhibiting symptoms yet testing is revealing nothing. Another instance might be if you are feeling generally unwell simply as a result of a poor diet and a lack of exercise. Unless this has progressed to the point of disease and/or obvious nutrient deficiencies, this won’t show up on any test.

I hope this has helped to shed some light on the topic. Thanks for reading!

Dr. Kerri ND