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Unravel the significance of blood markers with insights from Dr. Rutherford. Discover how crucial blood panel analysis is and why simply relying on the “normal” label might be misleading. Learn how inconsistencies in lab ranges and the way doctors interpret results can impact diagnosis and patient care.
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So the question is, the good and bad of blood
markers. So I'm trying to think about that because There's a lot of things I'd like to say about
blood markers. Because when I get a blood panel, I sit down and our blood panels are long, but
I sit down for, sometimes I'm 20, 30 minutes Looking at a blood panel. And there's a story
in those numbers. And I must say, classically I've been to doctors and I've followed doctors
and I have patients who've been to doctors lots, And the doctor basically kind of glances at it.
I know doctors, this probably isn't all of you, But it's all the ones I've met so far. And they
kind of glance at it and there's a column on the Blood panels that says marker [inaudible 00:00:59]
says, and they just kind of glance down and just Look for that one column to see if the lab has
told them that the marker is normal or not. And let's say you have a vitamin D level of
30.1. That won't show up as abnormal because The range is 30 to 100. But 30.1 is kind of low
and I'm going to look at that and go, you know, You got low vitamin D. Whereas somebody just
looks at those, that column that just tells them Normal abnormal, normal, abnormal,
and then they look at the abnormals. That's not the way you're supposed
to look at blood panels at all. So the good and bad blood panels. So the good,
there's a lot of good in blood panels, especially If you're good at reading them, if you've
taken the time to understand what each Blood marker means or what it can means.
And if you take the time to look at how, Maybe … I'll give you a good example, how
maybe blood panels are associated with each Other. Somebody comes into the office and
they have symptoms of pre-diabetes. They're Falling asleep after meals. They're putting away
for no reason at all. They're urinating five times A night and so on and other things. And they have
all these symptoms. And then you look at the blood Panels and their A1C, which is the gold standard
in the medical model for blood sugar, is normal. Maybe it's high normal, but it's
normal. They're done. That's it. If that person has all the symptoms of it, then
you should know, and I must say there's just a lot Of people who don't know, to look further. Maybe
next thing you should look at is the lipid panel. Why would I look at the fat panel?
Because seven to 10 years before Your blood panels show pre-diabetes, your
triglycerides will go up, not your cholesterol, Not your low density, your triglycerides will
go up. If your triglycerides are equal to Or greater than your cholesterol and you
have pre-diabetic symptoms you should treat For pre-diabetic because not only are you
getting the symptoms, but you're getting the Inflammation. You're getting the inflammation in
the arteries and the brain and so on and so forth. So is that the bad or the good
part of lab numbers, of lab ranges? So the basics on lab range are this: each lab
range is affected by the lab that you go to. So Each lab has a patient population. So if you go
to Beverly Hills or if you go to the Ghetto in
Central Chicago, now I lived in Chicago and I was
in an internship in the Ghetto, so I can say that, Okay, don't cancel me or anything like that.
These are different populations. All right? And You're going to get different numbers from people
who are eating, maybe they're eating too richly, Maybe they're going to be overweight, or maybe
they're running on treadmills or stuff like that, Versus the people in the ghetto who maybe are
suspect of having, in a ghetto, of having a More difficult life, maybe having a little
bit more difficulty, maybe eating fast foods, Maybe not eating that type of stuff.
Their labs are going to look different. The lab range in that, and I grew up in a minimum
wage neighborhood, so we could use that too, The lab range in that neighborhood are going
to be different than the lab ranges in the Wealthier neighborhood. And so what they do
is to make the lab ranges for that lab, they Take a bell curve of all the people in that lab.
They cut off the ends and then that's their norm. Lately, so there's a lab number, there's a
lab marker called homocysteine. I'm going To use this for an example because this
is a perfect example for this question. What is the good of this marker? If you know how
to read this marker, you know that maybe this Person doesn't process their vitamins properly,
their B vitamins properly, you know that maybe Their liver's not detoxing properly, you know
that there's an inflammatory response going on Primarily in their brain and their nervous system.
You can know all that if that this lab is normal Or not normal. Okay, how do you know that
though? Because right now I don't know what's Going on with homocysteine out there, all
you guys in the labs, but the ranges can be Zero to 6.7. So over 6.7 means the person's
got high homocysteine, they're not bringing Down their B vitamins. If the person's coming
in here with brain fog, mental fog, anxiety, Things of that nature, short temper, that could
be a big finding. So that finding would be, Except I just saw one yesterday with a lab range
of 21. So you got to be over 21 there. So in their Lab everybody between 6.7 and 21 is normal and
they may be running around with shaky, anxiety, Tremors, they may be running around with brain
fog, mental disturbances of their serotonin or Dopamine. They may be told they're normal.
What is the normal range? I don't know. I use the lowest one because that's the safest
one for me because I'm going to be giving them B vitamins or B6 or B12 or something that,
but I have also seen in the last six months, Those of you out here at lab techs, I
have seen the range for homocysteine be Eight for at the low end. I've seen it be
14, I've seen it be 12. I've seen it be 16. I had another one last week that was
16. I've only seen one in the twenties. So that's the downside of lab ranges.
Hashimoto's thyroid disease, which I Treat a ton of, in the beginning when
I started, the range was zero to 100. Some of my colleagues who were doing research on
this said it should be zero to nine, so we use
Zero to nine because it seemed to make more sense
because we had a lot of people who were like 60 And they had all the symptoms of Hashimoto's
and they were being told they were normal. Now it's come down to, in my town, so I'm in
Reno, Nevada, so there's one hospital here, The range is zero to nine, there's another
hospital here, the range is zero to 34 and there's another hospital
here, the range is zero to 32. So how about all those people between nine and
32 and 34? Who's right? I use zero to nine. I believe the Mayo Clinic uses zero to nine,
but you can check me on that. But that's what I've heard lately. But zero to nine is probably
the right number just based on what I see when You look at people's symptoms, their exam
findings versus that. There I do patients From all over the United States, all over the
globe, in places in Alabama and Mississippi, The range is still zero to 100. And I have seen
those labs in as recently as the past year. In Georgia, in Southern Georgia too. I've seen them
them real high down in Southern Georgia and I've Seen a few areas where it's still like zero to 50.
So the downside of lab ranges is they're Mind-bogglingly inconsistent. So to
make the lab range more meaningful, I always use the narrowest ranges because that way
I'm just sure I'm not missing anything. But then You have to, so here's the downside to
lab ranges, the downside to lab ranges, What I was just going to say is the next thing you
need to do is you then need to go and do a history And an exam on a person and see if their history
and their exam findings are going to fit that. If you're got, and this is not to blame
the doctors. I am in full sympathy with The doctors. I mean, if you got 10 or 15
minutes with a patient, and you're going to See six patients an hour and stuff like that. And
that's what it's like around here, an awful lot. Well, you're not going to do any of that. In
fact, you're not going to look to see if it's 30.1 In a range of 30 to 100 and give the person
vitamin D, because you're not even looking at Those numbers. You're just looking at the flag
column that's says, no, everything's normal. Everything's normal. It's 30.1. It's normal.
Person's got symptoms of low vitamin D, But you're not going to give it
to them because it's in the normal Range and nobody's looked at the normal range.
So that's a problem. And I'm going to say I'm Getting up there in age a little bit. And when I
learned diagnosis, it was in the seventies, early, Mid-seventies, mid-seventies. And back then we
were taught, you do a history, you do an exam, Then you come up with your differential diagnosis,
meaning the top three things you think it is, In the order of the importance of the way you
think it is, and then you do labs in attempt to Confirm that. You don't just do a bunch of labs
to see if it's going to tell you what's going on. Because by the time you've
done a history and exam, You should pretty much know what's going on most
of the time, maybe not all the time, but probably
90% of the time or more. And then a lot of doctors
are going to say, "Oh, he's stupid. He doesn't …" No, because they don't do this anymore. I'm
not being mean, I'm just saying this is how it is. So now you do that, and then the lab says yes
or no, and then you go, well, the lab says no, But this all says yes, the diagnostics, the
history, the exam. So you treat them for the Diagnostic histories. That was normal procedure
up until probably like the nineties. That was Normal. Now we got so many tests and so many
people making money off of tests and all that Type of stuff. I mean I think it's part of it.
But then we got the doctor who looks at the Test and says, no, you don't have it. No, your
antibodies are down today. No, you don't have the Antibodies for Hashimoto's. Maybe it's an off day.
That's another thing. You can take a lab in the Morning. I've had people come in here, take a lab
in the morning, have one set of numbers, and then Something happened where they weren't feeling so
good. They went to the hospital in the afternoon, Did another set of labs and you wouldn't know it
was the same person. Now part of it was maybe they Developed a viral infection, maybe they're in an
accident. But even the other numbers that wouldn't [inaudible 00:13:04] in that, would be different.
So the downside of labs is it's a snapshot. It is a snapshot. Some things are going
to be more consistent than others and Some are going to be more unstable than others.
The glucose is so unstable. If you take a stick Of gum on the way to getting your blood taken, it
could go up and down 40 points. And most doctors Are aware of that. But a lot of the other ones,
a lot of doctors aren't aware of how if somebody, I just had a person come in last week and their
SGOT and their SGPT were off the charts. These Are two liver markers and if they're high,
you got to start looking elsewhere to try To figure out do they have a cirrhosis of
a liver? Do they have fatty liver? What do They have? They have alcoholic liver, what do
they got? Well, this patient has nothing else. They said, "Well, I was at a doctor, he said,
I got a fatty liver and I got to start taking This drug and that drug." And I said, "Do you
exercise?" "Yeah." "Do you exercise hard? Do You like do high intensity exercise and all that
type of stuff?" I didn't mean to make fun of that. I've done high intensity exercising. And she said,
yeah. I said, "Did you do it the night before you Went to the lab?" She says, "I did it the morning
before I went to the lab." That will raise those Two markers. She was probably normal.
So what are the positives of lab ranges And labs? The positives are we have them. The
negative is there's a lot to them and we either Don't take, as a healthcare professional today,
there's a lot of confusion on them. The ranges Differ. A lot of times we don't take enough time
to figure out what the lab ranges really look Like. Sometimes we just look at the flags column
and we don't really look at the numbers to see If they're borderline high, borderline low, and if
those numbers fit with the exam that we didn't do. That's the up and down of lab ranges and lab
numbers. And it's kind of a commentary on that's
Kind of the ups and downs of the
way we do diagnosis today. So I think that's the best answer that
I can give you on that question.