Connecting the Dots with Functional Lab Results
BY: Andrea Nakayama
DATE: 2021-10-20
At the Functional Nutrition Alliance we embrace the sometimes harsh but often beautiful reality that one-size-never-fits all and that we are all unique.
Similarly, we accept that one odd occurrence or unusual symptom doesn’t usually point to a diagnosis. A day of diarrhea may just be that… a day. And the reasons – without more context (such as what you ate, drank, where you were, how you slept, what you were stressing about prior to the loose bowels, etc.) – may remain unknown. A day of diarrhea is not a sign of chronic dysbiosis, IBS or some other worrisome chronic ailment.
It seems obvious, I know.
But you’d be surprised (unless you’ve been there), how many clients want to share every outbreak or toilet aberration.
While many of us desperately want to embrace that we are special and unique and that what’s commonplace does not (and even cannot) apply to us, we also look longingly for the box to place ourselves in, or the label we can wear and identify with. We value individuality, independence, and self-awareness in so many aspects of our lives (our Spotify playlists, our self-chosen career paths, our outspoken politics, and even our half-size bras and custom-designed mattresses that conform to the way our body meets the bed), yet for some reason, we’re surprisingly ready to relinquish our healthcare to the conventional or sensational tactic or theory, without more than a hope or an empty promise that it will deliver results and resolution.
Falling into the Pathological Assessment Trap
Recently, we’ve been exploring how we as coaches and clinicians looking to utilize lab work in our practices can fall into these same traps. Traps that lead us to the boxes and the labels, to the diagnoses and the determinants, to the x means y, or the a means you should take b. I hear things like this all the time…
a high TSH means hypothyroidism
a low ferritin means take iron supplements
etc etc, the list goes on
And while it can sometimes be that simple, the human body is often more complex than that.
As an example, a low 25-hydroxy vitamin D level on a lab report can simply indicate that vitamin D supplementation is needed, but it can also point to other considerations that can be considered in tandem with additional lab markers.
Put on your Functional Detective Hat
Your best work as a practitioner is going to come from thinking critically, getting curious and looking at the whole terrain.
Perhaps most importantly, your client or patient deserves someone like you, who can deliver a Functional approach that allows for a more nuanced assessment for more ease of implementation and sustainable results.
As we’ve been exploring in this series on reading labs through a Functional lens, one marker rarely means anything alone.
Here are the 3 key distinctions for becoming a master when reviewing labs:
functional not pathological
trends not determinants
constellations not singular elements
Please go back and read the other blogs in this series to ensure that you’re embracing a Functional approach to reading labs:
In this blog I want to explore the concept of “constellations”. I love thinking about health challenges and markers through the lens of constellations because it helps us to recognize and remember that everything in the body is connected! One thing rarely means one (other) thing! If there are microbial imbalances in the gut, they’re likely going to impact that person’s mental health and mindset. If there is chronic inflammation in the body, you may find that person “hot tempered”. If there are challenges with detoxification, countless other health concerns can arise that we don’t even think to attribute to the liver. (Hello hormones!)
Let’s look at that 25-hydroxy vitamin D marker I mentioned earlier through this fully Functional lens…
Functional not pathological
While both sets of ranges may vary depending on the lab, it’s location, and even who you ask (!) a pathological 25-hydroxy vitamin D level is usually between 32.0 – 100.0 ng/mL. A Functional 25-hydroxy vitamin D level will fall in a more narrow range of about 50.0 – 80.0 ng/mL.
Trends not determinants
If we see a marker on a client’s lab report that falls outside of that narrower Functional range, we may ask when they last had their vitamin D measured and if we can see those results. These two or more markers together help to tell a story and lead to more questions. Is there anything significantly different between the two? What happened around each lab draw and were there any differences in dietary intake, supplementation, geographical location, or anything else? This vitamin D “timeline” starts to illuminate more answers (or even more questions!)
But what about the constellation?
A “constellation” is a grouping or cluster of things. When we think about stars, we can imagine an area of the night sky or the celestial sphere in which a group of visible astronomical objects form a perceived pattern or outline. Basically, the Big Dipper! The Big Dipper consists of 7 stars that allow us to see that scoop shape that I’m sure you can visualize. One star alone would not reveal a dipper at all!
The concept is similar when taking a constellation approach to looking at labs…
That 25-hydroxy vitamin D level of 22 ng/mL means it’s likely time to supplement! But what else does it mean when we understand the full body systems, how everything is connected, and where we can gather other clues?
How does the 25-hydroxy vitamin D level relate to the other immune and inflammatory markers to create a more comprehensive picture of systemic immunity?
What do the magnesium and calcium levels look like and do we need to consider how these vitamins and minerals are working together to impact structural integrity and bone health?
Given that vitamin D is actually a pro-hormone, are we looking at it in relation to hormone health, ensuring that there’s vitamin D sufficiency while (or even before) assessing hormone health?
Have we stepped back to consider it in conjunction with other signs and symptoms, from depression to cognition to ADD
And what if supplementation is already part of the picture?
Here’s where we might consider quality, quantity (dosing) and timing (pulsing through the day.)
And we may need to go deeper to think into liver and kidney function for appropriate vitamin D absorption.
It goes without saying that in addition to the (1) marker, (2) trend (more than one draw), and the constellation of both (3) other lab markers and (4) signs and symptoms, that we’d want to consider some other key factors such as:
diet (eggs, fatty fishes and oils are all good dietary sources of D3)
lifestyle (sun exposure… not too much, but not too little)
skin color
and even the body’s vitamin D receptors, which could be impacted by genetic factors
But I’m not here to give you a lesson in vitamin D (you can listen to this 15-Minute Matrix podcast on the topic, if it’s of interest). Instead I’m here to speak into the beauty of constellations when reviewing labs!
Constellations help those lab markers tell a story. Looking through this lens and understanding the physiological connections so that you can create that story may take time and practice. At first it may seem like reading hieroglyphics or making sense of a tarot reading. And when you don’t understand the full body systems and how everything is connected, it may seem impossible. But I promise you that with practice, you too can be a Functional Nutrition master and bring this deeper insight and understanding to all you do – breaking out of the quick fix trap (even when it comes to reading labs!) and helping your clients and patients to do the same.
This is how we change the way we do healthcare and you become the master coach or clinician you want to be.
Change happens together! Full Body Systems offers a free bonus course on reading labs, in addition to the 10-month immersion program into the science and ART of Functional Nutrition. Take your passion for helping people feel better to the next level by becoming a Certified Functional Nutrition Counselor!
By: Andrea Nakayama, FxNA Founder & Functional Medicine Nutritionist
Functional Nutrition Alliance provides the comprehensive online Functional Nutrition training in the Science & Art of the Functional Nutrition practice. Learn to address the roots of your clients’ suffering with client education, diet & lifestyle modifications.