I know I promised a "How To Supplement" post first, but I assure you, this post is a necessary reference for supplementing.
During my holistic health and career change journey, I did a nutritional assessment with my mentor, Sue, and shadowed her and Dr. Faria at their functional medicine clinic in Sterling, VA. After shadowing and meeting Dr. Faria, she gave me a lab script to get my functional labs done in the setting of disease and deficiency prevention.
This post reviews everything that a basic functional medicine lab panel entails. This article will inform you what each lab value means and how it correlates to disease, some common medical myths, my supplement and acne plan, and a breakdown of the cost of seeking functional medicine evaluation.
This review is referenced by my functional medicine provider and mentor, Sue BSN, RN, FNT, and me, Tosha BSN, RN, (INHC). Not medical advice.
What are functional labs?
Functional labs are not just a CBC/BMP that you get done through your PCP or at the hospital. Functional labs are very comprehensive with OPTIMAL reference ranges. Traditional lab value ranges are based on the average 'healthy' American- which is not healthy at all. Functional labs also include hormones, minerals, vitamin levels, fasting insulin, inflammation markers, autoimmune markers, and more- IN ADDITION to a CBC/BMP/Lipid panel. Functional medicine clinics also offer more tests like GI Maps (stool tests), genetic testing, hair tissue mineral analysis, and nutritional assessments.
My lab results explained
CBC
CBC stands for a complete blood count. What we look at here is:
White blood cell count (WBC): High WBC numbers indicate active infection, and low numbers indicate poor immune function.
Red blood cell count (RBC): This indicates how many red blood cells you have.
Hemoglobin (Hgb): These are oxygen-carrying molecules in the blood. Low numbers indicate anemia or acute blood loss. Numbers under 7 require a blood transfusion.
Hematocrit (Hct): Correlates with Hgb.
Platelets (Plts): Low numbers indicate thinner blood; more likely to bruise and bleed, and high numbers indicate better ability to clot.
The rest of the numbers are only relevant in acute settings and cancer/immunocompromised patients.
CMP/BMP
A comprehensive/basic metabolic panel gives a good picture of your electrolyte and fluid balance, kidney and liver function, and blood glucose management. Here are the basics:
Sodium is pretty complex. It plays a big role in fluid balance, that's why it's recommended that those with hypertension are to reduce sodium intake but it's too often that these patients have too low sodium which can cause a variety of neurological deficits. Sodium is essential for almost every cellular pathway in your body. If you don't eat a lot of processed foods, you won't have to worry about your sodium being too high. I drink salt water every day and my sodium and chloride are fine. Read more about sodium and water here.
Glucose (fasting) shows how well you manage blood sugar when you're not eating. You may have insulin resistance or hyperinsulinemia if it's high or too low. The body naturally wants to maintain 100.
BUN, creatinine, and eGFR all represent kidney function.
Total protein is a reflection of your dietary protein intake. Mine could be higher!!
Albumin is another measure of dietary protein.
AST/ALT are liver markers. You want both numbers to be <25. This shows effective liver detoxification.
Lipid Panel
Let's talk about cholesterol myths:
The best way to measure the risk for heart disease/plaque is not, in fact, a lipid panel. The best test for this measure is a coronary calcium scan.
This costs $125 out of pocket - of course, it's not covered by insurance because why would our healthcare system want us to know our plaque status :,) and then who would buy their debilitating statins????
Your overall cholesterol ratio, LDL particle size, blood glucose levels, and levels of systemic inflammation are other important markers for your heart health.
Total cholesterol - 80% is made by the liver, and 20% is from your diet. If you have high total cholesterol, your liver may need some detox. This is not high because of eating saturated fats. You want to have adequate amounts of cholesterol in the body because your brain and sex hormones are made from cholesterol. You actually need cholesterol to SURVIVE.
HDL and LDL are carriers of cholesterol. Their jobs are to transport cholesterol throughout the body.
VLDL (very low-density lipoprotein) is the bad cholesterol. When VLDL and triglycerides are high, this indicates insulin resistance.
I was worried about my LDL being high because it's known as the 'bad' cholesterol, but Sue assured me that it is nothing to worry about. The stickiness of LDL and particle size is what would make LDL concerning.
Candida Antibodies
This just shows if I had a past candida (yeast) infection or current.
Vitamins
Vitamin B12 and Folate
About Vitamin B12:
Synthesized by gut bacteria. Absorbed in the stomach.
Decreased absorption as we age.
Involved in DNA production and brain function.
Depleted by birth control and irregular cortisol levels.
High content in oysters and leafy greens.
You want Vitamin B12 to be > 900. I have a great diet so I may have a methylation issue (genetic malabsorption) since my numbers are on the low side. I will be supplementing with a methylated form (see below).
About Folate:
Synthesized by gut bacteria.
Involved in RBC production and neurodevelopment in utero.
High content in leafy greens, asparagus, and lentils.
You want your Folate to be > 20.
Vitamin D
About Vitamin D:
Made from cholesterol in the body.
Essential for immune function and sleep health.
Fat-soluble, absorbed with food. Also, need Vitamin K2 to absorb (more bio-available).
Highest content in wild-caught salmon.
Fun fact: It takes 48 hours to absorb the vitamin D you make from sun-skin contact so if you wash your body with soap within 48 hours you wash most of that vitamin D off.
You want Vitamin D levels to be between 80-100. I will be double supplementing since I'm on the low end. I will be taking 10,000 IU/day for a bit and then 5,000 IU for maintenance.
Ferritin
You want your ferritin to be > 45. Ferritin is is a protein that absorbs iron in your cells. It is a marker for long-term iron intake. Low iron can cause chronic fatigue.
Hormone Panel
Thyroid
TSH is not the only player when it comes to thyroid markers. TSH signals to the brain to make thyroid hormone but T4 needs to convert to T3 too. To do this, we need iodine.
Iodine - the recommended dietary allowance is 450 mcg. This is not a lot. There is a huge deficiency in the USA and hypothyroidism is very prevalent in women.
Iodine disrupters: new car, fluoride in water, chlorine, preservatives (bromine)
Iodine in food: shellfish, seaweed
These are not great sources because of contamination and pollution, also iodine gets lost during cooking. Most times, it's best to supplement iodine.
Thyroid food: iodine, selenium, and zinc
I am not converting T4 to T3 well (we know this because my T3, free is low) so I will be supplementing with iodine (see below).
Anti-TPO is a marker for Hashimoto's.
Adrenal hormones
Cortisol
Yes, the dreaded stress hormone... but cortisol is more complex than that. It is made by the adrenals and follows a circadian rhythm, levels peak in the morning and decrease throughout the day. It's production is dependent on hypothalamic-pituitary-adrenal (HPA) axis which is the body's stress response system. Irregular cortisol levels points to HPA dysfunction and adrenal dysfunction.
More about cortisol:
Increases glucose
Anti Inflammatory
Works with the immune system
Affects salt-water balance
Improves energy and alertness
Reduces autoimmune risk
Affects memory
High levels of cortisol symptoms:
Jittery, anxiousness
Insomnia
Hair loss
Thin skin
Weight gain in mid-section
Increased heart rate and blood pressure
Low levels of cortisol symptoms:
Fatigue
Struggle waking up
Blood sugar problems
Long infections/sickness
Waking up in pain
Low blood pressure, dizzy standing up
My test was taken right after waking, so it is higher than it would be later in the day. Normal levels correlate with normal levels of energy and stress. To address abnormal cortisol levels, we would look into sleep, nutrition, hydration, toxins, and movement.
DHEA
DHEA is a good indicator of energy, most people can't get >100. You want to be >200.
It is produced by our adrenal glands, converts estrogen to testosterone, enhances memory, improves libido, and diminishes wrinkles.
Insulin
You want fasting insulin to be low. This says a lot about blood sugar balance and management.
Fun fact: Skin tags and large abdominal girth can indicate insulin resistance/ hyperinsulinemia.
Sex hormones
Testosterone
Free testosterone is what is available and usable.
In females: Testosterone is secreted by the ovaries and rises before ovulation to naturally increase libido. High testosterone can present as oily skin, acne, and hair loss.
FSH and LH
FSH (follicle-stimulating hormone) is a hormone made by the pituitary gland that helps women release their eggs and men make their sperm.
High FSH and LH are usually found in night shift workers and those who get <6 hours of sleep. High FSH is related to infertility.
LH (luteinizing hormone) is a hormone made by the pituitary gland that helps regulate the menstrual cycle and triggers the release of an egg from the ovary. The brain also signals to LH for sex hormone production.
PCOS is indicated when LH < FSH.
FSH and LH fluctuate during each phase of the menstrual cycle. Abnormal numbers correlate with irregular periods in women.
Estrogen
Estrogen is produced by the ovaries. It is dominant in the first half of the menstrual cycle. It builds the uterine lining, keeps skin supple, and our brain and heart in top condition.
Estrogen dominance presents as heavy/painful periods, fibroids, and breast tenderness, and increases your risk for breast cancer.
Estrone
Estrone is the 'bad' estrogen. It is linked to plastic toxicity (xenoestrogens) from using plastic products excessively and heating things in plastic containers.
Estradiol
Estradiol should be 2x estrone. Many people don't achieve that though. This raw carrot salad can help with estrone excretion and increase estradiol.
Estradiol also supports sleep. It increases the number of serotonin receptors in the brain (precursor to melatonin).
Progesterone
The chill pill hormone, progesterone, is dominant in the second phase of the cycle. It helps prepare the uterus for potential embryo plantation and supports thyroid health, cortisone, and bone health. Progesterone deficiency presents as anxiety, irritability, insomnia, and irregular cycles.
CRP
C-Reactive protein is an inflammatory marker. It increases with trauma, stress, and food intolerances (gluten). This is how you can tell if your celiac patients are really staying away from gluten or not because they lie LOL.
Hgb A1C
Hemoglobin A1C is a 3-month indicator of insulin and blood glucose activity.
Shows how metabolically flexible you are (able to use glucose AND fat for energy).
Most people don't get to the fat-burning stage because they are eating every 2 hours. Intermittent fasting can help with this. I do 12 hours daily, 16 hours weekly, and 22-24 hours monthly.
The @glucosegoddess has more blood sugar management tips.
Now that you know everything about my internal bodily functions...
My main concern is supplementing my deficiencies (see below) and getting to the bottom of my skin issues. Recently, in nutrition school, I learned that acne and skin issues are more internal than external. Liver congestion and hormone imbalance are ruled out because my liver panel and my hormone levels are normal (other than the slight hypothyroidism). So, I asked Sue what else could be causing my chronic bacne. She said it could be parasites or gluten and dairy intolerance. SOOO, I've been on a 2-week dairy and gluten-free diet and I'll be getting a GI MAP done soon. Stay tuned ;)
My Supplement Plan
I recently became a partner with Biotics Research because they have the highest quality, non-synthetic, bio-available, and research-based supplements. This is also the same company that Sue and Dr. Faria's functional medicine clinic uses and recommends!
The best way to supplement is to only supplement what you NEED. Blindly supplementing nutrients are not the way to go.
Based on my labs, here are the Biotics Research supplements recommended to me by Sue:
Iodiozyme HP (Iodine for thyroid)
Meda-Stim (for thyroid, conversion of T4>T3)
Zn-zyme forte (zinc, also good for acne)
Se-zyme (selenium, I am eating 4 brazil nuts daily instead)
Methylfolate Plus (a methylated form of B12, also increases folate)
Bio Dk mulsion (a bioavailable form of Vitamin D)
Bio AE mulsion (good for acne)
Conclusion
It is SO important to know this information about your cellular health for disease prevention, longevity, and maintaining an energized/holistic life. Obviously, I highly recommend seeing a holistic or functional medicine practitioner, getting your labs done, and working 1:1 with someone based on your health goals BUT I know it can be pricey.
Price breakdown: Because I know everyone wants to know
Functional medicine price is a big barrier for people because it is rarely covered by insurance (due to a lack of pharmaceutical and health insurance grants). I am also an average, working-class ~ frugal~ American who is always money conscious and I acknowledge that price is never communicated so I would like to put it out there.
Here is what I know/experienced:
Labs- $400
GI MAP- $350
Consult with FNT- $150
Consult with MD- $300 (I did not do this)
Supplements- $80 (with discount)
I know this is a lot of money for most people - and it is for me too - but trust me, prevention costs a lot less than treatment.
Budgeting every dollar you spend (boring) is a big part of my financial health. Money is God-given and has a purpose beyond keeping up with the Jones's. What can you do to re-evaluate your financial health?
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