How to Read Your Blood Test Results: Decoding Normal vs Optimal, Panel by Panel

Well, well, well. We are live and we are in the same room. This is weird making eye contact with you. I looked up from my computer. This is funny. Well, this is this is actually going to be way more exciting. Like a real more dynamic. Yeah, real podcast. Probably more dynamic. Um, if you're joining us live, we were a little late because we were figuring this out, but hopefully it's smooth sailing in the future. So, uh, today's a pretty exciting episode. It's definitely more broad than some of the ones we've done in the past and it's called decoding your normal labs. So, a lot of patients come to Med Matrix with the kind of key complaint that, you know, they go to their normal doc, their PCP, whatever, and they're told their labs look fine when they don't feel fine. They're told their labs look normal. So we're going to be jumping into like you know why that actually is and kind of how we take a different approach with functional medicine to really focus on what is optimal for the patient and how we do that right so this is going to be I think eye openening for a lot of people especially if you know you're you're that person who's like gone to your normal doctor and like you want to feel healthier you're especially if you're like trying to do the right things you're going to the gym you're taking supplements and you just like don't feel like you used to. So it's going to be a fun one. Um, this is for educational purposes only. Don't, you know, take this as medical advice. If you want medical advice, you're welcome to become a patient. You can go to medmatrixusa.com and talk to a patient coordinator. Um, see if we can help you. But, um, with that said, Dr. Rose, why don't you give a little intro on kind of like how you got into functional medicine and your Yeah. your experience. Yeah. Let's hear it. Yeah. Um, I'm Dr. Sasha Rose. I'm a naturopathic physician and a licensed acupuncturist. Been practicing for 20 years. I sit on the um Forbes medical um advisory board as one of the experts and I was drawn to functional medicine because it I find that it um it is backed by science but it is not kind of constrained by old beliefs. Okay. It's kind of um a really nice mix of um continuing like constantly like looking for more answers. Root cause medicine as we like to say um and based in science backed by evidence. So that just resonated for me from the beginning. Okay. Can you explain what you mean by that? Because like a lot of patients like they think kind of functional medicine is like woo woo and they don't they you know they think conventional medicine is the only real scientific way to like go about healthcare but like that's that's not true at all. Like can you explain like really like explain the merge of functional medicine and still conventional medicine? Medicine. Yeah. The way that I see it is that if anything in functional medicine, we are doing more testing and we are, you know, we're doing blood work, we're doing depending on the test, we're doing salivary testing, urine testing, stool testing, and that we're constantly kind of, in my experience, based on going to conferences and doing lots of continuing education, we're always kind of um asking more questions. and digging deeper and looking at the research, combining it with our own clinical experience and kind of innovating. And this is I fully admit somewhat of a biased opinion, but I feel like conventional medicine because of its constraints with insurance, because of its constraints with and maybe influence from pharmaceutical companies doesn't move as fast and is um sometimes impacted by ideas and scientific beliefs that are actually not current. It just takes longer in that conventional medicine system for things to actually change for like the people's providers, doctors, clinical practice for what they're doing to actually shift. And I think that anybody that I've worked with in functional medicine, like we're always doing more research and we're always again going to conferences and um and making our own, you know, decisions based on on the studies and on the research and where the information is coming from. So it's like yeah it just feels more um just to use the word again like more dynamic more um kind of in tune with not just what people need but what the mo what the most recent research is telling us. Yeah totally. Um, can you give like an example of a way that like conventional medicine has kind of fallen behind and you know patients are coming to med matrix and functional medicine and like getting ahead of the curve with medicine if that makes sense like yeah that was a good point you raised. Yeah. So one here's something that comes up pretty frequently in my own practice. Um, it has to do with hormone replacement therapy. And the the thought I would say has been or up until recently um and still is embedded in uh many areas of conventional medicine. Mhm. that if a woman is 10 years post-menopausal or over the age of 65 that it is not safe for her to do any hormone replacement therapy. End of story. Mhm. And those of us who practice what we call menopause medicine hormone replacement therapy, specifically bioididentical hormone replacement therapy, we know that when estradiol, for example, estrogen is taken administered topically or transermally versus oral and when it is bioididentical, not synthetic, that it is completely safe for for a woman who's over 65 or 10 years postmenopausal. Okay. So, but I So, here's an example. I will have patients come in who are say in that category. They're over 65. They're um 10 years postmenopausal and there's reasons, which I won't go into right now, why the two of us, me and the patient feel like it would be it's it's worth exploring putting her on some bio identical hormone replacement therapy. I will always tell her what I know from the most recent research um and based on what I have learned and what I am continually kind of keeping on top of. And I will tell her it's possible that when you go tell your primary care doctor that you're doing this that they will freak out. Mhm. Um, and just so you know that and I'm I'm giving this advice based on my you know my education, what I've seen, what I'm studying um to at this time and just so that's an example I guess. Yeah. Okay. It's like it's like an old way of thinking and we're you know we're all guilty of that like we're all guilty of like we've known we were taught something and that's we kind of we stay in that mindset. Mh. Um yeah. Okay. Thank you. Um what like I guess what outcomes like happen when you start to like think outside of the box with patients and like really look at patients like an individual like the example you just gave. You know what I mean? When you start focusing on things that really do matter like hormones and so on and so forth. So, you know, the classic example is somebody who has been dealing with hot flashes and night sweats for 15 years. But now that, you know, now that the um FDA removed the blackbox warning on estradiol, she, you know, she's interested, she wants to start estrogen, but now she she's been told that it's too late for you, but she's still suffering, right? And we know that there are still benefits to her in terms of improving her, you know, lowering her risk of dementia, cardiovascular disease, etc. She still is going to have some benefit from that. Um, yeah, I think that answers your question. Yeah, totally. Um, I guess one thing I think a lot of patients wonder is like how can you go to your doctor, not feel fine? like you're lethargic, you're not sleeping well, you're overweight, you have joint pain, anxiety, they're giving you all these medications and your lab work comes back as normal. Like how is that like how can you not feel great but labs look totally fine? Yeah. So two things. One is what are they testing? What are the actual labs that they are offering? And again, sometimes that's um limited by what the insurance will cover and or just the knowledge of the provider. also limited somewhat by I think and I've said this before on this podcast that literally the time of the visit, the time that that provider has with you to really like look at you as a whole person. Ask about the quality of your sleep, ask about your stress level, ask about all the questions, all the lifestyle questions. like there's literally just not that amount of time in a visit and there's these constraints in terms of what's the insurance going to cover and just the training and the expertise of the provider. Mhm. Um so there's that kind of limitation. Um and what is and this is kind of what we always come back to and big part of this podcast today is what's what is normal, right? Versus what is off. What like what is normal labs like when you hear like oh your labs look normal and you know you get the blood report and you see the little range or the sliding scale and everyone's different like how do they come up with that normal range? You will notice also that like different labs will have different reference ranges. So it's based on statistics it's based on certain group of people demographics. Some of the people within that pool have dis disease and some people don't. But it's basically just a statistical reference. So it includes people in all states of health and honestly all ages, right? So you know when you're being told you're normal, you're being put up against someone who's really unhealthy. Yeah. So one way that I think of it sometimes is like, you know, you might be within normal, but is that really where you is that where you want to be? Like if unfortunately if you look around in this country I mean I can tell I think anybody can tell just by looking at people if you go into if you know anywhere that most people aren't super healthy you can see it on the outside right. Yeah. Okay, I understand. What are um like I think I want to talk a little bit more about one thing you said which is the extent of testing, right? It's like you know a couple markers might look normal because that's all they're testing, right? They're not looking at a whole lot. So like what are some of the other tests that you think are really important that you like to run on your patients um initially and then kind of follow up testing as well? So some of the ones that I like would include ones that the a primary care might might do. So like a CBC is a complete blood count, right? So say let's take our hypothetical patient who is tired. Okay. Um fatigue, exhaustion, one of the most common kind of complaints. So a CBC is going to show us um you know it's going to show us a white blood cell count, but it's also going to show us a lot of biomarkers around red blood cells and hematocrit and hemoglobin first. And if those are epimeatocrit and hemoglobin are low, that's an indicator that this person has potentially has anemia. Okay, iron deficiency anemia being one of the most common. Also B12 and um deficiency anemia is another one. So CBC, that one is done kind of somewhat regularly. Um comprehensive metabolic panel is also one that's maybe done not as often as I would like within kind of conventional medicine, but it is done. Mhm. Um and that's going to show us your fasting blood sugar, your liver enzymes, your basic kidney health, your electrolytes. Um and then conventional medicine will al this doesn't really relate to fatigue, but like a lipid panel. Okay, that's usually about it in terms of what I've seen other providers run. they might run a what's called a TSH or a thyroid stimulating hormone if they are wondering if your thyroid is out of out of balance. What I and what we at Med Matrix like to see is all of what everything I just mentioned and a complete thyroid panel. We can get into that a little bit more later if you want, but it's not just the TSH. It's the actual thyroid hormones. Yeah. It's it's the antibodies to see if you if the person has an autoimmune condition called Hashimoto's which 80% of people with hypothyroidism it is Hashimoto. So um 80% about 80%. Wow. Um and then we do we do micronutrients which again that's not traditionally run. So we're looking at someone's vitamin D, their B12 level, their folate level. um not just iron which can fluctuate a little bit more dayto-day but ferotin which is your liver's ability to store or the reserves of iron that's a much better test than just your iron. So we have these micronutrients and then we have these kind of panels and then we've got cortisol, right? So that's going to that's if somebody is not sleeping well, they're stressed, they're tired, that's an important marker. Um and then and then of course the hor we kind of the sex hormones as well and if there's an imbalance there that can contribute to all sorts of things. Uh hormones are rarely tested within conventional medicine. Sometimes if somebody asks, their doctor will um will order them. Um but usually not. And again, there's a normal versus optimal for a lot of hormones, too. Sure. Yeah, that's a good point. Um let's let's talk about each one of the subjects for a little bit longer. I guess like thyroid is a big one that comes up a lot. Like what you you've kind of teased this a little bit, but like what is a full thyroid panel and like most patients aren't even getting Yeah. Like why does it matter? Like most patients aren't even getting their doctors aren't even telling them about this, right? Yeah. So often times and again maybe if somebody is fatigued they will run a TSH but it's not part of a regular panel. Um TSH is just part of it though. Yes. So our panel is it includes thyroid stimulating hormones. Um, and it also includes T4, which is basically the inactive form of the thyroid hormone. If if you're watching or listening and you or you know somebody who's on a medication called levothyroxine or synthroidid that is T4, it's basically the inactive form of the thyroid. So, we test levels of that. And then we also test T3 which is the active form. We test reverse T3, which is kind of this inert competitor to T3. If that's too high, that's kind of kicking T3 out of the way. It's not letting T3 lock into receptors. Um, we also do thyrolobuline antibodies and thy peroxidase antibodies. Again, answering the question of an autoimmune component. Mhm. So that panel is really thorough because it's not just do you have hypothyroidism or hyperyroidism which is a lot less common but that here's the TSH but okay let me finish that thought but it also tells us um like if you have hypothyroidism and you're on a medication are you on the right medication? Are you are you there's an issue with conversion. T4 has to be converted to T3. Is your body doing that optimally. Maybe your T4 is normal, but your T3, which is the one that's actually doing the work, is suboptimal. Okay? So, we wouldn't see any of that with TSH. We also wouldn't see if you have Hashimoto's or not. We would just see if the TSH what where the TSH is. So, those are some kind of common examples. Um TSH is a really good example of kind of normal versus optimal. So yeah, on the lab that we use, the normal reference range is 0.5 to five. Um, so for conventional medicine, you could be at 4.99 and you're normal. In convent in functional medicine, we have a more narrow window of what we consider to be optimal. So right again, normal versus optimal. Nor optimal is usually in the ballpark of like 75 to two. Um now that so if you're outside of that you don't necessarily have an actual diagnosis of hypothyroidism or hyperyroidism but we know that you're like kind of borderline you know you're maybe it's maybe the beginning of um of one of those conditions again usually hypothyroidism. Okay. Um and it's we always piece together the lab values and the symptoms and signs of the patient. So it's not just chasing lab values. Yeah. Is that something that you feel like is missed in conventional medicine? A lot. You mentioned like the visits are quicker. Like it's it's missed one because say somebody comes in, they're really tired and the doctor does order a TSH and again it comes back at like four. They're going to say you're fine. I'm going to say you're fatigued, your hair's been falling out, you can't lose weight, and your TSH is a four. I think that's pretty much a a hypo or a borderline hypothyroid state. Like that will intervention. Okay. Yeah. And then talk about like the way that also because it's not just about like normal versus optimal elaborations. It's also about like the like the solutions that then how right what are right so it's not just right so what's in the toolbox it's not just uh leopyroxin right it's like I like I I when I work with my patients I don't like to tell them what to do I like to give them a menu. Yeah. And I'm only going to recommend things that are safe that are backed by science that I've seen actually work. Um, but like in this case, there's more than one thing that works. So yes, levothyroxine or synthroidid is an option. There's another prescription called tyrant that people sometimes do well on, but they haven't done well on other ones. And then there's like a natural alternative. I use NP thyroid, which is like a combination thyroid, right, product. So, um, and there's the we have the ability not just to prescribe T4 like with levothyroxine, but to add in a very small amount of T3. Mhm. So, it's really like they're all potentially good. Sometimes it's trial and error. Let's start you on a low dose of this and see how you do. We retest in 3 months. Yeah. And let's see a how you're feeling. B what your follow-up labs look like. Okay. Gotcha. I got a question here. So, we're going to move on from thyroid. I think we're going to do some we've done episodes in the past that dive really. So if you're listening this now, you're listening live or uh listening to recording, just go check out the podcast and listen to a thyroid episode. Um but we got to keep it moving here. So one of the things is blood sugar, right? So blood sugar is another example where normal doesn't really mean optimal. So like what are some of the metabolic markers that might signal early insulin resistance before diabetes develop? like how does functional medicine approach things like diabetes and you know A1C differently than you know your normal doctor would. Sure. So again on our initial panel we include um both insulin these are this is a fasting lab so both insulin um which it does matter if you're fasting or not and then hemoglobin A1C it doesn't really matter if you're fasting. So insulin is the hormone put out by the pancreas. It helps glucose um to be directed into the cells. Yep. Um hemoglobin A1C is a threemon marker, three-month average of your blood sugar. So it doesn't it's not it's much better marker than that fasting blood sugar that's included because that's just a snapshot. So your hemoglobin A1C it's calculated in percentages. So anything again according to normal according to conventional medicine anything um under 5.7% for hemoglobin A1C is considered um fine normal. Once you're at 5.7% to about 6.5% that's considered pre-diabetes and then over 6.5% is diabetes. Okay. So again if you're at 5.6% 6% you know not all some provide medical conventional medicine providers would be like you're fine and we see that as kind of like potentially a pre a pre pre-diabetic state right so ideally you're closer to 5.2%. I had a patient today who um uh we wanted to revisit that we she we had t we she had seen her original blood work with me back in October and of course it included the hemoglobin A1C and she was 5.6 at that percent at that 5.6% 6% at that time. Um, and she has been making some dietary changes, some lifestyle changes, and so, um, she's coming to us because she's being proactive with her health, and she's doesn't want to become pre-diabetic. So, we are, you know, every 3 months we're we're checking it. We're monitoring it. um insulin um insulin if you start to get into that um insulin resistance stage where the cells the insulin the receptors on the cells are no longer responsive to insulin. Okay, insulin has been blood sugar has been too high in um for too long and therefore insulin has been too long has been too high for too long. The cells kind of stop responding. they're just kind of they're just not sucking it up as much and so the pancreas puts out more insulin. Okay. Same thing um if your insulin is at like 17, you know, if if a doctor were even to test it, if your insulin was 17, that would be probably considered fine. I see that as like you're on your way to insulin resistance because once you hit 20, then you're technically insulin resistant. Okay. And can you like come back from there or is that Absolutely. Yeah. Yeah. So, lifestyle, you know, a lot of a lot of great tools, but um some of the things that most people know, which is, you know, lowering your glycemic load, um moving your body, you know, regular consistent exercise, and then we do have some tools, um like peptides, like GLP-1s, um and potentially other neutrauticals that can really help with that. Heard. Okay. Um All right. So, we're kind of moving on from like area of the body, of the body. So, we've covered uh thyroid, blood sugar. Now, let's talk about a little more about sex hormones like how are sex hormones like first off for people don't know like what are sex hormones and how are they looked at differently in a conventional versus functional lens? So, sex hormones are um well, I'll just list them. Um we have uh the most common the ones that we hear about the most would be estrogen and the ones that we test that there's three types of estrogens. The strongest one and the one that we test for on blood work is estradiol. So that's what is um tested and much of the time if you're going to be like say on an estrogen patch you're taking estradiol progesterone testosterone and then we have some additional ones in our panel um follical stimulating hormone and luteinizing hormone as well as prolactin. So those are all considered kind of um sex hormones. Um, again, not routinely tested in conventional medicine unless um, say you are um, going through infertility, you're having a hard time conceiving. Um, you're and that yeah, you're a woman having a hard time conceiving. Um, or you're amenoric, meaning you don't you there's no you don't know why, but you're not getting your period. So, other than those situations, those sex hormones aren't usually tested. Um, yeah. What was the second part of your question? Why are they so important? Like a lot of people actually don't even like a they're not getting tested, their doctor's not talking about them, and they feel like Yeah. For lack of a better term. Yeah. And they're not even talking about sex hormones. Like why are sex like sex hormones, you know, why how do they place? It is. It isn't. So I'll just use kind of, you know, a lot of the people that come to us are women who are say over, you know, between 35 and 60, 55 or 60. So they're either entering pmenopause or they're actually menopausal somewhere in that in that window. Um what we see is that you know I can look at lab I can look at those results and I can see if a woman is still cycling or not just based on those hormones. I haven't even met her yet. I can just tell if she's if she's still having a period. Um in the same way I can tell if she's actually post-menopausal. Now, when you're permenopausal, so that 10 to 15 years before you actually stop bleeding or yeah, before you stop bleeding, it can be all over the place. So, your your estrogen level might drop, your progesterone level might drop, but you your ovaries are still producing them. Um, and the fluctuations might be kind of changing. And so, we're kind of trying to get a baseline with that. Now the American College of Gynecologists they that kind of standard of care is doesn't usually include testing for the pmenopause or menopause state. They will prescribe or they will say that it's okay to prescribe hormone replacement therapy without testing. I do agree with their line of thinking that we're largely doing this. We're largely prescribing on symptoms, signs and symptoms, and what we know to be like the preventive reasons to do HRT. But the value of baseline testing and then monitoring while somebody is on HRT is yes, in addition to how they're responding symptom-wise, but you know, we can see the levels changing in the blood and we can kind of match their symptoms to the to this blood. Sure. Yeah. Gives you like a point of reference. Exactly. But what about women who are postmenopause, right? Because you can tell when a woman is postmenopause based on her blood work, right? So, so basically there's her there's no progesterone, there's no um estradiol, and actually her FSH and her LH go up. Okay. And let's not forget the guys. Let's talk about Let's talk about the guys. Let's talk about the guys like we've got and testosterone is a female hormone. It's not just a male hormone. Yeah, let's talk about that. Okay, we'll talk about that before we move on to the guys. Um because a lot of women just think of testosterone as a as it's only important for men. Women think of it. Everybody thinks of it that way. We were taught that. Yeah. So like why is testosterone so important in like just the way a woman feels every day? Yeah. So women actually have um more androgen receptors than men. So androgens is kind of the category. The testosterone falls under the category of androgens. So we just like we have estrogen receptors everywhere, we have testosterone receptors everywhere. Um testosterone is not a menop it doesn't shift with menopause. Testosterone in both women and men starts to decline actually in our 30s and it's more of like a slow steady drop. M now of course there's situations when like I have one patient who a male patient who has some kind of testicular torin when he was an adolescent and so that you know situations like that like he's had low testosterone kind of for sure yeah that's a structural thing right but other than those situations for all of us it's just aging and literally aging when we start in our 30s so it's not unlike um progesterone and estradile and women that kind of goes like this in pmenopause and then it's like off the cliff in menopause. Testosterone has just been continually declining. Why does it matter for women to have optimal levels of testosterone? Um and I should note that that is um we do a full testosterone panel for women as well, not just men. Okay. So women need optimal not normal optimal levels of testosterone for cognitive health. Um so for those symptoms of brain fog for example, word recall um uh overall drive and motivation including libido including sex drive. Um some people say that or I have heard some experts say that um low um suboptimal levels of testosterone in women can um basically make a woman unable to have an orgasm. So if you kind of optimize that, she gets the ability to have an orgasm back. That's one reason why optimal levels of testosterone can be beneficial. One thing that I talk to my female patients about a lot is the physical benefits of optimal testosterone. So, muscular health, bone muscular health, strength, mobility, balance, and how that translates to bone mineral density. Um, so I I feel like I'm a little I'm a bit on a mission to kind of change the mindset around women and testosterone. That's funny. Yeah. No, I mean, if it sounds like makes a pretty big difference. So yeah, it's like everything. It's not like every woman should be on HRT. Not every woman should be on testosterone, but right. Um, yeah. But yeah, if it's something that like you're going to your doctor, you have no libido and you're losing all your muscles and you just got no like motivation and they're not even looking at that, you know, you can't get out. It's bas Well, it's not FDA approved for women, right? So you would Yeah, it's kind of off label. A and for those patients who are on a GLP-1 medications, one of the potential side effects with those is some loss of skeletal muscle mass, a very low dose of testosterone can be one tool to help maintain that. Okay, that's awesome. And that's a cool thing you get to do when you see providers like yourself because I think a lot of, you know, there is kind of a whole world of like the online like the HIMS and hers and, you know, you get a GLP1, but they're not there's no other support, right? Yeah. They're not looking at the full picture. All right. All right. And we got to talk about the guys for a second because but let's get back. Sorry. I'm so I'm so womenentric. That's all it's all good. But like with the guys um it's talked about more, right? Testosterone is something that's like we've all known like you think about guys think about testosterone. If a primary care if a urologist test uh tests testosterone in a man, it's usually total total testosterone. Um we do what I think of as a complete testosterone panel. So it includes total It includes something called sex hormone binding globulin or SHVG. So, this is my little spiel on this. This is a protein. It's floating around in the blood along with testosterone molecules. Um, it's like a bit of a sponge, this protein. When it attaches itself to a testosterone molecule, it kind of soaks it up. It renders that testosterone molecule inactive so that the testosterone can no longer lock into a receptor. Right? Therefore, the higher your sex hormone binding globbulin, the less of your total testosterone is actually doing anything. So, um I had a patient this afternoon who had um uh for his age, um mid low 60, early 60s, pretty high level of total testosterone, like over 700. Hm. But his sex hormone binding globbulin was also really high. So then what we have on our test is we have a test called free testosterone and bioavailable testosterone. And those are telling us what's the body actually able to tap into and that's a more accurate read. So that came back as low. His bioavailable testosterone was actually low even though his total was high. So you're not going to catch any of that. Gotcha. And what were his symptoms like? Was he tired? Was he Did he have difficulty? May like um like physically like super fit guy like super physically active but feeling despite that like he's losing muscle mass. Gotcha. Interesting. Okay, cool. Now, let's talk about kind of last segment here. Gut health. What's Yeah. How does like conventional medicine look at gut health or how does functional medicine look at gut health differently than you know conventional medicine? Yeah. Um so that's a kind of a big topic. Um so usually with I would say within kind of um uh primary care uh the if somebody's not feeling well, they're either constipated, they have bloating, um that kind of thing, they might be told to to go on Mirillax, right? To do like an over-the-counter laxative. Um, now if they're having, you know, if it's something more acute like acute diarrhea or something, they're they will do like a an appropriate workup for some kind of infection, right? So they'll do a stool test. They'll kind of make sure that it's but I'm talking about chronic gut stuff. Yeah. Um, and then so sometimes they'll say take a probiotic, take a laxative. Um maybe depending on the knowledge base of the provider, maybe some d, you know, referral to a nutritionist or some dietary recommendations. And then usually if that nothing's working then they're referred to gastronurologist. Okay. Um the extent usually from gastronurology is colonoscopy andor endoscopy and um I find those tests to be super valuable. I refer people to those all the time. Um what we do in functional medicine does not take the place of those screening tests or those those scopes basically but what we do is we will do a very comprehensive stool test and so that is looking at parasitic infections viral infections bacterial infections it's a very thorough H pylori test um actually the actual like readout of your microbiome in gut inflammatory markers if anybody's heard of leaky gut it has the leaky gut marker. So, it's just again it's you're it's information that you're not getting from a colonoscopy or endoscopy, but it does not take the place of those tests, those screening tests. So, that's just one that's just one type of comprehensive stool test, but it's the one that I order the most often, and it's just kind of outside the knowledge base, I guess, of most conventional providers, but really any functional medicine provider should be doing that. Okay, heard. Um, what about nutrients? Like you talked about micronutrients not even really being looked at on kind of normal screenings. Like can you give me some examples of like what optimal nutrient levels look like? Yeah. Yep. So also one kind of connection there is and maybe we would circle back to this but is um kind of the impact of if you're if you're having if there's issues with the gut and if there's malabsorption issues you are most likely you know you're not absorbing those micronutrients optimally. So you might have a fabulous diet. Yeah. You might be eating the, you know, on paper the right amount of protein and therefore getting the right amount of iron and the right amount of B12, but when we do the blood work, we and I'll go over the specifics like there. It's not optimal. And you're like, but I eat really well and I get the highest quality food and I'm even, you know, taking some oral supplements, but it's not showing up in your blood work because your gut is is not balanced, not supported. Um, yeah, sure. It's a good point. Yeah. How often do you find that happen? How often do you find it like patients are doing a lot of the right things, taking supplements, eating good foods, but their gut just isn't absorbing it? It's fairly It's fairly common. Um I don't I can't give you a percentage, but it's common enough that I probably have that conversation a couple times a week. Okay. And how do you start to I know we're trying to stay higher level with this, but I'm just curious like what do you start like what are the things you're starting to look at to like fix absorption in the gut? Well, I'd like to get I'd like to get that comprehensive stool test because it really gives me specifics on, you know, what is going on with the microbiome and maybe and not just is there malabsorption, but why is there malabsorption, right? So, what's the level of inflammation and um you know, are they tending to be more constipated, bloated, more on the loose stool, frequent like I kind of piece that all together. Yeah. Um, so circling back to the question about micronutrients. So vitamin D is another really good example of of normal versus optimal. Mhm. Um, vitamin D um is a fat soluble vitamin which means that it can accumulate in the tissue in the fat tissue in the body. So we do there is a there is a level of toxicity. Now, in conventional medicine, if your numbers are really anything over 40, you're say you're supplementing with vitamin D3 and your doctor high 30s, but above 40, they're going to probably tell you um you need to drop your dose or if anything, do not increase your dose. Mhm. Um in functional medicine we like to see we consider optimal so normal might be like 25 to 80 on like the lab's reference range. Mhm. But optim but that's normal but optimal is anywhere from like 60 to 80 or I even know some providers that like it 80 to 100. Okay. Why does that matter? What we see is that when we can maintain somebody's vitamin D levels within the optimal range, we're seeing improved calcium absorption. We always prescribe vitamin D3 with K2 so that the D so that the calcium which is absorbed goes to the bones um not to the arteries. Okay. We see optimal vitamin D levels in um improving somebody's immune strength. So better ability to fight colds and flu and to recover faster. We see mood regulation. We see people better muscular strength. There's a lot of vitamin D receptors on muscles. So if you have a lot of vitamin D, you're basically your muscles. Okay. What about other vitamins that you see have a big needle vitamin B12? Um that one again like the optimal the normal level lab might be 200 to um 700 but really optimal is probably close to like okay vitamin B12 is one of those ones that is well they if people have a history of alcoholism they probably if somebody is a vegan or maybe a not super healthy vegetarian, they're probably not. If you if somebody has been living with chronic stress, their nervous system is going to be basically taking up all of that B12 from their food and they're most likely suboptimal. Okay, gotcha. A lot of different things. Um, so you're going through my notes here. I mean, I would I we normally do, if you're new to this show, we normally do case study, right? But kind of all the patients fall into that range, right? Here's a question that I I get. I used to get when I was doing the patient coordinator role was what happens if nothing comes back? People would say like everything what it's funny that actually said that to us. They're like, "What? What happens if I go to you and do all this testing? Everything's normal again." Not even right. I have r I don't know if I've ever had 100% right. I've certainly normal. Um even if even if you're optimal or you're optimal, that's great bas. Yeah, it's a great baseline because it's entirely possible that five years, 10 years, you're not going to be feeling as good and and then if we test you again, we see that there's a change. We know what's been going on for five years. It hasn't been going on for 20. M um and I have had a lot of people come in or ask me about kind of what we do and interested in coming in not because they're feeling super symptomatic in any way. They just want to know more. They just want more information than what they're standard what they're getting want they want the numbers. They want to know. Mhm. So they come back that's peace of mind. Yeah, that's awesome. Let's um let's still try to do a patient case study. Why if you can think of someone who would otherwise be told they're normal like who really struggled with just doctors brushing them off. Yeah. That when reality one looked under a you know individual lens as this person, right? what what's what is their health potential that actually a big change day that make sense? So, um I really just um so this is a woman who is in her 40 and um she has she came in already with they've been diagnosed years ago with um I don't think it was I think she knew okay she had been on synthroidid and they you know maybe felt fine for a decade but really for almost 10 years really was still feeling super fatigued some joint pains and knew her body well enough to kind of know she just felt intuitively at least I'll put it that way that it was her diary she her doctor maybe she just test the TSC normal right whatever that means within normal so she's frustrated she comes to us we do the initial TSH.9 okay again optimal is optimal is 75 to two like some of my other patients who again had hypothyroidism for a while dealt with fluctuating numbers fluctuating levels of medication she knows pose or she in her recollection was that she actually feels when she close to pretty finely tuned, right? Yeah. But her providers for me were really unwilling to her last, right? So, she goes to restoration. We do the full thyroid now. I feel like she needs a higher dose. Um, I also feel like she needs not four, but based again on that her she's really not um and it's really breathe low is when you're going to you're going to be symptomatic. So you like to see. So um what I did with her is I actually took her off of switched her to the more natural combination the again. Um, and I have conversion so I could see what a conversion between like the thyroxine and the natural. And I so I did the conversion then I went um and saw her I think it was 10 eight weeks later. So I retested TSH was not it was it was not quite as long. I think it was she was feeling a lot better. She was like, I think I can picked it a little bit up a little bit more, right? And then the next time we did get that TSH closer to her and feeling now wasn't that complicated. That's awesome. The other thing that I think we find out because we do we include the antibodies is we did find out that it was information. Wow. What a life what a life-changing thing for someone, right? Because she that's the scary thing, right? I mean, that lady might have gone her whole life kind of just getting the same answers from doctors and kind of not feeling as good as she she truly could in life, which is um crazy thing with, you know, your health and Yeah. I mean, your health is I mean, yeah, health is like the way you feel every day, man. Man, this is more important 100%. And I think the other element of that story that she was feeling a little gas lit she knew she knew her disease long enough to kind of be able to recognize if not entirely. Yeah. And she knew what she she knows what she feels like when she feels good. She knows when she knows when she feels good. She knows when she doesn't feel good. She knows, you know, and yet the authorities, the experts kept telling her, "No, you're fine. Your labs are fine." Yeah. It's, you know, here's an anti-depressant. It's really not good. Yeah. I like like anything, you know, like I feel like like when I had a if I had ever had a coach and, you know, was in a sport, anything, a teacher, anything in life, the expert, like I never want to hear, "Nope, you're doing good enough." You know, like if I'm going for feedback, I want something to work on. I want I want something to do. You know what I mean? Like imagine going to a teacher and being like, "Hey, I'm I want to be smarter. I'm not good enough at math or whatever." Well, no, you're giving up. I mean, like like you're going to improve yourself. Yeah. There's nowhere in other than life than really like the conventional medical system where people go to get better and they're told that they're good enough. You know what I mean? Evidence of disease. Yeah. Like imagine like you wanted to I'm trying to make analogies here, but imagine like you go to a contractor, right? You want to renovate your house like, "Hey, like I want my house to look nicer. I want to make my kitchen look cool. You know, I want these granite countertops and newer cabinets." And contractor comes to your house. Well, no, your kitchen looks good enough. You should just It's It's all good. You just live with it. You know what I mean? Your fridge works. You're fine. What's the problem? Yeah. Exactly. So, it's like you're you know, food and so it's all good. So, it's just like a weird thing where you don't really see that in other places, but I think that's why patients love coming here because, you know, we can so many testimonials are just like, "Yeah, I feel good again." It's pretty exciting. So, um yeah, that's that's what we got for time today. We got started a little late because our cameras are going out now. So, that's good timing with the new system. We'll get it down. But, um yeah. Any um anything you want to communications with or listen to this or Yeah. Um, I mean, one thing that I said before, which I'll just say again, like I feel like we all deserve more information about our health and um, you know, you might be getting what you want from your current providers at your current at, you know, what you have right now, but there's this whole other world here where there's just more information. And, um, for most of us, it's worth looking into that. It's worth exploring. Even if you, you know, again, even if you feel fine, but you just want that baseline information, it's still worth it. Cool. Yeah. All right. What patients do they uh they should contact Medatrix? Yeah. How how do they contact? Uh can they they can call they can put something they can DM us. DM us. They can you can find us on Instagram. Yeah. Yeah. Yeah, that's it. Okay. Thank you. Great.