Author: Dr. Bonnie Brock, NMD, RD, MPH
As a physician in alternative medicine, I am often working as a member of a collaborative team of practitioners on the health and wellness of patients. Sometimes I am the lead or primary care physician, but more often as a naturopathic medical doctor, my services are sought after a patient has been to several other doctors for problem symptoms or ailments with no resolution. I commonly hear some version of the phrase from patients “my doctor says my bloodwork is normal, but I still feel lousy!”. When I inquire with a patient as to the extent of the bloodwork run, I often find it lacking. This limited running or analysis of labs is often the result of health insurance limitations, the specialization of medicine, meaning only a specialist runs extensive labs, or just plain practitioner short-sightedness. I have a long history of analyzing labs, starting in my days in the early 90s reading through paper charts as a hospital Registered Dietitian, and continued as a Naturopath in private “cash” practice, functioning outside the bounds of health insurance limitations. With all that time and experience, I feel as if I have become a bloodwork “sleuth” of sorts, knowing what to look at in each circumstance and always thinking “outside the box”. I’d like to share some things that I have learned over the years that may help you at your next doctor’s visit.
Thyroid – The symptoms of thyroid dysfunction are vast and varied and can be mistaken for normal aging, depression, menopause and obesity. It isn’t that thyroid “looks like” these other conditions as much as thyroid dysfunction can cause these other conditions. So many people are being treated for obesity, depression, anxiety, sexual dysfunction and fatigue that is actually a symptom of an under or over-active thyroid. Once thyroid dysfunction is rooted out and treated, many of these other issues will remedy. When looking at the thyroid, it is important to run a thorough panel, that includes TSH, free T3, free T4, total T4, total T3 and thyroid antibodies. Thyroid antibodies like thyroid peroxidase antibody (TPOAb), thyroid-stimulating immunoglobulin (TSI) and thyroglobulin antibody (TgAb) can help diagnose the auto-immune thyroid conditions of Hashimoto’s or Graves’s disease. Auto-immune thyroid disease is one of the fastest growing types of auto-immunity and is often missed until symptoms are severe and permanent damage has been done.
Menopause – As the old phrase goes, I wish I had a nickel for every woman that I see who is suffering from the symptoms of menopause and told that it is just “normal aging” and to learn to tolerate it. While it is true that menopause is a natural condition and shouldn’t be looked at as a disease state, but for some women, the symptoms can be unbearable. Hot flashes, night sweats, vaginal dryness, low libido, abdominal weight gain and lack of motivation can be eased or even avoided if caught early with lab work in perimenopause. Ask a menopause-informed practitioner to start looking at FSH, LH, estradiol, testosterone, progesterone and estrone in your late 40s to get a sense of what levels are normal for you and when things start to change.
Men’s Health – I am continually surprised by how many men reach their 50s and do not know their hormone levels, and specifically testosterone. Testosterone is the primary sex hormone in men and plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting increased muscle and bone mass, the growth of body and scalp hair and sex drive. Testosterone levels decrease by 1-3% per year starting at age 30, and this can be felt as low libido, brain fog, early muscle fatigue, general body fatigue and depressed mood as early as 40 years old. I recommend every male measure their testosterone levels starting at age 40 in order to manage decline and the associated symptoms. In addition to testosterone, men should look at prostate health with a PSA measurement, vitamin D levels, zinc and magnesium I the RBC, estradiol and inflammatory markers like CRP and ferritin.
Lipids – A lipid panel measures the amount of circulating “fat” in your blood and can be an indication of risk or cardiovascular disease and overall heart health. A “standard” lipid panel contains measurements of total cholesterol, HDL or “good” cholesterol, LDL or “bad” cholesterol and triglycerides. While these are important numbers to know, there are so many other cardiac lab measures that can help identify risk early and more thoroughly. In fact, nearly 50% of all heart attacks and strokes occur in patients with ‘normal’ cholesterol levels. Recent evidence goes beyond lipids to suggest that inflammation within the artery wall is the primary contributor to this residual risk for heart attack and stroke. Inflammation contributes to both vulnerable plaque formation and to plaque rupture. Asking your doctor to measure particle size and inflammatory markers, including oxidized LDL, myeloperoxidase, hsCRP, Apolipoprotein B (ApoB) and A1 (ApoA1), lipoprotein (a) and perform a coronary calcium study can make the difference from preventing and experiencing a coronary event.
