Dr. Aaron Hartman explains why normal lab ranges miss early disease. Your fasting glucose might be 'normal' at 105 but optimal below 90. He walks through functional thresholds for cholesterol, liver enzymes, thyroid, and white blood cells that catch problems before they show up in standard tests.
Questions this episode answers
83 ("for every five points your glucose goes over 83, you have a 6% increased chance of developing diabetes.")
Prediabetes: 100–125 mg/dL; Diabetes: three fasting sugars over 126 mg/dL.
Less than 20 (optimal for liver enzyme level).
Optimal WBC: ~4–7 x10^9/L; values around 8–9.9 are noted as markers of inflammation and increased heart disease risk.
Around 150–250 x10^9/L (speaker said "play the plate level like... 150-250ish").
Chapters
A lot of times your doctors say your sugar is normal, but what's optimal? For every five points your glucose goes over 83, you have a 6% increased chance of developing diabetes. Think about that for a second. So what does that mean? That means an 89 or 90 fasting glucose actually is not optimal. Is it normal? Sure, it's not optimal. What are your regular lab tests that your doctor's doing? What are they not showing you? What are they not telling you? I'm gonna take a little bit of a different view on this than what most people probably expecting. This is one of the weekly mini podcasts we're doing towards end of the week, putting out there in response many to people asking us questions through social media, newsletter, etc. So if you have a question you'd like us to answer or put into this list, you know, drop it on our social media, wherever you follow us, and we'll hopefully be able to get to it. So what are you missing with your conventional labs? What I want you to think about is a concept of functional lab values. What is that? It's the idea that all the labs you're doing with your regular doct have a lot of hidden gems in them that are being overlooked. So what do I mean by that? Let's start with a couple basic things. You know, a glucose level, there's a normal level, normal range for sugar, you know, whatever it is, like 50 or 60, up to, you know, 129 or whatever. And so a lot of times your doctors say your sugar is normal. But what's optimal? If your glucose, for every five points your glucose goes over 83, you have a 6% increased chance developing diabetes. Think about that for a second. So what does that mean? That means an 89 or 90 fasting glucose actually is not optimal. Is it normal? Sure, it's not optimal. It means a 96 is not optimal. You know, we, we do know that, you know, sugars between 100 and 125 are considered, you know, pre diabetes or insulin resistant. And if you have three fasting sugars over 126, that's considered diabetic. How many times do you get a 102, 105, and it's just of ignored because it's considered normal. Something else to think about with labs is the idea of normalcy. Typically, lab ranges are based on two standard deviations of the mean, meaning the average typical person, 95% of the population falls in that range. Well, today's normal quote, unquote, people are sick. We're Diabetic, we're obese, we're inflamed, we have high blood pressure, we have metabolic syndrome, we have toxicity issues, we have all immune problems. So that concept of a normal range, super helpful anymore. So let's go through a couple other labs like that. When you're looking at a comprehensive metabolic panel, you might see your liver enzyme levels and have a normal range, but actually optimal for your liver is actually a level less than 20. So if you have a liver enzyme of 32, it's normal, but your liver is actually a little inflamed. One test they actually used to routinely include in lab panels was a ggt, a gamma glutamyltransferase. It started to become so commonly elevated in a standard lab panel. It actually was removed. My father in law actually told me about that when he was younger. It was a standard insurance lab panel and they stopped doing it when it was elevated on everybody. Super easy lab to do. But that's an example of how as time's gone on, we've kind of ignored quote unquote, the normal, normal levels. White blood cell counts, another great example of a functional versus normal range. Normal is less than 9.8, 9.9. But if your hemoglobin, if your white blood cell count is actually eight, that is a marker for inflammation and increased risk for heart disease. So what's an optimal white blood cell count? It's probably less than 7, greater than 4, that 4 to 7. But if it's like 8, 8.5, 9, you actually are inflamed. You can also look at your basic metabolic, sorry, comprehensive panel, look at your platelet levels. If your platelet levels are 250 to 300, though normal platelets can be marked, are called an acute phase reactant of inflammation. So now you can look at your platelets and know if you're a little inflamed. If they get less than 120, 150, that can be a marker for bone marrow, liver issues, spleen issues. That can be related to a thing called thrombocytopenia, which can have a whole lot of, lot of issues you'll see in patients with liver issues as well. So you really probably want to play the plate level like 1,150-250ish, plus or plus or minus. You can look at the sum of your monocytes, eosinophils and basophils on your, on your blood pain, on your blood count. Right. If you add those up and it's greater than seven, your gut's inflamed Rarely ever, when I add those percentages together. Ever see anybody who has a normal MEB monocyte, eosinophil, basophil level?
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Foreign let's hop over to other labs that were done. Cholesterol Panel this is where it gets interesting because people focus on the total cholesterol of 200 and 210. Did you know? Well, here's a question. What is the optimal cholesterol number for all cause mortality, meaning deaths for dying for any reason? What's the optimal number? There's a thing called a J curve. And what it is if your number gets too low, you have an increased risk of dying. If it gets too high, you have an increased risk for dying. That little meniscus, the little valley, is where you want to be. The edges, the cuffs of that for cholesterol 200 to 240. So if you want to live as long as possible, the numbers are too high increased risk for heart attack, strokes too low increased risk for cancers, low testosterone. These are real risks. Optimal for total cholesterol. Optimal for total cholesterol is between 2 and 240. So what's under the hood? What's your LDL number? LDL again, not super helpful. But what is your non HDL cholesterol? Typically you want that to be less than 160. Even more so less than one hundred and thirty. That's your total cholesterol minus your HDL. That's a surrogate marker for a lab called apolipoprotein B, which usually isn't done. Should be done on anybody. Super helpful for looking at heart disease. Again, these are all things found in the basic lab panel. What's your HDL to triglyceride ratio? So that's another super important level for people with metabolic syndrome. Let's say your triglycerides are 150, which is barely normal. And let's say Your HDL is 40, which is low normal. That ratio between those is greater than three and that's associated with metabolic disease. You want that to be over four is a big jump. You want to be less than 3. Closer to 2 to 1 to 1 to 1. So for me personally, my HDL runs about 70 and my LDL is about 110 to 120. So I'm like in the good range. But just looking at those ratios can be super helpful. What's your risk for heart disease? Other labs, thyroid TSH normal TSH is 0.5 to 4.5 to 5. Optimal is 1 to 2. So if your TSH comes back at 3 to 4, 4 and a half, you might have a thing called subclinical hypothyroidism. So you have to now start looking at your free T4 and free T3s. If you see they're in the lower first quartile and if you see your reverse T3 is a little low, less than 15, maybe 10 or 11, that's you telling, that's your cells telling you you actually need more thyroid. And supporting your thyroid can be super important. So what's the point of this little miniature course, so to speak, on fun functional lab evaluation. These are all normal labs that you get on a routine physical. But if you understand more than just the normals, the optimals and what they mean, you can use regular labs to get some really good information that's actionable, that can change your health trajectory. So hopefully this was helpful. If this was, you can like subscribe, follow. I was going to make a recommendation, which I'm going to go ahead and make that recommendation. Something I'm doing more these days is using information like this and plugging into an AI tool. You could take this, record this, you know, take the, the put an AI tool and actually create your own miniature functional lab assessment tool. These are things we do in our community that we do with patients in our office. It's a little trick you can do out there to help you and use this information in that fashion to actually help empower you and uplevel your health. So anyway, I hope that was a helpful little biohack. Take care and we'll talk to everybody soon.
