Why Your Lab Results Keep Changing:

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode.

Hello everyone, Dr. Stillman here for another episode of Integrative Medicine with Dr. Stillman. This podcast episode is a dedicated podcast episode where I cover my labs. I originally had intended to record this as a video, and I did record it and livestream it to my social media as a video. I encourage you to go watch it there because it's a lot easier to just see the numbers on the page. And in the middle of recording it, I realized it was going to make a poor podcast episode because I was just saying things like low and high. And if you're listening, it's really not that helpful for me to say low and high. On the other hand, it's very cumbersome and laborious for me to say the normal range for creatinine is 0.76 to 1.27, and mine was 0.99. So here's what I'm going to do for you all in the podcast episode. I am going to just give you the pertinent abnormalities and walk you through what I think of them. And hopefully it'll work as a narrative. I don't know how to do this otherwise. If you've got feedback, advice, or input, I'm happy to get it, but I wanted to try and make this work as an audio only for those of you who are busy driving to work, driving to exciting fun places where you're doing exciting fun things. So hopefully you enjoy the episode and thank you for listening. Let's jump in. Okay, so to give you some context, I run my labs multiple times a year.. And this year I ran them on December 18th, 2024, January 4th, 2025, and February 10th and February 21st, 2025. And then I had a, a smaller lab draw done in March. I did this for the purpose of educating you all on the pitfalls of lab testing and also some of the value of lab testing that I see my patients getting in the real world in my practice every single day. A big part of the value of coming to see a doctor like me who runs a lot of these tests and who takes the time to test basically the lab himself is that I know things that I don't hear other practitioners talking about. If they know about them, they don't talk about them. And a lot of it affects treatment decisions, and I want the public to know just how flawed our lab testing is. And I'm not blaming the lab. This is just the fact that human physiology varies from day to day and week to week and month to month, and there's really not that much we can do about it other than repeat labs and interpret them based on history. So let's jump into my lab abnormalities that most interesting this year. So the first of these I'm going to tackle is cholesterol. For those of you familiar with me and doctors like me, most of us don't think cholesterol causes heart disease. That's a long story. My favorite book on this is The Great Cholesterol Con. I believe that's by Ruve Ravinskov, but don't quote me on that. There's a ton of titles on this. Anyway, when I decided what am I going to interpret as my lab normal for cholesterol, I decided that I was going to look at one of my favorite markers or metrics, which is What's the average cholesterol level that optimizes for lowest risk of death? What does that look like? You take tons and tons and tons of studies and you say, the people who have the lowest risk of death, where does their cholesterol tend to cluster? And it tends to cluster around 223. So if you have a lower cholesterol than 223 in the United States, anyway, this is based on a lot of US data, or higher than 223, as you go further and further and further out, your risk of death goes up. Now I'm not saying carnivore and keto diets aren't safe because you will get cholesterols of like 300 and 400 there. It's way more complex than that. But if I'm looking for problems with cholesterol, I'm looking for people who are at the extreme. Their cholesterol is 300 or 400 and they're not on a keto diet. Their cholesterol is 120 or 140 and they're not on a keto diet, or they're not on a— they're not even eating meat maybe, because that's where we can find people who are not eating enough red meat or not absorbing their food or not getting enough cholesterol-rich foods, period. Or on the other hand, we can find people who are not able to handle the fats in their diet. Usually, if that's actually a problem, we also see an elevation in triglycerides. So what are my levels? My cholesterol is 221, that's total, and my triglycerides are 87. So this is right on the money as far as I'm concerned. My A1C is 5.3, that's excellent, it's in the— well in the normal range. I'm not going to go through Like I said, all of these markers, uh, I'm just going to talk about cholesterol first. So it was 221, and then on my next lab draw in early January, it was 216. My triglycerides were 99 after having been 87. And then my cholesterol on the third lab draw was 209, and my triglycerides were 116. So 3 lab draws, those are the 3 values, or 3 series of values. Why am I telling you about this? Because my cholesterol tends to vary very little. Some of you, it varies a lot. I've seen it vary by 20 or 30 points. Okay, next lab abnormality I want to talk about: cortisol. My first round of tests in the past, uh, 4 or 5, 6 months now actually, was a cholesterol of 4.5. Very low actually for a morning cortisol. I didn't do anything about it. I didn't have any symptoms of adrenal exhaustion or adrenal fatigue or hypocortisolism. I just kept living my life because I know how much this lab num— number varies. And the next time I did my labs, my cortisol was 11.7. The next time I did it, it was 14.8, and the next time I did it, it was 8.5. My point in measuring this 4 times in about 4 months is that some of you are gonna be diagnosed with low cortisol or high cortisol or whatever. This number varies a ton. So take it with a very large grain of salt. When I see a low cortisol or a high cortisol, I'm apt to repeat it after I've corroborated it or correlated it with the patient's symptoms. We don't treat numbers, we treat patients. So I just take this with a big grain of salt. Okay. Another number that people often ask about is TSH. My TSH varied in these lab draws from 3.49 on the first to, um, where is it? 2.45 on the second to 1.8 on the third. And this is why I don't actually run TSHs at all. Another lab that varied significantly in my labs the last 6 months is my cardiac C-reactive protein. So it was 0.40 on the test, and then it was 0.19, and on the third test it was 1.46. What does that mean? Cardiac CRP is divided into low, average, and high-risk categories based on the number. Low risk is low risk of, of heart disease or heart attack. Average risk is average, and high risk is high. I went from the low risk in my first two lab draws to the average risk category. What happened? I didn't change my diet. I didn't change my lifestyle. What I did was I flew to San Antonio and visited a friend for 3 or 4 or 5 days and had some wine over the weekend. And between the two flights and the wine and the rich food that I ate over the weekend, I wound up putting my cardiac C-reactive protein into the average range. I see a lot of flight attendants, pilots, traveling salespeople, sales and medical— we have a lot of pharmaceutical and medical device reps in the practice because they want a doctor who doesn't just they know how, how the medical system is, and they want an independent practitioner to take care of them and their families. I often have hard conversations with them about the fact that their traveling is putting them at a higher risk of all kinds of illness. And this is, you know, very anecdotally my experience, but it's very consistent, and it is supported in the literature quite robustly. Anyway, I didn't worry about this. I went back to my normal day-to-day life, and my cardiac C-reactive protein was, 11 days later, 0.32. And I want to make make a point here. If you do have a lab abnormality, you don't need to freak out about it. You should talk to a competent clinician about it and figure out what it means. And then you should come up with a plan of care from there. All right. With the elevation of my cardiac CRP, I also saw an increased L— elevation in my homocysteine. So my homocysteine was 8.6, and then it was 12.8 when I went to San Antonio or came back from San Antonio, and then it was 9.4. So I like homocysteine to be below 9, but I'd like it to be a little bit lower than it was for me, but it was 8.6 on the first test. And I'm very concerned when it gets anywhere up over, you know, 10, 11, 12, 13. The reason why is that as you get higher and higher homocysteine levels, your risk of death goes up. And I care very much about preventing death. It's kind of my job as a physician. So I really want people to have a homocysteine that's on the lower end. If you look at the literature, it suggests that a homocysteine below 6 is ideal. I don't see my patients getting there and still performing performing at a high level, I think that requires you to eat a low protein diet. And I just don't see my people feeling well, performing well on a low protein diet. So I don't recommend it. So most of my people wind up somewhere in the 6 to 10 range, and I'm okay with that so long as their other markers look good. My fibrinogen activity, I'll mention as well, went up with that plane flight. So fibrinogen is a marker of platelet aggregation, which basically means blood clotting. It's another excellent marker for your risk of things like heart disease and stroke. My fibrinogen activity was 202 on the second lab draw of the year. I omitted it in the first because I changed the panel slightly, and then it was 292 when I came back from San Antonio, and then it was 207 after 11 days home and back to my normal daily routine. So again, just like the homocysteine, just like the cardiac CRP, this returned to normal with my daily routine, which is why I'm so adamant about My Daily Routine. We really do get people dialed in with the approach we use at the practice, and I know this because it works for my own labs as I'm telling you now. Another lab I'd really like to talk about wasn't abnormal in my data. It was the free T3. So I see a lot of patients getting wrapped around the axle because of their thyroid hormone, and you know, their thyroid hormone's normal, but they feel like they've got low thyroid symptoms. I've tested a lot of different thyroid hormone markers, and the one I keep coming back to is the most helpful is free T3. This may vary based on the lab you're using. You may have a better lab, uh, than we do for certain other markers. Whatever your lab is and however good it is, this is how I use free T3. So my free T3 was 3.2 on the first lab draw of the year, then it was 3.6, then it was 3.8, then it was 3.3. Okay. So huge spread there. And why is this so important? Well, if you're replacing your thyroid hormone based on a number that varies as much as TSH or free T3, you are perhaps going to underdose yourself or even overdose yourself. And so I like to take a history very carefully to understand where somebody is in relation to their symptoms of low or high thyroid function, and then talk to them about the free T3 and have a shared decision with them about what's best for them based on their goals of care. And I want to share a story with you about this that really changed my thinking on it. So a young woman not a member of the practice, actually, just someone I know personally, had a free T3 level done, and I walked by it and said, that looks kind of low. This woman was struggling to conceive. She'd been struggling for years. She'd finally managed to have a child with IVF, and she'd had to have some surgeries in order to prepare for that. And so I said, look, that's low. I referred her to a friend, and this friend of mine replaced her thyroid hormone with a thyroid glandular., and she was pregnant, I think, 2 months later. And she said to me, I'm sure the thyroid hormone did the job because right after that my cycles normalized and I felt much better. So it just really grieves me that people are out there spending insane amounts of money on things like IVF when something as simple as the right dose of thyroid hormone could be all they need to unlock their hopes and dreams. Really very sobering for me as a physician to see something like that happen. When this person has, I believe, very good competent physicians. I don't think they're adequately educated on the power of thyroid hormone. And I say that as somebody who really came to using thyroid hormone more aggressively as I saw it helping more and more of my patients. So, you know, I've certainly been there, but I believe people need to do better with thyroid hormone replacement in their patients. Anyway, this number varies about 20% or more from 3.2 to 3.8 in me. And I've seen patients all over the map. So, you really have to pay attention to your symptoms, and if the number doesn't agree with your symptoms, it's very reasonable to retest or even to treat, assuming that the number you're looking at isn't actually a good reflection of your thyroid hormone function. I started practicing that way and my patients have been very pleased with the results. I will mention it, I think it's everyone's responsibility to focus on supporting thyroid hormone function. You need basic nutrition in order to do that. You need a basic daily life routine that's healthy and supports things like healthy circadian rhythms. When that doesn't get the job done, we start to look at thyroid hormone replacement for patients. And in some cases, that's because there's only so much they're willing to do to change their diet and lifestyle, which is a long story maybe for another day. Okay, so that's my free T3. Another lab I wanted to talk about was my testosterone. So testosterone gets a lot of attention. Truly, low T is an epidemic in our country now, and unfortunately, because of the effects of estrogen-mimicking compounds, because of sedentary, sedentary lifestyles, because of modern technology and the culture and all these other problems that we face today, have seen my testosterone vary enormously in prior year lab draws, and this year was no exception. But it started out looking like I'd almost doubled my testosterone from the year before because my first total testosterone was 711. My free T, which I— it varies a lot more and I put less stock in it, was about 12.3. And that's in nanograms per deciliter for total, and that's in picograms per milliliter for free. The Europeans have different units of measurement. I won't get into that here. I do provide more detail, by the way, in the video version of this, but it was just too hard to go through it all in an audio podcast because the numbers just didn't feel right. So I'm doing an abbreviated version here for you on the podcast with really the highlights. Okay. My second lab draw, total testosterone 758, free T was 10.7. And in the third lab draw— and at this point I thought, oh my gosh, I've cracked the code. My diet, my lifestyle, my nutritional supplementation protocols are boosting my testosterone by 200 or 300 points. Came to find out next lab draw, my testosterone total was 468, free 7.6. Why am I telling you this? I have been shocked at the variability in testosterone in my patients. One day it's 200, the next day it's 500, the next day it's 150. And I say this because if a man comes in and has symptoms of low T, I worry less about what his number is and more about how do we get him well. And I'm going to wrap up my tests and then I'm going to tell you a quick story that I think is really powerful about this. My last lab draw testosterone of the year, my total testosterone was 552. My free was 8.9. So tons of variability in there. In the practice, a couple months ago, a gentleman came to us. He'd been unfortunately harmed by a medication. He had a serious, serious depression come on after administration of this thing, which shall remain nameless for various reasons that I'm sure you can deduce if you know me and follow my work. What ended up happening was he went to the psychiatrist. He ended up hospitalized in inpatient psych wards, which are about the most difficult and depressing places on planet Earth. I know because I've rotated through them as a medical student, and then I've worked on them as a physician. And he ended up going in for electroconvulsive shock therapy for his depression. He went through every medication in the book. This poor guy suffered for years, finally came to see us in Naples, Florida, and his testosterone was low, his thyroid hormone was low, his cortisol was low, and his DHEA was low. And we replaced all of them. And in a month and a half, he says, Dr. Stillman, I'm 110% better. So that's the power of hormones. Nobody looked at his hormones. Nobody thought that maybe this guy had a massive hormonal abnormality in his labs. They just kept treating him like someone with a neurotransmitter imbalance. And this is why people bother to fly to see us, because we'll get people 110% better who went to see all their doctors locally for 2 or 3 years and nobody could figure it out. Very sad to me that this guy went through what he went through when it was as simple as checking some labs, doing some basic thinking about how this might affect his physical and mental state, and then starting these things with a simple prescription to the pharmacy for each of those hormones. Well, I hope this was helpful. I hope, hope it was informative. This is a real window into my practice and what I do with patients in the real world when we go over their lab testing. And I hope these stories were insightful. And help you understand the power of really working with doctors who care about you, who will really spend the time with you interpreting your labs, not just in the context of numbers, but in the context of you as a person. Thank you for listening. Thank you for subscribing to the podcast. Take care and have a great day.