Blood tests/naturopathic medicine, Lab testing/Common blood values

Naturopathic Interpretation of Common Blood Tests

by Dr. Douglas Lobay, BSc, ND

Naturopathic interpretation of blood tests provides nutritional and biochemical insight into each person’s unique biological chemistry. This interpretation does not necessarily focus on pathology per se, but provides attention to variances of the norms and what this means. I have found that the common blood tests provide an incredible amount of nutritional and biochemical information about each individual patient. From an allopathic perspective you are considered healthy if nothing shows out of range on a blood test. By attending many different seminars and conferences, networking with other doctors, both naturopathic and allopathic, I have developed a systematic approach to evaluating basic medical blood tests from a naturopathic perspective.

I remember listening to the esteemed nutritionally oriented physician Dr. Alan Gaby talking about lab testing. He said something to the effect that he likes to do basic common blood tests on a patient. It provides him with a wealth of nutritional information about the patient upon which he would, in part, form his clinical assessment and treatment plan. I also remember a valuable lesson many years ago when I performed a 24-hour urine adrenal hormone assessment on a patient. I received a complicated diagram of the biochemical pathway of urine steroids that were evaluated. The patient asked about an obscure adrenal steroid that was low. I looked at the same diagram, scratched my head a bit, and said it probably means your adrenals are taxed and you need adrenal support. The complicated test did not change my assessment or treatment plan. Keep it simple, observe slowly and read between the lines. See if you gain nutritional and biochemical insight in common blood tests. There is more there than meets the eye at first glance.

HGB or HEMOGLOBIN. Hemoglobin is the oxygen-carrying molecule in red blood cells. It consists of iron and a protein called heme. In every red blood cell there are approximately 270 million hemoglobin molecules, each capable of carrying four oxygen molecules. Reference values are 120-160 grams hemoglobin per liter for women and 140 to 180 grams hemoglobin per liter for men. Low levels of hemoglobin indicate low oxygen carrying capacity of blood. Symptoms of low hemoglobin include fatigue and lethargy. Iron, B12, folic acid, and protein deficiencies, poor absorption, and blood loss are frequent causes of low hemoglobin. High levels of hemoglobin can be caused by iron overload disease, and high-altitude conditioning.

RBC or RED BLOOD CELL COUNT is the number of red blood cells per volume of blood. References values are 3.8 to 5.2 trillion cells per liter of blood for women and 4.5 to 6.0 trillion cells per liter of blood for men. Low values of RBCs can be caused by anemia, acute or chronic blood loss, and chronic disease. Symptoms of low red blood cell count include fatigue, weakness, and lethargy. High values of RBCs can be caused by iron overload disease, hemochromatosis, and high-altitude conditioning.

HCT or HEMATOCRIT is the percentage of red blood cells in total blood volume. After blood is spun down in a centrifuge, the height of the column of red blood cells is measured and compared to the column of original whole blood. Reference values frequently quoted are 37 to 47% for females and 40 to 54% for males. Low values of HCT can be caused by anemia, acute and chronic blood loss, and chronic disease. High values of HCT can be caused by iron overload disease, hemochromatosis and high-altitude conditioning.

MCV or MEAN CORPUSCULAR VOLUME measures the average size or volume of a red blood cell. Reference values for MCV are 80 to 100 femtoliters or cubic micrometers. A MCV value of 95 or high indicates a larger than average red blood cell. An increased MCV can indicate vitamin B12, folic acid, and vitamin B6 deficiencies. A MCV value of 85 or lower indicates a smaller than average red blood cell. A decreased MCV can occur with iron deficiency, anemia, chronic disease, lead poisoning and elevated red blood cell counts.

MCH of MEAN CORPUSCULAR HEMOGLOBIN indicates the weight of hemoglobin in the average red blood cell. Reference values are 27 to 31 picograms. The MCH depends on the amount of hemoglobin in red blood cells and the size of red blood cells. The same factors that affect hemoglobin and red blood cell count affect the mean corpuscular hemoglobin.

MCHC or MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION estimates the average concentration of hemoglobin in the average red blood cell. MCHC depends on the relationship of the amount of hemoglobin to the volume of the red blood cell. Thus, MCHC does not depend on cell size alone. MCHC can be decreased in iron deficiency, anemia, and chronic disease. MCHC can be increased in heavy smokers, autoimmune disease, and people with high blood fats.

RDW or RED CELL DIAMETER AND WIDTH measures the amount of variation in the red cell diameter or width. Reference values are less than 15.6%. There should be less than 15.6% variation in the diameter or width of all red blood cells. Variation in RDW can be caused by vitamin B12, folic acid, and iron deficiencies, illness, and certain types of cancer.

PLT or PLATELETS measure the number of platelets per volume of blood. Reference values are 150 to 450 billion platelets per liter of blood. Platelets are involved in bleeding and blood coagulation. Low platelet values are associated with an increased tendency to bruise and bleed. Causes of low platelet values are disease, anemia, infection, enlarged spleen or lymph nodes, bone marrow abnormalities or various toxins. Elevated platelet values can be caused by certain malignancies, acute blood loss, autoimmune disease, and acute infection.

WBC or WHITE BLOOD CELL COUNT measures the number of white blood cells in the blood. White blood cells are the main part of the immune system that protects the body from invading micro-organisms and foreign toxins. The normal reference value for total white blood cell count is 4.0 to 11.0 billion cells per liter of blood. A low or decreased value less than 4.5 may suggest low immune system status. A high or elevated value may suggest acute infection, cancer, or inflammation. Some nutritionally oriented doctors suggest that a WBC count of 8.0 or greater is consistent with generalized inflammation or sub-acute infection in the body.

NEUT or NEUTROPHILS are the foot soldiers of the immune system. They are the first line of defense that most microrganisms and toxins encounter in the blood stream. They are also the most abundant type of white blood cell. The normal reference value for neutrophils is 1.8 to 7.5 billion cells per liter of blood. They normally account for 50 to 70% of all white blood cells. Bacterial infection and acute inflammation are the most common causes of elevated neutrophil count Low neutrophil count can indicate low immune system status and may follow after an acute infection. An elevated neutrophil count may indicate acute infection (especially bacteria), inflammation, or in rare cases, certain types of cancer.

LYMPH or LYMPHOCYTES are the second most abundant type of white blood cell in the immune system. Lymphocytes have several different and important functions in overall immune stature. Certain lymphocytes called T-lymphocytes, or thymus-developed lymphocytes, are associated with the lymphatic system. Other lymphocytes called B-lymphocytes produce many different proteins or antibodies to infectious micro-organisms and toxic chemicals. The normal reference value for lymphocytes is 1.0 to 4.5 billion cells per liter of blood. They normally account for 20 to 40% of all white blood cells. Low lymphocyte count can indicate low immune stature. Elevated lymphocyte count usually occurs with viral infection or in rare cases in certain types of cancer. Some nutritionally oriented doctors consider a lymphocyte value of 1.5 or less as indicative of low functioning immune system.

MONO or MONOCYTES are the third most abundant type of white blood cell in the immune system. Monocytes usually show up later in cases of infection or inflammation. They perform “mop up” duty and help clean up after the acute battle is finished. The normal reference value for monocytes is 0.0 to 1.1 billion cells per liter of blood. They normally account for O to 7% of all white blood cells. Low monocyte value can indicate low immune system status. Elevated monocyte value can indicate chronic infection including parasites, autoimmune disease, or certain types of cancers.

EOS or EOSINOPHILS are white blood cells that are associated with parasitic infection and allergies. The normal reference value for eosinophils is 0.0 to 0.7 billion cells per liter of blood. They normally account for 0 to 5% of all white blood cells. An elevated eosinophil count can indicate parasitic infection or the presence of allergic reactions.

BAS or BASOPHILS play a background role in the immune system. The normal reference value for basophils is 0.0 to 0.3 billion cells per liter of blood. They normally account for 0 to 1% of all white blood cells. Elevated basophil count can indicate acute disease, including certain types of cancer.

SODIUM is the most abundant extracellular electrolyte in blood. Only small amounts occur inside cells. Sodium regulates electrolyte balance, pH, body and blood fluid volume and nerve conduction. The body requires 1000 to 3500 milligrams of sodium per day. The normal reference value for sodium is 133 to 146 millimoles per liter. Low sodium levels can indicate low dietary intake of salt, sodium loss through the kidneys or as a side effect of certain prescription medicines or inherited genetic disorders. High sodium levels indicate can indicate excessive dietary intake of salt, high blood pressure, edema or swelling, and heart disease.

POTASSIUM is the major intracellular electrolyte in the body. The body requires 1875 to 5625 milligrams of potassium per day. Potassium plays a major role in regulating fluid and blood pH, acid-base balance, water retention, muscle activity, and nerve conduction. A deficiency of potassium can cause muscle weakness, muscle cramps, fatigue, and heartbeat disturbance. Excess potassium can cause heartbeat disturbance, paralysis, and death. The normal reference value for potassium is 3.5 to 5.0 millimoles per liter.

CHLORIDE is the major negative electrolyte in the blood and tissue. It functions in combination with sodium. Chloride serves as a buffer in pH regulation and an enzyme activator. It is also a component of hydrochloric acid in the stomach. Most chloride is present in fluid outside cells and less than 15% is found within cells. The normal reference value for chloride is 96 to 107 millimoles per liter. Low chloride values can occur low salt intake, dehydration, or profuse sweating. High-chloride levels are associated with excessive salt intake, high blood pressure, or edema.

TOTAL C02 measures total carbon dioxide value in your blood. Carbon dioxide values depend on the amount produced in the body, acid-base balance, and the breathing capacity in the lungs. C02 is produced during the normal metabolism of carbohydrates in the body. It is buffered in the blood to help eliminate acids. C02 is eliminated through normal respiration through the lungs. The normal reference value for total C02 is 23 to 32 millimoles per liter. A low C02 value can indicate alkaline body pH or hyper-ventilation through the lungs. A high C02 value can indicate an acid body pH or ventilation through the lungs.

CREATININE is a waste material that is produced by metabolic activity in muscles. It is produced at a fairly constant rate and is filtered by the kidneys. It measures how well the kidneys are filtering. The normal reference value for creatinine is 40 to 115 micromoles per liter. A low creatinine value can indicate low muscle turnover or very good kidney filtration. A high creatinine value can indicate high muscle turnover or poor kidney filtration and function. Generally, the higher the creatinine value, the weaker the kidneys.

GLUCOSE refers to blood sugar levels. Blood sugar levels are affected by dietary intake, insulin production in the pancreas, liver metabolism of glucose, and certain hormones. Blood sugar dysregulation can be caused by excessive sugar and consumption of carbohydrates, poor pancreas and liver function, and hormone dysfunction. The normal reference value for fasting blood glucose is 3.3 to 6.0 millimoles per lite. Low blood glucose levels are associated with hypoglycemia. High blood glucose levels are associated with pre-diabetes end diabetes. Three classic signs of diabetes include increased frequency of urination, increased thirst with increased fluid intake, and increased food intake with increased food consumption. Nutritionally oriented doctors consider blood sugar to be tightly regulated and consider 4.2 to 6.0 millimoles per liter as well regulated, normal blood glucose values.

CALCIUM refers to blood levels of calcium. 99% of body stores of calcium is in bones and teeth. Calcium is necessary for electrolyte transport across membranes. Calcium is also required for muscle contraction, blood clotting, and heart contraction. The normal reference value for calcium is 2.10 to 2.60 millimoles per liter. Low levels of calcium can be caused by low dietary intake, hypoparathyroidism, and poor absorption. Long-term dietary deficiency is one of the main causes of bone thinning and osteoporosis. Deficiency is also associated with muscle excitability and cramps. High levels of calcium can be caused by excess digestive disturbances, kidney disease, and certain bone diseases and cancer.

PHOSPHORUS refers to blood levels of phosphorus. About 80% of phosphorus is in bones and teeth. Phosphorus is a component of every cell and of highly important substances such as nucleic acids found in DNA and ATP, the high energy molecule and is a vital component of cell walls. The normal reference value for phosphorus is 0.80 to 1.45 millimoles per liter. Low levels of phosphorus are associated with low protein and essential fatty acid intake. High levels can be caused by excess intake or kidney disease.

UREA is a normal breakdown product of protein that is produced in the body. It is filtered by the kidneys and reflects kidney function. The normal reference value for urea is 2.5 to 8.0 millimoles per liter. A low urea value can indicate low protein turnover. A high urea value can indicate poor kidney function. Other causes of high urea value include excess protein breakdown, shock, dehydration, bladder or prostate obstruction.

URATE also known as uric acid is a protein breakdown product normally produced in the body. The normal reference value for urate is 150 to 400 micromoles per liter for females and 200 to 450 micromoles per liter for males. Low levels or urate are associated with low protein intake and turnover. High urate levels are associated with blood over-acidity and gout. Increased production of urate in the body or an inability to excrete urate through the kidneys may be responsible for elevated levels in the blood. Nutritionally oriented doctors also consider high urate levels associated with oxidation of DNA in the cell nucleus and an indicator of systemic candida yeast in the body.

TOTAL PROTEIN refers to total protein content in the blood. Total protein is made up of the amount of albumin and globulin. The normal reference value for total protein is 64 to 84 grams per liter. Low protein levels can be caused by low dietary poor absorption or systemic loss of protein through the kidneys, digestive system or skin. High levels of protein are rarely caused by excessive intake. High levels are more often caused by inflammatory conditions in the body, dehydration, or certain types of cancer.

ALBUMIN is the most common protein subtype in the blood. Albumin is responsible for maintaining fluid pressure in the blood and as a transport vehicle for drugs, hormones, and a few other substances. The normal reference value for albumin is 35 to 50 grams per liter. Low levels can be associated with low dietary intake, poor absorption, or loss of albumin. High levels of albumin can be associated with certain inflammatory conditions, dehydration, or certain types of cancer.

GLOBULIN is considered to be the remaining non-albumin fraction of total protein. Globulin is made up of several subtypes including alpha, beta, and gamma globulin. Globulin plays an integral part of the immune system. Immunoglobulins refer to antibodies utilized by the immune system to attack and recognize micro-organisms and foreign chemicals. The normal reference value for globulin is 24 to 37 grams per liter. Low levels of globulin can be caused by low dietary protein intake, protein loss, and chronic illness. High levels of globulin rarely occur with high dietary protein intake. High levels can be caused by inflammatory conditions, certain cancers, and chronic disease.

A/G RATIO or the ALBUMIN TO GLOBULIN RATIO refers to the ratio of the protein subtypes albumin to globulin. Albumin and globulin are normally distributed in a specific ratio, where there is more albumin than globulin. The normal reference value for albumin to globulin ratio is greater than 0.9. Irregularities in the A/G ratio reflect abnormalities in the amount or distribution of albumin or globulin.

BILIRUBIN, TOTAL is a breakdown product of the hemoglobin in old red blood cells. Bilirubin is produced in the lymphatic system and liver. The normal reference value for total bilirubin is less than 20 micromoles per liter. Some nutritionally oriented doctors suggest that bilirubin levels reflect liver drainage as does creatinine in the kidneys. Low levels of bilirubin reflect low red blood cell turnover and good liver drainage. High levels of bilirubin in the blood cause jaundice, which is manifest as a distinct yellowing of the skin because of high circulating bilirubin levels. Three major causes of high bilirubin are hemolysis of red blood cells, liver disease or damage, or biliary outflow obstruction. Abnormal liver drainage and outflow are considered the most common causes of high bilirubin. Gilbert’s syndrome, a genetic condition that affects about 5% of the population is marked by a deficiency in the liver that causes elevated bilirubin levels.

BILIRUBIN, CONJUGATED refers to the part of the total bilirubin that is further broken down or conjugated in the liver. The normal reference value for conjugated bilirubin is less than 7 micromoles per liter. Abnormal liver function can cause elevated levels of conjugated bilirubin.

LD or LACTATE DEHYROGENASE is an enzyme found in heart, skeletal muscle, red blood cells, and to lesser extent in lung, lymphoid tissue, liver, and kidney. Lactate dehydrogenase breaks down lactate produced in the body from breakdown of sugars. The normal reference value for LD is 100 to 225 units per liter. Low levels of LD indicate low enzyme in those tissues that contain the enzyme. High levels of LD can be caused by acute or chronic inflammation of those tissues especially red blood cells, muscles, and liver. Some nutritionally oriented doctors suggest that the one of the most common causes of LD elevation are caused by essential fatty acid deficiency.

ALT or ALANINE TRANSAMINASE is an enzyme found predominantly in liver and to a lesser extent heart and skeletal muscle. The normal reference value for ALT is less than 50 units per liter. Low levels of ALT indicate low enzyme activity and low levels of liver inflammation. High levels of ALT indicate liver inflammation. Many nutritionally oriented consider ALT values of 25 or higher to indicate some degree of liver inflammation.

AST or ASPARTATE TRANSAMINASE is an enzyme found in several organs and tissues including liver, heart, skeletal muscle, and red blood cells. The normal reference value for AST is less than 40 units per liter. Low levels of AST indicate low enzyme activity and low levels of inflammation. High levels of AST indicate inflammation and damage in those tissues and organs. Many nutritionally oriented doctors consider AST value of 20 or higher indicating some degree of inflammation or damage in those tissues or organs.

GGT or GAMMA GLUTAMYL TRANSPEPTIDASE is an enzyme found predominantly in liver and gall bladder and to lesser extent in intestines, heart, brain, pancreas, and spleen. The normal reference value for GGT is less than 55 units per liter. Low levels of GGT indicate low enzyme activity and low levels of inflammation. High levels of GGT indicate high levels of inflammation. Many nutritionally oriented doctors consider GGT value of 27 or higher indicating some degree of inflammation or damage in those tissues and organs.

ALKALINE PHOSPHATASE is an enzyme found in many tissues, with highest concentration in liver, gall bladder and bone. The normal reference value for alkaline phosphatase is between 30 to 130 units per liter. Low levels of alkaline phosphatase indicate low enzyme activity in the liver and low bone activity. High levels of alkaline phosphatase indicate inflammation of those tissues or high degree of bone activity. Many nutritionally oriented doctors consider alkaline phosphatase values of 80 or more to indicate some degree of inflammation in those affected tissues.

CHOLESTEROL refers to total blood levels of cholesterol and is usually measured in a fasting state. Cholesterol plays an important role in the body including in hormones and cell membranes. The body produces 60 to 80% of total cholesterol, while dietary sources account for 20 to 40%. The normal reference value for total cholesterol is less than 5.20 millimoles per liter. Low levels of total cholesterol can be caused by low dietary fat intake and can be associated with fatigue, essential fatty acid deficiency, and hormone irregularities. High levels of total cholesterol can be caused by excessive intake of fat or abnormal cholesterol production in the liver. High values of total cholesterol have been associated with increased risk of atherosclerosis, heart disease, and stroke.

TRIGLYCERIDE refers to total blood levels of fats that aren’t cholesterol. Triglycerides are made up of glycerol and fatty acids. Triglycerides reflect dietary intake of fat and sugar, or abnormal liver production of fat. Excessive intake of sugars and refined carbohydrates can increase triglyceride values. The normal reference value for triglycerides is less than 2.30 millimoles per lite. Low levels of triglycerides can be caused by low dietary intake of fats and sugars. High levels of triglycerides can be caused by excessive intake of fats, sugars, and refined carbohydrates. High values of triglycerides are just as bad as high cholesterol levels and are associated with increased risk of atherosclerosis, heart disease, stroke, and diabetes.

HDL CHOLESTEROL or HIGH-DENSITY LIPOPROTEIN refers to ‘good” cholesterol. This type of cholesterol returns circulating cholesterol and fats back to the liver for processing. HDL cholesterol consists of a lot of un-oxidized form of total cholesterol. The normal reference value for HDL cholesterol is greater than 0.90 millimoles per liter. Low levels of HDL cholesterol have been associated with increased risk of atherosclerosis, heart disease and stroke. High levels of HDL cholesterol have been shown to dramatically lower the risk of cardiovascular disease.

LDL CHOLESTEROL or LOW-DENSITY LIPOPROTEIN refers to “bad-cholesterol. This type of cholesterol takes circulating cholesterol and fats from the liver into systemic circulation where it can be deposited in arteries in atherosclerotic plaques. LDL cholesterol consists of a lot of oxidized cholesterol. The normal reference value for LDL cholesterol is less than 3.40 millimoles per liter. Low levels of LDL cholesterol have been shown to lower the risk of atherosclerosis, heart disease, and stroke. High levels of LDL cholesterol have been associated with a dramatically increased risk of cardiovascular disease. Nutritionally oriented doctors like to see LDL cholesterol levels less than 3.0 in high-risk patents.

TOTAL CHOL/HDL RATIO measures the ratio of total cholesterol to “good” HDL cholesterol. Some individuals can have levels of total cholesterol greater than 5.20 and have high HDL levels in excess of 0.90. Other individuals can have high total cholesterol levels and low HDL cholesterol levels. If total cholesterol levels are elevated above 5.20 it is much better to have high HDL levels. Generally, the higher the HDL levels the better. The normal reference value for cholesterol to HDL cholesterol ration is less than 4.5 millimoles per liter.

IRON reflects the iron in the blood bound to serum proteins. The normal reference of iron is 8 to 25 micromoles per liter. Iron levels are decreased with poor absorption, iron deficient anemia, or blood loss. Iron levels are increased in iron overload disease, hemolysis of red blood cells, excessive iron, or liver disease.

TIBC or TOTAL IRON BINDING CAPACITY measures the ability of a protein called transferrin to bind iron. The normal reference value for TIBC is between 40 to 80 micromoles per liter. TIBC values are low in cases of iron overload, protein deficiency, and certain chronic diseases. TIBC values are high in cases of iron deficiency, liver disease, pregnancy, alcoholism, and with certain drugs.

SATURATION INDEX measures the degree of transferrin saturation. The normal reference value for saturation index is 0.16 to 0.60. Under normal circumstances transferrin is about one-third saturated. Low levels of saturation index can be caused by iron deficiency and certain chronic diseases. High levels of saturation index can be caused by iron excess and protein deficiency.

FREE T4 or FREE THYROXINE measures the free, unbound levels of T4 or thyroxine circulating in the blood. The thyroid gland, which produces thyroxine, controls the rate of metabolic activity in the body. The normal reference value for free T4 is 9.0 to 23.0 picomoles per liter. Low levels of T4 indicate low levels of thyroid functioning. Symptoms of low thyroid function include fatigue, lethargy, weakness, sluggish activity of all organs, and cold temperature throughout the body. High levels of T4 indicate high levels of thyroid functioning. Many nutritionally oriented doctors consider a low normal level of free T4 to indicate a sluggish thyroid.

Useful Reference

Ravel Richard. Clinical Laboratory Medicine: Clinical Application of Laboratory Data. 6^th edition. Chicago, Illinois; Year Book Medical Publishers Inc.;1995.