Deciphering Pathology Results: A Naturopathic Lens
Deciphering Pathology Results: Understanding Intraindividual Shifts and Contextual Clues to Health
In the world of healthcare, pathology results are invaluable tools for diagnosing and monitoring various conditions. However, interpreting these results isn't always straightforward. Even when values fall within the reference range, intraindividual shifts in pathology can provide crucial insights into an individual's health status.
This is why Naturopaths LOVE getting their hands on a copy of your pathology history, and why they insist on having this information even when you have been told there isn’t any “issue”. You see, we like to keep an eye on YOUR normal, not some random populations “normal”. We also like to do nerdy things like work out ratios within routine blood chemistry, and we also like to prevent disease, rather than treat it. It’s called being proactive, rather than reactive.
The Importance of Intraindividual Shifts
Intraindividual shifts refer to changes in an individual's pathology results over time, regardless of whether the values remain within the reference range. These shifts can signal subtle changes in health that may not be apparent at first glance. For example, a gradual decrease in hemoglobin levels within the reference range may indicate early iron deficiency before it progresses to anemia. Or the steady decline of thyroid hormone may warrant further investigation into thyroid antibodies, or iodine levels.
Understanding Reference Ranges in Australia
Reference ranges, also known as “normal” ranges, are established based on the results of tests performed on “healthy” individuals. In Australia, these ranges are determined through population studies conducted by pathology laboratories. It's important to note that reference ranges can vary between laboratories, depending on factors such as the population demographics and testing methods used.
Some laboratories use external national or international references to establish their ranges, while others develop their own in-house reference ranges. As a result, reference ranges may wildly differ between labs, highlighting the importance of using intraindividual changes and context! Some labs may use populations as small as 100-200 people and average out a “norm” but is this population actually “healthy”? Who knows!
As time goes on and we as a population get more and more unhealthy and chronic disease becomes the norm, we will see consistent shifts in “normal ranging” alongside this, so when is healthy not healthy? If you look at reference ranging over the decades you can see the shifts already happening. The benchmarks are changing and not for the better.
Looking Beyond Individual Values: The Role of Ratios
In addition to individual values, analyzing ratios in routine biochemistry can provide valuable insights into a person's health. For example, the ratio of total cholesterol to HDL cholesterol is a better predictor of cardiovascular risk than either value alone. Similarly, the albumin-to-globulin ratio can not only indicate liver or kidney dysfunction, but also inflammation and oxidative processes. We can also use Urea to Creatine ratios to assess if someone is getting sufficient protein intake, or muscle loss over time. Even within these rations though, it is important use context, and this is the job of the clinician to ask appropriate questions and decipher the information.
Context Matters: Factors Influencing Pathology Results
When interpreting pathology results, considering various contextual factors is essential. Age, ethnicity, stage of life, time of day tested, time of cycle tested (for females), medications, supplements, concurrent illnesses, exercise status and fasting status can all influence results.
For example, certain medications or supplements may affect liver function tests or alter electrolyte levels, iron and lipid studies. Similarly, hormonal fluctuations throughout the menstrual cycle can impact sex hormone levels, thyroid function, and some iron study markers measured in blood tests.
Navigating Controllables and Keeping Results in Context
While some factors influencing pathology results are beyond our control, others can be managed to ensure more accurate interpretation. For instance, scheduling blood tests at the same time of day and under similar conditions can minimize variability. Additionally, informing healthcare providers about medications, supplements, and relevant medical history can aid in interpretation.
what can you control?
To help control the controllables I recommend patients do the following:
Fasting vs Fed: Majority of the time I get my patients to fast, but not longer than 10 hours (anything longer than this can start to affect certain markers)
Exercise: Rested is best. Limiting high intensity activity and heavy strength training which can both affect certain markers. If this is not possible, then accounting for the training and ensuring future testing conditions are similar will assist.
Supplements & Medications: I prefer supplements to be ceased 2-3 days prior to testing but in some circumstances not at all. Medications should never be ceased unless advised by the prescribing practitioner, but do need to be taken into account when deciphering results.
Day of menstrual cycle: this is super important for cycling women so we can accurately read and compare hormone results, thyroid results, iron studies and more!
Be Hydrated! Ensure you have consumed sufficient water in the 24 hours leading up to the blood test.