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Basic Lab Tests_Final

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>> Hi there, and welcome back. It's great to see you again. In this lecture, we'll be talking all about lab testing. As a Health Coach, you won't be ordering or interpreting lab tests for your clients, but you may work with them to understand options and encourage them to visit their doctors for testing. This is why it's helpful to understand the tests that are most commonly ordered by doctors and what these tests look for. Before we get started, let's talk about what's normal. Test results are assigned a range of normal values. This is done using standardized statistical methods that look at the average and where 90% of people fall on the curve. This includes people who are sick, so normal doesn't necessarily mean healthy. As Health Coaches, we often want more for our clients than to just get into the normal range or empowering them to achieve optimal health. Normal may not translate into your clients feeling their best. Optimal health isn't about a number on a graph, it's about a person's picture of overall health and wellness. A client might, for example, have a thyroid level that fits nicely on the normal curve and yet still have hair loss, brain fog, weight gain, and fatigue. Overall, this client isn't in a state of optimal health. If a client comes back with normal numbers from their doctor, it may be that something else is going on or it may be that the tests aren't picking up on this person's level of sickness. Either way, this client can benefit from a supportive coach who will listen and provide support for making better choices in diet, exercise, and lifestyle. And you can help them with all of these things without getting into diagnosis, test interpretation or treatment, things that put you outside of your scope of practice. Also, one thing to remember about getting testing is that it isn't an answer rather it's the beginning of helping a client understand the whole picture of their health. With coaching, a client's test results are only one part of the big picture to helping them understand what overall health looks like. To better understand the small yet important part of health, let's look at five types of standard tests that your clients may be getting. These are complete blood count, liver function tests, cholesterol and liquid markers, blood sugar markers, and vitamin levels such as folate, B12, and vitamin D. Let's look at each of these in detail. The complete blood count or CBC includes information about how many red blood cells there are, how many white blood cells there are, the number of platelets, and information about a person's hemoglobin, which is the oxygen carrying component of red blood cells. Although it's a common test and seems simple, it can give good information about general health. Let's take a look at the components of the CBC tests and what information they provide. The optimal level of white blood cells or WBC is 5,000 to 7,500 cells per microliter. Levels below 5,000 can indicate that a person's immune system isn't functioning well or it could be a sign of malnutrition. High levels can mean chronic or active infection. Other things that can cause an elevated white blood cell count include high levels of cortisol, poorly controlled diabetes and smoking. The hemoglobin level refers to how much of the oxygen carrying protein hemoglobin is present in the red blood cells. Hemoglobin is the primary way that iron is carried through the body. The optimum levels for adult males are between 14 to 15 grams for deciliter, and for an adult female, they're between 13.5 to 14.5 grams per deciliter. When hemoglobin levels are high, it may be a sign of hemochromatosis, dehydration, respiratory disease, high cortisol levels, polycythemia which is overproduction of red blood cells, or splenic dysfunction. It can also be seen in people who live at high altitudes. Low hemoglobin levels can be seen in cases of iron deficiency anemia, blood loss, pregnancy, severe water retention, chronic disease such as cancer or kidney failure, and in diseases of the bone marrow such as leukemia. The hematocrit is the percentage of red blood cells to the total volume of blood. The optimal range for women is 39% to 45% and for men, 42% to 48%. Hematocrit levels correlate to hemoglobin levels, and so low or high levels indicate the same thing as they do for hemoglobin. Anemia can show up in two ways, too few red cells or a normal number of red cells that contain too little hemoglobin. Low hemoglobin or hematocrit is a sign of the first kind of anemia. The mean corpuscular volume or MCV is a measurement of the size of each red blood cell. This is important because a low MCV can mean iron deficiency, while a high MCV can mean a vitamin B12 deficiency. The normal functional range for MCV is 87 to 92 cubic microns. A cubic micron is an extremely small volume, 1 quadrillionth of a liter. The platelet count can also be a clue to underlying abnormalities. The optimal range for platelet count is 230,000 to 400,000 cubic millimeters. Platelets are involved in the clotting process. A low platelet count can cause increased bleeding in response to a cut or trauma, and a high platelet count on the other hand can be associated with increased clotting, heart disease, and stroke. Some health issues that may be associated with a high platelet count are infection, rapid blood loss, cancer, and diseases of bone marrow. Low platelets that may indicate low folate or vitamin B12 levels, liver cirrhosis, cancer involving the bone marrow, and clotting disorders. Next, we have the liver function tests. These include AST, ALT, alkaline phosphatase, bilirubin, albumin, and protein. AST and ALT are liver enzymes. They both have an optimal range of 20 to 30 units per liter. When the liver enzymes are elevated, it means that there's been damage to the liver cells. Some of the causes of this damage include chronic alcohol use, hepatitis, fatty liver disease, heart attack, and blockage of the liver duct by a gallstone or cancer. Some clients who eat too many carbohydrates in their diet may find elevated liver enzymes upon testing. This is a cause of a nonalcoholic fatty liver disease. It takes a long time to accomplish, but fortunately, this condition can be reversible with dietary changes. Alkaline phosphatase is another enzyme used as a marker of liver function, while it may be used as a liver function test, the level can also rise due to issues with the bones. The optimal level is 42 to 107 international units per liter. Bilirubin is a waste product produced when the body breaks down hemoglobin. It has a distinct coloration to it and is responsible for the color of both bile and stool. When levels are very high, it can turn the skin and the whites of the eyes yellow, which is called jaundice. This jaundice is a classic sign of liver disease indicating that the liver is obstructed. The body is always breaking down red blood cells so there is always some bilirubin in the system. Elevated levels may be due to increased breakdown of blood cells, poor liver function, obstructed liver ducts, or a malfunction of the enzyme that breaks bilirubin down. The optimal level is 0.1 to 1.2 milligrams per deciliter. In babies, however, jaundice at birth is usually just a sign that the liver is not yet mature enough to process all of the bilirubin produced in their body. It rarely is any indication of any kind of blockage and most often resolves within a few days. Albumin is a protein in the blood that is responsible for helping to maintain blood pressure and fluid balance. It also acts as a carrier for other chemicals in the blood such as medications, calcium, fatty acids, and heavy metals. It's produced in the liver, so when the liver isn't functioning well, the level of albumin may be low. Other causes of low albumin include poor nutrition, severe fluid retention, and renal failure. The optimal level for Albumin is 4 to 5 grams per deciliter. A low albumin level can cause medications that are usually bound to albumin in the blood seem to be free resulting in higher medication levels more rapid breakdown by the liver or both. Third, we have the lipid panel. Traditionally, the lipid panel includes total cholesterol, low density lipids or LDL, high density lipids or HDL, and triglycerides. When there's too much cholesterol in your blood, it builds up in the walls of your arteries. This causes a process called atherosclerosis, which is a form of heart disease. The arteries become narrowed and blood flow to the heart muscle is slowed down or blocked. So there is value in knowing the cholesterol numbers and, in particular, knowing the numbers for the smaller lipid particles in sub-fractions. These smaller particles may be early markers for risk of heart disease. The number of low density particles and very low density particles is more important than the LDL level presented in traditional lab values. The optimal level for the number of LDL particles is less than 1,000. The optimal number of small LDL particles is less than 700. Also there's some evidence that having too low a cholesterol number is more of a risk than being slightly high. This is partly because cholesterol is the backbone of all of the steroid hormones, and it's used to build cell membranes. A good portion of the brain is also made up of cholesterol, in fact, it's almost 25% of the cholesterol in the body. Total cholesterol levels, which includes both HDL and LDL, below 140 have been associated with memory loss and depression. On to the next text, blood sugar markers. These include fasting glucose, oral glucose tolerance test, and hemoglobin A1C. The optimal level for fasting glucose is 75 to 85 milligrams for deciliter. Most Western medicine doctors don't become concerned until the fasting blood sugar is over 100 and don't consider a patient diabetic until it hits 126. However, it's important to consider that once this test is abnormal, there's already damage. Most people don't have an abnormal fasting blood glucose until fairly late in their disease. The oral glucose tolerance test is performed after an eight-hour fast. The patient is given a standardized dose of glucose and then the blood sugar is measured after one and then two hours. If at two hours, the blood sugar level is over 140, it may indicate pre-diabetes. If it's over 199, that typically indicates diabetes. It's important to keep in mind, how close your client is to 140. If they're within a few points, say 135 after two hours, there's still reason to be concerned. Someone with perfectly normal blood sugar control would be able to normalize that dose of glucose within two hours. So consider this test along a spectrum rather than as a cutoff point. The hemoglobin A1C or A1C is a measurement of how much sugar has become attached to the hemoglobin. The more sugar there is in the blood, the more sugar gets attached to the hemoglobin. The theory is that the higher the A1C is, the more sugar exists chronically in the bloodstream. Since the blood cells last an average of three months, this gives a longer-term picture than the fasting glucose or the glucose tolerance test. This test has become more popular in recent years as a better way to evaluate blood sugar management. It's used both as a diagnostic test and to help people who are already diabetic to see how well their sugar is managed. The normal range is 4% to 6%. Unfortunately, there are a number of reasons why this test can be inaccurate including anemia and shorter or longer lifespan of the blood cells in the expected 90 days. A few other tests may help to give a bigger picture of blood sugar management, including tests of fasting insulin, insulin-like growth factor IGF and leptin. These tests help determine hormonal pancreatic function. The important thing to consider with all of the blood sugar tests is where they fit on the spectrum not whether or not the test is considered normal. Blood sugar problems have to start somewhere, and these tests can help give a clue if your client is beginning to have difficulty maintaining a blood glucose in optimal range. Finally, we've tested for vitamin levels. Specifically, the vitamins involved in metabolism, including folate or vitamin B9, vitamin B12, and vitamin D. These vitamins are important co-factors in nearly all of the metabolic processes in body. This is why it's crucial to maintain normal levels of these vitamins in order for the body to be able to function optimally. Folate or vitamin B9 is a necessary vitamin for almost all of the biological enzyme processes in the body. It's particularly needed for normal development of an embryo into a fetus. Low folate levels have long been known to cause what are called neural tube defects where the spinal cord or brain cavity does not close completely during development. This includes spina bifida and anencephaly. People with genetic mutations such as MTHFR may require much higher levels of folate than usual recommendations. This is because the body is unable to utilize it as well as somebody who does not have the mutation. Optimal levels are considered to be greater than eight micrograms per liter. Folate levels can vary throughout the day and with the diet, so it's best for the test to be taken after an eight-hour fast. Encourage your clients with the MTHFR or other genetic mutations to get their folate levels tested and to consult with their doctors about how much to increase their intake. Vitamin B12 is a B vitamin that's involved in many processes in the body and adequate levels can improve heart, skin, hair, and digestion. It also has an effect on moods, energy levels, and memory. In order to resolve adrenal fatigue, adequate levels of vitamin B12 are essential, it's a required part of enzyme production, DNA synthesis, and hormonal balance. It also helps to maintain both the nervous and cardiovascular systems. Clients with adrenal fatigue or with these symptoms should visit their doctor to have their vitamin B levels tested. Low levels of B12 can also be a sign of malabsorption in the gut. Vitamin B12 is absorbed in only one short segment of the small bowel. And if this is inflamed, then B12 levels will be low. It also may be related to a vegan diet, alcoholism, and smoking. Vegan diets can cause B12 deficiency because only animal sources and foods that are supplemented provide B12. The optimal level of B12 is generally thought to be greater than 550 picograms for milliliter. Unfortunately, many people will test with normal levels of vitamin B12 and still may have what's called a subclinical deficiency, meaning that they don't have a low value on the test but they may have signs of cognitive impairment and poor memory. Additional tests may be needed to definitively show B12 deficiency in these people. Another test that may help identify a subclinical level of vitamin B12 deficiency is called the methylmalonic acid test. This test can help identify early vitamin B12 deficiency. Symptoms of a B12 deficiency include fatigue, muscle aches, difficulty concentrating, memory issues, heart palpitations, poor appetite, depression and anxiety, and mouth sores, or bleeding gums. Lastly, we have vitamin D. The optimal level of this vitamin is a bit controversial. Traditionally, between 12 and 13 nanograms per milliliter was considered normal. We now know that these low levels aren't enough for truly optimal function of the body. However, they're still little agreement about what that level is. Even traditional medicine has increased their range to 20 to 50 nanograms per milliliter. Functional medicine practitioners typically agree that the bare minimum for vitamin D levels is 50 nanograms per milliliter. And studies to prevent complications from vitamin D deficiency such as bone fractures and heart disease have shown that 90 nanograms per milliliter is the level with the least complications. Vitamin D levels higher than 100 can be dangerous and are associated with increased risk of cancer, particularly pancreatic cancer. Your clients should be getting their vitamin D levels tested by their doctor and should not be supplementing unless they are under the supervision of their medical practitioner. If their doctor is not in favor of a higher dose of supplemented vitamin D, they can safely increase their vitamin D intake by consuming more vitamin D rich foods. Okay, that wraps up our discussion of the five most common types of basic lab tests your clients may be getting to assess their health. To recap, these are complete blood count, liver function tests, cholesterol and lipid markers, blood sugar markers, and vitamin levels. We discussed why normal test result values may not be accurate markers of optimal health and how important it is to put these tests into perspective. These lab tests serve as an introduction to the possible issues your client may have and pave the way for you to work safely under the guidelines of their doctor's treatment protocols to help your client achieve optimal health through lifestyle and nutritional improvements. Have you ever been administered any of these tests by your doctor? Share your experiences with us in the Facebook group and let us know if you have any questions about them. Thanks so much for joining us. We'll see you soon.

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Duration: 18 minutes and 11 seconds
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Language: English
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Views: 5
Posted by: ninaz on Apr 13, 2018

Basic Lab Tests_Final

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