Functional Lab Values: An Important

Harm-Reduction tool
Dr. Christa M. Whiteman
About me
B.S. in Biochemistry

NY licensed Doctor of Chiropractic since

2007

Functional Medicine training and Study

with Dr. Datis Kharrazian & IFM

Clinical Herbalism training with David

winston, RH(AHG)

In Private Practice in the Hudson Valley,

NY
 What we’ll Cover today
• How a patient’s complaints & symptoms can be missed
(or dismissed) when only normal lab values are used

• How functional lab values & interpretation can help us

validate & acknowledge their complaints and provide
preventative care

• We’ll review some speci c examples of common tests

that are particularly problematic or often missed

• We discuss how Herbalists can use this knowledge to

provide more skilled, empathic, trauma-informed care
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 The Problem
• #1 non-pain complaint that brings people to medical care is Fatigue (lots of
potential causes!)
• Often the Patient knows something is not right with their body, but without
corroborating evidence, their healthcare practitioner may not be able to help them.
Even worse, the provider might even dismiss their complaints as being ‘all in their
head.’
• Compounding trauma -> deteriorating symptomology while they wait for labs to
be ‘bad enough’ to receive care.
• Patients need to be able to trust their healthcare provider to reduce harm & trauma
 A Solution
• Normal vs. Functional lab values
• normal values are looking for overt disease (pathology)
• functional values can help detect changes in physiologic processes that
are leading to bigger health issues, but not yet causing overt disease
• Increased sensitivity, but lower speci city. Look for patterns, not just
one value
• green vs. yellow vs. red
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 Let’s Look at some Examples
• TSH Normal Range 0.5 uIU/mL to 4.5 uIU/mL
• most common measure of thyroid function
• normal lab values are calculated- average of level of people who’ve had the test, out
to two standard deviations, to make a bell curve.
Haggstrom, M. (2014). Establishment and clinical use of reference ranges. WikiJournal of Medicine, 1(1), 1–7. https://search.informit.org/doi/10.3316/informit.349845426379426

• having ‘normal’ TSH, means a patients simply is not as sick as the highest or lowest
10%
• under the bell curve may contain folks being treated for/diagnosed with
hypothyroidism!
• American Academy of Clinical Endocrinology Functional Range 1.8-3.0 uIU/mL
 Thyroid Physiology
• Thyroid Function is an axis (HPT axis) between the hypothalamus, pituitary, thyroid gland, and end organs
(basically every cell in the body)
• (brief) Physiologic review:
• hypothalamus monitors blood T4 levels, if low, TSH is secreted from the pituitary, if high, TSH levels drop
• TSH acts on the thyroid gland itself to stimulate T4 production. 80% of thyroid output is T4, 20% is T3. T3 is
the active hormone
• T4 need to be converted to T3! Gut microbiome plays a role in this conversion
• Relative levels of other hormones, such as estrogen and testosterone, can affect Free vs. Bound levels of T4 and
T3.
• T3 has to be able to get into cells to have an effect. Anemias and poor circulation can also affect the ability for
suf cient T3 to act on the individual cell’s metabolism
• BUT most folks only do a ‘TSH re ex’ test, which means, if the TSH is in normal lab range, follow up tests of T4,
T3 or other levels won’t be done -> patient may still have clinical hypothyroid symptoms, but told their “thyroid is
ne” https://www.aacc.org/cln/articles/2013/may/tsh-harmonization
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Primary Hypothyroid Patterns
• The problem is that the thyroid gland is not responding to stimulation by
the TSH secreted from the anterior pituitary
• TSH above 3.0 uIU/mL
• normal or decreased T4 level
• Lab Range 4.5- 12 mcg/dL
• Functional Range 6.0- 12.0 mcg/dL
• increased cholesterol (>220), triglycerides (>110) and MCV (>90.9 fL)
 Secondary Hypothyroid
Patterns
• The problem is that the hypothalamus is failing to respond to
decreased circulating T4 levels and stimulate the anterior pituitary to
act accordingly by raising TSH
• Decreased or inappropriately normal TSH
• Low Total and Free T4 and T3
• TT3 Lab Range 80-180 ng/dL
• TT3 Functional Range 100-180 ng/dL
 Hashimoto’s Autoimmune
Thyroid patterns
• Estimated that Autoimmune thyroid accounts for 80-90% of hypothyroid cases in
the U.S.
• Positive TPO (thyroid peroxidase enzymes)
• The rest of the thyroid panel can show hyper- or hypothyroid patterns depending
on whether the thyroid gland is being actively attacked at the time of the
bloodwork.
• Suspect Hashimoto’s in cases of ‘mixed’ symptomology
• Gluten ingestion can lead to molecular mimicry and result in antibodies that cores-
react with the TPO enzyme
 What Herbalists Can Do
• Investigate to nd the ROOT cause. What is the underlying imbalance or dysfunction?
• Primary hypothyroid (or hyper) - support with our ‘thyroid herbs” like Ashwagandha, Bacopa,
Rhodiola. Blue Flag, Motherwort, Self-heal
• Secondary hypothyroid - Use case-appropriate adaptogens like Ashwagandha, Rhodiola to
support HPA-axis and other hypothyalamic-pituitary endocrine axis
• Hashimoto’s thyroiditis - While their PCP might just give levothyroxine (synthetic T4), we can
help support their immune system imbalance with immunoregulator herbs (Reishi, Maitake,
Turkey tail), immune amphoteric (Astragalus, Licorice and alteratives (Sarsaparilla, Yellow Dock)
• Many autoimmune and autoimmune-like illness has its genesis in the gut/digestive system. so we
can help them with a diet that removes in ammatory & processed foods (start with gluten)
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 Hypochlorhydria & Biliary
Stasis
• Suf cient stomach acid is needed for the absorption of minerals such as Fe, Ca, Zn and
vitamins like B12. Therefore, insuf cient acidity can lead to anemias. Iron de ciency and
pernicious anemia.
• Hypochlorhydria can present similarly to GERD and heartburn. Patients may be prescribed
PPIs that further lower stomach acid.
• Pyloric sphincter control and gall bladder tone is in under the regulation of the hormone
cholecystokinin (CCK), which can be decreased by malabsorption pathologies in the gut.
• The trigger for CCK release is the presence of fatty acids and certain amino acids in the
duodenum
• pH is a trigger for pyloric sphincter opening.
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 Hypochlorhydria & Biliary
Stasis
• Without suf cient stomach acid, speci c vitamins and minerals are
not absorbed and pyloric sphincter opening is hampered
• Chyme doesn’t move ef ciently into the duodenum to trigger CCK
release.
• Insuf cient CCK will lead to biliary stasis, lack of bile production at
the liver and insuf cient pancreatic enzymes, further impeding the
the digestive process.
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 Hypochlohydria Patterns
• Increased globulin (>2.8)
• indicates increased in ammatory processes -> antibodies
• Lab Range 2.0-3.9 mg/dL
• Functional Range 2.4-2.8 mg/dL
• Normal or decreased Total Protein (<6.9) and/or albumin (<4.0)
• impacted by digestion & absorption of protein from food
• Lab Range 6.0-8.5 g/dL
• Functional Range 6.9-7.4 g/dL
• Increased BUN (>16)
• Urea is made in liver and indicative of protein metabolism, excreted by kidneys
• Lab Range 5-25 mg/dL
• Functional Range 10-16 mg/dL
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 Biliary Stasis Patterns
• GGTP increased (>30) This is not always on a standard CMP!
• a key liver enzyme, but also found in quantity in gall bladder, prostate.
pancreas
• Lab Range: 1-70mcg/L
• Functional Range: 10-30 mcg/dL
• SGOT/AST & SGPT/ALT may be normal or increased (>30)
• Bilirubin mat be elevated (<1.1), along with alkaline phosphatase (>100) and
total cholesterol (>220)
 What Herbalists can Do
• Where can their diet be improved? Are they eating enough fruits and vegetables? Are there trigger foods in the
diet that need to be removed? (gut pathology may decrease CCK signaling)
• Is there GERD or signs of hypochlorhydria (lack of agni/digestive re)?
• Can decrease protein absorption, mineral absorption such as Fe, Ca, and Zn, B12
• Lack of stomach acid/enzymes can allow parasitic in ltration- SIBO, H. Pylori, etc.
• Insuf ciently digested proteins can increase the risk of antigenic responses from the immune system in the gut
• Bitters, cholegogues and choleretics for biliary stasis dandelion root, artichoke, etc.
• Herbs that can increase stomach acid, such as Chen Pi/Orange peel, Ginger
• Pay attention to heat or lack there of, with GERD symptoms. Use cooling herbs if heat, warming bitters if no
heat
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 the CBC w/ DIFF
• RBCs and the “MCs” tell us more than just whether someone has iron
de ciency anemia
• Other anemias from B vitamin de ciencies that affect the size and
hemoglobin density of a RBCs- microcytic hypochromic vs. megaloblastic
anemia
• Remember that at the level of the capillaries, RBC’s must go through
single le. If they are too large, can’t t, poor tissue profusion. If they are
too small, they can get bunched up and create a dam, that can also lead to
poor tissue profusion
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 Lab Range Optimal Range
M: 4.6 -6.0 x 10⁶/mm³ M: 4.2 - 4.9 x 10⁶/mm³
RBC
F: 3.9- 5.5 x 10⁶/mm³ F: 3.9 - 4.5 x 10⁶/mm³
M: 40-52% M: 40-48%
HCT
F: 35-47% F: 37-44%
M: 13.0-17.5 g/dL M: 14-15.0 g/dL
HGB
F: 12-16 g/dL F: 13.5-14.5 g/dL
MCV 81.0-99.0 mcg³ 82.0-90.9 mcg³

MCH 26.0-33.0 pg 28-31.9 pg

MCHC 32.0-36.0 g/dL 32.0-35.0 g/dL

RDW 11.7- 15.0% <13%

Iron Deficiency Anemia Patterns
• RBCs decreased
• HCT decreased
• HGB decreased
• MCV decreased
• MCH/MCHC decreased
• Iron decreased
• Lab Range 40-160 mcg/dL, Optimal Range 50-100 mcg/dL
 B6 Deficiency Patterns
• Sideroblastic (acquired) anemia
• RBC normal
• HCT decreased
• HGB normal or increased
• MCV decreased
• MCH/MCHC decreased
• Iron normal or increased (increased because it can’t be incorporated into the RBC)
 B12 Deficiency patterns
• Megaloblastic anemia
• RBCs decreased
• HCT decreased
• HGB decreased
• MCV increased
• MCH/MCHC increased
• Iron may be increased
 What Herbalists can Do

• Be aware of folks who may not be good methylators, help them get B
vitamins in proper form
• Supplement vitamins, but work to support the root cause- digestion
or malabsorption syndromes
• Consider use of herbs like Ashwagandha that may support iron
levels, or a more nutritive herb like Amla that also supports
circulation/capillary health
Trauma-Informed Healthcare

• Thorough history & intake. The client will tell you what is wrong, you
just have to be listening when they do. (Speci c Indications!)
• Try not to draw conclusions or make assumptions until you have all
the facts! Conversely, be aware of your own history and assumptions
• Many clients seek out the help of an herbalist because they want not
only a holistic solution, but holistic experience as well- to be really
seen, heard, witnessed in their vulnerability and/or individuality

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“A doctor who prescribes an identical treatment for an identical illness
in two individuals and expects an identical development may be
properly classi ed as a social menace.”
- Lin Yutang (1895- 1976)
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Thank YOU!
Q&A
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christa@wildwomanherbalist.com