Reasons Why You Can’t Interpret Your Own Lab Results

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There is a new federal rule for lab companies that requires them to report your blood tests to you as soon as they are finished, often even before your doctor has seen them.  This rule, deemed unreasonable, was established by individuals without medical expertise (politicians), who know little about interpreting lab data or the workings of doctor’s offices. Sending your lab results to you before doctors can assess them is not a decision rooted in sound medical practice but rather in the notion of individual freedom. While this is important, it does not compare to having an expert interpret your results with you.

The law requiring that your lab results be sent to you as soon as they are completed does not consider the fact that these results are not designed for laymen to interpret. Additionally, lab results are meant to be analyzed alongside a patient’s medical history, age, gender, and medications.  The results are not tailored to report information specific to your situation, which is how a doctor would interpret them.

• Lab results often lack layperson-friendly explanations. This new protocol can cause anxiety, as patients may panic over results that appear abnormal, even if they are normal for their specific medical condition and treatment. Furthermore, lab companies only request your age and gender. The factors that doctors evaluate when interpreting your results are diverse and numerous, each influencing the overall interpretation.

What are the considerations that doctors add to their interpretation?

• Menopausal status
• Medical conditions
• Healthy normal for young and healthy adults
• The newest recommended ranges for health
• Body weight
• Other lab values seen on the same report

The problem with you getting your own lab and interpreting it as written is multifactorial:

1. The lab is sent to you digitally with very little explanation except for reference ranges.

There is no information about who you are being compared to. Other women, both men and women? Old women? Young women? Women with symptoms or women who are well without symptoms.  The reporting of the lab results to a patient directly may hide problems that need action or create fears that are unnecessary.

2. Anxiety over your results will continue until your doctor’s appointment to discuss … so you may experience unnecessary worry in many circumstances.
3. Reference ranges make many assumptions, but labs don’t input vital information about you into their computer.
   1. your age of menopause,
   2. your weight
   3. your height (or BMI)
   4. previous illnesses and your medications.
   5. if you are on hormones or testosterone

 

Here is a good example. The test for pituitary hormones FSH and LH.

When a woman aged 45 is menopausal, and has a very high FSH and LH, the lab says it is “normal” (in the reference range), yet the woman is having severe hot flashes, night sweats, anxiety, and insomnia.  That is not healthy or “normal”.

The same two tests can be used to determine if a person is menopausal.

Let’s say a 42-year-old woman has elevated FSH and LH, but her estradiol is very high (200-300). To the layperson, this looks like menopause, but in reality, it is the picture of ovulation, not menopause. One has to look at another test, estradiol, to determine whether she is premenopausal and ovulating or menopausal (her estradiol would be very low, and FSH and LH would be high). See the problem?

4. Reference Ranges don’t tell you what the doctor is looking for.

The same two tests, FSH and LH, are used to diagnose polycystic ovaries (PCO) too.  In women without PCO, the FSH is higher than the LH, but if the LH is greater than the FSH, the diagnosis of PCO should be considered! There is no information about this interpretation in the lab report.

5. Falling within the reference range doesn’t guarantee health or absence of symptoms. If patients are to interpret their own lab results, reference ranges should reflect health in every possible scenario.

FSH and LH are influenced by BCPs and menopausal HRT. Lab results should be interpreted considering the information regarding BCPs or ERT that the patient is taking. When women are on BCPs and HRT or ERT, their FSH and LH levels are suppressed to an extremely low point. If you are unaware that the patient is taking these hormones, it may appear that the diagnosis is pituitary failure affecting estrogen levels and ovulation. Only doctors can interpret this test. There should truly be a “normal” range for those undergoing hormone replacement therapy, along with a reference range that reflects overall health, rather than merely the average for your geographical area in the US or your age group.

5. Please make an appointment with your doctor to review your lab results so you can understand how they are interpreted. If you have questions about your lab results that are concerning you, schedule a time to discuss them with your doctor. Doctors don’t have the time to explain results over the phone or through email—that is what appointments are meant for. Phone calls to doctors’ offices are not intended for lab result interpretation. You or your insurance will not compensate the doctor or NP for this service over the phone.

 

6. The reference ranges for many tests and medical situations are actually wrong. If you aren’t trained as a doctor or Nurse practitioner who interprets metabolic lab results every day, you could get the wrong diagnosis!!!
   10. For example, when evaluating a patient for insulin resistance, the reference range was officially changed almost two decades ago. Still, the lab companies have left the normal range very high (insulin> 18). In the revised range, fasting insulin diagnoses insulin resistance if the value is > 10. The resulting outcome is that many people are not diagnosed at a time when they can be easily treated without drugs and are told that they are “normal” when they are really experiencing insulin resistance. This is misleading and just wrong!

7. Lab values are not adjusted to your individual situation.

 

1. Many tests are adjusted for gender; however, some are specifically adjusted for women who are menstruating regarding H/H. In other words, men and women have different “normal” H/H levels in the reference range. Women who do not menstruate or who are menopausal should be compared to the same reference range as men, but that does not happen.
2. This leads to menopausal women, who are normal, often being told they have too many red blood cells when that is not the case. Conversely, menopausal women who are truly anemic are told they are normal, which means it takes longer to diagnose their anemia from colon cancer! The H/H should have a reference range that is considered “normal” for a woman’s stage in life, depending on whether she is experiencing menstrual periods or not.

8. Many reference ranges are averages for regions of the US and vary between lab companies; therefore, they are not reliable values for comparing patients.

 

1. For instance, the Homocysteine test has a normal range that is relatively high, and each lab has different reference ranges. This test serves as a screening tool for MTHFR genetic risk related to embolic stroke and heart disease.   The suggested treatment involves methylated B vitamins; however, the interpretation on the lab printout advises taking B12 and folic acid, which, in my experience, tends to increase the number rather than decrease it.

• Reference ranges for nutrients, vitamins, and minerals reflect the minimum levels needed for survival, not optimal health.

1. For example, B12 reference range levels for B12 blood levels are listed as 200-1100 pg/ml, yet I was trained to try to achieve 400 -1500 pg/ml. The lower range of the written reference range (200-400) is not healthy.
2. The desired blood levels for vitamins are often controversial, and various medical colleges issue new recommendations on Vitamin D levels each month. Consequently, doctors must determine which level of Vitamin D to recommend for their patients. These institutions not only provide changing reference ranges but also offer differing advice on how frequently to test Vitamin D. This inconsistency arises primarily from the ongoing debate about the minimum acceptable level of Vitamin D.

I have more information about your lab results next week that your doctor may not share with you. There is a lot of controversy surrounding the reference ranges on the lab sheet, and you should know the truth in case your doctor doesn’t.