3 "Normal" Lab Values...
That May Still Leave You Feeling Like Trash 🗑️
I'm a fan of lab testing, but I also recognize there are limitations. Unfortunately, labs aren't black and white, good or bad. There are definitely scenarios where labs look great, the person is doing everything he/she wants to do in life and "normal" can mean healthy.
But one of the biggest drivers of people coming to the clinic is that they have "normal" labs but feel like complete trash.
This is where lifestyle contexts have to be considered when interpreting labs as whether the person is "normal" or "healthy." I want to highlight 3 routine values that often look good on paper but, in reality, can tell a much different story.
ALBUMIN
Albumin is the main type of protein found in your blood and extracellular fluid. It's produced in the liver. It serves a vital role in being a carrier protein for hormones, vitamins, minerals, fatty acids, enzymes, amino acids, and medications.
In labs, there is often a high value and low value. With albumin, and any lab analyte, there are reasons it could be at either end of the spectrum.
A main reason albumin would be HIGH in your labs is due to dehydration. If there isn't enough fluid, then the substances in the fluid look more concentrated, creating a value that is high.
A big reason albumin would be LOW is inflammation. Inflammation is in response to injury and/or infection. This doesn't have to be large injuries or infections, but internal ones where your arteries are being damaged by chronically high blood sugars, for example.
The dilemma is that the person feels like complete garbage because they are potentially both dehydrated and dealing with chronic inflammation at the same time, but the lab value looks "normal" because the scenarios balance each other out.
MEAN CORPUSCULAR VOLUME (MCV)
MCV is the measure of the diameter of your red blood cells. Knowing the size and shape of the red blood cells allows for a determination of anemia as well as nutritional and environmental factors impacting the health of your red blood cells. MCV is tested alongside MCH, MCHC, and RDW.
A common reason your MCV might be high is due to a type of anemia called megaloblastic. When new red blood cells are formed, they are very large. They have to undergo a division, which then creates a more uniform size and shape. This cell division requires nutrients like B12 and folate. In addition to those nutrients, alcohol intake disrupts the maturing of the red blood cells.
What about if your MCV is low? One of the main reasons for that is being iron deficient.
What if you are deficient in B12, folate, AND iron? Your MCV and MCH may look great, but you're exhausted all the time due to all types of anemia not showing due to the balancing act.
Being deficient in these nutrients isn't just an intake issue. What if albumin is off like discussed above? Remember, albumin is responsible for carrying around your nutrients so they are better utilized.
ALT (ALANINE AMINO TRANSFERASE)
In your routine labs, you will often see ALT and AST. While both are looked at as liver damage markers, the actual function is more nuanced. ALT converts alanine into pyruvate, which is a major fuel source for your cells. The liver is the first place we store excess fuel.
In a non-damage scenario, ALT can rise due to a fatty liver. What a fatty liver tells me is that there is too much stored fuel. In terms of ALT driving the conversion of alanine to pyruvate, pyruvate is derived from glucose. The point is that ALT will rise in a non-alcohol fatty liver situation typically due to too much glucose (carbs and sugars). ALT is working overtime to convert that glucose into a more usable fuel, pyruvate.
On the flip side, ALT requires B6 to work. When someone is B6 deficient, ALT will be low or low normal.
Therefore, ALT may balance out to a "normal" value even when someone has a fatty liver in addition to not using/processing enough B6.