Two Updates to Your Bloodwork

Two Important Updates to Bloodwork
Bloodwork can be a regular part of your routine health check-ins.  Each practitioner has their own list of items that they like to look at, to gain better understanding of the internal environment of your body, cells and metabolic health.  The data is then compared to the established reference ranges and then your numbers are determined to be "normal" or flagged as outside the typical or desired levels. 

If you've ever brought your bloodwork to me for my clinical impression, you will know that I don't just look at the numbers to know if you're "fine", I also explain what each marker means and what we would be looking for optimally.  This different lens strives to keep you well, and ultimately your health thriving.

In the last little while there have been some changes to the reference ranges of two of the most commonly tested values:  cholesterol and ferritin.

• Cholesterol
  
  Cholesterol is a fatty substance crucial to making cell membranes, hormones, vitamin D, and bile acids for fat digestion.  Cholesterol can get a bad wrap when there's an abundance in the bloodstream.  You might not know this, but 80% of the cholesterol in our bodies is actually made by the liver, while only 20% comes from our food (1). I find that cholesterol can tell us about inflammation and liver function, since higher levels in the blood can be a response to damage that our bodies are trying to patch up. 
  
  As a fat, cholesterol cannot travel freely around without an escort (think of how salad dressing separates in the bottle) so it is packaged into several forms.  The two types you would know best are LDL "bad" and HDL "good".  LDL transports cholesterol from the liver to the rest of the body, while HDL moves cholesterol from the tissues back to the liver for breakdown and excretion.  If LDL becomes oxidized, it is present for the thickening and damaging of the blood vessel lining (2).  This is a much longer conversation, but I'll leave it here for today.
  
  In 2023 the range for Total Cholesterol was recommended to be less than 5.2 mmol/L, LDL less than 3.5 mmol/L, and HDL above 1.3 mmol/L.  Prior to this, most lab results only noted LDL should be less than 2.0 and HDL less than 2.6 mmol/L.
  
  I like to see both LDL and HDL close to 2.0 mmol/L.
  
  Apolipoprotein B is a commonly recommended test by various cardiovascular associations, including in this paper by the Canadian Journal of Cardiology (3), as a better assessment of cardiovascular health than LDL but it doesn't seem to be implemented in the clinical setting yet.  ApoB is ideally above 1.05 g/L.  
  
  Every single cardiology or heart association recommends lifestyle based approaches as a first line of therapy, since nutrition and exercise are powerful health modulators, but I'm not always seeing this supported in the real world.  In 1988 when the first cholesterol guidelines were published, it was "recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid." (4)  Now, first line treatment is statin medications, with the goal of reducing cholesterol numbers as much as possible.
  
  The challenge then becomes, what happens to hormones, nervous system, cell membranes, fat digestion, vitamin D all all the other body systems that rely on cholesterol when the value is low?  Consideration should be made for the big picture of lipid health, and all the complex intertwining systems.
  
  
  
• Ferritin
  
  Ferritin is a protein that stores and releases iron as needed, acting as a buffer to keep iron levels in range.  Iron absorption and levels are tightly regulated in the body.  Iron is needed in the production of red blood cells, which circulate oxygen, and a healthy immune system.  I've also seen low iron impact sleep, anxiety, picky eating, dark circles under the eyes and leg cramps.
  
  It used to be flagged only if it was below 10-15 ug/L (depending on the lab).  Oftentimes people would have suboptimal iron levels between 11-30, and exhibit all the symptoms (fatigue, brittle hair, cold temperature intolerance), but ferritin was not flagged so results would be considered "normal".  Naturopathic doctors would commonly want to see ferritin above 50 ug/L, and ideally 80-100. 
  
  Now, the lab tests have been updated and indicate ranges for ferritin: 30-50 ug/L is a probably iron deficiency, and 51-100 is possibly deficient if risk factors are present.  To get a more thorough picture of iron status and rule out inflammation as an intervening variable in the ferritin reading, an iron panel containing TIBC and Transferrin Saturation are very helpful.
  
  The upper limit for iron is usually considered 300 ug/L, as too much iron can indicate chronic infections, hemachromatosis, liver disease, and sleep apnea and should be further investigated.  
  
  Clearly, there's a sweet spot for ferritin levels, but I've often seen iron deficiency get missed.  This change could be why you are suddenly being told that your iron is low, after years of suspecting it.  I'm glad to see this adjustment to the bloodwork reference ranges so that we can quickly begin to treat this common imbalance. 
  
  You can read more about iron deficiency here.
  
  

Most of us have online access to our bloodwork results, but if not, you can ask your practitioner for a copy or we can do a release of records request to have the results sent here.  I'd love to walk you through your numbers so that you fully understand what has been tested, and what it might mean for your health now and down the road.  So often we are told everything is "fine" and then one day it's not.  Or maybe it's "normal" but close to the line and you have all the symptoms of a certain condition.  When we take a moment to appreciate exactly where you're sitting, we have a wonderful opportunity to support your body right now, and prevent future illness from developing later.  Ultimately, it's your health on the line.
See you soon,
Dr Christa

1.  https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body
2.  https://www.ncbi.nlm.nih.gov/books/NBK279327/
3.  https://onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext
4.  https://onlinecjc.ca/article/S0828-282X(18)30995-4/abstract

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