What’s “Normal” Health? with Dr. Mark Hyman

Mar 26, 2019

The one and only Dr. Mark Hyman is here to help us find the confidence we need to have meaningful conversations with our doctors.

For today’s episode, we treat you to a sample of his Commune course, “Hacking Your Healthcare,” about understanding lab results in order to make the right choices for our personal health and wellbeing.

Learn more at www.onecommune.com


Jeff: Welcome to Commune, where each week we explore the ideas and practices that bring us together and help us live healthy, purpose-filled lives. I’m your host, Jeff Krasno.

In addition to being a podcast, Commune is also an online course platform hosting some of the world’s greatest teachers. To learn more, click the link in the episode show notes, or go to www.onecommune.com.

Have you ever been to the doctor and told them your symptoms and they said ,"Oh, I did a full blood panel and everything came back normal?"

Dr. Mark Hyman believes that either you're crazy or they're missing something. And his bet is they're missing something because they're looking in the wrong place for the answers.

Dr. Mark Hyman is a practicing functional medicine doctor, author, the Founder and Director of the UltraWellness Center in Massachusetts, and the Director of the Cleveland Clinic Center for Functional Medicine.

His course Hacking Your Healthcare will help you find the right doctor to work with and how to form the most beneficial relationship with them that allows you to get what you truly need.

A doctor that's willing to work with you in the way you want, one that hears you, that's open to your requests, and discovering new information. One that is open to advances in science and systems approaches to get to the root cause of what's up with you - AKA functional medicine.

For today’s episode, we’re going to treat you to a sample of Dr. Hyman’s Commune course, Hacking Your Healthcare, where he digs in a little deeper on the nitty-gritty of lab test results, specifically your vitals, like heart rate, blood pressure, Vitamin D, body temperature, weight, and more.

Understanding how your body works is really important to optimize your health, and his course aims to give you the confidence you need so that the next time you’re at your doctor's office, you can ask questions and have a meaningful conversation with your doctor.

Dr. Hyman: Hey everybody, it's Dr. Mark Hyman.

Today we're going to talk about laboratory reference ranges. Sounds boring, but it's really important. See doctors typically interpret tests as normal or abnormal. Now let's talk about what normal means. It means that 95, or so, percent of the population falls into that range. It doesn't matter if you're sick or not, young or old, two or 92, well there are some adjustments for kids actually, but normal is just a statistical number which means that you fall into two standard deviations from the mean. That means on either end they are only a couple percent of people who are high or low.

Now, that doesn't mean it's normal in the way we think of it, or optimal. It's just a statistical number. In fact, health and disease occur along a continuum from super healthy to super sick and these tests need to be interpreted according to what is best for a healthy human. For example, vitamin D levels are considered normal if you're over 20, but the ideal is over 50, why is it 20, 'cause 80% of the population is vitamin D deficient so they fall into that range. It doesn't mean that 20 is the best number for your health. For example, blood sugar number that's normal is under a hundred, but we know the optimal is 70 to 80, anything over 80 you start to get increasing risk. It's just the fact that we're a sick population. Also if you were to be a Martian and you landed in the United States it would be "normal" to be overweight because 70% of our population is overweight.

Even the skinny ones have metabolic issues, right? 25% of the skinny people, we'll call skinny-fat, and they're not healthy even though their weight is normal. So the normal weight in America is fat and that's not what we want to aspire to. We want to aspire to health. So with that understanding let's jump right into some basic medical measurements that are so simple, but can tell us a lot about our health and our constitution and they're often overlooked. Let's just spend one more minute on normal. Often you go to the doctor and you're told your tests are all quite normal, but you still don't feel good.

So what does that mean? Does it mean you're not sick? Does it mean you're thriving? And it means, like I said before, one of two things, either your doctor is missing something or you're crazy, and I'm betting your doctor's missing something. Now this is one of the main differences between functional medicine and conventional medicine. In functional medicine we're not playing the game of sick care, we're aiming for optimal health. We're looking for more subtle deviations from optimal. When most tests are "abnormal" for example, your kidney function, you've lost half your kidney function. By the time your liver function's abnormal, your liver cells are dying, that's a little late.

A functional medicine doctor may review the results you get from the same lab tests much differently than a conventional doctor. This is because the ranges that we're aiming for are more specific to optimal health, not disease. Now most conventional doctors are not trained to analyze labs from the perspective of health and then they either take a watch-and-wait approach, which can be quite dangerous, or they will order the minimum testing required to label you as, not sick.

In fact, one patient came in with a blood sugar of 120, and 126 is type 2 diabetes, and I said did you see your doctor about this. And he said, yeah. I asked him what the doctor said. He said, well he said wait until I actually had diabetes and then come back for medication. That is the last thing we want to be doing. In medicine we use things called, reference ranges. These give us a range of values that have been seen in the normal population and normal is relative.

It changes based on age, gender, physical activity, and so much more. In fact, if you were to assess someone's weight in America today, it would be normal to be overweight as I said, because 70% of us are overweight. We keep changing the reference ranges based on a sick population. This is not what we should aspire to. This is why functional medicine treats the individual, not just the numbers. In addition, what's considered normal ranges, by the labs, change over time. You know one fascinating example of how these ranges change is seen in a recent change made by a known global lab company, called LabCorp. Now they recently changed their reference ranges for male testosterone levels. Previously LabCorp considered the normal range of testosterone for an adult to be 348 to 1,197. Now this value was based on a population of lean adult males. However, in 2017, they lowered the bottom end of that range from 348 to 264, and the higher range down to 916.

This means that overweight men, but not the obese men, were likely included in this cohort, which led to the reduction of what is considered a normal testosterone level. It's know that excess abdominal fat leads to lower testosterone levels and by changing these reference values conventional medicine is now considering overweight individuals as the norm. That is not what we want. We want to be healthy, not just a little fat. So let's pause for a second. This is really mind blowing. This is the exact reason you need to take control of your own health. And as society gets sicker, and one in two people have a chronic disease, we have to rethink how we interpret labs and that normal, may really not be normal, just average for a sick population. Now the goal of this video series is to empower you as individuals to become the CEO of your own health. To understand what your lab tests mean, understand what optimal looks like, what labs are designed to assist health and not just disease. I also want you to make an informed decision on who you choose to hire to be your doctor, or partner, in your health. So let's dive right into the most common measurements performed in medicine, but those that are often misunderstood and poorly interpreted as well. Your vital signs. Now everybody knows when you go to the doctor the first thing you do is you get your vitals taken by the nurse, your blood pressure, your weight, your heart rate, your temperature, maybe your oxygen saturation, but do they tell you what these numbers mean? Does your doctor discuss them with you? Why do they take them at all if they're not going to do anything with them and just record them and never discuss them with you? Well if you have high blood pressure maybe they will, but otherwise, maybe not. Do these values actually say anything about your health? Do they just mean you're not dying? How can you tell if you're thriving?

Well if you have something horrible, like high blood pressure, or a heart rhythm problem, they're going to tell you, but otherwise, not so much. The first vital on deck is your heart rate. Now your pulse is a measure of how fast your heart is working. Your heart beats more then a 115,000 times per day, that's a lot. If that isn't significant, I don't know what is. Now, if your heart rate is above 100, then we define that in medicine as having a high heart rate and your doctor might take a look into that. But if you have a heart rate higher then 80, that also puts you at increased risk for heart disease. So what causes this increase. Well it could be a bunch of things, but a big one that we all see is stress, because it raises your adrenaline and that causes higher heart rate and blood pressure. But it could also be too much coffee, or a stimulant medication like Adderall, or an overactive thyroid, or heart or lung problem.

You know our fight-or-flight response, this is our emergency activation system, and this gets activated during times of stress, this can cause your heart rate to go up. Now if your heart rate is regularly above 80 then you want to start to incorporate some other things in your life. For example, mindfulness meditation, or other forms of meditation, other forms of stress management. Stress is not the only cause though of a high heart rate. It could be dehydration, could be anxiety, could be low magnesium, it could be being out of shape, it could also cause that, and just know that this is something you want to look into further.

You want to have a lower heart rate? Ideally, under 70. On the other side of the coin is a heart rate below 60 and that can indicate that the thyroid gland is not functioning well. Maybe you have a low thyroid. Athletes, and distance runners, actually have low heart rates because they're so well-conditioned that can be up to 50 or 45 even, that's fine, but if this doesn't fit into your health picture then ask your doctor about it. Now we're going to revisit this over-and-over again, this thing that you're the CEO of your own health. That you need to hire a doctor who's willing to have these conversations with you and can support you in the process of achieving optimal health. Now one thing even more important then your heart rate, is your heart rate variability. Now this reflects the complexity of your heart rate and the health of your autonomic or automatic nervous system which controls all the unconscious parts of your nervous system such as digestion, and heart rate, and breathing.

The worst heart rate, flat line, no variability. The best is lots of variability so your heart rate isn't 72, but it's 69, 71, 68 1/2, 73 and so on. It varies from beat-to beat. Your heart rate variability is directly correlated to longevity and death. The less variable your heart rate, the more likely you are to die. Most doctors will not measure this, but you can do it on your camera, on your iPhone, with lots of different apps. Exercise, meditation, Yoga, saunas, hot-and-cold therapy, all will improve your heart rate variability. Now let's move on to blood pressure. If you lined up all the vessels in your body, there would be 59,000 miles of blood vessels.

That's almost seven times around the earth, oh my goodness. Now these vessels carry over 7,500 liters of blood throughout your body every day. As the heart beats this blood is pushed against the artery walls and that creates an increase in pressure. Blood pressure has two numbers. The top number is systolic, that's the pressure when the heart is contracting, and the bottom number is diastolic, and this is the pressure when the heart is at rest, or relaxing. The normal blood pressure limit keeps changing because what we keep finding is that what we used to think of as normal, first 140/90, then 130/80, is still correlated with higher risk of stroke and heart attack. Your doctor may mention your blood pressure only if it's over 130/80. Now the reason that blood pressure is important is that when it's elevated it puts extra pressure and demand on your arteries and heart which can lead to heart disease, or stroke, or heart failure, or even kidney failure. But it isn't only your heart that's impacted by your blood pressure, it's your brain, and your kidneys, and your eyes, all can be impacted leading to strokes, dementia, kidney failure, blindness, and more.

Keeping your blood pressure at an optimal level is crucial for your overall health and this is really important to work on sooner, rather than later, if your blood pressure is starting to creep up. In fact, the ideal blood pressure is now thought to be under 120/80, but it may turn out to be even lower. My blood pressure is 110/70 and I think that's good. Too high is bad, but also is too low. Now a good functional medicine doc will not only discuss if you have elevated blood pressures, but they will also talk to you if your blood pressure is too low.

A blood pressure below 100/60 may be problematic, not necessarily, but may be problematic if there are symptoms associated. We can think of the vessels in the heart as this mechanical system, like pistons in a car. If we don't have enough pressure built up then it becomes really hard to move the blood against gravity. Since our brain is positioned higher than our heart, we rely on this pressure system to supply our brain with adequate oxygen and nutrients in order to just function at normal speed. If your blood pressure is too low, you might have other symptoms, like fatigue. You might get dizzy when you stand up. You might feel weak. You might have brain fog. And chronically elevated blood pressure, and chronically low blood pressure may both contribute to an increased risk of dementia.

So we've talked about heart rate, we've talked about blood pressure. Now what about your body temp? Everybody knows that an elevated body temperature can mean you have an infection of some sort, it's a fever. But our temperature can also give us insight about our metabolism. The lower someone's metabolism, the less heat they produce which may show up as a slightly lower-than-normal body temp. The thyroid plays a big role in metabolism. And regulating your temperature, so you're always running on the cold side, you might want to discuss ordering the right thyroid panel with your doctor. So what tests should you ask for? Don't worry, we're going to dive into the thyroid tests in the video on hormones. You're temperature should be about 98.6 Fahrenheit. If it's lower than 97.7 it may mean you have a thyroid problem. The last measurements we're going to talk about in this section, are your height and your weight.

Now your doctor uses your height and weight to calculate your body mass index, or BMI. However, this number doesn't factor in your body composition, percentage of body that's made up of fat versus muscle. So let's take Ron for example. Ron Gronowski, a pro football player. He's 6'6" and 265 pounds. Now this equates to a body mass index of over 30 which puts him in the obese category. Now if you've seen him with his shirt off you would never categorize him as obese. This shows you that BMI isn't a very useful measurement especially for athletes. Also having a low BMI, if you're a 65-year-old woman with a BMI that's optimal of 21, you could be almost mostly fat, because you've lost muscle 'cause you never exercise and be very sick even though you're not fat. Instead a lot of functional medicine docs will use waist-to-hip measurements. Is your belly bigger than it should be? This is a super simple measurement you can do at home and it gives you an idea of your body fat distribution which is a better indicator of your risk of metabolic dysfunction. It's so important since the biggest single health problem, globally we face, is the metabolic disaster that has lead to global epidemic of obesity, type 2 diabetes, and heart disease. All these are caused by excess belly fat, or fat around your organs. When we're accumulating fat around the mid section, we're at a really high risk for heart disease, and metabolic issues like diabetes, things like cancer, dementia, and much more. I'm going to show you quickly how to calculate your waist and hip ratio. So when we accumulate fat around our mid section we're at a high risk for these cardiovascular and metabolic diseases like heart disease, diabetes, cancer, and even dementia.

I'm going to explain and then I'm going to show you later how to calculate your waist to hip ratio. First for the waist you basically take your fattest part, not the skinny part, where your belt is if you're overweight and you have that hanging belly, but right around the biggest part around your belly button usually is where it is. And then for your waist you take the biggest part around your waist which is usually where your hip bones are on the side. So you do those measurements and then you divide your waist by your hip.

Now this is really the most important number to look at. Unless you're a skinny old lady or something with low muscle mass, and you have to use a body composition machine, but this is a good second best. Now in men a waist-to-hip ratio of less than 0.9 is ideal. If it's greater than one, meaning your belly is bigger than our hips, I mean, you actually just need a mirror to look and tell you this, honestly, but then if it's greater than one, it puts men into the category of high-risk for metabolic syndrome, for heart disease, diabetes, stroke, cancer, and dementia. For women anything less than 0.8 is good and anything over 0.85 is high-risk for metabolic syndrome for women. So that's it. These are vitals. These are not numbers that should just sit in your medical chart, they matter after all. They're vital to your health. Understanding how your body works, as a unique organism, is really important to optimize your health.

So next time you are at your doctor's office, ask what your measurements are and have a conversation with your doctor if you're out of the optimal ranges. I truly believe that doing a combination of your own research, and building a great relationship with a qualified practitioner, can lead you on the road to great health. Now healthcare is a team sport and finding a doctor that will work with you well is essential to getting the results that you deserve. If your doctor is not willing to have a conversation with you about your health goals, or the lab work that's needed to track your results, then you might want to consider finding another doctor. Your doctor works for you. They need to be in your corner.

Your doctor is supposed to help you. If you learned something today about the simplest measurements in medicine then you will definitely enjoy the next video where we discuss some blood tests that can be used to determine if you have any nutritional deficiencies. See over 90% of Americans are deficient in nutrients at the RDA level.

That's the minimum amount to prevent deficiency diseases like scurvy and rickets. Not the optimal amount to create robust health. We're going to discuss how a functional medicine doctor looks at some of the results in a different light, and what tests your doctor might be unaware of, but can tell us a lot about your nutritional status. Thanks again for joining me so far and I'll see ya tomorrow.

Jeff: Taking control of our healthcare is such an important step in our individual journeys to healing. Because health isn’t a final destination, it’s an ever-changing journey, one that requires us to stay in touch with our bodies, and to make sure that we have the support we need to take care of ourselves.

To learn more or explore the many courses Commune offers, click the links in the show notes, or go to www.onecommune.com.

Thanks for listening to The Commune Podcast! We’re back with new episodes every week, so hit subscribe, leave a review, and share us with a friend.

I’m Jeff Krasno, and I’ll see you next week.

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