blood tests
Ann Louise Gittleman, PhD, CNS

Ann Louise Gittleman, PhD, CNS

Award-winning nutritionist and New York Times bestselling author.

July 26, 2019

Getting Healthy by the Numbers

Become your own health advocate by learning to read what your test results really mean.

Each year, we flock to our healthcare providers’ offices looking to see how our dietary and exercise habits – good or bad – have affected our health. Thanks to most health insurances covering – if not requiring – yearly physicals, blood tests for preventative health have become the norm. But when the letter comes, saying your results are “normal,” what does that actually mean? And are the standard tests they run really the most accurate tests to determine the status of your health?

The Truth About Testing

Every laboratory has a standard reference range they include with the results of your tests when they send them to your healthcare provider. But, it’s up to your provider to interpret the tests beyond that range of normal values and apply it to your individual situation. Unfortunately, we get very little face-to-face time with our chosen healthcare providers today, and as a result they often use only the lab’s normal range to interpret your testing.

What you may not know is that there is an abundance of evidence-based research out there that shows there’s a better set of data known as the “optimal range” that more accurately predicts your risk of underlying disease. These ranges are not provided by the lab but are available to anyone willing to look at the research – including you. There are also other factors that should be taken into account that affect your results, like whether you are well hydrated before testing, whether you fasted the required length of time, or if you misunderstood the directions in any way.

Did you know you don’t have to settle for the standard letter summarizing your results? You can request the actual numerical results that your provider sees, or some clinics and hospitals will give you access to an online portal where all of your results are available at the click of a button. And, many tests are now available at your request, without needing to see a doctor first. Here’s what you need to know about some of the important preventative tests I recommend getting.

Tips for Accurate Testing

Testing for preventative health issues is a great investment. For the best results, follow these tips:

  1. Stay hydrated. When you’ve been exercising or out in the heat and not drinking enough water, you can become dehydrated, and this affects the total volume and concentration of your blood. When you are even mildly dehydrated, your blood becomes more concentrated and can falsely elevate your test results. So, for example, if your blood sugar has always been ideal, it came come back high if you are dehydrated. On the other hand, if you’ve always been slightly anemic, dehydration can make it look like you no longer have low iron, when that isn’t the case.
  2. Make sure you understand the directions for fasting blood work – and follow them. Fasting blood work can vary in the amount of time you need to go without food, and whether you can take medications before the test. Make sure you understand if you need to fast for 8 hours instead of 12, and what exactly you can’t have during the fast. Most fasting blood tests allow you to drink water and aren’t affected by fasting longer than the amount stated.
  3. If you become ill before testing, contact the lab or your provider before you go. There are excellent preventative tests that will be invalid if you have even a common cold or allergies. And even a small bout of diarrhea or vomiting can cause mild dehydration or upset your electrolyte balance. It’s better to reschedule testing for when you are well, since it is a measure of your wellness that you are seeking in the results.
  4. Notify your provider of all of your medications and nutritional supplements before testing. Some tests are only accurate when certain medication and supplements are stopped for at least a few days before testing, or may require a different test entirely. This is especially true for over-the-counter progesterone creams and adrenal supplements. If you are unsure and your provider is unfamiliar with the supplements you are taking, it’s best to stop them 3 to 5 days before your testing to be on the safe side.
  5. Just because your clinic won’t order the test for you, doesn’t mean you can’t get it done. In some states, the testing you can get done through your clinic you can order for yourself – although insurance may not cover it this way. This is an excellent option if you don’t have insurance, if you want to be sure the same lab does your testing from year to year, or if you just want an added layer of privacy. All states allow mail order testing, so if the lab tests you want aren’t available without a healthcare provider’s order, then check into UNI KEY Health and other online sources for your testing needs.

Blood Chemistry and Mortality Risk

The results from your Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP or Chem Panel) can be used to determine your risk of dying from any disease in the next month, year, and 5 years, using the Intermountain Risk Score Calculator. This calculator is based on data from tens of thousands of research participants spanning several years. You may think your blood test results look good, your diet is healthy, and you exercise moderately, but you could have a higher than normal 5-year mortality rate because of health issues you aren’t aware of.

Even though these lab tests are routinely done, they are complex and rich with information, making them difficult to interpret. Here are some simple things you can look for:

  • A WBC (White Blood Cell Count) under 3.0 indicates you likely have a virus, so if Epstein-Barr Virus has been an issue for you in the past, this could be a hint to its reactivation.
  • Eosinophils that are elevated can be a sign of allergies, parasite infection, or leaky gut syndrome.
  • The fasting (for at least 8 hours) Glucose on the CMP has a very narrow optimal range, according to several studies. While the lab declares normal to be anywhere from 70 to 100 mg/dL, the optimal range is only 82 to 88 mg/dL.
  • Two tests for liver health on the CMP are AST and ALT. The ratio of these two tests is an important indicator of Non-Alcoholic Fatty Liver Disease (NAFLD). When ALT is significantly higher than AST, the ratio is less than 1, which is an indicator of NAFLD. If this is the case for you, I strongly recommend testing your fasting Triglycerides and GGT levels, measuring your BMI and waist circumference, and using this Fatty Liver Index calculator to get your score. According to studies, this calculator is more than 85% accurate in determining whether you have NAFLD.

Do You Have the Inflammation that Causes Heart Disease?

It seems like every disease these days is being traced back to inflammation as its root cause, but how do you know whether the inflammation you have is the type to cause heart disease? The answer lies in a specific measurement of C-Reactive Protein in your blood, called the Cardio CRP or hs-CRP test. This is an early marker of inflammation that is specific to cardiovascular disease. Studies show this test is an accurate predictor of heart disease – whether it runs in your family or you have no history of it at all.

The laboratory normal range for this test is 0 to 3 mg/dL. The optimal range is much more narrow, and is different for men and women. For women, you want the result less than 1.5 mg/dL, and for men it should be less than 0.55 mg/dL. This test won’t be accurate if you have high levels of other types of inflammation, like uncontrolled autoimmune disease or an active acute illness like influenza. Once your overall inflammation decreases, this test can be done.

Fasting Insulin Is NOT Just About Diabetes

Unless your provider specializes in Functional Medicine, you’ve most likely not heard of testing your fasting insulin level. Fasting blood sugar (glucose) is covered on the CMP, but fasting insulin is not. An elevated fasting insulin level can be a sign of insulin resistance, and that you may be developing one or more of any number of associated chronic conditions, including obesity, metabolic syndrome, diabetes, cardiovascular disease, and even cancer.

Insulin resistance happens when your diet doesn’t match your physiology. Too many carbs, too much sugar, and not enough exercise to offset these cause blood sugar levels to rise, which then signals insulin levels to rise. If you have high levels of insulin circulating while you are fasting, when there hasn’t been a meal to trigger this release, then it is a sign you are insulin resistant, and this should be a warning to you to take action.

The normal range for fasting insulin from the lab is huge, from 2.6 to 24.9. The reason for this range is because the data was based on diabetics only, not the population as a whole. The optimal range is anything under 5, for both males and females.

Iron Overload

When it comes to iron, too much is NOT a good thing. Iron overload affects the health of your brain, liver, and heart, and is a harbinger of heart disease. Young women have the greatest need of iron, but men and postmenopausal women have a much lower need for iron, which is why there are multivitamins that don’t contain iron marketed specifically to them.

Serum ferritin should be tested yearly, as a marker of your iron stores. The optimal range for men is 50 to 70 ng/mL, and for women is 20 to 40 ng/mL, with postmenopausal women tending to be at the higher end of the range.

What You Need to Know About Thyroid Testing

Countless clients have come to me over the years convinced they have a thyroid problem – and I believe them. But, while they have all of the classic symptoms, their blood testing is in the normal range. There are two main reasons for this – first, their thyroid hormones aren’t biologically active, and second, the normal range is not the range for optimal thyroid function.

The hormones your thyroid makes rely on a steady supply of iodine in order to be biologically active. Iodine is in the halide family on the Periodic Table of the Elements. So, when iodine is in short supply, your body will use any of the other halides – fluoride, bromide, etc. – as a replacement. But, when these replacements are used, the hormones are no longer biologically active. The blood tests used can’t tell the difference between them, so your T4 and T3 levels look normal, even when the hormones aren’t usable.

The first comment I often hear in response to this is, “But, I use iodized table salt!” This salt was introduced back when goiters were becoming epidemic, and while it may keep a goiter at bay, it isn’t enough to feed your industrious thyroid. And, considering the amount of fluoride we get through our toothpaste and drinking water, plus the amount of bromide we get from processed foods, the tiny amount of iodine present in that salt is outcompeted thousands of times over by the fluoride and bromide alone.

The second reason thyroid diagnoses are missed is because of the lab’s normal range for the tests. First of all, it’s often just the TSH (Thyroid Stimulating Hormone) test that is ordered, and that is honestly more a measure of how your brain is responding to the signal from your thyroid than it is a measure of the thyroid itself. The proper thyroid tests need to be ordered to accurately measure your thyroid function. Here are the tests I recommend with their optimal ranges:

TSH:          0.3 to 3

Free T4:    1.2 to 2

Free T3:    3 to 4.5

Thyroid testing doesn’t need to be done yearly or as a preventative, unless you have a personal or family history of it.


For a FREE daily dose of tips and strategies for maintaining healthy weight, conquering insomnia, and much more… check out my Radical Health Tips.


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Ann Louise Gittleman, PhD, CNS, is an award-winning New York Times bestselling author of more than thirty books including The Fat Flush Plan series and her latest book, Radical Metabolism. She’s been rewriting the rules of nutrition for more than 40 years and is internationally recognized as a pioneer in the field of diet, detox and women’s health issues. 

For a FREE daily dose of tips and strategies for maintaining healthy weight, conquering insomnia, and much more…check out my Radical Health Tips.

I’d like to meet and greet you on my Facebook groups, so won’t you check us out at the Radical Metabolism RevolutionFat Flush Nation, or my Inner Circle!


  1. Cindy

    Love your tips for accurate testing! This is a really helpful article!

  2. Melanie

    I recommend having the blood draw scheduled in advance of your doctor appointment, if possible, so you can discuss particular concerns based on the results. This is usually possible, just contact the clinic ahead of time so the orders are available to the phlebotomists.


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