Understanding Lab Numbers

Transcript:

LEAH: Welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. We are a Minnesota company that specializes in real food nutrition education and counseling. At the time when this podcast airs, we'll be celebrating Thanksgiving in a few days. I wanted to take a moment of gratitude and to thank all of our clients and all of you listeners out there for your dedication to real food for real health over the last year.

Whether you are one of Dar’s original clients in the old St. Paul office, or this is your first episode of listening to Dishing Up Nutrition, please know that you are a vital and appreciated part of the NWW family. Thank you for trusting in us and trusting in the real food message that we strive to put out every single week.

TERESA: Yes, Leah, I share your sentiment. It is a great time of year to take an extra moment to think about some of the things we may take for granted in our everyday lives. One of those things for me is how grateful I am to have the privilege of sharing this real food message with all of you. In the spirit of gratitude and taking time to reflect, I would like to pose a few questions to those of you listening.

How has real food impacted your health over the last year? Do you look at food differently now this year than you did maybe before? What kinds of successes have you seen from changing your food choices? Does your memory work better? Do your knees or your back or your hips give you less trouble? Are your hair and nails growing thicker and stronger?

Are you no longer having diarrhea four times a day and/or reflux every single night? Do you have effortless energy to get through your workday now? Are you able to avoid the afternoon crash or avoid falling asleep on the couch at 7 PM? Besides the weight on the scale, there are so many ways to measure health.

LEAH: Yeah. And there is such power in knowing and paying attention to the signals that our body gives us. But another way we can get triangulated in on our health is by getting lab work done every now and again. For most people, you get some basic labs drawn at your annual physical or your wellness visit.

Some people get annual or even biannual lab work done through their workplace or through their health insurance. A lot of times you need to get blood work done before you go in for a procedure or you have a surgery done.

And sometimes you need blood work done on a regular ongoing basis in order to monitor changes in lifestyle efforts or medication adjustments. So we wanted to do a whole show today dedicated to understanding lab numbers that we as dietitians see a lot and that you might get at your doctor's office.

TERESA: I frequently get asked by clients, what labs should I ask for when I go to see my doctor? Well, this is the episode to answer that burning question. You might want to get a pen and paper out or bookmark this episode to go back to, as we are going to go over a lot of different labs, what they mean, and what ranges we are looking for.

I'll give you a hint. Sometimes the ranges that are normal on the lab report aren't always optimal. And we want to be optimal, right? You might even want to pause this episode for a minute, log into your, MyChart or whatever healthcare portal you use, pull up your most recent labs and follow along with us.

If you've ever felt a little lost or overwhelmed with all the letters, numbers, red flags, yellow triangles, or exclamation marks, we hope this show will provide some simplicity and clarification on your numbers so you can feel confident again in what you're seeing.

LEAH: Yeah. And I know not everyone loves to get their labs done. I've had some clients say it feels like they're getting a report card like they did back in school. But I personally love when a client brings in lab work or uploads their recent lab documents for me to look at. It just adds another layer or another lens through which we can analyze things.

So I often will tell my clients it's like checking under the hood of the car. So what labs would be on my wish list for a client?

Check labs surrounding blood sugar control

Well, let's start with checking blood sugar control because would it even be a Dishing Up Nutrition episode if we didn't talk about blood sugar?

TERESA: I don't think so.

LEAH: Probably not. So I'd be looking for three things: a fasting glucose, a hemoglobin A1C, and a fasting insulin. Fasting glucose and fasting insulin, as the names imply, are taken in a fasted state when you haven't eaten anything, usually for at least 8 hours, and usually there's a range given like between 8 to 12 hours. For this reason, most people schedule their labs to be drawn in the morning after you've had an overnight fast, or hopefully you've been sleeping most of that time.

TERESA: A fasting glucose or a fasting blood sugar is a very standard lab test. It can be a standalone test, but most of the time you'll find it as a part of a comprehensive metabolic panel or CMP. And it may just say glucose. A fasting glucose is a snapshot of where your blood sugar is at the time when your blood was taken.

The normal range given is usually between 60 and 100 milligrams per deciliter. I like to keep that upper part of that range just a little bit lower. I'd rather see the fasting glucose at less than 90 milligrams per deciliter. I don't know what your thoughts are on that, Leah.

LEAH: Yeah. I would, I'd say the same thing, you know, blood sugar is a spectrum, not necessarily a black and white, yes, no situation. We can't say that at 101 milligrams per deciliter, you have prediabetes, but at 99 milligrams per deciliter, you are totally fine and there's nothing to worry about. You know, a reading of like 98 or 99 would raise a caution flag for me.

And I'm going to asterisk that and say like the occasional fasting glucose that's in the 90s or slightly over 100 usually isn't a big cause for concern, but if you're consistently seeing those blood sugars in the high 90s or 100s for that fasting glucose, it's definitely time to take a closer look.

TERESA: If you have that sort of random high nineties or maybe just over a hundred, you can look and see, well, what's going on in my life. Have I been sick? Do I have a lot of extra stress in my life? So it could be, that could be the outlier that's causing that spike in blood sugar. That's not usually where that is. And so sometimes that can really put people's minds at rest, like, oh yeah, I was just getting over an infection.

LEAH: Yeah. Or if you didn't sleep well the night before or something like that.

TERESA: Oh yeah. Good point.

LEAH: Not sleeping is an easy way to shoot those blood sugars up. So yeah, that's a great point. But that does take me to the next step in the process, that hemoglobin A1C. So we said that, that blood, that fasting glucose is a snapshot, just kind of like taking a picture of what your blood sugar is doing in that moment.

A hemoglobin A1C gives us a bigger picture. It gives us an average glucose levels over the last three-ish months or so. A hemoglobin A1C measures the amount of sugar that accumulates on the molecule hemoglobin, which is a part of our red blood cells. And a red blood cell lives about three months in the body.

TERESA: And that hemoglobin A1C just to kind of say some of the same things that you were saying, Leah, is it's a value. It's given in percentages and it's the percentage of how much sugar is attached to that red blood sugar molecule, particularly to the hemoglobin. And I think for me it's helpful to visualize some of this, you know, you have your red blood cell.

But hemoglobin is a protein that's a part of that red blood cell. And that hemoglobin is responsible for carrying that oxygen from our lungs to the rest of our body. So that's what that sugar is sticking to is that protein molecule. So when we have sugar floating around in our bloodstream and it encounters the red blood cells, it attaches itself to that protein, to that hemoglobin, where it will stay for the rest of that red blood cell’s life, which is that three months that you said.

LEAH: Yep.

TERESA: So in those percentages, normal is anything under 5.6%. 5.7 to 6.4 percent is considered prediabetes. 6.5 percent or over is type 2 diabetes. So this is another example, like we were talking about before with the fasting blood sugar. This is another example where I get a little concerned if I see an A1C at that 5.5 or 5.6.

It's like just in that normal, but just getting towards that, okay, we're starting to see some blood sugar imbalances. It's still considered normal and your provider may not mention anything, but to me that says, well, we might not be on the right path here with our food choices for good blood sugar management and for overall health. So a more ideal range would be more in that 5.4 percent or lower. Once an A1C gets over 5.2%, there's potential to see brain shrinkage. Isn't that wild?

LEAH: Yeah, that's really wild, and I remember that nugget that came out of that conference, and when the presenter said that, it just kind of made me do a little inhale of like, okay, like, we really have to have some good glucose control if we want that overall health, like you said. And I recently had a client, this is a great example, I think, so she brought me some of her lab work. We had already met once previously, and then she brought some lab work in. She had a fasting glucose of 84, so again, by all standards, like that's a pretty good glucose, but her hemoglobin A1c was 5.5%.

And her provider hadn't mentioned anything about her blood sugar in the note that she sent. But I did point this out to the client that this was a trend that I was like, okay, I would love to keep an eye on this and make sure we don't go any higher than this. Ideally, we'd love to inch that number a little bit lower.

And for her, it also reinforced some of the things that we had already talked about in that previous appointment. We had focused on her blood sugar control and how that would be helpful for her weight loss and her energy so seeing some of those numbers for her just reinforced like, yes, we're already on the right path. We were kind of talking about the right things already.

TERESA: And it's another way to measure success, right? As you're, you know, hey, I'm putting all this work into changing my eating habits. You can watch the scale go down if that was part of your goal, but you can also watch that hemoglobin A1C.

LEAH: So, yeah, I think it's helpful to cross reference that fasting glucose with the hemoglobin A1C just to get a better picture of what those blood sugars are doing. And unfortunately, more often than I'd like, I find that clients do have to ask for that hemoglobin A1C to be done, especially if there's no family history of diabetes or a personal history of gestational diabetes. Most providers are willing to order it. It just might not always be on the top of their mind. So it might be you as the patient having to bring it up.

Overviewing fasting insulin level

TERESA: Yeah, that's a good point. And I do think that, you know, your doctor is a part of your team and they want to help you out. Let's talk about fasting insulin levels. This one is not as common of a lab as fasting glucose or a hemoglobin A1C. This one you'll definitely have to ask for. And even then there may be some hesitation from the ordering provider. I always tell my clients, they can throw me under the bus and tell their provider that their dietitian is asking to have that lab be done.

A fasting insulin level, like a fasting glucose level, is a snapshot of what your insulin level is at the time of the blood draw. After an extended period of time of not eating. Like fasting glucose, this number should be pretty low if the insulin isn't dealing with the glucose from a recent meal. If it is high, even after a longer period of fasting, that means you'll likely have a fair amount of insulin resistance and your fat cells will remain on lockdown, meaning that high insulin makes it difficult to access the fat stores in your body and makes weight loss very challenging.

LEAH: Yeah. And I remember learning early on in my career here at Nutritional Weight & Wellness that you'll often see insulin levels on lab work go up before you start to see the blood sugar levels go up. So by the time you actually start to see a higher A1C or a higher fasting glucose, you very well already may be down the rabbit hole of insulin resistance.

So it makes sense that if you can, get a measure on insulin instead of waiting for things to get wonky with your blood sugar. And so then, what are we looking at in terms of fasting insulin? Normal insulin is considered to be between 2 and something like 24 to 25 microunits per milliliter.

Now, there is some variation in what's considered ideal, depending on the research or the providers that you talk to, but a range of seven to eight microunits per milliliter is often what's thrown out there. I'll usually tell my clients, if we can get you into the single digits, we're doing pretty good.

The importance of vitamin D

TERESA: Yeah, I agree. Well, on that note, I think that wraps up lab work for blood sugar. So let's move on to vitamin D. Vitamin D is a simple blood test and an important one when it comes to our risk for seasonal, affective, or other mood disorders. It also plays a significant role in our risk of osteoporosis, cardiovascular disease, cancer, autoimmune conditions, and many, many more.

With the days getting colder and darker here in the Northern Hemisphere, our main source of vitamin D has pretty much gone dormant for the next few months. We can still have some clear sunny days during the winter, but just because you can see the sun doesn't mean you are able to make vitamin D.

LEAH: And I think that's a common misconception, right? Just because the sun is out and you can see it, you should be able to make vitamin D and that's not the case.

TERESA: Yeah. In fact, it's funny that you say that because you'll see people that are celebrating the sun being out, maybe on social media and they're saying, hey, I'm out getting my vitamin D. And I always kind of snickered at myself like, well, I don't know. Sure.

LEAH: Yeah. There are benefits to seeing the sun. Absolutely; that are beyond vitamin D. But like, yeah, unfortunately, especially with us being up here in Minnesota, we're past that point of being able to make vitamin D from the sun.

TERESA: I mean, I think seeing the sun boosts our mood, but it's not because of the synthesis of vitamin D. It's, you know, just seeing that sun. Cause it is so great to see the sun. And you also have to think you have to have skin exposed, right? And so for the more north you go, the less skin is probably exposed in these colder months.

So we don't have enough even skin exposure. The reason why we can't make that vitamin D is because the sun is at such a low angle in the sky that anyone who lives north of Atlanta is not going to be able to make that vitamin D from the exposure of the skin to the sun.

So it's going to be a few months before we'll be able to naturally synthesize that vitamin D. There are some food sources that are an okay source of vitamin D like cod liver oil, fatty fish, and egg yolks from pasture raised chickens. But they're not usually going to do the trick alone. Supplementation is often required to maintain a decent vitamin D level year round.

LEAH: Yep. And so that begs the question, what's, what is a decent vitamin D level? Most standard lab ranges will say 30 nanograms per milliliter is sufficient. But ideal is likely at least 50 nanograms per deciliter, and even upwards of 70 to 80 nanograms per milliliter is fine. Actually, the Endocrine Society sets its upper limit at 150 nanograms per deciliter. So, a range of 50 to 70 or 50 to 80 is very reasonable and safe.

In my experience working with clients, who in turn work with their providers. It's a mixed bag as to who's willing to test vitamin D. Some providers are very open to it and some are resistant to it for a variety of reasons. So vitamin D is a lab you may have to ask for.

If I could make a lab wish list, I'd have my clients get their vitamin D level tested at least twice a year, once in the early fall, where hopefully you've spent a lot of time in the sun and you're outside and the weather is nice, so you've built up some nice vitamin D stores, and then get it tested again in the spring time where we’ve kind of come out of several months of winter where this will naturally be your lowest time of the year. So you can kind of get a sense of how do you average throughout the year with your vitamin D level.

TERESA: I think that's super smart.

LEAH: Yeah. But that's my wish list; not always realistic, but even getting it once a year is a win, I think in most people's books.

TERESA: Right. And what I would say spinning off of that is really pick a time of year and then try to be consistent with that time of year. And I generally tell people, I like to test it when I think it's going to be at its lowest, so we know what we need to do. So I like that springtime if possible.

LEAH: Absolutely. Well, we do have to take a quick break, but we will be back in a moment and we will talk more about some of these important lab numbers.

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TERESA: Welcome back. You are listening to our weekly Dishing Up Nutrition podcast. Before we went to break, we were just wrapping up our recommendations for vitamin D levels at your doctor appointments or what we hope to find on a lab test.

Overviewing cholesterol levels/lipid panel

Next on our lab work list is the lipid panel. Or cholesterol panel. I'd say almost no other lab values get people's attention as much as their cholesterol levels. It's been drilled into us for so long that cholesterol is something to be feared and that this is the crux of all heart disease; poor, misunderstood cholesterol.

So let's break this lab down. When you get a standard lipid panel, you will get several different numbers. You'll usually get a total cholesterol number, an HDL number, an LDL number, and a triglyceride number. There's probably also a total cholesterol to HDL ratio number in there too, which provides kind of a quick glance/risk assessment for your provider. That ratio, it should be less than 3.5 for the lower risk tier, and the highest risk tier is over 5.5. So that is your total cholesterol to HDL number in that ratio.

LEAH: So beyond that, the first number I go to on a lipid panel is the triglyceride number. Ideally, this is another lab that would be done fasting.

Triglycerides are a way that the body transports fatty acids throughout the body. These fatty acids come from the fats and the sugars that we eat, and also the fats and the sugars that we have stored in our liver and our fat cells. When triglycerides are high, it means we have a lot of excess energy floating around in the bloodstream.

Having high triglycerides is an independent risk factor for metabolic disease and heart disease. So that just means without looking at anything else, we can say that high triglyceride numbers put you at a higher risk for some of these other chronic diseases. Most labs set the cutoff point at 150 milligrams per deciliter, so higher than 150 would be too high, less than that would be fine. We like to put a cap on that a little earlier and say anything under 100 milligrams per deciliter is better. And even under 75 is amazing.

TERESA: Right. It goes back to that optimal versus good, right?

LEAH: Absolutely. Yep. And we see really great progress and results with our clients who eat a real food, lower carbohydrate diet, and also make sure that they're eating quality fats. So things like butter, olive oil, avocados, nuts and seeds, olives, heavy cream, things like that.

TERESA: Right; out with the daily intake of breads, pastas, cookies, crackers, sodas, high sugar coffee drinks, and candy. And in with the sweet potatoes, wild rice, fruit, and a variety of vegetables.

LEAH: Yum.

TERESA: And after triglycerides, I start to look at the HDL number, which most people know as the good cholesterol. I should put “good cholesterol”. We like to call it the garbage hauler. It gathers cholesterol and particles from the cells in the body and transports them back to the liver to be dealt with. So, I mean, if you think about it, a city without enough garbage trucks would eventually lead to a very dirty city.

The same thing happens if we don't have enough HDL particles in our bloodstream to clean up the trash. So we want that HDL number to be at least 50 mg per deciliter for women and at least 40 milligrams per deciliter for men. A real food eating plan will help boost your HDL levels, as well as regular exercise and eating a lot of fatty fish or taking an omega-3 supplement.

LEAH: Yep, and then there's LDL. This is the one that gets everyone up in arms and most people know it as the, like you said Teresa, “bad cholesterol”. But LDL truly has some amazing and helpful functions in the body. LDL's job is the opposite of HDL. LDL takes cholesterol from the liver to the various cells and tissues in the body. We need that cholesterol for our brain to work well, our hormones to be balanced, and our cell membranes to have good structure, and that's just to name a few things that it does. LDL also takes cholesterol to places in the body that need healing or patching up.

On most lipid panels, the cutoff for LDL cholesterol is 130 milligrams per deciliter. So anything over 130 is considered high and therefore potentially harmful. I don't see a lot of clients who have less than 130 milligrams per deciliter unless they're on a statin medication. And there certainly are exceptions, but I often will see 140s, 150s, 160s even.

TERESA: Right, it's incredibly common. And dare I say, normal for LDL cholesterol to go up as we age. And this is especially true for women as they go through perimenopause and move into the post menopause phase. That big hormone shift often calls on more cholesterol and more LDL. A high sugar diet, low thyroid function or a recent chronic infection can also be reasons why you may see elevated LDL.

If you do see an elevated LDL level in your lipid panel, start with the basics. Eat well, move your body, and sleep well. If those items are in check, then it may warrant asking for additional testing to see what that LDL is made out of, what your inflammation level is like, and if you have any calcium or plaque buildup in the arteries.

An LDL particle test will help determine if that LDL is large and fluffy or small and dense. And if I do have a client that does do a particle test, the number that I'm particularly interested in is labeled as Lp(a). So it's capital L, lowercase p, parentheses little a.

LEAH: It's kind of a funny lab marker.

TERESA: And the reason why it’s that one in particular is it's just known as the particle that's especially damaging to the blood vessels. And so if that number is high, we want to work to lower that Lp(a) number.

There's also something called the coronary calcium test to see if there are any calcium deposits in your coronary arteries. So we can get calcium stuck in our arteries, which then can lead to blockages. So that test is a really good test to have done.

LEAH: Yeah. I have seen several clients who have that elevated LDL, but their coronary calcium score is zero.

TERESA: Which is good.

LEAH: That's what you want. You want a lower score on that test because that means there's less stuff in your arteries blocking them up. So yeah, it's, that high LDL doesn't always correlate with things going wrong in the arteries.

Checking inflammation levels through labs

And then I, also let me take a hold of that inflammation piece really quick because that would be another item on my lab work wish list for clients is getting an idea of where your inflammation level is, and you can do this by doing a high sensitivity C-Reactive Protein Test, or (hs-CRP)

CRP is a protein that's released by the liver in response to infection or inflammation or other malignancies, and that hs-CRP really picks up on low grade inflammation in the blood vessels. Ideally, we'd like to see an hs-CRP level at one milligram per liter or lower. I have seen some labs that will say under three is fine, but again, like tighter range, we probably want to see at one or under.

And just for kind of like a reference range too, my aunt, one of my aunts had a major surgery on the back of her leg maybe a year and a half, two years ago now at this point. They tested her CRP level a day or two after surgery. And it was 70.

TERESA: Yeah.

LEAH: So like very high inflammation after a major surgery and recovery, lots of tissue damage. So that would make obvious sense. That's a pretty extreme example, but like in just kind of going about your daily life, we'd like to see those inflammation levels as low as we can.

Homocysteine: another clue about inflammation levels

Homocysteine is another marker that can give us a clue about inflammation levels. Homocysteine is produced naturally in the body as we break down and metabolize amino acids. But if our bodies can't clear that homocysteine effectively, then we get a buildup of homocysteine in the bloodstream. And so high homocysteine has been correlated with an increased risk for heart issues, osteoporosis, and dementia. So we can't let it run around unchecked.

TERESA: Interestingly, we need B6, folate, and B12 in order to clear homocysteine well. So if we see a high homocysteine, we should be making sure that this person is supplementing with quality forms of those three nutrients and trying to stay away from grain products that are fortified with B vitamins. So, and the reason being is those fortified versions of those B vitamins, they kind of gum up the system, right?

When we have these highly bioavailable versions of B6, folate, and B12, for them to work, they have to attach to those receptor sites, but if we're taking in those fortified synthetic versions that can sort of get in the way of the good versions to do their job.

So for normal homocysteine levels, we want those levels or normal levels are considered to be under 15 micromoles per milliliter. For the normal levels of homocysteine, levels are considered normal under 15 micromoles per liter, but we like to see this number at 8 micromoles per liter or less.

In my experience, homocysteine levels aren't super common to see in lab work. So more often than that, I'll see these done by functional medicine or integrative professionals. But the hs-CRP that Leah was talking about is one that regular doctors have access to. So you probably just need to ask for it.

Overviewing a thyroid panel

LEAH: Yeah. And before our time gets away from us today, I want to bring up two more sets of labs that I feel are important to mention. One is a thyroid panel and honestly, Teresa, you and I were talking about this, like we could do a whole independent show by itself on just this one panel alone. But today, we're just going to hit the high notes.

In my opinion, I think a thyroid panel is so crucial for women to have checked regularly as thyroid issues affect eight to nine times as many women as men. And when we talk about thyroid issues, the majority of the time, we're talking about low thyroid function or hypothyroid function.

That's like 90 percent of thyroid issues out there. The most basic screening for a thyroid abnormality is a TSH or thyroid stimulating hormone. This is the signal from your brain to your thyroid on how much thyroid hormones to make. Now, the normal range for TSH is 0.3 to 5.0 micro units per milliliter.

More ideal might be more between 1 to 2 microunits per milliliter. I start to get a little suspicious if I see a TSH that's getting into the threes, the fours, the fives, because a higher TSH means potentially lower thyroid function. Or I'll tell my clients like, it looks like this is a stressed thyroid.

So the brain is just putting out more signals to say, hey, like we need to make more thyroid hormones. So if I'm working with a client, we start to dig in and just say, hey, what is stressing out this thyroid right now?

TERESA: Right. And beyond that TSH, I really encourage my clients to also ask for a free T4 and a free T3 and also the thyroid antibodies. T4 and T3 are the inactive and active forms of thyroid hormones, respectively. So the T4 is inactive, T3 is the active. The majority of thyroid hormones that are made in the thyroid are that T4 that I was saying.

The T4 travels around the body until it reaches some of the cells that need to use T3. The cells take that T4 and turn it into T3 so that they can do all their metabolic processes. A lot of this conversion is happening in the liver, in the kidneys, and in the gut. You can run into thyroid problems and symptoms if you're not making enough T4, or you're not converting that T4 into T3 effectively.

Deficiencies in nutrients like zinc and selenium can be reasons for these conversion problems, but so can stress and inflammation in the gut. And so when we're looking at the levels, where do we want to see these? I would say normal free T4 levels are 0.8 to 1.9 nanograms per deciliter, and the normal free T3 levels are 2.8 to 4.0 picogram per milliliters.

LEAH: And lastly, thyroid antibodies, so these, the more common ones, especially for testing that low thyroid function, are thyroid peroxidase and antithyroglobulin antibodies. This can tell us if the thyroid is under attack from the immune system. The biggest cause of hypothyroidism or low thyroid function is an autoimmune condition called Hashimoto's thyroiditis.

High levels of antibodies tell us if Hashimoto's is present. Ideally, these antibody levels should be very low, like with the thyroid peroxidase antibodies, they should be under 35, or under 0.94 thyroglobulin antibodies. I once saw, this was very early on, I think I was even training with one of the other nutritionists here at Nutritional Weight & Wellness, we were seeing a client together and this client had TPO or those thyroid peroxidase antibodies, they were over 1200 when she was diagnosed with Hashimoto’s.

So she had a very high level initially. And I remember she was able to, so we had seen her then at a follow up appointment down the road. She was able to drop her antibody levels to around 300 with the interventions that she was doing. She was working on her food and figuring out kind of what foods work for her body and her thyroid and her immune system.

Iron and its importance

TERESA: Yeah. That's pretty incredible. Yeah that is a big drop. I do want to tie in iron levels into this picture also, because it's an important nutrient for that conversion process of T4 to T3. So it's crucial for thyroid health. But having good iron levels also keeps our energy levels up and helps us transport oxygen around the body.

If you ask anyone who has had an iron deficiency before, they'll tell you that they felt tired, sluggish, weak, like their feet are dragging through mud and they could nap at a moment's notice. Some people also feel dizzy and get short of breath. Women tend to fall in that iron deficiency more common than men because of the blood loss with our monthly menstrual cycle.

And women may also be more likely to under consume meat and animal proteins, which are the best food sources of iron. So for my active menstruating female clients, I'm definitely having them keep tabs on their iron levels.

LEAH: Same. So checking a hemoglobin level is one way to check your iron. And I do want to know, like, so hemoglobin is just checking that is different than the hemoglobin A1C that we mentioned earlier that checks blood sugar control.

TERESA: Yes. Thanks for verifying that. Cause that gets confusing.

LEAH: It does. It does. So, you'll see hemoglobin on lab work. Usually it's under a complete blood count, or CBC, and that's where they're also checking your red blood cell count, and your white blood cell count, and a couple other things. A CBC is a very standard lab that usually gets run just automatically as part of your annual physical, your wellness check.

So, for women, a hemoglobin level should be between 12 to 16 grams per deciliter. Men can go a little bit higher. That should be between 13 to 18 grams per deciliter. Hemoglobin is the last number to drop in an iron deficient state. So I encourage my clients to also ask for a ferritin level, which is usually the first iron marker to drop when we start running low in iron.

And ferritin is just the storage form of iron in the liver. So if we're starting to run low in our iron we can still feel those symptoms of iron deficiency, even if that hemoglobin level is in the normal range. And ferritin has a very big range. For women, it's between 13 to 150 or so nanograms per milliliter.

And this might vary a little bit based on the labs. Men have a little bit bigger range, 30 to 200. I've even seen normal ranges up to 400 nanograms per milliliters for men. And I personally have had a ferritin level at 14 before, and I can tell you that did not feel great. So even though technically I was in the normal range, so I can tell you like my workouts did not feel good. I did feel like short of breath and like, why can't I catch my breath? Like I was exhausted after my warmup for my workout.

So I knew something was up and we figured it out that it was a low ferritin. So I usually aim to get women up to around at least 60 nanograms per deciliter with that ferritin. And then we're also just keeping an eye on the hemoglobin too.

TERESA: Yep. And just kind of one thing to note too, going back to our conversation earlier about inflammation, ferritin can also be a sign of inflammation if it's too high. So it gets tricky. I mean, really going through and looking at your numbers is important. It's kind of like the Goldilocks effect. We want things to be not too high, not too low, just right.

Well, this was an information packed episode, lots of labs, ranges and numbers to keep track of. Our goal today was to summarize and simplify. And yet you still may have questions or maybe unsure of what the next steps may be. If that's the case, don't hesitate to call us and make a nutrition counseling appointment to do a deeper dive together.

Schedule Nutrition Counseling

We can set you up with a real food balanced eating plan to support your goals and your lab work. Our phone number is 651-699-3438. And our website is weightandwellness.com.

LEAH: Yes, our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple, yet powerful message. Eating real food is life changing. Thank you for listening, and if you enjoyed this show, please head over to iTunes or your favorite podcast app to leave a review and help others find our show.