Autoimmune disease is recognized as a major health crisis in the United States. Today, 50 million Americans—80 percent of whom are women—suffer one or more autoimmune conditions. Thirty years ago, only one in 400 people developed an autoimmune disease. Today, one in 12 Americans—one in nine women—have an autoimmune disease. More women are diagnosed each year with an autoimmune disease than breast cancer and cardiovascular disease combined.
An autoimmune disease is a condition in which the immune system mistakenly attacks the body’s own tissue. Some of the more common conditions include rheumatoid arthritis, lupus, multiple sclerosis, psoriasis, Hashimoto’s thyroiditis, type 1 diabetes, and ulcerative colitis or Crohn’s disease, but the National Institutes of Health estimates there are more than 100 types of autoimmune diseases.
David J. Bilstrom, MD—the Director of the International Autoimmune Institute & Bingham Memorial Center for Functional Medicine—provides information about the importance of proper lab testing, the correct interpretation of those labs, and following proper treatment options.
Understanding lab tests
Blood work is one of four types of lab work that we like to get on everyone with an autoimmune disease. There’s a lot of importance in what gets ordered and the results that are found. However, the interpretation of the results is the most important of all.
“Many people have the experience where they just don’t feel that well,” says Dr. Bilstrom. “They go in to a see a physician, blood work is ordered, and then the lab tests come back and the patient is told ‘oh, everything looks fine.’”
In most cases, people know that’s not true and they definitely don’t feel fine; they know that there’s something wrong and perhaps they wonder if the wrong tests were taken. Sometimes the right tests might be run but the interpretation is off. Or, truly the tests weren’t done in-depth enough to really discover what’s going on.
The reason results need to be interpreted is because of the reference ranges, also referred to as normal ranges, for each test.
“Most of the time people treat the reference range as ‘that’s where the healthy people are,’” says Dr. Bilstrom. “When a person’s results come back as being within the range they are told, ‘You’re fine. You’re healthy. You’re good. Don’t worry.’”
“The problem is that range is not based on where the healthy people are,” says Dr. Bilstrom. “What I do when we review labs is write down “where the healthy people are” and if someone’s results are not in that range, then we wonder if we can help a patient get into that range, will they feel like a healthy person? Like an astronaut, for example.”
There is a difference between the statistical range that is used to determine the “reference/normal” range and the physiologic range—where human beings are optimally functioning. The statistical range is simply based on statistics and who has been tested.
“When labs test people, they test a lot of people, and they get a lot of results,” explains Dr. Bilstrom. “Some results are on the lower end of the range and some results are on the upper end. If I, for example, decide to test the height of 100 people, I will find that some people are short, some people are tall, but most people fall in the middle.”
When a lot of testing is done, there tends to be a distribution of results that looks like a bell-shaped curve with the mean (average results) right down the middle. Like a grading curve in school. Some results are on the lower end and some results are on the upper end, with the majority in the middle. When labs see this distribution, they say “how can we come up with some kind of range to put on this result sheet.”
In statistics, 95 percent of all results fall within two standard deviations of the mean, which is two portions towards the higher numbers and two portions towards the lowers numbers from the mean, or the average of the results in the middle. When someone is within the range, it doesn’t mean you’re fine, you’re healthy, or you’re great. What it really means is you’re not one of the five worse out of 100.
“It’s like taking a test in school,” explains Dr. Bilstrom. “If you’re within the range, you’re not an ‘F.’ But that leaves you somewhere between a ‘D-minus’ and an ‘A-plus.’ It’s nice not to be an ‘F,’ but you also don’t really want to be average at a ‘C, D, or D-minus’ either. Where you really want to be is an ‘A to B-plus,’ because that’s where the healthy people are.”
If anything ever falls out of the reference range on a blood lab test, whether it’s on the high or low end, then automatically that person is considered one of the five worst. If someone’s results falls within the range, we know they’re not an ‘F’ but more information will be needed—to understand their true ranking.
Knowing that statistics determine the reference range, that’s one reason why different labs have different reference ranges. No matter what sample group they start with, only five out of 100 can fall out of the range. It can be 100 sick people—only five fall out—or 100 healthy people—only five fall out. And usually the people that have tests run aren’t feeling so good. You’re being compared to people who are already sick.
“If we wait to treat someone when they are actually the five worst out of 100, you’re basically waiting until someone is almost dead before they are treated,” explains Dr. Bilstrom. “This is as opposed to treating someone when they are starting to have issues and trying to get them to the same place our astronauts are at because those are some of the healthiest people.”
Problems with varying reference ranges
Another thing to take into consideration is that in different populations, results vary. This is why there are different reference ranges in different populations. A good example of this is the reference range for vitamin D. A lot of labs will have vitamin D reference ranges—the amount someone should have in their body for normal function—between 20 and 80, sometimes 20 to 90, or sometimes 30 to 100.
“An example of how variable these ranges can be is when I practiced medicine in Chicago,” says Dr. Bilstrom. “Some of my patients would get their labs drawn at the University of Chicago, and the reference range for vitamin D at the University of Chicago was 10 to 50.”
This is alarming because scientifically it is known that vitamin D levels in children should be at least 30 to prevent rickets. Also, someone really should be in the mid to upper 40s to prevent cardiovascular disease. “And, if every woman had a vitamin D level of 53 or above, there would be 50 percent less cases of breast cancer,” states Dr. Bilstrom.
“One may think ‘how can there be a reference range for vitamin D that’s at 10 to 50, and how can people be told that if they have a vitamin D level of 11, that they’re fine,” says Dr. Bilstrom. “That’s one of the things that makes those reference ranges so confusing. And, it’s not only confusing for the people that are getting the tests, but also for physicians themselves.”
One of the reasons that makes Dr. Bilstrom’ s medical practice so unique is that he takes the time to thoroughly talk to his patients about the differences between physiological versus statistical range. He draws pictures on their reports so they can take them home and share them with their primary care physician in their own community.
“One example of how interpreting lab results and understanding treatments amongst other physicians can be confusing comes from a patient I see from Boston,” says Dr. Bilstrom. “She had extremely low levels of iron, one of the five worst out of 100, so I recommended she receive iron through an IV once a week for two weeks.”
She returned to Boston and shared all of the information that had been given to her, including all of the notes from Dr. Bilstrom on her bloodwork, with her primary care doctor. Her physician, who is a very fine physician, really could not understand the recommendation. And, thus, when she saw that her iron levels were extremely low, her physician said, “it’s not that low—you’re just barely out of the range.” Her doctor then told her she really didn’t need IV iron, and to just take an iron pill.
“Unfortunately, taking iron orally takes several years to ever significantly change iron levels, as opposed two weeks with an IV, which could make a profound impact on a person’s health,” says Dr. Bilstrom. One reason iron is so important is that it carries oxygen around the body. It kind of comes in handy to have oxygen in your body. You don’t get very far without oxygen in your system. “This kind of misinterpretation of the results can then make it difficult to produce these really profound changes in these chronic health issues.”
Instead of an IV iron treatment once a week, for only two weeks that could totally correct the iron deficiency right away, the recommendation was to take iron orally that’s going to take a good three, four, or even five or more years to correct the iron deficiency, optimally.
“Please remember that your body is always ready to heal,” says Dr. Bilstrom. “It just needs to be given a chance.”
About David Bilstrom, MD
Dr. Bilstrom is Director of the International Autoimmune Institute & Bingham Memorial Center for Functional Medicine, which is the first medical center in the country to treat all types of autoimmune diseases. It is also the first to use nature, and its ability to improve human health and well-being, as an integral part of a wellness program.
Dr. Bilstrom works closely with experts in a number of medical specialties to evaluate, diagnose and treat chronic and autoimmune diseases. He is always welcoming new patients at his office within the Bingham Specialty Plaza in Blackfoot. Appointments can be scheduled by calling (208) 782-2444.
Taking the mind, body, and spirit into consideration, Dr. Bilstrom understands firsthand the benefits integrated medicine can provide to patients. He is quadruple board certified in Functional and Regenerative Medicine, Integrative Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. He has extensive experience in Anti-Aging & Regenerative Medicine, Acupuncture, Integrative Medicine, and Complementary and Alternative Medicines.
Bingham Specialty Plaza
326 Poplar Street
T: (208) 782-2444