Office Hours: The Blood Tests That Actually Matter for Your Health

0:12Welcome to Office Hours. This is our dedicated one-on-one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and each week, we're going to pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here.

0:40Dr. Mark Hyman:This episode is brought to you by Function Health, empowering you to live 100 healthy years with over 160 lab tests at just$365 a year. Sign up today at functionhealth.com slash mark and use code mark2026 to get$50 towards your membership. Imagine spending hundreds, maybe even a thousand dollars on your blood work, only for your doctor to look you in the eye and say, everything's normal, you're fine, but you're not fine. You're exhausted, you have brain fog, you can't lose weight. And that frustrating gap between what the lab says and what your body is screaming is the very reason we created this episode.

1:16We're going to show you why those quote, normal ranges are actually broken and not accurate, and how to find the real hidden story your blood is telling you. Whether you're using a function or just looking at labs your doctor ordered, this is about helping you make sense of your numbers so you can be proactive about your health. I always say, if you go to the doctor and you get a checkup and you feel like crap and your doctor says, well, your exam is fine. Your labs are fine. There's only two possibilities there. One, either you're crazy or your doctor is missing something. And I don't think you're crazy.

1:45And the truth is your doctor is missing something. So let me tell you why understanding labs are important and why understanding how to use them, how to interpret them is even more important. So lab tests are powerful tools for understanding what's going on underneath the hood in your body. They can help you identify things that are cooking along the continuum disease. It doesn't just happen from one day to the next that you get sick. You get sick slowly, invisibly, pre-symptomatically, asymptomatically, until one day you start to get symptoms. And then eventually you get a disease. And then you need a drug.

2:19And then it's just a chronic, vicious cycle from there. And the key here is to understand labs in the context of your biology and how to optimize your health through tuning your system up. It's like all the systems in your car. Everything's got to be tuned up right for your car to run right. You need the right air in the tires. You need the right truing for your steering wheel. You need, I don't know, I'm not a mechanic, but anyway, you get what I'm saying. And the idea is that, you know, we don't really do that to our bodies. We don't have a dashboard for understanding what's happening. Well, this is what we need to do.

2:49We need to have a dashboard. The beautiful thing about what's emerging in science is we have a model now of understanding not only what disease is, but what health is. What we want to look at is not just the normal ranges of your lab tests and not just the typical lab tests that doctors do in a checkup, which is like 20-something labs that really only are abnormal if you're about to die. Like if your liver fails or kidney fails or your electrolytes are off balance or, you know, your blood count is super low. I mean, these are things that we use in the hospital and they're very helpful in acute medicine.

3:19But for a checkup, they're pretty useless and mostly don't show anything. In fact, the annual checkup, as is currently done, has been scientifically shown to be pretty much useless. So what we really want to do is understand the root cause, not just a symptomatic approach. And we want to look at what the body is doing. I co-founded a company called Function Health to really help empower people to be on their own health, to understand what's going on under the hood, to have agency over their health, to be the CEO of their own health and look deeper into the root causes, into subtle disturbances that can lead to symptoms later, diseases, or even to find out things that are currently going on that you might not know about.

4:01I mean, you could have diabetes and not know it. You could have an autoimmune disease and have subtle symptoms that you don't know about that are not tracking. And the beautiful thing about function is it helps you look at things over time, not just a snapshot in time, but a continuous longitudinal deep data set on what's going on with your body. Now, your health's always changing, and that's true throughout your life. You're going through different phases, ages, experiences, and the only way to really understand what's happening inside your body is through doing comprehensive diagnostic testing on a regular basis, not just once a year, not when something goes wrong, consistently, longitudinally, so you can track things, catch problems early, and stay ahead of the problem.

4:40And this way, you know, you can honestly prevent most of the diseases. We're able to stick it in very, very rare signs of metabolic dysfunction, for example, like where they're heading for diabetes or Alzheimer's risk or obviously cardiovascular risk, hormonal dysfunction, and nutritional diseases and deficiencies that are really common that often would lead to problems later on. So most of us are walking around with these blind spots. We don't really know we have these problems. We think we're fine. We don't really know what's going on. And we think how we feel is kind of normal. We just have these subtle symptoms or it's kind of just how we are and i call it the flc syndrome when we feel like crap and and we think it's normal we should have you know headaches or we should have joint pain or we should have sinus issues or we should have migraines or we should be tired or i should have irritable bowel or i'm a little depressed or whatever these are things we come to accept as just part of who we are they're really not they're just signs of imbalances and so we don't really want to guess we want to test and that's what i would say test don't guess and and we want to use real data, including your medical history and your lab data and lots of other information we're collecting with functional health, including wearables and your genetics, eventually stool testing.

5:47And this is really where we have access to stuff that you never had access before, unless you went to the doctor and had him or her know what the order, which they usually don't because they're only looking for acute disease and understand how to interpret them, which they don't and the insurance pay for them, which they won't. So you're kind of stuck in a system that doesn't allow you to be proactive about your health, but that's why we co-founded Function was to help really create that platform where you can do this. And when you look under the hood, you do full body lab testing, just comprehensive testing of every system in your body, not necessarily looking for disease, but also looking for imbalances that lead to disease, doing advanced full body MRI imaging, which we now offer through Ezra as part of Function.

6:26You go to function.com and learn all about this. You get real insights and clarity about what's going on with your health. You can being preventive and proactive instead of just being in a reactive system. We have a reactive medical system, not a proactive system. And that needs to change. We wait until you have a disease and then we give you a treatment. I had a patient once who had a blood sugar of like 115, which was heading towards diabetes. And I said, hey, did your doctor ever check you on this? And he said, oh yeah, we checked. He said, what did the doctor say? Well, he said, we'll follow it.

6:57And when it gets to the diabetes range, we'll give him medication. And I'm like, That is the worst approach. You want to be the opposite of that. And really Function Health was created out of this need for at least what I believe and the co-founders believe was for people to be able to actually have access to their own health data and to own it. And we with Function can test hundreds and hundreds of biomarkers for a dollar a day, which is just really affordable for most people. This is less than a cup of coffee a day. you can get a comprehensive assessment of over 110 biomarkers twice a year and even add on other tests that are advanced tests or looking for alzheimer's autoimmune disease or allergies or other things you might want to look at mold and it'll tell you what's going on it'll help you reveal these patterns it'll give you the clues of what's going on in your body and it'll help guide you with what we call medical intelligence which is a system that allows you to filter all of your personal health data including your history your lab data your wearables everything into a system that also is almost omniscient.

7:56In other words, it knows all the scientific literature. It's been trained by hundreds of knowledge experts. It looks at the data through machine learning AI and helps you to understand where you are, where you're going and what to do about it in a way that we never had possible before, in a way that's way smarter than most doctors and honestly way smarter than me. You know, I've been doing functional medicine and doing this for 40 years. It's really so good in terms of understanding what's happening in the pattern. So let's talk about the problem with lab tests in general the first problem is you get your last black and your doctor goes well they're normal they're normal what the hell does normal mean normal is essentially it's a scientific term that means two standard deviations from the mean so when you look at the you know the average of population do two standard deviations separate from that that's what's normal so it could be if you're two or 92 you know that's a big range of people uh and we want to look at what's what's optimal, not what's normal.

8:54And just to help you understand this, if you were to land in America and you were to say, you know, what is the normal weight of Americans? It's overweight because 75 % of us are overweight. It's abnormal to be thin in America today, but it doesn't mean it's good. It just means it's quote normal. So we want to get away from saying, oh, your labs are normal. You're fine. We want to look at what is optimal. What is an optimal lab range? In other words, your vitamin d on the lab says it's 29 that's low if it's 31 that's good but actually it should be more like 50 as optimal so even though the lab breath range changes are showing you a number that seems like it's normal let's say your lab range is 31 that's not good you're going to get more bone loss more immune dysfunction your risk for autoimmune disease risk for heart disease dementia cancers all go up if your vitamin d levels are not over 50 i mean if you if you had a COVID infection and your lab of vitamin D was over 50, there were zero deaths in that population, zero.

9:54So we need to look at what's optimal, not what's normal. So the conventional lab ranges just miss this early dysfunction. Like in other words, we keep shifting the goalposts. We talk about hypertension, then we talk about pre-hypertension, and we talk about diabetes, and we talk about pre-diabetes, we talk about autoimmune disease, and we talk about pre-autoimmune disease. Well, it's not pre-anything. These are just early disturbances that are leading you on that path. so if your blood sugar is normal it's uh 70 to 100 but what if you're 99 that's not really optimal it should be probably between 70 and 80 87 according to the literature because after that your risk goes up when doctors order tests you're just ordering things that that are really like i said only abnormal if you're in the hospital they got your cbc which is your blood count so if you're anemic well great i mean i i had surgery i was anemic i needed to check my blood count was low.

10:42I got a blood transfusion. You know, that's good. It's helpful. You can see if you have an infection, high white count, but you have to be kind of sick, really sick. It doesn't really look for chronic illness. Your basic metabolic panel is your blood sugar, electrolytes, liver, kidneys. I mean, those are really things that are only abnormal. Your calcium, these are abnormal when you're really sick. Cholesterol, they check for sure, but again, the way they check it is really outdated and almost meaningless. That's the one kind of thing they're looking at in the screening, but it's basically a reaction.

11:11If you have a cholesterol, take a statin, which is not always the right answer. So a lot of things also that are symptoms that get missed, you know, have, have clues in your lab tests, right? So fatigue, it could be so many things that are causing that. And it could be thyroid, it could be autoimmune disease, it could be low B vitamins, it could be low vitamin D, a brain fog, same thing. And a weight gain, you know, you, you may, you're struggling with weight gain. Why? Maybe you may have normal blood sugar, but your insulin levels might be sky high. You might have depression or mood changes, but you might have very low folate or B12, which may be showing up through our advanced testing of homocysteine and methylmalonic acid, which are the better tests to check for B12 and folate.

11:50Or maybe you have low omega-3 fats, which we check, and that can lead to, obviously, depression if you have low omega-3. So joint pain, same thing. Maybe you have gluten sensitivity. Maybe you have a high CRP that's showing that you have an autoimmune disease or an autoimmune marker. Skin issues, also same thing. There's so many things that we can test. You might have dairy allergy. You might have gluten issues. You might have insulin resistance if you have acne, which we can tell. So all these things that seem quote normal actually have things that we can find on your lab tests and then help you fix.

12:20Now, thyroid is a great example. Most doctors don't check thyroid as a routine screening test. If they do, they only check one out of five important tests that you need to look at your thyroid. Five. And they only do one. And it's called TSH. and that can be quote normal but the range there is 0.5 to 5. Now that's not actually good because according to the American College of Medicinology it should be anything over three and a half should be considered a slow thyroid but again most doctors don't treat that don't look at it and then they don't look at the whole picture they don't tell the whole story you want to look at the the actual thyroid hormones because TSH is just checking your brain and seeing if it's making the stimulant for your thyroid, the thyroid stimulating hormone.

13:04But the T3, if you have low T3, that's the active hormone that actually does the work in the body. It may be low because there's a conversion problem from T3 to 4. And that can be for a lot of reasons like selenium deficiency or mercury poisoning or yeast overgrowth or toxins. A lot of things can affect it. And you also have a high reverse T3, which again is another test we do, which is kind of like a break on your thyroid that can happen from chronic disease so you might have normal looking thyroids but your reverse t3 is high and you're basically thyroid's not working you can also have thyroid antibodies a lot of people have thyroid antibodies which we check and 13 percent of function members have elevated thyroid antibodies and i bet you a lot of those people are not treated their incidental findings that they didn't know they had that are causing subtle symptoms.

13:52It could be, oh, my hair's a little dry or my nails are cracking or my skin's dry or a little fluid retention or a little depressed or my cholesterol is a little high or I'm a little constipated or my sex drive is a little low or very, very like subtle symptoms of thyroid dysfunction or I'm not sleeping. And you might have an autoimmune thyroid condition that's not even actually showing up on the other test. And so your TSH could look normal, but you're basically low thyroid function. So you might feel these symptoms, right? Brain fog, fatigue, weight gain, constipation, depression, but you're told that, you know, it's normal and maybe it's in your head.

14:27But the truth is there's something going on. And if you look deeply, and this is why we've done this, and we basically developed a lab panel based on the most common things that people are suffering from, that doctors are missing, that have a profound impact on improving their health in the long term. And so when we look at what's going on, we look at all the patterns in the data. It's not just one analyte. We look at everything together.

14:51There's something I need everyone to know. You can have, quote, normal cholesterol and still be at serious risk for a heart attack. Because with your standard annual exam, you get a few basic heart markers checked and you carry on. But cholesterol is just one piece of the puzzle. The most important tests are missing, like ApoB. Have you ever had that done? Probably not. It helps move cholesterol in the bloodstream and is a powerful marker for your risk of cardiovascular disease. Or HSCRP, which is a marker of systemic inflammation in the body. These are some of the tests that give warning signs years before symptoms show up.

15:24And that's why we built Function over 160 lab tests, including a cardiovascular panel that goes way beyond basic cholesterol. An all-in-one check for your entire body for just$365 a year. So you track your data and you take control at functionhealth.com. And you don't want to just look at that, but you want to look at, we actually can do an advanced test for insulin resistance, where we look at markers that are just now available. but also your liver function test may be abnormal your kidney function might be abnormal you might have protein urine you might have low testosterone if you're a man you might have high testosterone if you're a woman you might have a other issues like hyaric acid you might have inflammation on high crp you can see these patterns that kind of tell you a story it's not just one lab test but how are these all connected and the key is you want to understand how your body is this one big system and everything affects everything.

16:14So when you really look at what function's doing, it's really providing you with a deep, comprehensive picture of your biology in the moment and then longitudinally over time. And it helps you understand what those patterns are, where your personal health is and how to understand what's going on, and then how to optimize things and get them into an optimal range, not just normal range. And in doing that, people will have a profound improvement in their overall health. It's really quite remarkable what happens when you start to tune people up, even the simplest things. I mean, if you're just low in vitamin D, you know, you could be getting more frequent infections and colds.

16:51You could be having seasonal affect disorder or the winter blues. You could have muscle aches and pains. You can have all sorts of things that are subtle, but when you correct it, you feel better. And the FLC syndrome or feel like crap really improves. All right, so let's get into it. What are the core labs that everybody should know about and should track in their bodies, right? And what do they tell you? I mean, if you can only run a few tests to truly understand what's going on in your body, what would be giving you the most valuable information and why? So let's break it down into the big categories of what we track and what we need to track.

17:24The first is metabolic health. And when I say metabolic health, I mean blood sugar regulation and insulin. This is what's driving most of the disease in America today, heart disease, cancer, diabetes, dementia, aging itself, weight gain, obesity. I mean, the list goes on.

17:40Dr. Mark Hyman:So the things that we track are fasting glucose, which most doctors will check on your checkup. We also check A1c, even if you're not diabetic, because it changes slowly. And as I said, anything from over five starting to increase can be a concern. And we check your fasting insulin, which is really important because that's the first thing to go up. Before your blood sugar or A1c go up, your insulin goes up fasting, and it's really important to look at that. So you want to look at what the optimum range is for blood sugar, not the reference range. And the optimum range is probably 70 to 85, not like up to a hundred.

18:12Now, if you go to a hundred to one 26, that's diabetes, one 26 is diabetes, but it's a continuum of dysfunction. And when you fix your metabolic health, it improves everything, your energy, your mood, longevity. It's the key to longevity is understanding what's going on with your metabolic health. And if you have insulin resistance, you might have belly fat and weight gain, sugar cravings, you might feel crashes up and down with your energy after meals, like hypoglycemic, you might have brain fog, tired, and you might have many, many other symptoms too, like diseases, but those are symptoms that are common.

18:46And often people just dismiss those. But when you look at the full function health panel, it includes all this metabolic testing we're talking about, but also includes, and we'll talk about in a minute, special cholesterol testing that most doctors don't do that has been around for about 40 years, but still hasn't been adopted because it takes decades for things that are innovations to get into medicine. The next big category we want to look at is inflammation because inflammation, again, is one of the biggest drivers of chronic illness. And the major cause is metabolic dysfunction, which is related to blood sugar, but there are other causes.

19:21When we look at your inflammation level, something called HSCRP, which is a cytokine or molecule the liver makes that is related to inflammation. We look at ferritin, which can be an iron storage marker, but if it's high, it also is an inflammation marker.

19:35Dr. Mark Hyman:We also look at your blood count and your white count and your white cells and all those tell a lot of a story about what's going on with your immune system and inflammation. So we can tell if there's low-grade inflammation and this underlies most chronic conditions. So when you identify inflammation earlier, you can find out the cause. What is the cause? It can be toxins, poor diet, stress, allergens, you know, microbes changing your microbiome. But this creates this quiet, silent, deadly killer of inflammation. And that leads to pretty much, as I said, almost all the diseases of aging. In fact, one of the hallmarks of aging is inflammation.

20:11Heart disease, cancer, diabetes, obesity, dementia, stroke, kidney disease. These are all inflammatory diseases, even hypertension, inflammatory diseases and if we figure out the cause of inflammation we can get it sorted it'll also help us track autoimmune diseases as well they're really important and a lot of people can have vague symptoms of inflammation they just might not feel good they might be achy they might be tired they might have brain fog they could obviously have weight gain because of that inflammation from any cause will cause weight gain for example if you have a gut issue and you have bad bugs in your gut and they're producing inflammatory molecules you can gain weight independent of having a crappy diet because it'll just drive inflammation.

20:50All right, let's talk about cholesterol. Cholesterol is one of those things that, you know, doctors check, everybody gets it, it's standard, but they don't do the right test. And they miss doing a whole bunch of tests that are really, really important. So yes, we look at total cholesterol and HDL and LDL and triglycerides, but we look at the quality of those particles and cholesterol molecules. We look at the size of them and we look at the number of them and it tells us a very different picture of what's going on so you can have a perfectly normal cholesterol but it can be made up of all the worst particles and your risk of heart disease is really bad or you can have a really high cholesterol and it's made up of all the good particles and not a lot of them and you're totally fine so you you can't really tell what's going on with your heart cholesterol or disease risk without doing the right cholesterol test.

21:41And Function Health does that. Now, we also test other things that doctors miss. We look at ApoB, probably one of the most important predictors of heart disease risk, which is a sort of measure of all the small and bad particles in your blood. We also look at something called lipoprotein little a or LPA, little a, and that's a genetically determined cholesterol marker, but it can be managed and treated. And it's important to know because you have to manage your other risks more aggressively. And a lot of people have it and doctors miss it and they don't even look for it. Now, the thing about heart disease is, I don't want to scare people, but the first symptom of heart attack and heart disease, for 50 % of the people that have it, you know what it is?

22:20Sudden death. You literally drop dead of a heart attack and you have no idea it's coming. Literally no idea. That's terrible. So you don't want to wait. And then it's often subtle, even if you have symptoms. So people don't know. And they can be a little tired, a little short of breath, a little whatever, and they don't know how bad their heart disease. I had a friend who was like 53 years old, and he had pretty significant heart disease and 90 % occlusion, and he was jogging and felt a little tired, short of breath, and he didn't get any issues. When he got checked, he had full occlusion, and he has really bad lipid particles.

22:52So really important to get this diagnostics early and manage it. It can be managed through lifestyle. It can be managed through supplements. Sometimes medications are needed, but really important to manage your risk. We also look at thyroid. We talked a little bit about that earlier. I won't go too much into it, but you know, it's important to do the full panel of thyroid tests, including TSH, free T3, free T4, thyroid antibodies, sometimes reverse T3. And you have to look at what's optimal, not just what the normal range is, but what's optimal. Like if the range is 0.5 to 5 for TSH, probably the optimal should be like one to two.

23:22And so we look at that and try to get people in the optimal range and not just manage to the lab reference range. And you get really subtle symptoms, as I mentioned, fatigue, hair loss, constipation, brain fog, weight gain, depression, low sex drive, cracked nails, hair loss, I mean, loss of the outer throat of your eyebrows, all kinds of stuff that just don't really maybe seem serious, but that are serious. Because if you have it untreated, you actually will end up having a higher risk of having heart attacks and other conditions later in life. What about nutrients? Doctors don't check your nutritional status.

23:55Now, what is the point of nutrients anyway? I mean, there's 37 billion trillion chemical reactions in your body every second. Every single one of those chemical reactions, because you've got about 40 trillion cells, every single one of those chemical reactions needs a helper, an enzyme, to convert one molecule to the next. And every enzyme needs a helper. And those helpers are vitamins and minerals. So they literally grease the wheels of your metabolic system in such a profound way that one third of our entire DNA codes for enzymes. And those enzymes need these nutrients and they all need different amounts.

24:29So getting the right nutrient status for you is really important. And that's why we do a deep dive on nutrients. We look at vitamin D, we look at zinc, magnesium, iron studies, omega-3s, folate, B12, minerals, a lot, lots more. We can check all kinds of things, but you really want to get a good basic picture. We do that on the, on the basic function panel, but there's also add-ons so you can do much, much more. And you want to track it over time because it changes and your needs change, but getting your nutrient levels optimized is so important. We also look at things that can relate to abnormal gut function, you know, things like