Page 3 - Autoimmune Diseases Blood Testing

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.”