Strive For Optimal Not Normal
You may have noticed that I mention “optimal” a lot. If you haven’t noticed, stick around and you will. From what I have seen in my years of practice as a nurse practitioner, “normal” just doesn’t cut it in a lot of cases. It’s kind of like saying fine or average when it comes to some measurements. You should want your health to be great, fabulous, showing up and showing out!
Optimal is not a new term to healthcare. The phrase I use, “strive for optimal not normal” refers to your overall health but more specifically, a measurement of your overall health - laboratory work. Each lab value for a specific test has a “normal” or reference range. This range is what is in the parameters for good health. Normal ranges can vary slightly depending upon the lab and units of measurement used. The reference range is important but is not always the full big picture!
Normal laboratory ranges are typically developed from data collection in scientific research and statistical analysis of test results from a healthy population. However, while sometimes this research helps us to more safely and specifically define “normal” (like with the change in protocol for “normal blood pressure” several years ago), sometimes, the data and statistical analysis changes the “normal range” to be too broad or not narrow enough. In other words, if the “healthiest” among a population isn’t all that healthy, depending upon what percentage of the population is considered, you could have skewed statistical analysis. So, as our population gets more obese and the pandemic of chronic disease worsens, these numbers have the potential to not be as true of a measurement in all cases as they should be.
For example, vitamin D. Vitamin D is important because low Vitamin D has been linked to high blood pressure, diabetes, heart disease, many cancers, chronic muscle pain, bone loss and more. A low vitamin D basically leaves you with a much weaker immune function. The “normal” range varies, and you can find it to be anywhere between 20-150 nanograms per milliliter (ng/mL). However, more and more research is showing that you are more protected from various illnesses and conditions when your Vitamin D is above 50 ng/mL. Some recent research has even shown that a higher vitamin D level can reduce your risk of the flu even more than the flu vaccine and more and more research has shown a correlation with more serious illness from Covid and lower vitamin D levels. So, you would be “normal” with a vitamin D of 30 ng/mL and you aren’t going to get Rickets (one of the original concerns with low vitamin D) but this level would not be “optimal” for reducing your risk for heart disease, diabetes, many cancers and more.
Fasting insulin is another one. Most primary care providers don’t even order this lab regularly although they should as research has shown it is a better indicator of insulin resistance in that by the time a fasting glucose or Hemoglobin A1C is elevated, the fasting insulin has been elevated for months or even years. The normal range in many places is 6-35 microunits per mililiter (uU/mL) but the optimal range is less than 5 uU/mL and most that study or know the latest research on insulin resistance would argue that anyone over 15 uU/mL is most certainly dealing with some level of insulin resistance.
Fasting glucose, triglycerides, ferritin measurements for Restless Leg Syndrome, total cholesterol, thyroid labs and more are just some of the labs to be looking for optimal not just normal. It is important to discuss each of your labs with your primary care provider and to understand where you fall on the spectrum and what your “optimal” goals should be. And although this term applies well to lab work as it is a specific measurement of how we may be doing in terms of our health, you should strive for “optimal” in all things that pertain to your health – the quality of your food, exercise, sleep, relationships and more.