Barbell Shrugged - [Optimal vs. Normal Health] Why Normal Reference Ranges Will Not Lead You to Optimal Health w/ Anders Varner, Doug Larson, Travis Mash and Dan Garner Barbell Shrugged #676

Episode Date: January 4, 2023

In this Episode of Barbell Shrugged: The spectrum of health from sick, to not sick, and to optimal. Optimal is a word thrown around with ease in the healthy space. What does optimal health look and feel like? Why are the current blood markers in a normal range and not optimal? Where are normal reference ranges created? If you want to know optimal ranges, where do you find them? Why are optimal ranges a better reference point than normal ranges? Hope can you be labeled “healthy” by normal ranges but still have underlying issues that go undetected? To learn more, please go to https://rapidhealthreport.com Connect with our guests: Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram Dan Garner on Instagram

Shrugged family, this week on Barbell Shrugged, we are talking about normal versus optimal health. And where we are going to take this is Dan Garner is going to walk us through a lot of the things that you're going to see in the normal reference ranges in your blood work. Like if you go get your standard physical done each year, there's so many things that you could be missing because the reference ranges that your doctor is going to be looking at are what are considered normal. That's not what we're doing here. Nobody listening to this show and trying to get healthy and trying to perform and feel their best is happy with the idea of normal. We're all looking for optimal. We want to be playing this game at the highest level possible.

And today's episode, we're digging into a lot of the differences between normal reference ranges and what is optimal and how that affects your health, the things you may be missing, and a lot of examples. So get out your pen and a paper. Take some notes. Dig into this thing. There's tons of good information. And I think you're getting a lot out of this just because the optimal ranges for so much of the things that you are focusing in on your health journey just are not available, except here on Barbell Shrugs. And of course, friends, make sure you get over to rapidhealthreport.com where you can see all of this in action and what it looks like. Actually, while Dan is reading your labs, friends, let's get into the show.

Welcome to Barbell Shrug. I'm Anders Varner, Doug Larson, Coach Travis Mash, Dan Garner. Today on Barbell Shrug, we are going to be talking about the difference between normal and optimal health. And a lot of people are going to be wondering, well, what is the difference? I get my blood work done every year and they say that I'm healthy. And what we are going to discuss today is kind of like a little bit of the history of the blood test, kind of understanding where those numbers come from and why they may be misleading you. Really what I want to start though, is this word optimal gets kicked around a lot. And I sometimes wonder like, where on the spectrum does optimal land in comparison to the normal? And why is everybody's

real goal to achieve normal as opposed to sick? And really digging into that spectrum of what categories do we actually put into health and how do we start to look towards more optimal ranges? Yeah, I think that a good way to kick off this podcast, and I've talked about it before, but I think it's just a good framework for optimal versus normal is this like little cheap health skill that I've created in my mind over time. It's got three points on it. We've got death, fake health, and real health. That's it. Death is pretty simple to understand. This is deceased, you're done. Fake health is where 90 plus percent of the population lives because they perceive healthy as purely the absence of disease, which is completely and utterly incorrect because 90% of the population isn't who they actually want to be. They aren't living the

life that they are on this planet to live. That is what optimal people do. Somebody who's optimal, they have high energy. They have a libido. They don't have gut problems. They sleep well at night. They are very in tune with their stress management. They are able to tackle their bucket list. These are the people that you see, and that's actually who kind of inspires you to start setting goals. Whereas the average person, they've got a lot of average person symptoms. They have lower libido. They have an inability to drop body fat. They have a difficulty building muscle mass. They have hormonal imbalances. They have bloating, distension, gas, constipation,

diarrhea, they have a lot of things that you don't necessarily aspire to be, but don't put you into a category of disease either. So that three point health skill, it's always been a way in which I've been able to deliver a point to people where purely just because you have the absence of disease does not mean you're actually healthy. And over the course of my career, I've always had people come to me never with the goals of normal, ever. I never wanted to get someone normal results. That was never what I wanted. I always wanted optimal. But the fact that the reference ranges were basically so brutal and so normal, I had to carve out an entire niche of the industry in terms of a knowledge base, in terms of

an algorithm, in terms of delivering results that I could call objective because it was based on labs, but I could also call optimal because it had nothing to do with being normal. Yeah. I'm actually, I spent like three and a half hours parked in an airport and did all of the observing of all of the humans around me and wondering how many, like if we were to get blood work, what's that? I love doing that. Yeah. You just sit back. Actually, one of the questions I asked myself so many times was people watching and judging harshly. Yeah. He he's like i love doing that

yeah it's the best i feel so good about myself me too it has to be a work thing right you're working if you're doing that uh but one thing i actually thought about many times like as i was just walking around four and a half miles in bwi which i've probably spent like three weeks combined of my life in that airport um is like how many people go to the doctor in this airport right now and their doctor just looks at their yearly blood work and they go, yeah, you're not dead. Like your cholesterol is high, but they're clearly like not healthy people. Yeah. So I'll play, I'll play a quick game with you guys. How many people do you think got their blood work done in the past year?

Probably quite a bit. I think that's probably a lot of people. That's got to be a seven-figure number. Yeah, that's a huge number. Like a percentage of the population? What do you think a percentage of the population is that have gotten their blood work done in the last year? 60. No.

What? Lower? I mean, it's high. Half the people? I mean, lower. No way. I was thinking like 3%. I feel like

everybody gets their blood work that's part of your physical everybody no way part of your physical i know some of you that don't look it's a yearly physical i feel like that's because you hang out with healthy people healthy people don't get it done shit unhealthy people don't get it done like my i think my grandfather died at 95, never getting a physical. Your grandfather, that was a different stage of the era. Dan's like, I have a real point to make you idiots talking about numbers you'll never be able to prove. Someone's trying to win a conversation that's unwinnable right now. Yeah, it's a bunch of hypotheticals right now. So now that we're past that, of those people who got their blood work done, what percentage of them do you think we're told are normal? You're fine.

That's the percentage that's not. Probably most of them. How many of those people do you think were functionally optimal? Zero. We know too much now from you. Yeah, exactly. It's an incredibly lopsided scenario where an enormous amount of people get their blood chemistry done every single year. 99% of them get told that they're normal and healthy. 1% of them feel like they're healthy. And that's a huge, huge problem. And we have to redefine the term healthy,

because that's why I do like it's kind of cheap. And it's kind of laughable when I say fake health, but I do mean it. No one we don't have a term to define a person that's existing, but they don't have a disease, but they're also riddled with symptoms. i think that actually has a normal a huge uh point of um a huge point of interpretation as far as looking at reference ranges and how they're designed because they are purely just designed upon statistics like everybody can imagine a bell curve right now this is how reference ranges are made by the way you a bell curve, and then you have 95% of people in the middle chunk, and then the two and a half percent fringes on the outside. The two and a half fringes are excessively low or excessively high. Everything in between is considered normal.

And that's why you have so many people who fall within a normal reference range. But if you had a vertical axis, so let's imagine we have a horizontal axis of that bell curve of how we create reference ranges. But then our vertical axis is how people actually feel. We would have a bell curve of how normal reference ranges are created. But then how people feel would be plotted all over the map of like crap, pretty good, even though they're in this part of the reference, like crap, pretty good, even though they're at this part of the, they would be all over the place. And that's because when you base somebody on a 95% statistical average, and you understand the bio individuality between people, their context, their goals, it begins to stop making sense really, really, really fast. So looking at someone

through the lens of their subjective feeling, as well as their objective results is really how you can begin to start pinpointing the story of their physiology and how you are going to truly optimize it. Yeah, I think a lot of I've said this on the show Yeah, I think a lot of, I've said this on the show before, I think a lot of this is easier to see and easier to conceptualize. If we take it out of the kind of the metabolic world, we put it into like the physical performance world where we all have an idea of what like our mile time is or like what our bench press is

or what our body fat percentage is. So if we looked at like a million people randomly selected in the population and we took their mean body fat percentage, like the average, and then we looked at two standard deviations above and below, like you were just talking about for the 95%. So a million people, the average body fat percentage for a million random males. What do you think that would be? I'll ask you, Dan, like roughly.

I'm going to say 30. Yeah. I think 30 is probably fair. Yeah. I was thinking like 25 to 30, something like that. And so two standard deviations above and below that, like we're looking at like, we'll say 10% to 40%, something like that.

So if you went in to a gym and you got your body fat checked and they were like, yep, 35%, you're in the normal range. Good to go. Thanks. Thanks,

homie. Take care. Or you did like a mile time. Good to go. Thanks, homie. Take care. Or you did like a mile time. Like what's a mean mile time for a million random people? Walking 12 minutes, 10 minutes? No. Most people can't even run it.

Most people can't run it. Okay. So yeah, we'll say 12, 13. It's a slow walk. Okay. So let's say it's 12, which is maybe even better than it might be. And two standard deviations below that might be as low as like seven. And above that might be as high as like 17, something like that. So you go, you run your mile and you come in and they go, okay, well, 14, 50.

You're in the normal range, healthy as can be on your way, sir. That is insanity to us as health and fitness professionals. Like who wants a 14 minute mile and wants to have 35% body fat and be in the normal range? No, like you want to have, you want to have your six minute mile and you want to be 8% body fat or whatever it is. Like you don't want to have a normal range, 170 pounds bench press when you're trying to like be a fit athletic person doing jujitsu and whatever else you want to do in your life.

Like you want to bench body weight in half or whatever like you want you want to be strong and fit as you possibly can and so when you take it out of the uh kind of the more ethereal like metabolic numbers that you really don't understand or really don't have context for and you put it into the physical world you go oh yeah i don't want to just be in the normal range i want i want i want to be much better than normal. They need to break it down into more subcategories. It should be more like you're on your way to dying. Here's death. On your way to dying, you'll live, and then optimal.

Instead of just like you're normal or you're dead. That sucks. Because if you're like the low end of testosterone what is it like 100 or something or i don't even know that's very low the testosterone reference range is usually on most labs is 300 to 900 is that 300 is the bottom yeah so like you know if you're at 350 that sucks you know like you're not feeling good you know so like the doctor instead of saying check mark you should be like you know here's some you know you're in that you're in that warning category and so instead of giving a man a false hope so he goes home feeling like shit

but then the doctor says hey you're okay and he's like i don't know what's wrong with me when it was very clear what's wrong with them but for sure and i think doug made an awesome point too because um when when you are told that you're normal on a lab you're actually just given no action points so you're just done you're normal and you can go continue your life but if you went to the gym and you were told you're 35 body fat then that's actually the gym saying you don't need a membership you're good yeah you're fine everything came back normal because you're good. Yeah, you're fine. Everything came back normal, because you're within that deviation. I love that example. Because that is a very real world way in which you can conceptualize the the insanity at which there is no, there is low high, but then we need the low

and highs because there's absolutely a place for real medicine to take place. But we do need trending low and trending high, because there is a lot of data in the world of trending low and trending high to add to Travis's point that multiplies your mortality risk by quite a bit, even independent of your specific context, your environment, your current activities, your current lifestyle, there's so many things that can really throw people off. And a weird situation that like, I've dealt with a lot in my career and now dealing with here in rapid is something I've never talked about on a podcast before. I've called it my HLA theory. That's a healthy lifestyle abandonment theory.

Shrug family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidealthreport.com. When you get to rapidealthreport.com, you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health. Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach. So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the

work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep, and then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the most severe things first. This truly is a world-class program. And we invite you to see step one of this process by going over to rapidhealthreport.com. You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and just my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over

to rapidealthreport.com. Watch the video of my labs and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidhealthreport.com. And let's get back to the show. It's a healthy lifestyle abandonment theory. And how I've kind of come across this is that you can live a healthy lifestyle and have a root cause problem. So you basically imagine, imagine the story of having a root cause problem and not feeling optimal. So you do a Google search and you find out maybe I should try this diet. Maybe I should try this supplement. Maybe I should meditate. Maybe I should sleep better. Maybe I should start exercising. And

these are all great habits to have. So this can actually, and that's why I call it HLA is healthy lifestyle abandonment, because your healthy habits will have converted your outside of range, slightly inside of range. So you're either now trending high or trending low low because you are adopting healthy habits. But if you didn't have those healthy habits, then someone would have actually helped you because you would have been outside the reference range. So here you can have a situation where somebody's healthy habits are what actually cloud their root cause problem for the rest of their life.

Because in the absence, and this is why I tell people, get off of supplements before you do your labs, there needs to be a clean slate. I don't want you changing. I don't want anything to muddy the signal in the noise. Because if I applaud your healthy habits and efforts, but if that is clouding the signal in the noise and correcting a reference range that would otherwise have been out of balance based upon the current root cause that's actually creating problems in your life, we're never going to be able to detect it. So you're going to be abandoned by the health professionals that are supposed to help you because this healthy lifestyle abandonment theory of you correcting your own reference range with symptom managers rather than root cause solvers.

And they are feeling better by doing all those things, but you're not eliminating like the viral infection in your gut. Right. And that thing's still just wreaking havoc on your immune system, like chronically beating it down over time. I think that was like when Doug and I were down in Texas

and we had the big breakthrough moment, we looked at each other like, dude, we just feel awesome right now. That was like probably the first moment where I just didn't assume that I was always extremely healthy. Yeah. A lot of people don't understand how good the human body is really designed to feel and how at risk you can be with your number showing up as green.

You know, like albumin coming, albumin is a protein involved in a lot of important processes in the body. But when albumin is below four, you are at a 187% increased risk of all cause mortality, but reference ranges go down to 3.5. But below four, you're almost doubling your mortality risk. When you have TSH, it's a thyroid marker, thyroid stimulating hormone, the reference ranges regularly go up to four, but it's been demonstrated very clearly that you can begin creating auto antibodies after two and a half. So by the time you actually trip four is you are deeper into autoimmunity than you otherwise needed to be based on what could have been preventative rather than

reactive. Same thing with glucose, like we've talked about every one point above 85, increasing your diabetes risk over the course of the next decade by 6%. So and you won't get tripped off until you hit the 100 mark. So 85, even to 95 is a 60% increased risk of developing type two diabetes over the course of the next decade. But no one's going to tell you and you're still five points away from what would have actually been a problem. Yeah, like homocysteine is another monster one homocysteine reference ranges regularly go up to about 15. And I've seen reference ranges as high as 21. Your risk for cognitive decline begins to increase after 11. And then your risk for cognitive decline increases by 88% after 20. So this is the fact that we have these kinds of canaries in the coal mine are why like, I really believe it's my purpose

on this planet to like, we have to stop this whole low high thing. And we have to create low trending, low, optimal, trending, high, high, high. Like that scale absolutely exists. And the longer we continue to ignore that, the longer people are just going to not be the best versions of themselves. I actually, so how did they create the reference ranges? Is it just like a wild ass guess? They were like, most people are alive at this level and we should call that normal.

Because I assume it didn't just like overnight like first off like people have gotten significantly more unhealthy but also at the same time i feel like insurance companies probably have a large uh a large voice and what these reference ranges are because as soon as you're like you exceed normal, then there's gotta be some sort of red tape, bureaucracy type thing on what's covered, what's not covered. And that whole relationship is a weird one. But where did like normal ranges actually come from?

Because you think people would just want to start at optimal. Like if I was the designer of blood work, I would want to just know like, what's the best. And then let's work backwards from there to see how far we need to go. Well, as far as creating reference ranges, like previously stated, they're based on massive statistical pools. So you're taking in millions and millions and millions of people. And then you are creating that bell curve deviation and placing the two and a half percent

on the fringes and then 95% in the middle. And that actually, to your point, Anders, you said people are getting sicker and sicker and sicker. Well, reference ranges are getting wider and wider and wider. Yeah, specifically the testosterone one. Like if you're at 300, they're like, yeah, you're good. Yet you feel like crap. That's the most broad one of all. Yeah. And it goes lower.

It only gets lower so that they don't have to cover because they don't cover TRT. Well, they're extremely broad. All of them are very, very broad. And it makes you think like, I don't know how this could even exist. Like a TSH, we already talked about it. It's pretty good example. Lots of times the reference range is around 0.5 to four and a half. It doesn't seem a lot because you think four points, but when you think of the multiple of 0.5 to 1, 1.52, it is a many, many, many multiples between the bottom end of the top end. It's very, very, very far from optimal. And even a non educated person would be able to like, yeah, that that actually doesn't make any sense at all. How could there be that big of a difference? So testosterone

is a good one, too. There are many that just have an absolutely huge reference range. And the crazy thing is it's based upon statistical analyses. So as society continues to get less and less healthy, the reference range actually moves with that. And then to make things even muddier, reference ranges can change based on location. So in North Carolina, it can be different than New Jersey, it can be different than LA. There's not a US reference range. And there's actually a joke in the functional world where if you've got a thyroid problem, no problem, just change states, you won't have a thyroid problem over there. Because you move to a state that matches your reference range. And then you could go, hey, I'm good, I'm fine in this state.

And sometimes the multiples are just absolutely crazy. Like DHEA is a very androgen based hormone. And in Europe, many cases, the reference range is around three at the top end, whereas in Canada, it's 10. So there is just a huge, huge difference in reference ranges from location to location, but then also from year to year. So it becomes even more important to analyze the data as a totality and create an actual optimal reference range on healthy people in a client specific demographic. So you're truly helping that person and not just based upon their location and the current year. Won't some of it be though, okay, I mean, this is like, only a few things,

but like, in Alaska, obviously, we're probably going to hold more body fat. I mean, this is like only a few things, but like in Alaska, obviously we're probably going to hold more body fat. I mean, it's just colder. Your body's going to adapt. You know, it's just evolution. Will, will some of that be important that there are some changes like Canada versus Florida? I think that there definitely would be some demographic changes, but as far as things like as body fat percentage, there are some laws of physiology that are just not going to be conducive as far as body fat percentage and insulin resistance, body fat percentage and inflammation. As far as you know, staying warm, I'd say wear a coat instead of be obese. There are some, there are definitely some changes that physiology will

just deny kind of based upon your environment. But then there are other environments too, where you'll actually see certain things shift, such as GGT, GGT being a reliable marker for environmental pollutants, you are probably likely to see a lot less GGT in Alaska than you are in LA. So you would have major, major differences in something like that. Where in LA,A., some people are like, well, what do you talk environmental pollutants? I don't think I'm exposed to any of that. Like, well, you sit in traffic with a million people every single day. You eat processed food and you drink water from a tap. So I don't think that I'm some fringe wild guy for suggesting that you're probably exposed to more things than people in Alaska who don't see any of that and can actually see the stars at night. Yeah. And Anders mentioned earlier something along the lines of the insurance

companies having an influence over the ranges. To what extent do you think that's true? And or I heard someone say a while back, they're referencing pharmaceutical companies saying that, and I, again, I don't know if it's actually true, say 30 years ago, low cholesterol, or rather, high cholesterol was like 220. But then if they can have an influence and make high cholesterol now 210 or 200 or 190, every time they tick down another 10 points, now all of a sudden, another 10 million people have high cholesterol, which is growing the market for people that they can sell statins to or whatever it is. So to what extent do you know insurance companies and or pharmaceutical companies are influencing the reference ranges purely from a profit standpoint?

It would be tough to say. I basically don't trust anybody in this world. So it's very hard to say. But to be fair, the albumin study I already referenced, that was out of the Journal of Insurance Medicine. So they were the ones that actually identified that. It would be my position that probably pharmacies would want to tighten things up in order to make more sales in the world of medicine and that insurance would want to widen them up so they don't have to pay for it. I think that would be a natural business decision and may influence data collection, or even data publishing, maybe things don't even get published. I don't know how that whole world works. But I wouldn't be surprised if it did work that way. Which means you kind of have to get people that are very passionate and educated in the world of science to look at these studies and truly interpret and extrapolate them to create optimal ranges that don't have their hand in insurance and don't have their hand in pharmaceuticals. That's how you're going to actually get someone who's going to provide you real advice. And I think that way across the board. I mean, if you have someone who sells the carnivore diet, if you have someone who sells the Mediterranean or fasting, they're

naturally going to recommend everybody go to their product, even at the expense of what's actually best for that person. So I think we'll catch that in all faucets and corners and nooks and crannies in the health industry, and not just in lab ranges. So we got to keep our eyes peeled all the time and look at science objectively. Yeah, every industry though. Not just, not, yeah. Not just, not just pharmaceuticals, every industry. Anytime there's like money, it's going to be skewed. That's why when you do research, you have to proclaim, you know, these are some of the issues.

Yeah. And something I've said a bunch in my career is I don't sell products. I sell expertise. So I don't actually care what tool I'm using for. I'm applying that tool to you. And then you can utilize that tool in the absence of my pocket being involved in that tool. I want to sell expertise, not products. Correct.

Is part of the problem with having a quote unquote optimal number for any number of things? If I referenced the example I used used earlier it's like if you want to have an optimal number for body fat percentage now you're eight percent and the optimal number for bench press now you're 300 uh you bench 300 pounds the optimal number for running your mile now you're running a five minute mile like these are very hard to be optimal all at the same time with blood work is optimal in one situation different than optimal in another situation if one number is really really high and like another number is really low for one person is really good but then it's like it's slightly different for other people based on their

situation their goals their age whatever it is like how is it possible to be have one optimal number for each um different metabolite or whatever it is for? Is this even something that we can actually do? Yeah, like that? Yeah, of course. Yeah. And I would have like a bunch of answers for it. I think that the hunt for optimal everything will lead to neurosis, you'll just you'll constantly be taking that thing at this time, and this thing at this time. And that's saying that, you know, you can really get to the health world. And we've all seen it has got a lot of neuroses surrounding that kind of behavior. I don't even think that you're going to check the box of optimal in everything all the time. But I don't think that it's a bad mission to go on. You know,

if you have the ability to remove yourself from neuroses and you have someone who understands optimal blood work versus normal blood work, then I think that you should actually be looking at it, not necessarily to always be optimal, but to catch something before it happens. Like the trending high and low, the ratios, the calculations, the predictions that you can create from a blood chemistry that nobody uses, by the way, they're so insightful to where you can find a canary in the coal mine and say, hey, I got you before it actually turns into a problem. Like to

me, that's optimal. If I can prevent something from happening, then I have absolutely optimized my decision making. Now, with that said, I've got a couple of caveats here. One would be efficiency and another one would be the art of blood work interpretation. So in terms of efficiency, I actually had a college football player in North Texas and he was an animal. He was huge. And he was at a testosterone of about 375 or 400, if I remember. So it would classically be considered low, quite low. But then he had such a low sex hormone binding globulin that his free testosterone was jacked up. So when I was able to review, he's recovering from training. This dude is, you know,

an easy 235 right now. He's lean. He's legitimately natural. And his body is just extremely efficient. Because if you've got someone who's strong, jacked has the libido gives you no symptoms of low testosterone. And they instead just have an efficient mechanism of I may have a lower total testosterone, but my increased free testosterone has absolutely made up for that differentiating marker. There is a case of efficiency in that world because optimal testosterone on some sort of global scale, maybe 700 to 900. But if you have the free testosterone of someone who has the total testosterone of 700 to 900, even though you're at 400, then who am I to mess with that physiology? It sounds like a very efficient situation, objectively and subjectively. So efficiency is, it can throw off

the world of trying to seek optimal in everything, because you actually might throw off your own natural balance, which was optimal to begin with. The second thing that I would say, in terms of optimal is the art of blood work interpretation. Albumin, we've already said it a couple of times on this podcast. Albumin is pulled up in response to dehydration, but it's also known as an acute phase reactant, which means it is pulled down in the presence of inflammation, which means if someone comes to you dehydrated and inflamed, which isn't a crazy situation in everyday society, their albumin can actually just land rock solid in the middle. And then it looks like an awesome albumin, but it was pulled up from dehydration and then pulled back down because it's an acute

phase reactant. So you actually have to be able to look at the other markers, what's going on in inflammation with respect to ESR, with respect to CRP, with blood sugar values, with lipid peroxides, you're able to actually look at all that and identify where you should actually place that and then look at some of the hydration markers. What's the blood urea nitrogen? Where is their electrolytes at? Where is the specific gravity of their urine? There's so many things where you can actually patterns begin to come out at you like you're looking at some sort of Rubik's Cube, and then you're figuring it out. And then when you get all those sides to align, you can actually see where they actually belonged

on the scale to where it appears optimal, even though it could actually be low or high, based upon physiological factors that pull things up or bring them down. So the hunt for optimal, you know, long answer made short. A, I don't think the hunt for optimal is a bad thing because you can catch a canary in the coal mine that can save your life. B, you may just be efficient. So the optimal thing shouldn't always get in your head. And you really, that's a part of subjective analysis to where don't think that something's wrong with you because of an objective component.

If subjectively you feel fine, because we've got a really bad way of telling ourselves a story about our health and then making that come true based upon a number we saw rather than something we actually felt. And then lastly, get someone who actually looks at blood work on a regular basis to review your blood work because the art of interpretation is much more sophisticated than what you can Google online. Yeah. I mean, I think everyone listening to the show by now knows that. You know how good it is? You can't even go to chat GPT and find out. Dan Garner is the only person. He's smarter than AI right now. He's got all the ranges. I even love-

Don't put that evil on me. AI is listening right now. Yeah, I heard that. That's right. That's right. They're going to kill it. Don't put it on me, Ricky Bobby. I put it into Chad GPT and it doesn't come back. It just said, go call Dan Garner.

He's the only man that knows. Dan, what would you say now that you've looked at, I don't know, how many would you say you've looked at? How many blood panels have you looked at? There was over a thousand in my folders in the high teens. So it was like 2018, I think. I had already done over a thousand blood cams and it's been four years or close to five since. So easily 1500 because business only got busier since then. All right. So thousands. And then what would you say are the most common? If you had to pick the top three common deficiencies, what would they be?

Oh, that's a good one. A big one I think would actually revolve around the sodium to potassium ratio. And this is very case study based where someone has a sodium to potassium ratio is very reflective of one's adrenal status. It's one of the most evidence-based ways you can actually look at adrenal function. There's a lot of, you know, very non evidence based ways in which people talk about the adrenal fatigue and things like that, that lack a lot of scientific literature to to validify what they're saying, but those people conveniently don't cite their cite their sources. But when it comes to sodium potassium, this is actually

utilized to begin the initial diagnosis process for real things such as Addison's or Cushing's, which are massive adrenal excess, or almost completely absent adrenal output. Sodium potassium is your canary in the coal mine there where you're able to catch these things. And one of the reasons why so you got adrenal glands, they're tiny little things that hang out on top of the kidneys. And they do a lot of awesome stuff that we've talked about in podcasts in the past. But one thing that they do secrete is this hormone called aldosterone. Aldosterone does a lot of cool stuff, but it's also a mineral corticoid, mineral as in electrolytes, corticoid as in hormone coming from the adrenal glands. It's a huge player in the regulation of electrolyte status. And a key component of what it does, relevant to

the context of this conversation, is that it reabsorbs sodium from the kidneys, and it excretes potassium from the serum. So when aldosterone is doing its job, it's reusing the sodium that's still really good for a lot of stuff and then balancing out the potassium. When you see the reverse begin to happen and you see a lot of sodium depletion and potassium retention, for example, potassium above 4.5 has been associated to increase all cause mortality, but potassium regularly on reference ranges goes up to 5.2. So like that's those I could do those examples all day, by the way. But if you see a sodium beginning to get trending low

or low, and then a potassium trending high or high, it is a representation of adrenal insufficiency because it is a representation of low aldosterone output. And that electrolyte regulation status is actually you learn about it through the functional adrenal physiology. It's a real important component of functional adrenal physiology. But then you actually begin to extrapolate and apply it to athletes at the same time. Because lots of times athletes don't necessarily have an electrolyte problem. They have a functioning organ system that's supposed to be regulating the electrolyte problem. So they'll see their electrolytes and like, man, I need more

salt. I need this potassium. I need this kind of, but it's like, why was that actually offset in the first place? You do need to begin asking that question. Do you have a diet that's so insufficient in electrolytes or do you have an organ system that is inefficient in regulating them? And many of these answers are found within adrenal gland function through the mineral corticoids, aldosterone being one example that you can pick up on, on a blood chemistry with trending low sodium and trending high potassium. See that a lot. Does it have any like the sodium potassium? Like, uh, I mean, that pretty much regulates everything since it's you can't have a nerve, you know, you can't have a stimulus from a nerve. The sodium potassium pump is everywhere. It's everywhere.

It's everything. So if that shit's wrong, you're dead. Yeah. Yeah. And that's why you get those all cause mortality things like that's always that's not surprising. Like when you start to see all cause mortality increase after certain points, it's because a critical functioning component of your physiology is suboptimal. Now you multiply that by 20 years and that's a 1% problem, a 2% problem, a 3% problem, 4%.

And that actually just multiplies. And by the time you get there, like people are like crap, but I'm kind of like, man, I'm not surprised because I asked for your previous blood work and you gave it to me here. And I could have told you this five years ago and we could have created a protocol in order to prevent and optimize your current situation. Nothing happened. So now here we are today. No one's been able to tell you answers and you're here. That happens a lot, dude.

Yeah, I feel like the blood sugar one, too, has to be something that is just with the 6% per point above 85. That just shows up all over the place. I had no idea. I would have never thought that had I not had blood work done with you. And that number is actually just terrifying to think that that percentage jumps so much, like 6% doesn't seem like a lot, but three points later, and now you're close to 20%. And it's like, that thing that gets elevated quickly. Can you talk about that a bit more? for every one point above 85. You will have there's other literature that puts you in as an independent risk factor. That's why I'm bringing up this literature in between 91 and 99. So if you have a glucose that falls between 91 and 99, it is an independent risk factor for diabetes. So key emphasis that's independent of your BMI, independent of your body fat percentage, independent of your activity level, independent of other blood sugar markers, such as fructosamine, C-peptide, insulin, independent of those like that. And in between 91 and 99, it's an independent predictor of type 2 diabetes, but it's in

the normal reference range like that. That's absolutely crazy. And to kind of go in line with what we were talking about previously, um, it was from the adrenals. Like I talked to mineral corticoids, also glucocorticoids, glucose, glucose, corticoids, hormone coming from the adrenals, like I talked to mineral corticoids, also glucocorticoids, gluco glucose, corticoids, hormone coming from the adrenals. So if you actually have elevated glucose, sometimes it's not insulin resistance, but rather elevated stress response in the body. So you can actually cortisol is something that creates blood glucose elevations in the body,

because it has glucocorticoid functions. So this is someone who may be and this is where the art comes back into play. Maybe you have a 95 blood glucose, but maybe you have insulin sensitivity, and you're a healthy person. But the very fact that you have the 95 was rooted in the stress response, and not necessarily because you have insulin resistance or an actual risk of type two diabetes. So that, that distinction is super important to point out when it comes to that kind of thing. Yeah. Or even someone working out, it'll go up, correct? Like, well, yeah, if someone's working out, it's like, so if you, if Travis goes and front squats at 7,000 pounds for a double, for a double, for a double for a double for a double. Yeah, you'll actually see there's very characteristic

things. So you'll see low white blood cells in response to high exercise output. You'll see low white blood cells, but elevated neutrophils. And that's a very typical response in someone who's training. If someone is training, then they're going to have stress hormone output. And that's, you know, whether it was distress or eustress, you're still creating glucocorticoids, and that is going to elevate glucose. So elevated glucose reduction in total white blood cells increase in neutrophils. But then you'll also see elevations at ALT and AST in response to muscle damage as well. So being able to interpret that pattern, sometimes you might look at something and you want to attach an ailment to them. But instead, they just had a killer workout. So you have to understand that too. And it's a big reason why I like baselines, no supplements, don't do any

hard training within a few days of your labs. Let's get a pure and raw baseline so I can truly understand who you are in the absence of any noise, mighty years. Yeah. MASH, you were bringing up pre-show stuff about one of your athletes. I don't know if he's cool with us talking about him, but with his cortisol and testosterone levels, what were you saying about that? Well, I guess, you know, Ryan, my top athletes, he's one of of your guys's clients and he had super high elevated testosterone which is a good thing for us but in the presence though of cortisol so it was like um i never really got to ask like your interpretation of all that yeah he's stressed out he's gotta look

at that freaking barbell every time you put 600 pounds on it i just stressed out of my mind too shit i gotta go hang out travis mash and lift weights with that guy today that old ass man walking through the gym like a bulldog trying to attack college kids that are the best in the world you know i should have listened to you quicker because you know as you know at the end of the year like the stress got the best of us and like um so like what was your interpretation like how can that be how can someone have a thousand plus testosterone count and then have high cortisol at the same time? Like, freak or what? Right? Well, definitely freak and cortisol can go up in response to high volumes of training,

like we're just talking about the way it's a lot of people don't know, actually, a marker of if someone's beginning to overtrain a sex hormone binding globulin. This has actually been in a lot of military research. Most people look at overtraining with respect to purely cortisol and if testosterone is beginning to lower. But one of the key canaries in the coal mine, again, to overuse that analogy here is an increase in sex hormone binding globulin. So there's also military research to basically overtrain the hell out of people for six weeks and their testosterone stayed relatively the same but their cortisol and sex hormone binding globulin were

the key indicators of over training and injury risk so in terms of someone like Ryan I would be looking at okay as testosterone solid so he's not too deep into recovery debt right now his cortisol is up which is probably just a half-life effect of him being exposed to a stressor and then getting his blood work done what's going to be my key differentiator here for actual um overtraining syndrome it would be the white blood cells and sex hormone binding globulin of which his were fine so okay rock and roll keep training he needs to a retest here because definitely by the end of the year, it was like – I mean, all I have to go by is the evidence of he couldn't –

we'd given time off, and he was not improving, and he couldn't sleep. It was just all the symptoms of over – it was overreaching. It was overtraining. We definitely overtrained him by the end, which is my fault. just all the symptoms of like over it was overreaching there's over training we definitely over trained him by the end which is my fault you know like um hey man i think you'd probably agree you're supposed to feel like shit sometimes yeah he did that's a function of trying to be the best in a sport you're not going to get there without extreme effort and with extreme effort comes extreme fatigue like yeah in the world of optimal i hate when people try to feel amazing all the time because if you want to get strong

you need a fucking stimulus yes and then that stimulus is going to create fatigue and that you're not going to always feel great if you always feel great then i would argue that you're not providing a strong enough stimulus to actually demand an adaptation. Right. The key would be like matching the timing, you know, like we now we're doing I got lazy on a subjective questionnaire, but now we're making sure at the end that he does the RPE of the session and the, you know, times the time and looking if it's matching. Cause you know, obviously like most good coaches, I have a distinct, you know,

intent for each session. And so if the intents aren't matching up this time, matching because you know obviously like most good coaches i have a distinct you know intent for each session and so if the intents aren't matching up this time then we'll i will i will address it much quicker you know this coming year so what about one time one thing that has actually driven me more towards labs is because my athletes like sometimes sometimes they are their own worst enemy because i'm like hey man how you, how you feeling today? Good coach. Good. I know. That's him.

No matter what. It's like, and you get that a lot in fighters. It's like, yeah, you can go wrestle. You can go wrestle for 90 minutes today. You sure? Yeah. What are you talking like? I can wrestle.

That's right. Yeah, absolutely. And it's what makes them great. But it also is what can create a ball. Beat their ass too. MASH, were you seeing a reduction in his, in like the pre-test depth jumps and the things that you run on a daily basis? I was, but by the time that, you know,

I realized it was a problem. We were already screwed because we had scheduled him to do the junior. You know, here's the thing is I took all the research, which would say that, you know, at junior level athletes, you can beat the shit out of them. And like, so like I've always tried to get as much as I could out of juniors until they're 20 years old. You know, once they're 21,

we start being a little bit, you know, wiser in the approach. So I just went one meet Tuesday. We have PR every single meet for eight years in a row, a little bit you know wiser in the approach so i just went one meet tuesday we have pr'd every single meet for eight years in a row every single intended meet mic drop years in a row until the last one and so but by the time i realized that we were in trouble it was too late it was uh we because he had junior pen amps and then like just three or four weeks later we had the senior worlds and so i you know i i you, you question yourself all the time, but maybe I should have not done the junior Pan Ams course if I had not done it.

And we still did poorly at the worlds. Well, then we'd be in big trouble right now because, you know, because he killed it at the juniors, we're still sitting in first place in America and looking good. But, but at the worlds when we needed to, there's nothing I could do. I knew three weeks out we were in big trouble, and we were lying to each other. I was doing the same.

I don't want to tell him that we're screwed. I'm hoping that we'll find a way out of it. But I deep down knew that there was nothing we could do. Yes, you were seeing it too. That's a good lesson, though. Any honest coach has had those lessons man and that shit won't happen again well and any honest coach they learn those lessons but they also take a responsibility for them too like i've had to do that before um where i'm like fucked up man yeah yeah yeah i get it's a what makes me cringe the most is if somebody absolutely has no responsibility or blames their athlete or said they they didn't follow the system

they didn't it's like huh you didn't give them a system that they could follow that was successful no he did problem yes that's what was the problem was not him he did everything i asked too much to see like yeah where he should have told me but now we have that talk next time when you feel terrible you need to tell me don't say i feel great you know but but we've put a lot in place now subjective questionnaires the testing be more i would look i would love to do blood testing way more often i just don't know how you know um how it's every four months is optimal i'd like to do shit every day to make sure every single day yeah his stress response from the wild workouts like looking at like creatine kinase based on muscle damage and just him still saying i'm fine coach we're good i would love that

that dude's an absolute animal he is an animal but then we did – here's one thing for people who can get this. The people listening will like this. We did a personality test. And now we have a guy, my assistant coach, and he's one of my – Brian Reisenhower. He is a PhD in sports psychology. And he took the – Brian took the test, and then Brian immediately sat me down. He said, look, man, he's got super high anxiety levels, which if you see that kid, you would never guess it.

Cause he's so chill, so chill. So then after practice that very night, I sat him down and I'm like, are you stressing later at night? And he said, yeah, man, I can't sleep. So it opened the door for us to have that talk. But that was already too late though. It was already within that three week window that I knew we were in trouble. But anyway, we learned a lot.

And so there we go. Yo, real quick before we shut it down, let's talk numbers one time here. Give us like three examples of what the normal range is on a lab and then what you consider to be the optimal range. Oh yeah. And how they differ?

Great question. Go with an easy one. Cholesterol, triglycerides, LDL, HDL ratios, hecko. Well, triglycerides is an interesting one. So triglycerides has a dose-dependent increase in cardiovascular-specific mortality after 90. Dose response means for each point going up, you're going to have an increase in risk of mortality. The one with triglycerides, though, that's interesting for Doug's conversation is that the reference range is just less than 90. So that's, it'll just say and I just even again, even to the person who doesn't look into blood chem, how does that make sense at all? So you can have a zero triglycerides? Well, no, because there's extensive literature connecting zero triglycerides or low to autoimmunity. So when it just keeps getting lower, it's not even being tripped off, yet it is a predictor of autoimmunity. So above 90 can be an issue, but then below 50 can start becoming an issue. So you're starting to create that a real nice sweet spot in the area of say,

lower 50s to high 90. As far as homocysteine goes, let's get that lower than 11, but above five, because if we have really, really low amounts, it can be associated with lower glutathione in the body. But above 11, that's when that cognitive decline risk begins to start tripping off. As far as glucose, we talked about it being above 85 is a problem. Glucose has a U-shaped risk factor. Now, despite popular belief of low carb eating, low glucose actually increases risk of all cause mortality in the same way that elevated glucose does. So when you see a U-shape, it means too little of something increases your risk.

The right amount of it is a sweet spot where you have very low risk. And then as you increase it, you have more risk again. That elevated risk, of course, is very commonly known. People know it's associated with type two diabetes, metabolic syndrome, those types of events. But low risk are connected to many, many mortalities. And you can you can begin to kind of conceptualize that with how many hormones bring up glucose versus how many bring it down. There is like five plus hormones that bring it up because it's absolutely critical for many functioning systems, but to bring it down one insulin, so you'll have a very clear U shaped factor to where optimal glucose reference ranging

is typically from 80 to 88. In that real sweet spot, if you start getting above 85, I know that I've said the 85 to 88 can begin to increase risk factor, but the independent predictor between the 91 and 99 is a real one you want to shy away from. So in terms of glucose, that's our low and high in terms of triglycerides, that's our low and high in terms of homocysteine, that's our low and high testosterone from a total perspective, 700 to 900. Of course, this is in the absence of understanding what's going on with free testosterone and sex hormone binding globulin in the rare cases where efficiency does win. But 700 to 900 is a very good sweet spot for that as well. albumin between four and four and a half because increased levels are associated

with dehydration, lowered levels below for increased mortality risk. There is a lot more that we can continue to hear CRP below point three, because you have a dose dependent increase in cardiovascular risk as you go one, two, three, same thing with ESR, ESR. So C-reactive proteins, acute inflammation, erythrocyte sedimentation rate is chronic inflammation. So if you're looking at CRP for acute, ESR for chronic, ESR, the reference range goes to zero to 15, but below five, it's considered optimal for ESR. So as far as acute and chronic goes, it'd be below 0.3 for CRP, below five for ESR. You guys want me to keep rolling? No, we got to shut this thing down. The dude's reading everyone's blood work right now.

We could do every single marker. We could do every single marker. And then there's actually the calculations and ratios and even reactants as to what pull those things up and down. So there's an extreme art to it on top of just knowing the reference ranges. Everybody just pulled over and they're getting on your website. Rapid Health is what I would say. They're like, I'm dying. There it is. You probably are.

So pull over. Dan Garner, where can the people find you? You can find me at dan garner nutrition on instagram there it is travis mash uh go to mash elite um at mash elite performance on instagram and then just www.mashelite.com there it is doug larson on instagram douglas e larson i'm anders varner at anders varner i'm actually going to tell the people not to go to barbell shrug today but we're going to go to Rapid Health Report on Instagram. We just started a new Instagram page,

breaking all this stuff down that's coming out of Dan's mouth from the show and putting out some really cool reels. And we're like 420 people. We got 20 new people yesterday hanging out with us on the first day of 2023. But we're making a big push to get all this content out to multiple different channels here, not just on the podcast. So head over to Rapid Health Report on Instagram. And then of course, get over to rapidhealthreport.com. If you would like to see all of this, everything we just talked about in action with Dan reading my labs and friends, we'll see you guys next week.