Barbell Shrugged - Physiology Friday: [Bloodwork] High Performance Blood Chemistry w/ Dan Garner, Anders Varner, and Doug Larson

Episode Date: May 10, 2024

In today’s episode of Barbell Shrugged Dan Garner dives into how you can start to analyze your yearly bloodwork for performance. Standard blood tests can be ordered around the globe, in every country, and are the gold standard for understanding basic health. The normal reference ranges, however, are not giving you the answers you are looking for when it come to optimizing your health and performance. In this episode you will learn: What's the mindset/philosophy of looking at bloodwork for performance if it's classically a health screen? Generally speaking, energy is what every performer needs regardless of their pursuit. How can one look at bloodwork to improve their energy levels? Electrolytes come on every panel, can these be used to look at hydration and performance? You've talked a bunch about the immune system in past podcasts so I'm wondering what a basic blood panel can tell us about the current state of our immunity? What general recommendations do you have in terms of preparation so when someone gets their blood draw they can ensure it's accurate? To learn more, please visit rapidhealthreport.com to see Dr. Andy Galpin and Dan Garner do a free lab, lifestyle, and performance analysis. Dan Garner on Instagram Anders Varner on Instagram Doug Larson on Instagram  

Shrug family, this week on Barbell Shrug, we're gonna be throwing it back to a new segment that we're gonna be calling Physiology Fridays. Many of the shows that we have, many of the guests that we have may not hit home to specific things that you have going on in your health and performance journey, and we totally understand that.

But when it comes to physiology, we all have it, we all need it, and we all need to be improving it. Therefore, every Friday, we are going to be posting shows based around your physiology, what your blood work means, what some of more comprehensive diagnostic testing could be, symptomatic things that you could be dealing with, and actionable steps that you could be putting together to improve your own physiology, health, and performance. Many of these shows are going to be with our own internal team here at Rapid Health, which is going to be Dan Garner, myself, Doug Larson,

Coach Travis Mash, Andy Galpin, and many of them we are reposting these because we want you to understand what it means to optimize your health. We also want you to have control over kind of that conversation that you may be having with your doctor, things to be looking out for based on the symptoms you may be having. And then of course, if you're feeling great, how do you take your health to the next level? And that's why we want to be reposting a lot of these because when you post 700 something episodes of a podcast, a lot of them can get lost in the feed of other podcasts. So bringing these to the top of your list because we believe that they are extremely important for you to be living your best life and of course, the constant pursuit of optimizing your health and performance. So with that, friends, make sure

you get over to rapidhealthreport.com. That's where you can learn from Dan Garner and Dr. Andy Galpin as they do a free lab lifestyle and performance analysis. And you can access that free report over at rapidhealthreport.com. Friends, let's get into the show. Welcome to Barbell Shrug. I'm Anders Marner, Doug Larson, the samurai of blood work, Dan Garner. I've been trying, I watch, I listen to this podcast, the all-in podcast. They have the greatest and like the longest like things for each person. It takes them like five minutes to get through these like ridiculous intros of each introducing each person, but it makes me laugh. And I always think you're the samurai when it comes to blood work. Today on Barbell Shrug, we're talking about high performance

blood chemistry. Let's be honest. Every single person on this planet has gotten blood work in the most average way possible by going on their physical and getting that average blood chem. But today we're going to teach you how to, uh, dig in and look at this thing in a much more, uh, performance manner. So I'd love to dig in why, uh, first off, why is blood chemistry like the number one thing that, that everybody's going to be doing and why is it not seen, um, really in like a performance manner? Yeah. I mean, first off, it's funny that we got the, the samurai type thing. Cause on a previous, not even long ago, I was called a nutrition ninja. So it's like between ninjas and samurais, they were fighting each other. I'm always

associated to some martial art. Yeah. Well, I'll be blatantly honest when I was writing the Instagram post of you kicking my ass and the thing and trying to condense all the words into things. I was like, samurai is fucking gangster because ninjas, I think, are protected more of the common people, which is cool.

But samurais protected the ruling class. I like samurais. They're like more cerebral and they're very precise. And that's lab work. I think you're right. We're precise. Way more Samurai than Ninja to me.

Yeah. All right. So on that note. And I only know that because while I was writing it, I was like, should we go Ninja or Samurai for the clever meter on this Instagram post. And then I learned that the ninja protected, protected the common people and the samurai protected the ruling class. And I went, dang, ours, definitely a samurai. Yeah, yeah, let's go. Let's go. I just gonna add that any kind of intro I do in the future, just introduce me that way without a smile. I'm a samurai.

If the NSCA has to do an introduction for me, I want them to introduce me that way without smiling. That's my job title. That's it. But yeah, dude, when it comes to blood work, blood work's phenomenal, dude. It gives you insight towards so many different things. It's typically not seen as a model of performance enhancement because it's seen as a model of health enhancement and basically if

you're just told the same thing enough times over and over and over again you're going to start to believe it so people start to think that due to the i suppose the boring nature of what a blood chemistry looks like it's a black and white sheet with some things that don't necessarily jump out at you that make sense, like hematocrit, hemoglobin, platelets, when people don't know what these things are. And then when they look at some sort of functional medicine panel that has dials and colors and images and says, this is your grade out of whatever, it makes a lot more sense. It's a lot more tangible to them. But blood chemistry is without a doubt the best.

It's been around for many, many, many decades. It's in every single city in the world for a reason. And it's because the amount of literature behind it is vast. The machines behind the processing and accuracy of the specimens is the most advanced in that what you're seeing on the paper is what you're looking at. And it's the most global. Like that's really why doctors use it because of its global nature. So for example, when I look at a lab, I am trying to be a detective, I am trying to basically utilize a detective philosophy towards unlocking what's the constraint holding that athlete back. When I when a detective approaches a crime scene, they're essentially approaching the crime

scene with a wide view. They're trying to look at absolutely everything to see what catches their eye. So a stool analysis, although extremely valuable, its value is quite localized within the gut. Whereas blood work, its value is towards any organ that has a blood supply, which is all of them. That's all of them. That's why you get biomarkers for kidney health, for liver health, for brain health, for lungs, for gut health, you get biomarkers for everything. So when you're looking at the crime scene, and you're trying to have a global view of where this possible constraint might be, blood work is fantastic because you're getting

so many organ systems at the exact same time. And the story of that person's physiology begins to unwrap itself as you begin to look at trends and start looking at markers. And it's also not typically seen as a model of performance enhancement because reference ranges are built off of population norms. So as the sicker the population gets, the worse reference ranges are built off of population norms. So as the sicker the population gets, the worse reference ranges get. And we're basically at an all-time high of illness, blood sugar issues, obesity. People essentially compared to previous decades just don't take care of themselves the same way they used to. I actually think the trend is starting to move in a better direction with tastier ways to eat healthy,

gym memberships, gym availability, at-home workouts. I do think things are moving in the right direction, but comparatively to say like 1950 or 1960, where you're doing barbell squats in gym, we're just living in a different world now. But blood work, without a doubt,

due to its availability around the world and due to the amount of research behind it with a sophisticated understanding of a reference range for performance. That is when you can unlock somebody's, somebody's true potential by applying the right tool for the right job. So what can typically happen in performance is you'll get an athlete who may suffer from fatigue. And this athlete has fatigue. And let's say they're, let's say they're a tennis player, and they suffer from fatigue. And like that, I just keep getting tired out in the court, what do I need to do, I need to add more cardio to my routine, I need to add more conditioning to my routine, I need to talk to somebody do some energy system work that's specific to tennis. So I have better conditioning

in my sport. This is a totally logical way of thinking. It is not incorrect to think about this in that way at all. You want to do, you want to have better conditioning in your sport. So therefore you want to utilize a conditioning method specific to your sport in order to excel in that sport. But what I've seen in my practice is that people are trying to use an outside-in tool for an inside-out job. They're looking for programs and resources from the outside-in when really this could have possibly been a magnesium deficiency.

Anybody right now could go open and depending on who you learned it from, maybe you learned it as the Krebs cycle, maybe you learned it as a citric acid cycle. Doesn't matter how you spin it. ATP production demands magnesium as a substrate in so many different parts of the pathway for ATP production, both aerobic and anaerobic. So this person, through a perfectly logical chain, is adding more conditioning to the program and not being more conditioned in their sport because of it. A lot of people can probably sympathize and empathize with that right now about applying more effort towards something

and not getting back what they feel that they've earned. But that's the very nature of what lab work provides and why I've said in the past that sometimes lab work is actually more important than your training program because your training program provides a stimulus, but your blood work provides the strategy at where you're going to apply that stimulus. The way in which you're able to harness the right tool for the right job allows you to surpass the people that think hard work gets you results. The hardest worker in the room does not always get the best results. It's only the hardest worker who is able to apply that effort into the intelligent areas of sports

performance who's going to get the best results. That's ROI. You see ROI in finance. You see ROI in business. You see ROI in athletic development. Looking at blood work through a performance lens allows you to have the right tool for the right job every single time. Yeah, dude, everything you just said got me so hyped for the O'Malley fight, knowing that you've been doing this for five plus years on that guy. I'm all fired up right now. I actually have like a maybe maybe it's like a half-baked thought in that if people are going and getting their standard blood work done at their physical,

and they're chasing these average ranges built off norms, but we are a very sick population, and the normal is built off of the sick people, by following and chasing, trying to get to average. Could people actually be trending in the wrong direction by putting the work in to try to be in these normal ranges? Yeah. So that's not a half-baked thought because if you are say a bodybuilder, a power lifter or a CrossFitter, and you don't have a high ALT, I'm going to wonder if you're training hard or not. If you're somebody who is training, if you've trained within two days of your blood test and your blood urea nitrogen isn't high, I'm going to wonder if you're training hard or not.

Like these are markers that are actually expected to be high. And that's when you look at blood work for, I keep saying athlete because it's my vocabulary, but anybody training hard, anybody physically active and getting after something, this applies to you too. And I'm going to call you an athlete all podcast. But when you when you look at say athletes blood work, GGT is more representative of liver health, because AST and ALT are going to be offset due to

muscle mass and muscle damage. Something like cystatin C is going to be more representative of kidney health, rather than creatinine and blood reinitrogen because those represent catabolism and protein metabolism. So if you have AST and ALT being disrupted by muscle mass and muscle breakdown, and you have blood reinitrogen and creatinine representing muscle mass, protein metabolism, and overall catabolism, then if you're actually after organ health for an athlete, you can't really use those markers anymore because they're very disruptive. Now, I do recommend that you don't train legs within five days of blood draw and you don't train upper body within at least 48 to 72 hours of a blood

draw. But even still, those markers are not necessarily reliable because of how connected they are to the physical exertion that you're placing upon your body and how abnormal you are. If you have a bodybuilder who does a blood test, how is his, if we have creatinine, which is representative of muscle mass, how is his going to fall within the population norm? It's not. To be a bodybuilder is like less than 5% of the population in terms of actual muscle mass on your body. So you're not going

to fall within that reference range, and you shouldn't. So to actually gain an insight on your organ health, instead of using creatinine for kidney health, you're going to have to use cystatin C. Or if you are under the impression that your liver may be under distress for whatever reason, you should be looking at GGT instead of actually looking at AST or ALT because these things will be off so what you're saying is totally right in that if you're trying to over correct for those things you what you're looking at is an adaptation like that your blood work is the adaptation to the physique that you've built away from what the population norm is which isn't always a bad thing. Yeah, and as a trend of a culture,

it's trending in a direction and overall doctors are chasing a path in which you're not getting healthier. You're kind of, you're following a model that it's very similar to like the, oh man, the body composition one. I'm losing it. I can't believe I can't remember this right now, but when they go in and they say, oh, you're obese. And you're like, oh no, I'm not. That's called muscle mass. Sorry. The BMI. Yeah. Yeah. Nope. I'm not obese. I can

promise you. Uh, but it says I'm considered obese. Yeah. It says on the chart and your weight and you go, you've got a problem. But blood work is now trending in that direction where they go, well, it's out of the reference range. You go, yeah, of course it is, because I've got muscle mass. I train hard. I eat well. And I'm not in the normal. Right.

Yeah. I'm out of the reference range. That's why I'm out of the reference range. I am no longer in the reference range. Yeah. I love that. Go ahead, Doug. that's why i'm no longer in the reference range yeah love that go ahead doug i'll say relative to a bodybuilder you said for creatinine you're not talking about just the fact that they have

um they're they're sore they've had a lot of muscle breakdown lately due to training you're saying just because they have an excess amount of muscle mass they have more protein turnover in their body so they're going to have more creatinine at all times not just just, you know, post training when they've broken down a bunch of muscle tissue. Correct. At baseline, they will have higher creatinine. So creatinine is something that will trail up with the amount of muscle mass you have. And that also by itself makes it a bad kidney marker. So let's, let's just imagine the opposite. Okay. So let's imagine we have an elderly woman who is, she's elderly, she's a woman, and she's vegan.

Okay, so the fact that they're elderly makes them have less muscle mass. The fact that she is female is going to make her have a little bit less muscle mass. And the fact that she is vegan is going to decrease her protein intake. So we have three things bringing down creatinine. But now if she has an actual clinical kidney issue, she's just going to be brought up into the normal reference range. So creatinine is actually a bad marker for kidney health all by itself, because those three things brought her down. And then an actual issue only made her in the normal reference range. So there is a giant science and art to lab interpretation to where like the science

is understanding biomarkers. What actually is each biomarker on a cellular and tissue level? What function does it have in physiology? What are the feedback loops involved with that biomarker? This is stuff that you can all read. But in terms of the art of interpretation, that's looking at outside in and inside out. That's looking at patterns and relationships between things. And that's really connecting their biomarkers to their goal and what they're after and kind of seeing through what's happening. Like another good one, too, is Billy Rubin, for example, the relationship between Billy Rubin and hemoglobin A1C.

Hemoglobin A1C is a representation of chronic blood sugar, which is very relevant to athletes because it represents blood sugar stability, energy stability, sleep quality in a big way, represents inflammation management. There's so many things connected to blood sugar that we've done podcasts on it, right? But hemoglobin A1c, the reason why it's a chronic marker for blood sugar isn't because it's a marker that can magically look back in time. It's a marker that is representative of damage. So when you have elevated blood sugar hanging around your red blood cells too often, it

creates something called glycated hemoglobin, which is glycated sugar damage, hemoglobin, red blood cell. So you've got this damage happening to your red blood cell. That damage from sugar hanging out and being neighbors with your red blood cells too often creates damage. And that damage is represented by hemoglobin A1c. So we're able to actually look at the past three, four months of blood sugar control via damage to your red blood cells. That's how you can look back in time. Now, bilirubin is a marker

of red blood cell turnover. So we have the, like I'm talking here, the red blood cells, they have a turnover rate of every 120 days. So imagine from the moment right now, in four months, you're going to have brand new red blood cells, which is pretty cool. The body's a fascinating thing. But if we have trending high or high bilirubin, that means our red blood cells are turning over really fast. And if they're turning over really fast, that means we're making new red blood cells really fast that haven't had time to take enough damage to be a representation of your chronic blood sugar measure. So you actually have to have red blood cells that live the lifespan of three to four months without being destroyed and metabolized to get a proper insight towards one's blood sugar status. So if you have a high red blood cell

turnover rate, this has actually been demonstrated in the research to have a negative correlation with hemoglobin A1c, making it artificially look like you've got great blood sugar control, which in reality, it may be one of the reasons why you have such a high red blood cell turnover rate. So seeing through those patterns and relationships, this lab thing is a real science and an art. And it's a game that it's one of those cool things that you can spend the rest of your life learning about. To what degree can you be like two or three standard deviations away from the mean? You got a large population that you're sampling from. There's presumably some type of bell curves. Most people are going to be in the middle of course. And then if you're

two or three standard deviations away from the mean, maybe that's totally normal for you. That is, that is healthy for you. Like most people are, you know, five foot eight or whatever it is, but some people are seven feet tall and that's just, they just are that. And it's totally normal for them. Um, like I remember, I want, I want to say it was like maybe someone like Sean Shirk, remember who that was, um, UFC, like who, like who who you know in his case totally looks like he's on steroids but i think it was him or someone similar that they they look like they're on steroids and so if they get accused or they pop for something that everyone's just going to assume it's totally correct but he he had some type of blood work done and i think he was like double or maybe

maybe slightly more than double like the amount of testosterone of a normal person and his argument was like yeah i'm not a normal person i'm a fucking world champion i'm not normal i'm not i'm not i'm not the average person like of course my testosterone is higher than than everyone else's because i am an elite fighter like that that is that thing got me to where i am today i'm not a normal person. Hence the belt I'm hanging around my shoulders. To what degree is it normal for people just to have that natural to be two or three standard deviations above or below the mean, but still be totally healthy and normal for themselves? Well, purely by definition, if you're a few standard deviations away from the mean, you're a one percenter. A one percenter can absolutely exist being a one percenter for the rest of their life. So that is somebody who could have a one percenters amount of muscle mass who actually had a really low total testosterone,

but his free testosterone was off the charts. So it's just something I've seen as a 1% or I was like, wow, like this guy's testosterone efficiency is so efficient that his total amount doesn't need to be as high because his ability to utilize his free amount is always through the roof. And I've seen that a ton with thyroid as well. You'll see someone with a borderline low TSH, but then their T3 is excellent. Their T4 is excellent. And that's just because the efficiency from pituitary to thyroid and signaling is absolutely excellent. So yeah, I would say by definition, if you are an elite person, you will have elite blood work. And based on how we create, or not we here at Rapid, we do create elite blood work. But based on how we create, or not we here at Rapid, we do create elite blood

work. But based on how blood work is standardized, you will show up as offset. And that's a problem because like as Anders alluded to, it can lead you down a road that will completely throw off what makes you elite. An example could be drawn into the world of sports performance with respect to structural imbalances. Sometimes your structural imbalance is an adaptation. If you're structurally imbalanced in golf from rotating one way all the time, your body has probably adapted certain tissues to perform in that range of motion. Same with rotating in baseball all of the time. Same with fighters. if they have a preferred kicking leg they're going to have that planter foot's going to be a lot more stable but this

takeoff leg is going to have different type of explosiveness and springiness to it this these are adaptations they're not always asymmetrical and the body is the ultimate adaptation machine it's going to adapt to whatever stimulus you give it to. And lots of times it's adaptations are purely that. And that's just another component of the art of lab interpretation. Yeah. I think the book, uh, sport or the science of sport or sport science, it's something along those lines, um, laid that out really, really well. And it was like, you can, you can practice jumping as much as you'd like, but when the guy that has the really tight Achilles tendon shows up to the high jump, you're screwed.

Those things matter to separate you from the masses. There's a story in the sports gene. That's the one, yeah. Yeah, I think we're talking about the same thing. I'm going to butcher the hell out of this, but I'm pretty sure a dude showed up and in 13 months won the Olympics. Yeah, that's exactly what I'm going to butcher the hell out of this, but I'm pretty sure a dude showed up and in 13 months won the Olympics. Yeah.

That's exactly what I'm talking about. Yeah. I was like, Oh my God. Genetics matter. That book, that book changed my whole like understanding of professional athletes. When it was like,

when it, when it lays out the percentage of how tall you are to the percentage chance that you have a playing in the NBA. And I was like, what do you mean? No five, eight people that have small verticals make it to the NBA. This doesn like, what do you mean no five, eight people that have small verticals make it to the NBA? This doesn't seem fair for me. What do you mean no five foot seven white guy in

his basement in Canada? What are you talking about? I was supposed to be there. But on a side note, I actually, this kind of bothers me in the world of muscle building because people say genetics don't matter. You just need hard work. Talent doesn't matter. Like that, that exists in muscle building. People say you just need hard work. Genetics don't matter. That's absolute and utter nonsense. In the same way, I'm never going to be in the NBA because of genetics. In the same way, I'm not going to be a hundred meter sprinter because of genetics. People will not always look like bodybuilders because of genetics. People will not always look like their favorite Instagram person because of genetics. Those matter a lot.

You can totally make progress. You can get better 100%, but you're not going to make it to a world-class level necessarily. If you're naturally, if you didn't train, you only benched 185, and then you trained your whole life and you benched 450, there are some people that, within six months of training, bench 450. They just do, because they're just really fucking strong.

Look at Travis. Travis is just a strong dude. He's 50 years old. He still front squats like 500 pounds. He's just strong. That's why he was a world champion powerlifter back in the day. Travis, on this podcast, said he would still be able to front squat 500 pounds an hour after he died.

Sounds like something Travis would say. Here, back to blood work real quick. That's exactly what he would say. So if you look at, and you can correct me on these numbers, but even like standard reference range something like blood sugar it's usually on the lab it's like it's like 70 to like 99 right but i've also heard you say something along the lines of you know every point above 85 puts you at at six percent you're six percent more likely to become diabetic for every point above 85 so being 92 is in the in the reference range but that's also not optimal it's not good if you're trying to be a world-class athlete you you don't want to be 92 for resting, resting, uh, or fasted rather blood

sugar. So for things like that, what, what are the more optimal numbers somebody should be hitting versus what would be on a standard lab? Yeah. So typically for blood sugar, you want to hang out in like a 77 to 85 range. Um, most things, what you see on labs, uh, blood sugar included will have a type of U-shaped risk factor to it to where it's like the Goldilocks effect. If you have too little of something, there's a risk associated to it. If you have the right amount, it's beautiful and you're in rapid. But if you have too much of an amount, then it goes back to having a risk factor again. So you get that U-shaped risk curve, right? When it comes to blood sugar,

it seems to hang out in the 76 to 85 zone. And to kind of pull that into athletics, it really does matter because blood sugar, that's a conversation that impacts a lot of things super relevant to athletes, because we have talked about in the past for every point above 85. And that's why that's the cutoff value for every point above 85, you are going to increase your risk of type two diabetes by 6% over the course of the next decade. But there's also literature exact same number. If you're above 85, you're at a statistically significant increase of cardiovascular death. So it's not just type two diabetes, it's also cardiovascular death. And then in between 91 and 99, there's actually further data on this to suggest that

even in healthy populations, you should begin, you should be beginning and the authors, scientific authors said this, you should be beginning preventative measures to prevent type two diabetes if you are between 91 and 99. So these are all components of blood sugar that act as canaries in the coal mines like, hey, this is absolutely suboptimal at this point in time. People come to me to be optimal. They do not come to me to be normal. And when it comes to blood sugar, it's one of those things that's so globally impactful

that if you can hit the nail on the head and correct someone's blood sugar, you can correct a few of the biggest things associated to the reasons they're coming to you for. Number one, energy fluctuations. Okay, there is many beautifully over complicated and sophisticated conversations you can have about energy, you can talk about micronutrients, you can talk about neurotransmitters, you can talk about the cofactors and coenzymes required for enzymes to catalyze ATP production. You can talk about mitochondrial density. There's amazing, fascinating stuff that you can talk about in the world of energy production.

But if you have blood sugar instability, none of that matters. None of it. Okay, this is like that kind of rock in the jar analogy. You got to have your big rocks figured out first before the little pebbles and sand even matter. Blood sugar, if that is unstable, chronically elevated, chronically low, or have variability, your performance will suffer, not just in athletics, your performance will suffer in your job, your performance will suffer as a dad, your performance will suffer as a partner. Energy is like the seed of life. And I believe we've talked about this before too. Like

I see energy as like a major component because it takes energy to be a good partner. It takes energy to be a good dad. It takes energy to go to the gym and get the job done. It takes energy to be great at your profession. These things all require energy, which means blood sugar is going to help your entire freaking life. Like that's a huge thing that you want to catch early before you're above 99. And suddenly you're a pre diabetic. You don't want to wait that long because you've already hit the threshold of cardiovascular death and type two diabetes risk many times over by that point. You've also actually hit neuropathy risk at that point to above 95. You're beginning to degrade tissues. So you guys have seen diabetics who've lost fingers or toes, or have undergone diabetic

retinopathy, where they begin to actually lose their vision, these things actually begin after 95. And you're still within the frickin reference range, which is insane. So you want to catch these things very early to maximize energy to maximize your entire life. Now blood sugar also impacts sleep in a big way. And in the same conversation, right? All those sophisticated conversations we can have about energy and the science of biochemistry behind it. If you don't have your sleep or blood sugar in check, that's another giant rock. You need to sleep well to have excellent energy. And then that's going to be an entire thing by itself with sleep's connection

to endocrinology, sleep's connection to immunology, sleep's connection to hunger and cravings, sleep's connection to blood sugar, because that actually acts as a chicken and the egg back and forth due to sleep's impact on cortisol. Blood sugar impacts sleep in a big way, because if your blood sugar is unstable, you can create cortisol at the wrong time of the day. So let's say let's let's use the example of somebody who has variations, or if they achieve states of hypoglycemia, so it ends up just getting a little too low. What can happen is you have your meal, whatever dinner or your evening snack, and then you go to bed. It's been three, four, five hours since your your meal, whatever, dinner or your evening snack, and then you go to bed and

it's been three, four, five hours since your last meal. And then because of the lack of resilience your physiology has towards blood sugar management, your blood sugar ends up getting lower and lower and lower and lower and lower. Now, when it gets to a certain point of low, the brain says, hey, that's my favorite fuel source, and I'm kind of important. So we're going to need to increase availability of that fuel source so the brain can continue to be being fed. And we're not going to run into any issues here, because if I shut off, we all shut off.

So it's seen as a stress and emergency mechanism to get blood sugar back to a stable level. Anything that is a stressor is going to form a stress response. And one of the hormones that allows us to liberate glucose from glycogen is cortisol. So if we have lower blood sugar throughout the night and it passes a certain threshold to where the brain deems it as an emergency, it is going to increase cortisol. When it increases cortisol, it's corrected the blood sugar problem because we've liberated glucose from glycogen around the body. We are good to go in a glucose perspective. However, cortisol in and of its nature of being a stress response hormone runs antagonistic with all things inhibitory. So cortisol being excitatory,

it is involved in excitation of the stress response, the fight or flight, all of that type of stuff. It runs antagonistic with things that are inhibitory, things trying to calm us down like serotonin, like melatonin, like GABA. We are actually reducing these things. And it had nothing to do with our pre-bed meditation and nothing to do with our pre-bed gratitude journal. It had nothing to do with our pre-bed breathing routine. Again, are any of these things illogical to do? Hell no. Those are all great things to do and things that you should try, but it's an outside in tool for an inside out job. It was blood sugar is the reason you're waking up at 2am. And it ain't

because of your gratitude. Okay, so that stuff, you're not going to get the same results from. And one of the worst fates actually is to get a little bit of results from that stuff. Because then you keep chasing that tail. Yeah, then that tail. Yeah, you triple your meditation time thinking you're going to triple the ROI on that on that pre bed routine. 100% and the same the tennis player, he's going to triple his cardio. And he's just going to keep running down that track. And he's going to understand like, dude, I have to do two cardio, two hours of cardio a day in order to have the same conditioning as that guy over there. What am I doing wrong? Wrong tool for the wrong job.

You just got the wrong tool, man. You needed a hammer. You're running around here with a drill like a fool. You need to look at your blood work and look at it and address the right thing at the right time. So blood sugar impacting energy, blood sugar impacting sleep, blood sugar is also going to impact inflammation. I mean, that's another thing we've done full podcasts about. Inflammation, increasing the pain sensitivity of your joints. Athletes, this is so critical to you. I work with a ton of UFC fighters. And one of the reasons why they freaking love me is because I use diet and supplementation to lower their inflammation, which allows their joints to have less pain during grappling, during wrestling, during sparring, during striking, during the strengthening, conditioning they have to do after all of that shit. Those guys take a real beating,

meaning their joints can take a real beating. And in that process, the more you can manage inflammation, the less pain sensitivity they're going to have in their joints, the more they're going to feel better, move better, fight better, all of that. And for the average person, you're just going to move better, feel better, perform better in the gym, in your average life, in your sport. Not all, like everything I just said just came down to looking at your blood sugar readings like that. And on a standard lab, by the way, you don't need a continuous glucose monitor. On a standard lab, between glucose, hemoglobin A1C, fructosamine, C-peptide, insulin.

I hope everybody just ripped their CGM off their tricep right there. Yeah. Just for everybody out there, as a note on this, CGMs are quite popular right now. And I believe that they can provide value in the future. But key emphasis on in the future. I currently work with people who don't really have a budget. And I still don't utilize CGMs. I just don't. Just think about this logically. I'm not going to dive into any biochemistry. Okay. Number one problem in America being obesity. Number one problem with obesity, blood sugar control. Okay. There are many, many, many type two diabetics,

right? This is just as undeniable. The amount of research that has been conducted on glucose, C-peptide, insulin, fructosamine, glycomark, HbA1c. Like we've got HbA1c for chronic blood glucose control. We've got glucose for acute blood sugar measures. We've got fructosamine to look at it over the past couple of weeks. We've got glycomark to measure variations and not just whether it's high or whether it's currently low.

We've got insulin and C-peptide to back up as hormonal processes as to what's happening hormonally behind the actual structural glucose molecule itself. We're looking at a giant picture of your entire glucose control that has many decades of literature behind it and has so much highly controlled research behind it due to the amount of medical problems that it creates in very well developed societies. So when we kind of just throw all that out the window and say, hey, this new thing's kind of cool. I've learned a lot in my career that new and improved doesn't always beat tried and proven. We've already got great

stuff. Just learn more about it and you're going to be able to use it so much better. I've also been in rooms, by the way, where someone able to use it so much better yeah i've also been in rooms by the way where someone sorry just one last point i've also been in rooms where someone's wearing a glucose monitor on each arm and getting different results so my right side my right side love sugar by the way take from that what you will. Let's dig into hydration. When you did my labs a couple years back, that was one thing that I was like, doesn't water do hydration? How's this guy reading my standard blood work that many doctors have read in the past and nobody's ever told me that I'm dehydrated even though I drink a gallon of water a day? Where do you find these?

Like, what are you looking for on blood panels for hydration? You can look at urine specific gravity for hydration. But yeah, purely purely for blood. You're looking at you're looking at sodium, you're looking at red blood cell count, you're looking at hemoglobin, you're looking at hematocrit. Between sodium, red blood cell count, hemoglobin, and hematocrit, those are your acute hydration markers. So those four represent acute hydration. You add one more guy on the end called albumin, and now you've got a chronic representation of hydration. Okay. So sodium, red blood cell, hemoglobin, hematocrit for acute, and then the exact four, but then adding albumin to the end is what makes it chronic dehydration. All of them being elevated. So it's a very easy algorithm that I just provided you.

If those ones are elevated or any percentage of them are elevated, you're looking at someone who's likely acutely or chronically dehydrated. You can also use like, say, blood urea, nitrogen, and creatinine as hydration markers, but they're less sensitive due to their connection to protein metabolism, someone could just be on a high protein diet, and those could be elevated. But those are actually excellent, excellent markers of hydration all by themselves. And then you can also go on there's this free thing online called MD calc, I think there's a few of them. But MD calc is just so easy. I think it's md calc.com. Type in serum osmolarity. Serum osmolarity is an algorithm that you can use to assess hydration

status of somebody and it's actually a gold to assess hydration status of somebody. And it's actually a gold standard of hydration status. The standardized reference range is from 285 to 295, but an optimal reference range is 288 to 292. So if you want to be optimally hydrated and you want to actually assess this at the tissue level, you want to look at the five biomarkers that I just provided you, and then also use that algorithm that I just provided you as well. Between those tools, you have very objective tools to assess your hydration status. But while you're at it, you can look at electrolytes to measure total stress load. But one of the most underrated components of lab-based interpretation is the sodium

to potassium ratio. The sodium to potassium ratio. The sodium to potassium ratio is huge as it's a representation of adrenal function. We've all come across people in the past who've talked about something like adrenal fatigue and they conveniently don't attach references to their claims or their talks or anything like that. That's very, very convenient, but that doesn't mean that it's untrue. And you can look at this thing in an evidence-based way. And one of the most evidence-based way to assess adrenal status is through electrolytes. It's actually how they look at actual medical-based issues like Addison's disease, where you have

major cortisol, either highs or lows. You can look at that. That's the beginning diagnostic process for cortisol variations in the body. There's two, there's Addison's and there's one other that's currently leaving me right now, but it doesn't matter in any sense because that's not what I do. But in any sense, what you're looking at is essentially the function of aldosterone. Aldosterone is secreted from the adrenal glands. It's got two big jobs. It wants to reabsorb sodium from the kidneys

and allow for potassium excretion to take place. So we're reabsorbing sodium, we're excreting potassium from the kidneys when aldosterone is healthy. When you start to see the opposite and this ratio starts to go on the other way to where potassium is um equal to or greater than 4.5 even though the reference range usually goes up to 5.2 but that's neither here nor there when it starts to exceed 4.5 and then when you start to get sodium to get lower than 140 um that's when your ratio is going to be off. Your ratio for sodium potassium should be 30 to 35. When it is lower than that, it represents adrenal hypo function. So it's quite low adrenal output. So this is somebody who's probably undergone chronic stress. So you would actually be looking for more chronic stress markers to essentially create a consensus on this person. Their sodium

potassium ratio is quite low. So what am I going to expect from chronic stress? Probably low cortisol at this point, as opposed to high. And then I'm probably also going to see low immune system function at this point, because although acute stress is stimulatory for the immune system, chronic stress is very suppressive for the immune system. So I'd start attaching other consensus markers associated with chronic stress to that. But then if we have adrenal hyperfunction, we have sodium potassium ratio exceeds 30 to 35, then we're looking at someone

who's currently in hyperfunction. So they may be, they may currently just be training hard, they may be currently exceeding their current recovery capacity as an outkick in their coverage on what their body's resilience can currently handle. And then you just be looking for acute stress markers. So in this case, cortisol would be high, white blood cells would be high. Since cortisol increases glucose, glucose will probably be high. So they don't actually have a blood glucose problem, what they have is acute stress. And you can actually corroborate that with the sodium potassium ratio, even though the sodium potassium ratio might still be is what ratio what is where is the ratio leaning because i don't want to treat you like a normal person i want to treat you like an individual which means you're going to have an individual ratio that i can connect to other biomarkers

to create a current consensus on the current stress load that you're currently recovering from or not recovering from probably not recovering from if you're seeing me for any current issues at the time, at the time of this blood draw. So yes, many hydration markers to go back to your original question, but then I went off on a tangent there. Those same hydration markers represent total stress load. And all of this is going to lead back to kind of like, and we've done an entire episode. So I wish I had that number on me right now, but on the immune system. And I would say that most people, and we talk about it on that show, that 70% of your immune system surrounds your gut. And if you're not taking a stool sample, then it would seem

like, oh, well, I guess I don't get to learn about my immune system, but that's not true. They can, what biomarkers can they look at in their blood work to start to look at immune function? Yeah. You can look at total white blood cell. you can look at platelets, you can look at the differential of white blood cells between neutrophil, lymphocyte, monocyte, eosinophil, basophil, and to connect it to your gut health too, because this is a pretty cool thing that you just brought up. So you know that chronic stress suppresses immunity, and you just brought up how that chronic stress can impact gut health within the immunity. Well, there's something known as hyperuricemia, where uric acid is a biomarker you'll see on blood work that and if that increases,

that's actually associated to intestinal hyper hyperpermeability. So if uric acid, typically, if it's above eight, that's associated to hyperpermeability, or to put another way, leaky gut. So that's another to hyperpermeability or to put another way, leaky gut. So that's another, I would consider that a chronic stress marker and, or a reason to order a stool analysis because this person that has more biomarkers than one currently be in being impacted by the physiologic state that they're currently in. But to trail that back to immunity, that's another beautiful way to kind of stamp home the idea of the art of lab interpretation.

There's this white blood cell differential between neutrophil, lymphocyte, monocyte, eosinophil, and basophil. And if you add those five up, it equals 100 because it's representing a percentage of distribution to what your body is currently making. So we have our total white blood cells, and then we have these five white blood cells that represent a percentage of what we're currently making. The real awesome art of lab interpretation here is taking a step back and looking at that percentage and going, huh, I wonder why the body thought that was a good idea.

Because I've never been at a point in my career where I was smarter, where I thought I was smarter than biology. Biology has been around for millions of years. The human body is fascinating. And it's answered questions that we don't even know were questions yet. So you look back, and it's this awesome opportunity to where you can see what the body is making, and just as importantly, what it's not making. So if you have, say, a three to one ratio or greater ratio of neutrophil to lymphocyte, then the body is fighting a bacterial infection that's also associated to inflammation. If the body is more leveled off, and it's got a one to one ratio of neutrophil to lymphocyte, this is actually associated also to inflammation, but also toxic load in the body. Monocytes being above 7%, this is more connected to a fungal growth,

a parasitic growth, or a bacterial growth. Eosinophils being greater than 5%, that's being connected to parasites or allergies. And then basophils also connected to parasites or allergies. And these all have certain triggering and cutoff points. And then you connect them to the other markers. You connect them to the subjective symptoms. And then you have a situation where I'm at in my career right now, where I authentically believe that blood work is as important as your training

program. Because although the training program provides a stimulus, the blood work provides a strategy. And that's the only stimulus that matters is the stimulus you can actually adapt from. And if you're missing something in your blood work, that's robbing you of your adaptation. You are not getting maximum ROI from your stimulus. I would co-sign on that. After doing this thing for two years now and watching the results and watching the videos and seeing how it's all linked together.

What goes on on the inside people people will like nothing drives me more crazy i love training at the globo gym and seeing what the mass population looks like and i see that kid over in the corner that like is just doing a million reps of everything and still weighs 125 pounds or or the people that are starving themselves or they're they can't figure out how to eat or what's going on why do they keep having these issues and why do they not get the results when they put the work in like yo that's like level five frustration when you're in the gym for that long trying to trying to get somewhere and you don't realize that the problem's not on the outside it's on the inside yeah that

person's all stimulus no adaptation yeah danarner, where can the people find you? You can find me at Dan Garner Nutrition on Instagram. Doug Larson. Also on Instagram, Douglas E. Larson. I am Anders Varner at Anders Varner, and we are Barbell Shrugged at Barbell underscore Shrugged. And make sure you get over to rapidhealthreport.com. That is where Dan Garner and Dr. Andy Galpin are doing a free lab lifestyle and performance analysis. And you can access that free report

over at rapidhealthreport.com. Friends, we'll see you guys next week.