When Abnormal Does Not Mean Sick

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That red number in your lab portal can hit like a verdict. We know the feeling: your mind jumps from one “abnormal” result to the worst-case story, even if you feel the same as you did yesterday. But medicine has changed, and “abnormal” often reflects how much we measure, how we define normal ranges, and how quickly a borderline finding can turn into a lifelong label.

We walk through why it’s become so hard to stay “normal” on paper without ever getting sick. First, we simply test more, and when you run enough labs or scans, something is bound to look off. We dig into classic examples like back MRIs that look abnormal in many pain-free people, plus thyroid cancer screening that found far more “cancer” without reducing mortality. We also talk about genetic testing, including APOE status for dementia risk, and the key question most people forget to ask before ordering a test: what will I do with this information?

Next, we tackle moving goalposts, when guidelines shift for blood pressure and LDL cholesterol. Earlier detection can save lives, but it can also turn huge portions of the population into patients overnight. Finally, we discuss the rise of new labels for common symptoms and why the suffering can be real even when the diagnosis is not clearly evidence-based.

Our practical takeaway is a four-question framework you can use with your doctor: Is it real? Is it relevant? Is it risky to me? Is it resolvable? If this helped, subscribe, share it with a friend who is staring at a red result, and leave a review on Apple or Spotify.

Transcript

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Red Results And Instant Fear

SPEAKER_00 0:00

Have you opened your online health portal and seen a lab result in red? Or did your doctor say that your blood pressure or cholesterol or blood sugar is no longer normal? Did that scare you? Here's the thing. In modern medicine, abnormal doesn't always mean something new and bad happened. Sometimes it means we ran a hundred tests and found the one that was bound to look off. Sometimes it means the goalposts moved. Today I'll help you stay calm, ask better questions, and figure out which abnormalities actually matter. Because the goal was never to be normal on paper. It's to know which ones count and which ones don't. Hi, I'm Dr. Bobby Du Bois, and welcome to Live Long and Well, a podcast about what the evidence can and can't tell us about living healthier lives. As a physician, scientist, Iron Man athlete, and author of several hundred scientific papers, I read the studies so you don't have to, helping you cut through the hype, focus on what actually works, and make better choices for your health. Welcome, my dear listeners, to today's episode, moving the goalposts when abnormal doesn't mean you're sick. Now, most of my episodes are focused on evidence. What do we know about microplastics? Is coffee in the morning a great idea or not? Do we need eight glasses of water a day? What is the evidence on reducing our risk of cognitive decline? But today is different. Today I want to talk about how hard it's gotten to simply be normal. In a bit I'll share my story. But first, some fun history.

Dr. Nock And The Patient Trap

SPEAKER_00 2:29

Let me take you to a small French village. A writer named Jules Romans in the 1920s wrote a play about a country doctor named Nock. So Dr. Nock arrives in the village full of annoyingly healthy people. Nobody's sick. And for Dr. Nock, that's not a public health triumph. It's a business catastrophe. So he opens a clinic, hangs scary anatomical charts, uses impressive sounding jargon, and convinces a man with a small twitch that his spine is rotting. An attired woman that she's really a ticking time bomb of bad health problems. By the end of the play, the hotel becomes a hospital, the whole village is bedridden and happily paying him as their doctor, living on broth and taking their temperature every hour. Nox's motto, which we often refer to now as Knox Law, is that a healthy person is simply a patient who doesn't yet know it. Now here's the thing: everyone forgets about that play. Nock was in fact a crook. That was the joke. He wanted the money. He knew those villagers were just fine, and he made them sick on paper on purpose. And if that were our story today, a few greedy doctors inventing diseases to sell cures, this would be a pretty easy episode. Name the villain, avoid the villain, done. But that's not what's happening.

Good Intentions And Narrow Lanes

SPEAKER_00 4:26

And that's what makes 2026 stranger than 1923. Because today, mostly, there are very few Dr. Knox. There are very few villains. So what are there? They are well-meaning people, doctors, each doing exactly what we asked them to do. The cardiologist who wants to treat your blood pressure before it causes a stroke. That's a good person doing good work. The endocrinologist wants to catch your blood sugar before it becomes diabetes. Also, good. The radiologist reading your scan a little more carefully, the geneticist offering to tell you your risk, the lab adding 20 more markers to their usual panel, every one of them is trying to help. And in their own lane, most of them are right. Each expert wants to optimize their own corner. Nobody's actual job is to stand back and add it all up. And when everyone lowers their threshold to catch their disease a little easier, the person in the middle, you, quietly collects a stack of labels and wakes up one morning, a full-time patient, without ever having gotten sick. Now, are there people cashing in? Of course. More labels means more visits, more scans, more stuff to sell, like supplements, and parts of the wellness world run on exactly that. And we've talked about hype, what causes hype, how common hype is. And I really, really welcome you to listen to some of those episodes because it's so central to how I look at the world. But that is not the main driver. The main one is a thousand good intentions, and nobody thinking more broadly about what is happening. So you and I, let's think more broadly today. And again, today is not a story about villains. It's a story about what happens when everyone is right in their own lane and nobody's watching the whole swimming pool. Today, I want to explore why it has become so hard to just be normal. And because I always want this to be action-oriented for you, what do you do about it? Well, let me give you the punchline.

Four Questions Before You Panic

SPEAKER_00 7:27

We're going to talk through this a few times during the course of today. Ask four questions. Is that lab result or office visit finding real? Relevant? Risky to me, or resolvable? Four questions. So many of you have signed up for my newsletter and one my one-page action um prescriptions. If you haven't, please do so. Simple, easy, free. Link in the show notes, or just go to drbobbyvidence.com and sign up. I love to reach out to you on a regular basis with each of my episodes. I try to tell a little story in each newsletter and give you a chance to click on references and get those one-page summaries.

My Tests That Changed My Labels

SPEAKER_00 8:28

Okay, I would like to share two stories. Two stories about me being a bit personal, giving you some history of me to get us started. Okay, it was in my late 30s. I thought, well, if I'm ever going to run a marathon, now's a pretty good time to get started. So I would get up early in the morning before our two daughters were awake and my wife was awake. So I would walk out the door, begin running, and then come to a red signal and stop. Oops. The next thing I knew, and this happened several times, I had fainted on the ground, looking up in the middle of the street at five in the morning. Okay, not so good. And of course, as any good doctor, I ignored it. Ah, can't be anything serious. Well, eventually I did go to the doctor, ended up with the cardiologist, ended up with many, many, many tests, a cascade of tests, heart tests, x-rays. Well, what do we find? Well, nothing bad. Good. That was good news. Um, I didn't need medicine. I didn't need a procedure. Um, I had an autonomic nervous system that allowed my uh blood pressure to fall and to faint if I started exercise, then stopped suddenly, kind of like a horse at the end of a race. You continue to walk them, you don't stop them because bad things happen. Okay, so nothing serious. I learned how to deal with it. But in the course of those tests, I went from normal to worrisomely abnormal. Why? Because on one of the scans, one of the tests, one of the x-rays, I had a big heart. Now, was that big heart due to my exercising a lot? Was that big heart due to some heart abnormality or genetic abnormality? I don't know. They didn't know. And in the cardiologist's office on his bookshelf with something titled, the book titled Sudden Death in Athletes. I'm like, well, this isn't very reassuring. What did I do with that information? I have carried that with me for the last number of decades. I have a large heart, and we don't really know what it means. Now, in in this case, the testing was appropriate. So I'm not, this is not an anti-testing show. But I became a patient with a large heart. Okay, story one. Second story. Well, I started doing marathons, and I started doing triathlons and then ironman distance triathlons. And I'm fortunate that age 70, I'm still able to do them. The half distance, Iron Man triathlons takes me about seven and a half hours, seven hours, something like that. Okay, I've been feeling fine five to seven years ago. My blood pressure, my cholesterol, my blood sugar went up a tiny bit. But it wasn't that my values changed, it was the goalposts change, which I'll come back to. And now I have high blood pressure, high cholesterol, high blood sugar. And these are three heart risk factors. And I'm getting close to having what's called metabolic syndrome. So did I get sicker, sicker, sicker, or did my tests pretty much show something and everybody changed the rules for what's abnormal? And as we'll get to, there's a lot of that going on. Okay, that's my story. Everyone gets their own version. So why is it more likely that you will have a red lab result moment? Well, there are three reasons, and we're going to walk through each one of these carefully because it's very important you understand how it happens, because we'll then talk about the antidote of how to deal with this. So, three reasons. We are testing more, we are moving the goal posts, and we are diagnosing more. Those are the three we're going to walk through

More Testing Means More False Alarms

SPEAKER_00 13:10

them. Driver one, we measure more. Now, what happens? We measure more, you are more likely to find an abnormality. Why is that? Well, every test has a statistical normal, which is generally the 95% of all people who took the test are called normal. And then if you're at the upper couple of percent, the lower couple of percent, then you are abnormal. And that's where those red results come from. Not a specific thing that says, okay, now your iron is bad, but it is a statistical definition. So you do a bunch of tests, positive findings are inevitable. What's happening? Well, doctors order more tests today to be complete. You've also heard about all these, oh, get a hundred blood tests for $400. And they're pushing this for people who are well. If you do a large number of tests, an abnormal result is nearly inevitable. Now here's the problem. That red flag on that health portal can feel like a diagnosis. But sometimes it's just the arithmetic of testing. Okay, I'm going to walk through four questions, and this will help us tease apart what to do when somebody tells you that you're not normal or a result isn't normal. Question one, is it real? Is that result real? Repeat it and find out. Question two Is the result relevant? Do we have symptoms? Is this relevant to our symptoms, or was it just a routine panel? And genetic testing today is much more common as an example. We're all concerned about the risk of dementia. And now there are gene testing to help us figure out what our risk might be. And there's a gene, the APOE gene, which I've talked about in prior episodes. And there's the version that's the APOE3, the version that's the ApoE4. ApoE4 is a problem and more likely to cause dementia. And you get a copy of this gene from your mom and a copy from your dad, so you have two copies. And here are the data. If you don't have the APOE4, you just have ApoE2 or ApoE3, your risk, if you don't have any of those, is about 10% risk of dementia. If you have one ApoE4 copy, jumps to 20% risk of dementia. If you have both genes are ApoE4, it rises to about 60%. So you do the blood test in yourself. You feel the same before the blood test, you feel the same after the blood test. Now you've got this risk. Now your brain's obviously unchanged between yesterday and today, but your self-image of how you look at yourself and your life ahead of you may shift. So remember a couple of those questions. Is that is the result real? Well, it probably is. These are pretty accurate tests. Is it relevant? Yes, if you're worried about dementia, it's relevant. So now we have two more questions. Passes the first two. Third, question three, risk. Does it increase your risk of dementia? And the answer is yes, it does. At a population level, it increases your risk. And question four, is it resolvable? So if you had that positive gene testing, would it change anything? Would it change how you prevent or treat things? And the area of dementia, it's a bit problematic, but listen to my episode on can you reduce your risk of dementia? And I talk about a whole series of things you can do. And 45% of dementia, it's estimated, is preventable at the population level. So before doing a test, you have to ask yourself the question: why am I doing this test? What am I going to do with that information? And there's even a new test. And that's the Tau blood test, which is getting a lot of attention now. I'll probably do a full episode on it that supposedly predicts whether you're going to get Alzheimer's in the next decade or so, five years, 10 years. Let me know if you'd like me to do an episode on this. Now, it isn't just genetic testing. There is an increased tendency to test more broadly. If you have back pain, get an MRI. If you have a headache, get an MRI. If you watch Instagram or talk to your friends or read news reports, get a total body MRI. I have another episode called To Test or Not to Test, where I walk through all of this. So please take a listen and you'll get a sense of the pros and the cons. In general, I'm not big on total body MRIs. Okay, let's step back. Here's a study which is critical and is not unique to back pain. So in 1994, there was a really interesting study, one I found really interesting, in the New England Journal of Medicine. They took 98 pain-free people. So no back pain. Nothing suggestive of a back problem. What did they find? Well, 36% of the MRIs on these people were normal. Okay, that's great. 36 were normal. Uh-oh. That means 64% weren't normal. And these were normal people with no symptoms. So two-thirds of asymptomatic people with respect to back pain did not have a normal scan. 52% had a bulging disc. Doesn't that sound scary? 27%, one in four, had a protrusion, a piece of the disc that was squeezing out to cause problems. And 1% had an extruded disc, meaning a piece of it had broken loose and was in your spinal canal. These people were asymptomatic. So if you routinely get an MRI because you have a little twinge of back pain, you have a two-thirds chance for it to be abnormal, which is why you need to think carefully before you get a test. Because you may find it's abnormal. You may then want to do all sorts of things to solve the problem when in fact you had that problem even before you got symptoms. Here's another example, and I talked about it in my testing episode. South Korea decided in the 1990s it was going to catch and reduce thyroid cancer. And so they did lots and lots of ultrasounds of your thyroid gland, which sits in your neck. And what do they find? Over the course of 15 years, there was a 15-fold increase in cancer. Hmm. Wow, they were finding lots of cancer on these ultrasounds and then doing biopsies and all the rest. Guess what? Even though they found all that evidence of thyroid cancer, mortality didn't change. All right, so that brings us to question two Is that abnormal result relevant? Now we need to see why, with an MRI of the back, why, if you did an ultrasound to the thyroid, you might find something, but it may not be relevant. A bulge in your disc doesn't really explain anything. A thyroid nodule didn't affect most of those people. Okay, so do lots of tests, get abnormalities. Many of those are going to be incidental or statistical and may not mean anything to you other than we've now started to scare you. Okay, next driver of why it's harder and harder to be normal.

When Guidelines Move The Goalposts

SPEAKER_00 22:47

And that is we move the goalposts. So we became abnormal, not because our blood values changed, but because the definition changed. There's no villain here. As I said earlier, there's just many doctors and scientists trying to find concerns to address. All right, let's step back. Is moving the goalposts a real issue? Well, a study was done by Moynihan, published in PLOS Medicine. They looked at 14 different conditions, diagnoses, over a period of time. And what they found was in 10 of those, the definition broadened, broadened, broadened. What does that mean? We have a wider net to catch more fish. So we found more people with high blood pressure, we found more people with a blood sugar problem. Not because there's more of those people over that period of time, but because we widened the definition. Now, is this good that we're widening the definition, or is it bad? Like most things, it's a bit of each. Let me give you some examples. And some of these examples fit right into the story I've already told you. So the first one is blood pressure. Now we've talked in many, many episodes that blood pressure is a problem. It increases our risk of a stroke, of a heart attack, of dementia, of heart failure. It's a real, real issue. And the beauty is we can do something about it. But now, here's the nuance. Here's the problem. Historically, if we go back a couple of decades, we ran around with this idea that your blood pressure is normal unless it gets above 140 over 90. And that was kind of historically how we thought about it. But then in 2017, the American Heart Association changed the definition. Instead of 140 over 90, now, if your blood pressure was above 130 over 80, you were have high blood pressure. Guess what? In one day, that change meant that there were 45% of U.S. adults, almost half of every adult now had high blood pressure. And if you read the latest guidelines, they want you to get your blood pressure under 120. 60% of Americans are not normal with respect to blood pressure when you do this. So what is normal? What should you do? How should you think about it? So now I have treated high blood pressure because the definition shifted. Treatment is probably a good idea, but this is one of the reasons why, or one of the examples of why it's getting harder and harder to be normal. Here's another one: cholesterol, LDL. It is a real marker of high risk for heart disease. And many, many studies have shown that lowering the LDL level matters. Okay, in the 1980s and 90s, the LDL goal was to get the blood value less than 130. But then in the early 2000s, there were new guidelines that targeted an LDL level less than 100. So we went from 130 is becomes abnormal to now anything above 100. In 2010, American College of Cardiology dropped it even further. Normal. The goal is to get the LDL below 70. And if you've had a heart attack, drop it to below 55. Okay, so we started at 130. Now we're already seeing it should be less than 70, maybe less than 55 in some circumstances. But the average LDL in the United States is 111. So 80 to 90 percent of adults would now be referred to as having an abnormal cholesterol. Not because their cholesterol changed over the course of a couple of years, but because the definitions changed. So now I have high cholesterol too. Again, because the goalpost did some shifting. Now let's ask our four questions. Are those cholesterol levels real? Yes. Obviously, you would repeat them if you think maybe you had a fatty meal before you got the blood test. So yes, by all means repeat it. Likely it's real. Question two, is that elevated LDL relevant? Well, yeah, the the risk, the problem is there. And question three, is there a risk associated with a high LDL? Absolutely. Question four, is it resolvable? Yeah, statins, which is the most common, are cheap and pretty safe, and they're effective. But as many folks have talked about, if you just have an isolated LDL level that's a bit elevated, it's not absolutely clear whether treatment is really necessary. Now, if you have high blood pressure and a few other things, then absolutely yes. So that's the second driver. So the first one is you do more tests, you find more abnormal. Second one is the goalposts keep shifting, the nets wider, we find more people that are abnormal. The final driver.

New Diagnoses For Common Symptoms

SPEAKER_00 29:04

Now we have more labels. We label more. Part of the reason it's hard to be normal are common symptoms. And struggling with the question, are these common symptoms a disease? Or is it just the human condition? My belief is everybody has fatigue at times. Everybody at times feels down or has headaches or has some aches and pains, especially as you get a bit older? We all periodically have bloating or brain fog or poor sleep. These are common symptoms. And very likely, very likely many of you have them. So, tough question. When do common life experiences become an illness to treat? Because almost everyone has some of these symptoms. I like to ask the question: well, are the symptoms very serious or just annoying? And are they really new? Is this something that has cropped up? Remember Dr. Nock and Nox law. A healthy person is simply a patient who doesn't yet know it. And there are no lack of experts coming up with new answers, new diagnoses for some of these symptoms. So I've been around for a while. Back in the 1980s, these kinds of symptoms were called chronic Epstein Barr virus syndrome or chronic candida or Lyme disease. Well, now we have new labels. Well, it's your mold in your system, or it's other toxins in your system, or it's adrenal fatigue, or leaky gut, or long COVID. The symptoms that you're experiencing can be real, even when the label, the diagnosis, isn't. As an example, the Endocrine Society basically summarizes the information about adrenal fatigue, that there's no proof adrenal fatigue is real. Leaky gut, very interesting. Theory, not really diagnosable or clearly treatable. Yeah, there are real cases of long COVID and autoimmune illnesses after infections. But labeling, labeling is too common. Like Dr. Nock, for functional medicine, it's good business. Have a new diagnosis, even if the evidence doesn't support it. Therefore, we have to test you for this diagnosis. And oh, by the way, if it's abnormal, I've got a protocol to sell you, or a subscription, or supplements, or something else. The suffering is real. Now, the label, the diagnosis, has to earn its keep. So keep in mind questions two and four. Is it relevant with these theories, these tests? Yeah, maybe not. Is it resolvable with evidence-based treatments? Yeah, probably not. Okay. What I've tried to build the case is it's getting harder and harder to be normal. Now, is that good or bad? And like most things, it's often both. What are the harms of

Anxiety And The Cascade Of Care

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all this? There are three. First, anxiety. You get this abnormal test. I got the finding of a large heart. And you worry. You worry a lot. What does this mean for my future? Being with my wife and my kids. You do the gene tests for dementia, and it's positive. What does this all do? So anxiety is a big issue. Second issue that's a harm. This is a cascade of tests. Remember me, I got, I fainted, I got this test, this cardiac test, this other test, this other test. So it's a cascade of tests. It takes time, it takes money, you may find weird abnormalities. And when you find something, that might lead to, oh, you need a biopsy, or you need radiation or surgery or medications. And third, when you get these abnormal tests, it costs money and it costs time. So I don't want to leave you depressed. I don't want to leave you with, what do I do, Dr. Bobby? There is an antidote, the framework. So, to recap, four questions. Is it real, this abnormal finding? Is it relevant, this abnormal finding? Does it increase my risk of with this abnormal finding? And can we do anything about it? Is it resolvable? Think twice before you get a test and understand if it's positive, what that label means, and how it may apply to you. Ask your doctor, ask for the evidence that this approach will help you, that doing these tests will inevitably help you. All right, let's wrap things up.

Wise Testing And Final Takeaways

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Health is not having a perfect lab panel, a spotless scan, or a perfect genome. Health really is, as the title of my podcast suggests, live long and well. So it's an opportunity to live the life you value with the most function and freedom from suffering, avoidable suffering you can get. Today's healthcare has given us so many genuine miracles. We can prevent strokes by treating blood pressure, we caught heart attacks by treating the right people, we catch dangerous cancers, we find genetic risks that may truly matter. But every powerful tool or test casts a shadow. And the shadow of this one is that we can now measure more than ever we did before. And we label more and we move the goalposts a lot. So the answer was never to reject testing or diagnoses or treatment, but to be aware of what is happening. Not under-tested, not over-tested, wisely tested, wisely labeled, wisely treated. So the next time you see a red value on your internet health portal or a scary word on a scan, a new diagnosis, or a company asking, hmm, wouldn't you want to know? Pause and run the four questions. Is it real? Is it relevant? Is it risky? Is it resolvable? Being normal doesn't mean having no abnormalities. It means knowing which ones matter. You can get a one-page summary if you go to the link, and this will summarize some of these questions for you. And tell me your story. Do you have a story about an abnormal finding, the path it took you on? Let me know. Until next time, as always, I hope you live long and well. Thanks so much for listening to Live Long and Well with Dr. Bobby. If you like this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at Dr. Bobby Livelongandwell.com. That's doctor as a dr bobby live long and well dot com.