To help Thomas get back on track, Moylan used narrower, or “functional,” reference ranges supported by the American Association for Clinical Chemistry. Taking this approach, Moylan found more than a dozen results “within the limits” of normal reference ranges but that fell outside of functional ranges, or the ranges an athlete’s results should be within to remain healthy and able to consistently respond to training stimuli.
Thomas’ sodium level of 143, for example, was within the normal reference range of 135 to 145 mmol/L but outside the narrower functional range of 135 to 140. This high sodium level naturally upset his electrolyte balance, something critical to performance for any endurance athlete, yet his initial practitioner overlooked it.
Moylan compares the “normal ranges” that are tested for in traditional lab tests to the FDA’s recommended daily allowances for vitamins. These recommendations are structured to provide the minimum nutrients necessary to stave off disease.
Similarly, lab values falling within a normal range simply mean that there’s likely an absence of disease, not necessarily normal health.
Using these functional ranges for guidance, Moylan helped Thomas tweak his diet and suggested nutritional supplements and a detoxification regimen. After Thomas spent a year rebuilding his health, he was able to respond to training stimuli again and continues to train at an elite level to this day—almost seven years after his Ironman incident. Indeed, Thomas won the individual general category of the pro/Cat. 1 division of the 2011 Valley of the Sun Stage Race in Arizona in February despite being twice as old—42—as the youngest rider.
Thomas’ example demonstrates just how important it is for athletes to find a conscientious doctor who is experienced with athletes and willing to take a long, hard look at current and past lab results. This doctor must also be adept at evaluating not only disease states, but also whether or not an athlete’s body is functioning as optimally as possible.