Realfoodology Podcast Episode Summary

Episode Title: What Your Labs Don’t Tell You (and Why Women Get Misdiagnosed)
Date: August 26, 2025
Host: Courtney Swan
Guest: Dr. Josh Red

Overview

This episode zeros in on the blind spots of conventional lab work in healthcare, especially how these gaps contribute to chronic misdiagnosis—most commonly in women. Host Courtney Swan and Dr. Josh Red, a naturopathic and functional medicine expert, discuss why standard lab ranges often miss the real issues, how hormones and autoimmune conditions play a role in chronic symptoms, and what practical steps listeners can take to advocate for themselves and get to the root cause of persistent health concerns. Real-life case examples, including Courtney’s own lab results, drive home these points and offer invaluable, actionable insights.

Key Discussion Points & Insights

1. The Problem with "Normal" Labs and Misdiagnosis

• Lab Ranges Reflect Unwell Populations:
  • Standard "normal" lab ranges are derived from people already dealing with illness, not from a healthy baseline.
    • "That lab range is just a sick range." — Dr. Josh Red (15:07)
    • "They're taking the average of all Americans. And we know that 93% of Americans are metabolically unwell at this point." — Courtney Swan (15:13)
• Women's Symptoms Are Particularly Overlooked:
  • Women, due to hormonal fluctuations and unique biochemistry, are at higher risk for vague, chronic symptoms that get dismissed by standard medicine.
  • Dr. Red notes that many of his female patients feel "crazy" after being told everything’s normal, despite feeling unwell.
    • "I can't tell you how many women we see where they literally feel like they're crazy...And in reality, they're not normal." — Dr. Josh Red (13:06)

2. Going Beyond the Basics: What Labs Are Missing

• The Need for Comprehensive, Contextual Testing:
  • Standard panels rarely check markers like homocysteine (for methylation), in-depth blood sugar trends, inflammatory markers, or full thyroid panels.
    • "If you have a glucose level that's under 80 on a consistent basis ... that's likely that you have reactive hypoglycemia. If you have above 90, you could have insulin resistance." — Dr. Josh Red (23:21)
    • Insulin resistance shows up first in high fasting triglycerides (≥100), not just glucose numbers.
  • Optimal vs. Clinical Laboratory Ranges:
    • Healthy "optimal" ranges are narrower and more predictive of long-term well-being.

3. The Interplay of the Brain, Gut, and Hormones

• Brain-Gut Axis:
  • Brain trauma (even mild) disrupts gut health by causing intestinal permeability (leaky gut), which in turn stirs immune dysfunction and food intolerances.
    • "Within seconds, that causes intestinal permeability. And then ... you start absorbing proteins... and then your immune system freaks out..." — Dr. Josh Red (08:15)
• Digestive Dysfunction and Early Disease:
  • Gut function is often an early warning—e.g., poor digestion and motility predate Parkinson's diagnosis by 20 years.
    • "Earliest symptoms is you're going to have digestion issues. And that could be for 20 years before you even get diagnosed with Parkinson's." — Dr. Josh Red (11:36)
• Hormonal Imbalances and Adrenal Function:
  • Disruptions in cortisol/adrenal function are a root cause for myriad low-energy symptoms, more common in women—especially with age.
  • Low blood pressure (100/60 or lower) is often celebrated in medicine but may indicate poor perfusion and adrenal fatigue.
  • Fasting and blood sugar variability are problematic for many women.

4. Practical Solutions for Listeners

• Recommended Labs:
  • Fasting glucose, fasting triglycerides, homocysteine, CRP, ferritin, full thyroid panel (including TPO and antithyroglobulin antibodies), estrogen-progesterone ratio, and morning cortisol.
• Basic At-Home Checks:
  • Regular blood pressure measurement, monitoring energy/fatigue through the day, food symptom tracking.
• Dietary Interventions:
  • Avoid common triggers: gluten, dairy, soy, eggs, pork (especially for those with autoimmune tendencies).
    • "Probably the top autoimmune triggers will be gluten, hands down. Dairy's a close second... after that, soy, rice, corn, eggs..." — Dr. Josh Red (43:54)
  • Increase protein intake (most women undereat protein), eat more consistently, and incorporate healthy fats to stabilize blood sugar.
• For Autoimmunity and Inflammation:
  • Elimination diets guided by food intolerance testing (IgG), followed by gradual reintroduction.
  • Turmeric, Boswellia, resveratrol, and glutathione supplements can help calm autoimmune activity and inflammation.

5. The Critical Importance of Hormone Optimization

• Perimenopause Menopause Neglect:
  • Women in transition (perimenopause/menopause) are especially underserved. There are still pervasive misconceptions that hormone therapy (even bioidentical) increases cancer risk—Dr. Red asserts new research refutes this and supports hormone optimization for quality of life and prevention.
    • "Bioidentical hormones done the right way can be life-saving for women as they age too." — Dr. Josh Red (54:55)
• Fertility and Hormones:
  • Optimizing adrenal function and progesterone is essential for fertility.
  • Anecdotes of dramatic improvement in fertility and energy by correcting hormone and blood sugar imbalances.
    • "We put her on progesterone, we corrected her blood sugar, we improved the adrenal dysfunction—and she was pregnant." — Dr. Josh Red (58:08)

Notable Quotes & Memorable Moments

• On Women’s Experience in the Medical System:

  • "I can't tell you how many women we see where they literally feel like they're crazy...And in reality, they're not normal. They're just being totally misdiagnosed and mismanaged." — Dr. Josh Red (13:06)

• On Adrenal Function and Morning Fatigue:

  • "You have low blood sugar levels, you have low cortisol ... and low blood perfusion because your blood pressure is too low. Like, it's really, really common." — Dr. Josh Red (26:09)

• On Lab Ranges:

  • "That lab range is just a sick range. It's not a healthy range." — Dr. Josh Red (15:07)

• On the Gut-Brain Connection:

  • "A lot of our intestinal patients actually have brain issues. And we have to get the brain to fire properly... in order for you to produce digestive enzymes and HCl and blood flow to the gut..." — Dr. Josh Red (09:43)

• On Inflammation and Disease:

  • "Inflammation is a leading cause of pretty much every condition in our country right now. If we can calm down inflammation as fast as possible, our quality lives will be markedly better..." — Dr. Josh Red (41:09)

• On Hashimoto’s (Thyroid Autoimmunity):

  • "If you have a thyroid problem ... and you don't know if you have Hashimoto's, run to your doctor right now and check for a TPO antibody and an antithyroglobulin antibody. If any of those come back positive, you don't have a thyroid issue. You have an autoimmune issue that's causing your thyroid problem." — Dr. Josh Red (61:00)

• On the Power of Turmeric:

  • "The best supplement [for calming autoimmunity] is turmeric ... It has boswellia, resveratrol ... three of the top things to help calm down autoimmunity in people." — Dr. Josh Red (67:54)

Timestamps for Important Segments

• [07:07] — Dr. Red discusses cortisol/adrenal and hormone issues, especially in women.
• [10:51] — Surprising early signs of Parkinson’s disease: gut issues.
• [13:07] — Why women are misdiagnosed; the flaws in how doctors interpret labs.
• [15:07] — The "sick" lab range and what it means for patients.
• [22:17] — Methylation (MTHFR), homocysteine testing, and fatigue
• [24:54] — Adrenal dysfunction and why many women can't fast
• [28:05] — Women's aversion to morning protein & blood sugar issues
• [30:17] — The importance of estrogen-progesterone ratio
• [41:09] — The American inflammation crisis
• [43:54] — Major food triggers for autoimmunity
• [46:17] — Dr. Red's elimination/inflammatory reset diet approach
• [52:14] — Bioidentical hormones: misconceptions and new science
• [58:08] — Real-life fertility improvement via hormone optimization
• [60:37] — Incomplete thyroid (Hashimoto's) evaluation in conventional care
• [67:54] — Turmeric and supplements for autoimmune disease

Resources & Next Steps

• Labs and Guides: Dr. Red offers a free list of recommended lab tests and optimal ranges on his website drjoshred.com.
• Find Providers: Seek out functional or integrative medicine practitioners with strong patient reviews and comprehensive lab interpretation skills; nurse practitioners are excelling in this field.
• Self-Advocacy: Request comprehensive testing from your own doctors, especially for thyroid, blood sugar regulation, inflammation, and hormonal balance.
• Contact:
  • Dr. Red’s Clinic: Red River Health and Wellness (redriverhealthandwellness.com)
  • Instagram/TikTok: @drjoshred

Tone & Final Thoughts

Both Swan and Dr. Red maintain an empathetic, curious, and empowering tone, aiming to arm listeners—especially women—with education and tangible tactics to break out of the cycle of misdiagnosis and fatigue. The episode is full of accessible science, concrete recommendations, and real hope for those struggling with elusive symptoms.

For those feeling dismissed by "normal" labs or stuck in cycles of symptom management, this episode is a must-listen and a practical roadmap to reclaiming your health.