Dr. Michael Cutler
My patients often come asking for blood tests for a general health assessment. It’s part of the annual health “physical.” I think of blood tests for screening as basic, more advanced, and in-depth for disease risk profiling.
Having a little information about the different types of tests available to you may ease your mind and help you be the best patient advocate for yourself or others.
Tier 1 tests
The first and most basic screening blood tests I usually order for my patients with no known disease are the following:
CBC: the complete blood cell (CBC) analysis measures your red and white blood cells. Your red blood cells carry oxygen throughout your body; the most common disorder here is anemia. Your white blood cells are a measure of your immune system status and are rarely abnormal when you are not fighting an infection. White blood cell cancer is known as leukemia.
CMP: The comprehensive metabolic panel (CMP) reveals the general function of your liver, gall bladder, and kidneys. It measures your blood sugar, mineral electrolytes (sodium, chloride, potassium, and calcium), acid-base balance, and blood protein (called albumin).
TSH: The thyroid stimulating hormone (TSH) is measurement of the pituitary hormone (from your brain) that controls the secretion of your active thyroid hormones T3 and T4 (from your thyroid gland). When your TSH level is low, it is generally an indicator of hyperthyroidism and you are expected to have elevated thyroid hormones circulating in your blood. However there is some recent science showing that genetic variances in a nearly a third of our population cause thyroid hormone function not to be accurately reflected by measurable TSH and thyroid hormone levels.
Lipid Panel: This is your basic cholesterol panel, showing your total cholesterol, LDL (low density lipoprotein) or “bad” cholesterol, and HDL (high density lipoprotein) or “good” cholesterol, with ratios. You must fast 8-12 hours preceding this test for it to be accurate. The lipid panel has general implications for cardiovascular disease (CVD) risk. However, elevated “bad” cholesterol or low “good” cholesterol levels have a poor correlation based on more recent scientific studies. The incidence of heart attacks among individuals with normal cholesterol levels is more than individuals with abnormal lipid levels.
Tier 2 tests
If you have an abnormal result from basic screening blood tests or if you want a more thorough assessment of your disease risk, I like to order these additional blood tests:
HbA1c: your blood glucose level can be in the normal range, especially if you were fasting 12 hours prior the blood draw. You can have pre-diabetes or even long-standing diabetes and miss it on a fasting specimen. The HbA1c test reveals your average blood sugar level over the past 3-months. Results ranging from 5.7% to 6.4% demonstrate pre-diabetes (glucose intolerance), which means you are not metabolizing sugar normally and really should make some serious improvements in your diet and exercise (or begin the medication Metformin). In the Diabetes Prevention Program, 58% of participants prevented progression to diabetes through diet and exercise interventions (compared to 31% who prevented progression to diabetes by taking Metformin).
Vitamin D: Approximately 75% of American adults are deficient in Vitamin D. I find this to be accurate from routinely testing my patients. Therefore, I test the 25-Hydroxy Vitamin D level, and if low (below 30), supplementation will bring it into the optimal range (50-100). Click here for my article about Vitamin D deficiency posted earlier this year.
Vitamin B12 & Folate: Elevated vitamin B12 can be an indicator of the common MethylTetraHydroFolateReductase (MTHFR) gene polymorphism which causes a host of symptoms of illness and can be corrected by supplementing with methylated folate or methylcobalamine. Click here for my article, “Coaching your genes to do a better job.”
Free T3 and T4: Triiodothyronine (T3) and thyroxine (T4) measurements will tell you how much thyroid hormone is circulating in your blood. It may not necessarily tell you if it is effective in your thyroid-sensitive organ tissues. Click here for my recent article, “Low thyroid function causes high health risks.”
Cortisol: A serum cortisol level will give you an idea of adrenal stress/fatigue and the need for treatment. Click here for my article “Tired, depress and hurting? Could be adrenal fatigue.”
Testosterone, estradiol, progesterone: Low testosterone in men or women is treatable. Low estrogen or progesterone, or estrogen dominance is also treatable safely from natural sources. Click here for my articles on testosterone. And here for my previous articles on menopause.
C-reactive Protein: This is produced by your liver and indicates inflammation in your body. Although non-specific, an elevated level is considered a “marker” for disease.
Saliva hormones: cortisol (8am, noon, 4pm, bedtime), melatonin, DHEA-Sulfate, free and total Testosterone, Estradiol, and Progesterone. I have used Access Medical Labs but there are several other specialty laboratories that do these, but are typically not covered on insurance.
In my next article (see below) I’ll explain more very important tests for disease profiling.
http://easyhealthoptions.com/demystifying-diagnostics-blood-tests-may-may-not-need/Doctor’s guide to advanced blood tests
You’ve probably had your fair share of blood tests and other diagnostics at your doctor’s office. Last week, (see the article preceding this) I shared some that are rather routine so you’d have a guide to understanding them better.
In this article let’s look at more advanced blood tests your physician can order to screen for illness — illness that is developing but not yet showing signs or symptoms.
Tier 3 tests
When you consider that 1 out of 3 U.S. adults has some form of heart disease and approximately 50% of people who experience a heart attack have “normal” cholesterol results, it makes sense to use the most accurate and predictive testing for risk assessment. Chronic illness doesn’t manifest until years after it has been developing inside you. So let’s now consider the most accurate blood tests (bio markers) available for early detection of risk for heart disease, inflammation, and diabetes.
Because these tests are newer, ask your doctor to order them from your usual lab company and bill it to your insurance. Alternatively, you can go directly to specialty lab companies to get these and bill your insurance or pay out of pocket, and these companies are “in-network” providers for a growing list of insurance companies. Specialty lab companies include True Health Diagnostics, Genova and SpectraCell.
Heart disease tests
Oxidized LDL measures the amount of your sticky or “oxidized” LDL cholesterol. As I mentioned previously, measuring all LDL does not correlate well at all with heart disease risk. Oxidized LDL is a much better predictor of progression towards arteriosclerosis (“hardening of the arteries”). [1]
LDL particle number and size is another highly valuable piece of information regarding your heart disease risk. The more particles of LDL and HDL you have, the higher your risk for arteriosclerotic plaque to build up inside your heart arteries. You can have low LDL cholesterol (LDL-C), but a high LDL particle (LDL-P) count, which is a hidden risk for cardiovascular disease. Also, when HDL-P count is low, you are trending towards insulin resistance. Also, smaller LDL-P size can more easily enter the blood vessel wall and cause heart disease. Worse, small dense LDL can more easily get into the artery wall to develop arteriosclerosis and can be measured too. Nuclear magnetic resonance (NMR) spectroscopy is the preferred way to measure LDL particle concentrations (LDL-P). [2]
Apolipoprotein B is another way to estimate LDL particle concentration. [3] Low levels correspond with increased risk of plaque build-up, or arteriosclerosis. Dietary measures and an active lifestyle improve these measurements.
Lipoprotein (a) is a genetic risk for heart disease that is does not improve much with cholesterol medications. The Lp(a) test is especially valuable for you if you have a personal (or family) history of heart disease with a normal LDL-C level.
Tests for inflammation
High levels of blood fats as well as insulin resistance trigger inflammation in your arteries. Inflammation inside your heart artery walls is what causes plaque build-up, known as arteriosclerosis. This is why diabetes is now considered a “cardiovascular disease risk equivalent” equal in importance to having already had a heart attack.
Lipoprotein-associated phospholipase A2 measures inflammation inside your artery wall; high levels indicate the risk for rupture and can be lowered by diet, exercise, fish oil supplementation, and blood pressure control.
Homocysteine is an amino acid that becomes elevated when there is heart vessel inflammation. One cause is a MTHFR gene abnormality. See my article on MTHFR gene SNP entitled “Coaxing your genes to do a better job” found online here.
Fibrinogen is a blood clotting protein. Inflammation activates this to become elevated, leading to worse risk of arteriosclerosis, while consistent exercise can lower this.
Brain Natriuretic Peptide (BNP) is an enzyme that becomes elevated in several heart or lung stress conditions. It is a marker of congestive heart failure.
Diabetes risk tests
Adiponectin is a hormone from secreted from your fat cells to control body fat storage and if it gets too low from eating too many sugar foods you are not well protected from heart disease. This is the earliest detection of trending towards diabetes, even before other tests show abnormalities (glucose, HbA1c, Insulin).
Insulin: when fasting insulin is rising and adiponectin is low you are even further along the path to diabetes. Your blood sugars and HbA1c levels may still be normal.
Proinsulin: This is a measurement of insulin your pancreas is producing. By the time your proinsulin levels are on the rise (along with low adiponectin, high insulin and rising post prandial blood sugar levels), you’re clearly into insulin resistance and pre-diabetes even though your fasting blood sugar may still be in the normal range.
Fructosamine shows an average of blood sugar control over 2 weeks. Remember that the HbA1c test (previous article) measures blood sugar average over 3 months.
Leptin is the hormone responsible for your appetite and feeling full. This may become less functional when you are insulin resistant.
Free Fatty Acids (FFAs): These are elevated the more fats in your diet turn into triglycerides and may cause insulin resistance to develop. It is a measurable link between obesity and insulin resistance.
While these “advanced” blood tests are leading edge, they don’t uncover another aspect of disease that often gets completely overlooked: intestinal health. In my next article I’ll look further into intestinal health, this important link to chronic disease development, and ways to measure your intestinal and immune system health.
To feeling good each day,
Michael Cutler, M.D.
Easy Health Options
Easy Health Options
[1] http://www.truehealthdiag.com/wp-content/uploads/2015/09/Diabetes-2004-Holvoet-1068-73-oxLDL-mets.pdf
[2] Jeyarajah EJ, Cromwell WC, Otvos JD. Lipoprotein particle analysis by nuclear magnetic resonance spectroscopy. Clin Lab Med. 2006;26:847–70. [PubMed]
[3] Sniderman A, Vu H, Cianflone K. Effect of moderate hypertriglyceridemia on the relation of plasma total and LDL apoB levels. Atherosclerosis. 1991;89:109–16. [PubMed]
http://easyhealthoptions.com/doctors-guide-advanced-blood-tests/[2] Jeyarajah EJ, Cromwell WC, Otvos JD. Lipoprotein particle analysis by nuclear magnetic resonance spectroscopy. Clin Lab Med. 2006;26:847–70. [PubMed]
[3] Sniderman A, Vu H, Cianflone K. Effect of moderate hypertriglyceridemia on the relation of plasma total and LDL apoB levels. Atherosclerosis. 1991;89:109–16. [PubMed]
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