Most of us probably have a primary care physician with whom we schedule our annual physical. We step on a scale, have our blood pressure, heart rate, and O2 saturation measured by an physician’s assistant or nurse. Then the doctor checks in with us and listens to our heart and lungs, looks into our eyes, nose, ears and throat, and reviews our chart. It’s often a quick examination; however, if we have symptoms or issues related to a specific part of the body or disease, we may be referred to a specialist. We are sent off with a prescription for fasting blood and urine tests. After our scheduled labs, we might notice if a result is flagged higher or lower than the standard range, or we might receive a call for a follow up. How many of us dig deeper?
After reviewing medical histories and discussing health and wellness goals with clients, it is apparent that many are less than satisfied with our current healthcare systems. How do we advocate for our wellness and how can we make the most of an annual visit?
Let’s start with a list of some of the typical blood tests:
- CBC with Auto Differential
- Comprehensive Metabolic Panel
- Lipid Panel
- Vitamin D 25 hydroxy
- Vitamin B12
- Fasting Blood Glucose
- Hemoglobin A1C*
- High Sensitivity CRP
- Ferritin
- Iron + TIBC
- Lipase
- Magnesium
- Phosphorus
- Uric Acid
- Thyroid-stimulating hormone
- PSA – Prostate specific antigen for men
Other tests that may be ordered:
- Urinalysis
- Mammogram – for women
- Bone Density (DXA) for Peri-and Post-Menopausal women
- Cologuard or Colonoscopy
* If you are at risk for diabetes or metabolic syndrome (insulin resistance) – men’s waist size greater than 40 inches, women’s waist circumference greater than 35 inches, have high blood pressure, high triglyceride level, have had an A1C that is in the pre-diabetic range, you might want to ask for the following tests:
- Fasting Insulin
- Leptin Resistance Test
- Ultrasound of the liver (if there is suspected Non-Alcoholic Fatty Liver Disease)
In his book, The New Rules of Aging Well, Dr. Frank Lipman, M.D. discusses expanding the list of tests you might want to explore to look at aging biomarkers, which are not necessarily markers for disease, but may show the predisposition or warning signs of possible disease. Early intervention is possible with diet, exercise and supplements. Dr. Lipman, who practices Functional and Integrative medicine, looks beyond the standard blood levels for optimal function. Some of these additional tests include:
Hormone Levels. Most hormone levels decrease as you age.
- Thyroid-stimulating hormone (TSH): 0.5-2.5 microU/mL
- Free T3: 3.0-4.5 pg/mL
- Free T4: 1.3-1.8 ng/dL
- Reverse T3: less than 20 ng/dL
- DHEA sulfate: 300-450 mcg/dL
- Pregnenolone: 50-150 ng/dL
- Total Testosterone: 500-1000 ng/dL
- Free Testosterone: 6.5-15 ng/dL
- Progesterone: results vary with age, where you are in your cycle, and whether you have gone through menopause
- Estradiol: results vary with age, where you are in your cycle, and whether you’ve gone through menopause
Vitamin levels.
- Vitamin D: 50-80 ng/mL
- Vitamin B12: greater than 500 pg/mL
- Folate: 10-25 ng/mL
- RBC magnesium: 5-6.5 dL
- RBC zinc: 12-14 mg/L
- Serum selenium: 110-150 ng/mL
Advanced lipid evaluation. The most extensive lipid evaluation and barometer of cardiac function is the Boston Heart Test. It measures inflammatory markers and cholesterol particle size. It provides much more information than the standard cholesterol test, measuring important heart risk factors like Apolipoprotein A-1, Apolipoprotein B, and Lipoprotein (a). Quest CardioIQ also has similar tests.
Ratio of omega-3 to omega 6. You want your ratio to be at least 3:1.
Homocysteine. This measures methylation, an important biochemical process to break down toxins. You want a level less than 8.
Insulin-like growth factor 1. You’re looking for a number that’s less than 200. As we get older, our IFG-1 should not be high, and could be a marker for cancer.
Fasting Insulin. The sweet spot is around 5 microU/mL. If your number is high, you’ve really got to watch your sugar. It might be an early sign of carbohydrate intolerance and diabetes. Most doctors say under 18 is good, but you want it much lower, closer to 5.
APO-E4 gene variant. The “Alzheimer gene.” If this shows up in testing, it doesn’t mean you’re going to get the disease, but you’re more prone to it. Lifestyle habits have a big impact.
While you may not need to test everything on Dr. Lipman’s list, please do discuss all your health concerns with your primary care physician.
Don’t be anxious about looking under the hood! Knowledge is power. Without knowing, how can we be proactive?
♥ Susan L. Ward
Integrative Nutrition Health Coach