1. Lipid Panel - (video to learn more) This test measures fat molecules in the blood. Cholesterol and triglycerides are two important types of lipids that are carried inside particles called lipoproteins.

The lipid panel analyzes your blood to measure different types of lipids: Total cholesterol: This measures your overall cholesterol level. Low-density lipoprotein (LDL) cholesterol: This type of cholesterol, known as “bad cholesterol,” can collect in blood vessels and increase your risk of cardiovascular disease. High-density lipoprotein (HDL) cholesterol: This type of “good cholesterol” helps reduce the buildup of LDL. Triglycerides: Excess amounts of this type of fat are associated with cardiovascular disease and pancreatic inflammation.  We also look at Advanced Lipid Panels as well - check out this video

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2. Essential Nutrients: iron/ferritin, vitamin D, vitamin B12, folate, magnesium

Iron, vitamin D, vitamin B12, and magnesium are so important for optimal bodily function, but they’re usually not checked at a routine primary care visit. Many people are deficient in these nutrients for various reasons, so it is imperative that we check these levels and supplement them when they are not optimal. Supplementation with any of these nutrients when people are low can be completely life-altering. 

Again, it’s important that we concern ourselves with getting to “optimal range” as opposed to “normal range”. For example, in the case of vitamin D, the “normal range” can be from 30-100 nmol/l, although we try to get our patients in the “optimal range” which is more like 50-80 nmol/l. Reviews of many scientific studies have shown optimal levels are at least 75 nmol/l in relation to bone mineral density (BMD), lower extremity function, dental health, risk of falls, admission to a nursing home, fractures, cancer prevention, and incident hypertension.

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3. Complete Metabolic Panel and Complete Blood Count (CBC)

These are two blood tests that are always ordered at a primary care yearly physical and offer a lot of information. They are essential to understanding a person’s electrolyte and hydration status, kidney function, liver function, and blood cell values. These values would also tell us if someone is fighting an acute or chronic infection, has anemia, or has clotting issues.

In terms of optimal ranges, when we look at liver enzyme levels that are still considered in “normal range”, but on the upper end, we can tell that there might be a detoxification or liver inflammation issue that should be addressed right away to prevent further progression of the illness. A number of studies have shown that this upper lab limit should be decreased in order to catch liver inflammation early, especially among certain ethnic populations.

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4. Metabolic Markers: Hemoglobin A1c, fasting glucose and insulin, lipid panel

Metabolic markers like these are essential to understanding how a person is processing the macronutrients that they eat. In most primary care visits, a basic lipid panel and glucose level would be done yearly, and if you’re lucky you’ll also get a Hemoglobin A1c. For patients at higher risk of heart disease, we run extensive lipid panels as opposed to a basic one. This can help us better determine whether there is actually increased heart disease risk from their cholesterol levels or not. Many times people are told that they have high cholesterol levels when they are not actually a risk.

The Hba1c is a measurement of blood glucose level average over the past 90 days or so, but it is also a relative marker of oxidation in the body. Having elevated blood glucose levels creates oxidation, or damage to proteins, DNA, and tissues in our bodies over time, so this is an imperative value to know and optimize.

Elevations in any of these levels are a sign that your body is not processing glucose properly, which can increase your risk for diabetes, heart disease, cancer, and Alzheimer’s disease. One study published in the Journal of Neurology in 2005 (6) showed that even if your Hba1c is considered in the “normal range”, every increase by 0.1 will increase the rate at which your brain shrinks in size per year. This is why being advised on how to reach “optimal range” is so much more important than simply saying you’re in “normal range”.

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5. Inflammatory markers: hsCRP, homocysteine

Inflammatory markers like these are almost never checked at a routine primary care visit. hsCRP is an inflammatory marker that can indicate your general inflammatory status. Even mild increases in hsCRP are associated with increased risk of things like cardiac events or depression. An elevation can tell us that there is something inflammatory happening in the body that should be addressed, whether it be from physical trauma, emotional stress, oxidative stress, environmental toxicity, allergy, sedentary lifestyle, or food sensitivities.

Homocysteine is an amino acid that requires methylated-vitamin B12 and folate to be cleared. Elevations in this level indicate a multitude of things like stroke and heart disease risk, B vitamin status, ability to methylate, ability to detox and make neurotransmitters, and ability to turn off cancer genes. It’s an important marker that we try to get into optimal range by supplementing with methyl-B vitamins when necessary.

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6. Thyroid Screening

This will give you a little glimpse of how the thyroid is functioning. There are 6 additional thyroid-related values that we routinely check for our patients: Free T4, Total T3, Free T3, Reverse T3, anti-TPO Ab, and anti-Thyroglobluin Ab. If any of these blood tests values are not optimal, we can start our patients on a program to prevent full-blown thyroid dysfunction or disease.

We look for “optimal ranges” as opposed to “normal ranges” of these labs. For example, the “normal range” for TSH is generally considered 0.2 – 4.5, however, there are studies that show that the body does not function properly when TSH rises above 2.5. A study published in the Journal of Endocrinology and Metabolism in 2010 even showed that the rate of miscarriage in first-trimester pregnancy was almost double when the TSH was over 2.5.