Must-have markers on your labs

If you feel like you’re getting shuttled through a system, or that you’re being told you’re fine when you feel like something is off, or wondering if you’re fine why you’re on medication or being recommended supplements, or - and last one - nothing seems to be getting better (i.e. can’t lose weight, not sleeping right). Maybe you got a thorough work-up, or basic yearly bloodwork, and then all the numbers still come back in range. Or they’re slightly off but not enough to warrant medication, but let’s watch and wait. You’re not alone.. and this is way way more common than it should be.

Generally speaking, blood tests are ordered based on symptoms and to rule in or out certain concerns, except now we are in a day and age where many concerns span multiple concerns, or very general ones, like weight and sleep. You may see similar bloodwork year after year like red and white blood cells, cholesterol, electrolytes, thyroid, and iron, yet there is so much more that can be ordered that is still covered under ‘basic’! For example, usually just TSH (thyroid hormone) and T4 are ordered, but if your thyroid number seems within range (typically 0.45-4.5), yet you’re not sleeping right, can’t lose weight, always tired, constipated, hair falling out, etc. then your number may be closer to 4.5 (most people feel good around 1-2), or you’re not converting correctly. Meaning, the thyroid produces mostly inactive T4 that gets converted predominantly in the liver to active T3- if we’re stressed, T4 metabolizes into an inactive version called reverse T3. All of these can be tested. Similarly, if we have our iron tested, numbers may be within normal limits and we may still feel fatigued, dry, brittle nails, etc. but it’s really ferritin that we should look at (and have ordered, as well as a full iron panel), as it’s a better marker of iron than iron itself.

As a glimmer I mentioned briefly that the ranges of labs can certainly be tightened to help explain all those questions/thoughts we may have in bold. Consider vitamin D- the range is 30-100, but there isn’t any difference to be felt if you’re at 29 or 31. Actually, much research and people report feeling good at around 50. This is also something you don’t want too high as it can leach calcium from bones into blood, but for that to potentially happen levels are well over 100. Hormones are also incredibly important to be tested too such as in painful or irregular periods, hot flashes, low libido, and especially around weight, sleep, stress management, and mood. However, hormones are pretty volatile, and this is a snapshot in time. Further, estrogen and progesterone are best measured with saliva or urine (typically not covered by insurance) because blood measures both free and bound- and it’s only the free that’s active. This brings another point that even if we tighten the ranges, there may still be symptoms because the blood test doesn’t decipher how much is active or bound (aka a ‘normal’ number may have very little free).

Here are some other markers to consider for overall health:

  • Homocysteine- One of the main cardiovascular risk factors as if it’s elevated, it has been linked to increased risk of heart attack and stroke, as they are thought to contribute to plaque formation in our blood vessels. It is an amino acid (breakdown product of protein), that gets metabolized into methionine so it can get excreted by the body. However, the enzyme that does this is called methylenetetrahydrofolate reductase (MTHFR.. yes, it’s really the acronym), and in the majority of people, this enzyme functions pretty well. Except pairing this with bigger-than-usual red blood cells (i.e. MCV > 95, indicating a B12 or folate deficiency), the body may not be processing this conversion too well. Fortunately, this can be tested through genetic testing (typically a cheek swab) or blood test to find out its function.

  • Hemoglobin A1c- This is the amount of sugar on a red blood cell over a period of time, and sugar, not just from carbohydrates or bread, but stress, poor sleep, or anything that’s not exactly pleasant going on inside our body. Ideal levels for these are closer to 5, as this is where anything above a 5.7% can indicate pre-diabetes, and over a 6.4% may be Type 2 Diabetes. Statins, cholesterol lowering medications, can also raise these levels. In other words, this gives you and the clinician another idea of what your sugar levels may be even if your glucose (snapshot in time) is normal.

  • hs-CRP- A general inflammatory marker, stands for high sensitive C-Reactive protein, is made by the liver, and can also give insight to heart disease and risk for heart attack, strokes, and peripheral vascular disease. Inflammation can be from too much weight, smoking, alcohol, high blood sugar, poor sleep, poor nutrition, or any other outstanding concern where the body is just not happy.

At the end of the day, it’s the person sitting in front of me, combined with their history and family history, that helps narrow down what lab tests to hone in on, what to wait on, and what are the largest obstacles to cure. Supplements and medications should not be taken forever unless we’ve discussed every part to your health and done all that we could to optimize your present and future health. If you’d like to know more, I’m happy to set up a time to chat where we can make sense of it all!