Friday, October 14, 2011

Top 3 Blood Tests Almost Everyone Should Request

One of my favorite activities in my practice is helping explain the deeper meanings of blood test results. I love being able to explain what may have caused an abnormal reading and to show connections between abnormal readings in different body systems. While doing this, I'm often surprised that blood tests I consider "standard" are frequently not ordered. What I find more surprising is how shocked people are when I tell them they should request specific blood work. We seem to forget that our doctor is our customer and that he or she needs to listen to our requests. If you wish to have specific blood tests done, please ask your doctor to order it. There may be times s/he may resist due to concerns insurance won't pay for it, but most docs will listen to your desires and order it. If you have a doc that refuses to listen to your concerns, perhaps you should consider finding a different practitioner.

Please note this post only mentions the top three blood tests I feel are most often overlooked. There are a multitude of blood, urine and stool tests that may be beneficial to helping predict or identify a health issue. Please work with your practitioner as a team to determine which tests will be best for you.

Although I identify these tests as being good for people carrying a bit of extra weight, it can be helpful to request these tests as part of a yearly physical in order to establish a baseline and spot early changes. Anyone who has health issues, is overweight or has had trouble losing weight, or has unexplained fatigue, headaches, etc. should always request the following blood tests:

  1. Insulin: Most doctors order a blood glucose level, and some may order a Hemoglobin A1C which provides an "average" of blood sugars over a period of about three months. However, I rarely see insulin levels ordered by anyone other than a holistic MD. Fasting insulin level shows how much insulin your body is producing. High insulin levels are an indicator the body has developed insulin resistance, which may lead to Type 2 diabetes. This test is important to request because people with pre-diabetic conditions or with Metabolic Syndrome may have fasting blood glucose levels that are normal, but often have high insulin levels. Most labs identify levels of around 5-17 as "normal." I like to see levels below 8-10. If someone has levels above 8, I typically start a revised eating plan with appropriate supplements if necessary.

  2. Full Thyroid Panel: When thyroid disorders are suspected, many doctors order a Thyroid Stimulating Hormone (TSH) test, but do not order tests to measure the specific levels of thyroid hormones in the blood. The TSH test measures the amount of TSH hormone being secreted by the pituitary gland. The thought is that you can measure the health of the thyroid gland by measuring whether or not the body is trying to increase or decrease its function. In my perspective, this is somewhat similar to checking the oil level in a car that's overheating instead of actually measuring the fluid level in the radiator. I believe there is value in the TSH test, but only when combined with tests that measure the actual amount of thyroid hormones in the blood stream. Two of the most commonly run tests to measure thyroid hormone levels are Free T3 and Free T4. (Those are two of the most important hormones secreted by the thyroid gland.) If thyroid issues are suspected, PLEASE insist your doctor order the Free T3 and Free T4. I know from personal experience that many docs are unwilling to order these tests. The true health of your thyroid gland cannot be adequately assessed without them. It can also be helpful to request an Antithyroglobulin test to determine if thyroid issues are caused by an autoimmune condition. I share a bit more detailed information in a prior post, Thyroid Hormones & Bone Marrow Biopsies: Please visit Stop the Thyroid Madness for in-depth information about thyroid issues and recommended blood work.

  3. High-Sensitivity C-Reactive Protein (hs-CRP): I am pleased that many more doctors are ordering a hs-CRP test for their patients. C-Reactive Protein is a protein produced by the liver in response to inflammation. A regular CRP test may be done after surgery or during various treatments to evaluate the level of inflammation in the body. The High-Sensitivity CRP is currently used as a possible predictor of potential heart disease. The hs-CRP can detect lower levels of inflammation. It is thought these levels often result from inflammation in the tiny blood vessels and other tissues in the heart. Although elevated hs-CRP levels do not guarantee heart disease, studies have found a definite connection between elevated hs-CRP levels and heart disease. I typically begin addressing cardiovascular issues when I see an elevated hs-CRP level. The CDC identifies levels below 1.0 as indicating low risk level; 1.0-3.0 as indicating a normal risk level; and levels above 3.0 as being high risk. These levels are obviously more of a concern when extremely high levels of triglycerides and/or cholesterol are present.
I can often tell quite a bit about a person's health from abnormal results in these tests, especially when combined with other blood work. These tests obviously all need to be used in conjunction with other blood tests and other assessment techniques.

My other encouragement related to blood work in general is to not become concerned by abnormal blood work before discussing it with your practitioner. There are many reasons for abnormal levels in some of the more general tests, so please do not jump to conclusions and assume the worst before discussing the results with someone who knows how to interpret them.

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