Are You Getting the Right Lab Work?
Your annual labs may be missing important clues about your health.
Who else thinks healthcare can be so frustrating?
Some people are lucky enough to find an amazing doctor who stays current on nutrition and has a more functional, whole-person, let’s-find-the-root-cause-instead-of-just-slapping-a-prescription-on-it approach. But many providers are still limiting patients to the standard, basic lab work and relying on the lab’s reference ranges (instead of what’s optimal).
Sometimes that’s because insurance won’t cover additional testing. Other times, it’s simply not part of their routine. But the good news? Many of these biomarkers are actually pretty inexpensive, so they may be worth paying for out of pocket if you meet resistance.
So I thought I’d put together something to help you out. 🙂
If you’re not trying to investigate a specific medical condition and simply want a better picture of your overall health and to identify areas that might need a little extra love, these are the labs I recommend. If your doctor isn’t able to order them, you may also be able to order some of these tests yourself, depending on the laws in your state.
You can also schedule a session with me to order labs and review your results from an optimal health perspective and not just whether they’re technically “within a normal range.”
Before you head to the lab: Most of these tests are ideally done after a 12-hour, water-only fast.
Heart health:
Lipid Panel:
This is commonly ordered during an annual physical, and it’s still an important piece of the puzzle. The key numbers to pay attention to are:
LDL (often called the “bad” cholesterol),
HDL (often called the “good” cholesterol),
Triglycerides (which are often influenced more by refined carb and alcohol intake than saturated fat)
But if your doctor is up to date on current cardiovascular research, they’ll also know that LDL alone doesn’t tell the whole story. I also like to check these two:
Apolipoprotein B (ApoB):
How much ApoB you have is like how many taxis you have taking your bad cholesterol to be deposited in your arteries. Fewer taxis = better health.
Even if LDL is just a little high, if we have a lot of ApoB, that means there’s a greater chance for cholesterol to be deposited into your artery walls, increasing the risk of heart attack and stroke.
Lipoprotein(a) (Lp(a):
This is helpful to measure regardless of your LDL number.
Lp(a) carries cholesterol and is mainly determined by genetics. That means your LDL could look perfectly fine but if your Lp(a) is elevated, your lifetime risk of cardiovascular disease may still be higher. Since lifestyle doesn’t significantly lower Lp(a), knowing your number helps you and your healthcare team be more proactive with the risk factors you can control.
hs-CRP:
This is a marker of low levels of inflammation throughout the body. Chronic inflammation has been linked to heart disease, insulin resistance, and other chronic diseases. It can provide another piece of the puzzle when looking at overall cardiovascular and metabolic health.
Metabolic Health (The Pre-Diabetes Watch):
Hemoglobin A1c:
Many doctors already include this test. Hemoglobin A1c shows us what percentage of your red blood cells (specifically the hemoglobin) has sugar stuck to it over the past 3-ish months. It’s commonly used to diagnose pre-diabetes or diabetes.
However, if you want to get ahead of the game, then ask for…
Fasting Insulin:
Before fasting blood glucose and A1c rises, your fasting insulin increases as your body works harder to keep blood sugar under control. So if your A1c isn’t bad but your fasting insulin is greater than 5 or 6, I would start improving your nutrition, increasing physical activity, and lowering blood sugar spikes - all things you can get into with your dietitian.
Nutrients:
RBC Magnesium:
You don’t need to pay much attention to the regular magnesium in your bloodwork because our body works hard to keep that normal. The real way to find out if you’re deficient in magnesium is by testing your RBC Magnesium. It should be above 5 or 6.
B12, Folate, Homocysteine:
I clump these together because B12 and folate both help recycle homocysteine, an amino acid that when elevated has been associated with damage to the lining of blood vessels, increased inflammation, and cardiovascular risk.
B12 is especially important to monitor if you eat little or no animal products.
Vitamin D:
This is low in many people and would need to be supplemented, but you won’t know if you do or what dose to take without getting it tested! Vitamin D can be stored in fat and your liver so if you over-supplement, it can be toxic.
Iron Panel AND Ferritin:
If I could only choose one iron marker, I’d pick ferritin. Ferritin reflects iron storage and is often the earliest indicator of either iron deficiency or overload. Pairing ferritin with a full iron panel gives us an even clearer picture.
PS: These tests are especially important to do with athletes and menstruating women.
Nice to Test:
The labs above are the ones I’d love to see for nearly every client. Depending on your age, symptoms, goals, medications, family history, and diet, I might also like to see these:
Hormones:
Testosterone (total + free):
Helpful for both men and women when evaluating energy, muscle mass, libido, recovery, and body composition.
DHEA:
This is a hormone made primarily by your adrenals and is a building block for testosterone and estrogen. It can help provide insight on adrenal function, stress, healthy aging, and hormone production.
SHBG:
This is a protein that binds to sex hormones like testosterone and estrogen – it’s acronym stands for sex hormone binding globulin. Even if your total testosterone looks normal, SHBG can affect how much is actually available for your body to use. This is often very high in women who have taken birth control.
Female sex hormones:
These become more complicated because the “normal” ranges change depending on where you are in your menstrual cycle (or whether you’re postmenopausal). I recommend talking with your doctor or dietitian about the best timing before ordering these.
Thyroid Panel:
Rather than checking only TSH, I prefer the complete picture:
TSH
Free T3
Free T4
Thyroid Antibodies (when appropriate)
Other Helpful Labs:
GGT:
This is an enzyme that can assess liver function but I also like it as a marker of oxidative stress.
Uric Acid:
This is best known for its connection to gout, but elevated levels have been associated with overall metabolic health as well.
Cortisol:
As one of the body’s primary stress hormones (with other use too!), it can be helpful to look at if your blood sugar is high but your diet is spot on or you’re struggling with other stress-related outcomes. However, it naturally rises and falls throughout the day so it’s important to discuss the timing and type of testing with your doctor or dietitian to make sure the results are useful.
There you have it! I hope this helps you advocate for your health at your next appointment. Please note that I didn’t include most of the standard tests that a doctor will order to check your liver and kidneys, but tried to focus on most of the ones that are typically not ordered (but imo should be).
If you’d like me to order these labs (where permitted) and review the results from a functional nutrition perspective, I’d love to help.
In health & happiness,
Erica Giovinazzo
MS, RD, IFNCP, CF-L2
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Disclaimer: The information in this article is intended for educational purposes only and should not be considered medical advice. It is not intended to diagnose, treat, cure, or prevent any disease. Always discuss laboratory testing, supplements, medications, and treatment decisions with your physician or other qualified healthcare provider. Never disregard professional medical advice or delay seeking it because of something you’ve read here.