What Should a Complete Blood Test Include?
10/1/2016 1:42 PM
To find out the cause it is imperative to do thorough blood testing. The more information I have the better. I am blown away by the simplicity of the majority of the blood work patients come into the office with from other health care providers.
Usually, the blood test is 1 to 2 pages. It barely scrapes the surface in evaluating the true health of the patient. Most tests include the basic chem screen with 25 markers including glucose, calcium, BUN, creatinine, albumin, sodium, iron, calcium, and several liver enzymes. In addition, all patients have the old, outdated lipid panel including total cholesterol, triglycerides, LDL and HDL. Some other markers I might see could be a CBC (cell blood count), TSH, T4 regarding thyroid health, vitamin D3 and hemoglobin A1C, a marker to determine how your body has handled blood sugar over the past 90-120 days. A basic urine analysis and that is it. This is as basic as it gets. When I send a patient for blood work it is often 10 pages and patients are amazed by how much information I review with them.
The blood work I request will include other biomarkers that have extensive documentation in the medical literature, but seems to be ignored by the majority of physicians. A more complete blood test should include all of the above mentioned and the following: TSH, T4, T3, rT3 and both thyroid antibodies. You can see if you have an autoimmune thyroid issue by looking at antibodies. A more thorough evaluation must also include the expanded lipid panel. This includes particle size and particle number of both HDL and LDL. By just looking at the total numbers without looking at what it is made out of is passé. Most pharmaceutical approaches for dealing with cholesterol are not very effective in altering particle size and number. According to the research, this is what drives the risk of cardiovascular disease. Native LDL is not artery clogging. It is oxidized LDL that has become damaged from either glycation (blood sugar) or inflammation (hs-CRP). If you do not evaluate correctly then the information is inaccurate. As a result so many patients end up on a statin drug like Lipitor, who should not be on one.
Other important markers should include:
· Homocysteine: This is a risk factor for many disorders from Alzheimer’s disease, stroke, cardiovascular disease and estrogen related cancers, just to name a few. This is a marker of how well the patient is methylating and a window into the MTHFR genotype that so many patients have read and are concerned about.
· hs-CRP is a marker of inflammation. Many of the chronic diseases of aging are associated with inflammation.
o A heavy metal profile including:
· For patients who are immune compromised I would add in an immune panel including:
o T cells
o B cell
o NK (natural killer cells)
o Viral load including:
o Herpes virus
o Epstein Barr virus
· If I suspect mold then I test for Candida and several other mold markers.
o A full hormone panel including:
Starting at age 30 men should have a PSA done so you have a baseline moving forward.
I am still surprised that very few doctors check for fasting insulin levels. Insulin is a key player in driving glucose into the cell. Before a patient becomes a full blown diabetic they are insulin resistant. This number should be below 5. My goal is to help a patient go from being insulin resistant to insulin sensitive. Once that code is cracked we can now improve weight, blood sugar issues, fatigue and overall health. Pre-diabetes is already a disorder. You need to check fasting insulin!
The good news is that all of the above testing is performed by the major labs in the U.S. including Quest Diagnostics and LabCorp. It is generally covered under most insurance plans.
Once this type of testing is performed we can then move into more functional testing through specialty labs.
This can include:
o Adrenal Stress test
o Small Intestinal Bacterial Overgrowth test
o Comprehensive Digestive Stool Analysis
o Estrogen Metabolites
o Food allergy (IgE) and food sensitivity (IgG)
o Cyrex testing
o And more
If you do not live near my office, not a problem. We can send you a script via email and do the consultation over the phone or Skype.