Doctor’s guide to advanced blood tests

You’ve probably had your fair share of blood tests and other diagnostics at your doctor’s office. Last week, I shared some that are rather routine so you’d have a guide to understanding them better.

In this article let’s look at more advanced blood tests your physician can order to screen for illness — illness that is developing but not yet showing signs or symptoms.

Tier 3 tests

When you consider that 1 out of 3 U.S. adults has some form of heart disease and approximately 50% of people who experience a heart attack have “normal” cholesterol results, it makes sense to use the most accurate and predictive testing for risk assessment. Chronic illness doesn’t manifest until years after it has been developing inside you. So let’s now consider the most accurate blood tests (bio markers) available for early detection of risk for heart disease, inflammation, and diabetes.

Because these tests are newer, ask your doctor to order them from your usual lab company and bill it to your insurance. Alternatively, you can go directly to specialty lab companies to get these and bill your insurance or pay out of pocket, and these companies are “in-network” providers for a growing list of insurance companies. Specialty lab companies include True Health Diagnostics, Genova and SpectraCell.

Heart disease tests

Oxidized LDL measures the amount of your sticky or “oxidized” LDL cholesterol. As I mentioned previously, measuring all LDL does not correlate well at all with heart disease risk. Oxidized LDL is a much better predictor of progression towards arteriosclerosis (“hardening of the arteries”). ^[1]

LDL particle number and size is another highly valuable piece of information regarding your heart disease risk. The more particles of LDL and HDL you have, the higher your risk for arteriosclerotic plaque to build up inside your heart arteries. You can have low LDL cholesterol (LDL-C), but a high LDL particle (LDL-P) count, which is a hidden risk for cardiovascular disease. Also, when HDL-P count is low, you are trending towards insulin resistance. Also, smaller LDL-P size can more easily enter the blood vessel wall and cause heart disease. Worse, small dense LDL can more easily get into the artery wall to develop arteriosclerosis and can be measured too. Nuclear magnetic resonance (NMR) spectroscopy is the preferred way to measure LDL particle concentrations (LDL-P). ^[2]

Apolipoprotein B is another way to estimate LDL particle concentration. ^[3] Low levels correspond with increased risk of plaque build-up, or arteriosclerosis. Dietary measures and an active lifestyle improve these measurements.

Lipoprotein (a) is a genetic risk for heart disease that is does not improve much with cholesterol medications. The Lp(a) test is especially valuable for you if you have a personal (or family) history of heart disease with a normal LDL-C level.

Tests for inflammation

High levels of blood fats as well as insulin resistance trigger inflammation in your arteries. Inflammation inside your heart artery walls is what causes plaque build-up, known as arteriosclerosis. This is why diabetes is now considered a “cardiovascular disease risk equivalent” equal in importance to having already had a heart attack.

Lipoprotein-associated phospholipase A2 measures inflammation inside your artery wall; high levels indicate the risk for rupture and can be lowered by diet, exercise, fish oil supplementation, and blood pressure control.

Homocysteine is an amino acid that becomes elevated when there is heart vessel inflammation. One cause is a MTHFR gene abnormality. See my article on MTHFR gene SNP entitled “Coaxing your genes to do a better job” found online here.

Fibrinogen is a blood clotting protein. Inflammation activates this to become elevated, leading to worse risk of arteriosclerosis, while consistent exercise can lower this.

Brain Natriuretic Peptide (BNP) is an enzyme that becomes elevated in several heart or lung stress conditions. It is a marker of congestive heart failure.

Diabetes risk tests

Adiponectin is a hormone from secreted from your fat cells to control body fat storage and if it gets too low from eating too many sugar foods you are not well protected from heart disease. This is the earliest detection of trending towards diabetes, even before other tests show abnormalities (glucose, HbA1c, Insulin).

Insulin: when fasting insulin is rising and adiponectin is low you are even further along the path to diabetes. Your blood sugars and HbA1c levels may still be normal.

Proinsulin: This is a measurement of insulin your pancreas is producing. By the time your proinsulin levels are on the rise (along with low adiponectin, high insulin and rising post prandial blood sugar levels), you’re clearly into insulin resistance and pre-diabetes even though your fasting blood sugar may still be in the normal range.

Fructosamine shows an average of blood sugar control over 2 weeks. Remember that the HbA1c test (previous article) measures blood sugar average over 3 months.

Leptin is the hormone responsible for your appetite and feeling full. This may become less functional when you are insulin resistant.

Free Fatty Acids (FFAs): These are elevated the more fats in your diet turn into triglycerides and may cause insulin resistance to develop. It is a measurable link between obesity and insulin resistance.

While these “advanced” blood tests are leading edge, they don’t uncover another aspect of disease that often gets completely overlooked: intestinal health. In my next article I’ll look further into intestinal health, this important link to chronic disease development, and ways to measure your intestinal and immune system health.

To feeling good each day,

Michael Cutler, M.D.
Easy Health Options

[1] http://www.truehealthdiag.com/wp-content/uploads/2015/09/Diabetes-2004-Holvoet-1068-73-oxLDL-mets.pdf
[2] Jeyarajah EJ, Cromwell WC, Otvos JD. Lipoprotein particle analysis by nuclear magnetic resonance spectroscopy. Clin Lab Med. 2006;26:847–70. [PubMed]
[3] Sniderman A, Vu H, Cianflone K. Effect of moderate hypertriglyceridemia on the relation of plasma total and LDL apoB levels. Atherosclerosis. 1991;89:109–16. [PubMed]