Demystifying diagnostics: Blood tests you may or may not need

Some doctors can go overboard with diagnostics. Others don’t seem to take every precaution you might expect when you’re concerned about your health.

My patients often come asking for blood tests for a general health assessment. It’s part of the annual health “physical.” I think of blood tests for screening as basic, more advanced, and in-depth for disease risk profiling.

Having a little information about the different types of tests available to you may ease your mind and help you be the best patient advocate for yourself or others.

Tier 1 tests

The first and most basic screening blood tests I usually order for my patients with no known disease are the following:

CBC: the complete blood cell (CBC) analysis measures your red and white blood cells. Your red blood cells carry oxygen throughout your body; the most common disorder here is anemia. Your white blood cells are a measure of your immune system status and are rarely abnormal when you are not fighting an infection. White blood cell cancer is known as leukemia.

CMP: The comprehensive metabolic panel (CMP) reveals the general function of your liver, gall bladder, and kidneys. It measures your blood sugar, mineral electrolytes (sodium, chloride, potassium, and calcium), acid-base balance, and blood protein (called albumin).

TSH: The thyroid stimulating hormone (TSH) is measurement of the pituitary hormone (from your brain) that controls the secretion of your active thyroid hormones T3 and T4 (from your thyroid gland). When your TSH level is low, it is generally an indicator of hyperthyroidism and you are expected to have elevated thyroid hormones circulating in your blood. However there is some recent science showing that genetic variances in a nearly a third of our population cause thyroid hormone function not to be accurately reflected by measurable TSH and thyroid hormone levels.

Lipid Panel: This is your basic cholesterol panel, showing your total cholesterol, LDL (low density lipoprotein) or “bad” cholesterol, and HDL (high density lipoprotein) or “good” cholesterol, with ratios. You must fast 8-12 hours preceding this test for it to be accurate. The lipid panel has general implications for cardiovascular disease (CVD) risk. However, elevated “bad” cholesterol or low “good” cholesterol levels have a poor correlation based on more recent scientific studies. The incidence of heart attacks among individuals with normal cholesterol levels is more than individuals with abnormal lipid levels.

Tier 2 tests

If you have an abnormal result from basic screening blood tests or if you want a more thorough assessment of your disease risk, I like to order these additional blood tests:

HbA1c: your blood glucose level can be in the normal range, especially if you were fasting 12 hours prior the blood draw. You can have pre-diabetes or even long-standing diabetes and miss it on a fasting specimen. The HbA1c test reveals your average blood sugar level over the past 3-months. Results ranging from 5.7% to 6.4% demonstrate pre-diabetes (glucose intolerance), which means you are not metabolizing sugar normally and really should make some serious improvements in your diet and exercise (or begin the medication Metformin). In the Diabetes Prevention Program, 58% of participants prevented progression to diabetes through diet and exercise interventions (compared to 31% who prevented progression to diabetes by taking Metformin).

Vitamin D: Approximately 75% of American adults are deficient in Vitamin D. I find this to be accurate from routinely testing my patients. Therefore, I test the 25-Hydroxy Vitamin D level, and if low (below 30), supplementation will bring it into the optimal range (50-100). Click here for my article about Vitamin D deficiency posted earlier this year.

Vitamin B12 & Folate: Elevated vitamin B12 can be an indicator of the common MethylTetraHydroFolateReductase (MTHFR) gene polymorphism which causes a host of symptoms of illness and can be corrected by supplementing with methylated folate or methylcobalamine. Click here for my article, “Coaching your genes to do a better job.”

Free T3 and T4: Triiodothyronine (T3) and thyroxine (T4) measurements will tell you how much thyroid hormone is circulating in your blood. It may not necessarily tell you if it is effective in your thyroid-sensitive organ tissues.  Click here for my recent article, “Low thyroid function causes high health risks.”

Cortisol: A serum cortisol level will give you an idea of adrenal stress/fatigue and the need for treatment. Click here for my article “Tired, depress and hurting? Could be adrenal fatigue.”

Testosterone, estradiol, progesterone: Low testosterone in men or women is treatable. Low estrogen or progesterone, or estrogen dominance is also treatable safely from natural sources. Click here for my articles on testosterone. And here for my previous articles on menopause.

C-reactive Protein: This is produced by your liver and indicates inflammation in your body. Although non-specific, an elevated level is considered a “marker” for disease.

Saliva hormones: cortisol (8am, noon, 4pm, bedtime), melatonin, DHEA-Sulfate, free and total Testosterone, Estradiol, and Progesterone. I have used Access Medical Labs but there are several other specialty laboratories that do these, but are typically not covered on insurance.

In my next article I’ll explain more very important tests for disease profiling.

To feeling good each day,

Michael Cutler, M.D.
Easy Health Options

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Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.