The Lab & Health Tests Nutritionists Recommend (and Why) - Ask a Nutritionist

Transcript:

Brandy: Hello and welcome to Dishing Up Nutrition's midweek segment called “Ask a Nutritionist”. My name is Brandy Buro. I'm a Licensed and Registered Dietitian here at Nutritional Weight & Wellness, and today I will be talking about a question, a conversation that comes up a lot when I'm working one-on-one with clients.

A lot of clients come to me and they're wondering, what kind of labs should I ask for at my annual physical? Or, I've got a wellness checkup coming up and I just want to make sure that I get the most out of my visit. Are there any lab tests that you would recommend that I request? So if you have ever gotten your labs back after that physical or annual exam and thought, okay, I see all these numbers.

There's a bunch of acronyms, but what does it really mean? You're not alone? That can be pretty overwhelming to look at those lab results and make sense out of it. So today I'm going to walk you through what are some basic lab tests that I like to see from an annual physical and a few extra tests that you can ask for that gives us a little more insight into your metabolic health and your heart health.

And a few extra add-ons that I might suggest based on personal health goals or symptoms that we're trying to get a little more insight on, dig a little deeper and understand maybe the root cause of why you feel the way you feel. And finally, we will talk a little bit about how to prepare for your lab tests so that you get the most accurate results. So this is an episode that you might want to save, maybe re-listen to before your annual exam so that you feel as prepared as possible and you get the most out of that visit.

How lab results can be helpful for our nutritionists 

So first, let's talk about how a dietitian or a nutritionist might use some of these lab results during an appointment. When I'm working one-on-one with a client, I'm looking at lab tests. I'm asking two big questions. First, is there an obvious problem that needs attention sooner than later?

For example, maybe you have a very low vitamin D level, or maybe your blood sugar is very elevated. Those are things that we can address today. Second, even if things are “normal”, maybe they are in that normal reference range, are they actually optimal for how you want to feel? Are they supporting good moods, stable energy? Does it suggest that things are headed in the right direction to prevent disease and support long-term health?

So this is where we bump into the idea of a “normal” range versus optimal range. The conventional medicine range that you'll probably see in your lab report is a reference range, and it's usually designated to help diagnose disease. And that reference range is usually pretty wide. So if your numbers fall outside of that range, it could be a quick indicator that possibly you have already developed an issue.

But a more functional or optimal range is much narrower. It asks where do these numbers ideally fall for people to feel their absolute best and have the best health outcomes? This range is also very useful for identifying early development of various health issues at the point where we can actually make some changes, implement some interventions before the disease progresses, and it can even help explain certain symptoms that are consistent with a particular health condition, even if the lab values don't exceed that traditional threshold for diagnosing a disease.

So if you've ever walked away from your physical or an appointment and you're told everything is normal. Your labs are all within normal range, but you still feel tired, you still feel inflamed, or you're still dealing with some concerning symptoms. You're not imagining things. That normal range on paper does not always equal “I feel amazing”. So that's where digging a little deeper into some of these lab results can be really helpful.

Labs to get tested on a regular basis (#1: vitamin D)

So, what labs should you get tested on a regular basis? Well, let's start with the list that I like to suggest for everybody who's getting an annual physical. Let's start with vitamin D. So, vitamin D is a very simple blood test. I like to get it tested at least once a year, if not twice a year. Because vitamin D plays a lot of essential roles in the body and keeping your vitamin D levels in the optimal range is really important.

And the only way to know how to do that is to get your vitamin D level tested. Vitamin D acts more like a hormone than it does a vitamin. It plays a role in your immune function, your mood, bone health, and even your metabolism, and especially if you live in a northern climate or maybe you spend a lot of time indoors year round, or maybe you are very diligent with wearing sunscreen when you are outside in the sun, your vitamin D level can easily slip down below those optimal levels or even into deficiency without even realizing.

And a simple blood test can help you decide if you need to take a supplement and how much you need to supplement in order to get your labs into a more comfortable place. In reality, most people will need to take a supplement to do that. And your blood test is going to give us the best idea of how much to supplement. So we'd like to see your vitamin D levels between 50 and 80 nanomoles per liter, and even up to a hundred is okay.

Because vitamin D is a fat soluble vitamin, it is possible to over supplement and have too high of a level, but it is, it's pretty rare. You really have to supplement at very high doses for a long period of time before we reach that point. So it is a good idea to get your vitamin D level tested regularly, just so that we can keep an eye on it and optimize those vitamin D levels.

Fasting blood sugar

Next, let's talk a little bit about blood sugar. Fasting blood glucose is a very simple lab test to help assess your blood sugar control. This one is usually part of a basic lab panel. You will probably get it tested every time you get a physical. It tells us what your blood sugar is after not eating for several hours, and it gives us insight into your metabolic health.

So ideally your fasting blood sugar or your fasting blood glucose should fall around or below 90 milligrams per deciliter. So all on its own, your fasting blood glucose is really only one snapshot in time. That number can fluctuate a little bit day to day, depending on, you know, what you had to eat the day before, how well you slept, if you're sick or not.

So it's better to have some other labs in combination with that to get a, a good assessment on your blood sugar control. So when we pair your fasting blood glucose with insulin and your hemoglobin A1C, now we have a more accurate picture of how well you're managing your blood sugar.

Fasting insulin

So let's talk a little bit about fasting insulin. Most people are used to hearing about getting your fasting blood sugar tested, but not everyone has heard of fasting insulin. Fasting insulin is another blood test and it looks at how hard your body has to work to regulate your blood sugar and keep your blood sugar in a normal range. When you see your fasting insulin start to increase, when you see that number higher than optimal levels, that can be one of the very first signs that you are developing insulin resistance. Insulin resistance is the stage before you develop prediabetes or diabetes, where basically your body needs to use more and more insulin just to keep your blood sugar regulated.

And it's pretty interesting. You could have a completely “normal” fasting blood glucose while your insulin is quietly creeping higher and higher in the background. I think this is one reason why it is so useful to know what your fasting insulin is, and it really helps us in our nutrition work because if your insulin levels are elevated, that is a sign your blood sugar is not very well controlled, and then we can do something about that with our food choices.

We can often intervene with a real food meal plan, eating in balance, other lifestyle strategies to help address those blood sugar problems before they become a bigger issue like developing diabetes. So when you're at your next appointment, you can ask your doctor, “ In addition to testing my fasting glucose, could we also include the fasting insulin so that I can see how hard my body is working to keep my blood sugar balanced?

Hemoglobin A1C

Next, tying into the blood sugar and the insulin is that hemoglobin A1C. Hemoglobin A1C is just another way of looking at blood sugar. But instead of looking at a single point in time like your fasting blood glucose, it gives us a bigger picture of what your blood sugar patterns are over a longer period of time.

So that A1C is sort of an assessment of blood sugar control over the last two to three months. And when we're working on things like sugar cravings, energy crashes, or weight management concerns, or maybe even fatty liver, this number is absolutely part of that story. So when you think about blood sugar labs, I like to see all three of those numbers: your fasting glucose, your fasting insulin, and the hemoglobin A1C. That that trio tells us a lot more about your blood sugar control than that fasting glucose all by itself.

Liver enzymes

Next up I want to talk a little bit about liver enzymes. So liver enzymes that are listed as AST and ALT on your lab report. AST and ALT are two liver enzymes that are typically included in a complete metabolic panel. Sometimes that's listed on a lab test as a CMP. So why is this something that dietitians care about?

Well, when your liver enzymes become elevated, that can be a sign that your liver is inflamed, or it could be a sign of metabolic dysfunction. So we think about things like non-alcoholic fatty liver disease, which is closely tied to blood sugar control and insulin issues, not just alcohol consumption. And if your provider orders a complete metabolic panel, those liver enzymes, AST and ALT should be included along with those lab tests along with electrolytes and your fasting glucose.

And they give us another angle by which to look at your metabolism. It gives us a little insight, you know, behind the scenes at your metabolic health.

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Cholesterol/lipid panel

And finally, for some of those basic tests that I would recommend everybody get at your annual physical, I would also recommend getting a cholesterol panel or a lipid panel tested. Again, this is something that most physicians would order at an annual physical. This includes your total cholesterol, your HDL cholesterol, LDL cholesterol, and your triglycerides. So from a nutrition standpoint, we're not just looking at the good cholesterol versus the bad cholesterol.

We are looking at the patterns and how these numbers relate to each other, so we can even take a look at the triglycerides on their own. If triglycerides are higher than expected, that gives us some insight into your heart health and your diet.

We also look at your HDL. Is it on the low side or is it in optimal range? And does the pattern that we're seeing fit with other signs and symptoms of insulin resistance or inflammation? So if your cholesterol numbers are a little off, we focus on some strategies to improve those numbers. We could focus on increasing regular exercise, better sleep, eliminating added sugar and reducing processed carbohydrates. And in some cases there could be some key supplements that we integrate into your supplement plan to help optimize those numbers.

Advanced lab tests for heart health

And if you have a family history of heart disease or a personal history of heart concerns, or maybe that basic lipid panel looks a little worrisome, there are some numbers of concern, this is where I may suggest to request some additional more advanced lab tests to assess heart health.

We can think of these labs as zooming in on your cardiovascular risk. A couple labs that I might suggest are lipoprotein (a) and the NMR lipoprotein profile. Lipoprotein (a) is a specific lipoprotein that is largely genetic. The higher that number is, the more your risk is of developing a heart issue, like a heart attack or a stroke; even if your standard cholesterol panel looks okay.

So this might be useful information to know in motivating you to be consistent with some of those lifestyle strategies that I just mentioned earlier: exercise, eliminating processed foods, getting good healthy fats in your diet. And focusing on certain supplements.

Now, an NMR profile or that LDL pattern type is going to give us a little more detail that the standard cholesterol panel does not tell us. It gives us details about the cholesterol particle size and the number of particles, not just the total amounts, so it can help clarify risk of developing a heart issue like a stroke or a heart attack, even when that basic panel is maybe a little borderline or leaves us with more questions.

I may suggest that an NMR profile test when that standard lipid panel is borderline and maybe the physician is recommending certain medications when the client is really trying to avoid medication use. So this test can give us a little more insight and give us maybe more direct nutrition strategies to help improve those numbers before needing to do more dramatic interventions with medications. So these tests are not necessary for everybody, but if you do have a strong family history of heart disease, I think they're worth asking about.

ApoB100 is another very helpful marker because it is an accurate measure of all of the atherogenic lipoprotein particles that are in circulation. So basically. ApoB100 can tell us how many particles there are that have the potential to cause that plaque buildup that leads to a stroke, heart attack, and you know, even high blood pressure.

Sometimes two people can have the exact same LDL cholesterol number, but they can have very different ApoB numbers. The ApoB gives us a little more detail. Again, it tells us how many particles are circulating around that could cause an issue. The more particles that there are, the more potential there is for heart issues. The analogy that I like to visualize is cars on the freeway. The more cars there are on the road, the more potential there is for one of those cars to bump into another and cause an accident. The same is true with these cholesterol particles. The more particles there are, the more risk there is of an accident.

Next up I want to talk about C-reactive protein or CRP. CRP is a marker of inflammation. When your CRP is elevated, it could be a clue that there's more systemic inflammation going on, which is part of why it's tied to heart health. From a nutrition standpoint, if CRP is elevated, we are immediately thinking about how we can lower inflammation with an anti-inflammatory meal plan, focusing on real food and minimizing those ultra processed foods, processed and refined oils, refined carbohydrates and added sugars, and adding in more high quality protein, healthy natural fats, and lots of colorful vegetables with antioxidants that actually help lower inflammation.

And finally, for a basic workup, I also like to see homocysteine levels. Homocysteine is another blood marker connected to your cardiovascular risk and also to your B vitamin status. When that homocysteine level is elevated, we may think about your nutrient intake, especially certain B vitamins. B vitamins help keep homocysteine in check as well as lowering inflammation and liver function.

So again, none of these more advanced markers are required for everybody, but they can be very helpful if you or your family have a history of heart disease or if your provider is concerned about your risk of heart disease, and that basic cholesterol panel does not tell us the full story.

Additional lab considerations for understanding certain symptoms

Next, let's talk about some additional labs that we could look at to get a deeper understanding into why somebody is experiencing certain symptoms. These tests are more in the vein of, it kind of depends on the person kind of tests. So I might suggest these tests if your symptoms point us in that direction.

Ferritin

So first off is ferritin. Ferritin might be part of the conversation if chronic fatigue is an issue. So ferritin measures your iron stores. Ferritin, I think is a great way to kind of assess, a root cause for chronic fatigue or just feeling wiped out after doing normal everyday activities. Other signs that your ferritin could be off would be hair loss or hair shedding, or maybe you feel cold all the time.

It's especially important for menstruating women because of the potential for blood loss, but it could be relevant for anybody. It could be especially important for anybody with gut health issues. So if your basic blood work panel comes back “fine and normal”, but you are still exhausted through the day, you just can't make it through the day without a nap, or you have to lay down on the couch right after work; especially if you're getting enough sleep, you know, ferritin, low ferritin could be a missing piece.

Thyroid panel with antibodies

Now let's talk about a thyroid panel with antibodies. This might be recommended if somebody has signs of hypothyroidism. So things like trouble losing weight, chronic fatigue, hair loss, constipation, feeling cold all the time. So these all could indicate an issue with thyroid health, and I'm often interested in that full thyroid panel, not just the TSH, which oftentimes if you ask your doctor to test your thyroid, that may be all that they test.

So be very specific and request the full panel that includes the TSH free T4, free T4, reverse T3 and those thyroid antibodies that can help us screen for an autoimmune thyroid issue. Those antibodies give us another layer of information and can help explain symptoms that don't match the “normal”, basic thyroid screening.

Prostate specific antigen (for men)

Next up for men, especially as men enter middle age, we may start talking about testing their PSA or the prostate specific antigen. So this is usually going to be part of the conversation you have with your primary care provider or your urologist. But from a nutrition standpoint, if that PSA is starting to creep up or it's already elevated, it's another reminder that we need to work on lowering overall inflammation and think of strategies to support a healthy weight by prioritizing healthy, real foods and other strategies to support hormone balance.

Usually your provider is going to talk about getting your PSA tested routinely, probably by the time you're in your fifties, but if you are in your fifties and it still hasn't been tested, I think it's definitely worth asking about. You may even want to ask about it earlier, maybe in your forties if you have a family history of prostate issues. Yeah, it's something that you might want to start monitoring a little sooner.

Preparing for getting your labs tested

Now that we have gone over all of these labs, let's talk about how to prepare for the day that you get your labs tested. So you have your list of all the labs that you want to get tested. Now let's make sure that the results that you get back are actually useful.

So here are some practical tips. First, plan ahead and plan to be fasted. For a lot of the labs that we just talked about, you do want to be fasted, which means, you haven't eaten anything for at least 10 hours; 12 hours would be better; before you get your lab drawn. Water is usually okay. Sometimes black coffee or tea could be okay as well, but really try to stick to water only leading up to that lab draw.

For this reason, I recommend trying to schedule your appointment early in the morning so that if you are getting some blood drawn, that you are in a fasted state. Then you can still have your breakfast at a reasonable time and you're not, you know, suffering through your whole day, just being famished.

Next, you do want to try to pause any supplements that you're taking in advance. Some supplements can artificially skew those blood results. For example, certain vitamins, minerals, creatine, even fish oil can move those numbers in the short term, so we really want to try to pause your supplements for at least three days.

I would recommend trying to go a full five to seven days off of your supplements before getting your labs done so that you have the most accurate results. This is especially important if we are trying to establish or understand what your baseline levels are before making decisions around supplementation or before making decisions around whether or not you want to start a medication.

And I do like to suggest putting a reminder somewhere on a calendar or on your phone. That's seven days ahead of that appointment so that you remember to pause those supplements because if you remember the day before, the night before, it's kind of too late.

What happens after the lab draw

Finally, let's talk about what happens after the lab draw. So it's one thing to have those numbers in front of you. It's a completely different thing to know what to do with them, how to interpret them, and how to apply it in your life. So a few key points to emphasize is that “normal” lab results do not necessarily mean that they're optimal.

So if you get your lab results back with a little note that says, everything looks fine, it's all normal, I think it's worth it to take a closer look and review the results with somebody that you trust, somebody that can help you interpret those.

And remember, those conventional medicine ranges are usually intended to diagnose disease, to flag major issues. They're about catching major problems after things have already sort of surpassed a certain threshold. They're not necessarily intended to catch a brewing issue.

Now the functional or optimal ranges are all about fine tuning those lab results for your best energy, mood, metabolism, and long-term health, potentially catching an issue before it progresses into a full-blown disease that needs more advanced treatment.

You might be told that everything looks normal, but maybe your fasting insulin is quietly climbing and it's much higher than that optimal range, signs of insulin resistance, or maybe your vitamin D level is within their, well, the clinic's normal range, but it is far outside of that optimal range.

And maybe your liver enzymes are okay, but they are nudging upward and they’re continuing to increase over the years. And your thyroid, maybe your thyroid is within the clinic's normal range, but we see signs of hypothyroidism. And your symptoms match that. So these are all opportunities to use nutrition and lifestyle as a way to change the trajectory rather than waiting until something more serious develops. And before, you know those labs are clearly outside of that “normal” range.

So if you are someone who likes to be prepared, here's a little homework idea. Make a simple one page list with three sections. On the top, write down the basic annual labs that you want to get tested. If heart health is a concern for you, tack on some of those labs that we talked about to assess your risk of developing cardiovascular issues.

And if you do, if any of those symptom-based labs resonate with you, chronic fatigue or hair shedding, maybe we tack on ferritin and a thyroid panel. Now bring that list to your appointment or maybe even send it to your physician ahead of your appointment and say something like this. These are the labs that my dietitian and I have talked about in order to help fine tune my nutrition plan and my health goals.

Which of these labs make sense to get tested this year given my history? I think this just helps keep the tone more collaborative and respectful, but you're still advocating for yourself and getting what you need, getting the information that you need about yourself.

So as you head into your next wellness checkup, remember, labs are not about being perfect. Labs are information. It's valuable insight into your own body, and we can use that information to catch things early. We can catch insulin resistance developing before it's prediabetes or diabetes, or we can catch an underactive thyroid or we can watch for signs of inflammation.

And with the right support, like working with a dietitian, you can use that information to make simple, actionable changes with real food and other lifestyle habits to turn the course and prevent those issues from spilling into something that's harder to correct. So keep that list of labs that you requested and the results so that you can test them again after making those changes and track your progress.

Well, thank you so much for listening today. I hope you found this information helpful. If you did, share it with a friend or bring it to your next appointment as a reference to help you remember what to ask for in that appointment with your physician. And if you want a little more support, maybe a one-on-one conversation to make sense of your lab results and turn those numbers into actionable steps, our team of dietitians is here to help you. Give us a call at (651) 699-3438 or you can visit our website at weightandwellness.com to learn a little bit more. Well, thank you so much for listening today and have an excellent day.

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