Top 10 Lab Tests
Updated: Apr 19
Written by Dr. Dane Donohue, Co-Founder of 8WW
Health and sickness lie at opposite ends of a continuum. Just like a football team can’t be on offense and defense at the same time, your body can’t be moving towards health and sickness at the same time. In the case of your health and how you are aging, I believe the direction is more important than speed. It’s more important to be moving towards health, and away from sickness and a poor quality of life. However, some people, in fact, a lot of people are not only moving towards illness, but there are moving towards that destination very rapidly. Look at the continuum below and ask, “where am I right now?”. Next, ask where would you like to be? Are you moving in the right direction? If your answer is no and you are moving towards disease and ill-health, then it’s time to “take inventory” and see what needs to change and improve.
One of the best ways to objectively know where your health is or if you are in a “pre” disease or full-blown disease state is your bloodwork. When I evaluate a person’s labs, it’s like looking at a crystal ball that helps me to accurately predict their future based on what’s going on inside their body. The saying goes that “ignorance is bliss”, but not when it comes to your labs. Ignorance is IGNORE-ance, meaning you don’t know what’s going on because you don't know what you don't know. How many lives have been saved by fire detectors and how many lives have been taken by ignoring a smoke detector or worse, not having a smoke detector? We can do better with our health and avoid SO many struggles when we know what’s going on inside our bodies. It’s like the Marvin Gaye song “What’s going on, what’s going on…tell me what’s going on?”. Well, your labs will tell you what’s going on.
Here are the 10 labs I think are critical and remember that some of these aren’t usually ordered in your annual lab test done at your primary doctor's office. So, you have to ask your doctor to order them.
1. General lab panel and CBC- This is a low-cost general blood panel that can give you a broad range of diagnostic information to assess your vascular, liver, kidney, and blood cell status. A general lab panel will give you your basic lipids such as total cholesterol, HDL, LDL, and triglycerides. Remember, the Triglyceride/HDL ratio is MUCH more predictive for cardiovascular events than simply looking at total Cholesterol alone. You should try to keep your ratio less than 3 and less than 2 is ideal. So, for example, if your fasting triglycerides were 100 and your HDL was 50, you’d have a ratio of 2. The general lab panel will also tell your fasting sugar (glucose) but this can be misleading and doesn’t always tell you the whole story.
2. HbA1C- Hemoglobin A1C. This test measures a person's blood sugar control over the last two to three months and is a strong independent predictor of heart disease risk in persons with or without diabetes. I think this is one of the most important lab tests because the higher your HbA1c, the “stickier” your cells become and the faster you age. I would call this lab marker the “aging” lab test because the higher it is, the stiffer everything in our body becomes. We should shoot for an HbA1c of less than 5 and prediabetes starts at 5.7 and diabetes is diagnosed when your HbA1c is above 6.5.
3. Hs-Crp- High sensitivity C-reactive protein. This a lab test that measures the systemic inflammatory load in the body. So many diseases are caused by inflammation or create inflammation in the body. When the body has an "itis" or is “on-fire” with inflammation, it can result in things such as cardiovascular disease, type II diabetes, neurodegenerative conditions such as dementia, and even auto-immune diseases such as rheumatoid arthritis. The lab reference range is 1-3 mg/L, but you should shoot to be below 1 mg/L.
4. Homocysteine- Homocysteine is an amino acid that is formed via the metabolism of methionine, which is found in turkey, beef, fish, pork, tofu, milk, cheese, nuts, beans, and whole grains like quinoa. High homocysteine causes blood vessel damage and can lead to cardiovascular disease and other blood vessel diseases such as macular degeneration and cognitive decline. Homocysteine is converted to glutathione when adequate levels of methylated folate are present in the body. Some people genetically are better at “methylating” folate (Vitamin B9) than others. However, you can take methylated folate if your homocysteine is too high. I like to see homocysteine levels less than 8 umol/L and usually put patients on methylated folate if they are over 10 umol/L.
5. Fibrinogen, LpPLA², MPO- These are a group of lab tests that I like to order in patients with
confirmed or suspected cardiovascular disease, such as patients with hypertension or abnormal lipids. Fibrinogen is a clotting factor and a higher level than normal is associated with coronary lesions (clots) and all-cause mortality (death). MPO is associated with atherogenic plaque (clots) and LpPLA² is indicative of unstable clots that may rupture and cause a stroke. Since cardiovascular disease is the #1 killer of Americans, these lab tests are important to know how "at-risk" a patient may be.
6. Fasting Insulin- Hyperinsulinism has been identified in prediabetes, type II diabetes, dyslipidemia, obesity, hypertension, polycystic ovarian disease (PCOS), fatty liver disease, certain cancers, cardiovascular disease, renal failure, and sleep apnea. The overwhelming burden of these diseases makes this lab test critical. Insulin is a hormone secreted in response to the type and amount of food you eat. Refined carbohydrates are devoid of fiber and cause you to release the most insulin. Insulin causes us to gain and store fat in our abdomen (visceral or belly fat) and so I call insulin “fat fertilizer”. When your insulin is high over an extended period of time, you can become insulin resistant, and this leads to high blood sugar, diabetes, and cardiovascular disease. I believe that high blood sugar and the resultant diseases that come from increased blood sugar is one of the biggest health issues that Americans face today.
7. Thyroid Panel (TSH, total and free T3 and T4 and TPO)- Knowing the functional state of your thyroid is important. Your thyroid is that master gland that controls your metabolism, and when it is over and underactive, problems will occur in the body. An underactive thyroid can cause metabolic disease (obesity) and high cholesterol. The thyroid is susceptible to autoimmune problems such as Hashimoto’s or Graves’ disease and getting your thyroid antibodies (TPO) is important to know as your thyroid problem may be coming from an autoimmune condition.
8. Free Testosterone- Testosterone is produced in the testes in men, in the ovaries in women, and in the adrenal glands of both men and women. Men and women alike can be dramatically affected by the decline in testosterone levels that occurs with aging. Low levels of testosterone are associated with numerous adverse health conditions, including diminished libido, metabolic syndrome, erectile dysfunction, loss of muscle tone, increased abdominal fat, low bone density, depression, Alzheimer's disease, type II diabetes, and atherosclerosis. The optimal range is men is 15-26 pg/mL and the optimal range for women is 1.4-2.2 pg/ml.
9. Estradiol- Estradiol is the primary circulating form of estrogen in men and women and is an indicator of hypothalamic and pituitary function. In women, blood estradiol levels help to determine menopausal status and sexual maturity. Increased levels in women may indicate an increased risk for breast or endometrial cancer. Low levels are associated with an increased risk of osteoporosis and bone fracture in men and women. Elevated levels of estradiol in men cause gynecomastia (breast enlargement), diminished sex drive, and difficulty with urination. Since belly fat produces estradiol, reducing visceral (belly) fat can reduce excess production of this hormone. The optimal range in women is 352-528 pg/ml and is 10-30 pg/mL in men.
10. Vitamin D3- Vitamin D3 is critical to your overall health. There are receptors for Vitamin D3 on nearly every cell in the body and it has so many important roles in the body. Some of these include calcium uptake to prevent weak bones and fractures, reducing the risk of diabetes and heart disease, improving your mood, improving immunity and improving the function of the nervous system. The role of vitamin D3 in immunity has prompted many studies correlating Vitamin D3 levels with Covid-19 mortality rates. It is estimated that nearly 40% of Americans are deficient in this essential nutrient and that has been my observations after years of testing with my patients. The optimal levels of Vitamin D3 are between 30-100 ng/ml.
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