When a patient walks into an integrative physician's office how do we comprehensively evaluate their complex symptoms? Let's say they are chronically tired, with recurring abdominal pain and restless nights—not atypical for an integrative medicine office.
Such multifaceted health complaints require a nuanced approach that goes beyond conventional diagnostics.
The Role of Testing in Personalized Healthcare
Healthcare is moving toward a more personalized approach, where understanding the unique makeup and needs of each individual is pivotal. Comprehensive testing serves as the foundation for this approach:
Establishing a Foundation: Baseline tests provide initial values, offering a starting point to track your health over time.
Risk Assessment: It helps in identifying potential health vulnerabilities.
Diagnosing Acute Conditions: Immediate health concerns can be detected and addressed.
Planning for Optimal Health: These insights help design a comprehensive health plan tailored to your needs, aiming for not just longevity but thriving wellness.
As science advances, our diagnostic toolbox has expanded.
We now have access to microbiome analysis, hormone profiling, coronary artery evaluations, and DEXA scans for bone and muscle health. However, embracing these innovative tests might sometimes mean embracing additional costs. While many tests are insurance-covered, others might require out-of-pocket expenses.
Standard Baseline Blood Testing
To develop an approach to testing it is important to understand the rationale behind the tests. Here is a list of blood tests I recommend and brief reasons of the why.
I'm also including some notes on what is "normal" and "optimal" levels for each test. The challenges is that most normal values in conventional medicine are based on total population norms. Unfortunately, this means that as we as a society get progressively less metabolically healthy, the "normal" range listed on many lab tests includes more of the unhealthy population.
While there is an attempt to correct this, I am listing both the "normal" and "optimal" lab test values where possible.
Complete Blood Count (CBC): The Complete Blood Count is a fundamental test that examines various components of your blood. It not only helps identify anemia, a condition that can leave you feeling fatigued and weak due to low red blood cell levels, but also provides insights into your immune system's health through the levels and types of white blood cells present. By analyzing the proportions of different blood cells, we gain a better understanding of your overall health and potential areas that need attention.
Normal red blood cell count ranges from 4.5 to 5.5 million cells/mcL for men and 4.0 to 5.0 million cells/mcL for women. A white blood cell count of 4,500 to 11,000 cells/mcL is typical. Optimal levels depend on individual health goals.
Comprehensive Metabolic Profile: The Comprehensive Metabolic Profile offers an overall view of your body's metabolic functioning. It includes measurements of electrolytes, kidney function, and liver health. Electrolyte imbalances can impact your heart rhythm and muscle function, while kidney and liver health indicators give us insight into how efficiently your body is clearing waste and processing nutrients. By assessing these parameters, we can tailor recommendations to support your body's balance and functioning.
Normal blood electrolyte ranges: sodium 135-145 mEq/L, potassium 3.5-5.0 mEq/L, chloride 98-106 mEq/L.
Normal serum creatinine is around 0.84 to 1.21 mg/dL for men and 0.7 to 1.18 mg/dL for women. Optimal levels can be adjusted based on your specific needs.
Specifically, ALT, a liver function test, above 30 units/liter raises the possibility of ‘fatty liver disease’, a common early sign of metabolic syndrome.
Insulin: Insulin is a hormone that regulates your blood sugar levels. Testing insulin levels provides valuable information about how well your body processes sugar. Elevated insulin levels, even before fasting blood sugar levels rise, can signal insulin resistance, a condition where your cells don't respond properly to insulin. This is a crucial early warning sign of potential future issues with blood sugar control and metabolic health.
Fasting insulin levels typically range from 2.6 to 24.9 microU/mL. Optimal levels should ideally be less than 10, as higher levels might indicate insulin resistance.
Hemoglobin A1C: The Hemoglobin A1C test is a reliable marker of your average blood sugar levels over the past three months. By measuring the amount of sugar attached to your red blood cells, we can assess your longer-term blood sugar control. This test is essential for understanding how effectively you're managing your blood sugar and whether adjustments are needed to reduce the risk of complications over time.
An A1C level of 5.7% or below is considered normal, while 5.7% to 6.4% suggests prediabetes. Optimal A1C levels for overall health are usually below 5.5%.
Homocysteine: Homocysteine is an amino acid that can impact both inflammation levels and the processing of important B vitamins like folate (B9) and B12. Elevated homocysteine levels might indicate an increased risk of inflammation and potential issues with these critical vitamins. By addressing elevated homocysteine levels, we can work to reduce inflammation and support your body's ability to utilize these essential nutrients.
Normal homocysteine levels are below 15 micromoles per liter (μmol/L), but optimal levels are often recommended to be around 7 to 8 μmol/L for cardiovascular health.
Ferritin: Ferritin is a protein responsible for storing iron, a mineral crucial for various biochemical reactions, including oxygen transport, energy production, and immune function. Assessing ferritin levels helps us understand your body's iron status and whether you have enough stored for optimal bodily functions. Low ferritin levels can lead to fatigue, weakness, and impaired immune function, while excessively high levels can indicate potential inflammation or other underlying conditions.
Normal ferritin levels vary by gender and age, but generally range from 12 to 300 nanograms per milliliter (ng/mL). Optimal levels might fall between 50 and 150 ng/mL for men and 20 to 150 ng/mL for women.
Thyroid Function Tests (TSH, Free T3, Free T4, Thyroid Antibodies): Thyroid hormones play a significant role in regulating your metabolism, energy levels, and overall hormonal balance. TSH, Free T3, Free T4, and thyroid antibodies provide a comprehensive picture of thyroid health. TSH reflects how well your thyroid is being stimulated, Free T3 and Free T4 indicate the actual thyroid hormone levels, and thyroid antibodies are selectively ordered to help diagnose autoimmune thyroid conditions. These tests guide us in assessing and optimizing your hormonal well-being.
TSH levels typically range from 0.4 to 4.0 milli-international units per liter (mIU/L), but optimal levels for well-being are often between 1.0 and 2.0 mIU/L.
Free T3 and Free T4 levels should fall within the laboratory's reference ranges, but mid-range values are generally desirable.
Thyroid antibody levels are typically optimal when they're low or within the reference range.
Uric Acid: Uric acid levels can indirectly reveal your intake of fructose, a type of sugar found in various foods and beverages. High uric acid levels are associated with conditions such as gout and may also indicate increased fructose consumption, which has been linked to higher blood pressure. By addressing uric acid levels, we can work to manage your dietary choices and reduce potential risks to your cardiovascular health.
Normal uric acid levels are typically 3.4 to 7.0 mg/dL for men and 2.4 to 6.0 mg/dL for women. Optimal levels may be closer to the lower end of these ranges to minimize health risks.
Vitamin D: Often referred to as the "sunshine vitamin," vitamin D is crucial for bone health, immune function, and overall well-being. Measuring vitamin D levels helps us understand whether you're getting enough sun exposure or dietary sources to maintain optimal levels. Deficiencies can impact bone health and immune function, while adequate levels are linked to a reduced risk of various chronic diseases.
Normal vitamin D levels are often defined as 20 to 50 ng/mL, but optimal levels for overall health are often considered to be 40 to 60 ng/mL or higher.
Vitamin B12: Vitamin B12 is essential for numerous bodily functions, including the formation of red blood cells, proper nervous system function, and maintaining energy levels. Low B12 levels can lead to anemia, fatigue, and even impact your mental well-being. By assessing your B12 levels, we can ensure you're getting enough of this vital nutrient to support your overall health.
Normal vitamin B12 levels range from 200 to 900 picograms per milliliter (pg/mL), but optimal levels for optimal health are often recommended to be around 500 to 700 pg/mL or higher.
Omega-3 Index: Omega-3 fatty acids are critical for cellular health, especially in neurons (brain cells) and the cardiovascular system. The Omega-3 Index measures the levels of these beneficial fats in your blood. A higher Omega-3 Index is associated with better heart and brain health, while a lower index may indicate a need to increase your intake of omega-3-rich foods or supplements.
An Omega-3 Index above 8% is associated with a lower risk of cardiovascular disease. Optimal levels are typically in the range of 8% to 12% or higher.
Cholesterol Panel: The Cholesterol Panel provides a detailed breakdown of various types of cholesterol in your blood, including LDL, HDL, and total cholesterol. This information helps us assess your risk for cardiovascular issues over the long term. By understanding your cholesterol profile, we can develop strategies to manage your cardiovascular health through lifestyle modifications, nutrition, and potential interventions if necessary.
Total cholesterol levels below 200 mg/dL are generally considered normal, but optimal levels for cardiovascular health may be around 160 to 180 mg/dL. LDL cholesterol levels should ideally be below 80 mg/dL, while HDL cholesterol levels above 60 mg/dL are considered heart-protective.
Apolipoprotein B: Apolipoprotein B is a protein that's part of certain cholesterol particles. Measuring Apolipoprotein B provides insights into the number of particles that contribute to atherosclerosis and cardiovascular disease risk. This measurement gives us a deeper understanding of your heart health beyond traditional cholesterol readings.
Normal levels are usually between 50 to 120 mg/dL, but optimal levels are often closer to 70 mg/dL or lower for reduced cardiovascular risk.
High Sensitivity C Reactive Protein (CRP): CRP is a marker of inflammation in your body. Elevated CRP levels are associated with various health conditions, including cardiovascular disease, autoimmune disorders, and infections. Measuring CRP helps us assess overall inflammation and design strategies to manage and reduce inflammation, which is crucial for preventing chronic diseases and promoting well-being.
CRP levels below 1.0 mg/L are considered low risk, while 1.0 to 3.0 mg/L suggests moderate risk. Optimal levels are often below 1.0 mg/L to minimize inflammation-related health risks.
Please note that optimal levels can vary based on individual health goals and circumstances, so it's important to discuss your results with a healthcare provider who can offer personalized recommendations.
Integrative / Functional Medicine Testing
In addition to what I recommended above, integrative and functional medicine often includes additional tests to dig deeper.
Organic Acid Test: The Organic Acid Test is a comprehensive assessment that examines the byproducts of your metabolism. It provides valuable insights into how your body processes nutrients and produces energy. By analyzing organic acid levels, we can uncover potential vitamin and mineral deficiencies, imbalances in neurotransmitter activity, and markers of oxidative stress. This test is important in creating a personalized plan to optimize your nutritional status and overall well-being.
Microbiome Testing: Microbiome testing evaluates the health of your gut microbiota—the trillions of microbes residing in your digestive tract. This test offers an in-depth analysis of your gut bacteria, viruses, parasites, and other microorganisms. By understanding your gut composition, we can identify potential imbalances, assess digestive function, and recognize factors contributing to various health conditions. This information helps us develop a targeted approach to enhance your gut health, digestion, and immune system function.
In addition, there are other tests to explore as indicated such as hormone panels, toxic substance screens and others.
Many of these tests will be covered by traditional commercial laboratories although some may be rejected as "not indicated or not supported by a diagnosis."
The two above are specific integrative/functional medicine tests not often covered although if you have an FSA or HSA they are reimbursable. In the worst-case scenario, you will spend close to $1,000 if nothing is covered. Not a small sum for sure but a worthwhile investment in your health especially if you want to plan out a roadmap for personal health or are struggling with chronic conditions which have not been addressed by traditional medicine.
These tests collectively provide a comprehensive picture of your overall health, allowing us to create a tailored plan to support your well-being and address any potential areas of concern.