The following lab test suggestions are from Life Extension foundation, Dr. Mercola MD and additions from me. I posted these lists because they support my understanding of what should be included in a yearly blood lab along with CBC, lipids and chemistry, which are always included. The first list (from Life Extension) concerns “any program aimed at reducing the risk of vascular disease”. The interpretation of uric acid levels and disease risk was introduced to me by Dr. Mercola. My comments are italicized. I highlighted the tests that I like to see from everyone. Other tests on this page may be indicated for certain individuals in light of their medical history. Of interest is the optimal range in contrast to the blood lab’s reference range. A lab’s reference range is the set of values that 95 percent of the normal population falls within. Optimal ranges are set by doctors and researchers who consider “average” as not good enough. Reading a blood lab is part art and science. Acombination of several tests, a patient’s medical history and symptoms are needed to help complete the medical picture. Optimal levels of sex hormones for women (testosterone, estradiol, estrogen metabolites and progesterone) are individually determined. At the end of this page you will find a general list of tests that you should ask your doctor to include in your next blood test. Blood Test Conventional Medicine’s Reference Range Life Extension’s Optimal Range Fibrinogen (blood clotting marker) Up to 460 mg/dL 200 to 300 mg/dL *C-reactive protein (inflammation marker) Up to 4.9 mg/L Less than 0.55 mg/L (men) Less than 1.5 mg/L (women) *Homocysteine (high levels may damage arteries) Up to 15 mmol/L Less than 7–8 µmol/L Cholesterol Less than 200 mg/dL 160 – 180 mg/dL LDL Less than 100 mg/dL Less than 80 mg/dL HDL Greater than 40 mg/dL Greater than 50-60 mg/dL Triglycerides Up to 199 mg/dL Less than 80 mg/dL Fasting Glucose 65 – 99 mg/dL Less than 86 mg/dL Fasting Insulin Up to 24.9µIU/mL Less than 5 µIU/mL *Total Testosterone (men) 280 to 800 ng/dL 600 to 800 ng/dL *Free Testosterone (men) (low levels are a heart disease risk factor) 6.8 to 21.5 pg/mL 20 – 25 pg/mL (LabCorp testing method) *Estradiol (men) (I added this) 7.6 to 42.6pg/ml 20-30 pg/ml (LabCorp testing method) *TSH (thyroid stimulating hormone) (I added this) .450-4.50 uIU/ml Below 2 (must consider symptoms; can’t just go by the numbers) Omega-6:Omega-3 ratio None established Less than 4:1 Lp-PLA2 (another inflammation biomarker but high levels may be due to non arterial causes) Less than 200 ng/mL Less than 200 ng/mL (High levels may promote atherosclerotic plaque instability) CoQ10 0.37 to 2.20 µg/mL At least 3.0 µg/mL (preferably higher) *25-hydroxy Vitamin D 32 – 100 ng/mL 50 – 80 ng/mL ♦Cholesterol HDL ratio: HDL divided into total cholesterol. The best ratio would be 2 or 3, or less than 4 (exceed 24% with below 10% a cardiac risk marker). This calculation is always included in a lipidpanel. ♦Triglycerids/HDL ratio: Triglyceride divided into HDL. You want the optimal number to be below 2. Research supports this calculation as an indicator of the LDL particle size. When the number is low, you have more large, less artery damaging, LDL particles. ♦Percentage of body fat: (the lower end of the range or the high end of the athlete range is ideal). Women: 25-31% (over 32% is obesity). Athlete 14-20% Men: 18-24% (over 25% is obesity). Athlete 6-13%. ♦ Uric Acid Level: ideally you want it below 4mg/dl for men and 3.5 mg/dl for women or at least not over 5.5 mg/dl. Dr. Richard Johnson brought this health risk marker to the attention of Dr. Mercloa who subsequently became a firm believer in keeping this marker low. They think this is a marker of too much fructose intake for one’s unique biochemistry. I think the main concern is taxing the liver. This test is always included in an annual physical lab. VAP TEST (Vertical Auto Profile) The expanded information from the VAPtest includes: More accurate, direct measurement of LDL. Measurement of LDL pattern density (important because small, dense LDL (“Pattern B”) triples the likelihood of developing coronary plaque and suffering a heart attack. Measurement of lipoprotein subclasses, which include HDL2 (most protective) and HDL3 (less protective), intermediate-density lipoprotein (IDL) (elevated in diabetes), very-low density lipoproteins (VLDL1, VLDL2, VLDL3), and lipoprotein(a)[Lp(a)], a particularly dangerous lipoprotein that can lead to heart attacks and strokes. (Apolipoprotein(a) has an unusual structure that resembles the clot-dissolving protein plasmin. It is thought that the Lp(a) portion inhibits the action of plasmin, preventing clots from being broken down normally.This is a good test to have at least once. Lp(a) levels are considered to be heredity but it is still important to know all of one’s risk factors to determine aggressiveness of treatment options. It is informative to know LDLpattern size because it is the small dense particles that are atherosclerotic. You can get a surrogate indication of LDL size by calculating the triglyceride/HDL ratio (explained above). My VAP showed pattern A (less dense particles) which could be predicted by my low triglycerides and high HDL. LDL-P blood test: optimal is below 700 nmol/L. This test measures the number of LDL particles as opposed to measuring the amount of LDL.The American College of Cardiology and American Diabetes Association issued a consensus statement saying that the measurement of LDL particle number (LDL-P) is a more accurate method of quantifying cardiovascular risk than traditional measurement of LDL. Cholesterol is carried in particles within our blood called lipoproteins.We now know that it is the number of particles that carry cholesterol in the bloodstream, not the total amount of cholesterol that causes vascular disease. As the concentration of particles goes up inside the bloodstream, the more likelythese particles are to enter the wall of the vessel resulting in the deposition of cholesterol. LDL-P is the measurement of these cholesterol transport particles.I became aware of this test through Dr. Osner who agrees with the above organizations on its utility. This test may be useful to help determine how aggressively one should be in reducing vascular disease risk factors. Dr. Osner goes on to explain some new data “This data shows people from the Framingham study who are in the lowest quartile of LDL measurement still had 37% more cardiovascular events than those in the lowest quartile of LDL particle (LDL-P). In other words, you can have low cholesterol and still be at risk for vascular disease”. Could be a good test if you have low cholesterol. My suggestions ♦ Hemoglobin A1c (glycated red blood cells): normal is between 4.8 and 5.6%. Diabetic individuals try to keep this marker below 7%. 5% would be the perfect number. I recommend this test for everyone. If you are satisfiedwith your numbers, you can get this test once so you have your “baseline” reading. If you are trying to optimize your longevity by aggressively reducing this number with a low carbohydrate diet, you can periodically retest. Every increment over 5% increases risk for heart disease, metabolic syndrome and accelerated aging. When its over 5.7% it is considered a risk factor for pre-diabetes and dietary/supplement intervention is a must. This is a surrogate marker for blood sugar control and a much better indicator than fasting glucose. Though there is more to levels of glycation in the body than just blood sugar levels, when I see this number in its higher range (above 5.4), I recommend reducing carbohydrate and sugar consumption. Glycation or glycation end-products (AGES) play a role in heart disease, cancer, neurodegeneration and accelerated aging [1, 2]. 1.. Robert L, Robert AM, Fulop T. Rapid increase in human life expectancy: will it soon be limited by the aging of elastin?Biogerontology. 2008;Jan 4. 2. Vasdev S, Gill V, Singal P. Role of advanced glycation end products in hypertension and atherosclerosis: therapeutic implications. Cell Biochem Biophys. 2007;49(1):48-63. Waist-Hip Ratio: This ratio determines your level of abdominal fat. The World Health Organization states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.85 for females. To determine if you have a healthy waist to hip ratio, use a measuring tape to measure the circumference of your hips at the widest part of your buttocks (you can feel the boney protrusions called the greater trochanters at this spot). Then measure your waist at the smaller circumference of your waist, (usually just above the belly button and below lower ribs). Stand relaxed with feet together and take the measurement at the end of exhalation breathing phase. To determine the ratio, divide your waist measurement by your hip measurement. Abdominal fat secretes the most inflammatorymolecules (cytokines) and is a predictor of metabolic syndrome [1] and sudden cardiac death [2]. Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. You can use this link to determine your ratio. 1. Jean-Pierre Després and Isabelle Lemieux. Abdominal obesity and metabolic syndrome.. Nature 444, 881-887 (14 December 2006). 2. Adabag S, Lopez F, Alonso A, et al. Risk of sudden cardiac death in obese individuals: The Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm Society 2012 Scientific Sessions; May 9, 2012; Boston, MA. High blood pressure is a rick factor for heart attack, damage to the arteries, stroke, heart failure and kidney disease. This is an extremely important risk factor that may respond to lifestyle changes, diet and nutritional supplements. Guidelines: “The medical establishment defines high blood pressure (hypertension)as over 139/89 mmHg. However, in 2006, researchers found that blood pressure levels ranging from 120-129 mmHg systolic/ 80-84 mmHg diastolic were associated with an 81% higher risk of cardiovascular disease compared to levels of less than 120/80 mmHg. Moreover, blood pressure levels of 130-139/85-89 mmHg were associated with a frightening 133% greater risk of cardiovascular disease compare to levels below 120/80 (Kshirsagar 2006)” [1]. Risk calculator: Carotid artery ultrasound scanning: Shows the amount of plaque buildup in the main arteries to the brain. Summary: The above is not a complete list of blood lab tests that may be indicated in individual cases to determine health risks and diet, dietary supplement or drug interventions. It does cover important tests for a thorough annual physical checkup. The following is a list of the tests you can ask your doctor to add to your blood work. This excludes the tests that are always ordered. *C-reactive protein *Homocysteine *FreeTestosterone *Total Testosterone *Estradiol *TSH *25-hydroxy Vitamin D
