Based on a recent poll from the WellWay Community on social media, more than 50% of you are getting labs done with your doctor every year – which is great! Using the benefit of seeing your doctor annually to get lab work done and check in on your health is the first step in prevention.
Unfortunately, more often than not, things can be missed in your annual check up. And while you might be reading this and be thinking to yourself “well, my doctor certainly knows what she is doing, and I will get the labs they recommend”, we encourage you to read on to get another perspective on the information you should be looking at annually (at a minimum) to not only detect disease, but optimize your health.
“I never tell my patients ‘your labs are normal’ because it’s not that simple. Basic labs are just one indicator of how your body is functioning and do not always provide enough information. Also, it’s tricky because the “normal” lab ranges provided by commercial labs are not necessarily ranges that indicate what is optimal for disease prevention or long term health, nor are those ranges always specific to your personal goals.”
– WellWay Chief Medical Advisor, Dr. Susan Ritter, MD
“Additionally, basic labs won’t necessarily pick up on the early stages of disease, when lifestyle and treatment initiation can be the most critical to preventing bigger problems down the road,” says Dr. Ritter.
Below are five things your annual check up might miss, and what you can add to your yearly lab work to get a more complete picture of your health.
Your ability to regulate your blood sugar.
Almost every yearly check up comes with a blood panel called a Chem-12 or Complete Metabolic Panel. This includes a fasting glucose. Your fasting glucose measures the amount of blood sugar circulating in your bloodstream after a 12 hour fast. However, this information is limited and can also be misleading. Getting your glucose tested when you are fasted is great, because it tells you if your body is able to get your glucose down to baseline, ideally 70-90 mg/dL, when you haven’t eaten. However, it doesn’t tell you what happens AFTER you eat, and based on what you’re eating throughout the day, you could have major swings in your blood sugar that are not going to be captured through a fasting blood sugar.
We recommend not only looking at fasting blood glucose, but also your hemoglobin A1c, as well as your fasting insulin levels to get a more complete picture of your blood sugar control. Your A1c measures your blood sugar regulation over the past three months. Your fasting insulin, which is your primary fat storage hormone, is also very important because you can have a difficult time burning fat if your insulin levels are elevated when you’re fasted. Additionally, elevated insulin levels when fasting (which can indicate insulin resistance) can develop decades before a diabetic diagnosis, so it’s very important to know your levels, even if your blood sugar levels are in a good place.
WHAT YOU SHOULD ASK FOR:
fasting blood glucose, fasting insulin, and hemoglobin A1c
How well your thyroid is functioning.
Your thyroid is like the thermostat for your body. The better it’s functioning, the better your metabolism. The most common test for thyroid functioning is your TSH, which is your thyroid stimulating hormone. This is a great starting place to look at thyroid functioning, but it has its limitations. There are very wide ranges for what is clinically acceptable for TSH levels, so you may not feel great, but you are told your thyroid is “fine” and continue on feeling crummy but thinking everything is OK. Additionally, you have two important thyroid hormones, T4, and T3, that should be measured to truly understand how your thyroid is working at a cellular level.
T4 can be considered the storage form of thyroid hormone, and it has to be converted into T3, the most metabolically active form of thyroid hormone. From there T3 interacts with your cells to regulate your metabolism. It’s important to have all three of these tested at minimum to get a better picture of thyroid function. Additionally, the ranges for what is considered “normal” for thyroid functioning are very big, meaning that you could have symptoms of low thyroid but get the feedback that everything is fine. We use smaller ranges to define what is optimal, and work with our clients on strategies to get all of these values optimized.
WHAT YOU SHOULD ASK FOR:
TSH, T4, T3
Your cardiovascular risk.
A standard cholesterol panel will look at your HDL-C, Triglycerides, Total Cholesterol, and a calculated LDL-C. The “-C” stands for concentration. This is measuring the concentration of cholesterol in a given sample. For example, if your HDL-C is 45, this means that the concentration of HDL cholesterol in that sample is 45 mg/dL.
There are some pretty gaping holes in the way that cholesterol levels and risk are assessed today. Think of it like this: if someone tells you that there is a lot of traffic on the road, it doesn’t really tell you much. All you know is there is a lot of congestion on the street. But, you don’t know if that means there are a lot of small cars lined up back to back, or if there are a handful of semi-trucks. And you don’t know how many passengers are in each car. Knowing these details gives you a better idea of what is really going on. Our cholesterol is the same way. To get a better picture, you need to know how many LDL particles you have (how many cars are on the road), and the size of those cars. Bigger cars are less likely to get into a bad accident, just like big LDL particles and less of them are not as concerning. Really small LDL particles create more of a risk, especially if there are a lot of them, as they are the ones that can sneak into your arteries. If you have small particles, and a lot of them, you are at a higher risk of heart-related problems.
You could have an LDL-C of 125, which is above what is considered optimal for good health, but have large particles, or you could have a lot of small particles and get the same measurement. Knowing all of the details is important to truly understand your risk.
WHAT YOU SHOULD ASK FOR:
NMR or VAP profile
Your nutrient status.
Vitamin D status is checked more often these days, but still isn’t something that is done with every annual check up. There are countless reasons why we need to know our vitamin D status, including optimizing our immune system, keeping energy levels up, protecting our bone and heart health, reducing cancer risk, and even supporting optimal mental health. The list goes on and on. It still surprises me how few people know their Vitamin D levels. I do recommend taking a minimum of 1000-2000 IUs of vitamin D per day regardless, but I recommend having your D levels checked at least once per year. While it’s unlikely, I have seen D levels that are actually too high as well, so knowing your levels can help you personalize your supplement and eating habits to maintain optimal levels, which are 50-80 ng/mL.
Vitamin B-12 is another common vitamin deficiency that is rarely checked for, but is common. Serum blood levels are not the best way to check for B-12, but are at least a good starting place. If your levels are below 400, you can take next steps to look at functional markers for B-12 status. The good news is that if your levels are low, supplementation can be an effective way to boost your levels.
WHAT YOU SHOULD ASK FOR:
Vitamin D and Vitamin B-12
What your results mean and what to do with them.
Perhaps one of the most important parts of getting your labs done every year is getting an explanation of what your results mean, even if they are in good ranges, and what to do with the results.
“Limitations with your doctor’s time may prevent a thorough discussion of how your lab results are relevant to your body, goals, and health concerns, and can also limit the amount of time needed to discuss further areas of investigation to optimize health and prevent disease. They also are not always equipped to properly discuss goal setting to maintain positive results or how to impact abnormal labs via nutrition, exercise, and lifestyle changes,” says Dr. Ritter.
There can be some frustration when clients get a note in their inbox that says ‘everything looks good, see you next year’ or the ‘things don’t look so good. You really need to lose weight and take these medications,”.
At WellWay, we make sure that all of our clients who complete lab testing with us have a thorough review of their results and walk away understanding what is good, what was not so good, why it matters, and what to do.
If you are thinking about taking a deeper look at your health with any or all of the recommendations above, here are a few things to consider:
- We recommend checking with your insurance provider to understand your health benefits, including what is/is not covered with your plan and any expenses that you may be responsible for. All plans are different, and even if your doctor orders labs for you, it does not guarantee that your plan will cover them, or that you won’t have to pay out of pocket.
- If your primary provider isn’t on board with getting these tests for you, or isn’t sure how to interpret them, let us know! All lab testing completed at WellWay includes a review and interpretation by our team of experts including our dietitians and medical advisor, and a customized plan that includes nutrition, lifestyle, supplementation, movement, and reassessment recommendations based on your lab results.