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Aug 31

Lab Tests – Measuring your Metabolic Health

Note from Craig–

In addition to helping Dave wrangle data behind the scenes, I will occasionally be dropping in as a guest writer to contribute some additional content. This blog was an invaluable resource when I first found out I was a hyper-responder, and I’m looking forward to helping others understand their own cholesterol situations. Hope you enjoy!

Background

I started on Keto five months ago as an experiment in endurance running. Tall and slim, I’d get funny looks whenever someone heard I was on a diet. But, if they didn’t have to eat it, nobody cared much about what was on my plate.  Then, the cholesterol bugaboo appeared.

Total Cholesterol 358
Triglycerides 66
HDL-C 114
LDL-C 231

(Frequent readers may find this pattern familiar.)

Suddenly, everyone was “concerned about my cholesterol” – my doctor, my mom, distant relatives. I wasn’t worried during the test, since I heard it was possible to manipulate, but the seed of doubt had been planted. I now needed a lot more evidence to prove to myself, and others, that I wasn’t doing myself harm with this experiment.

I redoubled my efforts reading and watching everything I can find on the links between diet, health, disease. I was especially worried about heart disease (what they say might kill me), and metabolic syndrome (what I think is most likely to kill them). Fortunately, a certain N=1 pioneer had already made a lot of progress on this path, and he was generous with his advice.

This article is one software engineer’s opinion on what blood tests are worth your while when you get your annual poke in the arm. These tests will provide the necessary feedback for those interested in “debugging” and “optimizing” the complex system that is their body.

If you can’t measure it, you can’t improve it. 

– Peter Drucker.

Asking for Tests

Ideally, you want your doctor to order the tests you’re seeking so that your insurance pays for it. But different doctors can have different reactions to these requests. Some will happily rubber-stamp your request without question, others will ask why you are interested in these tests and how you found out about them in the first place. If you find your doctor won’t order the tests you’re asking for, you can usually order them privately through a service like http://RequestATest.com.

If find yourself needing to explain ‘why’, here are some arguments that your doctor might find persuasive.

You will use this data to make informed decisions about your lifestyle.

“I am actively tracking my food, sleep, stress, and exercise and I want to know how my body is doing. Even though I feel much better on my diet, I’d consider changing if there was good evidence something was going wrong.”

You want to establish a broad baseline of health and disease risk.

“I’m concerned that conventional diets contribute to obesity and disease. I choose my diet to help with that, and I want to see if I’m making progress across the board. Then, I can tell if future changes help or hurt.”

Your body uses a higher percentage of energy from fat compared to typical diets.

“There’s a good reason that my numbers might be unusual. I want to see if my body is working well, but differently, or if something is going wrong. I also want to be careful when considering treatments, since they are rarely tested on people with my diet.”

Treating complications later is much more costly than testing now.

“A diabetes diagnosis more than doubles your average lifetime medical expenses, while a heart bypass surgery is over $100,000. I want to accurately assess my risk now, so I can take action to improve my chances of avoiding these outcomes.”


The Tests

Every time:

  • Insulin
  • Hemoglobin A1c
  • C-Reactive Protein (High Sensitivity, Cardiac)
  • Comprehensive Metabolic Panel (14)

Tracking your lipids:

  • NMR Lipoprofile (Nuclear Magnetic Resonance)
  • and/or Apolipoprotein A1, B

Tracking your risk of metabolic syndrome:

  • GGT
  • Ferritin, Serum
  • Uric Acid, Serum
  • Homocyst(E)Ine, Plasma

Tracking your general health:

  • Vitamin D, 25-Hydroxy
  • Cortisol
  • Cbc With Differential
  • Iron And Tibc-Iron Binding Capacity (TIBC)

Only once if normal:

  • Apolipoprotein Lp (a)
  • Thyroid Panel

Apolipoprotein A-1, B

Apo A-1 is the distinctive protein of HDL. Apo B is the distinctive protein of VLDL, IDL, LDL and Chylomicrons.

Measures the composition of your lipoproteins (the mass of the apolipoprotein), unlike cholesterol tests, which only measure their contents.  The lipoprotein particle tests are much better correlated with outcomes than cholesterol, but those two metrics are often discordant on a low-carb diet. I’d certainly want to have both results before making any decisions about “my cholesterol”.

$49 at RequestATest

Apolipoprotein Lp (a)

Apo (a) is the distinctive protein of lipoprotein(a), a subclass of LDL.

Lp(a) appears to be an independent risk factor for CVD beyond other blood lipid markers. It is largely determined by genetics, so testing it at least once will inform the importance of other more readily available LDL numbers. This result could raise the stakes of any lifestyle tradeoff you make.

$49 at RequestATest

Cbc With Differential

Measures the composition of your red and white blood cells.

Red blood cells deliver oxygen for burning. White blood cells are part of the immune system that protects your body from infection. This test helps give a broad picture of your health.

$29 at RequestATest

Comprehensive Metabolic Panel (14)

Measures various minerals and nutrients (including electrolytes) involved in your body’s processes.

This is a common test used to screen for a variety of conditions and nutrient deficiencies. This panel comes in (8) and (14), so be sure you specify the number.  This test helps give a broad picture of your health.  You can also use it to tweak your nutrition, for example, adding more salt if sodium is low.

$29 at RequestATest

Cortisol

Cortisol is a steroid hormone that your body releases in response to stress.

Chronic stress is extremely taxing on the body and can contribute to pain, hunger signaling, and heart disease.  Measuring your stress allows you to judge the effectiveness of your stress-reducing efforts, like exercise and sleep.

$45 at RequestATest

C-Reactive Protein (High Sensitivity, Cardiac)

CRP is a protein produced by your liver as part of the inflammatory response.

Inflammation is a process your body uses to fight foreign invaders. Appropriate when you scrape your knee, but problematic when prolonged. High CRP can be a warning sign that your body is reacting to something in your diet (gluten or vegetable oils) or body (damaged arteries).

$59 at RequestATest

Ferritin, Serum

Ferritin is a protein that stores Iron.

Elevated ferritin can be an indicator of high iron or metabolic syndrome. Recent research suggests that it may even play a causal role in CVD.  You can also mitigate high ferritin with regular blood donations. This test helps give a score in your struggle against metabolic syndrome.

$29 at RequestATest

GGT

γ-Glutamyl Transferase is an enzyme found in many parts of the body.

Elevated GGT is a diagnostic marker for diseases of the liver and pancreas. This test helps give a score in your struggle against metabolic syndrome.

$29 at RequestATest

Hemoglobin A1c

Hemoglobin A1c measures the glycation of your red blood cells and is a used to diagnosis diabetes.

Glycation is when blood sugars stick to a protein or lipid in your body, causing trouble. HA1c is an approximation of your average blood glucose of the past 3-months. This test helps give a score in your struggle against metabolic syndrome. Amy Berger’s low-carb testing series covers HA1c in detail.

$29 at RequestATest

Homocyst(E)Ine, Plasma

Homocysteine is a non-protein α-amino acid.

Homocysteine in the blood can make you more vulnerable to endothelial damage, so it’s a risk factor for CVD. These results could raise the stakes of any lifestyle tradeoff you make.

$69 at RequestATest

Insulin

Insulin is a control hormone that regulates the metabolism and storage of nutrients.

Elevated Insulin is part of the vicious cycle of metabolic syndrome. Although not as informative as a full Kraft Test (multiple insulin measurements tracking the response to glucose intake), fasting insulin provides a much better snapshot than glucose or HbA1c.  With the prevalence of diabetes in society today, it’s a wonder this test is not standard. Amy Berger’s a low-carb testing series covers Insulin in detail.

$49 at RequestATest

Iron And Tibc-Iron Binding Capacity (TIBC)

Iron is an essential nutrient used to produce red blood cells.

This test measures your levels of iron and proteins that transport iron. This test helps give a broad picture of your health.

$29 at RequestATest

NMR Lipoprofile (Nuclear Magnetic Resonance)

The NMR lipoprofile measures the number and size of your lipoproteins.

Not all lipoproteins are created equal, and those on a low carb diet often have much more favorable size distributions.  This gives the most detailed snapshot of your lipid system is working.

$99 at RequestATest

Thyroid Panel

The thyroid gland regulates energy use in your body in a multi-step process. This panel measures the levels associated with each step of that process.

How well your body metabolizes nutrients affects energy levels, heart rate, weight regulation, and temperature.  This test helps give a broad picture of your health. Amy Berger’s a low-carb testing series covers Thyroid in detail.

$49 at RequestATest

Uric Acid, Serum

Uric acid is an end product of purine breakdown and is found in urine.

Excess uric acid levels can cause gout and kidney stones. Your levels are affected by diet and kidney function, but also may be an independent risk factor for diabetes. This test helps give a score in your struggle against metabolic syndrome.

$29 at RequestATest

Vitamin B12 And Folate

Vitamin B12 is an essential vitamin used for making red blood cells and DNA.

Excellent B12 levels should be a expected on a diet rich in animal products. This test helps give a broad picture of your health.

$69 at Requestatest

Vitamin D, 25-Hydroxy

Vitamin D is a fat soluble vitamin needed for mineral absorption (calcium, magnesium, phosphate, zinc) and metabolic function.

Your body converts cholesterol to Vitamin D in the skin when exposed to sunlight. However, since we get much less sun exposure today, it often requires active supplementation to achieve adequate levels.

$59 at RequestATest

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31 Comments on "Lab Tests – Measuring your Metabolic Health"

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BobM
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They say Lp(a) is genetic, but mine has decreased by about 28% in 3 years, and this also seems to go up for long fasts.

Bonnie
Guest
Thank you for this list! I had very similar lipid results last spring and my GP was adamant I should take Statins. Of course I would not take such a controversial drug without a lot of research on my part. I am a fit, active 64 year old female. When I asked my GP for access to CAC and further bloodwork, she looked at me and said she was not familiar with the tests, would not be comfortable ordering them and referred me to a cardiologist. That was 3 months ago. I went ahead and paid for a CAC (750… Read more »
C
Guest
Hi Bonnie, Methinks you were ripped off with the CAC test….. in my neck of the woods it is $99 self-pay! BTW, here is an interesting site that estimates your arterial age based upon your CAC score: https://www.mesa-nhlbi.org/Calcium/ArterialAge.aspx Unfortunate, I am mostly in the same boat as you with the ignorance of doctors. My doctor never heard of most of these tests either… but I was lucky enough that he had heard of a CAC scan and was willing to write me a prescription for one. For most of the blood tests, I use RequestATest. In my layperson opinion, you… Read more »
Bonnie
Guest

Thank you for the feedback. That will save me a few dollars. One more question, if I get an A1C done, should I also get a fasting insulin? Or is that redundant?

Bonnie

Amy Paulshock
Guest
Hey, How do I jump on this bandwagon? I’ve also responded poorly, cholesterol-marker-wise, to low-carb/keto diets, and need help figuring out what to do about it. My latest particle count is 2152. My HDL is 132, which I now understand is NOT good. I am insulin resistant and was overweight until I went on this diet about 10 years ago. (no longer :o) Even now my A1c hovers around 5.6- 5.7. So the icing on the cake is, I have parkinson’s disease and want very badly to be able to stay in ketosis–studies suggest it might be neuroprotective. (And, interestingly,… Read more »
Amy Paulshock
Guest
Thanks for your quick reply! My understanding is that (sadly) the latest info on HDL is that anything over 100 might be, paradoxically, a bad thing. (Who’da thunk it!) I know, I know, read those books, and Peter Attia and Thomas Dayspring et al. and I’m not convinced I’m gonna die tomorrow, but I’m not convinced I’m not, either. I guess I’d feel better if I could get my LDL P down to 1600 or so…hedge my bets. I also have some inflammation markers, high Lp-PLA2, Lp(a)-P. And yes I want to get a CAC score! Excellent idea! I am… Read more »
Colleen
Guest

Amy: I believe from other reading that the MCT is a different structure saturated fat than the dairy, such that you may be able to keep MCT even if you are cutting out diary.

Colleen
Guest

Craig or others:

Any thoughts on Quest vs Labcorp? I had a sky high ferritin test with one and shortly thereafter, the other normal (basically an impossible result if both were accurate). I am thinking about rerunning a ferritin at both on the same day. Any thoughts on the cholesterol and other test kits online from Amazon?

Richard Maurer
Guest

Colleen,
Ferritin does bounce around – inflammatory reactions, especially infectious etiology, result in elevated serum ferritin. This helps drive the acute inflammatory response to eradicate the infection. Whenever I see an elevated ferritin, I run a repeat # a couple months later.

Labcorp and Quest in the US are very comparable -Practically, I would consider the results apples to apples. – note that even the same blood sample at the same lab can be up or down up to 5% (I have seen up to 10% on several tests) on repeat tests the same day.

Amy Paulshock
Guest
Colleen– I wondered about the MCT! I cut out straight coconut oil, but continued w/MCT until recently. Maybe I’ll go back to it. It does help. Craig– I try to avoid omega 6 PUFA’s (I mean, OK, we do eat Duke’s mayo once in a while, yes) but I take a teaspoon of ultimate omega 3 every day and eat a fair amt of fish. And yes my meats and dairy are grass fed blah blah I know the drill! :o) You know, I wish I had my own lab! I’d love to tweak my diet–test my blood….tweak again–test again.… Read more »
Jordan
Guest
I’ve been fairly strict keto for 1.5 years. Like Dave I’m fairly lean (7-8% BF) and muscular. Had a few cholesterol/blood draws in that time and my cholesterol is high but not as high as some folks here, but I’m not absolutely worried about it at the moment. One thing I am worried about is my inflammation markers. Of the 4 measured (CRP, Fibrinogen, Lp-PLA2 and Myeloperoxidase), all were within optimal range expect Lp-PLA2, which everytime I’ve measured has been greater than detection limit (>600 ng/mL). I’ve never done the cholesterol drop test to see if this changes with dietary… Read more »
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[…] were much less common. These included particle counts (HDL-p, LDL-p), glucose, HbA1C. See my previous post for recommendations on the best tests to […]

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[…] 
A good number of the lab tests that I order are very well explained by Dave Feldman on his website The Cholesterol Code, which is amazing. Dave is a senior software engineer and entrepreneur, and he’s created a protocol for people whose cholesterol doesn’t respond the way it normally does on a keto diet. So, you can check out the definition or reason behind certain labs here. […]

Justin J Lomery
Guest
Hey Craig, I was following a keto diet since March of 2017 fairly strict until mid Sept of 2017. My bloodwork was taken a week after starting Keto and it was as follows TC 224 Tri 81 HDL 44 VLDL 16 LDL 164 All other tests were normal My next bloodwork was taken on 10/30/2017 Mind you the month prior I wasn’t as strict keto and was also,coming off antibiotics and also not sure if Sam-E could have had any effect on the bloodwork but was also taking that for 2 weeks that month. I also demanded an LP(a) test… Read more »
Justin
Guest
Hey Dave, I was following a keto diet since March of 2017 fairly strict until mid Sept of 2017. My bloodwork was taken a week after starting Keto and it was as follows TC 224 Tri 81 HDL 44 VLDL 16 LDL 164 All other tests were normal My next bloodwork was taken on 10/30/2017 Mind you the month prior I wasn’t as strict keto and was also,coming off antibiotics and also not sure if Sam-E could have had any effect on the bloodwork but was also taking that for 2 weeks that month. I also demanded an LP(a) test… Read more »
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[…] test (NMR) for particle counts, and the standard lipid panel (for redundancy).  I followed my own advice on testing and also got hsCRP, Insulin, Metabolic panel, and […]

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