A little over a year ago, Craig wrote a post on what lab tests to get to measure your metabolic health. Although the original post still has great information, including how to request tests from your doctor, we figured it was about time to make an update, in order to provide information on which tests we think still remain relevant, which tests are worth testing frequently, new tests we’ve come across in the past year (or tests that have gained more relevancy over the past year), as well as make it a bit easier to pick tests based on specific needs (e.g. budget, level of data desired, etc). Hopefully this post will help with that, and make picking out tests, and tracking your health, a bit easier.
The tests are divided into “sets”, organized by what how much data you’re trying to gather, as well as by cost for those paying out of pocket (cost will vary by which provider you order through, but the tests which provide important information for the least amount of cost are in the first sets, while more niche tests are in the last sets). You can also click on the test names to get a brief description, and possible confounders for the results if we know of any.
The “Basics” Set
These tests are good to get every single time. This list is for those of you who are just looking for the bare basics and aren’t too interested in the more niche markers, or you’re paying out of pocket and you’re on a budget.CBC With Differential/Platelet
This is actually a pack of over a dozen different measures, which can help verify or hint at issues like anemia, or infection, among others. If self experimenting this can be helpful to verify possible illness wasn’t a confounder for your results.
Comprehensive Metabolic Panel (14)
This is another pack, but this one focuses on electrolytes (e.g. sodium, and potassium levels in the blood), liver enzymes (ALT, AST), and some measures of kidney function. Some of these can be impacted by simple issues (high BUN from dehydration, high ALT/AST from exercise prior to the test) so try to make sure you keep those in mind when getting the test done to make sure you don’t accidentally influence the results.
High Sensitivity C-Reactive Protein. hs-CRP is a measure of inflammation – however it’s worth noting that it tends to react pretty strongly to even small sources. Recent injury, intensive exercise prior to the test, infection, or issues related to diet or environment. Regardless, it’s worth it as a “look closer” marker, and can help suss out issues that weren’t noticed before.
Dave also has an article going over his experiences with testing hs-CRP which can be read here.
Short for Hemoglobin A1c. A measure of glycated hemoglobin (hemoglobin is a protein found in red blood cells), generally used for diagnosing pre-diabetes or diabetes. Good to keep an eye on!
Far before blood glucose dysregulation appears, some research suggests that hyperinsulinemia can be the canary in the coal mine for many health issues and can be a risk factor for issues ranging from diabetes to PCOS to psoriasis. Far beyond its use in energy metabolism, insulin can also have an effect on immune cells, and more as described in this post.
A collection of (generally) four tests, including Total Cholesterol, HDL-C, LDL-C, and triglycerides. You can also calculate remnant cholesterol from your lipid panel, as well as using it to determine if you are a so-called Lean Mass Hyper-responder. Common things people look for are high triglycerides, and low HDL. A note should be made that – triglcerides in particular – are very dynamic and so a normal fluctuation of roughly 20-30% for triglycerides is not unusual. HDL tends to be relatively more stable, although it can be affected by dietary fat intake, sudden drops in HDL-C (especially with no change in diet) are unusual.
“Digging A Little Deeper” Set
Perhaps you’re just interested in markers beyond the basics, you’re trying to pinpoint a problem, or you’re just looking to get a broader look at the bigger picture – this is the list for you! Combine this with the “basics” list.
Ferritin is a protein involved in iron storage, and testing it can help determine if one has anemia (if paired with other results), but it is also an acute phase reactant and can be paired with hs-CRP in order to help spot ongoing or acute inflammation.
GGT stands for Gamma-Glutamyl Transferase and is a type of enzyme found in multiple types of tissues, but is mostly found in the liver. It can be used to help detect possible liver damage, or other issues.
Uric Acid, Serum
Those with metabolic syndrome tend to have higher levels of uric acid in the blood, thus it can be used as an additional marker of metabolic health – high levels can also lead to gout (a type of arthritis affecting the joints). However, there appears to be a transient rise in uric acid during the adaption phase of a ketogenic diet, so any testing in that time period may be inaccurate in regards to this marker. Higher levels should resolve once adaption is complete.
Insulin and C-Peptide, Serum (instead of insulin from the basics set)
Includes an insulin test, as well as C-Peptide. C-Peptide is released when insulin is produced, and thus is another measure of insulin production in the body. It can be slightly more reliable of an indicator of insulin secretion, however, as it has a slightly longer residence time in the blood than insulin does.
This provides a bit more information than a standard lipid panel. Along with Total Cholesterol, HDL-C, LDL-C, and triglycerides, it also includes information like LDL-P (also referred to as “particle number”), small LDL, and HDL-P.
Lipoprotein(a) has been getting more publicity lately, and is generally considered a lesser known cardiovascular risk marker. Levels are generally considered to be mostly genetic, however recent experiments have demonstrated this may not necessarily be true – and high values could be the result of genetic factors, dietary factors, as well as inflammatory signalling. A more in-depth review on lipoprotein(a) can be found here.
A cardiovascular risk marker, and possible marker of oxidative stress, occasionally factored in when looking at lipoprotein(a) levels. Anecdotally it seems low carbers have slightly higher levels, but well below thresholds mentioned in studies using it as a marker of cardiovascular disease risk alongside lipoprotein(a)
“Citizen Scientist / Establishing Extensive Baseline” Set
Planning to do some heavy duty experimenting of your own, or planning to replicate one that’s already been done? About to make a major lifestyle change, and want to capture an extensive baseline? Got a Christmas bonus, and the thought of plentiful data tickles your fancy? This is the list for you! Combine with previous two lists.
Higher levels are possibly associated with a higher risk of stroke, heart disease, and other health ills. Higher levels could be due to deficiencies in B vitamins (like B12 or folate), which could be due to inadequate intake or issues properly absorbing the vitamins, such as those with mutations in the MTHFR gene, although there are other possible causes as well. More context can be provided by also testing B12 and folate levels.
Fatty Acids, Free (Nonester)
A measure of free fatty acids (e.g. fat-based energy) in the blood – another way to tune in to energy metabolism.
Vitamin B12 and Folate
Vitamins used for processes like mood regulation, creation of healthy red blood cells, etc. Deficiencies can lead to anemia, birth defects, and other issues.
Tumor Necrosis Factor Alpha. A pro-inflammatory cytokine (e.g. a protein used to signal inflammation). Another inflammatory marker.
Insulin-Like Growth Factor-1; a growth hormone. Chronically high levels (along with hyperinsulinemia) are associated with increased risk of cancer, as discussed here. Levels may also change during multi-day fasting, exercise, etc.
“Thyroid Check-in” Set
Want to check in on your thyroid health? Is your doctor not sure what to test for, or only tested TSH without looking further? Here are some other tests you can order, or suggest, that may provide more useful and in-depth information about how everything is working. Combine with any other list(s).
A thyroid hormone, which helps control metabolism. Low levels could be indicative of a condition called hypothyroid (marked by fatigue, cold extremities, sensitivity to cold, and others), but it’s also worth noting that those following a low carb, ketogenic, or carnivorous diet may have lower levels of T3 and yet be asymptomatic. This has been argued to be an adaptive mechanism, and may not necessarily be hypothyroid in-and-of-itself.
Reverse T3, Serum
Reverse T3 is essentially an inactive mirror version of T3. It competes for the same receptors, and thus inhibits T3 function. In other words, it helps to keep T3 in balance – where too much T3 can result in symptoms of hypothyroid while too little can result in symptoms of hyperthyroid (even if TSH and T4 are normal). It can help get a better over all picture of thyroid health, and the context of the other numbers.
Thyroxine (or T4) is another thyroid hormone, and is also used to regulate metabolism. Low or high levels can be indications of hypo- or hyperthyroidism as is true of T3.
Combined with T3 uptake, a free T4 index can be provided, which is used to evaluate thyroid function.
Thyroid Stimulating Hormone – it’s actually a hormone made by the pituitary gland, which stimulates the thyroid to produce thyroid hormones. Often this is ordered alone, but comes with the downside of the lack of context given by the other measures on the list. One can have normal TSH, but still be hypo- or hyperthyroid, thus the importance of verifying the other measures as well.
The most generally expensive or unwieldy tests belong here. Only for the most overachieving testers with money to burn, and questions to answer.
The counter to insulin. While insulin is generally used to signal building and storage, glucagon generally does the opposite. In Ben Bikman’s presentation from Low Carb Breckenridge 2018, he argued that insulin response should be taken into context alongside glucagon’s response as well (such as the insulin response to dietary protein intake).
Another pro-inflammatory cytokine – can be combined with others for redundancy and validation of higher levels of inflammation. This is on the overachiever set, because it’s generally more expensive than other options.
Where to Get Them
Depending on how open your doctor is to getting additional testing done, you could always work with them to order some of the tests, especially if it’s the items from the “Basics” set. However, the chance of them ordering high frequency tests (for experiments, etc), or some of the more obscure tests like IGF-1, is less likely. Dave and I are currently beta testing a way to get inexpensive labs available for those in the states, but in the mean time most people I’ve seen choose to go through third parties to order the tests, such as Request a Test and Ulta Lab Tests. These write up a lab order which you get fulfilled through a private lab, such as Quest or Labcorp. (This will obviously differ by country, however, so if anyone knows of different providers in other countries, feel free to leave them in the comments if you know they’re reliable.)
“if anyone knows of different providers in other countries, feel free to leave them in the comments if you know they’re reliable.” India: orbitoasia.com and https://aarthiscan.com. Both labs are run by top notch doctors sypathetic to LCHF (Indian Paleo). Both have modern automated equipment. At $30 for 100+ parameters, it may be possible to pay for US – India airfare and still come out ahead! Indian law does not require prescriptions for lab tests. I have used both labs. I have no financial interest in either lab.
Excellent! Thanks for the recommendation! 🙂
I’d include Fasting glucose so you can calculate HOMA-IR. Magnesium can be useful as well
Glucose is included in the Comprehensive Metabolic Panel 🙂
Magnesium (I believe RBC is recommended? I’m not sure) could be a good one though, I’ve never gotten it before.
CMP is American. Please list all the items for sake of completeness. The drop down didn’t mention Glucose.
A full list can be found here. Any other test listed in the post can also be found on Labcorp’s website with a list of what it contains, if it’s a group of tests.
RBC Magnesium is better but quite a bit more money.
well my serum mag was always ok but rbc mag always shows LOW … confirmed low mag by supplementing and sleeping better
That makes sense as serum levels are pretty tightly regulated. Glad you found relief!
RBC is supposedly the most accurate blood test (though there’s some debate on how well it correlates with magnesium levels in the cells).
Can you provide a listing of labs you would recommend in order, especially identifying those labs who do blood testing without a prescription from your primary?
I am able and willing to pay, and have been using AnyLabTestNow, as Quest and LabCorp in my area require a doctor’s prescription, and send the results to your doc, not the consumer.
Tests done so far:
Vitamin D 25-Hydroxy
Complete Thyroid Panel
I think it depends on the state, as in some states you’re required to get a doctor to sign off on the tests, regardless. But there are services you can order through (like Ulta Labs) where you go through labcorp, but the test orders come through ulta labs – no doctor required as far as I’m aware.
As far as the test results, if you make an online account through labcorp or quest, they upload the results to your portal.
Siobhan – I did not know how to accept facebook friend request, so click friend request on your facebook page.
That being said, do you have any opinion on the preferential nature of lipid/cholesterol tests from, Ulta Labs, Requestatest, as compared to Spectracell Laboratories’ Cardio Metabolic Risk panel?
Trying to decide which lab to use for next month’s blood draw and testing.
Just had Spectracell’s LPP+ report 2 months ago from AnyLabTest, and yesterday found that you can order Spectracell’s Cardio Metabolic Risk Panel directly from them online for $150. I can send you a sample report in pdf that they provided me upon request, but will need direction as to how to email or upload it to you.
I’m not sure about spectracell vs the others, but as far as I’m aware Ulta Labs is generally cheaper than request a test. You can upload the PDF to the site – near the comment box there’s a button for attaching a file.
Spectracell’s Cardio Metabolic Risk Panel costs $150 cash, $45 through insurance. Uploading copy of sample report. Ulta Lab’s Advanced Cardiovascular Health – Comprehensive Panel runs $535. Uploaded a copy of a screen grab of the tests included in UL’s panel.
I am trying to compare the pros and cons of the tests done by Spectracell for important lipid and metabolic information, as compared to Ulta Labs’ panel, especially in light of the $385 differential.
Apologies for the delay – it looks like Spectracell has plenty of great, useful information included, and is way cheaper – that’s the one I’d likely go for if it was me.
Is there a recommendation on how many days before the blood draw to eat (personally I’m LCHF) and for how many hours to fast before the blood draws.
For the US, if paying out of pocket, requestatest.com requires no Rx
Eat as you normally would for the week leading into the test. If you usually eat one meal a day, do that, if you normally eat three meals a day with snacks, do that. So no going off to new restaurants – just eat your standard fare.
Water fast for 12-14 hours before the blood draw (no coffee during this time!)
I wonder is there a way to get a proper CIMT test without doctor’s order? I did it through lifelinescreening.com and got basically useless “mild” value, they said if I want to get numeric result I need to go through my doctor, which is a hassle.
I’m not sure – both Dave and I go through a doctor to get it done. I’ve never heard of another option for numerical values.
Perhaps aim to get it during an annual physical?
Thanks, it looks like it’s the only option.
Any labs out there that measure oxLDL?
Labcorp and Quest both list it, but I don’t see it on Request a Test or Ulta Labs.
I think boston heart labs can do it, possibly.
I have some concerns over accuracy of the marker, but could likely be sussed out by pairing with other metabolic markers and taking in context as with anything
My husband and I have used healthtestingcenters.com for about 5 years. Great service and prices for ordering your own labs. They use LabCorp and Quest labs for the draw.
Would be great if a company would set up a deal for your fans of the tests you recommend for a negotiated lower rate
Yes it would! As mentioned, we’re trying to get something set up, but it’s still beta testing.
Is there a test that measures slightly and medium oxidized LDL?
Never mind. I found your discussion of the “oxLDL and oxidative stress test” in “Beyond the Lipid Hypothesis: Plaque Development” and the tests on Cell Biolabs Inc. I had tried a search of this web site to find such references but for some reason they eluded me. Sometimes a brute force eyeball scan is the only recourse.
Is Apo A1 and Apo B a marker set worthwhile? Do they correlate to pattern / particle size & risk?
Potentially they can be useful when combined as a ratio. But I suspect you can get just as much (if not more) useful information with an NMR.
Just found the site. I live in Vegas. I started keto 3 months ago. I had a blood draw then and again just recently my LDL and TC went up… apparently I’m one of them types. I received a call from my dr’s nurse today and she said my cholesterol was high and the dr wanted to see me. I suspect he won’t be thrilled to order more blood tests if I dont follow his recommendation of medicine to “improve” my cholesterol. So I would LOVE to know any details how Dave does it. I’ve considered getting a pts diag. But the test strips appear to be about 5 dollars per reading. I just watched my first video from Dave and he said he also lives in Vegas. Please email me so we can share details specifical to the valley. FWIW, I’m also in IT. Thanks!
Is there any way to get lab tested without a doctor but have insurance cover it? I’m in the states. I don’t have a problem with the doctor, it’s just a hassle. I just want to be sure I can test whats needed.
I think you need a doctor’s sign off to get things covered by insurance, as they’re the ones that have to code the reason for it, work with the insurance company, etc. That’s pretty much the trade-off you have to make, unfortunately.
You can order tests without a doctor’s approval (Depending on state) but you’d have to pay out of pocket.
Just a tip to add to the available blood test websites -Walk-In Lab (www.walkinlab.com). They have periodic sales with 15% off. I just did my second order with them (‘Basics’ set, w/NMR in place of Lipid Panel) for just under $170. I have nothing to compare it to, but it seems reasonable to me. Happy testing!
Hi I have recently tried to cut out a bunch of carbs. it’s amazing how many thing have so much sugar in them! I am also trying to lower down my blood sugar. As I am not getting any younger,and my family has a history of diabetes. I learn a lot with your blog, thanks a lot!!
Glad it was useful! 🙂
thank you for this info. My husband has a cardiologist appointment tomorrow. went to ER by ambulance on Wednesday at 10 pm, while I was at the hotel waiting for the conference to start. Blood pressure way too high and TSH way too low.
Hi Karen – I hope he is doing okay now and feeling better! So sorry to hear you both had to go through something so scary. 🙁
Here’s a Canadian source: https://bloodtestscanada.com/
I don’t see Apolipoprotein B on the list. I just heard Dave talking about it. I’ve never had the test.
Hi – I was the one who wrote the post, I didn’t include it to reduce redundancy, and I don’t usually test apoB and apoAI anyway so it wasn’t on my mind in the first place. Although the ratio between the two has shown to be a bit better than LDL alone as far as risk, in my experience it tends to be a bit redundant as I can probably guess what each would say based off of a lipid panel or NMR anyway.
Either way – you could always include it in your own tests if it sounds like a test that has value for you! It is certainly a rather popular one, for sure.
If you are trying to get labs values under typical circumstances (not making changes to diet, exercise etc) but injure yourself (swelling, bruising, pain) would it be better to hold off on the scheduled labs until recovered? Would the injury skew the cholesterol and hs-CRP numbers higher?
I can’t give medical advice as I’m not a doctor – but if it were me, I would hold off until I was feeling better. I would not at all be surprised if things look “worse” as healing takes place. I would expect inflammation to be higher, and depending on the severity of the issue impact on other markers as well wouldn’t be entirely surprising to me.
Hi Siobhan, I was watching Youtube video where you went on a 5 day water only fast, and then at meat/fat for 5 days. Do you remember the calories/macros of your eating days? or do you remember the type and quantity of food you ate? thanks.
Sure, the write up is right here. It was a 7 day water-only fast, and then 5 days of about double normal caloric value. I don’t have exact macros in the post but you can see examples of what I was eating (mostly pepperoni, high fat cheese, etc). If you want more detail I could probably go find the entries in MFP for you, since I was logging food to verify I was reaching at least 3k calories/day.
Fructosamine (glycated protein)
Good add – it’s something Dave gets, but I haven’t played with it much. 🙂
Like an amateur I selected everything through and including the Thyroid section (excluding IGF) on one order. After the fourth successive vial I passed out despite having only fasted 14 hours. The results that I have received are all where I want them to be. I’ll post them here once the order is complete.
Is there a good way to break this up into 3-4 visits with a maximum of three vials each visit, for instance, by doing one order per section above? Or is that dependent on the procedures of the specific lab?
Thank you so much for what you do!!!
Hi CNote – although we’re not doctors and can’t give medical advice, I don’t see why you couldn’t spread out the testing over multiple sessions. If it were me, I’d just want to make sure that my diet/lifestyle were held as steady as possible (e.g. amount of food, types of food, activity level, fasting time before the blood draw) until all the testing was done to make sure they’re all done in a similar context.
Not sure I am in the right field here but had a question.
Took myself off a statin about 18 months ago after being on them for 25 years.
Did light keto for 3 months and cut all sugars. Dropped 15 pounds and was excited to get new blood work but cholesterol jacked up to 415 and ldl was 332. Trig and hdl were very good. Ratio was 1.1.
Doc tried me to go back on statin but declined. Had CAC test done which was 0.
Now a year later still off statin but recent bloodwork is similar.
I am 57 years old and love to exercise. A little overweight (183lbs/5’10”).
Any info on CAC score and need to go back on a statin. I would rather lay for the CAC test every year than take a statin.
Any thoughts would be greatly appreciated.
Hi Pat, we’re not doctors and can’t give medical advice, though we can share our thoughts in case they may be of interest. As it stands, though, it’s hard to comment without further context. Would you posting what your triglycerides and HDL were, exactly?
Hi Siobhan. Thanks for responding. Much appreciated. My HDL was 65 and Trigs were 95 in 2021 and 64 and 79(trig) in 2020.
Testing in laboratories is becoming more and more in demand. And because of this, the level of the laboratories themselves rises. Previously, allergens could not be tested so easily, but now in almost every laboratory.
Is there a way to print this entire page out? I am having a blood draw tomorrow after 13 hours of Fasting. I follow the Ketogenic lifestyle and would like to show doctors the research I follow
I think in most web browsers you can set it to print the page – how you do so would depend on what browser you’re using. In my browser I just hit the menu in the top right of the browser, and then there’s the “print…” option.
Good recommendations. I was curious why a few other tests were not recommended? Things like chest xray (looking for cardiac risk with abnormal size, etc), cardiac stress treadmill test (again for heart health), 12 lead EKG or cardiac CT calcium score?
Hi Kel – that would be because this was only discussing bloodwork, not physical measurements! We’re of course mentioned in physical measurements as well, including those you mentioned and others, it just wasn’t the focus of this particular post. 🙂