The Investigation

Annual check-ups are supposed to confirm your health or raise flags on potential issues. But, could they be a false sense of security? I’ve had so many clients come in with a ‘clean bill of health’ from their doctor that doesn’t match how they feel. Today, we’re going to investigate why so many annual check-ups fall short. 

Insufficient Blood Tests

Are you getting the right blood tests with your annual check-up to truly determine if your healthy? It depends on your doctor. What tests are run is up to each individual doctor. I find that, unless you are seeing an integrative doctor, chances are good that your blood work is very basic. An integrative doctor will ensure that the blood work includes specific markers to get a complete picture of what’s going on in the body. 

How Health Mysteries Start

So often, clients dealing with a health mystery tell me that they’ve had an annual physical and that the blood work came back totally normal. Without more comprehensive blood testing, they presume that nothing is wrong and as a result, doctors may dismiss complaints or rule out issues prematurely. When we presume that things are ‘normal’ it can be very hard to dig deeper to find out what is really going on. And remember, imbalances often start months and years before symptoms appear and a disease is actually found. So, imagine if getting the right blood tests could mean that you catch things before they can turn into a health mystery! 

Avoid Becoming a Health Mystery

The number one way to avoid developing a health mystery is to use your annual check-up as an opportunity to do more comprehensive testing. What does this look like? Ask your doctor to do more than just the basics. You need to be specific, otherwise, you might still fall into a false sense of security about your health. 

Normal is Too Broad

Another way that issues can slip through the cracks is when our results come back inside the ‘normal’ range. The normal range is not the same as the optimal range and can vary depending on where you live. If you want optimal health, you have to compare your results to the ‘optimal’ range and not the normal range. 

What Blood Tests Should be in an Annual Physical

Most routine physicals will include a complete blood count (CBC), a metabolic panel (looks at your glucose, liver and kidney markers), and a lipid panel (cholesterol and triglycerides). This is typically not enough.  

Here is what tests you should have done and the optimal ranges to look for:

• Vitamin D
• • Check both 25 hydroxy and 125 hydroxy, ideally but if you just get one test, ask your doctor for the 25 OH. 
  • The typical ‘normal’ lab range for vitamin D is 30-100. Optimally, we want to be somewhere between 50-60 and if you have an autoimmune disease some say even closer to 70. 
• Thyroid (listen to Episode 27 for more on this!)
• • Most doctors won’t check this in a routine physical and if they do, it’s just a TSH test.
  • You should test TSH, Total T4, Total T3, Free T4, Free T3, Reverse T3 and Thyroid antibodies.
  • Check the PDF Download for optimal ranges of each of these
• Iron
• • While the CBC includes a marker called hemoglobin but it is typically not enough to truly evaluate iron levels
  • Ask for Total Iron, TIBC, Iron Saturation and Ferritin (which is the storage of iron).
• Inflammation
• • Inflammation is what often leads to disease and very few doctors test for it in an annual physical.
  • Ask for a test that looks a marker called HsCRP (high sensitivity c reactive protein). Ideally, this number should be below 1 even though the labs range may allow or up to 5.
  • Also test ESR. Normal ranges is below 15 but optimal range is below 5.  
  • High Homocysteine levels  can lead to inflammation and is a risk factor for cardiovascular disease. It is rarely checked. Most lab ranges show 0-15 as normal. Ideally, homocysteine should be between 7 and 8.
• B12
• • Normal ranges from 200 to 1100 but ideally, you want to be above 600.
• Hemoglobin a1c (if you’ve had elevated glucose or you have a family history of diabetes)
• • Most tests are a one-time check of glucose but the a1c looks at average levels over 3 months. 
  • Ideal levels are 5.6 or below. Between 5.7 and 6 indicates a higher risk for diabetes. 6-6.3 is considered pre-diabetes. Above 6.3 is diabetes
• ANA (anti nuclear antibodies) (if you suspect, have any history, or family history of autoimmunity)
• • This general marker does not represent a specific autoimmune disease, having an elevated ANA can be indicative of some autoimmunity.
  • If this is elevated, more investigation is warranted.
•  Histamine determination whole blood (done at Labcorp only, Test # 081315)
• • Learn more about this, the MTHFR gene, and methylation by listening to episode 34
  • The optimal range for this marker is 40-70

Redefining the Basic Tests

Most doctors will run the basics, including a CBC, Metabolic and Lipid Panels. Here are the key things to look for: 

• CBC
• • Look at the white blood cells. The lab range is wide but an ideal white blood cell count is between about 5 and 9.  
  • A low white blood cell count can mean there is some kind of underlying infection. 
  • Look at thewhite blood cell differential, too. This shows the percentages of the different types of white blood cells. If your lymphocytes are elevated (and you’re not sick) it may be a sign that something is going on, perhaps a hidden virus the body has a hard time fighting off.

• Hemoglobin
• • Note that the bottom end of the range is at 11.7 but women should ideally be between 13.5 and 14.5 and men at 14.5-16.5. 
• Metabolic Panel
• • Pay special attention to the glucose. It should ideally be between 79 and 90 
  • Bilirubin should be between 0 and .8. 
  • Numbers above .8 can indicate an issue with the glucuronidation cycle and tells me there can be an issue with hormone detox and potentially sulfur or oxalates. 
• Cholesterol
• • Most doctors are pretty vigilant and may prematurely prescribe medication. 
  • Remember, cholesterol is not the only predictor of heart disease so looking at how everything looks together including homocysteine and crp. 
  • Acceptable LDL levels have been moving down over the last 10 years. Normal is now below 100. However the ratio is very important. If you have a good HDL, which is the good cholesterol, an LDL that is a bit over 100 is not typically a huge issue but of course we have to be mindful if its trending up.

Prepare for your Annual Physical

I’ve shared a lot of information in this podcast about what test you should be requesting from your doctor and why. It can be a bit overwhelming, I know. So, I created this cheat sheet PDF that you can take with you to your annual physical appointment. The OPTIMAL range are also listed so you can assess your test results accurately.  Click HERE to access this free PDF. 

Eliminating Health Mysteries

Many health mysteries are preventable. Getting a clear and complete picture of your health at every annual physical is the first step in avoiding becoming a health mystery. Make sure you share this information with everyone you care about so that we can eliminate health mysteries for good. 

Links:

DFH Complete Multi

Seeking Health Prenatal/Multi

Thanks for Listening

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