Bloodwork: Request It!
Originally written 6/10/2019
Most people begin their fitness journey in the name of health. They decide to set a goal to hold them accountable, whether it be a marathon, a Crossfit competition, a boxing match, etc. But then at a certain point, they often will trade their health in the name of performance (i.e., lacking sleep, over-eating, over-stressing the body, etc.) In the past year, I’ve decided to reduce my hours training and see the overall picture – how this all fits into my wellness goals. I still train for marathons and OCRs but have cut my mileage and time in the gym to make sure that these things don’t overrule my life.As a result, I’ve gotten more interested in nutrition, recovery, and the significance of my bloodwork. I think everyone should take advantage of their annual physicals and bloodwork, but not only to check off that everything is “normal”, but to understand really what’s going on. Now, in conjunction with my training, I’ve begun tracking my results a little bit more frequently and relating my lifestyle and diet to my results.In addition to the standard blood panel (CBC, RBC, Lipid Panel, etc.), I started requesting the following additional exams:
- CRP & Homocysteine (Inflammation):
I always add on inflammation tests, in addition to an advanced NMR lipid panel (cholesterol) to best assess my risk of heart disease. At the least, you can throw in a C-reactive protein test.
- LDL- P and LDL Phenotype (Cholesterol):
Your basic lipid panel doesn’t give you a full picture of what’s going on. People oversimplify, HDL as “good” cholesterol and LDL as “bad” cholesterol, but the truth is that both are necessary and LDL has the important role of delivering life sustaining cholesterol to every one of our body’s cells. LDL becomes dangerous when it becomes oxidized once it is bound to sugar (another reason to lower carbs).
It’s suggested to test for the LDL phenotype and add in an LDL particle count. Ideally, you want to see a lower particle count with larger, less dense LDL particles (type A pattern) – which is associated with lower triglycerides, less insulin resistance, and lower risk of heart disease. You can ask for an NMR test (LabCorp) or Advanced Lipid panel (Quest Diagnostics).Side note: There’s interesting research showing that saturated fat/meat increases LDL large particle numbers, but leaves LDL with small particle numbers unchanged. (Source: https://academic.oup.com/…/doi/10.1093/ajcn/nqz035/5494812 6/4/19)
- Triglycerides/HDL Ratio:
This number is more important than the vilified LDL count. HDL/Triglyceride ratio is the most important value when it comes to your lipid panel as it measures the HDL responsible for removing excess Triglycerides from blood vessels – the ideal ratio here is less than 2:1. A good read on all things cholesterol is “Cholesterol Clarity” by Jimmy Moore.
- Omega 6-Omega 3 ratios:
Essentially fatty acids cannot be produced within the body and are only taken in from diet, so it’s good to have both of these in your diet. However, omega 6’s are inflammatory and can make red blood cells more susceptible to oxidative damage, so it’s best to keep a lower ratio of omega 6 – omega 3. Americans consume a 20:1 omega 6-omega 3 ratio, while the Japanese consume it at a 5:1 ratio. Many are now advocating a 1:1 ratio.Side note: Vegans typically will need to supplement an omega as ALA (flaxseed, walnuts, olive oil, etc.) conversion rates to EPA/DPA are very low.
- Hemoglobin A1C & HOMA-IR (Insulin Resistance):
Insulin resistance promotes weight gain as it requires more and more insulin/blood sugar to utilize glucose out of the bloodstream. Ultimately, insulin resistance is a warning sign for the eventual development of type 2 diabetes and Alzheimer’s (now commonly called type 3 diabetes).Typical tests for this are of Insulin and Glucose themselves. I would throw in Hemoglobin A1C – which measures your average blood sugar over the past few months, and your HOMA-IR score, which is a mathematical model to quantify insulin resistance.
- IGF-1 and Cortisol (Metabolic Hormones):
Cortisol, the stress hormone, can lead to weight gain and a suppressed immune system. IGF-1 measures Growth Hormone activity and these hormones are the main hormones responsible for cellular and muscle growth, and support anabolic pathways that lead to metabolizing fat to support such growth. Less talked about is high levels of IGF-1’s impact on longevity – while higher levels can help to build muscle, they are also associated with shorter lifespan. Dr. Richard Gaines suggests IGF-1 values between 80 and 150ng/ml.
- Electrolytes, Vitamins, and Minerals:
All useful information for your training as well that may not be included in a standard blood panel.
You can request bloodwork to be done when you get your annual physical exam. Furthermore, I would recommend taking a look at www.wellnessfx.com, for additional information or to order additional tests.