Laura Schoenfeld: You said other than standard labs like complete blood count, complete metabolic panel, lipids, and thyroid panel. Let me just get my list to see what else I ask people to get. I can share this link on Facebook also. It’s just a link to my website that I share with my clients.
Like you said, the comprehensive metabolic panel, so electrolytes, that kind of thing. Lipid profile, so total cholesterol, HDL, LDL, triglycerides. If somebody has a history of heart disease, having an NMR profile or an ApoB profile can be helpful. I don’t know if that’s covered by insurance. It could be for some people, might not be for others.
C-reactive protein can be helpful if somebody has autoimmune disease or some kind of indication of high levels of inflammation.
I like a blood sugar panel usually, so at least having fasting glucose. Depending on if they are having blood sugar issues, if I see a hemoglobin A1c or a fasting insulin, that’s really helpful because sometimes someone can have elevated fasting glucose but normal hemoglobin A1c, or maybe their fasting insulin is normal or maybe that’s a little elevated. There’s a lot you can kind of glean from a nice blood sugar panel.
As far as the thyroid panel, TSH obviously, and then free T3 and free T4 are also important to have as well. Reverse T3 can be helpful. That can explain thyroid symptoms when someone has normal TSH and free T3. Also if there’s any concern about Hashimoto’s, then getting those antibodies tested is really important. That’s not something a lot of doctors will order for someone that has thyroid symptoms, so sometimes patients have to ask for it.
Vitamin D is one that usually is covered by insurance, but not all doctors will order it on a habit. That’s important because I have a lot of clients that are supplementing with a lot of vitamin D and their levels are actually either good or even high. I’ll have clients that come to me and they’re on 5,000 to 10,000 IU of vitamin D a day, and we test their vitamin D and it’s 70 or something. That’s really important, especially if somebody is supplementing. If they’re on any more than 2,000 IU per day, I really suggest getting that tested twice a year at least to make sure that somebody is not overdosing on vitamin D. I’ve had clients that came to me with 110 as their vitamin D level, which is just crazy. I know that there’s a lot of controversy about what levels are optimal. I know Chris’ range is about 25 to 50 as optimal. I like to see numbers in the 30s and 40s ideally. If somebody is high 20s or low 50s, it’s probably OK. I’m not going to freak out about it, but if somebody is above 60 or 70 and they’re taking a ton of vitamin D, then that needs to be addressed.
The complete blood count is really important because that will show you if there’s any sort of iron storage disorders. It could identify some anemia. White blood cell count can be helpful because that can show if they have a chronic infection even if it’s not above the clinical range.
If there’s any sort of B12 deficiency or if they have a weird type of B12 deficiency anemia, so let’s say they have a high MCV but then they also have high levels of plasma B12, then that might indicate some kind of methylation issue. That can be really helpful there. Then, of course, the iron storage diseases can be important for men, women of postmenopausal age, anyone that has inflammatory symptoms or blood sugar issues that are not the typical insulin-resistant case, then that can be really helpful. Then, like I said, the B12 and the folate, those can indicate either deficiencies, or if there is anemia but then there are also high levels in the blood, maybe there’s a usage issue or maybe they’re taking some kind of supplement that is just providing way too much of a non-effective form of the nutrient.
Those are my basic ones. I think most of those are covered by insurance, in general, not all of them, and of course, it depends on the person’s insurance, but that’s usually a good place to start, and I generally like to have all of those for my clients before we start working together. I don’t always get them, but it’s really helpful if I have them because I can find certain things that are potentially not clear in the symptomatology or in their experience with other doctors. I might be able to find something that is a little unusual that can guide treatment. I’ll share that link on the Facebook page, and I’ll share the link to the estimated calorie requirement calculator that I use in my practice.