Most people who have been to a primary care doctor in the past have been told, “All your blood tests looks normal. Keep on doing what you’re doing.” They might even say this to you despite your physical, mental, or emotional complaints. What they really mean is, “Keep on doing what you’re doing, until something is so wrong with you that even your basic labs look abnormal, and then I can prescribe you a toxic drug.”
Unfortunately, our current medical system does not put enough monetary value toward the prevention of disease. It does not financially incentivize doctors to talk with their patients about their lifestyle habits or order extensive labs which could catch underlying dysfunction early enough to prevent full-blown illness.
At Parsley Health, we do exactly that. Members’ first visits are 60 minutes, so we get to know their entire life story. We order many advanced blood tests and we spend another 60 minutes with members going through every little detail. Then, we use that information to advise members’ care. Throughout the year, we follow the pertinent blood values to ensure members are optimizing their health.
In most primary care offices, if you’re lucky, your doctor will check 1 or 2 thyroid markers. Usually, the ones checked are TSH and/or total T4. These give you a little glimpse as to how the thyroid is functioning. There are 6 additional thyroid-related values that we routinely check for our patients: Free T4, Total T3, Free T3, Reverse T3, anti TPO Ab and anti Thyroglobluin Ab. If any of these blood tests values are not optimal, we can start our patients on a program to prevent full-blown thyroid dysfunction or disease .
We look for “optimal ranges” as opposed to “normal ranges” of these labs. For example, the “normal range” for TSH is generally considered 0.2 – 4.5, however, there are studies that show that the body does not function properly when TSH rises above 2.5. A study published in the Journal of Endocrinology and Metabolism in 2010 even showed that the rate of miscarriage in first trimester pregnancy was almost double when the TSH was over 2.5.
Iron, vitamin D , vitamin B12, and magnesium are so important for optimal bodily function, but they’re usually not checked at a routine primary care visit. Many people are deficient in these nutrients for various reasons, so it is imperative that we check these levels and supplement them when they are not optimal. Supplementation with any of these nutrients when people are low can be completely life-altering. I’ve had countless patients tell me how seemingly magical the improvement was in how they felt after taking these supplements when it was needed.
Again, it’s important that we concern ourselves with getting to “optimal range” as opposed to “normal range”. For example, in the case of vitamin D , the “normal range” can be from 30-100 nmol/l, although we try to get our patients in “optimal range” which is more like 50-80 nmol/l. Reviews of many scientific studies have shown optimal levels are at least 75 nmol/l in relation to bone mineral density (BMD), lower extremity function, dental health, risk of falls, admission to nursing home, fractures, cancer prevention , and incident hypertension.
These are two blood tests that are always ordered at a primary care yearly physical and offer a lot of information. They are essential to understanding a person’s electrolyte and hydration status, kidney function, liver function, and blood cell values. These values would also tell us if someone is fighting an acute or chronic infection, has anemia, or clotting issues.
In terms of optimal ranges, when we look at liver enzyme levels that are still considered in “normal range”, but on the upper end, we can tell that there might be a detoxification or liver inflammation issue that should be addressed right away to prevent further progression of illness. A number of studies have shown that this upper lab limit should be decreased in order to catch liver inflammation early , especially among certain ethnic populations .
Metabolic markers like these are essential to understanding how a person is processing the macronutrients that they eat. In most primary care visits, a basic lipid panel and glucose level would be done yearly, and if you’re lucky you’ll also get a Hemoglobin A1c. For patients at higher risk of heart disease, we run extensive lipid panels as opposed to a basic one. This can help us better determine whether there is actually increased heart disease risk from their cholesterol levels or not. Many times people are told that they have high cholesterol levels when they are not actually a risk.
The Hba1c is a measurement of blood glucose level average over the past 90 days or so, but it is also a relative marker of oxidation in the body. Having elevated blood glucose levels creates oxidation, or damage to proteins, DNA, and tissues in our bodies over time, so this is an imperative value to know and optimize.
Elevations in any of these levels are a sign that your body is not processing glucose properly, which can increase your risk for diabetes, heart disease, cancer, and Alzheimer’s disease. One study published in the Journal of Neurology in 2005 (6) showed that even if your Hba1c is considered in “normal range”, every increase by 0.1 will increase the rate at which your brain shrinks in size per year. This is why being advised on how to reach “optimal range” is so much more important than simply saying you’re in “normal range”.
Inflammatory markers like these are almost never checked at a routine primary care visit. hsCRP is an inflammatory marker which can indicate your the general inflammatory status. Even mild increases in hsCRP are associated with increased risk of things like cardiac events or depression. An elevation can tell us that there is something inflammatory happening in the body that should be addressed, whether it be from physical trauma, emotional stress, oxidative stress, environmental toxicity, allergy, sedentary lifestyle, or food sensitivities .
Homocysteine is an amino acid that requires methylated-vitamin B12 and folate to be cleared. Elevations in this level indicate a multitude of things like stroke and heart disease risk, B vitamin status, ability to methylate, ability to detox and make neurotransmitters, and ability to turn off cancer genes. It’s an important marker that we try to get into optimal range by supplementing with methyl-B vitamins when necessary.
Having blood tests done is not what’s essential to your health. The importance is in the interpretation and advice that you get from your doctor and how that translates into actual changes in your life that will affect your health. The distinction of what the doctors do at Parsley Health is that we are interested in our patients having optimal levels in every value that we check so that their health and function are optimized.