Most people who have been to their insurance-accepting primary care doctor in the past have been told, “You’re doing great. All your labs are normal. Keep on doing what you’re doing.”
They might say this to you despite your physical or mental/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.
Why Testing is Important
At Parsley Health, we do exactly that. We know our patients’ entire life story because we talk to them about it for 75 minutes at our first meeting. We order so much blood work that sometimes it has to be split into 2 separate lab draws (sorry guys, it comes from a place of love), and we spend another 60 minutes with them going through every little detail. This is how we believe medicine should be practiced.
The root of the word “doctor” means “to teach” in Greek and Latin. The role of the doctor in the past was to teach people about their health and physiology. Doctors would guide people through their health journey through collaboration and education. The current medical system does not allow for that. It is built on a paternalistic style of medicine where people feel completely out of control of their own health outcomes and vulnerable to the medical system.
In our model, we empower our patients with the knowledge they need to be actively involved in their own health. We do not accept insurance because it would not pay for our time in a reasonable way, but we know that our patients leave with something invaluable – the power and knowledge to take control of their life.
As previously mentioned, a large part of what we do for our patients is extensive blood work. For our Complete Care annual membership patients, we order the initial set of blood work on the day of the initial visit which is personalized to the individual’s case. Throughout the year, we follow the pertinent values as the patient modified his or her lifestyle and takes various supplements to optimize their health.
In contrast, at the Parsley Assessment membership (our version of the executive physical), extensive blood work is ordered prior to the visit for review on the day of the visit. If the person chooses to switch to the Complete Care membership, future labs would then be tailored to their individual case and followed over time.
Parsley Health combines cutting edge testing with conventional and natural approaches. This is modern holistic medicine.
The 5 types of blood tests you should do every year.
These are some of the labs that are included in the evaluation of our patients which I think are essential to track at least once a year.
1. Broad Thyroid Panel
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.
Many doctors say that they don’t see the value in checking of these additional levels simply because they don’t know how to interpret them. At Parsley Health, in addition to conventional medical training, our doctors are trained in advanced lab interpretation. If any of these thyroid values are not optimal, we can start our patients on a program to prevent full-blown thyroid dysfunction or disease.
Another major problem with typical thyroid lab interpretation is that the reference ranges are much too wide. At Parsley Health, our doctors look for “optimal ranges” as opposed to “normal ranges”. 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. For example, a study published in the Journal of Endocrinology and Metabolism in 2010 showed that the rate of miscarriage in 1st-trimester pregnancy was almost double when the TSH was over 2.5 (1). If pregnant women and fetuses do not function properly when TSH is greater than 2.5, then why do we expect other people to?
2. Essential Nutrients: iron/ferritin, vitamin D, vitamin B12, magnesium
These nutrient levels are unfortunately usually not checked at a routine primary care visit. Our bodies are a large bio-electro-chemical soup. There are countless essential nutrients needed for this soup to behave in a constructive and cohesive way. Four basic nutrients that are so important for optimal bodily function are iron, vitamin D, vitamin B12, and magnesium. Since so many people are deficient in these nutrients for various reasons, it is imperative that we check on 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. A chapter in the book Sunlight, Vitamin D, and Skin Cancer in 2008 published their conclusions based on a multitude of vitamin D research that 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 (2).
3. Complete Metabolic Panel and Complete Blood Count
These are two panels of labs 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 for example.
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 (3,4,5), especially among certain ethnic populations.
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4. Metabolic Markers: Hemoglobin A1c, fasting glucose and insulin, lipid panel
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 stratify 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. It’s important to also know what your glucose and insulin levels are in the morning after fasting for 10-12 hours.
Elevations in any of these levels are a sign that your body is not processing glucose properly, probably due to over-ingestion of refined carbs and sugar. This increases your risk for diabetes and almost every other disease under the sun like 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”.
5. Inflammatory markers: hsCRP, homocysteine
Inflammatory markers like these are almost never checked at a routine primary care visit. hsCRP is an inflammatory marker which can tell us the general inflammatory status of the individual. Even mild increases in hsCRP are associated with increased risk of physiological dysfunction that can manifest as cardiac events or even 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. Eating an inflammatory meal with refined carbs, refined sugars, and trans fats cause an immediate elevation in hsCRP that lasts for several hours.
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.
The important thing to realize is that checking labs 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.
We try to catch underlying issues early in the pursuit of disease prevention. Our more extensive knowledge of lab testing is certainly one of the major ways we are able to guide our patients in the most natural and effective way towards optimal health.