The 5 lab tests your doctor should be ordering every year (but isn’t) August 15, 2014 By Dr. Alexis Shields

You are putting yourself at risk if you are not asking your doctor for these tests every year. Monitoring the progression of your health with blood work each year is extremely easy and vitally important. However, the typical yearly physical is NOT a comprehensive look at your health, and it rarely prevents chronic illness. Therefore, it is very important that you take preventive health measures into your own hands. These five lab tests should be a crucial piece of your annual physical, and here’s what you need to know about them: #1 Vitamin D The Harvard School of Public Health estimates that 1 billion people worldwide have inadequate levels of vitamin D in their blood. It is estimated that that number becomes almost 50% of the world’s population if you include those in the suboptimal range. Why is it important?

Having a deficiency of this super nutrient has been linked to osteoporosis, increased fracture risk, cancer, autoimmune dysfunction, cardiovascular disease, multiple sclerosis, lowered resistance to the common cold and seasonal flu, type 1 diabetes, and hypertension. Therefore, Vitamin D levels may just be the most important preventive lab measurement. Based on the current research, I recommend a target Vitamin 25D level of 30­50 ng/mL for most people. #2 The 2­hour post­meal glucose Although a fasting glucose is usually included in a basic blood workup, a far more useful marker is the 2­hour post meal glucose. This helps you to determine the amount of time that your blood sugar spends elevated over the level known to cause the complications such as diabetes and heart disease. Why is it important? The food that we eat is eventually broken down into glucose, which is the sugar that circulates in your blood that provides your body’s cells with energy. Although glucose is crucial for providing energy, when it remains in the blood stream for too long it can damage the blood vessels and lead to cardiovascular disease. After monitoring hundreds of patient’s blood sugars each year, I have come to the conclusion that the American Diabetes Association (ADA) blood sugar targets are too high! If you are interested in optimal health and longevity, your ranges should be: Fasting blood sugar 75­90 mg/dL (ADA recommends <99) 2­hour post­meal blood glucose <120 mg/dL (ADA recommends <140) *This test can easily be performed from home with a cheap drug store blood sugar monitor or get this one delivered for free from Amazon! #3 A complete thyroid work­up Chances are, if you’ve had your thyroid tested recently, a lab marker called TSH was tested. The problem is, the thyroid hormone undergoes a complex cascade of steps before it is active and available to every cell of the body. Did you know that it is possible to have normal TSH blood levels but still experience the symptoms of a poorly functioning thyroid? Why is it important?

Thyroid disorders are on the rise. More than twelve percent of the U.S. population will develop a thyroid disorder in their lifetime, and up to 60 percent are unaware of their disease! One in eight women will develop a thyroid disorder in her lifetime. A more complete thyroid screening includes: 1. TSH (thyroid stimulating hormone) 2. free T4 3. free T3 4. TBG (thyroid binding globulin) 5. T3 uptake 6. For those with an autoimmune disease or family history of thyroid disease, also include: TPO antibodies and anti­thyroglobulin antibodies. #4 Screen yourself for a B12 deficiency It is common for someone following a vegan or vegetarian diet to be low in vitamin B12. But, you can eat meat and still be deficient! Additional factors putting you at risk for low B12 absorption are digestive disorders, diabetes, taking proton pump inhibitors or acid blocking medications, and being older than 60 years old. A review of 3,000 men and women in the ongoing Framingham Offspring Study found that 39 percent had B12 levels in the suboptimal range which are levels that can result in neurological symptoms! Why is it important? B12 deficiency causes a type of anemia that can result in neurological symptoms such as walking and balance disturbances, memory loss, cognitive decline, confusion, and dementia. B12 deficiency has also been linked to infertility, autoimmune disease, and autism spectrum disorders! What is a good B12 level? Currently the accepted deficiency level is 148pg/mL. However, Japan and Europe have their lower limit at 500­550pg/mL. I also recommend a level greater than 500pg/mL. If you suspect you have a B12 deficiency, an even more sensitive marker to include in your testing is methylmalonic acid (MMA). #5 Take your cholesterol test one step further with the VAP cholesterol test

It is NOT enough to know your total cholesterol, HDL, and LDL levels! LDL is the so­called “bad cholesterol.” But, not all types of LDL are related to an increased risk for heart disease. Why is it important? Only the small, dense type of LDL contributes to the rise in heart disease risk; however the basic cholesterol test does not tell you this information. Request a VAP! The VAP test is a specialized cholesterol test that tells you if you have the small, dense heart disease­related type or the large, buoyant heart protective type of LDL particles. …… A good annual physical should help you to catch the disease process early. But a great annual physical should help you to identify these areas of imbalance and give you the lifestyle and diet recommendations to reverse poor health. Requesting the above tests from your doctor is the first step in helping you to get more from your annual physical. For more information on the full list of testing that I recommend all of my patients do yearly, along with easily accessible and affordable lab testing, please feel free to contact me at dralexis@dralexisshields.com. Dr. Alexis Shields is a board­certified Naturopathic physician. She specializes in using a drug­free, natural approach to healing the body. She currently offers online health consultations and creates an individualized health plan based on a specialized assessment of your blood work, lifestyle, and diet. Dr. Alexis has been featured on the popular health blogs Mind Body Green and Eat Live Life, and she is a consulting physician for Wellness FX and Primal docs. http://dralexisshields.com