by Dr. Karl Nadolsky
A common question we get from patients and from folks on the internet is –
What blood tests should I ask my doctor to order at my annual physical?
There are some tests that are simply used for general screening purposes and then also some for symptomatic screening purposes. The general tests are what I order for everyone generally on an annual basis once they hit their 20’s or 30’s. Most people that are known to be healthy can get these tests done every few years if they’d like as well. The symptomatic screening tests are done if you are having some type of complaint such as fatigue. These tests are generally only ordered if you have a certain symptom (e.g. fatigue).
I know of A LOT of people touting on the internet to self experiment by getting a big battery of tests regardless if you have symptoms that would provoke the testing. There are two trains of thought here and I will try to give some insight and my own personal recommendations at the end of this article. First let me give some tests that can be ordered for general screening purposes and tests that can be ordered if symptomatic.
General Screening Tests
- Fasting Lipid Panel – Includes total cholesterol, HDL, triglycerides, and calculated LDL
- Basic or Comprehensive Metabolic Panel – Basic includes electrolytes as well as kidney function and glucose. Comprehensive includes all in the basic, but also adds some liver function studies (plus calcium).
- Complete blood count – This will give you a hemoglobin and hematocrit, a white blood cell count, platelets, as well as some red blood cell information that can clue in to different types of anemias if the blood count is low (hemoglobin and hematocrit is low). Some doctors might not order this but I tend to do it more often than not.
- Vitamin D – It seems like everyone and their brother is vitamin D deficient. Ask to get tested and make sure it is 25-hydroxy vitamin D and not 1,25-dihydroxy vitamin D.
Optional Add-ons to the above
- Hemoglobin A1c – This is a test that basically gives a 3 month average of your blood sugars. If you have any of the Metabolic Syndrome traits like increased waist circumference – (greater than 40 inches for men, 35 inches for women), high blood pressure (greater than 130/85), high triglycerides (greater than 150 mg/dL), low HDL (less than 40 mg/dL for men, less than 50 mg/dL for women), or a fasting glucose of 100 mg/dL or greater you should consider this test. Also if you have darkening of your skin on the back of your neck called –Acanthosis Nigricans.
- Oral Glucose Tolerance Test – This is a test that may be abnormal even when your fasting blood sugar or hemoglobin A1c is normal. You may want to consider this if you have the metabolic syndrome traits as stated above. You will need to be fasting for this test. Also just so you know, you’ll drink a super sugary drink and they will check your blood sugar a couple times over 2 hours.
- Fasting Insulin – This is another test that might give a clue if you have insulin resistance even when the above tests are normal.
Symptomatic Screening Tests
Fatigue
- Thyroid Stimulating Hormone (TSH) – This is the hormone from your pituitary gland (in your brain) that tells your thyroid to make more thyroid hormone. The thyroid controls the metabolism of all of your body’s functions. If you have a low thyroid hormone level in your body, the TSH should be high since your brain keeps needing to “scream” at your thyroid to make more. There is some controversy whether this is the best test for thyroid function, but either way it is an okay screening test for thyroid problems. I will make a whole article dedicated to the thyroid.
- Free T3/T4 – My teachers in med school and my attending doctors (superiors/teachers) in residency would probably be mad that I recommend these tests along with a TSH for hypothyroid screening. Classically we are taught in medical school that TSH is the only test needed to screen for hypothyroidism. However recently I have seen more and more that a patient’s TSH can be “normal” when in fact their free T3/T4 are low. The T3 is the active thyroid hormone in the body and if it is low, you will likely have hypothyroid symptoms. I will explain this more in the article dedicated to the thyroid.
- Complete blood count – see above
- Total Testosterone – This is obviously for males. If you are feeling tired, you may want to consider checking a total testosterone in the morning. Make sure that when you get this test, it is in the AM because that is when it is most reliable. If your testosterone is low you will likely have other symptoms (low libido, decreased erections, etc) but it is worth considering.
- Sleep Study – If you are tired, have a large neck, and/or you SNORE, get this done. You may have some form of sleep apnea and require a CPAP machine (continuous positive airway pressure).
Inability to lose weight / Weight Gain
- TSH/Free T3/T4 – See above
- Hemoglobin A1c / Oral Glucose Tolerance Test / Fasting Insulin – See above. When you have insulin resistance, you ability to lose weight will go down and must be treated if you want to lose fat.
- Testosterone – (Males) – If your testosterone is low, you will have a tough time losing weight. You may need replacement, or you may need to fix some other things in your life that will correct your testosterone. Read this article to learn about losing weight to boost testosterone, and read this article about replacing testosterone to lose weight.
- Sleep Study – If you aren’t losing weight and you snore at night, get this test. Sleep apnea will inhibit your ability to lose fat via excess cortisol levels as well as increased insulin/leptin resistance among many other mechanisms (increased cravings which increase food intake etc.).
This should be a good start to know which labs to request from your doctor based on general screening and based on some of your symptoms. As noted above I want to touch on the topic of self-experimentation. Many people, including myself, are starting to order loads of different tests just to see what their results are due to curiosity. This is fine, but understand that when you start to go searching for things that have what physicians call low pretest probability you might get false positive findings that will warrant further searching. What this means is that the probability of you having a certain problem is low, yet you go and order a test to “just check”, you may get a false positive. This will lead to further worrying and unnecessary tests that show the original test was a false positive.
I will eventually write an article about how I used two different labs at the same time to test my adrenal glands with saliva and got two completely different results. That’s a story for another day! Now on the other hand, it is possible you find something that is truly there. Then you can treat it before it becomes noticeable and worse! So my caution is to understand the risks when ordering extra tests that you probably don’t need.
Next time I will discuss how to interpret these labs once you get them – You will want to interpret them with your doc first, but a quick overview will empower you to take action.
Any questions? Feel free to come by our forum and ask the Lean Docs about lab tests or whatever else you have in mind.
Nancy says
Hi, Dr. Nadolsky. I’ve become acquainted with your work since signing on with Precision Nutrition for their Lean Eating Coaching program. Anyway, I was hoping you might know of any physicians in the Boston area who take a similar, rigorous, detective-like approach to solving difficult medical conditions.
I’m 48, female, and for the past 8 years or so have dealt with a problem called Burning Mouth Syndrome. It is not a serious medical condition, but on the other hand it’s been having a huge negative effect on my quality of life. There’s very little the standard medical community knows about it, and I’m currently trying acupuncture (which doesn’t seem to be working). It’s a very unpleasant condition to have, so I am flailing around trying to see if someone can help me pinpoint a solution for it, or alleviate it at least.
Thanks for your input.
Nancy
Dr. Spencer Nadolsky says
Hi Nancy!
Burning Mouth Syndrome is a really frustrating problem (I know a few who have had this problem). Would you like to come over to our forum and we can discuss it some more? Either that or we could do a quick consult sometime if you wish. Let me know!
I don’t know of any docs in the Boston area but maybe I could help empower you to talk with your current doctor about possible treatments. http://www.leanerliving.com/members/forum.php?
emily says
I am not concerned about weiigt loss.
I weigh 110# and am 5.2 tall …I am 84 years old; my body mass image says my real age is 49.
I am very concerned about blood sugar/ cholesterol control.
My HbA1C is slowly creeping up (6.1 in Nov.2011…now 6.4 in July, 2012)
I am taking armour thyroid and every time my thyroid is checked; the doseage has to be changed because either my tsh or t-3 (or both )are out of balance.
I have been on lBerberine for better than 6 months.
My cholesterol is 250; my Ldl is 171
It is difficult; but I am trying to cut out “carbs)
I siigned up for your “consult”…I do not want to loose any more weight.
Can you assist me only in bringing down my “numbers” with your consut?
Emily
Dr. Spencer Nadolsky says
Hi Emily! Yeah I can probably help you out. You should get a special link to fill out a bunch of information like your other medical problems etc. and current medications. Also be sure to check out our forum http://www.leanerliving.com/members/forum.php and ask any questions you might have.
It is possible that your thyroid isn’t dosed correctly which can make a difference in your HbA1c and your cholesterol.
Suzzie says
Google led me here as I have been searching for answers for the past 3 years! I believe that I have hypothyroid and am in the grouping of people who have normal TSH levels. I had my TSH checked in April of 2010 at a regular doctors appointment and it was .68 I believe. I felt great! In June of 2010 I began having dizzy spells, weight gain, fuzzy head, sensitivity to cold etc. I went to doctor right away and they checked my TSH and just told me I was normal. I have been to HUNDREDS of doctor appointments for this and have been checked by every type of physician imaginable! My TSH has been checked a few times and they always just tell me that I am in normal range! It wasn’t until I started doing research that I called the doctors offices back and asked for my levels! During healthy time- as I said, it was .68 and just 2 months later with the symptoms it was 1.63 and has been hovering around this the entire time! This has been really debilitating for me at times and seems to get worse during particular times of month. I have given up seeking help because Im afraid people think I am crazy at this point. 🙁 I just want normal back! Do you think this is possible that my set point is under 1 and its possible that I feel like this because it is over double that now?
Dr. Spencer Nadolsky says
Hi Suzzie did they check your other thyroid labs too? Like t3 and t4?
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