The Value of Preventive Medicine and Robust Lab Testing

How do you determine your health status? Most of us with American health insurance get a “free” yearly physical exam. We may get some routine blood work done, and if we’re lucky, we might be told that everything looks “normal” and that we can come back the following year.

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How do you determine your health status? Most of us with American health insurance get a “free” yearly physical exam. We may get some routine blood work done, and if we’re lucky, we might be told that everything looks “normal” and that we can come back the following year.

“Unfortunately, studies show that yearly physical exams, which typically include scant, superficial blood work, do not improve mortality or prevent disease .”[7/8]

Thankfully, as a patient of PrimeHealth, you will receive an in-depth understanding of your health status and preventive rather than reactionary medical care, through lab testing ordered specifically for you. These tests can not only tell us if you are fine, but more importantly, whether your health is optimal. Knowledge is power, and if you know certain lab values are not optimal, you can work with your doctor to correct them before problems arise.

Here are some of the most essential (yet rarely performed at routine yearly physicals) lab tests that we order, analyze and incorporate into your PrimeHealth care plan.

A Full Thyroid Panel

This full thyroid panel does not just include Thyroid Stimulating Hormone (TSH) and Free T4 levels, but also tests your Total T4, Total T3, Free T3, Reverse T3, Thyroid Binding Globulin, anti TPO-Antibody and anti Thyroglobulin-Antibody. These values can tell us whether and why you have low thyroid hormone, excess thyroid hormone, or a lurking autoimmune thyroid disease waiting to present itself.

There are many lifestyle and supplementation interventions that, if put into place, can improve thyroid function and prevent disease. Amazingly, lifestyle changes have helped many of my patients to completely resolve their autoimmune thyroid disease (Hashimoto’s or Grave’s). While lifestyle changes are not always easy to make, your PrimeHealth health coach provides the support, education and accountability to help you.

Another issue with thyroid labs (or other labs in general), is the immense contrast that exists between “normal” and “optimal” ranges. While lab results falling in the “normal” range trigger most doctors to say you’re “fine”, at PrimeHealth, we want you to be optimal. We work closely with you to achieve these results.

For example, the “normal” range for TSH is considered 0.2 – 4.5 mIU/L. However, studies show that the body does not function optimally when TSH rises above 2.5 mIU/L. One such study published in the Journal of Endocrinology and Metabolism in 2010 showed an almost doubling of miscarriage rate in 1st trimester pregnancy when TSH was over 2.5 mIU/L [1]. If pregnant women and fetuses do not function properly when TSH is greater than 2.5 mIU/L, then why would you?

Nutrient Testing

At a minimum, your nutrient testing should include ferritin, vitamin D, vitamin B12, and magnesium; despite their importance, most routine exams do not test these. Optimal levels of each nutrient are necessary for the bio-electro-chemical machinery of our bodies to function.

The majority of Americans are deficient in vitamin D due to lack of sunlight exposure, and in magnesium due food processing practices. Many patients are deficient in vitamin B12 and ferritin (iron storage level) due to gastrointestinal inflammation and/or a nutrient-poor diet. Upon discovery of nutrient deficiencies, many patients of mine have cured themselves of long-standing symptoms through supplementation. For example, magnesium supplementation has helped resolve migraines, insomnia, constipation, and muscle cramping.

Once again, it’s important to distinguish between “normal” and “optimal” ranges. In the case of vitamin D, the “normal” range listed is between 30-100 nmol/L. A study done on 4495 people in 2011 showed that even when using a cut-off of 20 nmol/L, the overall prevalence of deficiency was 41.6% [10]. Based on substantial research, I recommend 50-80 nmol/L as the optimal range. The book Sunlight, Vitamin D, and Skin Cancer concluded, based on extensive research, that optimal levels are at least 75 nmol/L for bone mineral density (BMD), lower extremity function, dental health, cancer prevention, incident hypertension, and decreased risk of falls, admissions to nursing homes and fractures [2]. Further, a study of 213 people demonstrated that for every 10 nmol/L increase in vitamin D level, the risk of Multiple Sclerosis (MS) in women decreased by 19% [9]. If your nutrient levels are not checked, you won’t know whether you could be preventing countless health issues in years to come.

Inflammatory Status

Inflammation is a major driver of all known chronic diseases, yet key inflammatory markers, like hsCRP and homocysteine, are not routinely checked. At PrimeHealth, we test and analyze both for each patient.

hsCRP helps us to identify and address inflammation which would otherwise go unseen. Homocysteine is an amino acid that can be elevated due to inflammation, nutrient deficiency, or genetics. If homocysteine is elevated, you are at increased risk for both cardiovascular disease and stroke, regardless of other factors. Thankfully, if discovered, homocysteine can often be lowered with B vitamin supplementation.

Tests of Insulin Sensitivity

Decreased insulin sensitivity leads to elevated blood glucose (sugar) levels. High glucose levels increase your risk for diabetes and almost every other chronic illness, like heart disease, cancer, and Alzheimer’s disease. We can assess your status of insulin sensitivity by testing hemoglobin A1c (HbA1c), fasting glucose, and fasting insulin level. We use this information to understand how your body responds to carbohydrates and to help guide your personalized diet plan.

HbA1c is both an average of your blood glucose level over the last ~90 days and an indicator of oxidative damage. Elevated glucose in your blood creates oxidation, which damages proteins, DNA, and tissues, so it is imperative to know and optimize your levels.

A study published in the Journal of Neurology in 2005 showed that even if your HbA1c % is in the “normal” range, every increase in value by 0.1 will increase the rate at which your brain shrinks in size per year [6] — yet another example of why it’s so important to work with your doctor to achieve optimal, rather than “normal” values.

Takeaway

These are just some examples of why more extensive testing and a focus on prevention are so important. Of course, it is not just knowing your lab values that is essential for your health, it is the subsequent implementation of advice from your doctor and health coach which leads to optimal long-term health. At PrimeHealth, our patients receive all of these tests (and many more) during your initial evaluation. We use advanced testing to catch and address underlying issues early and guide you on your health journey in the most effective and natural way.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/20534758
  2. https://www.ncbi.nlm.nih.gov/pubmed/18348447
  3. https://www.ncbi.nlm.nih.gov/pubmed/20162730
  4. https://www.ncbi.nlm.nih.gov/pubmed/23543089
  5. https://www.ncbi.nlm.nih.gov/pubmed/22497339
  6. http://n.neurology.org/content/64/10/1704.long
  7. https://www.bmj.com/content/345/bmj.e7191
  8. http://annals.org/aim/fullarticle/733296/systematic-review-value-periodic-health-evaluation
  9. https://www.ncbi.nlm.nih.gov/pubmed/18701572/
  10. https://www.ncbi.nlm.nih.gov/pubmed/21310306

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