What Are The Optimizing Labs?

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Readers Summary

  1. What labs might I consider with my healthcare provider?
  2. How do I start?
  3. Is the quantified self platform of testing a commitment?
  4. How long should it take before I become rockstarish?
  5. The secret sauce is not the lab data but in how they are interpreted!

When you finally decide to take total control of you life and optimize yourself I always suggest testing. Many of you have bombarded my email and my twitter account for a blog to a list of those labs. Well, today’s post is for you. I was resistant to do this because I felt having the list of labs is a waste of time if you don’t have a physician who can decipher what they all mean for you. 7 years ago, I could not tell you what this group of labs meant at all to your optimal health. I learned it by reading and going to classes to optimize myself. After much reflection I have decided to give you what you asked for. I am fortunate because many of the PCP’s I work with understand these tests well. I may also update it as I think it needs to be updated over time.

The first set of labs are what I call the core lab set for optimization. There are other panels I add to the core lab based upon the history, physical, and the food logs I will have patients give me. This blog is meant to be a resource for you to refer back to when the need arises. Discuss these with your doctor but don’t assume they will run out to order them because they may not know what all these tests will tell them. That part takes some time. I recommend starting the dialogue with your doctor to assess their willingness to help you. Most of my PCP doctors are awesome “helpers” to their patients with these issues. This requires a lot of work on the doctors part and the patients part. Do not be surprised if this is not covered by insurance. The time required to optimize someone is unreal. I know how long I spent optimizing myself 6 years ago. It was a tedious process but I was not going to give up because I believed my life depended upon it. For most people, 2-3 years you can expect the changes you want. If you are really in tough shape it may take longer but that should not deter you. I love patients who bring big challenges. They are the most appreciative patients I have had in the last 5 years. We can never settle for a C or D when an A is possible.

Lab Panels

  1. VO2 Max assessment (cardio pulmonary findings lead to a work up if needed.)
  2. Initial visit DEXA with body comp. Optimization a DEXA scan to include body composition scores.
    F/U visits I use BIA assessments to monitor progress and limit radiation exposure.
  3. Neuro cognitive battery of tests to assess processing speed, response speed, memory , learning, and attention repeated annually.
  4. Chemistry 20
  5. Liver function testing
  6. Serum Iron, TIBC, Serum Ferritin and Iron % Saturation
  7. Lipid panel: VAP and/or NMR analysis
  8. Homocysteine level
  9. Complete CBC with differential and platelet count (sometimes an Ivy bleeding time)
  10. Hormone panel includes (gender specific)……serum and salivary cortisol, Total testosterone, Free testosterone, % Free T, DHT, LH, FSH, Estradiol (E2) high sensitivity, DHEA-S, PSA, IGF-1, Consider based upon history testing levels of progesterone, pregnenolone, melatonin, serum and urine Osmolarity, Prolactin levels
  11. Complete thyroid panel with antibody screening (TPO etc)
  12. Complete Urinalysis (women get beta HCG if they menstruate)
  13. Highly Sensitive CRP (Not a regular CRP)
  14. Complete Vitamin D panel
  15. Omega 6/3 serum test (for severe findings consider tissue assay)
  16. Fasting serum insulin and HbA1c assessment
  17. No panel is complete without an ASI and salivary melatonin level.  Read Brain Gut 11 to understand why.

The next set of labs are considered add ons if the patients’ history or physical require it being looked at.

Cancer history of colon, breast, ovary

  1. CEA for colon cancer
  2. CA 125 for ovarian cancer
  3. CA 27.29 for breast cancer
  4. AFP blood test
  5. CA125, 15-3, 27.29, 19.9,
  6. BRCA 1 and 2 screen

Previous heart disease

  1. Apo A-1 and B
  2. B Natriurietic Factor
  3. LpA status, Lp-PLA2
  4. CIMT
  5. Calcium Index Score

Bone pathology

  1. Osteocalcin frozen blood analysis
  2. Se blood test
  3. RBC blood testing for Mg
  4. Deoxypyridinoline (DPD) Cross Link Urine Test
  5. Parathyroid Hormone assay

Inflammatory/autoimmune panels

  1. EBV panel
  2. ANA panel
  3. Complete Cytokine Assay
  4. Candida Antibodies
  5. Helicobacter IgG panel
  6. Hep A, B and C titers
  7. Breakout of Cytokine panel
  8. ESR
  9. RA factor
  10. SLE screen
  11. T Lymphocyte helper suppressor assay
  12. IL 8, IL 1 B or TNF alpha analysis

I also think you need to have a thorough history and physical exam. You need to retest on a quarterly or biannual basis to get feedback on your lifestyle and regimen to get things right over time.

Once this is all correlated,  you come up with a customized dietary plan, a medication/supplement plan, and exercise plan, basically a game plan for things you might consider altering for optimal health. It should be a collaboration between you and your doctor and your other health care providers.

This is a very labor intensive task for both patient and doctor. But if you remain persistent and consistent and your relationship with your physician congruent and always focusing in on your health you can reach any goal you have for yourself. It must be adaptable but yet have some core values to it to get you to the promised land. The secret sauce is not the lab list; it is found in the interpretation of those labs and how they correlate with your epigenetic switches. That is what determines how you partition calories and what diet and exercise program are best for your current biology. You should expect this to change over time as you become optimized. Nothing stays they same in biology. I learned this on my own journey and it has proven true in those I have helped re-engineer themselves back to optimal. Enjoy!

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Cites

  • LEF.org lab testing
  • http://www.healthcheckusa.com/
  • http://www.gdx.net/tests/search
  • http://www.anylabtestnow.com/
  • ZRTlabs.com
  • Metametrix.com

Comments

  1. Hi Dr. K, any chance you could show us how to read our labs so we can be smarter that the Docs? I also want to learn how to eat based on my labs. Thank you.

    • @Kami I do this in my clinic but I cant practice medicine on the internet. Many times I will comment on things like I did in the VAP blog when I think many people can learn from it.

  2. Thank you.

  3. Hi Dr. K. Thanks for this list. I am taking this to a new endoc. i am seeing on Mon (10.17.11). I know most of my issues are from leaky gut… which test on this list is a biomarker for how bad my gut is? Something that I can have re-done in 6 months so we can see if it is healing and at what rate. I am on HCG, so the restricted diet is helping me a lot. But this is my last round I am hoping with just 15 lbs left. Thanks.

  4. Good stuff Dr.K Could you elaborate how you use homocysteine, what values you shoot for, what supplements do you use to lower it etc?

  5. Hello to you all!!! With a special shout out to DR.KRUSE for his well thought out advice on the NIGHTLY horizontal bop therapy. For years I have had for the most part ,a complete disdain toward doctors , weather forecasters , most of our politicians and those in the media. I no longer include doctors on my hit list. Thanks to DR. KRUSE. Well I'm still keeping dr phil on my list. DR. KRUSE for PRESIDENT !!! THIS HAS BEEN A MESSAGE FROM STARLENES HUSBAND I like his way of thinking

  6. @Martin I dont really treat Lyme much at all so I am no expert there. But I will tell you that most infectious disease MDs do pro bono work. I know some of my ID docs do. You might want to look into that because this diagnosis in my opinion needs labs and a doc who know what they are doing to get you well.

  7. I've been researching Lyme heavily since the event. Diagnosing is very, VERY difficult and controversial. Some docs have had their licenses threatened because of challenging "proper CDC approved" diagnosing methods. Translation: The doc's LISTENED to their patients and looked beyond the restrictive guidelines set down by the Medical Establishment to get relief for their patients.

    I don't present many of the symptoms that others write about on the many blogs I visit. Research has found Lyme spirochettes in healthy people which leads this ol' boy to pursue building up my own body's ability to handle the infection.

    That's why your Quilt research is so important to get out there. I'm spreading the word on every forum I've been on. Your blogs are not only for fat people. I've jumped light years in my understanding where true health starts – leptin sensitivity!

  8. @Martin. You are correct it is not about obesity. It is about eliminating neolithic diseases that shorten our lives and dramatical alter the lives and time we exist in. This message is an interest to everyone who has a pulse.

  9. Yikes!!! I just want to feel good. With all those tests, optimizing isn't for me at this time–I'm poor. ; ) I did start to see a wonderful Brazilian doctor but moved and haven't been back since May of last year. I have some real medical issues that need addressing, no doubt, immediately and decided to go back to her and made an appointment for Jan 6th. Oh Yippee!! When she took tests my vitamin D was low, liver tests were higher then they had ever been and calcium always tests high. I have had hep C for, god knows, how long. Both adopted brothers and I, somehow contracted it and we never did intraveneous drugs. One of my brothers has passed on at 50 from liver disease. Pretty sure my liver won't test as high this time, since taking homeopathic remedies. I see a homeopathist who is also a chemist. Pretty smart guy. Diet is, hopefully, the key to feeling better. Will probably never be in optimmal shape which, for now, is really not my goal anyway. I don't know what tests are most important. I am going to try and convey as much info from your site as necessary for her to help me, but I am always a bit confused. It's why I can only take in a little at a time. Miraculously, I always manage to pull it together and get whatever it is I need to, across to people–will see. If any doctor will help me, I think she will. Going to have to knit her that beautiful shawl she was eyeing the last time I was in her office. ; ) ; )

  10. I bought a ZRT female profile III test. I wanted to collect the samples throughout the day tomorrow but I think I need to wait. I just experienced a very stressful event, cannot sleep, eat and my heart is racing especially at night. It would be quite pointless to test cortisol levels in this shape, right? Or should I do it regardless?

    • @Mart with saliva if you understand it……a recent stressor should not alter your salivary levels but it will trash your blood levels. So i think its still a green light.

  11. Great, working on it today.

  12. Dr. K this amazing stuff. I was diagnosed 1yr ago with persistant A-fibrillation and (viral?) heart failure EF 20%.

    The A-Fib is rate controlled from 200bpm to 70-80 with carvedilol. As well I am on ramapril and warfarin. Since going on these meds I need a sleeping pill at 10PM AND one at 3-4 AM. I have been thinking That I have a thyroid issue (last TSH 4.03) but am wondering now if I might be LR. age:62, 6', 170lbs. Before I slept like a baby and felt healthy but now realize my diet was poor. Am starting paleo. Will try to get a RT3 & saliva coritosol. No improvement from heart remodeling (LV dilation) after 1yr so Dr.s say live with it. Any thoughts would be appreciated.

    • @John W…….i bet your IL-6 levels are up and I bet your IGF-1 and free and total testosterone levels are bad. You need to get all tested because the latest data out of UCLA (Dr. Ernst Von Schwarz) is that heart patients like you have really bad growth hormone and testosterone levels……..if you optimize those two you will see massive improvements in your heart function.

  13. Dr. K, A friend of mine (Brad) recently had a surgery for cancer and is on lighter doses of Chemo. He is doing great and has become aware of how certain foods cause inflammation and others nourish. This is ALL new to him and he comes to me with many questions. I am happy to help, when I can, and that he's wanting to learn and take charge of his health is awesome. I gave him my beloved Paleo Solution book and several websites to peruse. (this one included, of course!) Recently he said he'd like to learn how to read his blood panel. I'm learning and, no rock star YET, so would like to know where you would recommend I direct him for basics and beginnings. Even that he understand the difference between lab ranges or optimal ranges would certainly give him information. Maybe there is a page here and I'm not finding. Any information/advice greatly appreciated.

    Thank you for helping others.. such a gift you offer.

    • @Kath he needs to eat a paleolithic diet to best handle his cancer………you need to buy him Wolf's book or Sisson's book stat.

  14. Thank you Dr. K, I did give him my Robb Wolf book and will pass on your information and encourage him to get started.

    • @Kath he has cancer…….if that does not motivate him to alter his approach nothing will. If he thinks he will get a different result eating the same shit he is just another foolish person.

  15. What kinds of supplements and deficiencies would a person look for on antipsychotics? My kid is supposed to be off them and she's on the lowest dose possible. The fear of an episode is diminishing much with the diet relief. We just want to get her in the best balance possible before the step and don't know what to ask for or look for or how long to reasonably expect good labs. Lithium 300 mg twice a day is also part of her daily routine. Unfortunately her good doctor retired and couldn't locate a suitable replacement. We just want her in fighting form before she comes off them and the next doctor switches her up. (or not)

    • @LeeVitamin B-6
      Low levels of pyridoxal-5-phosphate, the biologically active form of vitamin B-6, are associated with clinical depression, according to "Psychotherapy and Psychosomatics." Pyridoxine, the form of vitamin B-6 in most supplements, may enhance the therapeutic effect in patients taking psychiatric drugs. Research published in "Harefuah" found that schizophrenic patients with depression may benefit from pyridoxine supplementation in addition to ongoing antipsychotic medication.
      Vitamin C
      Atypical antipsychotic drugs are second generation antipsychotic drugs used to treat schizophrenia. They have less serious neurological side effects than first generation antipsychotic medications, and may have none at all. Nonetheless, atypical antipsychotics reduce blood levels of ascorbic acid, the biologically active form of vitamin C. According to "Psychopharmacology," oral supplementation of vitamin C with atypical antipsychotic drugs is effective in treatment of schizophrenia, and reverses deficiencies of ascorbic acid. The published study compared two groups of schizophrenic patients taking antipsychotic drugs. One group took vitamin C supplements, and the other group took a placebo. The group taking atypical antipsychotic drugs with vitamin C had increased blood levels of ascorbic acid, whereas the group taking atypical antipsychotic drugs with a placebo had low levels of ascorbic acid.
      Vitamin D3
      Vitamin D3 deficiency is common among people taking psychiatric drugs, especially the elderly, and often goes unrecognized. Schizophrenic women treated with antipsychotic drugs have vitamin D deficiencies and bone loss, according to findings published in "Human Psychopharmacology." Research published in "BMC Research Notes" discovered that vitamin D3 deficiency is prevalent among patients who reside in psychiatric hospitals. The results of the research showed 83 percent of patients with vitamin D deficiency and 92 percent with suboptimal levels. Of patients not taking vitamin D3 supplements, 100 percent had vitamin D3 deficiency. Vitamin D3 deficiency may lead to bone demineralization, softening of the bones, osteoporosis, bone fractures, seasonal affective disorder, multiple sclerosis, cancer, type 2 diabetes and heart disease, according to the University of Maryland Medical Center. Few foods contain vitamin D3, and the primary sources of vitamin D3 are exposure to the ultraviolet rays of the sun, oily fish and vitamin D supplements. Effective doses of vitamin D3 supplements range from 400 to 1,200 IU, depending on your needs. Talk with your doctor about the right form and dosage of vitamin D3 you should take.

      LITHIUM:
      – Drink 8 to 10 glasses of water or other liquids every day. Drinking plenty of fluids is important while you are taking lithium. Not drinking enough liquids may cause lithium levels to rise. You may need even more liquids during hot weather and during exercise when you sweat heavily. To avoid weight gain, select water and other non-caloric beverages.1

      – Keep your salt intake about the same. Do not begin a low-salt diet without first talking with your doctor or pharmacist. Do not suddenly increase the salt in your diet either. Less salt may cause your lithium level to rise. More salt may cause your lithium level to fall.2

      – Try to keep your intake of these salty foods about the same from day to day: luncheon meats, ham, sausage; canned or processed meats and fish; packaged mixes; most frozen entrees and meals; soups and broths; processed cheeses like American; salted snack foods; soy sauce; smoked foods; olives, pickles; tomato juice; most fast foods; salt, salt-containing seasonings and condiments like ketchup and meat sauces.3

      – It is also important to monitor that your lithium level not be too high. High lithium levels can cause shakiness, muscle weakness, slurred speech, nausea or vomiting, and drowsiness.4

      – Keep your caffeine intake about the same. Keep amounts of coffee, tea, cola, and other soft drinks with caffeine about the same from day to day. Less caffeine can cause your lithium level to increase; more caffeine can cause your lithium level to decrease. Avoid caffeine because the effect of these drugs may be changed if taken within 40 minutes of caffeine.5

      – Do not take Perphenazine mixed with caffeinated drinks, tannin containing drinks, or pectinate (applejuice).6

      – Take lithium with food or milk. This will reduce possible digestive side effects like nausea, vomiting, diarrhea, and abdominal pain.7

      References:1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

      2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999

      3 Warren Grant Magnuson Clinical Center, National Institutes of Health Drug-Nutrient Interaction Task Force

      4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

      5 Brinker F. Herb contraindications and drug interactions, 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

      6 Pronsky, Z Food Medication Interactions, 11th edition, 1999.

      7 Pronsky, Z Food Medication Interactions, 11th edition, 1999.

  16. Thanks so much!

  17. Dr. Kruse,

    I got salivary test results back. I am meeting with a new doctor that was recommended in a few weeks. I hope for the best but doctors like you do not exist in the Tristate area.

    I am good on progesterone but very low on Estradiol and Estrone so my PG/E2 ratio is high. Also my salivary DHEAS is high for my age. In addition my night cortisol is high as well which I know of very well.

    My fasting blood sugar and day blood sugar rarely goes below 100. I lost only 3 pounds in four months on LC and LR. Could this be the reason?

    What should my new doctor suggest going forward based on my results? I want to make sure that i am on the right track.

    • @Mart If that is all what it shows you should not be a tough hack to correct. I dont think you need a superstud doc with those results. Just some tweeking.

  18. Great, you made me smile :-)! Thank you!

  19. Dr. Kruse,

    I've been primal for over a year now. I was over 410 lbs but I'm now around 310. The last few months has seen little weight loss, low energy, hunger, and bad sleep. I've also got a chronic back issue (herniated disc) I'm trying to deal with. I just started your leptin rx, but are there any labs you would recommend for me? I'm a student on medical leave so money is tight, but I would try my best to get the most important tests done. Thanks.

  20. Dr. K,

    If you start the LR based on failing the mirror test, it would seem that the next logical point for testing would be when you start to see signs of LS coming back. That said if you are supplementing, how does this affect the gold standard tests for LR – HS CRP, rT3 and VitD? Or does it even matter? Can you if the clinical signs are there and these labs now in range – can you deem yourself LS "with supports" and move to the next phase with adding exercise and tweaking down the BAB? Or do you need to first pass a period of time to ensure that leptin receptor is really rewired from a neuroplastic perspective? Or do you need to be supplement free before you test again and move on? And with respect to the HS CRP, rT3, and Vit D – NSAIDS will mess with a CRP reading, but is there anything else that can skew a lab result when testing these core? I know this question isn't about optimizing everything, but targeting first that LR dysfunction. It would seem a good way to work a subset problem with a doc to build a good patient/doc relationship. Feel free to correct me. Obviously I need it or wouldn't be writing!

  21. @cgk clinical signs dictate moving on always not the labs. Building with your doc is key.

  22. FYI here are the Kruse Labs

    1

    Complete Blood Count (CBC) With Differential CPT Code: 85025

    Metabolic Panel (14), Comprehensive CPT Code: 80053

    Osmolality,serum CPT Code: 83930

    Osmolality, Body Fluid CPT Code: 84999

    Urinalysis, Complete With Microscopic Examination CPT Code: 81001

    2

    Hepatic Function Panel (7) CPT Code: 80076

    C-Reactive Protein (CRP), High Sensitivity (Cardiac Risk Assessment) CPT Code: 86141

    Vitamin D, 25-Hydroxy CPT Code: 82306

    Insulin, Free and Total, Serum CPT Code: 83525; 83527

    C-Peptide, Serum CPT Code: 84681

    Hemoglobin (Hb) A1c CPT Code: 83036

    3

    Ferritin, Serum CPT Code: 82728

    Iron and Total Iron-binding Capacity (TIBC) CPT Code: 83540; 83550

    4

    Homocyst(e)ine, Plasma CPT Code: 83090

    Lipoprotein Subfractionation Profile CPT Code: 83701; 84478

    5

    Cortisol CPT Code: 82533

    Dehydroepiandrosterone (DHEA) Sulfate CPT Code: 82627

    Dihydrotestosterone (DHT) CPT Code: 82651

    Estradiol CPT Code: 82670

    Estrogens, Total CPT Code: 82672

    Follicle-stimulating Hormone (FSH), Serum CPT Code: 83001

    Growth Hormone-binding Protein CPT Code: 83519

    Insulin-like Growth Factor 1 (IGF-1) CPT Code: 84305

    Luteinizing Hormone (LH), Serum CPT Code: 83002

    Pregnenolone, Mass Spectrometry CPT Code: 84140

    Progesterone CPT Code: 84144

    Prostate-specific Antigen (PSA), Serum CPT Code: 84153

    Sex Hormone-binding Globulin, Serum CPT Code: 84270

    Testosterone, Free (Direct), Serum With Total Testosterone CPT Code: 84402; 84403

    Prolactin CPT Code: 84146

    6

    Thytropin Releasing Hormone CPT Code: 83519; 84999

    Thyroid-stimulating Hormone (TSH) CPT Code: 84443

    Thyroxine (T4), Free, Direct, Serum CPT Code: 84439

    T3 Uptake CPT Code: 84479

    Reverse T3 CPT Code: 84482

    Triiodothyronine (T3), Free, Serum CPT Code: 84481

    Thyroxine-binding Globulin (TBG), Serum CPT Code: 84442

    Thyroid Peroxidase (TPO) Antibodies CPT Code: 86376

    Thyroid Antithyroglobulin Antibody CPT Code: 86800

  23. I have finally gotten started on testing.

    The naturopath asked me to get my FSH and LH tested to see if I am in Menopause before doing the hormone testing.

    I have the results here tonight, however they don't mean a thing to me. Can anyone with any knowledge of Canadian testing tell me what these results mean. From my results I think I can see I am not post menopausal but I am 52 yrs old this summer so I don't know what such low numbers mean ??

    Pituitary Function

    Follicle Stimulating Hormone

    2.6 < 133.1 U/L

    (Roche – Electrochemiluminescence)

    (2.0 – 11.0) Follicular

    (5.0 – 34.0) Midcycle

    (1.0 – 8.0) Luteal

    (28.0 – 133.0) Postmenopasual

    Leutinizing Hormone (LH)

    4.9 < 73.1 U/L

    (Roche – Electrochemiluminescence)

    (1.0 – 10.0) Follicular

    (18.0 – 49.0) Midcycle

    (1.0 – 11.0) Luteal

    (30.0 – 73.0) Postmenopausal

  24. Dr. Kruse – I stopped cooking in my (non-enameled) cast iron after my internet research of a panel in October indicated what appears to be near iron poisioning. I forgot to bring it up with the doc and he didn't say anything. I'm hypothyroid without medication. Overreaction or prudent (the alternative I am currently working with is coated aluminum)?

    Ferritin – 259 (20-320)

    Iron – 197 (40-200)

    Total Iron Binding – 292 (200-375)

    % Iron Saturation – 67 (20-55)

  25. lioness7 says:

    Dr.Kruse, my BIL has ferritin levels at almost 1000 ug/l My FIL did the HFE gene test and was positive so i am not surprised at BIL' s count. My husband's sit around 180. I try to avoid products with fortified iron alongside a pretty paleo diet on most days. Do you have any other advice, aside from phlebotomy as they are not really working for the BIL….in fact his counts are higher after the procedure which I assume may be to iron dumping. Personally, I don't think drs are taking this genetic problem seriously enough and don't pay attention until the counts are too high. What do you feel is an acceptable ferritin level for men /women? aside from blood giving/letting, any other suggestions?

    • @Lioness yes I do……have the BIL drink lots of coffee especially when he eat red meats or offal at the same time. Coffee blocks iron absorption. Moreover, he needs to avoid fructose of any kind becuase it increases iron absorption. The best paleo diet for him is the seafood ketogenic version……and he needs the CT protocol. It could change his life.

  26. Which Blog discusses the meaning of various test results/ labs in the most depth? You mentioned in a podcast a specific blog to review but I simply can’t find it.

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