5 Blood Tests You’re Probably Not Getting—but Should Be

Featured Article, Healthy Aging, Healthy Living, Multiple Sclerosis
on June 26, 2013
Blood tests everyone should get.

OK, you get all the requisite cancer screenings, have an annual head-to-toe physical to check your blood pressure and cholesterol, and even get routine colonscopies. So you’re in the clear, health-wise—right?

Not exactly. While check-ups and screening tests are a great way to monitor your health and allow you to take preemptive action should something not be quite right, you may be overlooking some blood tests that could detect health red flags. “Blood tests give insights into the biochemical uniqueness of a person,” says holistic practitioner Dr. Michael Wald, director of nutritional services at Integrated Medicine of Mount Kisco, New York. In fact, certain tests can find problems that standard blood tests miss, “sometimes years before they happen,” he adds. While some health insurers may not pay for the tests (check with yours before setting up your appointment to avoid any financial surprises), the peace of mind you’ll get may be worth the cost. Here, five blood tests recommended by Wald.

C-reactive protein (CRP). This test measures levels of CRP, a blood protein that rises if there’s inflammation in your body. It can also gauge your risk for coronary artery disease, narrowing of the arteries that could cause a heart attack. Caveat: A CRP test can’t pinpoint the source of the inflammation. “Your body doesn’t know if inflammation is caused by narrow arteries, arthritis, cancer, a bacterial infection or a stubbed toe,” explains Wald.

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Regardless of the cause, though, inflammation isn’t good. “CRP circulates in the body as part of a destructive process,” says Wald. That means it could up your risk not only for heart disease, but also Alzheimer’s and other conditions if you’re genetically predisposed to them. Elevated CRP is “one of the most predictable markers in the blood for all-cause morbidity and mortality,” says Wald. Because of this, he checks his patients’ levels annually. What’s considered normal varies from lab to lab, but if CRP is elevated, lower it by getting 4 to 6 servings of fruits and veggies per day; eating more whole grains; and cutting back on refined sugar, advises Wald. In addition, he has his patients take 400 IUs a day of vitamin E, 3,000mg of vitamin C and 200mg of lipoic acid.

The VAP (Vertical Auto Profile) panel. This panel should be done regularly instead of the standard fasting cholesterol blood test that measures total cholesterol, LDL (the so-called bad) cholesterol, HDL (the “good”) cholesterol) and triglycerides. The reason: The VAP “measures over twice as many blood fats as the regular cholesterol panel,” says Wald. What’s more, the VAP test is an actual measure of blood lipids—not an estimate, which is what the typical cholesterol panel provides. “If you measure more blood lipids, you can find more opportunities to prevent heart disease,” says Wald. A recent study published in the Journal of the American College of Cardiology found that the traditional lipid panel underestimated the risk of heart disease in 23 to 59 percent of patients who had LDL under 70 mg/dl, the level considered optimal, and triglycerides above 150, which is considered borderline high. If your VAP panel detects elevations, follow the recommended cholesterol-lowering guidelines: Watch your fat intake, exercise, don’t smoke, and reduce stress. If those strategies don’t work, you may need a statin drug.

Homocysteine. This amino acid is produced by your body, usually as a result of eating meat. Amino acids are the building blocks of protein. But high levels of homocysteine are associated with atherosclerosis (the build-up of plaque in arteries), which can cause heart attacks, strokes, and blood clots as well as dementia and Alzheimer’s disease. Typically, a level less than 13 micromoles is considered normal; 13 to 60 is moderately high; and anything above that is severely elevated. Homocysteine levels can climb in people who don’t get enough of the vitamins B6, B12 and folic acid, so if your levels are high, eat more B-rich foods, including fruits, vegetables (especially green leafy ones), poultry, fish and B-fortified cereals and grain products. Also, talk to your doctor about taking a multivitamin containing B-complex vitamins.

HbA1c. Most people are familiar with the fasting blood glucose test. But because it only measures the amount of sugar in your blood at the time of the test, your results may come back as normal when, in fact, you have pre-diabetes, says Wald. (Pre-diabetes means a person has higher-than-normal blood sugar levels that could lead to diabetes.) A better gauge of blood glucose levels: the HbA1c test, which measures the average levels of blood glucose over the previous two to three months. The test is routinely done on people with diabetes to see how well they are controlling their blood sugar. An HbA1c of 5.6 percent or below is normal; a reading of 5.7 to 6.4 percent is considered a sign of pre-diabetes; and 6.5 percent or above signals diabetes. “In my office, we have found many people who had no idea they were pre-diabetic because their blood glucose levels were normal,” says Wald, who tests his patients’ levels yearly.

Vitamin D. Though many experts don’t routinely test D levels, Wald isn’t among them.   “Everyone should get a baseline Vitamin D test,” says Wald—specifically the 25 (OH) D test, which is the most accurate. Indeed, he recommends yearly D testing. The reason?   Less-than-adequate levels are “the single-best predictor of early death from any cause,” he says. A study published in the Archives of Internal Medicine in 2008 reported that people with the lowest levels of D—less than 17.8 ng/mL—had a 26 percent increased rate of dying from any cause, including cancer and cardiovascular disease. Low levels are also associated with a greater risk for a range of conditions, including depression, osteoporosis, arthritis, multiple sclerosis, type 1 diabetes and assorted aches and pains. According to the government’s Third National Health and Nutrition Examination Survey, an estimated 41 percent of American men and 53 percent of women have D levels that are less than the optimal levels of 30ng/mL or higher. (People with levels under 20 are considered D-deficient.)  The Institute of Medicine recommends that until age 70 people should aim for 600 IUs of D a day; after that they may need up to 800 IUs daily. Even so, some experts say that’s not enough. (The safe upper limit is 4,000 IUs.) What’s more if you’re deficient in D, meeting the IOM guidelines probably isn’t going to get your levels within a normal range. “If people are deficient, they need appropriate therapy and should be rechecked until their levels are within a normal range,” says Wald.

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