Undoctored Suggested Labs
Undoctored
Suggested Labs
Edition: 2021-01-02 (DRAFT)
Although
this article is publicly visible,
some links may lead to UIC members-only content.
This is back in DRAFT status because it’s a major re-write of the
outdated article formerly at this location. Also, adding proprietary
lab order codes is contemplated.
The following table summarizes various medical lab tests that
are suggested in Undoctored and Wheat Belly publications,
along with target results ranges (where found),
and alternate units of measure.
For anyone just starting a program, you may have some of these, and
others you might want to obtain as baseline. Some need to be
avoided during weight loss. Some can be challenging to obtain.
See the various linked detailed discussions.
The target values can vary from both the Reference
Ranges provided by labs, and any assessment of
“low”, “fine”
“normal” or “high” provided by a lab or
consensus physician. See:
Blood tests:
There are BIG differences between “normal” and ideal
| Micronutrient Marker Name |
Target Value Range
(click
links for program references,
all of which are on other pages, and some of
which may be members-only) |
Further Information
Some links are on this page (Local), others as noted. |
| Micronutrient Serum Levels |
RBC Mg
Red Blood Cell Magnesium |
Upper half of lab “Reference Range”,
or even slightly above it |
Public: Magnesium Quick Reference |
25-OH D3
25-hydroxy vitamin D |
60 to 70 ng/mL (150-180 nmol/L) |
Public: Vitamin D Quick Reference |
| Omega-3 Index |
10.0 to 12.0%
(Undoctored, page 191 of print edition) |
Public: Fish Oil Quick Reference |
ω6:3 Ratio
Omega-6/Omega-3 Ratio |
0 to 2:1
(Undoctored, page 191 of print edition) |
| Vitamin B12
|
Upper half of Reference Range
(Undoctored, page 298 of print edition) |
Local: B12 detail |
| Methylmalonic Acid |
Upper half of Reference Range
(Undoctored, page 298 of print edition) |
| Serum Iron |
Conventional targets apply |
Local: Iron & Ferritin |
| Ferritin |
Conventional targets apply |
| Serum Zinc |
Conventional targets apply |
Local: Zinc detail |
| CBC, Inflammation &
Genetic Marker Name |
Target Value Range
(click
links for program references,
all of which are on other pages, and some of
which may be members-only) |
Further Information
Some links are on this page (Local), others as noted. |
Complete
Blood Count
Note: a complete run-down of CBC markers is contemplated,
and may become a separate page. |
ALT
Alanine Transaminase |
Within Reference Range. |
These are principally of use to
rule out fatty liver disease. |
AST
Aspartate Transaminase |
Within Reference Range. |
| Inflammation |
CRP
C-Reactive Protein
(or hsCRP: high sensitivity) |
0 to 1.0 mg/L (and zero is fine) |
Local:
CRP, hsCRP & Homocysteine |
| Homocysteine |
Dashboard has: 0 to 10 µmol/L
(0 to 1.35 mg/L) |
| Genetic |
Apo E
(Apolipoprotein E) |
Apo E3:3 requires no extra attention |
Local: Apo E testing |
Tips and Steps
0. Have a list of tests in mind
CPT codes are provided, where known, so that you can be
very specific in requesting tests. Learn what those cost when
done independently. Make sure
you live in a jurisdiction where your meddling medical mandarins
allow you to test your own body (e.g. not NY state).
1. Find out what your coverage fully covers
Your plan may include an annual check-up that
covers many tests at no extra charge.
2. Ask about the rest
Ask the doctor (ideally prior to the appointment) about
any tests not clearly in-plan, and whether they could be requested
and covered. Ask if they know if the patient can file a claim
independently (and they may not know for your plan). Ask if any
out-plan tests can still be ordered through the office at patient expense.
3. Get quotes
Even for covered tests, but particularly for any test
considered discretionary, and any bill-throughs, get pricing.
There’s no point in paying your doctor’s office more than
independent out-of-pocket.
If you can’t get your healthcare provider to order these tests,
or can, but they wouldn’t be covered by insurance, and you aren’t
subject to nanny state interference, you can often arrange them
on your own from services such as
Direct Labs
HealthCheck USA
Life Extension (which uses LabCorp),
Quest Diagnostics
Request A Test
ZRT Labs
(home tests, some mail-away)
If you have a medical set-aside/flex plan, you may be able to
use those funds to pay for otherwise out-of-plan tests.
4. Do the independent tests early
If you plan to have your doctor run some tests,
and obtain some independently, get the independent tests
done soon enough to take the reports along on the office
visit. You might get some useful insight (about your health,
or, alas, about the doctor).
Also give some though to which independent results to share, as they
are very likely to end up in your EHR. For example, unless you have a very
enlightened practitioner, there’s likely no benefit to you in
having your Lp(a) or Apo E status in the record.
Test Details & Discussion
Lipid Panel
CPT Code: 80061 Lipid Panel, Standard
(If the TG is over 400 mg/dL, the
lab may automatically also perform a
83721 DLDL.)
You rarely need to order this panel specifically, as it’s common
for routine/annual physicals, and it may be included automatically
with an NMR panel. It is important to have either drawn fasting, as the TG
(and NMR Small)
values can otherwise be materially distorted. Do not schedule a lipid
or lipoprotein panel unless weight has been stable for at least 30 days.
The lipid panel reports the useful TG (triglycerides)
and HDL (high density lipoproteins), along with the not usually
useful TC (total cholesterol), the often fanciful LDL-C
(low density lipoproteins, calculated),
and perhaps a preposterous
VLDL-C (very low density lipoproteins, calculated, often a silly
TG÷5).
High
blood TG can result from current diet, prior diet (in weight loss),
and some uncommon lipidemias. Where TG is high primarily due to liver
de novo lipogenesis of carbohydrates, the level responds
promptly to diet optimization.
HDL is slower to respond, but it does:
Undoctored Blog: I
raised my HDL by 350% (public).
Return to Lipoproteins
HbA1c
CPT Codes:
83036
Hemoglobin; glycosylated (A1c)
83037
Hemoglobin; glycosylated (A1c) by device
Home testers, and BG/A1c combination meters are available, but
they can present an economic issue, as the A1c test “strips”
have limited shelf life, are usually not replaceable,
and the test is typically not needed more than every
90 days or longer.
A1c is a proxy for average glucose over the last 90 days,
a time-weighted moving average, or area-under-the-curve.
Once correlated for a specific individual, it might be
the most useful single periodic marker of metabolic health. It needs
to be compared to other metabolic marker including FBGs, PPBGs,
fasting insulin, TG and NMR Small LDL-P.
The issue is that A1c is based on population data for RBC, and individuals
can be wildly idiosyncratic. Beta thalassemia, anemia, blood donation,
sickle cell trait, glucose-6-phosphate dehydrogenase deficiency,
high erythrocyte turnover and other factors can make it unreliable
until correlated for anyone in particular.
The 5.0% program cap, as noted in the table above, is an eAG (estimated
Average Glucose) of 97 mg/dL. It is possible to actually
measure what A1c is approximating. This requires a CGM (continuous
glucose monitor), and these are presently
Rx-only
devices in the US. If this situation changes, CGM might become a
major tool in the program. If you obtain one, and using diet as the primary lever,
the goal would be to keep the readings in the 68-90 range at all times. Return to BG & Insulin
FBG
CPT Codes: 82947,
82948
(by device is 82962)
82951
is OGTT, not recommended.
You are apt to get this test for any routine exam, but it’s much more
useful to obtain your own home test meter (usually around US$20),
and a generous supply of matched test strips. These can then be used
not only to check FBG, but more importantly PPBG (below).
Tip: if you are expecting a lab draw to include Glucose, take your
meter along and do a finger-stick test right after the draw.
Later compare the lab report to your meter reading.
Fasting blood glucose is subject to factors that can make readings
erratic, particularly early in the day. Checking immediately pre-meal
might be ideal, when checking PPBG is planned.. Return to BG & Insulin
PPBG
CPT Codes: {N/A}
82951
is OGTT, not recommended.
This test requires a home BG meter, which is used on a novel
timing schedule. Taking a PPBG implies that an FBG was
drawn just prior to the meal in question (providing the baseline
for comparison). Another draw is then done at 30 to 60 minutes
after the start of the meal. What’s being sought is the peak
BG response to the carbohydrates in that meal. The number
reported is primarily a scorecard for the recipe, but also a
reflection of insulin sensitivity.
In consensus diabetes care, the meter is used hours after the meal,
in order to adjust the medication dose. If you have T1D, LADA, or
unresolved T2D or GD, and are still on medications, continue
using the meter as prescribed (in addition to diagnosing meals).. Return to BG & Insulin
Fasting Insulin
CPT Codes:
83527 Insulin,Free
83525 Insulin,Serum
83525 (x3)
may be Kraft Insulin Assay, but neither it, nor 82951 OGGT are recommended, due to the bolus
of sugar required.
An elevated or high fasting insulin is suggestive of any of several
issues, none desireable. The reading itself is not diagnostic, but
indicates something that needs further investigation. Return to BG & Insulin
BMI, Body Composition, Weight & Waist
Body composition is worth testing for tracking purposes. See on the blog:
Track Your Undoctored Success
BMI is not actually measured. It’s a crude synthetic marker based on
weight and height. It falls apart for the very fit, the very tall and the
young. But it’s a number you often get without asking, and it provides
something to track as a marker of progress.
The program likewise does not obsess over weight and waistline, but a
desire to improve both is often what brings people to the program.
If progress does not meet expectations, see:
Members: Wheat Belly Weight Loss Secrets Workshop
(Module 1 of 5). Return to BG & Insulin
Vitamin B12
CPT Codes:
82607
Vitamin B12 (Cobalamin)
83291
Methylmalonic Acid, Serum or Plasma
See the discussion in the Undoctored book if deficiency
is detected, and also:
Members: MTHFR Basics Workshop Return to Micronutrients
Iron & Ferritin
CPT Codes:
83540
Iron, Total - Serum
82728
Ferritin
See the discussion in the Undoctored book (page 295)
if deficiency is detected. Other than vegetarians, iron-deficient
males should not unquestioningly accept iron supplementation, as
serious conditions need to be ruled out. Return to Micronutrients
Zinc
CPT Code:
84630
Zinc,Serum
See the discussion in the Undoctored book (page 296)
if deficiency is detected. Zinc testing is more useful for confirming
deficiency than confirming that you are replete. Return to Micronutrients
CBC: Complete Blood Chemistry/Count
CPT Codes (common):
85007
Blood Count, Differential, Manual
85025
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85027
Complete Blood Count, automated
Inflammation
CPT Codes:
86140
C-Reactive Protein (CRP), Quantitative
86141
C-Reactive Protein (CRP), High Sensitivity
83090 Homocysteine
Early testing for inflammation is usually not terribly useful,
as standard diets are expected to be inflammatory.
Additional inflammation markers that can be considered include
IL-6, IL-10, TNF-a. If you have them, IL-8, IL-18, leptin,
Lp-Pla2 and MPO also provide hints. Return to Inflammation
Apo E
CPT Code: 81401
This is a one-time test, but not recommended per se, as it often costs more than…
It usually is more economical to get a complete
gene sequencing, from a service that offers a download of the raw data.
With that in hand, the Apo E status can be determined by the
pairing
of SNPs rs429358 and rs7412. Each allele is E2, E3 or E4.
There is no program Protocol or other adjustment for Apo E.
Apo E4:x implies a more acute response
to inflammation. Both Apo E2:x
and Apo E 4:x
imply lower tolerance for carbohydrate over-exposure.
For Apo E4 risk in Alzheimer’s, see: Book Review: Bredesen’s “The End of Alzheimer’s” Return to Genetic
Bob Niland
[disclosures]
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