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Undoctored Suggested Labs

Member Forum >> Food and Diet >> Undoctored Suggested Labs

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Posted: 4/29/2016 4:56:25 PM
Edited: 1/31/2021 10:44:04 AM (10)
 
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This is back in DRAFT status because it’s a major re-write of the outdated article formerly at this location.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

Cardiovascular 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.
Lipoproteins
TG
Triglycerides
30 to 60 mg/dL
0.34 to 0.68 mmol/l
Local: TG
HDL
High Density Lipoprotein
60 to 240 mg/dL
1.55 to 6.2 mmol/l
Local: HDL
NMR Small LDL-P 0 to 200 nmol/L Public: Coronary Testing Quick Reference » NMR
Members: Making Sense of Lipoproteins Workshop
NMR Lipoprotein(a) 0 to 50 nmol/L Public: Lipoprotein(a)
Blood Pressure
Systolic 90 to 115 mmHG (12 to 15.3 kPa)
(115/80 mmHg and lower, but not much lower than 90/60 mmHg, or 15.3/10.7 kPa and lower, but not much lower than 12/8 kPa)
Members: How NOT to Have High Blood Pressure
Members: Product Review: Withings vs Qardio Blood Pressure Cuff
Diastolic 50 to 70 mmHg (6.7 to 9.3 kPa)
Calcification
CAC
CT Heart Scan (Coronary Arterial Calcium)
Calcium Score (Agatston): Zero (0).
If non-zero: growth -100% to +10% per year (lower is better)
Public: CT Calcium Scan
Metabolic 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.
Blood Glucose & Insulin
HbA1c
Hemoglobin A1c
4.0 to 5.0% (NGSP)
20 to 31 mmol/mol (IFCC)
68 to 97 mg/dL (eAG)
3.8 to 5.4 mmol/L (eAG, SI units)
Local: HbA1c
FBG
Fasting Blood Glucose
70 to 90 mg/dL (3.9 to 5 mmol/L) Local: FBG
PPBG
Postprandial Blood Glucose
100 mg/dL (5.5 mmol/L) or less, but ideally no rise from FBG
Test 30 to 60 minutes after start of meal.
Local: PPBG
Blog: The Most Powerful Weight Loss Tool
Fasting Insulin 0 to 4 mIU/L
0 to 27.8 pmol/L
Local: Fasting Insulin
BMI
Body Mass Index
18.5 to 24.5 kg/m² Local: BMI, body composition, weight, waist
Endocrine 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.
Thyroid
TSH
Thyroid Stimulating Hormone
0.2 to 2.0 µIU/mL Public: Thyroid Optimization Quick Reference
fT3
Free Triiodothyronine
Upper half of lab “reference range”
fT4
Free Thyroxine
Upper half of lab “reference range”
rT3
Reverse Triiodothyronine
Lower half of Reference Range.
Temperature
(arising oral)
97.3°F (36.3°C) or higher, but not much higher (Undoctored, page 286 of print edition)
Thyroid Antibodies: TPOAb, TgAb, TSI, (TBII)/TRAb Preferred tests are TgAb and TPOab. Target is within "normal" lab range, for both. A single antibody test may not be dispositive on thyroid autoimmunity.
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
u2695_staff_of_aesculapius Direct Labs
u2695_staff_of_aesculapius HealthCheck USA
u2695_staff_of_aesculapius Life Extension (which uses LabCorp),
u2695_staff_of_aesculapius Quest Diagnostics
u2695_staff_of_aesculapius Request A Test
u2695_staff_of_aesculapius 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).

u21f1_north_west_arrow_to_corner 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.u21f1_north_west_arrow_to_corner 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..u21f1_north_west_arrow_to_corner 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)..u21f1_north_west_arrow_to_corner 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.u21f1_north_west_arrow_to_corner 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).u21f1_north_west_arrow_to_corner 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 Workshopu21f1_north_west_arrow_to_corner 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.u21f1_north_west_arrow_to_corner 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.u21f1_north_west_arrow_to_corner 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.u21f1_north_west_arrow_to_corner 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”u21f1_north_west_arrow_to_corner Return to Genetic


Bob Niland [disclosures] [topics] [abbreviations]

Tags: labs,tests

Bob Niland

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Posted: 4/29/2016 4:58:21 PM
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Posted: 4/29/2016 9:31:36 PM
 
Berkeley also has an Lp(a) with ref range of <30 mg/dl, although the test is different than VAP.
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Posted: 9/2/2017 11:55:18 AM
 
And once we have these numbers, how often does the testing need to be repeated?  Is it the same for all test?  Thanks.
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Posted: 9/2/2017 1:59:23 PM
 
Thanks - and I didn’t see that Homocysteine was listed here when I read through this the first time, so my question about that elsewhere can be ignored or deleted.
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Posted: 9/8/2019 3:21:55 PM
 
What’s a "Sticky?"


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Posted: 9/11/2019 10:38:29 AM
 
Bob: Thanks for the "Sticky" clarification.
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Posted: 9/11/2019 11:56:30 AM
 
Can the above chart of Undoctored Suggested Labs be made into a stand alone pdf so that I can print it out?   


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Posted: 9/12/2019 1:07:59 PM
 
Sounds good, Bob. I admit I am still a paper girl and your chart is one that I would like to show others without having to scroll through a thread. 


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Posted: 9/13/2019 7:46:46 PM
 
Hi JannyLite.
That’s even easier.
Thanks!


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Tags: lab test timing,RBC Magnesium,Salivary Cortisol,Supplements

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Posted: 9/30/2019 7:50:24 AM
 
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Dr. Davis

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Posted: 9/30/2019 9:57:51 AM
 
No adjustments to diet, meds, or supplements required for those two tests, Janny. 
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JannyLite

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Posted: 9/30/2019 3:41:43 PM
 
Thank you, Bob and Dr. Davis. I feel rather foolish as I totally forgot about the Magnesium Quick Reference. Sorry.

Jan


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greyskyblue

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Posted: 11/20/2020 5:17:36 AM
 
Is this the most current Undoctored recommended labs list? Thanks, Gina
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Bob Niland

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Posted: 11/20/2020 9:18:07 AM
 
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Posted: 1/26/2021 7:13:55 AM
 
Bob: Thanks so much for the update!!  Would you consider adding back into the Vit D info the clarification on the test we should NOT order. Was helpful in pointing out the difference.  Thanks!

Jan
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Bob Niland

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Posted: 1/26/2021 8:37:12 AM
Edited: 1/26/2021 8:41:29 AM (1)
 
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JannyLite

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Posted: 1/26/2021 8:44:28 AM
 
Thanks for clarifying, Bob.  Also, a printable PDF would be great! I have copied and pasted to a Word or Libre document in past, but that involves some manipulation. A printable would be much appreciated 

Jan
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JannyLite

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Posted: 2/11/2021 3:09:42 AM
 
Any chance you could insert the linkable code so we can direct people to the various sections of the chart? E.g., Thyroid, Lipoproteins, etc.


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Bob Niland

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Posted: 2/11/2021 8:26:28 AM
Edited: 2/11/2021 10:51:04 AM (1)
 
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