Undoctored Suggested Labs

Edition: 2021-10-11 (DRAFT)
Although this article is publicly visible, some links may lead to UIC members-only content. Also, for the present edition, some range cites are to Cureality pages which may not be on-line at the moment.

Introduction

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.

Do not just run out and get all of these.
First, discover what you already have.
Then open a forum discussion about what makes sense for you.

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 local & 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 (Public)

This page only provides further details for markers that do not have their own pages elsewhere on the site. Where there are other pages, they are linked.

  By popular demand, this basenote is now available as a PDF (Members), but for printing only, as it’s just what Firefox renders (links don’t work, and fill colors, shadings & hovertips are also absent; this due to a variety of DTP, HTML and current browser incompatibilities that don’t promise to be resolved anytime soon).

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: Lipid Panel
HDL High Density Lipoprotein	60 to 240 mg/dL 1.55 to 6.2 mmol/l	Local: Lipid Panel
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: Lower blood pressure naturally 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
CCS Coronary Calcium Score*	CCS (Agatston): Zero (0). If non-zero: growth -100% to +10% per year (lower is better)	Public: CT Calcium Scan

* Also known as CAC: Coronary Arterial Calcium, and CT Heart 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 (mIU/L)	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 Draw 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
ω3 Index 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
MMA 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

Gut Flora (Microbiome)	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.
Prebiotic Fiber Challenge
20 grams/day, mixed & varied	No adverse reaction during ramp-up. This is not a clinical test per se. It’s just an often-revealing reaction to standard program diet.	Public: Gut Flora Resource Overview Members: Advanced Topic: Regularly Consuming Prebiotic Fibers
Breath Testing Note: see details discussion for current status of breath testing.
H2 (Hydrogen) Breath Testing	Less than 20ppm above baseline	Members: Undoctored Protocols: Small Intestinal Bacterial Overgrowth (SIBO) Public: How to use the new AIRE device Public: How does the AIRE device compare to formal H2 testing?
Bowel Flora Testing Note: see details discussion for current status of direct bowel testing.
Stool Testing	See local discussion below for current status.	Members: Advanced Topic: Bowel Flora Testing - A Practical Guide

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 (and see also Lp(a) above)
Apo E (Apolipoprotein E)	Apo E3:3 requires no extra attention	Members: Apoprotein E4: What Role in the Undoctored Lifestyle? 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. CPT may not be recognized outside the U.S. 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. Plan for unexpected reactions (Members).

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 thought 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 Test Detail

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 to diet optimization.

HDL is slower to respond, but it does:
Undoctored Blog: I raised my HDL by 350% (public).  Return to Lipoproteins

HbA1c Test Detail

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 markers 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 R_x-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 Test Detail

CPT Codes: 82947, 82948 (by device is 82962)
82951 is OGTT, not recommended.

If you get this in a clinical draw, it may be labeled just "glucose". You are apt to get it 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 Home Test Detail

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 Test Details

CPT Codes:
83527 Insulin,Free
83525 Insulin,Serum
83525 (x3) may be the Kraft Insulin Assay, but neither it, nor 82951 OGTT are recommended, due to the bolus of sugar required.

An elevated or high fasting insulin is suggestive of any of several issues, none desirable. The reading itself is not diagnostic, but indicates something that needs further investigation. Return to BG & Insulin

Body Composition, BMI, 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 Test Detail

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 Test Detail

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 Test Detail

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

Breath Testing Options

There are a number of gasses that can be revealing of upper-GI dysbiosis:
◊ H₂ (hydrogen),
◊ CH₄ (methane),
◊ H₂S/H₂SO₄ (hydrogen sulfide/sulfuric acid) and
◊ excess CO₂ (carbon dioxide).
These gasses are sampled in breath after ingestion of various challenge carbohydrates.

H₂ is relatively straightforward to test in locales where the (original) AIRE device is available. This non-prescription home device is re-usable, and costs about as much as a single clinical H₂ test. FoodMarble (the makers of the AIRE device) plan to add CH₄ and H₂S capability in a future device (technical, regulatory & economic hurdles permitting). In the meantime…

Testing for methane- and sulfur-generating microbial overgrowth presently requires a prescription test, CPT Code 91065(x2) or 91299(x1) provides a single-use home kit. This can be useful in detecting CH₄ and/or H₂S SIBO, but is apt to not be economical in tracking treatment progress.

Due to copious CO₂ exhaled normally in healthy breath, excess CO₂ testing requires tagged CO₂, and is thus unlikely to ever be a home test. No program Protocol or Advanced Topic presently suggests testing CO₂. Return to Breath Testing

Stool Testing Options

This is a highly fluid situation (no pun intended), so stay tuned for developments, reports and recommendations. Any tests today that attempt to identify gut microbes have to rely on stool samples.

An ideal service would be capable of sequencing all life forms in the sample, from all Domains (perhaps including the Unknown Unknowns). They would then list everything in scope for detection, top down: Domain, Kingdom, Phylum, Class, Order, Family, Genus, Species, Strain, and possibly sub-strain. The report would have prevalence numbers. Scores relative to population data might be useful.

But few services today are this broad in scope (with many sequencing for bacteria only). Few report to strain. Some fail to provide actual numbers (only some vague ranking). Many provide premature health rankings, and utterly useless dietary and/or supplement advice. None of the currently useful tests may have CPT Codes.

Consensus medicine is so far only alert to a small number of well-known pathogens, so existing CPT Codes for stool testing are not the tests you are looking for in SIBO/SIFO. Return to Bowel Flora

CBC: Complete Blood Chemistry/Count Test Detail

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 Test Detail

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-α. If you have them, IL-8, IL-18, leptin, Lp-Pla2 and MPO also provide hints. Return to Inflammation

Apo E Test Detail

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] [topics] [abbreviations]