Getting a detailed Physical - What blood testing should I ask for?
My work offers one of these half-day, spa-like setting full and thorough Physical. They do all the routine stuff as well as some pretty detailed hearing chamber, eyesight testing, etc. etc. etc. I'm going in next Friday morning (yes, I specificaly scheduled it on my OS rest day) and I will be fasting before I go in and they will be doing a blood test as well.
I know very little about blood tests. Are they all the same, or are there specific things I should ask them to test for? Hemoglobin levels? Iron? Vitamin D? Others?
Any of the smart medical or nutritional peeps have any advice on this?
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Endurance sports can sometimes be connected to anemia. But, the standard stuff will cover that, hemoglobins, iron, etc.
I'm pretty sure you'll get a baseline ECG, or at least make sure you do. You're very healthy (as far as I pick up from here), but we do stress our hearts all the time.
I like the vitamin D test. My primary threw out some crazy numbers regarding how many of us are deficient and how it negatively affects us.
And, I guess, you could try to get an exemption for testosterone therapy
I agree with the suggestions above (CBC, Vit D, Cholesterol, Liver & Kidney, testosterone, PSA, thyroid, urine) and would like to add a couple more. I am big on the concept of recovery nutrition and one of the indicators that you're in a pro-inflammatory state is the level of your C-reactive protein. You put yourself through a lot training like this and if this is too high it is an indicator that you're not handling it all very well or that some other situation is dogging you. Another thing to think about is uric acid levels. Sometimes heavy duty workouts cause a lot of cell breakdown and knowing how well your body is handling the uric acid that derives from the breakdown of purines (parts of your DNA) is a good thing.
I'll probably think of more while trying not to fall off the back of the mill...
Cholesteral should be part of a "lipid panel". Equally important to cholesterol is checking LDL ("bad" cholesteral) and HDL ("good"cholesterol). Exercise, although in most instances a huge help, is no garauntee that the LDL/HDL ratio is most favorable.
Totally agree with checking Vitamin D levels: vitamin D has a big role in inflammation and pulmonary function. A deficiency is not unusual particularly for those that live in northern climates.
All - any thoughts on magnesium? Am I right that endurance athletes are at heightened risk for magnesium deficiency?
Great input so far!
@Dino-- I've been rockin' the OS so sometimes I wander what Jess is slipping me.
@Peter-- I have been off the "Recreational Sugar" and "Gluten Free" since Jan 2nd.I have been eating a tone of veggies and non-processed foods, so hopefully things are mostly good. I have been experimenting with something new this OS, Zero nutrition before or during any workout. I even went off plan one day and did a ~3hr Trail run after getting up and having nothing but water before and during and felt great. I almost always do a recovery shake and a ton of other stuff immediately after workouts. I also eat pretty much all day (snacking on fruit and nuts, etc.). I have not been hungry one single time since Jan 2nd and am down almost 8 lbs.
My Cholesterol was ~280 with my HDL's very low the last time I had one of these. I went on Lipitor and it fell to like 150. I have not taken my Lipitor in at least 9 months so I am very curious to see if my new diet and as always extreme physical activity is enough to counteract my horrible genes. We'll see if I'll need to go back on the Lipitor.
TOO FUNNY indeed!
{Thread Drift Alert}
Gen wants to know how you roasted them, and if they were any good. We only have them raw...and *I* load them up with salt. You can't have too much salt....
Back on topic... I am really interested to see what's happened with John's lipid panel. I'll be attributing any positive changes to his current gluten-free diet... ;-)
Most ALL medical doctors, endocrinologists included, only measure TSH and T4. But doctors who practice "functional medicine" like myself know that to really know IF and EXACTLY HOW the thyroid is dysfunctioning, a comprehensive thyroid panel is needed, which includes: TSH, total T4, FreeT4, total T3, free T3, TBG, FTI, T3 uptake, and probably most importantly(since most with hypothyroid in the U.S. have autoimmune thyroid/ "Hashimotos"), TPO and Tgb antibodies.
Also, these and all other markers need to be evaluated within their "functional"range. What's that? Well TSH for example is usually 0.5 to 5.0 on a lab range (this is DIFFERENT from lab to lab and from year to year BTW!), but a functional range for TSH is 1.8 to 3.0, which you can see is a big difference. Suffice it to say that there are many people who fall within the lab ranges but are actually outside the functional ranges, which explains why they've been feeling sick for sooooo many years( some having even been told they're just crazy- ie... "Maybe we should start you on an antidepressant").
Two last points. 1. TOTALLY agree with getting inflammatory markers measured. Inflammation is the REAL killer, and everyone should have CRP (c reactive protein) , and homocysteine measured. In fact, more recent studies have shown a much stronger correlation to elevated homocysteine and heart disease, than elevated cholesterol. But the medical model is slow to change ESPECIALLY when there is BILLIONS made in statin(cholesterol lowering) drugs every year ( BTW, did you know that studies have shown that those on statins have a 16X increase chance of developing peripheral neuropathy. This is because the statins deplete the cells of the enzyme CoQ10, which is needed to make ATP- which is ENERGY for the cells, and nerve cells are very highly metabolically and suffer the most ) 2. While everyone is "fat phobic" and thinks the lower the better with cholesterol and triglycerides, you don't want either of these TOO low. For example, you don't want cholesterol below 150: why? Well it's the building block of all our hormones, so if you don't think hormones are important, than go ahead and get your cholesterol real low. Also, triglycerides shouldn't be below 75 on a blood test: why? Well ALL the cells in your body have their protective cell walls made of fat.
Sorry I went on so long, but this is a passion of mine, and I see people every day who have suffered for TOO long in a health care system that is THE BEST at crisis care, but leaves much to be desired with chronic health issues. The take home message: try and find someone who practices "functional medicine" and will do blood tests(and if warranted some speciality tests) that are more in depth, and just as importantly, will evaluate the results using the functional/optimal ranges.
Results are in... Oct 2010 was the last time I had this detailed exam done. I had just started training for my first Ironman then and I was on 10mg per day of Lipitor. I have not taken Lipitor in about a yr. But I am now training for my 4th Ironman and have been on a Gluten Free diet for ~6 weeks and I have not eaten Recreational Sugar since Jan 2nd, 2013. Anyways, here's the comparison of the simple things... There are a bunch more line items but I didn't want to bore you all with everything.
Overall, I'm pretty damn proud of the results. I don't know what most of the stuff means or if the "Reference" range they post is even what is supposed to be normal for a fit endurance athlete... I'm shocked that my lipid profile is as good as it is with no meds. I was ~280 on total cholesterol at my worst like 7 yrs ago and an LDL/HDL ratio was around 8. From my laymens look at it, my Testosterone and Free Testosterone levels seem on the low side. The Hemoglobin and Hematocrit levels seem low as well, but I'm comparing to what I read in Tyler Hamilton's book, so maybe my sense of normal is warped... Anyways, would love any feedback if anyone has any...
@Steve, I couldn't agree with you more. The number of people with so called "normal" markers that are living in a diseased state is sad. The further you delve into it all it's pretty far from objective science.
@John, markers all look pretty good, but know that you live in a world where the difference between ordinary and extraordinary are a very fine line and the test you just did is not specific enough (why I haven't had a blood test in some time). I would look further into looking at your Testosterone and GH production or even consider supplementing naturally to see how you feel, especially as you approach 40. In the end I'd be proud of your results.
John- very good results, you should be proud of taking control of your health. Only a few comments:
Triglycerides- they are a little low (functional range 75-100). I would take a good quality Omega 3 supplement and make sure getting good fats in diet (avacados, fish, coconut oil, etc..)
Homocysteine- little high (functional range <7.5). Increased levels of "methyl donners" (Vit. B12) will decrease this</p>
WBC's- little low (functional range 5-8). This most likely due to general immune suppression associated with heavy training (ie.. be careful about overtraining).
There were a few other things a little outside of the functional ranges, but taken as a whole, these were the only I felt to comment on. Also, all iron levels were very good, which can sometimes be a problem with endurance athletes. Again, great job!!
Many thanks for taking a look! on your comments:
Triglycerides- mine have always been way high, so I was actually happy they were low. I didn't realize they could be too low... I take Omega 3 supplements every day and eat a lot of Salmon, Avacado, etc.
Homocysteine- I already take a Super B-Complex supplement...
WBC's- You're too late... I'm just getting over a cold that lasted about 2.5 weeks and caused me to stand down from training in a very major way.