Annual Labs and Nutrition

How to get the most out of your annual check-up.

If you have access to medical care, having annual blood work drawn can be very useful for monitoring your nutritional status. Below I am going to walk through the basic labs you can easily request from your doctor, what they mean for you & how to read them from a nutritional lens. Many of these labs will be helpful for common symptoms like fatigue, poor energy & trouble with weight loss which will help with insurance coverage.

*Disclaimer: this review only targets lab values from a nutritional lens, other more serious concerns will be flagged by your physician.

I recommend logging your results each year to identify any patterns. If your measures fall slightly lower than the functional range, but within the conventional range you can focus in on the nutrients that are connected with those values & track results.

Below is free lab tracker to track and assess your results from a nutritional lens.

Lab description & nutritional result assessment

Serum Vitamin D: I recommend this measure for everyone, especially for those in a climate like the Midwest where it gets cold & gloomy for months out of the year, or for those who stay indoors most of the day. Vitamin D is necessary for mood, immune health & bone health, among other things.

NOTE: for many, conventional labs will tell you Vitamin D is within range, but the optimal level of Vitamin D is closer to 50.

• Sources: sun light; fatty fish (with the skin) salmon, tuna, trout mackerel; pasture-raised egg yolks; fortified milk; beef liver

• Supplementing: find a quality supplement with both D3 and K2. Vitamin D is responsible for managing blood calcium levels & K2 is required for the absorption into bone. Too much calcium in the blood without Vitamin K can promote arterial calcification.

The CBC and CMP are common labs that will be run by a PCP to assess baseline health.

Complete blood count: CBC

Consists of white, red & platelet cells which can give insight into B12, folate and B6 status—key vitamins for overall health, as well as iron status since our red blood cells require iron to carry oxygen through the body.

White blood cell count:

• Increase with an acute viral or bacterial infection or stress

• Decreased in chronic infection, autoimmune disorders, hepatitis, B12, B6, folate or iron deficiencies

Major role of WBCs

• Neutrophils increase with acute infection, decreasing as infection becomes chronic

• Lymphocytes will remain increased with chronic infection

• Monocytes increase with viral infections

• Eosinophils increase with food allergies/sensitivities, intestinal parasites or asthma

• Basophils increase with inflammation or intestinal parasites, decrease under stress & hyperthyroidism

Red Blood Cell (RBC) count:

• Increased with asthma or higher altitudes

• Decreased with anemia from iron, B12, B6 or folate deficiency

Hemoglobin/Hematocrit:

• Increased with dehydration or asthma

• Decreased with iron, B12 or B6 deficiency, increased need for Vitamin C or copper, or gut inflammation

MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin), MCHC (mean corpuscular hemoglobin concentration):

• Increased with anemia from B12 or folate deficiency, increased need for Vitamin C, dehydration or hypochlorhydria

• Decreased with iron or B6 deficiency, heavy metals (lead, aluminum, cadmium)

Platelets:

• Increased with inflammation and autoimmune disorders, can rise during pregnancy

Comprehensive Metabolic Panel: CMP

There are 14 common measures included in a CMP-14 lab:

Albumin: major blood protein

• Increased with dehydration

• Decreased with hypochlorhydria, increased need for Vitamin C

Alkaline phosphatase (ALP): zinc dependent metalloprotein

• Increased with biliary dysfunction, intestinal permeability, increased need for Vitamin C, excess Vitamin D, fat or protein intake, adrenal hyperfunction, pancreatic dysfunction hyperthyroidism, tissue damage

• Decreased (under 70): zinc deficiency

  • Other clinical signs to assess for Zinc deficiency: white spots on nails, acne, slow wound healing, increased occurrence of cold, flu or infections, reduced sense of smell or taste.

  • Focus on increasing zinc rich foods and assessing gut health. When supplementing, be aware that zinc can deplete copper in the body.

Alanine aminotransferase (ALT): enzyme present in the liver

• Increased with fatty liver or liver dysfunction, muscle breakdown, alcoholism

• Decreased with B6 or protein deficiency, early development of fatty liver or liver dysfunction

Aspartate aminotransferase (AST): enzyme present in metabolic tissue (lunges, liver, heart, kidneys & muscle)

• Increased with cardiovascular dysfunction, asthma, alcoholism, pancreatitis

• Decreased with B6 deficiency or protein deficiency

Blood urea nitrogen (BUN): measures clearance of urea

• Increased with dehydration, kidney dysfunction, hypochlorhydria, excessive protein intak, gut dysbiosis, adrenal hyperfunction

• Decreased with low protein intake, malabsorption, pancreatic insufficiency, gut dysbiosis

Calcium: serum calcium is tightly controlled by the parathyroid gland

• Increased with hyperparathyroidism, excessive Vitamin D or calcium intake

• Decreased with deficiency of calcium, Vitamin D or magnesium, low blood albumin, calcium absorption issues, hypoparathyroidism

Carbon dioxide: measures bicarbonate in the blood (acid-base balance)

• Increased with metabolic alkalosis, hypochlorhydria, fever

• Decreased with Metabolic acidosis, B1 (thiamine) deficiency, dehydration, sleep apnea, diabetes, poor diet

Chloride: extracellular anion for acid-base balance, follows sodium

• Increased with Metabolic acidosis, adrenal hyperfunction

• Decreased with hypochlorhydria, constipation, diabetes, adrenal hypofunction

Creatinine: breakdown product of muscle contraction

• Increased with UTI, urinary inflammation or obstruction, dehydration, creatine supplementation, diabetes

• Decreased with muscle atrophy or increased need for exercise

Glucose: combination of glucose consumed and produced from liver or adrenal hormone signaling

• Increased with insulin resistance, hyperglycemia or diabetes, B1 (thiamine) deficiency, acute stress or liver congestion

• Decreased with hypoglycemia, adrenal hypofunction, hyperinsulinism, hypothyroidism

Potassium: major intracellular ion or pH buffer

• Increased with adrenal hypofunction, dehydration, tissue breakdown, diabetes

• Decreased with adrenal hyperfunction, diuretic prescriptions, hypertension, anemia, poor diet

Sodium: major electrolyte

• Increased with adrenal hyperfunction, dehydration, high salt intake

• Decreased with adrenal hypofunction, diuretics, low salt intake, diarrhea or vomiting, excessive sweating, or diabetes

Total bilirubin: breakdown product of hemoglobin (red blood cells)

• Increased with high destruction of RBC or biliary stasis (obstruction of liver/gallbladder duct)

Total protein: a measure of albumin & globulin

• Increased with dehydration

• Decreased with hypochlorhydria, digestive inflammation, liver dysfunction, low protein intake, B1 (thiamine) deficiency  

Add on: HbA1c: a measure of blood glucose over a 3 month period. Glucose in the blood attaches to hemoglobin in red blood cells, which live for 120 days.

• Increased with iron deficiency anemia, insulin resistance, pre-diabetes or type 2 diabetes

• Decreased with hypoglycemia or increased blood loss

Lipid Panel

Total Cholesterol: steroid found in every cell that controls cell membrane structure & fluidity

• Increased with hypothyroid, poor fat metabolism, cardiovascular disease, atherosclerosis, insulin resistance, metabolic syndrome, familial hypercholesterolemia

• Decreased with poor dietary intake, digestive malabsorption, increased heavy metal burden

HDL: High density lipoprotein, carries cholesterol from tissue to the liver

• Increased with autoimmune disorders, hypothyroid, insulin use, alcoholism

• Decreased with diet high in refined carbohydrates, metabolic syndrome (hyperinsulinemia), atherosclerosis, fatty liver, oxidative stress

LDL: Low density lipoprotein, carries cholesterol from liver to tissue

• Increased with diet high in refined carbohydrates, metabolic syndrome (hyperinsulinemia), atherosclerosis, fatty liver, hypothyroid, birth control pills

VLDL: very low density lipoprotein, similar to LDL but carries triglycerides through the body

Triglycerides: measure of fatty acids in the blood

• Increased with metabolic syndrome, metabolic syndrome (hyperinsulinemia), atherosclerosis, fatty liver, cardiovascular disease, hypothyroidism

• Decreased with insufficient fat intake, autoimmune disorders, adrenal hypperfunction

Iron Panel: looking at all 3 measures is the optimal way of assessing iron status or degree of deficiency

Serum Iron:

• Increased with liver dysfunction, iron overload, viral infection, B12, folate, B6, copper or molybdenum deficiency

• Decreased with anemia: low dietary intake, malabsorption, increased loss (blood loss) or increased need (pregnancy), hypochlorhydria, heavy menses, hypothyroid, increased vitamin C need, infection

Ferritin: storage form of iron

• Increased with hemochromatosis or iron overload, inflammatory disorders, b12 or folate anemia

• Decreased with iron deficient anemia (see above)

TIBC (total iron binding capacity): measure of the protein that carries iron in the blood

• Increased with iron deficient anemia (see above)

• Decreased with hemochromatosis or iron overload, protein malnutrition, chronic inflammation

Inflammatory Markers

Hs-CRP (high sensitivity C-reactive protein): protein produced by the liver indicated inflammation in the body

• Increased levels correlate to cardiovascular or neurological disorders, diabetes, Alzheimer’s and autoimmune conditions

ESR: measures tissue deconstruction, inflammation and dysfunction in the body

• Increased with tissue inflammation, destruction, cardiovascular or musculoskeletal conditions, peptic ulcer

Homocysteine: protein in the blood correlated to poor methylation or increased risk of cardiovascular disorders

• Increased levels signal a B12, folate or B6 deficiency and can also show signs of the genetic variant MTHFR, which is where the body cannot use folic acid and needs a specific form of the vitamin to be used in the body (methyl folate).

Thyroid Panel: with any energy or fatigue concerns, the thyroid should be assessed.

TSH, Thyroid stimulating hormone

• Increased with primary hypothyroidism (elevated TSH with normal to low T4 and T3), Hashimoto’s Thyroiditis

• Decreased with hyperthyroidism, secondary hypothyroidism (anterior pituitary hypofunction), heavy metals, protein malnutrition

Free T4: major hormone secreted by the thyroid, unbound for conversion to T3 (active form)

• Increased with hyperthyroidism, birth control, adrenal fatigue

• Decreased with primary hypothyroidism, Iodine deficiency, steroid usage, protein malnutrition, liver disorders

Free T3: active form of thyroid hormone, found in peripheral tissues

• Increased with hyperthyroidism, Iodine deficiency, protein malnutrition

• Decreased with primary hypothyroidism, selenium deficiency, liver disorders

If thyroid levels are abnormal, testing for antibodies will help assess the root cause

Thyroid Peroxidase Antibodies (Anti-TPO ab)

• When the immune system is over-active it can create antibodies that impact the synthesis of thyroid hormone. This measure is used to determine Hashimoto’s Thyroiditis.

Thyroglobulin Antibodies

• This antibody attaches to thyroglobulin, a protein required to make thyroid hormone and can inhibit production. When levels are increased, it results in low production of thyroid hormone.

NOTE: the information provided on the site is for educational purposes only, and does not substitute for professional medical advice

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