Essential Blood Tests and Their Associated Dysfunctions Part 2: Additional Tests for Further Assessment

These are more advanced biomarkers, and they are just as important as the basics. They can be obtained during routine blood work or ordered through direct access testing by the clinician or the patient.

Fibrinogen

• Is one of the principal clotting factors, is converted to fibrin in the presence of calcium.
• Levels will be affected by liver dysfunction, inflammation, and tissue destruction.
• Should be incorporated into an evaluation of inflammation, atherosclerosis, cardiovascular risk, and cancer.

hs-CRP

• Is an ultra-sensitive assay for C-reactive protein, a protein produced in the presence of inflammation; production is stimulated by IL-6.
• Is a reflection of acute and/or chronic inflammation.
• Is a better predictor of heart attack and stroke than serum cholesterol.
• Should be incorporated into an evaluation of cardiovascular risk, atherosclerosis, and conditions associated with increased inflammation.

Homocysteine

• Is formed during metabolic processing of the amino acid methionine.
• Builds up when vitamins B6, B12, and/or folate are insufficient.
• Can be elevated due to genetic variations, especially those involving methylation of folate or regulation of cystathionine b-synthase.
• Should be incorporated into an evaluation of cardiovascular risk, peripheral artery disease, endothelial dysfunction, inflammation and nutrient insufficiency.

Thyroid Panel

• The thyroid regulates metabolism via the thyroid hormone T4 and its active form T3.
• Thyroid-stimulating hormone (TSH) from the pituitary stimulates and regulates the production of T4; T4 is then converted to active T3 mainly in the liver and periphery.
• Thyroid assessment should include TSH, total and free T4, total and free T3, and reverse T3 (produced under stress).
• Thyroid antibodies should be tested if thyroid disease is suspected, including antibodies to thyroglobulin, thyroid receptor, and thyroid peroxidase.
• Should be incorporated into an evaluation of thyroid status, iodine or selenium insufficiency, symptoms of hypothyroidism including unexplained fatigue, constipation, weight gain, elevated cholesterol, or intolerance to cold. Hyperthyroid symptoms should also be investigated including nervousness, poor sleep, rapid heart rate, and weight loss.

 Fasting Insulin

• Insulin is an anabolic hormone produced by the pancreas in response to rising blood glucose levels.
• It primarily facilitates the transport of glucose into cells, reduces serum glucose, promotes the conversion of glucose to fat, and stimulates cholesterol synthesis. 
• Will be elevated in insulin resistance and early type 2 diabetes, but low or absent in type 1 diabetes.
• Should be incorporated into an evaluation of blood glucose dysregulation, cardiovascular risk, insulin resistance, metabolic syndrome, and insulinoma
• Should be evaluated with fasting glucose.
• If you run a Fasting Insulin and you have a Fasting Glucose, you can now run the HOMA2 calculator, a great way to further assess your patient's risk for insulin resistance Vitamin D.

Vitamin D

• is formed in the presence of sunlight in the skin from a 7-dehydrocholesterol precursor that is converted to active vitamin D by the liver and kidneys.
• 25(OH)D should be measured in the blood to evaluate vitamin D status, not the final 1,25(OH)D form.
• Vitamin D isn’t found in abundance in unfortified food, and many factors can reduce its production in the body including darker skin, obesity, living north of the equator, elderly status, sunscreen, and insufficient sun exposure.
• Should be incorporated into an evaluation of bone disease, chronic inflammation, chronic musculoskeletal pain, hypertension, cardiovascular disease, cancer, glucose regulation, immune function, and depression.

DHEA

• Is produced in the adrenals and is the most abundant circulating steroid hormone in the body, though levels decrease with age.
• Functions as a prohormone can be converted to testosterone, androstenedione, and estrogen.
• Affects more than 150 anabolic or repair functions in the body and brain, and plays a role in the response to stress.
• Circulating DHEA-s (sulfate) is the form that should be measured and used in clinical assessment.
• Should be incorporated into an evaluation of adrenal insufficiency, hyperinsulinemia, immune insufficiency/low secretory IgA, polycystic ovary syndrome, and age-related cardiovascular, nervous and immune system dysfunction.

Estradiol (E2)

• Is a steroid hormone by premenopausal women, and in smaller amounts by men and postmenopausal women.
• Can be synthesized from testosterone by aromatase enzymes.
• Low levels may negatively impact bone health in men and women and may trigger migraines in women.
• High levels may increase the risk of breast cancer in women and cardiovascular disease in men.
• Should be incorporated into an evaluation of bone density, cardiovascular disease, menopause, migraine associated with menstruation or menopause; and male gynecomastia, feminization, and excess abdominal obesity.

Free Testosterone 

• Is the free, unbound concentration of testosterone in circulation
• Is an anabolic steroid hormone that stimulates tissue and muscle synthesis
• Testosterone is produced by men and by women in smaller amounts, there is a general inverse relationship between testosterone and estrogen 
• Can be calculated from directly measured total testosterone, SHBG, and albumin
• Should be incorporated into an evaluation of male andropause/late-onset hypogonadism, abdominal obesity, depression, osteoporosis, metabolic syndrome, and heart disease, as well as female hirsutism, PCOS, and low estrogen

Clearly, these more advanced biomarkers can fill in some of the gaps in a comprehensive clinical assessment, especially in those with increased risk of preventable chronic disorders. They can be easily incorporated into a comprehensive functional blood chemistry analysis.

Keep in mind that the FBCA is an indispensable tool as you work your way down from the tip of the iceberg of dysfunction, further into the treasure trove of blood chemistry biomarkers.