What labs should you get? The ULTIMATE bloodwork podcast! Part 1

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Paul Saladino1h 16m · 2019-09-05

Claims Made

154

Claims Supported

85

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55%

Support rate

85 of 154 claims supported

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130

Well SupportedA fasting insulin level below 5 micro IU/mL is considered healthy.Well SupportedRegenerative agriculture practices benefit the animal, the soil, and the overall ecosystem.Well SupportedA normal cortisol rhythm involves high levels upon waking, a rise a couple of hours after waking, a fall in the afternoon, and low levels at bedtime.Well SupportedFasting insulin is the best test to assess insulin sensitivity, which is the most important metric for human health.Partially Supported

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A. Volkovreader

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Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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N. Park

2d

Would love a "what would change this verdict" RSS feed. Sign me up if it exists.

Statin use may impair cholesterol synthesis in the brain, potentially impacting cognition.

Well SupportedChecking homocysteine levels is sufficient to assess the need for folate and riboflavin without genetic testing.

Well SupportedTo accurately measure hs-CRP, it should be done first thing in the morning, in a fasting state, without strenuous exercise the night before or the morning of.

Partially SupportedWhen ldl increases, particle size typically increases, and particle number may not be as critical as metabolic health.

Well SupportedSleep deprivation can lower LH and FSH, reducing testosterone production, which is correctable with improved sleep.

Not SupportedThe number of LDL particles in circulation does not fully explain atherosclerosis.

Partially SupportedLarge VLDL particle number is a marker of insulin resistance, not a therapeutic target.

Well SupportedA comprehensive blood work panel should include inflammatory markers, fasting insulin, lipids, thyroid hormones, sex hormones, PTH, cortisol, c-peptide, CBC, and CMP.

Well SupportedElevated GGT can indicate environmental toxins or oxidative stress and should be added to a comprehensive metabolic panel.

Well SupportedThe primary targets for cardiovascular health should be insulin resistance and the subsequent susceptibility of LDL to oxidation, rather than LDL-C itself.

Partially SupportedSome individuals on a carnivore diet experience a large increase in LDL cholesterol and LDL particle count, while others have normal lipid levels.

Well SupportedAdding organ meats like heart and liver to the diet, either fresh or desiccated, is recommended for individuals with MTHFR polymorphisms and elevated homocysteine.

Well SupportedCarnivore dieters report low IGF-1 levels, with fasting levels ranging from 70-90 ng/mL, potentially indicating lower mTOR activation.

Well SupportedA HOMA-IR score, calculated from fasting insulin and fasting glucose, is an indicator of insulin resistance.

Well SupportedPopulations with an average fasting insulin of 8.6 ng/mL and 15.7 ng/mL, respectively, are likely insulin resistant.

Well SupportedFructoseamine measures average blood glucose over 2-3 weeks and can correlate with Hemoglobin A1C.

Well SupportedThymus extract may improve immune function due to thymosin and other thymic factors.

Well SupportedA significant decline in testosterone in men may indicate excessive stress from practices like fasting.

Well SupportedMeasuring Lipoprotein(a) is important because it can represent residual cardiovascular risk.

Partially SupportedThe speaker's LDL particles measure approximately 24.7 nanometers, near the upper limit of the reference range.

Well SupportedMeasuring both total and free sex hormone-binding globulin (SHBG) is important because free hormones are considered the active form.

Not SupportedTestosterone is overused, with treatment often based solely on total testosterone levels without considering free testosterone or symptoms.

Well SupportedTestosterone levels should be tested within two to three hours of waking, as they are highest in the morning.

Well SupportedA full thyroid panel is superior to ordering only TSH.

Well SupportedIndividuals with good libido, sexual function, and muscle mass should not be concerned if their testosterone levels are at the low end of normal.

Well SupportedLow LH and FSH levels can indicate secondary hypogonadism originating in the brain.

Partially SupportedThe thymus supplement from Ancestral Supplements is high in vitamin C and supports the immune system.

Partially SupportedCortisol should be highest in the morning as part of the circadian rhythm.

Partially SupportedLipid profiles should be interpreted in the context of inflammation and insulin resistance.

Well SupportedSophisticated lipid panels assessing oxidized LDL and its ratios are necessary because not all LDL is created equally.

Partially SupportedThere are approximately 10^18 LDL particles and 10^20 HDL particles per liter of blood.

Partially SupportedThe speaker's homocysteine levels are typically 10-11 unless they consume liver or a small amount of L-5-methylfolate or folinic acid.

Partially SupportedTesting heavy metal levels in the body via blood tests can provide insight into current exposure.

Not SupportedLipophilic statins that cross the blood-brain barrier may increase dementia risk by inhibiting cholesterol production in the brain.

Partially SupportedNuclear Magnetic Resonance testing counts the number of LDL particles, contrasting with traditional lipid panels that measure LDL by weight.

Partially SupportedPaul Saladino's LDL is 533 mg/dL, LDL particle number is 3283 nmol/L, and LDL size is 24.7, with total cholesterol of 647 mg/dL and HDL particle number of 50.6 mcmol/L.

Not SupportedThe oxidized LDL test from Cleveland Heart Labs is inaccurate because it only detects the presence of one oxidized phospholipid on an LDL particle.

Partially SupportedThe lean mass hyperresponder phenotype, with elevated cholesterol and LDL, is observed in the majority of humans who adopt animal-based diets.

Partially SupportedThe average HDL particle contains approximately 45 cholesterol molecules, while the average LDL particle contains about 1500-2000 cholesterol molecules.

Partially SupportedA direct LDL-C measurement of 504 mg/dL was observed with HDL of 97 mg/dL and triglycerides of 72 mg/dL.

Partially SupportedElevated desmosterol levels are a normal consequence of activated metabolic pathways on carnivore or ketogenic diets.

Partially SupportedIt is recommended to measure both insulin and C-peptide together, especially if insulin levels are at the high end of normal.

Partially SupportedStandard blood work should include CBC, comprehensive metabolic panel, fasting insulin, PTH, full thyroid panel, testosterone, prolactin, DHT, estrogens, progesterone, pregnenolone, cortisol, DHEAS, hs-CRP, liver enzymes, and lipid panel.

Partially SupportedA one-meal-a-day protocol can lead to low testosterone in men, which may improve by eating twice a day and increasing calorie intake.

Partially SupportedCompressing the eating window on a carnivore diet allows for precise control over mTOR activation and periods without ketosis due to sufficient protein intake.

Partially SupportedHigh-sensitivity C-reactive protein indicates systemic inflammation but does not specify its source, type, or chronicity.

Partially SupportedThe speaker's myeloperoxidase was 193 and fibrinogen was 363, both within normal ranges.

Partially SupportedPattern B LDL is generally considered the atherogenic pattern type, though some argue that a high particle count alone is atherogenic.

Partially SupportedAn NMR lipid profile and a basic lipid profile are recommended before and at 30-45 days for individuals on a ketogenic or carnivore diet.

Partially SupportedPaul Saladino's total testosterone increased from 261 ng/dL to 731 ng/dL and free testosterone from 32 pg/mL to 113 pg/mL, potentially due to increased fasting and reduced calorie intake.

Partially SupportedThe triglycerides to HDL-C ratio is a proxy for insulin resistance.

Partially SupportedHigh sex hormone-binding globulin (SHBG) can be associated with hypothyroidism or insulin sensitivity, while low SHBG may indicate hyperthyroidism or insulin resistance.

Well SupportedDoctors often refuse to order fasting insulin tests, with approximately 85% of people encountering this refusal.

Not SupportedPrescribing synthetic testosterone or testosterone replacement therapy can be a knee-jerk reaction by doctors for individuals told they have low testosterone.

Partially SupportedElevated homocysteine levels of 18-20 can occur in individuals deficient in folate or riboflavin.

Partially SupportedInsulin resistance can be assessed by triangulating measurements of triglycerides, hemoglobin A1c, and fasting glucose.

Partially SupportedPlant-based folate is dihydrofolate, while animal meat likely contains L-methylfolate.

Well SupportedSex hormone-binding globulin (SHBG) can indicate issues in other hormonal systems or general health problems.

Well SupportedSerum hormone levels are generally sufficient for initial assessment, and dried urine hormone panels are typically unnecessary unless investigating specific issues; urine testing is not recommended for androgens.

Well SupportedTriglycerides are a more important cardiovascular risk factor than LDL.

Partially SupportedA comprehensive blood work panel should also include a micronutrient panel, IGF-1, leptin, advanced lipid markers, a toxic metals panel, fructosamine, statin C-peptide, and coenzyme Q10.

Partially SupportedC-peptide is a stable blood indicator of insulin levels.

Well SupportedThe speaker's hs-CRP has been less than 0.03 on multiple occasions, and a carnivore diet does not elevate hs-CRP.

Partially SupportedBlood toxic metal testing is generally adequate for initial assessment.

Partially SupportedAssessing insulin sensitivity involves checking inflammatory markers, fasting insulin, fasting glucose, A1c, and fructosamine.

Partially SupportedThe biologically active form of testosterone is free testosterone, which represents 1-3% of total testosterone.

Partially SupportedTestosterone levels are generally highest in the morning and exhibit a diurnal pattern with a 20-30% swing.

Not SupportedSome individuals do not believe LDL cholesterol is directly toxic to the endothelium, nor that an LDL of 504 mg/dL is necessarily harmful.

Partially SupportedSerum levels are sufficient for initial hormonal testing, unless a diurnal cortisol curve is desired.

Not SupportedA carnivore diet does not significantly raise IGF-1 levels; high carbohydrate intake or frequent eating are more likely to increase IGF-1.

Partially SupportedA ketogenic diet can significantly lower triglycerides and increase total cholesterol and LDL cholesterol.

Partially SupportedElevated plant sterols in individuals not consuming many plants may be linked to coffee consumption.

Partially SupportedTissue sensitivity to testosterone is a critical factor in its effects, particularly for muscle building and libido.

Partially SupportedA complete blood count with differential is a necessary component of comprehensive blood work.

Partially SupportedPersonal testosterone levels can drop slightly due to stress, over-exercising, or poor sleep, without significant changes in FSH and LH.

Partially SupportedWhen assessing hormonal levels, pay attention to units and reference ranges as they vary significantly between labs.

Partially SupportedSophisticated lipid panel measures include plant sterols, campesterol, sitosterol, and ADMA.

Partially SupportedInsulin is a stronger activator of mTOR than leucine.

Partially SupportedCampesterol and sitosterol indicate the absorption of plant sterols, which may be relevant for individuals who consume plants and want to assess if they are hyper-absorbing them.

Partially SupportedMyeloperoxidase, fibrinogen, and homocysteine are valuable inflammatory and health markers.

Partially SupportedSubjective libido was not significantly different between testosterone levels of 261 ng/dL and 730 ng/dL.

Not SupportedCoffee consumption can elevate triglycerides and cortisol and should be avoided before blood tests.

Partially SupportedLP-little-a is a valuable lipid marker to assess.

Partially SupportedElevated hs-CRP is a valuable indicator of inflammation that should be monitored and addressed.

Partially SupportedA minor increase in hs-CRP to 0.05 may be attributable to recent resistance training, even with a 24-hour break.

Not SupportedLowering LDL from 3x10^18 particles to 1x10^18 particles may not significantly reduce atherosclerosis risk.

Partially SupportedFructosamine is a measure of glucose control.

Partially SupportedIndividuals on a ketogenic or carnivore diet typically exhibit very low hs-CRP levels.

Partially SupportedThe thymus is involved in immune function and immune system programming.

Partially SupportedAdvanced hormone and GI testing are valuable for clients with specific health issues.

Partially SupportedParathyroid hormone (PTH) may be a useful addition to a serum hormone panel.

Partially SupportedWhen assessing testosterone, it is important to also check SHBG, estradiol, LH, FSH, and prolactin levels.

Partially SupportedImproved sleep and increased food intake can lead to higher testosterone levels, even if LH remains low.

Partially SupportedAsymmetric dimethylarginine (ADMA) and other endothelial function markers are rarely found to be abnormal in individuals without frank metabolic syndrome.

Partially SupportedHigh SHBG can be associated with hyperthyroidism, anorexia, alcoholic cirrhosis, primary biliary cirrhosis, hypogonadism, and testosterone replacement therapy; low SHBG can be associated with hypothyroidism, sleep apnea, insulin resistance, diabetes, and growth hormone-secreting tumors.

Partially SupportedApolipoprotein B in LDL compared to apolipoprotein A in HDL may be a key difference in LDL's atherogenicity.

Partially SupportedA hypothetical scenario where oxidized LDL constitutes significantly more than 4% of total LDL particle number might represent a problem.

Partially SupportedHDL particles are not considered atherogenic, despite being present in much higher quantities than LDL particles and carrying more cholesterol.

Partially SupportedElevated desmosterol levels in individuals following ketogenic or carnivore diets are a normal consequence of activated metabolic pathways shared with cholesterol synthesis.

Partially SupportedDiet-induced hypercholesterolemia in the context of a ketogenic or carnivore diet may not be detrimental and could indicate healthy energy metabolism.

Partially SupportedHomocysteine levels can be lowered with methylfolate supplements, but some believe animal products provide sufficient methylfolate.

Not SupportedThe oxidized LDL test may not be a valuable marker as it tracks with LDL-P and represents about 4% of total LDL particles.

Partially SupportedA fasting insulin level of 1 µU/mL indicates a very low Homa IR and a generally super catabolic state.

Partially SupportedDave Feldman's work suggests higher fat intake can lead to lower LDL and fasting can increase LDL, hypothesizing LDL transports energy in lean mass hyper-responders.

Partially SupportedLow libido or erectile dysfunction in men, or low libido in women, can be related to low testosterone caused by insufficient calories, anorexia, over-exercising, life stress, or poor sleep.

Not SupportedDried urine hormone profiles may not be accurate for assessing androgens due to potential polymorphisms affecting urinary testosterone secretion.

Partially SupportedA 'statin C' test can be used as a measure of renal function and complements creatinine and BUN.

Partially SupportedPhysicians may recommend statin therapy for LDL cholesterol levels above 500 mg/dL.

Partially SupportedThe speaker is homozygous for the MTHFR 677 C to T polymorphism and relies on dietary riboflavin and active folate from organ meats.

Partially SupportedCaloric restriction and poor sleep can lead to secondary hypogonadism.

Partially SupportedNathan's LDL particle count (LDL-P) has ranged from 2,100 to over 3,500 and is currently stable around 3,500.

Partially SupportedFructosamine testing complements hemoglobin A1c for assessing glucose control.

Partially SupportedA ratio of oxidized LDL to LDL particle number significantly above 0.04 might indicate a problem.

Not SupportedLP-PLA2 is likely not a valuable marker for vascular inflammation or cardiac risk.

Partially SupportedC-peptide is a more stable measure of insulin activity than insulin itself, which can fluctuate significantly on a minute-to-10-minute basis.

Partially SupportedConsuming salmon roe may increase dihydrotestosterone (DHT) levels, as it contains a pigment that can inhibit DHT formation.

Partially SupportedLDL particles may function as carriers of energy in individuals running on fat.

Partially SupportedHigh LDL may not pose a problem for endothelial health in the context of insulin sensitivity.

Partially SupportedAnimal meat is hypothesized to contain L-methylfolate, the active form of folate, which is processed through the MTHFR enzyme.

Partially SupportedThe reference range for LDL particle number (LDL-P) is 1140 to 1410, and a value of 3500 is significantly outside this range.

Partially SupportedThe speaker's HDL particle number was above the optimal range of 43.

Partially SupportedLDL particles serve immunologic roles.

Not SupportedPlant sterols may be atherogenic or contribute to inflammation, and their consumption in high amounts is not desirable.

Partially SupportedThe Friedewald equation for calculating LDL cholesterol can be skewed by very high triglycerides or LDL levels, and direct LDL-C measurements are more accurate.

Partially SupportedThe MTHFR 677 polymorphism can be problematic if an individual has two copies of the T allele or it is combined with the 1298 polymorphism in a detrimental configuration.

Partially SupportedSerum coenzyme Q10 and red blood cell levels of folate and magnesium should be included in basic blood work.