Rule #7: Demand Certain Bloodwork from your Doctor!

DOUBLE DISCLAIMER: As you all know, I am not a doctor or a scientist. I am just reporting what I have learned and what has benefited me. Always ask a doctor if you have any concerns about your health! I hope this helps you start to understand your body and what is going on inside.

Knowing your body is important. You should always test not guess. Bloodwork is a critical way to get to know what is going on inside of you. Ultimately, my goal is to do an entire series of posts on bloodwork and the different markers that can help you learn about what is going on inside your body. Today, I am starting with five blood markers you must know and get at least yearly.

Casey and Calley Means provide a great summary of why you should know these numbers in their book Good Energy.

1. Triglycerides: Getting this marker will tell you if you are overwhelming your cells with Glucose.¹ Excess sugar and carbohydrates are converted into tryglicerides. As Dr. Means explains in her book, ordinarily triglycerides are used for energy when people are fasting. But in our current lifestyle where we eat too much and are largely sedentary they pile up in our bloodstream.²

Thus, high triglycerides are “a warning sign that you are eating too much sugar, refined carbs, and/or alcohol, and probably are not engaging in enough physical activity.”³ Remember, Rule 3: sugar, not fat, is the enemy.

Mark Hyman points out that, “When you ingest fructose in high amounts without the associated fiber found in whole fruit, it turns on the cholesterol-producing factory in your liver called lipogenesis which makes super dangerous small LDL particles, jacks up your triglycerides, and lowers the HDL (or good) cholesterol. So does sugar in any form, including flour and refined carbs.”⁴ So if your numbers are bad, look first to your diet.

When you get your triglyceride levels, they will tell you that a normal number is anything under 150 mg/dL. But as Casey Means points out “the probability of a cardiovascular event (i.e., heart attack and stroke) is 50 percent less in people with triglycerides under 81 mg/dL versus in people with levels between 110 and 153 mg/dL.”⁵ So work to get your number under 81.

2. HDL Cholesterol. This is often referred to as your good cholesterol. Why? Because it removes cholesterol from your blood and transports it back to the liver, which then gets rid of it.⁶

Thus, a high level of HDL cholesterol is not a bad thing. Women want a range above 50 mg/dL and men want one above 40 mg/dL. Of course, you can also get too high and that appears to be when your HDL cholesterol goes above 90 mg/dL. (A bit more on this later).

Triglyceride to HDL Ratio: Divide your triglycerides by your HDL. Why? Start with the fact that Dr. Robert Lustig believes it is the best biomarker of “insulin resistance and metabolic syndrome.”⁷ (As I explain later, insulin resistance is when your body can’t work to bring your blood sugar down without help—leading to problems like diabetes and heart disease. The NIH defines metabolic syndrome as “a group of conditions that together raise your risk of coronary heart disease, diabetes, stroke, and other serious health problems.”⁸)

While most doctors say a Triglyceride to HDL ratio below 2.0 is good, Dr. Lustig says you should really shoot to have the ratio below 1.5.⁹ If it is higher than 2.5, start paying more attention to your diet! Cut your refined carbs first.

A recent study proves that this ratio matters: if your ratio is high your risk for heart attack increases 1600 percent!¹⁰ (The study can be found here). Don’t just get these blood tests for yourself; get them for your children too.

Another doc posted the ideal levels that are slightly different but also posted Europe’s levels for comparison.

Regardless, you need to know your level and and work to get it into the optimal range!

3. LDL Cholesterol: “often referred to as ‘bad’ cholesterol because it can deposit cholesterol into the walls of the arteries, leading to the formation of plaque.”¹¹ Plaque can harden and narrow your arteries. And this narrowing can result in a heart attack. But, as discussed a little below, your LDL Cholesterol alone won’t tell you everything.

An interesting study: Between 2000 and 2006, researchers studied 136,905 admissions for heart attacks across 541 hospitals—59 percent of all heart attacks.¹² What they found was surprising. Even though many doctors today say LDL is one of the main culprits of heart attacks, this study found that 75 percent of the people who had heart attacks had “normal” LDL and 50 percent had optimal LDL levels.

But that isn’t the interesting part. As Mark Hyman pointed out, “Only 10 percent of the participants had levels of HDL (“good”) cholesterol over 60. This means that 90 percent of these patients who suffered a heart attack had HDL levels under 60.”¹³

So when you go to the doctor, don’t just get your total cholesterol and HDL/LDL. Demand a full lipid panel and make sure your good Cholesterol is in the 60 to 80 range!

(Food as medicine: to get your good cholesterol up eat “good fats in foods like avocado, coconut oil, extra-virgin olive oil, wild-caught fish, nuts, and seeds. Besides healthy fats, focus on a high-fiber, plant-based diet with lots of phytonutrients and omega 3 fats. That includes lots of non-starchy veggies. Consume plenty of good-quality protein found in beans, seeds, nuts, and high-quality, sustainably raised or grass-fed animal protein.”)¹⁴

Also, I am not saying LDL is not important. The statistics show, however, that the entire lipid panel is what matters not just one number. An advanced panel will include other important numbers like ApoB, Lipoprotein(a), and your C-reactive protein (hs-CRP). Regardless, if your numbers are off, talk to a doctor!

I am going to a do a more extensive post on the lipid panel and go into depth about the various additional markers that can help you understand your risk of cardiovascular disease. Remember, heart disease is the number one cause of death both globally and in the United States.¹⁵ “One person dies every 33 seconds from cardiovascular disease.”¹⁶

Don’t take a chance!

4. Fasting Glucose and 5. Fasting Insulin

Every time you do your yearly physical, your doctor should test both your fasting glucose and your fasting insulin. Why both? If your fasting glucose is high, it is a sign of insulin resistance.

Here is how Dr. Mark Hyman explains it:

“Insulin is a hormone that’s crucial for managing your blood sugar levels. When you eat carbohydrates like sugar and starch, they’re quickly absorbed into your bloodstream as glucose, raising your blood glucose (a.k.a. blood sugar) levels.

Your body is designed to tightly regulate blood sugar levels because when they get too high, it triggers inflammation that damages blood vessels. On the other hand, if blood sugar drops too low, it can impair your ability to function and, in extreme cases, even be life-threatening.

This is where insulin comes in. When your blood sugar rises, your pancreas releases insulin. Insulin is needed to help move glucose from your bloodstream into your cells, where it can be used for energy or stored for later use. Under normal circumstances, your pancreas releases just the right amount of insulin to bring your blood sugar back to the normal range of 70-100 mg/dL.”¹⁷

The problem occurs when your insulin doesn’t respond effectively to glucose. If you are experiencing insulin resistance and don’t deal with it (preferably through diet and exercise etc.), you can “damage your organs and blood vessels, and raise your risk of serious conditions like heart disease, stroke, and diabetes.”¹⁸

“Catastrophically” fasting insulin is not a standard test.¹⁹ Casey Means points out that a study in The Lancet showed if we regularly got our fasting insulin tested, we could pick up insulin resistance “a decade before glucose hits the diabetic range.”²⁰ Thus, she says it is the most important lab test you can get.²¹

Normal fasting glucose should be below 100, while the optimal range is 70 to 85.²²

“Fasting insulin should be between 2 and 5 mIU/dL. Anything greater than 10 mIU/dL is significantly elevated.“²³

Once you have both numbers, Dr. Means recommends you calculate your HOMA-IR (homeostatic model assessment for insulin resistance). You can do so by plugging in your fasting glucose and fasting insulin here. A normal value is between .5 and 1.4.²⁴

I hope this has been helpful to you as a start to learning about your body. It would be ideal if you could get these numbers at least two times a year. I plan to have future posts on additional important bloodwork, etc. Remember, test don’t guess!

1. Means, Casey, MD, and Calley Means, Good Energy: The Surprising Connection Between Metabolism and Limitless Health, at p. 80 (Penguin Publishing Group, 2024).

2. Id.

3. Id.

4. https://drhyman.com/blogs/content/7-ways-to-optimize-cholesterol

5. Good Energy at p. 81

6. Id. at 82.

7. Id. at 87.

8. https://www.nhlbi.nih.gov/health/metabolic-syndrome

9. https://www.instagram.com/drcaseyskitchen/reel/Ci2zI5SJSyd/#

10. Good Energy at 87.

11. Id. at 82.

12. https://www.uclahealth.org/news/release/most-heart-attack-patients-cholesterol-levels-did-not-indicate-cardiac-risk

13. https://drhyman.com/blogs/content/7-ways-to-optimize-cholesterol

14. Id.

15. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html#:~:text=Heart%20disease%20is%20the%20leading,people%20died%20from%20heart%20disease.

16. Id.

17. https://drhyman.com/blogs/content/blood-tests-to-ask-your-doctor-for

18. Id.

19. Good Energy at 83.

20. Id.

21. Id. at 88.

22. Id. at 84.

23. https://drhyman.com/blogs/content/blood-tests-to-ask-your-doctor-for

24. https://www.sciencedirect.com/topics/medicine-and-dentistry/homeostatic-model-assessment#:~:text=HOMA%2DIR%20values%20between%200.5,correlated%20with%20IR%20%5B129%5D.