Labs that can help us detect metabolic dysfunction early.

The following labs are what I include in a comprehensive metabolic assessment. Many of these labs are included in my routine panels, too.

Total and LDL cholesterol: I don’t get all that excited about LDL and total cholesterol, except in certain circumstances. Triglycerides and HDL tell most of the the metabolic story when it comes to lipids. I always calculate a triglyceride to HDL ratio. This is a marker of insulin resistance. If a person’s LDL is >300, we might need to look at possible familial hypercholesterolemia.

Triglycerides: Optimal levels are <80 mg/dL. There is a 50% less chance for developing cardiovascular disease when you keep your triglycerides <80! Triglycerides can be lowered by minimizing carbohydrates in the diet. Once triglycerides are >153, there is a dramatic increase in risk for developing heart disease. High triglycerides is one of the criteria for metabolic syndrome. 

High-density lipoprotein (HDL): Optimal is 50-90 mg/dL. This is our good cholesterol! When it’s too low, there is increased risk for heart disease. Low HDL is also one of the criteria for metabolic syndrome. 

Apolipoprotein B: We want this to be low. High levels of ApoB are associated with the buildup of plaque in arteries, making it a more accurate predictor of cardiovascular risk than traditional lipid markers like LDL. Because of its strong association with insulin resistance, metabolic syndrome, and obesity, ApoB can serve as an early warning sign of metabolic dysfunction and atherosclerotic disease.

Apolipoprotein A1: We want this to be high! It’s cardioprotective and protective against dementia!

Fasting blood glucose: 70-85 mg/dL is optimal. Once fasting blood glucose reaches 100 or greater, prediabetes is diagnosed. Together with the fasting insulin, we can calculate the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), which indicates insulin resistance when elevated. 

Fasting insulin: This is my favorite marker to order. Optimal is 2-5 mIU/L. This is NOT easy to accomplish. I don’t often see fasting insulins this low. Insulin begins to creep up before the A1C ever increases. Most providers will order an A1C at some point, but MANY do not check the fasting insulin. It’s SO important!! If fasting insulin is elevated, and we catch it early, it gives us an opportunity to get things under control before type 2 diabetes or metabolic syndrome become a problem. 

Hemoglobin A1C: This is a marker of your average blood glucose over the past 3ish months. Keeping your A1C less than 5.4% is ideal. Once the A1C reaches 5.7%, prediabetes is diagnosed. 

Uric Acid: You may have heard of uric acid associated with gout, but it’s also an important indicator of metabolic dysfunction. It has been implicated in cardiovascular and kidney disease. David Perlmutter, MD, recommends aiming for a uric acid level of 5.5 or less. He states, “Anything that raises blood sugar will ultimately increase fructose and raise uric acid.” He recommends staying away from processed foods, sugary beverages, and alcohol to keep uric acid low.

Gamma-glutamyl transferase (GGT): You’ve probably heard of glutathione. GGT is an important enzyme involved in glutathione metabolism, and its levels are closely tied to oxidative stress and inflammation, both of which contribute to insulin resistance, metabolic syndrome, and cardiovascular disease. Elevated GGT can also be an early indicator of liver dysfunction, particularly in conditions like non-alcoholic fatty liver disease (NAFLD), which is strongly linked to metabolic disease. Even in individuals with normal liver function, high GGT levels can indicate underlying metabolic dysfunction. Monitoring GGT levels, alongside other markers like fasting glucose, lipid profiles, and inflammatory markers, can provide valuable insights into overall metabolic health and risk of chronic disease.

Liver enzymes (ALT & AST): Along with GGT, ALT and AST can provide valuable insights into liver health. Keeping AST and ALT <17 IU/L is ideal. When liver cells are damaged, these liver enzymes are released. Elevated levels can sometimes point to metabolic dysfunction. 

HS-CRP: This is a marker of inflammation. When elevated, there is typically some metabolic dysfunction, putting you at increased risk for cardiovascular disease. Ideally, HS-CRP would be <0.3. mg/L. Many of us walk around with inflammation and don’t realize it. Knowing what your HS-CRP levels are can be another motivator for change, when needed. 

Vitamin D: Vitamin D plays a central role in metabolic health, influencing key processes such as insulin sensitivity, glucose metabolism, inflammation, fat metabolism, and cardiovascular function. Maintaining optimal vitamin D levels through sun exposure, diet, and supplementation (when necessary) is important for preventing metabolic dysfunction and reducing the risk of developing chronic diseases associated with poor metabolic health.

Thyroid panel: There’s a lot to say here, but just know, if you schedule with me, I will be checking your thyroid function. It’s SO important for so many reasons!!

Sex hormones - DHEA-S, progesterone, estradiol, and testosterone. These are important players in metabolic health and when they’re out of sync or deficient, we can experience problems. More about sex hormones in my other blog posts. Estradiol post coming soon!!

Supplements & medications: When needed, there are some great supplements and medications we can utilize to help with insulin resistance. I love berberine and inositol for this purpose. I’ll talk more about these supplements in another post. If together, we decide we need to utilize a prescription medication for a time to find metabolic health, I think it’s worth it, when warranted. Sometimes it’s appropriate to dig ourselves out of metabolic dysfunction with a shovel (diet, exercise, lifestyle changes), but sometimes we need to bring in the backhoe, and that’s okay, too!!

Continuous glucose monitoring: I want to mention the power of continuous glucose monitoring again. It’s a powerful, affordable tool that can help us see what foods and/or stressors might be negatively impacting our blood sugars. It can also be used for positive reinforcement when you see how much your glucose is lowered with a walk or some resistance training!!

If you’re ready to talk about your metabolic health - send me an email at kami@seaside-med.com! 

**Much of this information comes from the book Good Energy by Dr. Casey Means. It’s a great read!