If there’s one thing I’ve learned from my dad’s recent heart issues, it’s this:
A blood test is a vital first step in engaging actively in preserving your health.
It can show you areas to improve, or reaffirm that your active, nutrition-conscious lifestyle is working for you.
Regardless of what it says, it will give you peace of mind because a basic blood test is still our best way of understanding what’s happening in our bodies.
Now, allow me to explain where all this is coming from…
It starts with my dad, someone I’d consider to be fairly healthy. After being diagnosed with heard disease, he cut out most meats and began focusing on maximizing whole-food plant-based meals. As a result, he lost over thirty pounds, lowered his total cholesterol to 119, and improved his overall cardiovascular health.
Another win for plants!
That’s why it was surprising when, recently he began experiencing tightness in his chest (angina). As a result, he underwent an angioplasty — a risky procedure during which a camera is run through an artery in his leg and up into his heart to check for blockages.
Having just gone through this with him not that long ago, my family and I were once again fearing the worst.
But when the results came back, his heart disease had not progressed in severity since his last angioplasty.
When dealing with heart disease, I’ve found that “not worse” is something to celebrate…so, good news right?
Yes, but it still left us with the question: why was my dad tight in the chest?
Through the routine pre-procedure blood tests, doctors discovered that my dad had very low levels of hemoglobin, hematocrit, and red blood cells. In other words, he was severely anemic. And, thus, he was experiencing tightness in his chest, tiredness, and dizziness.
These are all good reasons to pursue an angioplasty — yet, it wasn’t blockages causing the symptoms, so an angio wasn’t the solution.
Instead, we learned (after the procedure) that it was likely the low hemoglobin, which helps transport oxygen to the heart, brain, and the rest of the body. No hemoglobin, no oxygen.
The fact is, a simple blood test could have alerted us to this issue months earlier.
And this isn’t the first time a standard blood test has had a huge impact on my family.
My wife and I both discovered deficiencies and food sensitivities through blood work. After years of a WFPB diet, I thought we would see amazing results in our blood test. Instead, she was diagnosed with hypothyroidism and I had “rheumatoid-like inflammation.”
This led to a manic search for answers. And many more blood tests. And eventually, through proper supplementation and modest changes to our diets, our lives and health have improved greatly.
Sometimes our bodies are telling us something that we don’t understand. But with insight from our blood markers and help from our doctors, we can learn a great deal.
5 Steps to a Successfully Talking to Your Doctor about Blood Work
As a compulsive self-experimenter, I get really excited about testing things in my body (despite my irrational fear of needles — like sweaty, OMG-please-don’t-let-me-pass-out sort of fear). I love to understand how my health has improved since my days eating anything aside from a whole-food, plant-based diet. And, to the extent possible, I like to see how tinkering with my diet changes the levels.
As I approach my fifth year as a vegan, I’m increasingly interested in getting a more granular view of my health.
That’s why I’ve been digging in to blood tests that help me understand my risk-factors for things like cardio- and cerebro-vascular diseases, as well as biomarkers for inflammation, micro-nutrient status, and the like.
But before I share the types of test I’ve been exploring, the obligatory disclaimer:
I’m not a doctor. Never have been and probably never will be. And I don’t pretend to be one on the internet. None of this should be interpreted as medical advice or recommendation. You should consult with a licensed physician to determine what blood tests are best for you, to help you interpret the results, and to craft a care plan. Below is simply my personal approach.
Now that we’ve gotten that out of the way, here’s my step-by-step approach to engaging with your doctor and getting these blood tests:
- Document all of the questions and concerns that you might have. The average doctor’s visit is 17.4 minutes long. If you don’t ask questions, and bring up your concerns, there’s no opportunity for the health provider to engage and to help.
- Find a doctor who will use nutrition as a tool to promote wellness, prevent disease, and possibly reverse existing conditions. Sometimes it’s difficult to tell, so check out this resource: Plant Based Doctors, which was built by friend of NMA, Matt Jager.
- When you’re with your doctor, mention whether you’re engaging in any strenuous activities, dealing with other stress, or eating a specific diet (whether that’s vegan or S.A.D or keto). Long-distance running, HIIT, strength training… All of these can skew a blood test.
- Provide the list of blood tests that you’re interested in pursuing, if you know them. Or at least the types of things you want to look for.
- Depending on whether you have specific conditions that need diagnosing, it can be useful to include tests of micronutrient status. In my experience, most doctors will not check your levels of B12, D, Omega-3, zinc, iodine, etc., unless you specifically request those tests. Again, this is why you should share all of the relevant information, like your preferred eating pattern.
The Blood Tests that I Rely On
Below are “the basics” that I like to test any time I get the needle — at least every 6 months, more if I’m actively experimenting.
After that are layers of additional tests, in order of frequency with which I like to use them. Depending on how you feel, and whether you’re dealing with any health challenges, your doctor will know what they are and when you should get them done, and they can walk you through the results.
These are fairly common tests, which measure a variety of things and can have a range of implications — from liver, kidney, and thyroid function to insulin sensitivity to markers of systemic inflammation.
Because they cover such a variety of markers, I’ll avoid going into too much detail here. But if you want to dive in more, check out the links for additional details.
1. Complete Blood Count with Differential and Platelets: Perhaps one of the most common, and most important tests, a CBC provides an overview of key markers, like red and white blood cells. This allows a doctor to diagnose anything from infection to, like my dad, an anemic state.
2. Comprehensive Metabolic Panel: A CMP offers a glimpse into your liver and kidney health and looks specifically at blood sugar and electrolytes (like calcium and sodium). All these factors allow a doctor to get a sense for how these systems are operating, since the liver and kidneys are critical to many processes involving digestion, detoxification, fluid balance, etc.
3. Lipid Panel: You’ve probably heard of this one: A lipid panel offers a measure of your risk factors for coronary artery disease (among other vascular diseases). You’ll learn your blood cholesterol level — total as well as high and low density lipoprotein — and triglycerides. If you’re particularly concerned about heart disease, be sure to ask your physician about more advanced tests (like those looking at particle number and particle size).
4. HS-CRP (high-sensitivity C-reactive protein): The simple explanation is that this test provides a sense for the level of systemic inflammation in your body. The more complicated part is what to do with this information — inflammation can have a vast range of causes and implications, so be sure to engage with a competent specialist if you’re concerned.
5. TSH: Thyroid Stimulating Hormone, which comes from your pituitary gland, serves a critical purpose of — you guessed it — stimulating your thyroid to excrete two hormones that are essential to proper metabolism in every tissue of your body. If your pituitary is not functioning probably, there can be a range of downstream issues. (This is what happened to my wife, and turned out to be an undiagnosed gluten allergy.)
6. Hemoglobin A1C: Given the rise of Type 2 Diabetes, we’re constantly hearing about the importance of blood sugar maintenance. Chronically high blood sugar can wreak havoc on every cell in your body. Testing your blood sugar (or more accurately, “blood glucose”) gives you a point-in-time reading. Measuring your A1C, on the other hand, gives you an average range of your blood sugar over the past 2-3 months. This offers a much more instructive data point, since blood sugar can swing wildly based on your exercise, stress, and food intake in a given day.
Additional Tests that I Do Regularly as a Vegan
In addition to the main six, because vegans and vegetarians are particularly susceptible to certain deficiencies, I also check out these markers at least once per year.
1. Vitamin B12: There is no plant-based source of Vitamin B12, so it’s critical for vegans to supplement.
2. Vitamin D3 (25 Hydroxy D): “D-ficiency” is widespread in the U.S., because of our distance from the equator and cold weather. On top of that, humans today wear clothing, work indoors, and ride in cars, all of which blocks sun from reaching our skin — a vastly different experience from that of our naked ancestors. Double check your levels with this simple blood test.
3. Methylmalonic Acid, Serum (MMA): A recent study suggests that a standard B12 test can show normal or high levels of B12, even in people in a B12 deficient state, and that MMA, in conjunction with homocysteine and Serum B12, is a better way to determine B12 status. As your doctor will share with you, increased levels of homocysteine and MMA can be suggestive of a mild (or nascent) B12 deficiency. Use all three biomarkers to ensure that you’re getting sufficient amounts of dietary B12.
4. Homocysteine: A common amino acid, homocysteine can help your doctor get a better sense for your risk factors for various chronic conditions, particularly cardiovascular diseases. It also plays a role in determining kidney health and, as described above, B12 deficiency.
5. Omega-3 Index: For vegans (and for vegetarians who don’t eat fish), Omega-3 fatty acids DHA and EPA can be very difficult to absorb in adequate amounts. This is why DHA/EPA, along with B12 and Vitamin D, are considered the “Big Three” for supplements for vegans to consider.
6. Zinc, Selenium, Iodine: I batch these together because they share a similar story: Unlike B12, Vitamin D, and DHA/EPA, these nutrients can be derived from plants. But for different reasons, zinc, selenium, iodine can be difficult to absorb or find in sufficient quantities, thus sometimes requiring supplementation.
7. Vitamin K2: K2 is essential for proper calcium management, helping to move calcium away from soft tissues, like heart and brain, and towards hard tissues, like bone and teeth. And unless you’re eating a Japanese dish called natto, you’re natto getting enough K2. (Note – Most tests will look at a functional marker for K2, since very little K2 is actually stored in the body and measurable directly.)
8. Iron (a.k.a Ferritin), total and TIBC: There’s much more to the story about heme and non-heme iron, and whether vegans can get iron as easily from plants. If you’re concerned, ask your doc to measure your blood levels.
9. Folate: An essential nutrient, folate (or B9), plays a key role in the conversion of homocysteine into methionine, utilizing B12 in the process. Goods news is that, according to the findings of the famous EPIC-Oxford study, vegans were found to have the highest levels of circulating folate when compared to omnivores and vegetarians. I still prefer to double check my folate levels because it helps to tell a more complete story of how my body is using B12.
For the Nerds Who Want More-Than-Necessary Details
New assays are being developed constantly. Depending on your health status and concerns, you may want to ask your doctor about what tests make sense for you.
For example, I’m particularly interested in looking at my specific nutrient status. There are a variety of ways to get a sense for how your body is using nutrients; what it might be struggling to absorb, convert, or otherwise utilize; or what might be missing from your daily diet. Work with your doctor to better understand what options are available to you.
I recently used the Genova Diagnostics NutrEval kit ($370 out-of-pocket cost, NMA has no affiliation). They send it to your house, although you need to visit a lab for the blood collection. Based on the metabolites in my urine along with the nine vials of blood, I was able to get a sense for everything from enzymatic activity to bacterial populations to heavy metal concentrations.
That’s just one example, and you may find something else to be better worth your money.
Interpreting Your Results
So you’ve gotten the tests, now what?
Most of these tests will come back with results about where you fall compared to the normal, healthy range. That can give you a general sense as to what could be a problem area.
But don’t stop there. Take your results to a doctor and have them help you interpret and address any abnormalities.
Where to Get Your Blood Tests
The first place to start is your primary care physician, who can order any of these tests, many of which will be covered by your insurance.
There are other means to acquire this data — like InsideTracker, Baze, or LifeExtension (which offers this vegan/vegetarian specific test). However, I prefer to engage a physician through this process in order to help analyze the results.
These web-based companies can make it easier to send in tests, but often remove you from engaging specifically with a physician to help analyze the results, and thus may mean you miss a red flag or misinterpret the findings.
(Note: Neither NMA nor I have any relationship with these service providers, nor can we speak to the effectiveness or accuracy of their tests.)
Let There Be Blood (Tests)
If there’s one thing I want you to take away from this post, it’s this: The best time to cure disease is before it happens.
We vegans consider ourselves healthy people. After all, for many of us health is a main driver for going vegan in the first place.
And because of that, we often neglect to actually peek under the hood and see what’s going on inside our bodies.
I know this first hand. So does my wife.
And had my dad used a blood test first, it could have saved our entire family a lot of anxiety (and the healthcare system a lot of cost)!
By engaging deeply in your health and by actively taking steps to improve it, you can save yourself a massive amount of time, pain, and money down the road.
Take it from a guy who is terrified of needles: It’s worth it.