What are the most important blood tests?

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Trevor
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What are the most important blood tests?

Post by Trevor »

I'm Apoe 4/4 and my senior Mom is Apoe 3/4. Long family history of Alzheimer's. My Mom hates asking doctors questions but I've been able after much work to convince her to ask her doctor for a few blood tests just to stay on top of her health markers. The problem is both my Mom and her doctor are resistant to running many tests, and my Mom is resistant to even asking for many. I look at the "The End of Alzheimer's" book and there is a dizzying level of suggested tests that I know I can neither convince my Mom or her doctor to run through as a whole. My question is, if I can only ask for say, a top 3 or a top 5, what would be the most important ones? I know that analogy that Alzheimer's is like a roof with 36 holes, but I'm only getting the chance to check a few here, so if you had to prioritize, which would you pick?
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Re: What are the most important blood tests?

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Trevor wrote: Wed Aug 17, 2022 9:52 pm I'm Apoe 4/4 and my senior Mom is Apoe 3/4. Long family history of Alzheimer's. My Mom hates asking doctors questions but I've been able after much work to convince her to ask her doctor for a few blood tests just to stay on top of her health markers. The problem is both my Mom and her doctor are resistant to running many tests, and my Mom is resistant to even asking for many. I look at the "The End of Alzheimer's" book and there is a dizzying level of suggested tests that I know I can neither convince my Mom or her doctor to run through as a whole. My question is, if I can only ask for say, a top 3 or a top 5, what would be the most important ones? I know that analogy that Alzheimer's is like a roof with 36 holes, but I'm only getting the chance to check a few here, so if you had to prioritize, which would you pick?
Hi Trevor,
Your mom is probably from the generation that didn't want to bother doctors and figured "no news is good news." It sounds like she and you have found a middle ground of looking for the best tests for her. Her doctor may be aware that Medicare only pays for certain tests, unless there's an indication of need--which they can sometimes find from family history. So here's a recommended list from an addition to our Primera few years ago from Dr. "Stavia". She, like you and I, also has ApoE 4/4 and is a practicing physician in a lovely country-- I trust her advice!
a. [Glucose and insulin Sensitivity]: HbA1c [measures average blood glucose over the last 3 months] fasting insulin, fasting glucose, 1 and 2 hour after eating (post prandial) blood glucose
b. [Cholesterol] Lipids - both basic (TC HDL LDL TG's) and advanced (LDL-p or apolipoprotein b)
c. Vitamin B12
d. Vitamin D3
e. TSH, T3, T4 (thyroid function)
f. Liver functions
g. Homocysteine
h. CRP (inflammation) (to define values under 1, a high sensitivity assay is used - denoted hsCRP) [Can indicate risk of heart disease]
i. Full blood count (FBC) also called complete blood count (CBC) in the USA, measures the red cells, white cells and platelets in the blood.
j. Ferritin (measure of iron stores but also goes up in chronic inflammation)
You may want to either talk with your mom's doctor (if you can go on the visit with her) or see if she will let you access her online patient portal to see past blood work. If she's always had good fasting glucose or low cholesterol, for example, then some of these may be less important. Some tests ("advanced LDL-P") are available through Diect to Consumer Lab test Options, where you buy the test and get an order to take to a lab near you (ex. Lab Corp or Quest). Vitamin B12 is something your doctor should be fine with testing, and if it's less than 500 you may want to get your mom some chewable "Methyl B-12" which is methylcobalamin and appears to be more readily absorbed by people with ApoE4 that the common cyanocobalamin in most drug store B-12 pills.
Sometimes it's good to just ask your mom: "Do you see changes over the last year that you wonder about?" Blood tests are great, but sometimes older individuals ignore changes in their vision or hearing that may be easily remedied, or changes in their balance that could be helped with some exercise or PT (or having fewer throw rugs on floors!).

Best of luck in conversations like these--and remember that your mom need to be able to say both "Yes" and "No" to feel like she is still independent.
4/4 and still an optimist!
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Re: What are the most important blood tests?

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Thank you so much for the thoughtful advice! I appreciate you taking the time out to write all of that. You're pretty great!
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SusanJ
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Re: What are the most important blood tests?

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Trevor wrote:I know that analogy that Alzheimer's is like a roof with 36 holes, but I'm only getting the chance to check a few here, so if you had to prioritize, which would you pick?
NF52's list is a great place to start, and most doctors will do a CBC and liver function test routinely anyway. Personally, I would also prioritize that list based on family history. Does anyone in your mom's family have heart disease? Then the lipids, homocysteine and CRP are critical. Did any of them have diabetes? Then all the insulin and glucose tests are important.

And sometimes it's easier to get doctors to test if there is a family history of something.

I'm sure your mom is grateful for your help navigating doctors, and good luck moving forward.
Last edited by SusanJ on Sun Sep 25, 2022 10:33 am, edited 1 time in total.
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Re: What are the most important blood tests?

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SusanJ wrote: Sat Aug 20, 2022 2:33 pm And sometimes it's easier to get doctors to test if there is a family history of something.
Why didn't I ever think of invoking my family history to get some of the tests I want? I will often say "I'm at risk for …" but clearly that's not as persuasive as "My father suffered from …"
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: What are the most important blood tests?

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circular wrote:Why didn't I ever think of invoking my family history to get some of the tests I want?
A little trick I learned in my masters in management program. If the conversation is going no where, you learn to come at it from a different perspective. ;)

It paid off after I had an OAT test and my former doctor was a bit surprised that the lab result for oxalic acid was off the charts. When I said, so that explains why 3 of 4 of my brothers have kidney stones, oxalates instantly became the focus of my plan going forward.
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Re: What are the most important blood tests?

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SusanJ wrote: Sun Sep 25, 2022 10:41 am
circular wrote:Why didn't I ever think of invoking my family history to get some of the tests I want?
A little trick I learned in my masters in management program. If the conversation is going no where, you learn to come at it from a different perspective. ;)

It paid off after I had an OAT test and my former doctor was a bit surprised that the lab result for oxalic acid was off the charts. When I said, so that explains why 3 of 4 of my brothers have kidney stones, oxalates instantly became the focus of my plan going forward.
How much did the OAT test cost? (I hate having to go through a functional medicine industry gatekeeper for information about my own body, which just makes all this stuff even more expensive.)

It's so great how much this test has helped you. I don't know if I'm being overly analytical, but my guess is that the test is best for learning off the chart results like yours, and that many of the things being measured fluctate frequently, so that values that are off, but not off the charts, may or may not say much without repeated testing for patterns. Do you think that would be correct?

I also wonder what the reference population size and background is. Their sample report indicates the reference range is based on age and sex.

These are all just questions I've pondered about this and other tests because money doesn't grow on trees, but I think off the charts results are worth the whole test, when one can get it, for revealing important interventions to try.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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SusanJ
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Re: What are the most important blood tests?

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circular wrote:These are all just questions I've pondered about this and other tests
Originally, my FL doctor did it to check gut health, neurotransmitters and methylation. OAT looks for metabolites of yeast, C. diff, etc and checks metabolites along the methylation pathway, among other things like toxic exposure, neurotransmitters and the like.

I can't speak directly to the fluctuation issue. I will note that many of my "normal" metabolites stayed pretty steady between the two I had. Not exactly the same value, but if the first test showed say, a value in the lower end of a range, the second one also fell in the lower range.

I definitely had some gut issues (it was about a year after an antibiotic treatment), which the test highlighted as high marker results, and we treated those. But my oxalate levels were like 3 times higher than the high end range. The oxalic values dropped from 278 to 94, (which is within range but on the high end) between the two tests after changing my diet and dropping Vitamin C, and has made a huge difference in greatly decreasing or totally getting rid of old symptoms. (I can still cause myself symptoms by overeating oxalates - an ongoing battle to find a diet that works and also helps me keep on weight. My NP said that oxalate problems are one of the hardest things for her to treat.)

I'm about to embark on getting out 3 small amalgams, so we'll see if the one toxic marker that was out of range, changes after that. I still have some methylation balancing to do, mostly by figuring out how to raise my B6 levels without side effects (mostly headaches). I also did a a Genova NutraEval about the same time as the second OAT, which also confirmed that I needed to up my B6.

I don't recall what the test originally cost and I can no longer access my FL doctor's portal. My NP has a monthly fee and she arranges deals to cover labs like this that come out of my monthly fee ($89). I did go to the Great Plains website and you can order online without a doctor at https://greatplains.mymedlab.com/great- ... ds-oat-gpl for $325.

I'd view it as a "do it if you're stuck" test, to track down the stubborn stuff to fix. Maybe plan to test once every year or two, until the results of your treatments/changes show you on an even keel.

I hear you about money not growing on trees. I also added up my supplements costs the other day and I'm an expensive person to keep healthy. ;)
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Re: What are the most important blood tests?

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SusanJ wrote: Sun Sep 25, 2022 3:58 pm I don't recall what the test originally cost and I can no longer access my FL doctor's portal. My NP has a monthly fee and she arranges deals to cover labs like this that come out of my monthly fee ($89). I did go to the Great Plains website and you can order online without a doctor at https://greatplains.mymedlab.com/great- ... ds-oat-gpl for $325.

I'd view it as a "do it if you're stuck" test, to track down the stubborn stuff to fix. Maybe plan to test once every year or two, until the results of your treatments/changes show you on an even keel.

I hear you about money not growing on trees. I also added up my supplements costs the other day and I'm an expensive person to keep healthy. ;)
Thanks for adding more detail about your results Susan. That's hopeful that perhaps many of the metabolites tested by OAT are fairly stable assuming fairly stable inputs.

I've never heard of a monthly fee arrangement that includes at least some testing. That's an interesting, budgeter-friendly approach. Hopefully this option is growing.

I know what you mean about the cost of supplements. One way to approach this is to consider: In some cases, if we look closely enough, we're making educated guesses in the absence of solid evidence to show that particular supplements significantly move one dial and/or another in our unique physiology. If educated guesses also appear to suggest that a "recommended dose" may be supra-physiological, sometimes extraordinarily so (someone is, after all, running a business behind the supplement), then one could save some money just by taking less than the recommended dose.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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