Baseline labs to help men prevent disease

It's crucial for men over 30 to have baseline blood tests done to detect the most common killers because you manage what you measure.

Here are three scenarios where labs are useful. This article focuses on #3.

1. You feel like crap so we order labs to help make a diagnosis.
2. You feel fine, but someone in your family has a history of heart disease. Your risk factors warrant earlier exploration than what's standard for everyone else.
3. You don't have any symptoms, but you don't want symptoms either. You want to understand your body using longterm trends while you're healthy so you can catch the beginning stages of chronic disease. You want to feel even better, and stay that way.

Why Blood Work Helps

Blood markers aren't perfect, but they do provide data beyond just relying on subjective information like symptoms. The last thing you want to do is wait until you have diabetes or a heart attack before the lightbulb goes off that something is wrong.

Men, and the men in our lives, need to monitor objective data from blood work to create optimal health. After all, the most effective way to survive diabetes, prostate cancer, or cardiovascular disease is to prevent it from ever happening. Simple enough, but it's challenging because there are often no symptoms with prediabetes or high cholesterol, making it mandatory to do some detective work using markers only found in your blood.

Also, I've noticed that for most men, seeing a HbA1c of 6.4% or an LDL of 150 puts enough fear in them to change their lifestyle and start taking control of their health.

Labs to Prevent Heart Disease

Heart disease, by far, kills more Americans than any other illness. 1 in 4 men die from coronary artery disease, heart attack, or stroke. Also, according to the CDC, about a quarter of all heart-disease-related deaths occur in men ages 35 to 65, which is unnecessarily young.

Research also shows that if your sibling has heart disease then you have about a 40% risk increase of heart disease, too. And if one of your parents gets heart disease at a young age then you have a 60% to 75% risk increase! The prevalence of heart disease in America is why I monitor blood pressure in every patient, and ask everyone about their family health history. Even if you're asymptomatic and otherwise healthy.

I also recommend these labs to monitor:

Cholesterol and Lipid panel: These show your cholesterol levels as well as your level of triglycerides. There is a lot of nuance here that your doctor can guide you through, but both tests are fundamental to assess your current risk for developing heart disease.

Apolipoprotein B (APO B): This is the newest lab on the list for me, and I'm excited about it's potential as a alarm for coronary artery disease (CAD). What's also interesting is how some people with CAD can have normal LDL cholesterol, but their APO B is elevated. You would miss that diagnosis if you don't check APO B.

hsCRP: This inflammatory marker is like a check-engine light for your heart. It's used to predict sudden cardiac death among healthy people with no history of heart disease.

Labs to Prevent Diabetes

While writing my newsletter last week, I came across the statistic that 1 in 3 Americans have prediabetes. It's alarming, but not surprising considering french fries are the most eaten vegetable in the US. What did surprise me, however, was that roughly 80% of Americans with prediabetes don't even know their blood sugar is trending toward turbulence. They're losing the window to prevent the damage that uncontrolled blood sugar has on blood vessels, nerves, kidneys, feet, and on and on.

Comprehensive Metabolic Panel (CMP): This is the most fundamental lab on this list and includes a snapshot of your blood sugar at the time of the draw. It's important to be fasting before this test to give you an accurate depiction, but it's only reflective of a single day so it's not diagnostic.

Hemoglobin A1c (HbA1c): This lab gives you a bigger picture of what your blood sugar has been doing for the previous 8-12 weeks. If your HbA1c is elevated above the normal range, then it's an accurate sign that your blood sugar is out of control.

Fasting insulin: This marker is rarely ordered, but it should be. High levels of insulin in your blood are associated with type 2 diabetes, obesity, heart disease, and all other metabolic disorders. You can also have normal blood sugar, and high insulin levels, which would be missed without this lab.

Labs to Prevent Cancer

For men, the leading causes of cancer-related deaths are lung cancer, prostate cancer, and colorectal cancer. Only the prostate has a blood marker allowing for early detection, which means you don't have to rely on symptoms alone. It's also easier to get than a colonoscopy.

Prostate Specific Antigen (PSA): PSA is used as a tumor marker for prostate cancer, but it's typically only ordered before you're 40 if you have symptoms. Levels vary based on the degree of normal, hyperplastic, or cancerous prostatic tissue, but overall it's a sign that something needs to be addressed. The problem with PSA is that it's not specific for cancer, and an elevated PSA can occur in a number of conditions. Additionally, a PSA result in the normal range does not rule out the possibility of prostate cancer. Obviously, this is when it's helpful to have your doctor's insight.

Bonus Labs for General Health

TSH (plus fT4, TPO and TG antibodies): Do you have bone-numbing fatigue, even on days when you sleep well? If so, your thyroid hormones could be off. Consider testing for autoimmune thyroiditis with TPO and TG antibodies, too, because it's common and, in my opinion, it dictates the treatment plan.

Vitamin D: Chances are you're deficient in Vitamin D because most American's are. This is the Swiss army knife of vitamins–it supports immune health, regulates mood, and even helps with weight management. You don't want to be deficient, but luckily it's easy to fix by taking, you guessed it, Vitamin D. The trick is finding out how deficient you are, so we can dose accordingly.

Male hormones (Total testosterone and free Testosterone, Estradiol, LH and SHBG): Another important set of labs if you're fatigued, or experiencing low-libido or erectile dysfunction. Again, these numbers are useful to know when you're healthy too, because you want to know which direction you're trending as you age. It's normal, for example, for testosterone to decrease as you age, but what's your normal?

ESR and CRP: These are general markers used to rule out active inflammatory diseases like autoimmunity. If these levels are high than more specific labs are indicated. These markers are more helpful if you have symptoms.

Why aren't all these labs standard of care?

Health insurance providers in the US will only cover what they deem is "medically necessary" and insurance has historically prioritized sick care. They don't give much attention to prevention, and they definitely don't care about optimal. This subjective approach blocks most people from even knowing their Vitamin D levels, let alone if they're trending toward heart disease. Thankfully, that's changing, even if you don't have health insurance or a doctor you trust.

DIY options where you pay out of pocket are now possible. Sure, it's complicated to interpret the findings, but at least it's an option. Here are a few reputable sources:

LabCorp On Demand: You choose your tests, go into a Labcorp for a draw, and they will send you the results. Not all labs are available this way, but the basics are covered. I would only recommend this if you already have a doctor, and you don't have any alarming symptoms (I'm accepting new patients).

Thorne Health Tests: Thorne offers several at-home tests that don't require a blood draw. You can test your thyroid hormone levels with a finger stick or your gut health with a stool sample. They also have a Weight Management test that will measure hormones, Vitamin D, and blood sugar levels. My favorite part of this option is that they will send you an analysis and recommendations for improving your diet, exercise, and supplement regimen.

Ultra Lab Tests: These guys can run any lab you want, so all you need is to find a place for a blood draw and pay-up. You could always order labs from here, and then ask your doctor if they offer an appointment with the sole purpose of reviewing lab results. Again, we do this at the clinic I work for in Montana, and it's usually the cheapest appointment option for patients.

Takeaway

As a clinician, I've noticed that men tend to ignore symptoms until they get out of control. That numbness in your left foot that annoyed you for years was actually a warning sign that you have diabetes. This is part of the reason why guys have a shorter life expectancy than women because of course it's easier to bury your head in the sand than to deal with potential health problems. Maybe this is why men are at a higher risk for heart disease, cancer, COPD, diabetes, and suicide (but less likely than women to get Alzheimer's, so hey, we got that going for us). As the guy who famously didn't go to a doctor until his appendix burst, I get your hesitancy.

This is where blood work comes into play. Baseline labs provide useful data that serves as a heads-up so you can prevent a crippling disease from ruining the last decade of your life. You don't even need to go to a doctor (yet) if you don't want to. The point is to start monitoring now, while there's still time to make changes.

Also, this list is just the beginning. There are many other labs and tests that might be more relevant to you as an individual that didn't make the cut, which further emphasizes why it's important to have a doctor guide you through this. A DEXA scan for bone density; a FOB test for early detection of bowel cancer; a urinalysis to detect kidney disease; ferritin and B12 to detect nutrient deficiencies. There's a lot to monitor, regardless of what your insurance says.

Medicine is constantly evolving. This list of labs may be irrelevant in 5 years, so I plan to update as the science improves and my opinions mature.