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Why You Need Comprehensive Blood Testing (Even if you think you’re healthy)

By Tom Nikkola, CSCS, CISSN, Pn1

When you look in the mirror, do you see a body that suggests you’re healthy or unhealthy? Do you look in the mirror and say to yourself, “I’m at least in better shape than…” Do you look in the mirror and convince yourself you’re healthier than ever? Do you totally avoid the mirror, hoping that if you don’t look into it, you won’t have to admit you need to take better care of yourself?

We often identify the “healthiness” of our bodies by how we look in the mirror. But whether your body looks the way you want or not, the mirror is a poor way to measure your health.

As a fitness professional, I couldn’t imagine working with someone who didn’t start with a comprehensive blood test panel. There are just too many things that can go awry with one’s metabolism to not check it out at the beginning of a fitness program.

To prove the point, we randomly grabbed the lab data from 430 people who completed our Longevity & Vitality Premium lab test.

Of the 430 people, 163 (38%) were male and 267 (62%) were female.

While I expected to see a convincing percentage of the people with some concerns, I was really surprised at how many had issues you might not expect in an exercising, proactive group of fitness club members.

I look at the results of the testing and am even more convinced of the importance of comprehensive lab testing as a part of any health and fitness program.

Whether you get such testing done through your doctor or order it directly through your fitness professional, as we offer at Life Time, the key thing is just to get the lab testing done.

Lab Testing Results Summary

The following table displays some of the markers tested in the Longevity & Vitality Premium lab test panels. For each marker, you’ll see the percentage of the total group (T), percentage of males (M) and percentage of females (F) who fell into each risk category. The reference ranges used are included in the references section. [ix]

Below the table, I’ve shared some interesting insights from the results. These insights highlight some of the reasons basic lab testing may not be sufficient to identify health issues people face. It also reinforces the need for even “health-conscious” people to get their lab work done periodically.

Low Risk (%)Moderate Risk (%)High Risk (%)
C-Reactive Protein464944293327251829
Vitamin D323484648495249
Free T3507138452756526
Free T4858784131213213
Normal Range (%)Out of Range (%)
Free Testosterone6337

LDL particle numbers can be more valuable than LDL cholesterol measures

You are probably familiar with standard cholesterol testing – total cholesterol, LDL cholesterol, HDL cholesterol, etc. While the testing is inexpensive and easy to administer, it doesn’t tell the whole story of one’s lipid-related cardiovascular risk.LDL Particle Numbers Can Be More Valuable Than LDL Cholesterol Measures

The difference comes in measuring LDL cholesterol, and actual LDL particles. Low-density lipoproteins carry cholesterol around in the blood. We can measure the amount of cholesterol that’s being carried, or we can measure the number of particles carrying the cholesterol.

To understand the difference, consider this example using cars on a freeway:

Our goal is to control congestion on the freeway. The more congestion there is, the more likely it is that there will be accidents (in the cardiovascular system, the more particles there are, the more likely it is there will be plaque development).

If there are 1000 cars on the road (LDL particles), and each car has four people in it (cholesterol), there will be 4000 people on the road. The count of people on the road is similar to the measure of LDL cholesterol. We know there are a lot of people, but if they’re all carpooling, it may not be much of a problem. But if we only count people on the road, we may overlook the more important risk of congestion on the freeway. If we assume that there are always four people to a car, we’ll make bad decisions about the risk of traffic congestion. So we need to count the cars on the road.

If we find there are 4000 cars on the road, we know there will be a greater risk of traffic congestion. If we count the number of LDL particles, we get a sense for the risk of some of those particles finding their way into the walls of vessels and causing plaque development.

The more particles there are, the greater the chance of plaque development.

NMR testing is a specific form of blood lipid testing that counts the number of LDL particles. We began offering this test a few years ago, as part of the Longevity & Vitality testing as well as our Cardio Metabolic Risk test.

In many cases, cholesterol levels and particle number go up or down together. In these cases, standard cholesterol testing works well.

Some people have elevated cholesterol, but low LDL particle counts. In these cases, people may be told they have an elevated cardiovascular disease risk when they really don’t.

And in still other cases, people may have low cholesterol levels, but elevated LDL particle numbers. For these individuals, standard cholesterol testing suggest they are at a low risk of cardiovascular disease, when they actually have an increased risk.

To be clear, this is still just one risk factor. Good healthcare practitioners always look at particle numbers, triglycerides, blood sugar measures, inflammation, iron and other risk factors before making a quick decision. One elevated risk factor by itself doesn’t suggest someone is at serious risk of cardiovascular disease.

In the population we reviewed from the Life Time membership base, we saw that half of men and more than one in four women were in the “high risk” category for LDL particle counts. Only 25% of women and 7% of men were in the low risk category.

In general, measuring LDL-C made the population appear to be at a lower risk of cardiovascular disease than then LDL-P was measured. As you can see, triglycerides were also a greater concern than LDL-C as well.

Good fasting glucose levels can be misleading

Fasting glucose is measured almost anytime you have blood drawn. Proper blood sugar management is really important, but fasting blood glucose levels aren’t a great indictor of one’s ability to manage blood sugar. It’s a decent first step, but other related testing provides more accurate indication of blood sugar management.

Fasting blood sugar levels can change dramatically, within hours. Most people, even those with insulin resistance, show relatively normal blood sugar levels after an overnight fast.

Hemoglobin A1c (HbA1c) and insulin tell a more powerful story of blood sugar regulation.

From the group of 430 people, we saw that almost 80% of people tested had optimal fasting glucose levels, but more than 93% had elevated HbA1c and over half had elevated insulin levels.

Fasting blood sugar measures sugar concentration in the blood after an overnight fast. It is highly variable, and can be lowered easily by refraining from carbohydrates for several hours, such as during sleep.

Glycated hemoglobin, or HbA1c, identifies average blood sugar levels over the previous 2-3 months. The more sugar you eat, the more of it that sticks to the hemoglobin. This is called glycation. A higher percentage of glycated hemoglobin suggests that carbohydrate or blood sugar levels have been consistently elevated. You can’t fool this test as easily as you can the fasting blood sugar test.

Insulin levels rise when the body’s cells become less sensitive to insulin. When blood sugar levels are consistently high, the body releases insulin to help remove the excess sugar from the blood. Over time, if blood sugar levels are consistently high, the cells respond less effectively to insulin. This is a warning sign of developing insulin resistance, which precedes type II diabetes.

Again, when you look at the numbers, the majority of people would have thought they were fine by looking at fasting glucose alone.

The majority of people were not fine when looking at HbA1c and half of them had elevated insulin.

This is pretty serious, as blood sugar problems are not only tied to obesity and diabetes, but are also associated with cognitive problems, certain cancers and other health problems.

Is it possible these people were just beginning their health and fitness journey, and these numbers are based on poor dietary choices in the past? Possibly.

Is it also possible that these individuals exercise regularly, but eat an excessively high-carbohydrate diet? Yes.

Chronic inflammation is more common than  we thought

Chronic inflammation is considered to be one of the driving factors in development of cardiovascular disease. It may also play a role in negatively impacting immune function, recovery from exercise and could lead to other degenerative diseases.

C-reactive protein and homocysteine are the two most common markers for testing inflammation in the body.

Again, when we look at a group of health club members, we’d expect to see more moderate levels of inflammation. Once again, it was a surprise to see that less than half of the population had optimal C-reactive protein levels and less than one-third had optimal homocysteine levels.

One marker alone shouldn’t be viewed as a major threat to one’s health, but high inflammatory markers plus high cholesterol or LDL-particles could become warning signs. There was not a significant difference between men and women, either.

Although it is not necessarily an inflammatory marker, a high level of ferritin is also a major cardiovascular risk factor. Pre-menopausal women are far less likely to have elevated ferritin, as blood loss during their period helps keep ferritin levels in check.

As you can see, almost two out of three males had high ferritin levels. Donating blood every 2-3 months is the easiest way to help maintain healthy ferritin levels.

Suboptimal vitamin D in 97% of people

The results from the vitamin D testing were not surprising to me. What is surprising is the number of people I talk to who don’t get their vitamin D levels tested and who don’t supplement with vitamin D.

Only 3% of the group had optimal vitamin D levels!

Vitamin D really isn’t a vitamin at all. It is a hormone, or pre-hormone.

Vitamin D is critical in hundreds of different pathways in the body. Low vitamin D levels are associated with metabolic syndrome,[i] elevated cholesterol,[ii] sarcopenia,[iii] cardiovascular disease,[iv] dementia,[v] and many other conditions.

Vitamin D is also critical for bone health and seems to play a role in muscle size and function.[vi] Because it may influence muscle function, it also seems to play a role in improving insulin sensitivity.[vii]


Dehydroepiandrosterone (DHEA) is a hormone precursor to the body’s sex hormones. It was fascinating to see that most people were outside the ideal range for DHEA.

Elevated DHEA can occur from supplementing with DHEA itself. It can also be elevated in women with polycystic ovarian syndrome (PCOS). Because DHEA affects androgenic hormones, the high DHEA could lead to undesirably high levels of testosterone in women.

Low DHEA occurs as a response of chronically high levels of stress and adrenal dysfunction. In this case, those who seem to do everything right with exercise and nutrition, but are constantly exhausted from stress find it difficult to recover. If DHEA is low, it will make it impossible to manufacture testosterone, which is necessary for recovery.

Measuring DHEA alone is not as valuable as assessing it in combination with sex hormones and cortisol, which are included in Longevity & Vitality tests as well as the sex hormone tests we offer.

TSH in Men and Women

Thyroid dysfunction occurs in women at a rate of about three times that of men. But that doesn’t mean men should overlook the significance of thyroid function. In the group we reviewed, the rate of abnormal TSH levels was similar in both men and women. There was a greater difference in abnormal Free T3 levels.

Subclinical hypothyroidism may lead to elevated cholesterol levels, LDL particle numbers and increased cardiovascular disease risk.[viii]

Low thyroid levels have a significant effect on metabolic rate as well.

Low thyroid levels limit a process called mitochondrial biogenesis. Basically, when thyroid levels are low, the body can’t develop mitochondria in the muscle cells. This makes fat burning more difficult, and limits one’s endurance performance.

Those with low thyroid will find it difficult to improve their running, cycling or other endurance performance levels.

In addition, low thyroid levels make it difficult to buffer acid levels in muscle tissue and produce ATP. As a result, strength improvements are limited as well.

Those with low thyroid may try as hard as anyone else while exercising, but see a fraction of the progress, which can be mentally difficult.


One could argue that 430 people is a relatively small population. I agree. But if you were one of the 430, wouldn’t you want to know if you had some stuff to work on?

These were just some of the markers measured in our lab testing. There were a number of others that were out of range in a large portion of the population as well.

The key point is that no one should assume he or she is healthy by how they look or feel. Comprehensive blood testing tells the truth of what’s going on inside.

Don’t make assumptions about your health when you have the opportunity to know for sure. Talk to your doctor about a complete lab assessment or order the testing through your Life Time Fitness Professional. You can even use your Health Savings Account or Flexible Spending Account.

Read more about what’s included in the lab test options.

 Thanks for reading. If you learned something new, please share the post on your favorite social media network.

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[i] Huang CY, Chang HH, Lu CW, Tseng FY, Lee LT, Huang KC. Vitamin D status and risk of metabolic syndrome in young adults. Clin Nutr J. 2014 DOI:

[ii] Qin XF, Zhao LS, Chen WR, Yin DW, Wang H. Effects of vitamin D on plasma lipid profiles in statin-treated patients with hypercholesterolemia: A randomized placebo-controlled trial. Clin Nutr. 2014 DOI:

[iii] Park S, Ham JO, Lee BK. A positive association of vitamin D deficiency and sarcopenia in 50 year old women, but not men

[iv] Weyland PG, Grant WB, Howie-Esqivel J. Does Sufficient Evidence Exist to Support a Causal Association between Vitamin D Status and Cardiovascular Disease Risk? An Assessment Using Hill’s Criteria for Causality. Nutrients. 2014;6:3403-3430

[v] University of Exeter. Link between vitamin D, dementia risk confirmed. ScienceDaily. ScienceDaily, 6 August 2014

[vi] Kottler ML. Is Vitamin D a Key Factor in Muscle Health? Endocrinology. 2013;154(11):3963-3964

[vii] Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The Roles of Vitamin D in Skeletal Muscle: Form, Function, and Metabolism. Endocrinology. 2013;34(1):33-83

[viii] Wang J, Ma X, Qu S, et al. High prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China. Exp Clin Cardiol. 2013;18(1):e16-e20


Low Risk (Optimal)Mod Risk (Sub-Clinical)High Risk (Lab Out of Range)
HbA1c4.8-4.995.0-5.6<4.8 or >5.6
Insulin2.6-7.998.0-24.90<2.6 or >24.90
C-Reactive Protein<1.01.0-3.0>3.0
Vitamin D80-10030-79<30
DHEA500-70131-499<30 or >701
Free T33.0-4.02.30-2.99
Free T41.0-1.50.80-0.99
In RangeOut of Range
Estrone12-72<12 or >72
Free Testosterone6.8-21.5<6.8 or >21.5
Ferritin30-400<30 or >400
The posts on this blog are not intended to suggest or recommend the diagnosis, treatment, cure, or prevention of any disease, nor to substitute for medical treatment, nor to be an alternative to medical advice. The use of the suggestions and recommendations on this blog post is at the choice and risk of the reader.
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