Before Purchasing Another Supplement, Consider These Lab Markers First

Many of the women who walk into my practice are already overextended in many areas of their lives: career, caregiving, household, relationships, you name it. They know their health should be a priority, but unless taking care of it feels manageable, it will keep falling to the bottom of their to-do list.

Genetics, quick fixes, or both?

Life moves fast, and we want our health solutions to move just as quickly.

One woman is searching for the quickest fix she can find: injections, a supplement stack, or a biohack. Except her body will wholeheartedly disagree. Likely, the quick fix will fall short, since what she’s looking for probably can’t be found in her online shopping cart.

Another woman is all-consumed with her genetic predisposition. Given that her grandparents had high cholesterol, her mom has diabetes, and her siblings are overweight, she is convinced that those diseases are her destiny.

Society is not suffering from a prescription-medication deficiency, and as such, we shouldn't assume every symptom represents a supplement deficiency either.

You don’t know what you don’t know

If cereal was a breakfast mainstay when you were growing up, why would you even consider eggs as an option, let alone the possibly better one? If mom and dad didn’t model physical activity outside of gym class, why would exercise be part of your everyday life?

We like to gloss over the diet and lifestyle portion of health because it isn’t quick or easy. Instead, we skip that foundation and turn to other interventions, including supplements that worked for a friend but may not work the same way for us.

Both women, one seeking a quick fix and the other fated to her genetic history, are coming from different starting points. Both are making decisions based on broad information or assumptions. Instead, both women should use objective data to determine the necessary interventions they need to achieve their desired outcomes. This is where testing is useful.

Where testing fits

Amid the obsession with quick fixes and genetics, another health and wellness trend has taken flight: more testing. These include whole-body MRIs, laundry lists of blood tests, and obscure testing methods. The reality is, if you’re searching hard enough for something, you will find it, but it doesn’t mean it’s a life-altering something.

More testing doesn’t necessarily equate to more clarity; it potentially drives more questions. Data without proper context and interpretation is just a bunch of numbers without a purpose. When having testing or blood work ordered, it must answer two questions:

• Does this marker investigate a concern, establish a meaningful baseline, or monitor existing trends?
• Will the results change what needs to happen next?

If we can’t explain why we’re ordering it or what we plan to do with the information, then we should question whether it belongs in our workup at all. Otherwise, they will be fluffy numbers that may blur more significant markers.

Another potential issue with too many labs or testing is whether they’re being interpreted in isolation or in context with each other. I see individual lab numbers as pieces of a whole puzzle, with less significance on their own and a greater role to play when evaluated together.

Five labs to establish a health baseline

Many women walk into the office with functional health reports and a pages-long interpretation of each independent value. This can be nice, but these women are left more confused than before they got the blood work. They feel as though everything is wrong, when it is more nuanced than that.

Consider a fasting blood sugar of 95. This falls within the normal laboratory range and, on its own, may not raise much concern. But if we also run a fasting insulin and it comes back elevated, suddenly we have more context: her body may be working much harder to maintain that seemingly normal blood sugar.

The opposite can be true. A woman may see a total cholesterol above 200 and immediately assume something is wrong, but cardiovascular risk is not determined by total cholesterol alone. Additional markers such as ApoB and Lp(a), family history, and overall cardiovascular risk can help provide a much clearer picture. Current cardiovascular guidelines specifically incorporate ApoB and Lp(a) as additional tools for refining risk assessment and not just total cholesterol alone.

In my practice, more important than isolated lab values are how they have changed over time and how they relate to the overall clinical picture, such as symptoms. A lab’s reference range may be help diagnose disease, but it isn’t necessarily helpful for identifying opportunities for earlier intervention.

This is why I’ve created a list of five labs I believe deserve consideration when establishing a woman’s annual health baseline. When ordered before there is an “issue,” we can establish health baselines, identify patterns sooner, and separate the fluff from the fine points.

1. Fasting insulin

Common misconception: “My fasting glucose is normal, so my blood-sugar regulation is fine.”

What is it?

Insulin is the hormone that helps move glucose (sugar) out of the bloodstream and into cells for use or storage. A fasting insulin gives you information about how much insulin the body is producing while fasting.

Why do you care?

Studies show predictive relationships years before any changes in fasting glucose or even an A1C. This is often a smoking gun for individuals struggling with weight loss because everything else has “looked good” so far, until this lab is ordered.

What value does this bring?

It may seem that it shouldn’t matter how much insulin the body produces to ensure normal blood sugar, but we need to evaluate this on a global scale.

At some point, if each of us worked our jobs without a break, we would fatigue; the same is true for your pancreas. It can only handle so much before it struggles to keep up, which is why we should be more aware of our  insulin status sooner.

2. Fasting triglycerides

Common misconception: “The only numbers that matter in my lipid panel are total cholesterol and LDL.”

What are they?

Triglycerides are fats carried in the bloodstream and represent one way the body transports and stores energy.

Why do you care?

This is the unsung hero of the lipid panel. While everybody is consumed with total cholesterol and LDL, triglycerides can be rising, and nobody is paying attention. Triglycerides are just as significant a marker as the other two more revered ones.

What value do they bring?

When elevated, this can be an indirect measure of how many unutilized carbs are in one’s diet, both in consumption and activity levels.

3. Full thyroid panel

Common misconception: “My TSH is fine, which means my thyroid is fine.”

What is it?

TSH plus T4 and T3, with attention to free and/or total hormone depending on the clinical situation. TSH reflects pituitary signaling to the thyroid; T4 is the principal hormone secreted by the thyroid, while T3 is the more biologically active thyroid hormone. Binding proteins also affect total hormone measurements.

Why do you care?

Your thyroid is based on feedback rather than one isolated number.

This is a common source of contention within the medical community, largely because the standard of care has established that TSH is to be used to diagnose an under- or overactive thyroid gland, so why would you need to know anything else?

What value does this bring?

Hormones are not siloed; they converse with each other by creating feedback loops that tell the body to make more or less of something. In the case of the thyroid, seeing the interplay of the other hormones (T3, T4) helps to give context to the entire picture, rather than just a piece of it.

In my practice, I've seen low T3 occur alongside low iodine status, and when the iodine deficiency is corrected, I have watched the T3 improve as well. That is one reason I’m unwilling to dismiss T3 simply because it is not routinely emphasized in hypothyroidism guidelines.

4. AM Cortisol

Common misconception: “Cortisol is bad.”

What is it?

Cortisol is an essential adrenal glucocorticoid involved in glucose regulation, blood pressure, immune activity, metabolism, and the body's response to physiological demands. It follows a circadian rhythm, normally being higher in the morning and falling throughout the day. Never interpret stress hormones in a vacuum.

Why do you care?

Contrary to cortisol’s bad reputation, it is a requirement for life. Also contrary to common assumption, cortisol does not have to be elevated to indicate a stressed-out state; however, this can happen during acute stressful situations, such as running late or being stuck in traffic on the way to the blood draw.

Salivary cortisol is my preferred medium, but serum is still an easy enough marker to include for more regular assessment given cost-effectiveness and accessibility.

What value does this bring?

A morning serum cortisol can provide useful information in appropriate clinical contexts, most notably when evaluating adrenal insufficiency. With that said, a single AM cortisol is a snapshot in time, which is why I prefer to have patients also have a DHEA-S drawn in tandem.

5. DHEA-s

Common misconception: “Cortisol is the only adrenal hormone worth looking at.”

What is it?

DHEA-S is an adrenal androgen. DHEA can serve as a precursor for downstream androgen and estrogen synthesis, and DHEA-S provides a relatively stable circulating marker of adrenal androgen production

Why do you care?

Because if you're interested in adrenal steroid physiology, cortisol only gives you one part of that picture. DHEA-S gives you information about another adrenal steroid pathway.

What value does this bring?

Are you writing checks that your body can’t cash?

It can add context regarding adrenal androgen production and, when clinically appropriate, can be interpreted alongside symptoms, other sex hormones, and cortisol rather than being treated as an isolated “good” or “bad” number.

Where patient evaluation begins

These five markers help me formulate the next steps for each patient. Where many may think this is where evaluation ends, this is where mine begins. Sometimes we do need to dig deeper and use additional assessments (saliva, urine, stool), but these only make sense in the context of preliminary bloodwork.

The treatment plan begins to unfold here and allows for individual refinement as I discern the dietary, supplement, and lifestyle interventions needed to achieve my patient’s goals.

If you’re feeling like you’re coming up short in meeting your health goals, let’s talk about it here!

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