4 Vital Lab Tests Your Doctor Won't Order (But I Will!)

 Four vital lab tests your PCP won't order, but I will! These are lab tests that aren't typically ordered by most PCPs, primary care providers, and because I don't want you guys to succumb to stress, I'm also going to share my list of foods, supplements, and prescriptions that can improve these levels. As a little bit of background, Most physician visits out there last about 15 minutes or less. And this is pretty much driven by the fact that there is a glut of patients and not enough primary care providers and health insurance companies are only willing to pay a doctor for each visit. So many primary care providers are consigned to filling up their schedules just to, you know, make ends meet. cover overhead. Upshot of this, the second and third degree effects of this are doctors, nurse practitioners, PCPs are doing the very minimum to get you going. They really aren't able to really do a deep dive into your health. And unfortunately, it's only going to get worse. There's going to be a projective shortage of, of about 124, 000 providers out there in 2034, which, you know, at the end of the day is really bad for patients. So one marker that I typically check that I've noticed a lot of primary care providers won't check is vitamin B12. B12 plays an important role in producing cell energy, formation of red blood cells, as well as functioning in your nervous system. So particularly in terms of learning and memory, B12 is really important for maintaining DNA synthesis in many cells. And if you don't do this, you can get abnormal red blood cells. There's a lot of causes for a low B12. There is a particular condition where some people develop Antibodies to this factor called intrinsic factor. Intrinsic factor is a special factor that helps you absorb B12 in the gut. And if you have an antibody against the factor, you may develop what's called pernicious anemia. Another cause is malabsorption. A lot of people are getting gastric bypass or obesity surgery. And if you bypass The stomach may not necessarily have this special intrinsic factor available, so many patients who have gastric bypass surgery end up with B12 insufficiency. Now the most common reason though is dietary insufficiency. Usually I see this a lot with people who have like a vegan diet, having more than two drinks a day, sometimes certain medications like heartburn medications, even metformin. There's a particular gene mutation that is gotten a lot of press recently, methyl tetrahydrofolate reductase or MTHFR. If you have this particular mutation, you may not be able to absorb B12 appropriately because you won't be able to methylate. For these individuals, it's really important to get a certain form of B12. Cyanocobalamin is typically used in most supplements because, well, it's cheaper. It's a synthetic form, but the issue with it is it's not as readily absorbed, and if you have an empty HFR gene mutation, it's going to be really hard to absorb that. You want to choose the methyl cobalamin form. Even if you get your B12 tested, you ideally want it a little bit higher than what's considered normal. Normal is anywhere between 550 to 800. There's actually a lot of research out there suggesting that higher B12 concentrations can improve. Athletic activity. We think it's primarily because of the increased red blood cell and oxygen carrying capacity. It allows you to work out longer and and have more functional exercise capacity. And then the other thing I get a lot is whether or not patients should take intramuscular B 12 or oral B 12. There is a concern that if you have a gastric bypass. Again, you're bypassing the stomach, you're not being exposed to that special protein, the stomach secretes intrinsic factor, you may not be able to absorb it appropriately. In those situations, yeah, maybe intramuscular B12 is a good idea where you inject it. But for the most part though, taking oral B12, particularly if it is the methyl Cobain, not the ano cobain. The methyl cobain seems to work well. The very last thing, of course, is you wanna make sure that you take an appropriate amount. I typically encourage patients to take at least a thousand micrograms of the methyl cobain form of B 12. Our ancestors probably ate a lot more magnesium than we do today, primarily due to the fact that, you know, soil quality is better. Obviously ate a lot less processed foods, so you probably didn't have as many issues as patients have today. Magnesium is a very important electrolyte that's involved in hundreds of processes like energy production, protein synthesis, muscle and nerve function, blood glucose control, and even blood pressure. A magnesium deficiency can cause fatigue, muscle cramps, anxiety, and depression, most importantly in a regular heartbeat. Why do we have magnesium deficiencies? Standard American diet, Eartha. The SAD. Yeah, that's the acronym we use. It only provides 50 percent of recommended daily analysis of magnesium. So, diets that are high in refined sugars, like processed foods, high in saturated fats, if they drink frequently, if they drink a lot of coffee, even carbonated beverages, they tend to reduce magnesium absorption. If you're under a tremendous amount of stress, that can actually utilize magnesium up. And if you have like GI issues, like prolonged diarrhea, you can get decreased magnesium. The recommended daily allowance is 420 milligrams, but typically I like to see patients take a bit more than that. So I like to see anywhere between 800 to 1000 milligrams and I usually split it up into two doses. You want to use a particular form. Now there's lots of different esters of magnesium. This is something that's kind of confusing. There is aspartate, citric. I personally prefer the magnesium glycinate because it seems to be the most easily absorbed. And it seems to go through the blood brain barrier and can be useful in terms of neurologic health. Oxide is the most common form of magnesium that you see in many supplements and they're cheaper than ones that you might find at like, you know, big box stores, right? I am not a big fan of it because the absorption is far worse than... Gluconate or citrate. You don't have to use supplements. You can get magnesium from a variety of sources. The biggest sources I see are in nuts like pumpkin seeds and chia seeds, almonds, but also vegetables like spinach and avocado. So those would be things that I would consider. Encourage people to look into. Insulin like growth factor one. The IGF 1 is a protein that is produced in the liver through stimulation of growth hormone. You typically see higher IGF 1 levels during a couple of periods in life right after birth, when you go from birth to about one year old, you see a tremendous amount of growth during that time period and during puberty. And it's very important in cellular regeneration. It helps with recovery and repair. But what a lot of people fail to recognize is that adults need growth hormone. Even after they've exited those time periods in their life, optimal levels of growth hormone and subsequently IGF 1 are important for exercise capacity, bone density, prevent fractures, muscle mass, and even can reduce your risk of heart disease and heart failure in the future. Low IGF 1 levels subsequently can lead to things like Higher body fat, anxiety and depression, decreased sexual function, low libido, low energy, less muscle, fractures. They can impact your lipid panel, which is probably one of the reasons why appropriate IGF 1 levels are associated with a lack of heart disease. These things, low IGF 1 levels can lead to a high LDL and triglycerides. So it's very important to optimize these numbers. In David Sinclair's book, Longevity, right? He talks about how Excessive levels can be risky. Like he said, there's like a healthy range, right? There is this concern that excessive levels might be associated with side effects like, uh, growth of cartilage, diabetes, swallowing, water retention, carpal tunnel syndrome, although it hasn't been shown in the literature possible linked to cancer. Typically, what I recommend is to keep levels within the range that is found within the 20 or 30 year old to 200 to 300 nanograms per deciliter. If you keep them within that range, you tend to avoid most of the side effects you see with higher IGF 1 levels. Most of my patients ask is, well, how can you raise those levels? Changing your lifestyle by leaning up, regular exercise, getting more sleep, these IGF 1 levels. There are some supplements that can help you increase your IGF 1. However, the only reliable way to really raise these, particularly in patients that are older, 40, 50 plus, is through hormonal optimization. Hormonal optimization outside of growth hormone, things like tests, thyroid, and DHA, can raise IGF 1 levels. I've actually seen patients who come to me with low testosterone levels and get on TRT and their IGF 1 levels will improve. In addition, I'm a big fan of a particular injectable amino acid, L carnitine. Utilizing this has also been shown with an increase in IGF 1 levels. L carnitine can be administered in two forms. You can inject it, like a intramuscular, or you can take it orally. The injectable form is much more absorbable than the oral form. Oral form you might get 10 to 20 percent. With the injectable you'll get 80 to 90 percent absorption. fourth lab value our final one and that is apolipoprotein b apolipoprotein b or apolipoprotein b 100 we've gotten a lot of press recently peter atia in his book outlived has talked at length about apolipoprotein b and its correlation with heart disease so basically it is A lipoprotein. So that is a protein that binds lipids, right? And it's found on chylomicrons V-L-D-L-L-P-A, and LDL. These are the lipoproteins that are most associated with heart disease, right? And essentially these are proteins that help carry fat and cholesterol throughout your body. Most of the research out there has shown that a lipoprotein B seems to be the primary driver of plaques that cause vascular disease. We're not entirely sure why. But we do know higher levels are definitely associated with a higher risk of heart disease. Most of the men that come to me have, unfortunately, elevated apolipoprotein B levels, so it's somewhere between 100 to 130 milligrams per deciliter, and ideally you want this to be below 90. What's your protocol, Dr. Ryan, for, uh, lowering? Hey, Poe. Routine babe. With conventional physicians, statins are a drug that's used pretty commonly. I'm not the biggest fans of statins initially because there's a lot of side effects with statin use. Um, the biggest ones I see are status, statin associated muscle symptoms, muscle breakdown, tendon tears, or even the worst case scenario is rhabdomyolysis, where you get muscle breakdown that can cause kidney damage. Statins are associated with... progression of diabetes, and in certain cases can actually elevate liver function tests. Now this doesn't occur with everyone, but they are known side effects. So I prefer not to go to them initially. What I prefer though is really to focus on patients diets. Through the clinic, we call it the Lean for Life Diet. It's a diet in which we radically reduce patients saturated fats and reduce their processed carbohydrates. And try to get them on more lean proteins, fats that are higher in omega 3 fatty acids and lower in omega 6 fatty acids like flaxseed oil. And unlimit their carbohydrates. They still get carbohydrates but they get them from much more natural sources like fruits versus processed carbohydrates. And by doing this, I've seen patients lower their A4 lipoprotein B significantly. In the process of change from your diet, you're likely going to improve your insulin resistance because you're reducing your carbohydrate load. And so my patients are on metformin too. Making yourself more insulin sensitive has also been shown to lower your A4 lipoprotein B levels. And then the last thing is just hormonal optimization. In particular, it's thyroid hormone optimization that I've seen. It's helped reducing apolipoprotein B levels, but I've also seen that true with testosterone, DHEA and growth. So like the macro question is like, why isn't this more mainstream? I think it's really a lack of education in regards to these lab values or the fact that many insurance companies won't pay for them up front. They need to have additional diagnosis codes for most insurance companies to reimburse patients for, for testing these labs. And since many physicians aren't unaware or they want to pass on additional costs to their patients, they, they just don't test for them. Again, you know, that's not really a concern for us because at Summa Up we're really focused on. longevity and we'll do what we need to do to ensure that we get these levels within range and and improve your health span the amount of years that you're looking and feeling the best in absence of chronic disease like heart disease, stroke, cancer, and diabetes. If you like what you heard and you're interested in potentially working with me or join the clinic, click on the link Summa Up and what the clinic and I can offer you.