And again, that’s if your doctor calls for any blood work at all. I actually went from age 25 to 30 with zero labs from my general practitioner, even though I have a family history of heart disease and high cholesterol. So then the question becomes: What’s a happy medium between bare-bones and borderline excessive lab testing? If you’re seriously proactive about optimizing your health and preventing issues, what are the key tests to consider getting done semi-regularly that pretty much any doctor can order and that will most likely be covered by insurance? It’s important to note that everyone’s health insurance coverage is different. This article will make a note of which tests are very likely, pretty likely, and less likely to be covered, but you can increase your chances of getting the tests you need (and getting them paid for) if you take the following steps before/during your next appointment: “A CBC will find anemia, which is common among menstruating women, and it’s also a screening test for immune system issues and different types of cancer—blood cancers that can happen in young people,” says Chloe Godwin-Gorga, M.D., an integrative primary care physician. “So if you get a wonky CBC, it’s a reason to be more thoroughly evaluated. That’s why it’s a really good basic test.” Who should get it? All adults. Coverage: A CBC is very likely to be covered by insurance as part of your annual physical. It typically includes a measure of your fasting blood glucose, which may not be the best test for predicting diabetes risk or blood sugar imbalances but gives you a general idea (pro tip: A fasting blood glucose of less than 100 mg/dL is considered “normal,” but most functional docs would like to see that number at around 70 or 80 mg/dL, says Heinz). It also looks at electrolytes like sodium, calcium, and potassium, which can indicate whether you’re dehydrated, and it’s a screening test for your liver and kidney function. Who should get it? All adults. Coverage: A CMP is very likely to be covered by insurance as part of your annual physical. An HbA1c test measures the percentage of red blood cells saturated with glucose. The higher your A1C, the higher the estimated average blood glucose. Your HbA1c number is generally considered to correlate to your average blood glucose over two to three months—not just a single day. In addition to diabetes, a high HbA1C marker may also increase your risk of Alzheimer’s disease and cancer—potentially making the test a good predictor of overall longevity. “Interestingly, in young women, having a high HbA1c is also associated with having polycystic ovaries (or PCOS), which can make it really hard to conceive,” says Godwin-Gorga. “So if you’re headed in that direction and your periods are a bit irregular, finding out that number can provide the motivation to make changes to your eating and exercise habits that benefit overall fertility and metabolism.” Then, you can retest in three to six months to see if you’ve moved the needle. Ideally, you’ll want your HbA1C to be 4 to 5.3, though lower is better. Who should get it? Preferably all adults, particularly if you’re overweight, at increased risk of diabetes, struggling with fertility or symptoms of PCOS, or over age 45. Coverage: An HbA1C test is pretty likely to be covered by insurance, but check first. Increasingly, integrative doctors, including Gandhi, Amy Shah, M.D., and Kristann Heinz, M.D., R.D., are calling for more advanced lipid panels, like those that include a breakdown of lipoprotein size (cholesterol particle size). Research suggests that looking at numbers of specific particles is more indicative of your risk than simply zeroing in on total or LDL cholesterol. Basically, you want your particles to be big and buoyant, not small and heavy, because then they tend to lodge in the walls of arteries more easily, which can increase your risk of heart attack and stroke. If your insurance doesn’t cover a more advanced lipid panel, you shouldn’t stress—but you should look at the numbers on your standard lipid panel more closely. “One of the strongest predictors for preventing heart disease is having a good HDL-to-triglycerides ratio,” says Steven Gundry, M.D., cardiologist and functional primary care physician. “So your HDL should be higher than or equal to triglycerides.” Who should get it? All adults, especially if you have a family history of heart disease or other risk factors. Coverage: A standard lipid panel is very likely to be covered by insurance as part of your annual physical, while more advanced lipid testing may depend on your risk or family history. This is why nearly every doctor I spoke with recommended some degree of thyroid testing for women (at least a thyroid-stimulating hormone, or TSH, test), and a more comprehensive thyroid panel for women experiencing unexplainable weight gain or loss, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and feeling generally depressed. For these women, Godwin-Gorga likes to run a panel of five tests: TSH, free T4, free T3, reverse T3, and two types of thyroid antibody levels called anti-TPO and anti-thyroglobulin. TSH alone can miss many cases of Hashimoto’s. That’s because thyroid function is very erratic (or up and down) in the early stages of this condition—so TSH levels may actually be normal at the time of your test, even if thyroid function is compromised. A more comprehensive panel can spot issues early while they can still be addressed with lifestyle changes. Who should get it? Monitoring your TSH levels over time is a good idea for most women, and a more extensive thyroid panel may be warranted for women with the symptoms above and/or a family history. Coverage: Thyroid testing is often covered by insurance if you’re experiencing symptoms like fatigue. In some cases, you may need to start with a TSH test first and go from there. Shah echoes this sentiment: “I check vitamin D levels on almost every woman,” she says, adding that this vitamin and hormone-precursor plays a key role in immune function and mood. Deficiencies in vitamin D can also be a factor in autoimmune disease and certain cancers. When it comes to vitamin D levels, keep in mind that a “normal” test result, which is anywhere from 30 to 80 ng/mL, does not necessarily indicate “optimal”—ideally, you want it above 50 ng/mL, says Gandhi. If you’re below that, supplementation will likely be necessary. Who should get it? Most adults, particularly women and those experiencing fatigue and poor mood. Coverage: Vitamin D testing is typically covered if you’re experiencing symptoms. Low vitamin B12 is common among vegetarians and vegans but can also exist among omnivores due to nutrient malabsorption issues caused by antibiotic overuse, or celiac or Crohn’s disease. Folate plays a crucial role in healthy pregnancy and preventing birth defects but often is not screened. And pretty much any menstruating woman has the potential to be low in iron. So, this combo of tests can be pretty revealing—and low levels can be easily remedied. “Iron is an interesting one,” says Godwin-Gorga. “It affects your thyroid, and if your iron is low, it can present as hypothyroidism. It’s so common for women to feel normal once we replenish their iron.” And interestingly, even if you’re not anemic (which can be tested for with a CBC), you can still be iron deficient—which is why testing for iron and ferritin separately is important. Who should get it? People experiencing fatigue, particularly if you’re a menstruating woman, or if you follow a plant-based diet. Coverage: Pretty much everyone with a period who’s experiencing fatigue can get an anemia panel covered by insurance, says Godwin-Gorga. So, what’s the solution? *Keep in mind: This article does not cover every single medical test or screening that you may need. Always consult with your doctor—getting second opinions when necessary—to come up with the testing regimen that’s best suited for you.
