Blood Testing Protocols
Updated: 07/18/2006

Too often, people fall victim to a disease that could have been prevented if their blood had been tested once a year.

For instance, we know that prescription drugs can cause liver and kidney problems, but other factors (alcohol, over-the-counter drugs, excess niacin, hepatitis C) can make a person susceptible to liver or kidney damage. These conditions often smolder for years until a life-threatening medical crisis occurs. Because of a phenomenon known as “individual variability,” some people are especially vulnerable to liver and kidney damage. The good news is that a simple blood chemistry test can detect an underlying problem in time to take corrective actions.

The average person older than age 60 takes several prescription drugs every day to treat or prevent chronic medical conditions. According to the American Medical Association, adverse reactions to prescription drugs are either the fourth, fifth, or sixth leading cause of death in the United States (Lazarou J et al 1998). The American Medical Association emphasizes that these deaths occur even though the doctors who are prescribing the drugs are supposed to be monitoring their patients to prevent such drug-induced deaths. The problem is that cost-conscious health maintenance organizations and hurried physicians are not mandating blood tests that would detect drug-induced tissue damage in time to prevent disability and death. If you are taking certain prescription medications, regular blood testing is mandatory according to the drug labeling, yet doctors routinely fail to prescribe the recommended blood tests, and their patients too often pay the “ultimate” price.

The reason most people consider blood testing is to ascertain their risk factors for cardiovascular disease. Published studies consistently show that various cholesterol fractions (HDL, LDL) and triglycerides can contribute to heart attack and stroke. What most people fail to realize is that significant changes can occur in their blood fat levels over the course of a single year, meaning that an earlier test may not accurately reflect their current serum-lipid status.

Since 1983 the Life Extension Foundation has advocated regular medical testing for the purpose of optimizing your personal life extension program.

The Importance Of Achieving Youthful Blood Test Readings

When physicians review a patient’s blood test results, their primary concern is any result that falls outside the normal laboratory reference range. The problem is that standard reference ranges usually represent “average” populations rather than the optimal level required to maintain good health. It now appears that most standard reference ranges are too broad to adequately detect health problems or prescribe appropriate therapy on an individual basis. This is especially true when these reference ranges are relied on to treat a patient with a serious medical disorder.

An example of flawed reference ranges can be seen in blood tests used to assess thyroid status. A long-standing controversy rages over the best way to diagnose thyroid deficiency. Most conventional doctors rely on thyroid blood tests whereas alternative physicians look for signs and symptoms of thyroid deficiency. An article in the August 3, 2002, issue of the British medical journal Lancet challenged conventional medical wisdom regarding the use of standard reference ranges in diagnosing and treating thyroid deficiency. According to the researchers, the problem with thyroid blood tests may be faulty reference ranges that fail to reflect what the optimal level of thyroid hormone should be in a particular individual (Dayan CM et al 2002).

The standard blood test used to determine thyroid gland hormone output is the thyroid-stimulating hormone (TSH) test. When a deficiency in thyroid hormone occurs, the pituitary gland releases TSH to signal the thyroid gland to produce more hormones.

When the TSH level is in the “normal range,” doctors usually assume that the thyroid gland is secreting enough thyroid hormone. The question raised by the Lancet article’s authors, however, was whether the current reference range for TSH reflects optimal thyroid hormone status.

The TSH reference range used by many laboratories is 0.35–5.50 mIU/mL (milli international units per milliliter). A higher TSH level indicates a thyroid hormone deficiency (because the pituitary gland is oversignaling TSH to compensate for low levels of thyroid hormone in the blood). Any reading of more than 5.50 mIU/mL alerts a doctor to a thyroid gland problem and the possibility that thyroid hormone therapy may be warranted.

The trouble is that the TSH reference range is so broad that most doctors will interpret a TSH reading as low as 0.35 to be as normal as a 5.50 reading. The difference between 0.35 and 5.50, however, is 15.7-fold, a range of values far too great to indicate optimal or even normal thyroid function.

A review of published findings about TSH levels reveals that readings greater than 2.0 may indicate health problems relating to insufficient thyroid hormone output. One study showed that individuals with TSH values greater than 2.0 have an increased risk of developing clinically significant thyroid deficiency during the next 20 years (Vanderpump MP et al 1995). Other studies show that TSH values greater than 1.9 indicate risk of autoimmune disease of the thyroid gland (Hak AE et al 2000).

A more startling study showed that TSH values greater than 4.0 increases the likelihood of heart disease in postmenopausal women (Hak AE et al 2000). Another study showed that administration of thyroid hormone lowered cholesterol in patients with TSH ranges of 2.0–4.0 but had no cholesterol-lowering effect in patients whose TSH value was in the 0.2–1.9 range (Michalopoulou G et al 1998). It also showed that in people with elevated cholesterol, TSH values of 2.0 or greater could indicate that a thyroid deficiency is the culprit, causing excess production of cholesterol, whereas TSH levels at or below 1.99 would indicate normal thyroid hormone status.

Doctors routinely prescribe cholesterol-lowering drugs to patients without properly evaluating their thyroid status. Based on the evidence presented to date, it might make sense for doctors to investigate a thyroid deficiency (based on a TSH value greater than 1.9) before resorting to cholesterol-lowering drugs.

In a study to evaluate psychological well-being, impairment was found in patients with thyroid abnormalities who were nonetheless within “normal” TSH reference ranges (Pollock MA et al 2001).

The authors of the Lancet study stated, “The emerging epidemiological data begin to suggest that TSH concentrations above 2.0 (mU/L – milliunit per liter) may be associated with adverse effects.”

The authors prepared a chart based on previously published studies that provides guidance when interpreting the results from TSH blood tests. Here are three highlights from their chart that may be useful in understanding what your TSH values really mean:

• TSH values greater than 2.0: increased 20-year risk of thyroid deficiency and increased risk of thyroid-induced autoimmune attack (Vanderpump MP et al 1995)
• TSH values greater than 4.0: greater risk of heart disease (Hak AE et al 2000)
• TSH values between 2.0 and 4.0: cholesterol levels decline in response to thyroxine (T4) therapy (Michalopoulou G et al 1998)

Despite these intriguing findings, the Lancet authors stated that more studies were needed to define an optimal TSH range, suggested as 0.2–2.0 instead of 0.2–5.5 (mU/L). Note: These optimal reference ranges are now expressed in mIU/mL, so the ideal range according to this epidemiological data is 0.35–2.1 mIU/mL.

If you have depression, heart disease, high cholesterol, chronic fatigue, poor mental performance, or any of the many other symptoms associated with thyroid deficiency, you may want to ask your doctor to “defy the reference ranges” and try a different thyroid replacement therapy.

The Risk of Following Standard Reference Ranges

Standard laboratory reference ranges represent average populations and not optimal levels. In the 1960s, for instance, the upper reference range for cholesterol was 300 mg/dL (milligrams per deciliter). This number was based on a statistical calculation indicating that it was “normal” to have total cholesterol levels as high as 300 mg/dL. Of course, it was also considered “normal” for men to have fatal heart attacks at a relatively young age. As greater knowledge accumulated about the risk of heart attack and high cholesterol, the upper limit reference range has gradually dropped to 200 mg/dL (American Family Physician 2001; ADVANCEDATA 1977).

Blood test reference ranges are not the only measures that fail to provide physicians and patients with optimal numbers. For example, high blood pressure (hypertension) is defined medically as a blood pressure reading of 140/90 (read as “140 over 90”) or greater. Yet a diastolic blood pressure reading (the second number in a blood pressure reading—90 in this example) higher than 80 mmHg (millimeters of mercury) is associated with an increased risk of stroke. A high percentage of people older than age 60 have diastolic readings higher than 80 mmHg, and this is the age group most vulnerable to stroke (Hansson L et al 1998). If your physician checks your blood pressure and says it is “normal,” Life Extension advises you to ask what the optimal range is. Optimal blood pressure is defined as 115/75. In fact, the risk of cardiovascular disease doubles with each increase of 20/10 mmHg, starting at 115/75 mmHg. It is important to know that midlife hypertension predisposes people to stroke later in life, so keeping blood pressure readings within optimal ranges is important at any age.

Standard Hormone Reference Ranges May be Antiquated

Conventional medicine tends to neglect the hormone imbalances that develop in both men and women as they grow older. The result is that aging people suffer a variety of miseries that are correctable and preventable if simple hormone adjustments are made.

Aging men, for instance, often suffer from excess production of insulin and estrogen, with simultaneous deficiencies of free testosterone and dehydroepiandrosterone (DHEA). The standard reference ranges for all four of these hormones are so wide that most men would fall into the so-called normal category. Standard reference ranges indicate that dangerously high insulin and estrogen levels are “normal” in older men (but so are heart attack, stroke, cancer, benign prostate enlargement, weight gain, type II diabetes, kidney impairment, and a host of other diseases that are associated with excess insulin and estrogen). The same standard reference ranges for free testosterone and DHEA show that very low levels are perfectly “normal” for aging men. It is no coincidence that aging men with low levels of testosterone and DHEA have high rates of depression, memory loss, atherosclerosis, senility, impotency, cholesterol, abdominal obesity, fatigue, and many other diseases related to low blood levels of testosterone and DHEA (Shippen E 2001; Tan RS et al 2001; Janowsky JS et al 2000; Barrett-Connor E et al 1999; Rabkin JG et al 1999; Schweiger U et al 1999; Seidman SN et al 1999; Shackman J 1999; Wright JV 1999; Gooren LJ 1998; Gelfand MM et al 1997; Phillips GB et al 1994; Tenover JS 1992).

Standard reference ranges have failed aging people because these reference ranges are adjusted to reflect age. Since it is normal for an aging person to have imbalances of critical hormones, standard laboratory reference ranges do not flag dangerously high levels of estrogen and insulin or deficient levels of testosterone, thyroid, and DHEA. The following table compares standard and optimal hormone and TSH blood reference ranges for 60-year-old men.

Defying the Reference Ranges

Traditional medical thinking accepts that imbalances of life-sustaining hormones are normal in aging people. Traditional practitioners almost never test hormone levels because they think that nothing should be done to restore hormone profiles to youthful ranges. For more specific information on optimizing your hormone levels, turn to the following protocols: Male Hormone Modulation, Female Hormone Modulation, Thyroid Deficiency, and DHEA Replacement Therapy.

The Most Important Blood Tests

The Life Extension Foundation suggests that a basic battery of tests be performed annually. The recommended male panel consists of a complete blood count (CBC)/chemistry test, homocysteine, free testosterone, estradiol, prostate-specific antigen (PSA), and DHEA. The recommended female panel consists of the CBC/chemistry test, estradiol, progesterone, free testosterone, DHEA, and homocysteine.

In addition to these special male and female panels, the following tests are especially important for men and women over age 40: fasting insulin, fibrinogen, thyroid stimulating hormone (TSH), and free triiodothyroxine (T3). If a serious abnormality is detected—such as elevated blood glucose (sugar), hormone imbalance, or high cholesterol—testing should be repeated more often than annually to determine the benefits of any therapy you are using to correct the potentially life-shortening abnormality.

We also recommend that you consult your physician regarding any other test that may be appropriate for your individual condition. The following list describes individual tests and ranges that can be used to assess your health and longevity. If your physician is unwilling to prescribe these tests, or if commercial laboratory prices are beyond your budget, we provide information at the end of this protocol about the availability of low-cost mail order blood testing.

Alphabetical Listing Of Blood Tests

ABO Grouping and Rh (D) Typing

This test is used to determine blood grouping and Rh typing. The possible blood types are O positive, O negative, A positive, A negative, B positive, B negative, AB positive, and AB negative.

Alpha 1 Antitrypsin (Serum)

This test is used to detect hereditary decreases in the production of alpha1-antitrypsin (AAT). Decreased or nearly absent levels of AAT can be a factor in chronic obstructive lung disease and liver disease. Elevated levels of AAT can be an indication of inflammatory states (e.g., rheumatoid arthritis, bacterial infection, vasculitis, or neoplasia).

Amino Acid Profile (Quantitative)

This panel evaluates 41 amino acids and is used to monitor body functions and nutritional status. Increased amino acid concentrations in plasma may reflect inherited metabolic abnormalities, as in the tyrosemias or phenylketonuria.

Apolipoprotein A-1

This test is used to evaluate survival rate or risk factors for patients with myocardial infarction and peripheral vascular diseases. APO A-1 deficiency states include Tangier disease, HDL deficiency, and hypoalpha-lipoprotein anemia. Apolipoprotein levels may be a better indicator of atherogenic risks than high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) measures.

B-Type Natriuretic Peptide

This test is used to support the finding of congestive heart failure.

Cancer Antigen (CA-15-3)

The CA 15-3 antigens are tumor-associated serum markers, most specifically for breast tissue, available for monitoring various types of malignancies, evaluating response to therapy, and possibly indicating recurrence.

Cancer Antigen (CA-27.29)

This test is used to monitor metastatic carcinoma of the breast. CA-27.29 is a useful measurement in the monitoring of both the course of disease and the response to therapy because there is a direct correlation between the changing levels of CA-27.29 and clinical status.

Cancer Antigen (CA-125)

CA-125 is a tumor marker for monitoring disease progression in ovarian cancer. It is most useful in monitoring progression or recurrence in cases of known ovarian carcinoma.

Candida Antibodies Qualitative

This test is used to diagnose systemic candidiasis. This test is qualitative, and if candida antibodies are found, you have had or now have a candida infection.

Carbohydrate Antigen (CA-19–9)

This test is used to monitor gastrointestinal, pancreatic, liver, and colorectal malignancies. This test may also be positive in patients with nonneoplastic disease, inflammatory disease of the bowel, cirrhosis, and autoimmune conditions.

Carcinoembryonic Antigen (CEA)

This tumor marker is used to determine the extent of disease and its prognosis in cancer patients (especially those with gastrointestinal or breast cancers). It can also be used to monitor the disease and its treatment.