Thyroid function is a hotly debated topic in the low-carb world. While most people typically experience fat loss, better energy levels, and improved overall vitality on a low-carb diet, in some individuals, measurements of thyroid-related hormones suggest that a low carbohydrate intake might be having adverse effects on the thyroid gland. Is it possible that a way of eating that has such wonderful benefits for so much of the body could be harmful for the thyroid?
This is the fifth installment of a series exploring lab tests for people following low-carb diets. Due to the effects of the low-carb or ketogenic ways of eating on overall metabolism, interpreting certain lab tests requires a slightly different perspective compared to results from people following high-carb diets.
Previous posts have explored blood glucose testing, fasting insulin, and HOMA-IR (and remember: if you’d like to get some tests your doctor isn’t familiar with, or to test more frequently than your insurance will cover, this recent Heads Up Health post will show you how to order your own lab tests).
Keeping track of your numbers is an important step for anyone who wants to transform their health. Heads Up Health was created to empower you to manage all of your health data, including your lab test results, in one secure location. You can learn more on our homepage or by clicking below to create your account and start building your own centralized health portfolio.
We’ve covered a lot in our low-carb lab testing series so far. At this point, we felt it was time for a real-world case study to tie everything together. In this post we will take a look at my own experience ordering fasting glucose and fasting insulin tests, calculating my HOMA-IR score and tracking results in my Heads Up profile.
Heads Up Health is a web-based product designed to help individuals centrally manage their health data. By giving you powerful tools for self-directed and data-driven care, our product can be your compass on the path to optimal health. You can learn more or create your account by clicking the button below. Or, read on for our case study on Low-carb Lab Testing.
Low-carb lab testing – a case study
As we’ve explored in previous posts, there are many reasons why an individual may see normal blood glucose levels and still be at risk for metabolic issues down the road. One possible reason is because the body is over-compensating with insulin to keep blood sugar within normal ranges. I decided to put this to the test with my own data.
Yes, I regularly check my fasting blood glucose levels at home as part of my low-carb/ketogenic lifestyle. And yes, according to my glucometer, my blood sugar is within healthy ranges. But as we know, relying on just my glucometer (without a corresponding fasting insulin test), doesn’t always tell the full story. I felt it was an ideal opportunity for some self-directed n=1 experimentation. I was curious to see the fasting insulin data and calculate my own HOMA-IR score.
Step 1 – Ordering the tests
Unfortunately, many conventional doctors within the US will not order a fasting insulin test unless they suspect metabolic disease (or you have already been diagnosed with a metabolic disease). This doesn’t do much good for the person who is trying to be proactive. Even if you do successfully sweet talk your doctor into ordering the tests you want, there are no guarantees your insurance company will cover the cost of the test. Fighting with an insurance company over tests they won’t cover is enough to make a grown man (or woman) cry. I’ve been on the losing end of many such battles and it’s a miserable place to be.
To bypass uncooperative doctors and insurance companies, I personally use request-a-test.com to order my own labs. Request-a-test allows you to choose between LabCorp or Quest Diagnostics for the blood draw. Heads Up Health can electronically connect to Quest Diagnostics so my results will update automatically.
I purchased the fasting insulin test for $49 and the fasting glucose test for $29. The overall cost was not much more than my insurance co-pay if I were to see a doctor.
Ordering your own glucose and insulin tests
Step 2 – Scheduling the blood draw
I scheduled an appointment with Quest Diagnostics to have the blood draw.
Note: for extra nerd points, I brought my glucometer with me to the lab. I wanted to take a reading with my glucometer at the same time as the laboratory blood draw so I could see how accurate my glucometer was compared to results from a full-blown lab testing company with far more sophisticated technology for analyzing blood samples. Results are covered later in this post.
To check the accuracy of my glucometer, I took a reading at the same time as my lab draw from Quest.
Step 3 – Assessing my test results
Within 24-hours, I received an e-mail notification from request-a-test that my test results were available. Since it had been many years since my last fasting insulin test, I was anxious to see the results:
- Fasting glucose: 84 mg/dL
- Fasting insulin: 4.8 µIU/mL
Note: The reading on my glucometer was 88 mg/dL (compared to 84 mg/dL from Quest), which was taken just moments before the blood draw from the lab. Overall, I’d say my trusty old glucometer held up pretty good!
Step 4 – Calculating my HOMA-IR score
With fasting insulin and fasting glucose readings in hand, I was now equipped with the data I needed to calculate my HOMA-IR score to assess my level of insulin resistance.
I used the HOMA-IR calculator located here. After entering my results into the HOMA calculator, my score was 1.0. I was pleased with this result and felt assured that both glucose AND insulin levels were in properly in check.
Calculating my HOMA-IR score
Step 5 – Tracking my results
Heads Up Health was designed to empower individuals to make informed, data-driven health decisions. Our product gives you the ability to easily track and manage your own lab test results, which can be a powerful tool on your own health journey.
I entered my results for fasting glucose, fasting insulin and HOMA-IR and saved this data in my Heads Up profile. I also uploaded a copy of the PDF from the lab so I have the source documents for future reference.
Tracking your results with Heads Up
This post is a simple example that summarizes the topics covered thus far in the Low-carb Lab Testing series. The post demonostrates how anyone can get in the driver’s seat and order their own labs when the need arises.
I was able to order my own fasting glucose and fasting insulin tests without the need for doctor intervention. I was then able to calculate my HOMA-IR score and assess my results. Lastly, I used Heads Up Health to store my results so I have easy access to them for future reference. I can also test again in a year or two and easily compare my results to previous tests.
This is true patient empowerment and something everyone should have access to if they so desire.
Create your Heads Up Health account!
Breast cancer occurs when the normal cells in the breast start growing rapidly and spreading locally. If left untreated, these cells can travel to other parts of the body and continue to grow. Besides skin cancer, breast cancer is the most common type of cancer and it is the second leading cause of cancer-related deaths in US women (lung cancer is the first). Preventing breast cancer is not possible in most cases, but thanks to a few simple breast cancer screening tests, we can detect breast cancer in its initial stages, when treatment is more successful.
How do we Screen for Breast Cancer?
You may hear about other ways to screen for breast cancer, but for average-risk women, screening mammography is the gold standard of care.
Breast cancer screening – National Cancer Institute – Bill Branson (photo)
A mammogram is an X-ray image of the breast that allows us to detect cancer at early stages, often when it is still too small to notice by touch. Currently, this is the most widely used and accepted screening method. While the other imaging techniques below may offer additional information, they should only be reserved for special circumstances and not for general screening purposes.
Magnetic Resonance Imaging (MRI):
MRIs use magnetic waves instead of X-rays to image the breast tissue. MRI detects breast cancers better than the mammogram, but because of its tendency to also over-diagnose cancer in healthy breast tissue, it leads to unnecessary, more invasive testing in people who do not need it. For this reason, a mammogram is still the gold-standard screening tool.
Ultrasounds use real-time sound waves to visualize the breast tissue and are also not recommended for general screening. It can be useful as a follow-up to an abnormal mammogram, or in women with dense breast tissue.
Women should also be aware of their normal breast tissue. If they notice any changes that are unusual or concerning, they should discuss them with their doctor.
Evidence shows that women who have regular screening mammograms are less likely to die from breast cancer than those who do not.
When does the breast cancer screening Begin?
Recommendations can vary slightly depending on the source you read, so it is always a good idea to talk to your doctor about your risk factors and determine the best option for you.
As a general rule:
Breast cancer screening – National Cancer Institute – Rhoda Baer (Photographer)
- Some low-risk women may have the option to delay mammograms for several years until the age of 45 or 50.
- All women by age 50 should have had at least one mammogram, regardless of risk.
- Screenings should continue every 1-2 years until at least the age of 74.
If cost is an issue, the CDC has resources to provide low-cost woman’s health services including mammograms. Check out their website to see if you qualify.
What does my Test Result Mean?
An abnormal mammogram result does NOT mean you have breast cancer. In fact, most women who are recalled for additional testing after an abnormal mammogram are found they do not have cancer. No screening test is perfect, and the mammogram is no different.
In most of these cases, we perform a diagnostic mammogram where additional images are taken of the breasts focusing on the area(s) of concern.
“On average, 10% of women will be recalled from each screening examination for further testing, and only 5 of the 100 women recalled will have cancer.”
A normal mammogram result also does not guarantee that you are cancer-free. Studies estimate that mammograms can miss early cancers in up to 20% of cases.
That is a scary thought, but it sheds some light on why it is important to continue scheduling your mammogram every year even if yours have all been normal. Each subsequent mammogram decreases the likelihood of missing early cancer exponentially — The odds drop to 4% after the second mammogram, and are just 1% after the third.
If you have been putting off that mammogram this year, now is a good time to call and schedule it.
- Over the age of 40? Then it is time to talk to your doctor about breast cancer screening.
- Already had your yearly mammogram? Head over to the Insights Page to check that off your To-Do list!
Let’s face it: if you’re concerned about your health, you’ve got to take matters into your own hands. Between battling your insurance company, working with an uncooperative doctor, and going up against outdated dietary advice that’s dying far too slow a death, if you want to attain and maintain optimal metabolic health, sometimes you have to get in the driver’s seat and order your own lab tests.
Doctors are intelligent, hardworking, and dedicated people, but they’re not infallible. Between seeing patients, dealing with burdensome paperwork, and overseeing the day-to-day operation of their offices, many of them have precious little time left for staying up-to-date on the latest research in their fields. And even if they’re keeping current with developments in their particular specialty, they might remain unaware of breakthroughs in other disciplines that could have important implications for their own—and for your health.
What this means is, if you’d like to run your labs more frequently than your doc is inclined to order them for you, or you want to get some lab tests your doctor isn’t familiar with, you have to go a different route.
In this post, we’ll show you how to run your own labs so you can obtain the information you need to feel in control of your health. We will also show you how Heads Up Health can help you manage all of your health data, including lab test results, in one single and secure location. You can learn more about the Heads Up Health service by clicking on the button below. Or, read on for more information on how you can take control of your health by running your own lab tests.
Reasons to Order Your Own Lab Tests
- Uncooperative doctors: If you request certain tests from your doctor because your own research has led you to believe they’d give you valuable information, don’t be surprised if the doc doesn’t share your enthusiasm. Even if you present them with an armload of studies from reputable scientific journals to support your case, your doctor still might not be keen on ordering anything and everything you request. For better or worse, lots of folks consult “Dr. Google” these days, and while there’s a world of helpful information regarding health and wellness to be found online, there’s also a lot that’s misleading, confusing, and just plain wrong. So you can’t blame your doctor for hesitating. While you’re the expert on your own body, he or she is the expert when it comes to medicine. So if your doctor is uncooperative, it’s not because they’re stubborn and enjoy giving you a hard time. More likely it’s that they’re simply not aware of the importance of some of the tests you might ask for. (Case in point: fasting insulin—the most important test doctors aren’t ordering.)
- You want to test more frequently than your insurance covers: When you make changes to your diet and lifestyle, good things start happening fast. For example, blood glucose, insulin, and blood pressure can decrease dramatically within just a few days of starting a low-carb diet. Other favorable changes take only a few weeks. But maybe your insurance covers a checkup and routine bloodwork only every six months, or once a year. You don’t want to wait that long. Seeing for sure that your triglycerides have come down or you’ve got much less inflammation could encourage you to stick with whatever plan you’re following. Nothing motivates more than results.
- Insurance doesn’t cover the tests you want: Insurance companies aren’t in the habit of paying for anything they don’t deem absolutely necessary. So if you’re looking for tests outside the mainstream—an advanced cholesterol panel, for example—you’re often on your own.
- You want a test that falls outside the conventional offerings: Food sensitivity tests, organic acid profiles, stool testing, and other tests that are well-known within the low-carb, ketogenic, and Paleo/ancestral health communities aren’t exactly household words. Many doctors wouldn’t even know how to order these for you. If you want this kind of cutting-edge testing—perhaps to get answers to longstanding health concerns that have not resolved after exhausting other options—you’ll need to find a private company that offers them.
So what’s a concerned patient to do?
Be proactive — get lab tests done on your own!
Good news! There are now several options available for you to order your own lab tests—no referral required! You can order the tests you’d like, print out the requisition, and visit a lab to have your blood or urine sample collected. The results are sent directly to you (usually electronically, through an account you create with the testing company).
The companies that provide these services typically don’t accept payment by insurance, but they can provide you with a detailed receipt or medical CPT codes so you can file for reimbursement from your insurance company. (Be sure to check with your provider; not all insurance companies will reimburse for this.)
Don’t let an uncooperative doctor or a stingy insurance company be a roadblock to gathering data you feel is important for your health. Remember: Nobody cares about your health more than you do. But you can’t track things if you don’t have the data, and you won’t have the data without running lab tests.
Here are five companies providing direct-to-consumer lab tests:
Note: When you purchase lab tests from Request-a-Test, DirectLabs, InsideTracker or MyMedLab, they will direct you to Quest Diagnostics to have the blood drawn and analyzed. The good news is Quest Diagnostics is already integrated with Heads Up Health. This means you can connect Quest Diagnostics to your Heads Up profile and your lab test results will instantly synchronize. See this video for more information on connecting Quest Diagnostics to your Heads Up account or contact us if you need assistance.
Tracking your results
Heads Up Health was designed to help you track all of your vital health data in one place, including your lab test results, so you can have a complete picture of your health available at all times. With connections to over 20,000 health systems across the US, you can easily integrate your lab test results into your Heads Up profile and track your results over time. You can also track your blood sugar, ketones, body composition and other important health metrics so you can better understand how your lifestyle changes are affecting your overall health.
Track your blood sugar test results with Heads Up Health
If you are ready to start taking control of your health data, create an account using the button below. You can also contact us any time with any questions or find us on Facebook, Twitter and YouTube for our latest updates.
This is the third installment in a series of articles exploring lab tests for people following low-carb diets, and how this way of eating requires a slightly different perspective for interpreting the results compared to results from people eating more carbohydrates.
In part 1, we covered tests for blood sugar (fasting glucose, hemoglobin A1c, and fructosamine). In part 2, we explored fasting insulin, the most important test most doctors aren’t ordering. Taken together, these explain why fasting glucose and hemoglobin A1c in the “normal” ranges don’t always mean someone’s in the clear with regard to insulin sensitivity and healthy glucoregulation. (Crash course: for many people, dangerously high insulin is the only thing keeping glucose levels in a healthy range.)
Throughout this series, we’re emphasizing that health cannot be determined by any single measurement in isolation. It’s a mosaic, made up of many individual parts that are best assessed as a whole. With this in mind, let’s dig a little deeper into the relationship between glucose and insulin. (more…)
This is the second installment in a series of articles exploring pertinent lab tests for people following low-carb diets, and how a slightly different perspective is needed when interpreting the results compared to results from people following high-carb diets.
In the previous post in this series, we looked at three measurements related to blood glucose: fasting glucose, hemoglobin A1c, and fructosamine. We left off saying that while these are important to monitor regularly, they offer a limited view of a much larger metabolic control system. Blood glucose, hemoglobin A1c (HbA1c), and fructosamine indicate only what’s happening with blood glucose. They reveal nothing about insulin, which we will explore in this post.
Knowing your numbers is an important step for anyone who wants to transform their health. Heads Up Health was designed to empower you to manage all of your health data, including your lab test results, in one secure location. You can learn more on our homepage or by clicking below to create your account and start building your own centralized health portfolio.
The Fasting Insulin Test
We said it last time, and it’s worth repeating:
A fasting insulin test is the most important test your doctor probably isn’t ordering.
The reason it’s so important to track insulin is that in many cases, fasting glucose and A1c remain normal due to chronically elevated insulin—that is, sky-high insulin is keeping the glucose “in check.” Fasting glucose and HbA1c are often the last things to rise, and they become elevated only after one of two things has happened:
- The pancreas can no longer pump out the inordinate amounts of insulin required to keep blood glucose within a safe range (sometimes called “beta cell burnout”). This is relatively rare, except in type-1 diabetes, which is an autoimmune condition and not driven by a poor diet.
- The pancreas still secretes large amounts of insulin but some of the body’s cells no longer respond to it properly, resulting in high blood glucose. (These cells become resistant to the presence of insulin.) This is far more common.
This explains why many people are surprised by a diagnosis of type 2 diabetes or pre-diabetes. They—and their doctors—had been lulled into a false sense of security by glucose measurements that fell within normal ranges for years, because no one was measuring insulin.
Medical professionals who are aware of the wide-ranging effects of chronically elevated insulin would agree that a fasting insulin test should be included as a standard part of routine bloodwork. But until that happens, if you’re concerned with getting and remaining metabolically healthy, you will need to specifically request it from your doctor or order it on your own from a direct-to-consumer lab testing service.
Insulin helps control blood glucose.
Here’s how to use a fasting insulin test as a gauge for metabolic health:
- Optimal range: 1- 9 μU/mL
- Intermediate risk range: 10 -11 μU/mL
- High risk range: ≥ 12 μU/mL
If your fasting insulin is in the double digits, it’s a sure sign something is awry. However, just as we explained regarding fasting glucose, if your fasting insulin falls within the optimal range, it doesn’t automatically mean everything’s fine. In some people, the fasting level is normal, but the level after meals rises very high and takes an extended length of time to come back to baseline—if it even does come down fully before the next meal. So it’s possible to have a fasting insulin level in the optimal range but have high insulin throughout most of the rest of the day.
Chronically elevated insulin ( called “hyperinsulinemia”) should be suspected when fasting glucose, HbA1c, and possibly fasting insulin are normal, but you experience unexplained or “idiopathic” health issues, such as:
- Stubborn fat loss
- Hypertension (high blood pressure)
- Headaches; migraines
- Skin tags
- Infertility (in women and men)
- Erectile dysfunction
- Benign prostatic hyperplasia
- Polycystic ovarian syndrome (PCOS)
- Gynecomastia (enlargement of breast tissue in males)
Unfortunately, owing to the complexity of the chemical assay used to measure insulin, there’s currently no way to measure insulin at home, the way you can do with glucose and HbA1c.
Why Track Insulin?
Medical professionals—particularly physicians, nutritionists, and researchers who work with individuals with obesity, type-2 diabetes, and metabolic syndrome—increasingly recognize that it is elevated insulin, rather than blood glucose, that’s responsible for many of the chronic illnesses that plague millions of people, robbing them of quality and quantity of life. Chronically elevated blood glucose (“hyperglycemia”) is dangerous and, over time, results in damage to the eyes, kidneys, liver, blood vessels, and extremities. Much of the organ and tissue damage that occurs in type-2 diabetics with poor blood sugar control results from chronic hyperglycemia.
But, many non-diabetics will experience physical deterioration in the absence of high blood glucose. In these individuals, it’s the insulin that’s the problem. These folks are essentially diabetic, but because their blood glucose is normal, they won’t be officially diagnosed. This is what Dr. Joseph Kraft called “diabetes in-situ,” or “occult diabetes”—occult, meaning hidden. The high blood sugar is hidden or masked by the pathologically high insulin.
A large and still growing body of scientific research indicates that chronic hyperinsulinemia is the unifying factor behind some of the most common chronic illnesses of our time. Michael Eades, MD, Mary Dan Eades, MD, and Loren Cordain, PhD, some of the earliest proponents of low-carb and Paleo diets, explained over a decade ago that hyperinsulinemia may be the driving force behind acne, skin tags, PCOS, myopia, and male pattern baldness (it’s not all genetic!). Chronically elevated insulin is also a risk factor for Alzheimer’s disease, infertility and sexual dysfunction, inner-ear and balance disorders (e.g., vertigo, tinnitus, Ménière’s disease), some forms of cancer (coupled with worse prognosis in those undergoing treatment), and cardiovascular disease. In fact, Dr. Kraft wrote, “Those with cardiovascular disease not identified with diabetes are simply undiagnosed.”
Want to stay healthy? Measure insulin!
Something to keep in mind is that hyperinsulinemia occurs in people of all shapes and sizes. Obesity is more often an effect, rather than a cause, of disturbed insulin and glucose signaling in the body. So individuals who are lean and appear healthy on the outside are not immune to the adverse effects of high insulin. These individuals have personal body fat set points that prevent them from becoming overweight or obese, but they’re not spared the other undesirable outcomes from derailed metabolism. (Researchers call this “normal weight obesity,” but more casually it’s referred to as TOFI – thin outside, fat inside. Even though these folks remain at a “normal” weight, their biomarkers indicate metabolic syndrome or insulin resistance.)
Tracking insulin is the canary in the coal mine – the “check engine light.” It’s an early warning sign that your diet and lifestyle need adjustments. You don’t have to wait until your blood glucose is high enough to prompt a type-2 or pre-diabetes diagnosis. Elevated fasting insulin might be one of the first indicators that something’s amiss, and you can take action to correct it.
Track your progress
The Heads Up Health app was designed specifically for individuals to take control of their health data so it can be used for better decision making. For our users within the United States, you can electronically link your medical facility to your Heads Up account and instantly import your lab test results. If we can’t connect to your medical facility or you live outside the US, you can easily enter your results manually:
Track your fasting insulin results with Heads Up Health
With subsequent tests, you can also trend your results over time to see how your low-carb lifestyle is impacting important markers like fasting insulin:
Trending your fasting insulin results over time
Heads Up can also integrate the data you are collecting at home – everything from weight to blood sugar and steps per day – so you can compare how your healthy lifestyle choices are impacting your lab test results.
Coming up next…
In the next post, we’ll introduce you to the HOMA-IR test that will help you connect your fasting insulin and glucose levels for a deeper analysis of your level of metabolic health.