Cardiovascular disease is not something that happens overnight. It is the lifetime accumulation of factors such as diet, environment, lifestyle, and exercise history (alongside genetic predispositions) which play a role in the development of disease. While the initial stages of disease may go undetected, there are often clues present well before symptoms emerge. Blood testing is a method that has been used for decades to screen individuals at risk of disease. As the scientific understandings evolve, so do the best practices for blood screening. Our list encompasses what we believe to be the best markers of cardiovascular disease of the tests currently available in NZ.
Lipid Profile: Total cholesterol, HDL, LDL, TRI, TRI/HDL ratio, TC/HDL ratio.
This test is the most well-known and widely used method of assessing cardiovascular disease. New understandings of the role of cholesterol in cardiovascular disease identify the limitations of using these metrics alone however. The cholesterol results of most interest to us are:
HDL: The ‘good’ cholesterol which aids in clearing cholesterol and triglycerides from the blood stream to be metabolised or excreted at the liver. Ideal values are >1.42 mmol/L (Dave Asprey, 2018 1).
TRIGLYCERIDES: The fat molecules present in the blood stream. Having too low triglycerides is as bad for your health as is too high triglycerides, thus the ideal range is within 0.79 – 1.24 mmol/L (Dave Asprey, 2018 1).
TRIGLYCERIDES/HDL: The ratio of fat molecules to ‘good’ cholesterol. Ideal values are < 2 (Dave Asprey, 2018 1)
Gamma-Glutamyl Transferase (GGT):
Increased GGT activity is a marker of inadequate antioxidant activity, resulting in increased oxidative stress and plaque development. High GGT is associated with 3 x the risk of developing heart failure, 7-9 x the risk of coronary artery disease, and 15 x the risk of diabetes (Ivor Cummins 2).
Risk increases with higher values. Ideal is < 14 U/L for males (moderately elevated if > 27 U/L) and < 9 U/L for females (moderately elevated if > 17 U/L) (Ruttmann et al. 2005 3). Similar ranges described by Dr Mercola, 2017 4.
Chronic elevation of the amino acid homocysteine is associated with cardiovascular risk via increased inflammation, damage to the blood vessel lining and blood clot development.
Ideally < 15 umol/L (Dave Asprey, 2018 1), optimal is 7-10umol/L (Dr Sinatra, 2018 5).
Two Hour Insulin Challenge:
Insulin is vital for regulating blood glucose levels after a meal – it signals the cells of the liver, muscles and fat to take up glucose from the blood to store as glycogen. A high insulin response after ingesting glucose indicates metabolic dysregulation, which is strongly related to cardiovascular disease and diabetes.
A normal response is < 30 mU/L following 100g glucose load (C. Crofts, 2015 6)
High Sensitivity C-Reactive Protein (hs-CRP):
High sensitivity CRP is a marker of inflammation produced by the liver. There is a strong and independent relationship between hs-CRP and cardiovascular disease risk.
The consensus is that < 1mg/L indicates low disease risk, with linear increases in risk with higher CRP values (AHA / CDC Scientific Statement 2003 7; Dr Daniel Amen 8; Dr Erin Connealy 9).
Lipoprotein (a) – Lp(a):
High Lp(a) levels are related to atherosclerosis and blood clot formation, increasing the risk of heart disease independent to other cardiovascular risk factors.
Cut off value of 50 mg/dL (EAS Consensus Panel – Nordestgaard et al, 2010 10 ; Guan et al, 2015 11). Lower is better, and ideally < 30 mg/dL (Khan 2016 12).
Vitamin D plays an important role in cell regulation (including those specific to the cardiovascular system), inflammation, and thrombosis. Low levels of Vitamin D are independently related to CVD.
Best for cardiovascular health > 75 nmol/L (Anderson et al, 2010 13; Norman & Powell, 2014 14).
High serum ferritin is associated with 5 x the risk of developing incident atherosclerosis and 10 x the risk of carotid atherosclerosis (Ivor Cummins 2).
Normal range: 50 – 150 ug/L, lower is better for males (Iron Disorders Institute 2009 14). Note that low iron increases risk for women. Ideal range of 30-60 ug/L for adult men and non-menstruating women (Dr Mercola, 2017 4).
Additional assorted research summaries:
Serum Ferritin: http://healtheiron.publishpath.com/iron-science-library
Do any of these symptoms sound familiar?
Slowed brain function
Lack of presence
The feeling that your brain is just not functioning like it used to
If so, the chances are that your brain is not operating at its best. Leading researchers in the field have discovered that the brain is extremely sensitive to its internal environment and relies heavily on having the right micronutrient content (vitamins and minerals) available to function optimally. Any divergence from the ideal range is likely to cause a deficit in brain function and may even harm the brain. Our collection of blood tests encompasses the nutrients that have been identified as critical for optimising brain function. Targeting any deficits identified now may be the key to safe guarding your brain from chronic diseases in the future.
Blood Tests – Explained / Optimal
Vitamin D: Vitamin D receptors are found throughout the brain. Vitamin D has been shown to promote neurogenesis (brain cell growth) and have a neuroprotective effect through the clearance of amyloid beta (a harmful end-product associated with Alzheimers disease). Low Vitamin D levels have been linked with impaired executive functions such as information processing, decision making, and recall tasks.
Optimal is 40-60 ng/mL (Steven Masley 1)
> 20 ng/mL (Dr Daniel Amen 2)
Folate: Important for homocysteine conversion into methione. Insufficient folate is related to impaired brain function through the negative effects of elevated homocysteine and impaired methylation reactions in the central nervous system. Folate deficiency is also related to endothelial dysfunction and inflammation, and has been found in those with Alzheimers disease and cognitive impairments.
Normal is 2 – 20 ng/mL, optimal is > 3 (Dr Daniel Amen 2)
Folate deficiency is considered as < 4.0 ng/L (Mayo Medical Laboratories 3)
B12: Also important for homocysteine breakdown into methione. Vitamin B12 helps with the formation of myelin (protective layers which surround the nerve fibres and support signal transmission) and vital brain chemicals such as dopamine, epinephrine, and norepinephrine.
250-300 pg/mL = low, 300-500 pg/mL = low normal, > 500 pg/mL = desirable (Steven Masley 1)
Optimal is > 600 pg/mL (Dr Daniel Amen 2)
HS-CRP: High sensitivity CRP is a marker of systemic inflammation produced by the liver. Elevated CRP is related to vascular disease, which also has implications for cognitive function via reduced blood flow and damage to the brain cells.
Ideal is < 1 mg/L. Greater than this represents the presence of inflammation (Dr Daniel Amen 2)
Red Blood Cell Magnesium: Magnesium is neuroprotective – It protects the brain from excitotoxicity (excessive excitation at the junction of nerve cells) by regulating cell receptor activity. Magnesium deficiency has been related to Alzheimers disease.
0 – 6.5 mg/dL (Dr Carolyn Dean 4)
Cortisol: Related to stress levels. Increased stress related cortisol has been associated with worse cognitive performance and memory function.
Requires multiple tests throughout the day, with values that vary depending on time:
am: 7-25 mcg/dL (i.e. normal is > 10 mcg/dL at 8am) (Mayo Medical Laboratories 5)
pm: 2-14 mcg/dL (Mayo Medical Laboratories 5)
Ferritin: Iron deficiency has been associated with cognitive deficits due to its role in neural signalling, myelin formation and brain energy metabolism. B. Too high ferritin has consequences for cardiovascular health, particularly in men.
Ideal = 50 – 90 ug/L (Dr Daniel Amen 2)
TSH < 3.0 (Dr Daniel Amen 2)
T3 – active form: 2.8-4.4 pg/mL (Mayo Medical Laboratories 6)
T4 – inactive form: 0.9-1.7 ng/dL (Mayo Medical Laboratories 7)
Homocysteine: Chronic elevation of this amino acid is associated with increased inflammation and oxidative stress – both of which are toxic to neuronal cells and damaging to the lining of blood vessels.
Optimal is < 8 μmol/L (Dr Daniel Amen 2)
“An increase in the plasma homocysteine level of 5 μmol per liter increased the multivariable-adjusted risk of Alzheimer’s disease by 40 percent” (Seshadri et al, 2002 8)
Zinc: An essential trace element which acts as a modulator for neuronal signalling between (intercellular) and inside (intracellular) cells. It also has neuroprotective benefits and aids in new cell growth. Zinc deficiency has a negative impact on brain function.
66 to 1.10 mcg/mL (Mayo Medical Laboratories 9)
Cholesterol: Cholesterol has implications for brain health due to the effect it has on blood flow.
HDL: The ‘good’ cholesterol which aids in clearing cholesterol and triglycerides from the blood stream to be metabolised or excreted at the liver. Ideal values are > 1.55 mmol/L (Dr Daniel Amen 2)
LDL: The form of cholesterol which is implicated in plaque development when oxidised. Ideal is < 2.59 mmol/L (Dr Daniel Amen 2)
Triglycerides: The fat molecules present in the blood stream. Ideal < 1.69 mmol/L (Dr Daniel Amen 2)
Complete Blood Count: Measures red blood cells, haemoglobin, haematocrit, white blood cells and platelets. Abnormal blood cell counts may influence blood flow and oxygen delivery to the brain cells (Dr Daniel Amen 2).
Red blood cell count (Mayo Clinic 10)
Male: 4.32-5.72 trillion cells/L (4.32-5.72 million cells/mcL)
Female: 3.90-5.03 trillion cells/L (3.90-5.03 million cells/mcL)
Hemoglobin (Mayo Clinic 10)
Male: 13.5-17.5 grams/dL (135-175 grams/L)
Female: 12.0-15.5 grams/dL (120-155 grams/L)
Hematocrit (Mayo Clinic 10)
Male: 38.8-50.0 percent
Female: 34.9-44.5 percent
White blood cell count (Mayo Clinic 10)
5-10.5 billion cells/L (3,500 to 10,500 cells/mcL)
Platelet count (Mayo Clinic 10)
150-450 billion/L (150,000 to 450,000/mcL)
Hormones: Hormonal imbalances can disrupt cognitive function.
Males: Testosterone levels fluctuate day to day and are higher in the morning.
Optimal values – Total serum testosterone: 500–800 ng/dL (Dr Daniel Amen 2)
Free testosterone: 12–24 pg/mL (Dr Daniel Amen 2)
Total serum testosterone: 40-82 ng/dL (Dr Daniel Amen 2)
Free: 1.0-2.2 pg/mL (Dr Daniel Amen 2)
DHEAS: Related to the female sex hormone, oestrogen.
Optimal result differs based on age and sex (Values available Dr Daniel Amen 2– pg 218).
Estrogen (Oestradiol): Women only
Pre-menopausal: 15-350 pg/ml (varies depending on menstrual cycle – ideally measured on day 21) (Mayo Medical Laboratories 11)
Postmenopausal: <10 pg/mL (Mayo Medical Laboratories 11)
Progesterone: Women only
Females: (varies depending on menstrual cycle – ideally measured on day 21)
1 to 0.7 ng/mL in the follicular stage of the menstrual cycle, 2 to 25 ng/mL in the luteal stage of the menstrual cycle (12)
Heavy Metals: When over exposed to these through our environment and diet, they become toxic and can have negative impacts in the body. This includes mitochondrial dysfunction (and as a result, poor energy production) as well as damaging the organs (particularly the brain) via increased oxidative stress. They also predispose an individual to neurological disorders and cancers.
Whole Blood Mercury: Considered the most toxic heavy metal in the environment, particularly for its effects on the central nervous system.
< 11 µg/L (Steven Masley 1)
Lead: Can compromise energy metabolism via its effects on heme synthesis (the chemical which carries oxygen in the blood) and impaired signalling mechanisms in the brain (GABA pathway). Worth testing if you are living or working in a building built before 1978.
Ideal = 0 (Steven Masley 1)
Copper: Essential for brain function, but in high levels can lead to oxidative stress
0.75-1.45 mcg/mL (Mayo Medical Laboratories 13)
Prices (this is a guide only as prices can vary per blood lab)
Tests (refined list):
Vitamin D: $51.00
Folate & B12: $21.50
RBC Magnesium: $49.00
Cortisol: $24.00 x3 (early morning, midday, late afternoon)
Thyroid: $40.50 (TSH: $13.50, Free T3: $13.50, Free T4: $13.50)
2 hour Insulin Challenge: $45.00 (based on a Glucose Tolerance Test)
Complete Blood Count: $26.00
Estrogen (Oestradiol): $24.00
Mercury (Blood): $97.00. …Not the same as ’whole blood’ mercury?
…Alternative Methods for Identifying Insulin Resistance (however the 2 hour insulin challenge test based on Catherine Croft’s PhD work is the most accurate)
Fasting Blood Glucose: Elevated fasting blood sugars are considered the strongest reversible risk factor for memory loss (this risk is compounded when combined with inflammation). The link between blood glucose control and brain function is so strong that Alzheimers disease is sometimes referred to as Type 3 Diabetes.
< 95 mg/dL (Steven Masley 1)
Normal is 70-105 mg/dL, optimal is 70-89 mg/dL (Dr Daniel Amen 2)
HbA1c (glycated haemoglobin): This is a measure of how many haemoglobin molecules have been glycated (‘caramelised’) by high levels of glucose in the blood. This is also used as an indication of blood glucose control, but reflects blood glucose levels over the past 3 months (the lifespan of a haemoglobin).
Optimal is < 5.3%. Over 5.7% is considered pre-diabetic, over 6.4% is considered diabetic (Dr Daniel Amen 2).
Fasting Insulin: A measurement of insulin sensitivity. Insulin is important for the removal of glucose from the blood stream.
Ideal is < 5 uIU/mL. 5-10 uIU/mL = at risk of insulin resistance, >10 uIU/mL = insulin resistance) (Steven Masley 1)
Fasting blood Glucose: $9.50 HbA1c: $30.00 Fasting Insulin: $39.50
… Additional tests but not available through NZ labs…
TGF beta-1: A protein found in the body which is often high following mould exposure or certain infections.
Normal is < 2380, but 0 is optimal (Dr Daniel Amen 2)
Omega-3: The total amount of EPA and DHA in red blood cells – this value is related to their activity in the brain.
Optimal is > 8% (Dr Daniel Amen 2)