Program Marker Targets

Edition: 2023-06-08
Although this article is publicly visible, links often lead to IC members-only content.

If you were perfectly healthy, how might that be measured and confirmed? The following tables offer a view of how health actually presents. If you’ve never seen anything like this from the sick care system, isn’t that interesting.

⟲ Introduction

This is not a formal program reference document. The following table summarizes various medical lab tests for which the program has suggested targets, with alternate units of measure provided here.

Do not just run out and get all of these.
First, discover what you already have.
Then open a forum discussion about what makes sense for you.

For anyone just starting a program, you may have some of these, and others you might want to obtain as baseline. Some need to be avoided during weight loss. Some can be challenging to obtain. See the various local & linked detailed discussions.

These targets are intended to be acheived via diet and lifestyle, and not via medications (with a few exceptions, such as for HTN and high BG, where the med is needed until it is not). It is, alas, not uncommon to need on-going HRT, such as with various thyroid situations.

The target values can vary from both the Reference Ranges provided by labs, and any assessment of “low”, “fine” “normal” or “high” provided by a lab or consensus physician. See: ⎆WBB: Blood tests: There are BIG differences between “normal” and ideal {Public}

This page only provides expanded details for markers that do not have their own pages elsewhere on the site. Where there are other pages, they are ⎆linked.

⟲   This basenote is available as a PDF.
Note: this PDF is just what the Opera browser generates locally on the authoring system. The links are active in the PDF, but some won’t work.

* Also known as CAC: Coronary Arterial Calcium, and CT Heart Scan
 

⟲ Tips and Steps

0. Have a list of tests in mind
CPT Codes are provided, where known, so that you can be very specific in requesting tests. Learn what those cost when done independently. CPT may not be recognized outside the U.S. Make sure you live in a jurisdiction where your meddling medical mandarins allow you to test your own body (e.g. not NY state).

1. Find out what your coverage fully covers
Your plan may include an annual check-up that covers many tests at no extra charge.

2. Ask about the rest
Ask the doctor (ideally prior to the appointment) about any tests not clearly in-plan, and whether they could be requested and covered. Ask if they know if the patient can file a claim independently (and they may not know for your plan). Ask if any out-plan tests can still be ordered through the office at patient expense. ⎆Plan for unexpected reactions {Members}.

3. Get quotes
Even for covered tests, but particularly for any test considered discretionary, and any bill-throughs, get pricing. There’s no point in paying your doctor’s office more than independent out-of-pocket.

If you can’t get your healthcare provider to order these tests, or can, but they wouldn’t be covered by insurance, and you aren’t subject to nanny state interference, you can often arrange them on your own from services such as
☤ Direct Labs
☤ HealthCheck USA
☤ Life Extension (which uses LabCorp),
☤ Quest Diagnostics
☤ Request A Test
☤ ZRT Labs (home tests, some mail-away)
If you have a medical set-aside/flex plan, you may be able to use those funds to pay for otherwise out-of-plan tests.

4. Do the independent tests early
If you plan to have your doctor run some tests, and obtain some independently, get the independent tests done soon enough to take the reports along on the office visit. You might get some useful insight (about your health, or, alas, about the doctor).

Also give some thought to which independent results to share, as they are very likely to end up in your EHR. For example, unless you have a very enlightened practitioner, there’s likely no benefit to you in having your Lp(a) or Apo E status in the record.

Test Details & Discussion

⟲ Lipid Panel Test Detail

CPT Code: 80061 Lipid Panel, Standard
(If the TG is over 400 mg/dL, the lab may automatically also perform a 83721 DLDL.)

You rarely need to order this panel specifically, as it’s common for routine/annual physicals, and it may be included automatically with an NMR panel. It is important to have it drawn fasting, as the TG (and NMR Small) values can otherwise be materially distorted. Do not schedule a lipid or lipoprotein panel unless weight has been stable for at least 30 days.

The lipid panel reports the useful TG (triglycerides) and HDL (high density lipoproteins), along with the not usually useful TC (total cholesterol), the often ⎆fanciful LDL-C (low density lipoproteins, calculated), and perhaps a preposterous VLDL-C (very low density lipoproteins, calculated, often an even more simplistic TG÷5).

⎆High blood TG can result from current diet, prior diet (in weight loss), and some uncommon lipidemias. Where TG is high primarily due to liver de novo lipogenesis of carbohydrates, the level responds to diet optimization.

HDL is slower to respond, but it does:
Undoctored Blog: ⎆I raised my HDL by 350% {Public}. ⇱ Return to Lipoproteins

⟲ HbA1c Test Detail

CPT Codes:
83036 Hemoglobin; glycosylated (A1c)
83037 Hemoglobin; glycosylated (A1c) by device

Home testers, and BG/A1c combination meters are available, but they can present an economic issue, as the A1c test “strips” have limited shelf life, are usually not replaceable, and the test is typically not needed more than every 90 days or longer.

A1c is a proxy for average glucose over the last 90 days, a time-weighted moving average, or area-under-the-curve. Once correlated for a specific individual, it might be the most useful single periodic marker of metabolic health. It needs to be compared to other metabolic markers including FBGs, PPBGs, fasting insulin, TG and NMR Small LDL-P.

The issue is that A1c is based on population data for RBC, and individuals can be wildly idiosyncratic. Beta thalassemia, anemia, blood donation, sickle cell trait, glucose-6-phosphate dehydrogenase deficiency, high erythrocyte turnover and other factors can make it unreliable until correlated for anyone in particular.

The 5.0% program cap, as noted in the table above, is an eAG (estimated Average Glucose) of 97 mg/dL. It is possible to actually measure what A1c is approximating. This requires a CGM (continuous glucose monitor), and these are presently ℞-only devices in the US. If this situation changes, CGM might become a major tool in the program. If you obtain one, and using diet as the primary lever, the goal would be to keep the readings in the 68-90 range at all times.⇱ Return to BG & Insulin

⟲ FBG Test Detail

CPT Codes: 82947, 82948 (by device is 82962)
82951 is OGTT, not recommended.

If you get this in a clinical draw, it may be labeled just "glucose". You are apt to get it for any routine exam, but it’s much more useful to obtain your own home test meter (usually around US$20), and a generous supply of matched test strips. These can then be used not only to check FBG, but more importantly PPBG (below).

Tip: if you are expecting a lab draw to include Glucose, take your meter along and do a finger-stick test right after the draw. Later compare the lab report to your meter reading.

Fasting blood glucose is subject to factors that can make readings erratic, particularly early in the day. Checking immediately pre-meal might be ideal, when checking PPBG is planned.⇱ Return to BG & Insulin

⟲ PPBG Home Test Detail

CPT Codes: {N/A}
82951 is OGTT, not recommended.

This test requires a home BG meter, which is used on a novel timing schedule. Taking a PPBG implies that an FBG was drawn just prior to the meal in question (providing the baseline for comparison). Another draw is then done at 30 to 60 minutes after the start of the meal. What’s being sought is the peak BG response to the carbohydrates in that meal. The number reported is primarily a scorecard for the recipe, but also a reflection of insulin sensitivity.

In consensus diabetes care, the meter is used hours after the meal, in order to adjust the medication dose. If you have T1D, LADA, or unresolved T2D or GD, and are still on medications, continue using the meter as prescribed (in addition to diagnosing meals).⇱ Return to BG & Insulin

⟲ Fasting Insulin Test Details

CPT Codes:
83527 Insulin,Free
83525 Insulin,Serum
83525 (x3) may be the Kraft Insulin Assay, but neither it, nor 82951 OGTT are recommended, due to the bolus of sugar required.

An elevated or high fasting insulin is suggestive of any of several issues, none desirable. The reading itself is not diagnostic, but indicates something that needs further investigation.⇱ Return to BG & Insulin

⟲ Body Composition, BMI, Weight & Waist

Body composition is worth testing for tracking purposes, and waistline is an easy indicator of progress of visceral fat reduction.

BMI is not actually measured. It’s a crude synthetic marker based on weight and height. It falls apart for the very fit, the very tall and the young. But it’s a number you often get without asking, and it provides something to track as a marker of progress.

The program likewise does not obsess over weight, but a desire to improve both is often what brings people to the program. If progress does not meet expectations, see:
Members: ⎆Wheat Belly Weight Loss Secrets Workshop (Module 1 of 5).⇱ Return to BG & Insulin

⟲ Vitamin B12 Test Detail

CPT Codes:
82607 Vitamin B₁₂ (Cobalamin)
83291 Methylmalonic Acid, Serum or Plasma

See the discussion in the Undoctored book if deficiency is detected, and also:
Members: ⎆MTHFR Basics Workshop⇱ Return to Micronutrients

⟲ Iron & Ferritin Test Detail

CPT Codes:
83540 Iron, Total - Serum
82728 Ferritin

See the discussion in the Undoctored book (page 295) if deficiency is detected. Other than vegetarians, iron-deficient males should not unquestioningly accept iron supplementation, as serious conditions need to be ruled out.⇱ Return to Micronutrients

⟲ Zinc Test Detail

CPT Code:
84630 Zinc,Serum

See the discussion in the Undoctored book (page 296) if deficiency is detected. Zinc testing is more useful for confirming deficiency than confirming that you are replete.⇱ Return to Micronutrients

⟲ Breath Testing Options

There are a number of gasses that can be revealing of upper-GI dysbiosis:
◊ H₂ (hydrogen),
◊ CH₄ (methane),
◊ H₂S/H₂SO₄ (hydrogen sulfide/sulfuric acid) and
◊ excess CO₂ (carbon dioxide).
These gasses are sampled in breath after ingestion of various challenge carbohydrates.

H₂ is relatively straightforward to test in locales where the AIRE or AIRE2 devices are available. This non-prescription home device is re-usable, and costs about as much as a single clinical H₂ test. FoodMarble (the makers of the AIRE device) reportedly plan to add H₂S capability (technical, regulatory & economic hurdles permitting). In the meantime…

Testing for sulfur-generating microbial overgrowth presently requires a prescription test, CPT Code 91065(x2) or 91299(x1) provides a single-use home kit. The mail-away ℞ ⎆Pimentel trioΔsmart® kit measures H₂, CH₄ and H₂S. It might be the most economical where H₂S coverage is needed. This kit can be useful in detecting SIBO gas markers, but is apt to not be economical in tracking treatment progress.

Due to copious CO₂ exhaled normally in healthy breath, excess CO₂ testing requires tagged CO₂, and is thus unlikely to ever be a home test. No program Protocol or Advanced Topic presently suggests testing CO₂.⇱ Return to Breath Testing

⟲ Stool Testing Options

This is a highly fluid situation (no pun intended), so stay tuned for developments, reports and recommendations. Any tests today that attempt to identify gut microbes have to rely on stool samples.

An ideal service would be capable of sequencing all life forms in the sample, from all Domains (perhaps including the Unknown Unknowns). They would then list everything in scope for detection, top down: Domain, Kingdom, Phylum, Class, Order, Family, Genus, Species, Strain, and possibly sub-strain. The report would have prevalence numbers. Scores relative to population data might be useful.

But few services today are this broad in scope (with many sequencing for bacteria only). Few report to strain. Some fail to provide actual numbers (only some vague ranking). Many provide premature health rankings, and utterly useless dietary and/or supplement advice. None of the currently useful tests may have CPT Codes.

Consensus medicine is so far only alert to a small number of well-known pathogens, so existing CPT Codes for stool testing are not the tests you are looking for in SIBO/SIFO.⇱ Return to Bowel Flora

⟲ CBC: Complete Blood Chemistry/Count Test Detail

CPT Codes (common):
85007 Blood Count, Differential, Manual
85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85027 Complete Blood Count, automated

⟲ Inflammation Test Detail

CPT Codes:
86140 C-Reactive Protein (CRP), Quantitative
86141 C-Reactive Protein (CRP), High Sensitivity
83090 Homocysteine

Early testing for inflammation is usually not terribly useful, as standard diets are expected to be inflammatory.

Additional inflammation markers that can be considered include IL-6, IL-10, TNF-α. If you have them, IL-8, IL-18, leptin, Lp-Pla2 and MPO also provide hints.⇱ Return to Inflammation

⟲ Apo E Test Detail

CPT Code: 81401
This is a one-time test, but not recommended per se, as it often costs more than…

It usually is more economical to get a complete gene sequencing, from a service that offers a download of the raw data. With that in hand, the Apo E status can be determined by the ⎆pairing of SNPs rs429358 and rs7412. Each allele is E2, E3 or E4.

There is no program Protocol or other adjustment for Apo E. Apo E4:x implies a more acute response to inflammation. Both Apo E2:x and Apo E 4:x imply lower tolerance for carbohydrate over-exposure.

For Apo E4 risk in Alzheimer’s, see: ⎆Book Review: Bredesen’s “The End of Alzheimer’s”⇱ Return to Genetic

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Bob Niland [⎆disclosures] [⎆topics] [⎆abbreviations]