The Most Important Blood Test Your Doctor Probably Never Orders

And why they’re not addressing it right, even if they do…

Doctors are notorious for being pretty temperate in their lab ordering:

A CBC (blood count), CMP (kidney and liver markers), TSH (thyroid), A1C (diabetes screening), Lipid Panel (heart disease risk screening), and maybe a Vitamin D level are pretty much all that most doctors routinely order.

But they’re really missing out.

Your blood is an extremely valuable resource—The skilled physician can use it to infer so much more about your health than just a generic, decades-old, atomized understanding of “Your A1C is less than 6.5; therefore, you do not have diabetes. Congratulations. Let’s check it again in three months.”

That approach falls far short.

I’m still surprised at how many times I have patients come to me saying things like: “My doctor ordered me so much bloodwork on my last visit. He must have checked everything! And all my levels were great! I don’t know what else could possibly be done!” And it turns out he ordered little more than the routine bloodwork above.

That’s fine for the minimalists out there. Ultimately everyone has to choose their own approach to their health.

But for those seeking health optimization and real, in-depth prevention that goes beyond waiting for the very instant your A1C hits 6.5 and the very moment your LDL passes the 100 mark, there’s a lot more that can be done. Let’s talk about just one simple example of that.

The case of homocysteine—the basic screening marker that most doctors miss

Elevated homocysteine is a well-established risk factor of cardiovascular disease. Yet, despite that, most doctors never order it.

High levels of homocysteine are well-known to correlate with an increased risk of cardiovascular disease, possibly due to its propensity to damage the lining of your blood vessels.

High homocysteine is well-known to correlate with an increased risk for dementia and memory problems in general.

High homocysteine is well-known to correlate with mood problems, including depression and anxiety.

And much, much more…

But the reality is: Most doctors simply never order homocysteine because they (1) don’t know what it is, (2) don’t know why it’s important, or (3) don’t know what to do about it.

In fact, I’ll argue that most doctors who do, in fact, order homocysteine have a problem with number 3 as well: They simply don’t know what to do about it.

How to fix high homocysteine

A biomarker like homocysteine is only useful if you can do something about it. It’s like being told you have an A1C of 10—a sure sign of diabetes—but being given no way to fix it. It’s only useful if you know how to address it.

Generally speaking, elevated homocysteine means that you have a problem with one of the two methods that your body uses to get rid of homocysteine, the remethylation pathway or the transsulfuration pathway. A defect in either of these pathways can make your body unable to effectively clear out homocysteine, so it builds up to pathological levels and ends up contributing to your memory problems, allergies, mood problems, cardiovascular disease, etc.

Fixing problems in these pathways—the remethylation and transsulfuration pathways—often consists of providing more of one or more of a set of vitamins known to be essential to these metabolic processes. Notoriously, these include vitamins B9 and B12.

Most providers who identify a high homocysteine (if they order it at all), will address it by putting you on high dosages of some form of B9 (folate), B12, or occasionally, B6. Eventually, the homocysteine comes down, at least a little bit. Problem solved—or so it seems.

The problem is: Homocysteine is not really the problem in and of itself. Homocysteine is really a marker of another problem, somewhere else, that needs to be fixed. You lowered the homocysteine, but you didn’t fix the problem. When you see a high homocysteine level, your goal is not to get that homocysteine down as fast as possible—treating the number, so to speak. An elevated homocysteine level is a signpost, not an end goal. It’s a red flag that points you to a problem somewhere else. It should prompt you to start looking. Not to stop looking.

What other tests should you get if you find a high homocysteine?

Homocysteine is just one of a set of highly valuable blood markers that give you an idea of the status of some of the biochemical pathways that I mentioned previously. But it really should not be looked at in isolation. It should be looked at in the context of other related, equally valuable blood markers.

It’s like the issue with the diabetes approach I mentioned above. Your A1C being 6.5 is not the problem. It’s a whole cascade of metabolic issues, starting in your muscle and liver cells, involving dysregulated insulin levels, resistant insulin receptors, subclinical nutrient deficiencies, etc. that come together to finally, at the very end, tick your A1C above that 6.5 mark.

The skilled doctor would have looked at biomarkers representing those other steps in the cascade way before your A1C got anywhere near the 6.5 mark. And those values would allow you to get the very root of the problem and fix it there and then.

Homocysteine is like your A1C. It reflects a cascade of other physiological issues, occurring elsewhere, that the astute detective will take into account in determining the right course of action towards fixing your problem. All the evidence must be gathered before drawing conclusions, right?

Things like methionine levels, SAMe levels, glycine levels, serine levels, and much more are all highly important in the homocysteine decision-making process.

Genetic markers are also highly important, as they help you determine what your underlying, genetic predispositions are. Those interplay with myriad environmental factors to produce the final homocysteine deviation that we’re hyper-fixating upon.

For those interested, our Ultimate Methylation Package tests all of these values, and more.

The key is, ultimately, to take a functional approach to health. Functional as opposed to discrete. An approach based on established, well-known mechanisms instead of based solely on a simple 1+1 understanding of calculated risk scores. A1C of 6.5 = diabetes.

More coming soon…

Keep in mind that this is not official medical advice. No doctor-patient relationship is established through this article or through any other information provided on this website.