Top 10 Labs for Athletes to get done in January
January is a time of reflection and renewal for most people here in the US, as we tend to use the calendar year as a sign of new things. If you are in the refresh and renew camp, before you go revamping your training or spending money on a cleanse, the best thing you can do is to collect your health data, look at it, and then make a customized plan from there along with your trainers, coaches and providers like me.
We can look at our personal health data in many ways, in fact some of you may be wearing a watch, band, or ring that monitors your sleep, heart rate, strain, and recovery. That is an amazing source of health data…do you actually analyze it?
In my opinion the most important piece of data to start with comes from your blood. Through a quick blood draw we can analyze hundreds of markers that give us insight into the health of not only your red and white blood cells, but how your thyroid is performing, what your hormones are doing, and how your body has been processing your nutrition over the past several months.
Here are the top 10 labs to talk with your team doctor and personal health care providers about, or if you like to take things into your own hands, I'll explain how you can order labs for yourself!
1) Advanced Lipid Panel
When we talk about “lipid profiles” we are looking at the fat molecules in your bloodstream. You may have heard of markers like Total Cholesterol, LDL (low density lipoprotein) and Triglycerides. A standard lipid panel will include 4 markers: Total Cholesterol, LDL (low density lipoprotein - the “bad” cholesterol), HDL (high density lipoprotein - the “good” cholesterol) and Triglycerides. I suggest going for the advanced panel, as there are additional markers on the advanced panel that are extremely helpful!
Particle Profile - this is a breakdown of the specific sizes and density of those LDL and HDL particles. It’s helpful to know if your high LDL is made up of the big fluffy particles that don’t do as much harm, or the little dense particles that like to stick to your arterial walls. This may be called an NMR LipoProfile or Lipoprotein Subfractionation test.
ApoB - this is a look at your LDL, VLDL (Very-low-density lipoproteins), IDL (Intermediate-density lipoproteins), chylomicrons and Lp(a). Lp(a) is another extremely important lipoprotein that has good evidence to show a correlation with predicting heart attack, stroke and atheroscleroitic cardiovascular disease. If you want to dive deeper into ApoB you can check out Peter Attia’s blog on it here. ApoB will include all of these, but Lp(a) is a marker that can be ordered on its own as well. Even as a young healthy athlete, many of you have a history of heart disease in your family and tracking this early on can be a life saver.
hs-CRP - high sensitivity c-reactive protein is an inflammatory marker that is a bit more sensitive than a standard CRP and therefore great for cardiovascular inflammation detection.
Homocysteine - this is a really interesting marker! High homocysteine can potentially damage the lining of your arteries or lead to blood clots. Surprisingly, high homocysteine levels are a result of inefficient b-vitamin metabolism. Oftentimes you’ll see insufficient levels of B6, B9, and B12 when there are high homocysteine levels. Quick fix - eat more foods rich in B vitamins or add an NSF Certified for Sport Vitamin B Complex!
2) Complete Thyroid Panel
Typically when you get your thyroid labs done it is one marker, TSH (thyroid stimulating hormone), which measures the amount in your bloodstream. Too high could indicate a hypothyroid condition, and a low TSH could indicate hyperthyroidism. However, these conditions can exist with a normal TSH level. I’ve caught many sneaky thyroid conditions by ordering a complete thyroid panel which along with TSH includes thyroid antibodies Anti-TPO and Anti-Thyroglobulin which can detect autoimmune thyroid conditions such as Hashimoto's and Graves disease. Some complete panels also include measurements of T3 and T4 which are additional thyroid hormones that can help your provider understand how the thyroid gland is functioning. Note that some thyroid conditions will require medication that also requires a TUE (therapeutic use exemption), so always review any outside labs or medications with your team doctor to ensure you have everyone on the same page.
3) Nutrition Specific Markers - Vitamin D
Vitamin D comes from the sun and things like clothing and sunscreen actually block the absorption of those rays into our skin to help us build up our Vitamin D stores. Keep wearing your sunscreen, but it is important for an athlete to keep this marker in the optimal range (not just standard range, but optimal range) since we use Vitamin D every time our muscles contract. Think about how much Vitamin D an athlete must use each day compared to us regular people in an office job!
Vitamin D is a fat soluble vitamin, meaning that excess is stored in our fat tissue. This means it can accumulate, and at high doses Vitamin D can be toxic. Many of you take Vitamin D without even knowing what your lab number is. It’s ideal to get your Vitamin D levels between 50-70, and if you know your number, you’ll know how much to supplement with. Keep in mind sun exposure changes with travel and location, so if you are used to playing in Seattle, but then get traded to Houston…your Vitamin D levels will change and so should your supplement!
4) Nutrition Specific Markers - Iron Panel
Not just looking at Total Iron (that’s the amount of the mineral iron floating around in your bloodstream) but also Ferritin (a protein that stores and releases iron), Transferrin (a protein that moves iron through the body), and Total Iron Binding Capacity (TIBC) (which shows how well iron binds to transferrin and other proteins in the blood). All of these put together gives a great picture of how well you are doing with your iron metabolism. This is especially important in women since we lose iron in our menstrual blood each month, and also in any athletes cutting out red meat or consuming more red meat, since it is a rich source of iron and intake over time will affect those iron levels in the blood. There are lots of diet and fitness influencers out there preaching their own way of eating via documentaries or social media channels, but the changes you make have drastic implications on your physiology and biochemistry, so make sure you are monitoring data like blood markers if you ever jump into something new.
5) Nutrition Specific Markers - Vitamin B12 & MMA
Nutrition markers can be tricky. In some instances, it is helpful to know how much of a nutrient is actually floating around in the bloodstream (called a serum or extracellular measurement), as is the case with Vitamin D and Vitamin B12 and others. In other instances a measure of the nutrient within the white blood cells or red blood cells (called an intracellular measurement) is much more helpful. Those intracellular labs are considered specialty labs and are not typically available through your standard team lab panels, so you can ask a provider like myself or a primary care physician if you’d like to explore nutrition labs deeper.
Vitamin B12 is involved in so many incredible processes from red blood cell production, cell metabolism and DNA and nerve function. A deficiency in B12 can cause anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood issues - not something you wanna mess around with as an athlete. Plus, B12 gives you that energetic feeling! A serum measurement of B12 is a good first look, but an additional marker called MMA (methylmalonic acid) will tell us if there is a full-blown deficiency going on.
6) Nutrition Specific Markers - Omega-3 Index
Omega-3s are probably the nutrition molecule I preach about most. In my opinion it is the closest we have to a magic bullet in the nutrition world. The omega-3 index was created by researchers Bill Harris and Clemens Von Schacky as an accurate measurement of the omega-3 fatty acids EPA and DHA concentrations in red blood cells. The omega-3 index specifically is a great marker that indicates a longer term view of omega-3 status. Your goal is 8-12%! You’ll either need to eat more wild fish (I recommend Premier Catch and yes this is a biased recommendation) or add a high quality NSF Certified for Sport Fish Oil.
7) Complete Metabolic Panel
This is a standard panel on all team labs but provides key information about your metabolic processes and includes: Sodium, Potassium, Chloride, Carbon Dioxide, Glucose, BUN, Creatinine, Calcium, Albumin, ALT, AST, Bilirubin, Total Protein, and Total Alkaline Phosphatase.
8) Complete Blood Count
Again, a standard panel that tells us about the health of your blood cells and includes: measurements of your red and white blood cells, and your hemoglobin and hematocrit. These markers can tell us about everything from dehydration to viral infections.
9) Creatine Kinase
Creatine Kinase is an enzyme found in the muscles, and when CK is high it can indicate muscle damage. The huge caveat to this is that strenuous exercise technically is muscle damage! You will see this elevated in athletes during training camps or intense tournaments, but not always. It can be helpful to measure in the off season especially if the focus is recovery and rest, or in an athlete experiencing lots of muscle pain and soreness.
10) PSA - for Men Only
PSA is prostate specific antigen and measures the amount of this protein in the bloodstream. This protein is produced in small amounts by healthy tissue but also by cancerous cells or from an enlarged or inflamed prostate gland. It's a great screening tool for prostate cancer and should be a regular part of mens labs.
And that ladies and gentlemen, is probably the most incredible set of blood data you can get to start the year!
The more you know about lab markers and how they drive decision making on things like diet and supplements, the more you can advocate for yourself. Sometimes it just takes asking the doc to add on a specific marker to a test they may already be running. Depending on your league and team and medical staff, they may have flexibility to order whichever labs they like, or they may have to stick to a standard lab panel that has been approved by the team for budget or other reasons.
Consider hiring your own personal providers that can follow you during the offseason and move with you regardless of which team you play for (and if you play for national teams). If that isn’t an option you can go the DIY route as long as you are willing to do the work to understand the markers! One of the easiest ways to order your own blood test is through a company called Direct Labs (no affiliation, it is just one I personally used early on in my career when I was learning about blood work) which allows you to purchase labs at discounted prices. They do not process insurance, instead they charge a heavily discounted rate so you can pay out of pocket.
You can search for any of the specific markers I’ve written about here or go with a curated panel like the “10 Most Important Tests + Cardio IQ Advanced Lipid Panel” which includes many of the markers above!