Direct-to-consumer lab testing gives us a chance to see our biochemical realities more clearly — sometimes with surprising results.
For years, football players, bicyclists and all manner of competitive athletes have depended on periodic blood testing to get an up-close look at every type of health marker, from their hormone and glucose levels to nutrient deficiencies. Now an increasing number of regular folks are taking advantage of the same lab-test technologies to better improve their own health and fitness.
In fact, the Wall Street Journal reports, these consumers are fueling a rapidly growing industry: In 2009, people spent about $20 million a year for testing. And, direct-to-consumer testing grows at a robust 15 to 20 percent annually. That’s because while mirrors and scales don’t necessarily lie, they don’t tell the whole, detailed truth that a vial of your blood can deliver on demand.
It’s important to note that this testing (now commonly done with blood, urine and saliva) is not meant to be a substitute for a medical diagnosis. Nor will it explain with certainty what’s causing a particular condition. But done properly and analyzed accurately, it can help people identify trouble spots and then seek appropriate medical expertise or adjust their nutrition, exercise and other lifestyle factors accordingly.
For example, testing could reveal that nutritional deficiencies or high stress levels are undermining an individual’s weight-loss efforts. Simple tests could also reveal problematic glucose and insulin levels consistent with prediabetes, or inflammatory markers consistent with heart disease, perhaps motivating an individual to take early preventive action.
Panels for common hormonal imbalances, chronic-disease risk factors, food intolerances, toxicities and many other health concerns are now available without a doctor’s office visit. And they can be had for surprisingly reasonable prices, ranging from $165 for a test that measures your risk of heart disease and type 2 diabetes by looking at cholesterol, blood glucose and insulin levels to $1,000 or more for a comprehensive health profile.
Not every health professional likes the idea of consumers going directly to the lab. (Many docs worry that people will get inadequate counsel about what their results mean, or inaccurately diagnose and treat themselves on the basis of iffy data.) But defenders of the trend insist it can have real value in turning up preclinical warning signs and motivating potentially transformative healthy lifestyle changes.
“The [process] helps you understand where you’re at, how to improve, and what tools — nutrition, supplements, fitness activities, lifestyle shifts — can best help you get there,” says Holt Vaughan, director of HealthCheckUSA, one of a handful of companies now offering direct-to-consumer testing. (Disclosure: HealthCheckUSA is a subsidiary of Life Time Fitness, Experience Life’s parent company.) Other direct-to-consumer testing companies include DirectLabs, Health One Labs and Personalabs.
Health-insurance plans typically do not cover the costs of such lab work, but the tests are generally much less expensive than those offered through a doctor’s office, clinic or hospital, and they can often be paid for with tax-advantaged health savings accounts (HSA) and flexible spending accounts (FSA).
Either way, the results are strictly confidential (in accordance with the Health Information Protection Act) but are yours to share with whomever you please, including doctors or nutrition coaches, many of whom are now encouraging clients to have such tests done as part of their intake and monitoring protocols.
Curious about the experience and potential outcomes of such testing, we sought three volunteers from the Experience Life editorial staff to undergo a battery of blood-based tests and share their findings.
Each of them had different reasons for signing onto the experiment. Senior editor Courtney Lewis Opdahl was looking to support the next phase of her weight-loss journey. Managing editor Craig Cox wanted to fine-tune his approach to healthy aging. Fitness editor Jen Sinkler wanted to optimize her vitality in the service of her hardcore fitness efforts.
Read on to find out what each of them learned from their respective lab-test results, and what they took away from the testing experience.
Courtney Lewis Opdahl
Losing Weight, Fighting Inflammation
Profile: Senior editor Courtney Lewis Opdahl, 31, had already lost 41 pounds, cut out gluten and dairy, and amped up her exercise routine at the time of the blood test. The results confirmed that her overall numbers are headed in the right direction, but also revealed relatively high cholesterol levels and increased inflammation.
In January 2010, stressed out from long work hours and 65 pounds heavier than she was at her 2006 wedding, senior editor Courtney Lewis Opdahl decided it was time to make her health a priority. She visited an acupuncturist; tested an elimination diet (which revealed gluten and dairy intolerances); cut back on her caffeine habit; and boosted her physical activity with “boot camp” fitness classes, Pilates and yoga.
The changes have had a significant impact: As of last summer, she already had lost 41 pounds. But Opdahl’s experience at the magazine taught her that overall health transcends numbers on a scale. She had undergone similar blood tests in the past, and she was eager to see how much more she could learn from the results of the Longevity and Vitality test.
Nutrition coach Paul Kriegler, RD/LD, says the test confirmed that Opdahl’s plan was working. Most of her numbers — including HDL (“good” cholesterol) and triglycerides — were all good. Still, Kriegler saw a few small areas that Opdahl could improve on.
To begin with, Opdahl had relatively high C-reactive protein (CRP) levels, which indicate inflammation in the body. Although this could be due to many factors (including allergens, latent infections and gut issues), to Kriegler, it suggested that Opdahl might be taking in too much sugar and too many grain-based carbohydrates. To help Opdahl scale back on sugar and grains, Kriegler focused first on building satisfaction into Opdahl’s eating plan. “We talked about adding lots of healthy fats — sunflower seeds, olives, avocados, wild salmon — so she’d feel satisfied,” Kriegler explains. “It almost automatically makes people push some of the sugars and carbohydrates out of their diets.” Many experts also stress the importance of non-starchy vegetables, which are high in water and fiber and, as such, are satiating.
Opdahl was already on the right track, Kriegler noted. Her CRP levels, while still somewhat high, were half of what they had been in tests she’d had done the previous year. His concern, though, was that Opdahl’s LDL (“bad”) cholesterol levels remained higher than ideal. Like high CRP, a high level of LDL cholesterol (particularly the small-particle-size type) generally signals the presence of inflammation. It is often associated with metabolic syndrome, heart disease and other inflammatory conditions.
“When our body encounters any sort of damage or inflammation —which is commonly caused by foods that either lack nutrients, drive up insulin levels, or demand a lot for our body to metabolize them — it produces cholesterol in response,” Kriegler explains. “That cholesterol acts as an internal Band-Aid,” he notes. But when it patches up inflamed or damaged areas within our arteries, it can also lead to the formation of dangerous arterial plaques. (Opdahl’s functional-medicine doctor, whom she has been seeing for two years, has noted that she is more likely emerging from metabolic syndrome due to her improved eating and exercise habits.)
To counter inflammation, Kriegler recommended that in addition to minimizing sugars and flours and emphasizing more healthy fats and non-starchy, colorful veggies, Opdahl double up on her fish-oil supplement, packed with inflammation-reducing omega-3 fatty acids. “You can make the same changes through diet alone, but that might mean eating 12 ounces of wild salmon a day,” Kriegler says.
For Opdahl, her lab results were an important reality check and also remarkably motivating. “It was nice to take the focus off the number on the scale to look at how much my health is improving and changing,” she says. “Overall, I’ve been happy with my progress. But these results will help me fine-tune things even more.”
To follow Courtney Lewis Opdahl’s progress, visit her blog, Coming Clean (ExperienceLife.com/coming-clean). To read about her experience at an integrative weight-loss retreat, see “Relax. Retreat. Lose Weight” at ELmag.com/kripalu. You can follow Opdahl on Twitter @clewisopdahl.
Health and Vitality for the Long Run
Profile: Managing editor Craig Cox, 61, commutes by bike, eats well and has a positive outlook on life. Although his results were generally impressive — especially for someone who is more than 60 years old — Cox was surprised to find out he has relatively low vitamin-D levels and slightly elevated cortisol and CRP levels.
Managing editor Craig Cox jokingly refers to himself as a member of the “geezer segment,” but a lifetime of eating well, exercising regularly and managing his stress levels gives the 61-year-old the health of a much younger man.
He starts his day with a short workout before breakfast and then hops on his bike for a milelong commute to work. In his downtime, he meets up with friends to play basketball or tennis and works on landscaping projects in his yard.
A longtime believer in organic, whole foods, Cox eats lean meats and fish, packs fruit for snacks at work, and drinks black tea each day. He occasionally heads to the local burrito shop for lunch, however, and admits that a single glass of wine with dinner might turn into two. “Maybe that’s not a good idea,” he says. “Then again, you only live once.”
Senior program manager of health and nutrition coaching Cindi Lockhart RD, LD, was impressed with Cox’s test results. “When I looked over his assessment, I thought, ‘He can’t be 61.’”
Lockhart did see a few opportunities for improvement, though. One was Cox’s relatively low vitamin-D levels, which were 45 nanograms per milliliter (ng/ml). (Optimal levels, according to many experts, are between 50 and 70.) Known as the sunshine vitamin, vitamin D plays a key role in preventing chronic disease. Office-dwellers like Cox, who spend a lot of daytime hours indoors, tend to be deficient.
Cox was surprised his vitamin-D levels were lower than optimal, since he spends time outdoors biking to work every day. Lockhart pointed out that he didn’t have a lot of skin exposed during his rides, though, and they rarely happened during peak sunshine hours. She also noted that when it comes to absorbing and utilizing nutrients, individuals vary widely — one reason that general health guidelines are often less useful than suggestions based on custom test results. Lockhart recommended that Cox take a higher-dose vitamin-D supplement for the next few months, then follow up with another test to benchmark his progress and adjust his dose if necessary.
Like Opdahl, Cox also had elevated CRP levels, indicating inflammation from an array of potential causes. These inflammatory markers often don’t manifest themselves with early physical symptoms, but they’re linked to an array of chronic conditions. Lockhart suggested Cox include more healthy fats, up his veggie intake and cut out inflammatory refined carbohydrates.
Cox also had slightly elevated levels of estrone, a type of the sex hormone estrogen found in all men. High levels of estrone can lead to prostate problems and prostate cancer, says Lockhart. By backing off that second glass of wine, Cox could bring the levels down. Lockhart also recommended limiting his exposure to “xenoestrogens,” chemicals found in plastics, cleaning supplies and toiletries.
The final area of concern involved cortisol levels, which were slightly higher than optimal, indicating stress. For Cox, who gets eight hours of sleep and meditates most mornings, it was an eye-opening result. Lockhart said that following up with a more detailed cortisol stress test, one which gauges cortisol levels four times throughout the day, could provide additional context.
Cox is already making small tweaks to his behavior, like keeping closer track of exactly how much he drinks. “It’s easy for some things to become a habit — like splitting a bottle of wine with my wife at a restaurant,” he says. “Maybe that’s what we actually want to do sometimes, but maybe we can do that in a mindful way, and not just out of habit.” He is also adding nuts to the fruit he brings for daily snacks and is making an effort to pack his lunch more often so he can better control what he eats.
“I don’t want to have to think about it too much,” Cox says. “But it’s not hard to make a lot of these changes, and that’s what will make them sustainable.”
Craig Cox writes about fitness and exercise at his blog, Pumping Irony, at ExperienceLife.com/pumping-irony. Follow him on Twitter @craigallencox.
Good to Great
Profile: Senior fitness editor Jen Sinkler, 34, maintains a stellar exercise and diet regimen. Still, she is the first to admit that she struggles with work-life balance. She wasn’t shocked when the tests showed elevated cortisol levels, but she was surprised by the hormonal imbalance and elevated vitamin-D levels.
Jen Sinkler calls herself a “lifelong jock.” A four-sport athlete in high school, the 34-year-old picked up rugby in college. She was co-captain of a team that won a national title, and then went on to represent the United States on two national teams between 2002 and 2009. These days, fitness has become a great way for Sinkler to keep in touch with people.
“I’m constantly making workout dates with friends and my boyfriend, because that’s what keeps me accountable and motivated,” she says. “I like fitness as a social activity, and honestly, I might not stay on it otherwise.”
In her job as Experience Life’s editorial director of fitness content, Sinkler climbed the professional ladder with the same drive that made her a top athlete, but she admits she’s struggled with work-life balance.
For Sinkler, there are no half-measures. When she decided to move to a “primal” diet, which mimics the diets of our Paleolithic ancestors, in 2009, she cut out all grains. Today her diet includes plenty of vegetables, and she prioritizes proteins, including eggs and most meats, and unrefined coconut oil — though dessert is an occasional
treat. Life Time corporate registered dietitian Anika DeCoster, RD, LD, calls Sinkler’s nutrition plan “impeccable.”
The pursuit of excellence has helped Sinkler accomplish an array of fitness, nutritional and career goals — but it’s also sometimes taken a toll. In addition to her new job responsibilities, she recently moved offices and homes. “I like having a fast-paced life, but lately, I’ve been feeling a little more brittle because of it,” she admits.
Sinkler felt confident that the testing would reflect the hard work she’d put into staying healthy. Indeed, most of her numbers were at or near ideal ranges — but there were three that were a bit off.
The first concern was elevated cortisol levels, which indicated that she was under stress — something she knew intellectually but didn’t fully acknowledge to herself until the test results came in. “I finally cracked open the meditation CDs that I bought three years ago,” she says. “And I feel better about taking time to chill out.”
Sinkler was surprised by the skewed ratio of estradiol to estrone, two types of estrogen. Optimal ratios of estradiol to estrone are 2:1, says DeCoster, but Sinkler’s levels were 0.2:1. Combined with a suboptimal ratio of total estrogen to its counterbalance hormone, progesterone, the tests suggested estrogen dominance. DeCoster says that Sinkler’s imbalance could lead to heightened menstrual symptoms, including fibroids and even hot flashes, and could also be related to her elevated cortisol levels. Because the culprit behind the skewed ratios wasn’t certain, DeCoster recommended further hormonal testing. She also suggested Sinkler follow a detoxification diet to clear out excess estrogen and that she consider changing her hormone-based birth control, which she had used faithfully for years. “Birth control pills are made up of artificial hormones, and some people’s bodies can’t detox them well on their own,” DeCoster says. “Everyone’s bodies react differently.” Sinkler immediately switched to nonhormonal birth control.
Finally, Sinkler had vitamin-D levels that were a bit too high, in large part because she had been taking a supplement of 2,000 IU per day, and tests revealed that she was absorbing more than her body needed. The health risks of too much vitamin D are up for debate, though some studies have linked it to long-term bone and kidney damage. Sinkler has eliminated the supplement from her regimen until further testing.
After some reflection, Sinkler has been able to put her results in perspective. The three areas of concern were relatively small, and the rest of her health indicators suggested that she is in fantastic health. “I like to fix things, and I definitely want to fix this,” Sinkler says. “But I realize that it’s going to be a process. Now, at least, I have a targeted plan.”
Connect with Jen Sinkler on Twitter @jensinkler, and visit her Facebook page at Survival of the Fittest.