In Episode 144 of Keto Talk, Jimmy and Dr. Will Cole dig into the subject of Functional Medicine and Dr. Cole explains to us exactly what tests every keto dieter should be running and what they mean to you.

“It's rarely one thing that is the magic bullet. Normally it's a confluence of different factors. These labs allow us to find the pieces of the puzzle.” – Dr. Will Cole

“You can take a shotgun approach with labs and do everything, or use them to really fine tune your health.” – Jimmy Moore

The specific tests we talk about in this episode and the ranges you should be looking for:

C-reactive protein

Inflammation is one primary way disease genes get turned on, and it is generally destructive all over the body. C-reactive protein is an inflammatory protein that, while it is essential for cleaning up bad bacteria, in excess it can lead to accelerated aging, chronic disease, and damage to the telomeres.

Optimal Range: < 0.5 mg/L

Small dense LDL particles

What you thought was “bad cholesterol” (LDL) isn’t all bad, and labelling it so is a simplistic and inaccurate view of cholesterol. LDL particles are proteins that carry cholesterol around in your body. Some of these particles are big and buoyant, while others are small and dense. It’s the small dense LDL particles that can cause damage, while the larger fluffier particles are essentially benign. Knowing your level of small dense LDL particles is much more instructive that simply knowing your total cholesterol, because it is the small dense LDLs – not the cholesterol itself – that indicate a riskfor heart attack and stroke (and thereby put you at risk for an earlier death).

Optimal Range: < 200 nmol/L

Homocysteine

This protein in excess (especially when coupled with a B vitamin deficiency) has been linked to cognitive decline, which can drastically reduce quality as well as length of life.

Optimal Range: < 7 Umol/L

Hgb A1C

This test tells you what your blood sugar has been, on average, for the past two to three months. When it is high, it can indicate pre-diabetes or diabetes, and an elevated A1C has been linked with higher rates of all-cause mortality in patients with diabetes.

Optimal Range: < 5.3%

Vitamin D

This nutrient is responsible for hundreds of different genetic pathways in the body but because most people spend most of their day indoors and get little sun exposure, vitamin D deficiency is rampant. That’s too bad because this deficiency is linked to chronic disease, and optimal levels are linked to an actual preservation of telomeres, meaning you live longer and stay healthier! If that’s not a reason to get a little sunshine, I don’t know what is. Note that vitamin D should be paired with other fat soluble vitamins, like vitamin A and K2, for maximum absorption.

Optimal Range: 50-60 ng/mL

Fasting insulin

When your body breaks down carbohydrates, and to a lesser extent, proteins into glucose, your blood sugar goes up. In response, your pancreas secretes insulin to send your blood sugar into your cells (for energy) and bring down the level in your blood. However, if insulin gets activated too often at too high levels, this has been linked to accelerated aging and telomere shortening.

Optimal Range: < 3 ulU/mL

C-peptide: Optimal Range: 0.8 to 3.1 ng/mL
Fasting blood sugar: Optimal Range: 75 to 90 mg/dL
Triglycerides: Optimal Range: < 100 mg/dL
HDL: Optimal Range: 59 to 100 mg/dL

Hormone testing: Urine and Saliva
Other Nutrients: Selenium, Mg, Iron, MMA,

Microbiome labs: We look to assess gut health, where around 80 percent of our immune system resides.

Intestinal permeability lab: This blood test looks for antibodies against the proteins that govern your gut lining (occludin and zonulin), as well as bacterial toxins that can cause inflammation throughout the body, called lipopolysaccharides (LPS).

Multiple autoimmune reactivity labs: This array shows us if your immune system is creating antibodies against many different parts of the body, such as the brain, thyroid, gut, and adrenal glands. The labs are not meant to diagnose an autoimmune disease, but to look for possible evidence of abnormal autoimmune-inflammation activity.

Cross reactivity labs: Helpful for people who are gluten-sensitive and who have gone gluten-free and eat a clean diet, but still experience symptoms like digestive problems, fatigue, and neurological symptoms. In these cases, relatively healthy food proteins—such as gluten-free grains, eggs, dairy, chocolate, coffee, soy, and potatoes—may be mistaken by the immune system as gluten, triggering inflammation. To their immune system, it’s as if they have never gone gluten-free.

1. AHCY:

This enzyme is responsible for breaking down the amino methionine by converting S-adenosylhomocysteinase into pro-inflammatory homocysteine. Mood disorders are common for those with a double mutation but typically do well with SAMe supplementation.

2. BHMT:

The BHMT gene directs the enzyme responsible for the amino acid methionine, the building block in the choline oxidation process for optimal brain function. Changes in this gene are associated with ADHD.

3. CBS

No, not the television network! It actually stands for the enzyme that makes the amino acid cystathionine. A mutation of this gene will lead a person to produce more sulfur end products and as a result will need to limit sulfur-rich foods such as legumes and dairy. These foods can increase ammonia levels and contribute to existing health problems. NOS and SUOX are two other genes that can increase sulfur and are linked to immune disorders like asthma.

4. COMT:

This gene is responsible for creating a healthy balance of neurotransmitters and, in turn, a healthy brain. A double COMT gene change is associated with increased risk for anxiety, OCD, bipolar disorder, and ADHD.

5. MAO:

The main role of the MAO gene is to clear out excess neurotransmitters like serotonin. When changes to this gene occur it can create an imbalance in neurotransmitters leading to increased rates of anxiety and depression. Those with an MAO mutation, as well as the MTHFR gene mutation, can have a higher rate of histamine intolerance. Because of this even healthy foods such as fermented foods, bone broth, and vinegar can increase inflammation.

6. MTHFR:

This is not an acronym for a swear word guys, get your mind out of the gutter. The biggest thing I use DNA testing for is to assess methylation, a biochemical superhighway that help your gut, brain, hormones, and detox pathways function properly. This process happens a billion times every single second so if methylation isn’t functioning well, neither are you. Since I often deal with a variety of gut, brain, and hormonal problems in my clinic it is important to see if my patients methylation is working well.

The MTHFR enzyme is responsible for converting folic acid into folate which acts as fuel to the methylation process. A1298C and C677T are the two main MTHFR mutation. When A1298C is altered it can lead to mood disorders due to its important role in neurotransmitter function. C677T changes can cause higher levels of inflammatory homocysteine. Both of these are linked to autism and autoimmune conditions like autoimmune thyroid issues.

7. MTR/MTRR:

These are necessary for B12 production, another methyl donor. Those who have this mutation need higher intake of B12 because their body uses it faster than it produces it. Oftentimes people who have this genetic change can also be low in lithium which is needed for mood regulation. We can easily check lithium levels through testing blood and hair.

8. VDR

VDR stands for vitamin D receptor. Every single cell in your body uses vitamin D. Other than your thyroid hormone, no other nutrient or hormone can claim that importance. It is responsible for over 200 different pathways in the body. Mutations in this gene make it really difficult to absorb vitamin D. It’s important to know if this is the case for you in order to supplement higher doses on a consistent basis to make sure you are getting enough of this vital nutrient.

9. Detox genes

I also look for changes in your detox genes such as CYP1A2, also known as your caffeine gene. This can show just how well you can tolerate caffeine and whether or not it can be harmful or beneficial to your health.