What Blood Tests You Should Ask For Based On Your Family History

When it comes to labs and blood work, it’s difficult to know exactly what to ask for. To lend some clarity to the confusing topic, we chatted with a handful of top integrative and functional M.D.s about what they’d consider their “top picks.” In addition to the seven blood tests you should ask for at your annual physical, you may want to bring up these tests if you have a family history of cancer, autoimmune disease, or heart disease. 

While you should always work closely with your doctor to determine what tests are appropriate, these outlined below may be worth bringing up at your next appointment—they could help you make the targeted lifestyle changes necessary to lower your risk.

Heart disease

In addition to an advanced lipid panel that differentiates particle size, you may want to consider testing oxidized LDL (OxLDL)—cardiologist and functional primary care physician, Steven Gundry, M.D.’s, favorite cholesterol test. “Cholesterol isn’t really bad for anybody unless it’s rancid,” he says. “Then it has the potential to stick to blood vessels and get incorporated into a blood vessel wall. We can measure the rancidity of cholesterol with oxidized LDL.” One of the reasons Gundry stresses the consumption of polyphenol-rich foods like berries and green tea is because it helps prevent your cholesterol from going rancid. 

If Gundry has a patient with a strong family risk of early-onset heart disease (say, a parent who had a heart attack in their 30s or 40s), he always tests levels of lipoprotein (a), or Lp(a)—a cholesterol particle that’s elevated due to genetics in about 20% of the population of northern European descent, and that can triple the risk of heart attack or stroke. Knowing that you’re genetically predisposed is super important as statin drugs actually raise Lp(a) further. The good news, Gundry says, is that it seems to be treatable with vitamin B3 (niacin).

*These two tests may not always be covered by your insurance, even with a family history.

Diabetes

In addition to an HbA1c, you may want to consider a fasting insulin test. That’s because it’s possible that “you can have an absolutely normal blood sugar with very elevated insulin levels,” says Gundry. “Insulin is released to pull sugar out of your bloodstream, and the ease at which sugar is pulled out of your bloodstream by insulin can mask a really bad condition.”

Bindiya Gandhi, M.D., a family medicine physician trained in functional medicine, agrees, adding that if she senses glucose intolerance in a patient despite them having a normal HbA1c, she’ll always check fasting insulin. Insulin levels also tend to become imbalanced well before blood glucose or HbA1c levels, making this a test that’s particularly beneficial for spotting red flags early. 

Cancer

Your particular screening/testing protocol will depend on which type of cancer runs in your family, and you should always listen closely to your doctor’s recommendations. For example, a history of colorectal cancer will lower the age at which you can start getting colonoscopies that are covered by insurance, and a history of breast cancer means you can start getting mammograms earlier than the average woman—my mom had breast cancer at age 35, so I started getting yearly mammograms at age 25. 

But what about tests that may be beneficial for those with a family history of any type of cancer? Gundry says he’d recommend a fasting insulin test, which is by no means a diagnostic test, but rather, a test that may prompt you to make lifestyle changes (e.g. scaling back on sugars and refined carbs) that could lower your risk. “Insulin is a growth hormone, and as we get older there’s nothing in any of us that we want to grow,” he says. “It’s actually very rare for me to see patients with cancer who don’t have an elevated insulin level.”

Dementia 

Although there’s no diagnostic test for Alzheimer’s or dementia, there are some markers you may want to keep tabs on that will help you make more targeted lifestyle changes. Imbalanced blood sugar and insulin levels can play a big role in these neurodegenerative diseases, which is why—yet again—Gundry recommends a fasting insulin test. “We know that people with elevated fasting insulin levels in their 40s and 50s will have significantly increased memory loss in their late 60s, 70s, and 80s compared to people who have a low fasting insulin level.”

You can do genetic testing to see if you have the APOE4 genetic variant.The presence of this gene does not mean you will get Alzheimer’s, but it is associated with an increased risk of earlier onset Alzheimer’s. “This gene makes people very susceptible to negative effects of saturated fats, particularly from animal sources,” says Gundry. “What happens is that the cholesterol carriers that deliver cholesterol to cells in the brain are incapable of picking it up and removing it safely. The good news: If you know you have this gene, you can take steps in your diet to reduce Alzheimer’s risk by curtailing your consumption of these fats.”

Not all doctors will test for this, but it’s something you can discover with an at-home genetic test like 23andMe. If you go this route, Gundry urges you to bring your results to a functional or integrative doctor for further interpretation and guidance.

Autoimmune disease

Even with a family history of autoimmune disease, most doctors won’t test you for anything unless you also have symptoms. “What I tell people is, if you have no symptoms, you do not have a disease,” says Chloe Godwin-Gorga, M.D., an integrative primary care physician. If you do have some symptoms, however, (say, you’re experiencing joint pain and rheumatoid arthritis runs in your family), doctors can run what’s called an antinuclear antibody (ANA) test.

“An ANA is a marker for autoimmunity. It’s most associated with diseases like lupus and RA, but it actually can be positive in a wide variety of autoimmune conditions” says Godwin-Gorga. “When you have a positive ANA, it will be reflected as a titer—meaning, the higher the number, the stronger the reaction is. A higher ANA can be a reason to get further evaluation.”

Autoimmune diseases all have an underlying inflammatory component. So keeping tabs on your levels of inflammation with a highly sensitive c-reactive protein (hs-CRP) test may be warranted. 

Under-testing and over-testing are both unwise—you want to find your sweet spot. 

The moral of this article is not simply that your doctor is doing it wrong. Many conventional doctors and medical institutions are basing their screenings on science-backed recommendations outlined by the U.S. Preventive Services Task Force (USPSTF). Here’s an example of the Cleveland Clinic’s screening guidelines. A cholesterol screening, for example, is recommended every 5 years (or more based on risk) after age 20.

This often catches big stuff, which is good, but not always in time for you to prevent it altogether. Case in point: After my five-year stretch with no blood work, a lipid panel actually revealed I had high cholesterol and borderline high blood sugar—something I was able to address, but that I could have addressed much earlier had I noticed my numbers slowly creeping up.   

The message isn’t “test for everything!” either. “Testing has been given this halo effect of, ‘You should test to be healthier,’ but some of these specialty tests are super unnecessary,” says integrative physician Amy Shah, M.D.. “I get people in my practice all the time who want to know their food sensitivities, but I have to be the bearer of bad news and tell them food sensitivity tests are really poor at this point. I try to stay on the side of less is more.”

The truth is: “You don’t need to have big fancy tests done to get a lot of information about how you are shifting metabolically,” says Kristann Heinz, M.D., R.D., a doctor board-certified with the American Board of Integrative-Holistic Medicine. You can glean a lot of information from pretty basic tests—the key is doing them regularly (preferably annually), so you can track your results over time and spot trends. You want to catch smoke before there’s fire.