Essential Blood Tests and Their Associated Dysfunctions Part 1: Basic Blood Chemistry Tests and Complete Blood Count (CBC)

Blood is a treasure trove of information about an individual’s metabolism, physiology, and disease risk. We just need the right tools to dig up and appreciate the treasure.

A Functional Blood Chemistry Analysis (FBCA) provides those tools along with clinical guidance and support. FBCA evaluates each biomarker within an optimal range to identify early trends toward dysfunction and detects biomarker patterns that can help guide intervention and therapy.

Many of the basic blood chemistry tests described below are found on what is known as the Complete Metabolic Panel or CMP14. These include metabolic markers that reflect liver function/health, kidney function, gallbladder function, hydration, electrolyte balance, protein status, and more.

The Complete Blood Count (CBC) includes markers that reflect red and white blood function and characteristics.

Here is a quick rundown of biomarkers found in a basic blood chemistry panel and CBC. 

Basic Blood Chemistry Tests

Don’t be fooled into thinking that basic blood tests aren’t valued. These blood chemistry tests hold a ton of functional information on your patient’s journey towards or away from optimal health and should be a part of EVERY blood panel you run on your patients. Below are some biomarkers that you can find in a basic blood test to indicate overall health.

Total Protein

• Includes albumin and globulins.
• Is affected by protein digestion, absorption, and assimilation.
• Should be incorporated into the evaluation of functional digestive issues, nutrition deficiencies, dehydration.

Albumin

• Is the most abundant protein in the blood.
• Is an important transport protein and a major factor in maintaining oncotic pressure.
• Short-term changes may reflect inflammation and reprioritizing of acute-phase protein production.
• Should be incorporated into the evaluation of liver function, long-term nutrition status, hydration, oxidative stress.

Globulin

• Includes immunoglobulins, transport proteins, hormone binding globulins.
• Should be incorporated into evaluation of inflammatory, digestive and infectious issues.

AST, ALT, GGT

• AST, ALT, and GGT are the main transferase enzymes in highly metabolic tissue.
• They are associated with liver pathology or other cell/organ damage.
• ALT is more liver-related.
• AST is more cardiac-related.
• GGT/GGTP is more gallbladder related. However, it is increasingly being recognized as a cardiovascular, metabolic, and oxidative stress marker. Emerging research suggests that levels above 17 U/L should be investigated further.
• GGT facilitates glutathione metabolism, with elevations suggesting increased oxidative stress.
• Usually parallels alkaline phosphatase except in bone disease where GGT will be normal and alk phosphatase will be elevated.
• Relationships between enzymes provide important clinical clues.
• Should be incorporated into the evaluation of alcohol abuse, and liver, gallbladder, and metabolic dysfunction.

AST/ALT ratio, the De Ritis ratio 

• An increasing ratio may indicate progression of liver dysfunction as hepatic tissue becomes scarred and non-functional.
• Should be incorporated into the evaluation of liver dysfunction.

Alkaline Phosphatase (Alk Phos)

• Represents a group of isoenzymes originating from the liver, bone, intestines, skin, placenta.
• Requires zinc for its synthesis.
• Should be incorporated into the evaluation of associated tissue function, biliary obstruction, bone disease, and zinc deficiency.

Bilirubin

• Is a breakdown product of hemoglobin from red blood cells.
• Is processed by the liver and excreted in bile.
• Direct bilirubin has been conjugated in the liver and will be excreted in the bile, a build up may indicate biliary obstruction.
• Indirect bilirubin has not yet been conjugated by the liver, a buildup may indicate reduced liver function.
• Should be incorporated into the evaluation of liver and gallbladder function, RBC destruction, and oxidative stress which can contribute to RBC breakdown.

Uric Acid (or Urate)

• Is an end product of purine, nucleic acid, and nucleoprotein metabolism.
• Is produced by the action of xanthine oxidase which is upregulated with reduced tissue oxygenation.
• Requires molybdenum for its synthesis.
• Should be incorporated into the evaluation of gout, renal failure, leukemia, detoxification, molybdenum deficiency.

Glucose

• Is a monosaccharide that serves as the main source of energy for many cells in the body.
• The pancreas and liver are the primary regulators of blood glucose levels.
• Several hormones contribute to glucose regulation including insulin, glucagon, cortisol, epinephrine, norepinephrine, and growth hormone.
• Fasting levels should be incorporated into the evaluation of blood sugar regulation, metabolic dysfunction, and possibly liver dysfunction due to decreased release of glucose from stored glycogen.
• Fasting levels should be measured with fasting insulin.
• Should be incorporated into the evaluation of blood glucose regulation, cardiovascular disease, and metabolic dysfunction. 

Lactate Dehydrogenase (LDH)

• Represents a group of enzymes involved in carbohydrate metabolism, catalyzes the conversion of pyruvate into lactate and vice versa depending on the LDH isoenzyme.
• Should be incorporated into the evaluation of tissue damage.
• Should be incorporated into the evaluation of blood glucose regulation including reactive hypoglycemia.

Potassium

• Is a major intracellular mineral and serum electrolyte.
• Participates in nerve conduction, muscle function, osmotic pressure, cellular transport via the sodium-potassium pump.
• Should be incorporated into the evaluation of acid-base balance, anion gap, kidney function, adrenal function, and cell damage.

Sodium

• Is a major extracellular mineral and serum electrolyte.
• Should be incorporated into the evaluation of acid-base balance, adrenal function, dehydration, and overhydration or fluid retention.

Chloride

• Is a major extracellular mineral and serum electrolyte.
• Should be incorporated into the evaluation of acid-base balance, adrenal function, and hypochlorhydria.

Bicarbonate (total serum CO2)

• Is a major serum electrolyte.
• Blood pH is regulated by bicarbonate at the level of the lungs and kidneys.
• Should be incorporated into the evaluation of acid-base balance and liver, kidney, and lung function.

Blood Urea Nitrogen (BUN or Urea)

• Is formed in the liver from protein digestion and metabolism and excreted by the kidneys.
• Should be incorporated into the evaluation of protein intake, kidney function, liver function, and hydration.

Creatinine

• Is a byproduct of muscle metabolism, produced from the energy compound creatine.
• Should be incorporated into the evaluation of kidney function and muscle breakdown.

Ferritin

• Is a major storage protein for iron in the liver, bone marrow, and spleen.
• Circulating levels reflect stored iron.
• May not be included in some basic panels but should be incorporated into the evaluation of anemia, iron overload, and inflammation.

Complete Blood Count (CBC)

Red blood cells (RBCs), also called erythrocytes

• Produced in the bone marrow.
• Contain hemoglobin that delivers oxygen and picks up carbon dioxide from tissues around the body.
• Should be incorporated into the evaluation of anemia, blood loss, oxidative stress, and testosterone therapy.

Hematocrit

• Represents the percentage of the volume of RBCs in a known volume of centrifuged blood.
• Parallels RBC count when RBCs are normal sized but not when small or large.
• Should be incorporated into the evaluation of anemia, blood loss, iron overload, and testosterone therapy.

Hemoglobin

• Protein within RBCs that contains iron, carries oxygen and carbon dioxide.
• Maintains normal shape of RBCs.
• Should be incorporated into the evaluation of anemia, blood loss, iron overload, and testosterone therapy.

Mean Corpuscular Volume (MCV)

• Measurement of the volume of an average single RBC in cubic microns.
• Indicates whether RBC size is normal (normocytic), small (microcytic), or large (macrocytic).
• Should be incorporated into the evaluation of anemia and nutrient insufficiencies. 

Mean Corpuscular Hemoglobin (MCH)

• A calculated value that expresses the average weight of hemoglobin per RBC.
• Should be incorporated into evaluation of anemia.

Mean Corpuscular Hemoglobin Concentration (MCHC)

• Is the calculated measurement of the average concentration of hemoglobin in RBCs, calculated from hematocrit and hemoglobin.
• Reflects chromaticity (quality of color) of RBCs, low concentration indicates hypochromic RBCs.
• Should be incorporated into evaluation of anemia.

RDW

• Is a gauge of the variation in the size of RBCs in a sample.
• Should be incorporated into the evaluation of anemia and B12, folate, and iron insufficiency.

White blood cells (WBCs)

• WBCs are the major immune cells produced in the bone marrow.
• Respond to inflammation and infection.
• A differential will provide information about the different types of WBCs.
• Incorporate into the evaluation of immune function, inflammation, allergies, infection, and leukemia.

Here are some examples of patterns that may be associated with specific dysfunctions

Essential Patterns of Dysfunction by Biomarker

Below are some of the dysfunctions you can assess from looking at patterns between various biomarker results: 

• CBC: anemia, nutrient insufficiency, immune function
• Blood proteins: hypochlorhydria, gastric inflammation, nutrient deficiency
• AST, ALT, GGT: liver function, gallbladder function, alcohol abuse
• GGT, bilirubin, alk phos: gallbladder issues, bone disease
• Albumin: liver dysfunction, oxidative stress
• Uric Acid: poor detoxification, inflammation
• Alk phos: zinc deficiency
• Anion gap: thiamine deficiency, electrolyte imbalance
• Ferritin and MCV: iron and B12 deficiency anemia
• LDH: reactive hypoglycemia
• Potassium: adrenal dysfunction
• BUN and creatinine: kidney and genitourinary dysfunction
• Albumin, cholesterol: oxidative stress

You can see that even basic blood chemistry is just the tip of the iceberg of a treasure trove of information about metabolism, physiology, and disease risk.

Functional blood chemistry analysis is vital to identifying and addressing early changes in metabolism before they progress into significant dysfunction or outright disease.