What Blood Work Is Worth Running Before a Reset

The draw that matters most is the one before day one

Most people think about blood work after a program, as the report card. That is backwards. The panel that does the most work is the one drawn before anything changes, because it is the only one that captures where you actually started.

Here is the reason, in one study. The Whitehall II cohort followed 6,538 British civil servants who did not have diabetes at the start. Over a median 9.7 years, 505 of them were diagnosed with type 2 diabetes, and because the cohort was tested repeatedly the researchers could look backward at what each marker had been doing. Insulin sensitivity, estimated by the HOMA method, declined steeply across the five years before diagnosis. Fasting glucose rose slowly and linearly for years and then turned sharply upward only about three years out, from 5.79 mmol/L to 7.40 mmol/L, roughly 104 mg/dL to 133 mg/dL. The authors describe changes appearing three to six years before diagnosis.^[1]

Read that as a statement about single lab reports. Any one of those yearly draws, looked at alone, would have printed inside the normal column. The information was in the direction, not the value, and you cannot have a direction with one point.

That cohort was 71 percent male and 91 percent white British civil servants, and the people in it were on their way to a diagnosis, which most people starting a reset are not.^[1] The transferable idea is not the timeline. It is that a first point makes every later point mean something.

This post covers which tests are worth having in hand before a reset, what each one is actually good for, what is usually not worth paying for, and what to do if your clinician will not order some of it. It is educational, not diagnostic. Labs are ordered and interpreted by a licensed clinician, and nothing here replaces that.

Start with the reports you already have

Before ordering anything, pull the last one or two panels you have had run. Many adults have had a basic metabolic panel and a lipid panel in the last couple of years, often at an annual physical, and the results are usually sitting in a patient portal.

Those old reports are worth more than they look, for two reasons. First, they are a second point, which is the thing a new draw cannot give you. Second, a standard lipid panel already contains one of the better simple markers of insulin resistance, and nobody has to order anything to get it.

In a study of 258 non-diabetic overweight volunteers whose insulin resistance was measured against a reference method, the researchers tested which routine markers best identified the people who were genuinely insulin resistant. Triglyceride concentration, the ratio of triglycerides to HDL cholesterol, and insulin concentration came out on top. The optimal cut-points were 1.47 mmol/L, about 130 mg/dL, for triglycerides and 3.0 in the traditional units printed on a US lab report for the ratio, with sensitivity and specificity of 67 and 71 percent for triglycerides and 64 and 68 percent for the ratio. For comparison, the full Adult Treatment Panel III criteria for metabolic syndrome performed at 52 percent sensitivity and 85 percent specificity in the same group.^[2]

Two numbers you already paid for, and one division. That is the first thing to do tonight, before any conversation about ordering more.

The pre-reset panel, line by line

What follows is what a provider hopes to see in front of them at a first visit, and why. Treat it as a menu to discuss with the clinician who orders your labs, not a checklist to demand.

Fasting glucose and hemoglobin A1c

These two are on almost every panel already, and they answer the same question at different time scales. Fasting glucose is one moment after eight or more hours without food. A1c reflects how much sugar has attached to hemoglobin in your red blood cells, usually described as a three-month average.

The average framing quietly assumes everyone's red blood cells live the same length of time. Researchers who labeled and tracked red cells directly in twelve people found the mean age of circulating cells ranged from 38 to 60 days in people without diabetes and 39 to 56 days in people with diabetes, and concluded the variation was large enough to cause clinically important differences in A1c for the same average blood glucose.^[3] That was a small study, so read it as a reason for humility about one A1c rather than a reason to skip the test. Practically: when A1c and the other markers disagree, the disagreement is itself information.

Fasting insulin

This one usually has to be requested, because it is not on a standard panel. It is the single most useful addition for a pre-reset baseline, because it is the number that shows effort rather than outcome. Holding a normal glucose easily and holding a normal glucose with rising insulin output look identical on the glucose line.

If you have fasting glucose and fasting insulin from the same draw, you also have HOMA-IR, which is a calculation rather than a test. The model was published in 1985 and validated against the euglycemic clamp, the laboratory reference standard, with a rank correlation of 0.88. The same paper reported a coefficient of variation of 31 percent for the insulin resistance estimate and stated plainly that this low precision limits its use.^[4]

That number is the argument for drawing a baseline early rather than repeatedly. With that much variation built in, two draws a few weeks apart tell you very little. One clean starting point and one recheck months later tell you considerably more. What each of these markers can and cannot show is covered in more depth in what the insulin resistance markers mean.

Thyroid function, starting with TSH

Thyroid belongs on a pre-reset panel for a specific reason: if thyroid function is part of why the last three attempts stalled, that is worth knowing on day zero rather than in week six.

It is not rare. In a cross-sectional study of 25,862 adults attending a statewide Colorado health fair, 9.5 percent had an elevated TSH against a normal range of 0.3 to 5.1 mIU/L and 2.2 percent had a decreased TSH. Among people already taking thyroid medication, 40 percent had an abnormal TSH. The authors also found that individual symptoms were not very sensitive, which is the part that matters here: you cannot rule thyroid in or out by how you feel.^[5]

There is also a population-level association between thyroid function inside the normal range and body weight. In a Danish cross-sectional study of 4,082 adults with no previous or present overt thyroid dysfunction, BMI was positively associated with TSH category and negatively associated with free T4. The difference in BMI between the highest and lowest TSH groups was 1.9 kg/m2, which corresponded to a difference in body weight of 5.5 kg among women, and TSH category correlated with weight gain over five years but not over six months.^[6]

Note what that is and is not. It is an association across a population, not a prediction about you, and a 5.5 kg average difference is not an explanation for a 30 kg goal. It is a reason to have the number, not a reason to blame it.

Liver enzymes

ALT and AST are already on a comprehensive metabolic panel, so this is usually a matter of reading a line that was printed and skipped rather than ordering anything new.

In NHANES III data on 15,676 US adults, 7.9 percent had an elevated aminotransferase level. In 69 percent of those cases the elevation was not explained by alcohol consumption, hepatitis B or C, or iron overload, and unexplained elevation was significantly associated with higher body mass index, waist circumference, triglycerides and fasting insulin, and lower HDL.^[7] The authors noted this pattern may represent nonalcoholic fatty liver disease.^[7]

For a baseline, that means an ALT worth looking at twice, and a number your physician may want to follow. It is a medical finding and it belongs with your physician, not with a wellness program.

A complete blood count

A CBC is cheap, routine, and mostly there to catch what a wellness plan should not walk past, anemia being the common example. It is also one of the findings that belongs with a physician rather than inside an eating plan.

When NHANES biochemical data on 15,030 Americans aged over nine were aggregated, 31 percent were at risk of at least one vitamin deficiency or anemia, with 23 percent at risk in one, 6.3 percent in two, and 1.7 percent in three to five. Risk was higher in women at 37 percent and in people with obesity at 39 percent.^[8]

Read the other direction too: roughly two thirds were not at risk in any nutrient measured.^[8] That is exactly why testing beats guessing, in both directions.

Vitamin D

Worth running once, at baseline, because deficiency is common enough that the result frequently changes something and because you cannot infer it from how much sun you think you get.

In NHANES 2005 to 2006 data on 4,495 adults, using a cut-off of 25-hydroxyvitamin D at or below 20 ng/mL, the overall prevalence of deficiency was 41.6 percent, with the highest rates in black adults at 82.1 percent and Hispanic adults at 69.2 percent. Deficiency was significantly more common among people who were obese, had low HDL, or did not consume milk daily.^[9]

One caution worth stating plainly: a low result is a reason for a conversation about repletion with the clinician who ordered it, not a reason to start a high-dose product you found on your own.

Kidney function and electrolytes

Creatinine, estimated GFR, sodium and potassium are already on the basic metabolic panel. They are baseline safety information, and there is one reason they are specifically relevant to the first week of an eating change.

Insulin acts on the kidney. Increases in plasma insulin within the physiological range stimulate sodium reabsorption in the distal nephron, an effect independent of changes in circulating metabolites or other hormones, and the same review describes the natriuresis of starvation and the anti-natriuresis of refeeding.^[10] When carbohydrate intake drops and insulin falls, sodium and water follow. That is part of the dramatic week-one scale drop, and for someone on a diuretic or a blood pressure medication it is also a reason the prescribing physician should know a reset is starting.

Two baseline measurements that cost nothing

Not everything worth baselining comes from a vein.

Waist circumference. A consensus statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk working group on visceral obesity argued that waist circumference provides information that is both independent of and additive to BMI for predicting morbidity and risk of death, and that it is still not routinely obtained in clinical practice. The group recommended treating reductions in waist circumference as an important treatment target and noted that clinically relevant reductions can be achieved through routine moderate-intensity exercise or dietary change.^[11] Measure it the same way each time, same point on the torso, same time of day, and write down the date.

A week of honest logging before you change anything. One ordinary week of food, sleep and movement, recorded before the plan starts, is the behavioral half of your baseline. It is also the thing that makes a week-six stall diagnosable rather than mysterious. More on how providers read those patterns is in reading a reset logbook.

What is usually not worth buying before a reset

The pre-reset window is when people are most willing to spend money on testing, which makes it the moment to be most skeptical.

• Large direct-to-consumer panels with dozens of markers. More lines do not mean more signal. They mean more values that fall slightly outside a reference range by chance, each of which now needs explaining.
• A continuous glucose monitor on day one. For most people starting a reset it generates more anxiety than insight, and the markers above are cheaper and better validated for this particular question. If your provider suggests one later for a specific reason, that is a different conversation.
• Broad micronutrient panels ordered speculatively. Given that roughly two thirds of the population studied was not at risk of deficiency in any nutrient measured, a wide panel run on a hunch mostly buys confirmation that nothing was wrong.^[8]
• Any test whose result would not change what you do next. This is the honest filter, and it removes most of the list by itself.

A reference range is also worth understanding before you pay for more of them. It describes how results were distributed in the population the laboratory drew from. It is not a statement about what is optimal for you, and "within range" and "where you want to be" are two different questions. Only the first one is printed on the report.

What the recheck is actually for

A baseline exists so that a later draw can be compared to something. The reason that comparison is worth making is that several of these markers do respond.

In a randomized controlled trial, adults with obesity who lost about 5 percent of body weight improved insulin sensitivity in adipose tissue, liver and muscle, and improved beta-cell function, all at the 5 percent mark. Further weight loss produced additional gains in muscle insulin sensitivity and beta-cell function, along with stepwise changes in adipose tissue mass and intrahepatic triglyceride content.^[12]

Five percent is about 9 pounds for a 180-pound person, which is a nearer target than the one most people set for themselves. It is also a useful expectation-setter in the other direction: it is a trial result in a specific group, not a promise about your numbers. Your clinician decides what to recheck and when, and the interval is usually months, not weeks, precisely because of the measurement variation described above.^[4]

Questions patients ask

"Do I have to fast for this?"

For glucose, insulin and HOMA-IR, yes, and the fast is what makes them interpretable. Lipids are more flexible than most people assume. A joint consensus statement from the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine concluded that maximal mean changes one to six hours after habitual meals are not clinically significant, reporting plus 0.3 mmol/L (26 mg/dL) for triglycerides and minus 0.2 mmol/L (8 mg/dL) for total and LDL cholesterol, with HDL cholesterol and apolipoproteins unaffected by fasting status, and recommended routine use of non-fasting lipid profiles while noting that fasting sampling may be considered when non-fasting triglycerides exceed 5 mmol/L (440 mg/dL).^[13] Practice varies by country and by ordering clinician, so follow the instructions your laboratory gives you. If you are fasting for glucose and insulin anyway, the question mostly answers itself.

"My doctor will not order fasting insulin. Does that stop the reset?"

No. A physician deciding whether you meet diagnostic criteria for a disease is doing the right job with the right tests, and that is a different question from whether your metabolism is under strain. If the extra marker is not available to you, you still have the triglyceride to HDL ratio from a panel you have already had, a waist measurement, and a logged week.^[2] Those three cost nothing and they are enough to start.

"How far before day one should I draw?"

Close enough that it still describes your starting point, and before the eating plan changes. A panel drawn in week two of a reset is not a baseline, it is an early result, and it will quietly understate whatever you went on to change.

"Can my Practice Naturals provider order these?"

That depends on their license and on your state. Some can order labs directly, and others work from the panel your physician already ran and coordinate from there. Ask when you book, and either way bring the reports you have. What the first visit covers is laid out in the provider visit, explained.

What to bring to the first visit

1. Your actual lab reports, not your memory of them. Two or three panels if you have them, because the trend across draws is worth more than any single value.
2. Your triglyceride to HDL ratio, already calculated. Both numbers are on any standard lipid panel.^[2]
3. Your waist measurement and your current weight, both taken the same way you intend to keep taking them.^[11]
4. A full list of medications and supplements, including doses. This is the one people skip, and it is the one most likely to change a recommendation.
5. One honestly logged week. Not your intentions. What actually happened.

That set lets a provider see a pattern instead of a value, which is the entire premise of how a Practice Naturals program is built. The framework is on our approach page.

Bottom line

Blood work before a reset is not about finding something wrong. It is about having a first point, so that every number after it means something, and about not walking past a finding that belongs with your physician rather than in a wellness plan.

The short version: use the panels you already have, calculate the triglyceride to HDL ratio tonight, and discuss adding fasting insulin, TSH and vitamin D with the clinician who orders your labs. Check ALT on the panel you already own. Measure your waist. Log one honest week. Skip the large speculative panels and the day-one glucose monitor.

If you want someone who reads those numbers as a pattern rather than a pass-fail column, find a Practice Naturals provider near you and bring your last two lab reports to the first visit.

References

1. Tabák AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimäki M, Witte DR. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009;373(9682):2215-2221. PubMed
2. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine. 2003;139(10):802-809. PubMed
3. Cohen RM, Franco RS, Khera PK, et al. Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c. Blood. 2008;112(10):4284-4291. PubMed
4. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-419. PubMed
5. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Archives of Internal Medicine. 2000;160(4):526-534. PubMed
6. Knudsen N, Laurberg P, Rasmussen LB, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. Journal of Clinical Endocrinology & Metabolism. 2005;90(7):4019-4024. PubMed
7. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. American Journal of Gastroenterology. 2003;98(5):960-967. PubMed
8. Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients. 2017;9(7):655. PubMed
9. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research. 2011;31(1):48-54. PubMed
10. DeFronzo RA. The effect of insulin on renal sodium metabolism. A review with clinical implications. Diabetologia. 1981;21(3):165-171. PubMed
11. Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nature Reviews Endocrinology. 2020;16(3):177-189. PubMed
12. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism. 2016;23(4):591-601. PubMed
13. Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points. A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. 2016;37(25):1944-1958. PubMed

These statements have not been evaluated by the Food and Drug Administration. Practice Naturals products are not intended to diagnose, treat, cure, or prevent any disease. This article is for educational purposes only and is not a substitute for professional medical advice. Consult your licensed healthcare provider before beginning any wellness program. Individual results vary.