Advanced Metabolic Weight Loss Blood Test

Adrenal hormones
Cortisol - Cortisol is a stress hormone produced by the adrenal glands. It is vital to survival given its role in functions such as immunity, regulating blood pressure and releasing insulin for blood sugar maintenance.

Cholesterol status
Total cholesterol - Cholesterol is an essential fat (lipid) in the body. Although it has a bad reputation it has some important functions, including building cell membranes and producing a number of essential hormones including testosterone and oestradiol. Cholesterol is manufactured in the liver and also comes from the food we eat. Although there are a number of different types of cholesterol, the two main components of total cholesterol are HDL (high density lipoprotein) which is protective against heart disease and LDL (low density lipoprotein) which, in high levels, can contribute to cardiovascular disease. Your total cholesterol result on its own is of limited value in understanding your risk of heart disease; high levels of HDL cholesterol can cause a raised total cholesterol result but may actually be protective against heart disease. Equally, you can have a normal total cholesterol level but have low levels of protective HDL cholesterol. The most important factors are how much HDL and LDL cholesterol you have, and what proportion of your total cholesterol is made up of protective HDL cholesterol. We give a detailed breakdown of the components of your total cholesterol in the rest of this cholesterol profile.

LDL cholesterol - LDL cholesterol (low-density lipoprotein) is a molecule made of lipids and proteins which transports cholesterol, triglycerides and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called 'bad cholesterol', can cause fatty deposits to accumulate inside artery walls, potentially leading to atherosclerosis and heart disease.

Non-HDL cholesterol - Your total cholesterol is broken down into 2 main components; HDL (good) cholesterol and LDL (bad). There are more types of harmful cholesterol in your blood than just LDL - these include VLDL (very low-density lipoproteins) and other lipoproteins which are thought to be even more harmful than LDL cholesterol. Non-HDL cholesterol is calculated by subtracting your HDL cholesterol value from your total cholesterol. It therefore includes all the non-protective and potentially harmful cholesterol in your blood, not just LDL. As such, it is considered to be a better marker for cardiovascular risk than total cholesterol and LDL cholesterol. The recommended level of non-HDL cholesterol is below 4 mmol/L.

HDL cholesterol - HDL cholesterol (high-density lipoprotein) is a molecule in the body which removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as 'good cholesterol'.

Total cholesterol : HDL - The cholesterol/HDL ratio is calculated by dividing your total cholesterol value by your HDL cholesterol level. It is used as a measure of cardiovascular risk because it gives a good insight into the proportion of your total cholesterol which is good (i.e. high-density lipoprotein HDL). Heart disease risk tools (such as QRisk) use the cholesterol/HDL ratio to calculate your risk of having a heart attack.

Triglycerides - Triglycerides are a type of fat (lipid) that circulate in the blood. After you eat, your body converts excess calories (whether from fat or carbohydrates) into triglycerides which are then transported to cells to be stored as fat. Your body then releases triglycerides when required for energy.

Diabetes
HbA1c - Haemoglobin A1c(HbA1c), also known as glycated haemoglobin, is a longer-term measure of glucose levels in your blood than a simple blood glucose test. Glucose attaches itself to the haemoglobin in your red blood cells, and as your cells live for around 12-16 weeks, it gives us a good indication of the average level of sugar in your blood over a 3-month period.

A raised HbA1c result points to diabetes or an increased risk of developing diabetes, which can have a significant impact on your lifespan and quality of life. Complications of uncontrolled diabetes include heart disease, kidney disease, eye problems, and vascular conditions. It can also contribute to mental health problems. And men with diabetes are three times more likely to have erectile dysfunction. Keeping your HbA1c within a normal range can help you reduce the risk of these conditions.

Hormones
FSH - Follicle Stimulating Hormone(FSH) is produced in the pituitary gland and is important for women in the production of eggs by the ovaries and for men in the production of sperm. In the first half of the menstrual cycle in women, FSH stimulates the enlargement of follicles within the ovaries. Each of these follicles will help to increase oestradiol levels. One follicle will become dominant and will be released by the ovary (ovulation), after which follicle stimulating hormone levels drop during the second half of the menstrual cycle. In men, FSH acts on the seminiferous tubules of the testicles where they stimulate immature sperm cells to develop into mature sperm.

Oestradiol - Oestradiol is the strongest of the three oestrogens. It's labelled a female hormone but it's made in both the ovaries and testes. It's responsible for the growth of breast tissue, the female reproductive system, and male sexual function.

In pre-menopausal women, oestradiol levels vary throughout the monthly cycle, peaking just before ovulation. Levels are lowest after menopause when the ovaries stop producing eggs. Low oestradiol levels in women can cause many symptoms associated with the menopause, including hot flushes, night sweats, and changes in mood. It can also increase the risk of osteoporosis (a condition where the bones become less dense).

In men, oestradiol levels tend to increase slightly with age as testosterone levels decline. Too much oestradiol in men can contribute to fertility problems, gynecomastia (enlarged breast tissue), and erectile dysfunction.

Testosterone - Testosterone is a hormone that causes male characteristics. For men, it helps to regulate sex drive and has a role in controlling bone mass, fat distribution, muscle mass, strength and the production of red blood cells and sperm. Testosterone is produced in the testicles of men and, in much smaller amounts, in the ovaries of women. Testosterone levels in men naturally decline after the age of 30, although lower than normal levels can occur at any age and can cause low libido, erectile dysfunction, difficulty in gaining and maintaining muscle mass and lack of energy. Although women have much lower amounts of testosterone than men, it is important for much the same reasons, playing a role in libido, the distribution of muscle and fat and the formation of red blood cells. All laboratories will slightly differ in the reference ranges they apply because they are based on the population they are testing. The normal range is set so that 95% of men will fall into it. For greater consistency, we use the guidance from the British Society for Sexual Medicine (BSSM) which advises that low testosterone can be diagnosed when testosterone is consistently below the reference range, and that levels below 12 nmol/L could also be considered low, especially in men who also report symptoms of low testosterone or who have low levels of free testosterone.

Inflammation
hs-CRP - C-Reactive Protein (CRP) is an inflammation marker used to assess whether there is inflammation in the body - it does not identify where the inflammation is located. High Sensitivity CRP (CRP-hs) is a test used to detect low-level inflammation thought to damage blood vessels which can lead to a heart attack or stroke. When you suffer a serious injury or infection you experience significant inflammation around the site of injury - such as the swelling around a twisted ankle. Any injury like this will cause your CRP-hs to rise.

Iron Status
Iron - Iron is a mineral that is essential for life. It is a component of haemoglobin, a protein in our red blood cells that is responsible for transporting oxygen around our body. If we don't have enough iron, our haemoglobin levels fall and we can't get sufficient oxygen to our cells. This can cause symptoms which include fatigue, dizziness, and shortness of breath. Serum iron is a very transient reading and can be influenced by the amount of iron-rich food in your diet in the days before your blood test. For this reason, iron is rarely looked at on its own, and is interpreted alongside other markers in an iron status test.

TIBC - Total iron-binding capacity (TIBC) is a measure of the ability of your body to efficiently carry iron through the blood.

Transferrin saturation - Transferrin is made in the liver and is the major protein in the blood which binds to iron and transports it round the body. This test measures how much this protein is 'saturated' by iron.

Ferritin - Ferritin is a protein which stores iron in your cells and tissues. Usually, the body incorporates iron into haemoglobin to be transported around the body, but when it has a surplus, it stores the remaining iron in ferritin for later use. Measuring ferritin levels gives us a good indication of the amount of iron stored in your body.

Liver Health
Bilirubin - Bilirubin is a product of the breakdown of haemoglobin from red blood cells. It is removed from the body via the liver, stored and concentrated in the gallbladder and secreted into the bowel. It is removed from your body through urine and faeces. Bilirubin causes the yellowish colour you sometimes see in bruises, due to red blood cells breaking down underneath the skin.

ALP - Alkaline phosphatase (ALP) is an enzyme found mainly in the liver and bones. Measuring it can indicate ongoing liver, gallbladder or bone disease.

ALT - Alanine transferase (ALT) is an enzyme which is mostly found in the liver, but is also found in smaller amounts in the heart, muscles and the kidneys. If the liver is damaged, ALT is leaked into to bloodstream. As ALT is predominantly found in the liver, it is usually an accurate marker for liver inflammation and can indicate liver damage caused by alcohol, fatty liver, drugs or viruses (hepatitis).

Gamma GT - Gamma GT, also known as gamma-glutamyl transferase (GGT), is a liver enzyme which is raised in liver and bile duct diseases. It is used in conjunction with ALP to distinguish between bone or liver disease. Gamma GT is also used to diagnose alcohol abuse as it is raised in 75% of long term drinkers.

Thyroid hormones

TSH - Thyroid stimulating hormone (TSH) is produced in the pituitary gland in order to regulate the production of thyroid hormones thyroxine (T4) and triiodothyronine (T3) by the thyroid gland. If thyroid hormones in the blood are low, then more TSH is produced to stimulate the thyroid gland to produce more of them. If thyroid hormone levels are high, then the pituitary produces less TSH to slow the production of thyroid hormones. If TSH is too high or too low, it normally signifies that there is a problem with the thyroid gland which is causing it to under or over produce thyroid hormones. Sometimes a disorder of the pituitary gland can also cause abnormal TSH levels.

Free thyroxine - Thyroxine (T4) is one of two hormones produced by the thyroid gland. It works to speed up the rate of your metabolism. Most T4 is bound to carrier proteins in the blood - it is only the free, or unbound, T4 that is active in the body, which is measured in this test. Free T4 is the less active of the two main thyroid hormones. To have an impact on your cells it needs to convert to the more active T3 when your body needs it.

Vitamin D - Despite its name, vitamin D is actually a hormone that’s produced by your skin when it’s exposed to sunshine. Before your body can use vitamin D produced by sun exposure (known as vitamin D3), it must be converted into another form called 25 hydroxycholecalciferol (25 OH). Vitamin D (25 OH) is the major circulating form of vitamin D, and so your vitamin D (25 OH) level is considered the most accurate indicator of vitamin D supply to your body.

Vitamin D is essential for healthy bones and teeth, as it helps your body absorb calcium. It also plays a role in muscle health, immune function, and mental health.

Low vitamin D symptoms include muscle weakness, mood swings, and fatigue. Many people in the UK have low vitamin D levels, and people with dark skin and people who don’t spend much time outdoors are particularly at risk.

Small amounts of vitamin D can be obtained from food, especially oily fish, eggs, and vitamin-D fortified foods. But if you have a vitamin D deficiency, you’re unlikely to be able to improve your levels by food alone.

Prepare for your Weight Loss Blood Test by following these instructions.

Sample collection and timing

• Take your sample between 6am and 10am.
• Take this test when any symptoms of short-term illness have settled.
• If you have an unusual sleep pattern, your cortisol results may be unreliable. If you must test, do so within 2 hours of waking and inform us in the supporting information.

Periods and contraception

• Take this test two to five days after the start of your period, ideally on day three. It can be taken any time if you do not have periods.
• Hormonal contraception can affect the results of this test. Taking a break from this and waiting for your periods to restart before your blood test will give more accurate results.

Fasting and hydration

• Avoid fatty foods for eight hours before your test, you do not need to fast.

Medications and supplements

• Do not take biotin supplements for two days before this test, discuss this with your doctor if it is prescribed.
• If you take thyroxine, you can take your medication as usual, either before or after your blood test. However, if you take desiccated thyroid extract (DTE) or liothyronine, it's best to take it after you've collected your sample. Please let us know in your supporting information if you take amiodarone or lithium as these can affect your thyroid function results.
• Take your sample at least 24 hours after any vitamin or mineral supplements.
• Corticosteroid medication can affect this test, ask your doctor whether to stop before testing.