1 Copyright © 2018 – Kelly Brogan MD

Have you been told that your

mental illness is a chronic
condition?
H AVE YOU BEEN DIAGNOSED with an ‘incurable’ disease like depression?
Were you told that your only hope is to manage your symptoms by taking
lifelong medications? What if you could eliminate this diagnosis by simply fixing
nutrient deficiencies or correcting physiologic imbalances? As such, proper
blood tests can highlight these vulnerabilities and guide healing protocols.

Some recommend running as many tests as possible, which can get expensive and
confusing. Years of clinical practice and a deeper understanding of common
symptoms have led me away from running dozens of lab tests. For example, I no
longer order salivary cortisol testing, as the results confirm what we already know:
we’re enduring unprecedented levels of stress. I’m happy to share with you the five
most common and helpful blood tests that I still use with my patients.

1 Thyroid function tests

These tests show how well your thyroid gland is working. As the thyroid is the
master regulator of metabolism, people with weight problems, depression,
brain fog, anxiety, and constipation often have impaired thyroid function.
Thyroid function tests give information about how well your brain is sensing
hormone levels. Furthermore, these tests show how your immune system is
interacting with your thyroid.

I’ll skip the complexities of thyroid hormone production and regulation, which
are covered comprehensively in this article. The key takeaway is that your brain and
thyroid gland produce hormones called Thyroid Stimulating Hormone (TSH), T3,
and T4. T3 is the active form of thyroid hormone, and it can exist as either free T3
(FT3) or reverse T3 (RT3).

2 Copyright © 2018 – Kelly Brogan MD

To screen for problems, most conventional doctors test only for TSH and possibly
T4. However, as T3 is one of the body’s master molecules, it’s important to know
free (unbound) T3 levels. For example, T3 helps regulate digestion, energy use, and
hormonal balance.

An autoimmune disease called Hashimoto’s thyroiditis is the most common cause

of hypothyroidism in women. I am living proof that this type of thyroid
autoimmunity can be reversed, even if you’ve been on a synthetic replacement (like
Synthroid) for years. Dessicated thyroid replacement, a natural form of thyroid
hormone, can sometimes be the first step to feeling better. Importantly, lifestyle
factors, especially nutrition, are essential for long-term optimal health and true,
lasting healing.

To screen for thyroid autoimmunity, I order a panel to measure thyroid peroxidase

antibodies (TPOAb) and thyroglobulin antibodies (TgAb).

Years of clinical practice and learning from experts have taught me the optimal
values for thyroid health, which I’ll share with you now:

Optimal values:
✦ TSH: less than 2 μU/mL
✦ Free T4: ideally over 1.1 ng/dL
✦ Free T3 (FT3): ideally over 3.0 pg/mL
✦ Reverse T3 (RT3): less than a 10:1 ratio RT3:FT3
✦ TPOAb: less than 4 IU/mL (or negative according to lab range)
✦ TgAb: less than 4 IU/mL (or negative according to lab range)

3 Copyright © 2018 – Kelly Brogan MD

2 Vitamin B12
Adequate levels of Vitamin B12 are critical for brain health. Yet almost 40% of
Americans are deficient in Vitamin B12. Gut dysbiosis, poor digestion (often from
hypothyroidism!), eating inflammatory foods, and using certain medications can
cause B12 deficiency. Specifically, heartburn medication, which suppresses
stomach acid, blocks the absorption of Vitamin B12.

Vitamin B12 is an all-star antidepressant that is essential to make red blood cells,

line nerve cells, and keep our brains functioning properly. Vitamin B12 deficiency
has been linked to deep depression, paranoia, and memory loss, among other
serious conditions. Furthermore, pregnant women deficient in B12 may put their
babies at risk for neurological disorders, developmental delays, and cognitive and
motor impairments.

While deficiency is usually defined as having blood levels below 200 pg/mL, I
like to see patients above 600 pg/mL. Importantly, blood tests for B12 don’t
tell the whole story; this vitamin works inside cells, and blood levels won’t tell
you your brain levels of B12. Therefore, it’s helpful to complement this test by
measuring homocysteine.

Homocysteine is an inflammatory protein that is metabolized by Vitamin B12 and

folate. When someone has high blood levels of homocysteine, it indicates that
Vitamin B12 is low. This surrogate marker provides more information on how well
your brain and body are functioning.

The optimal level of homocysteine is between 7 – 10 μMole/L, but when I

see a homocysteine level over 8, I recommend supplementing with B12 to
quench inflammation.

4 Copyright © 2018 – Kelly Brogan MD

3 High-sensitivity C-Reactive Protein (hs-CRP)
C-reactive protein (CRP) is another general marker of inflammation, and you want
to have blood levels of CRP under 1.0 mg/L. Numerous studies, including meta-
analyses that have analyzed tens of thousands of people, show that elevated CRP is
associated with depression and anxiety 1-3.

4 Fasting glucose/insulin/Hemoglobin A1C

These tests check blood sugar control. The most telling of these tests is Hemoglobin
A1C, as it gives an average of your blood sugar levels over the past 90 days. The
fasting glucose test provides a snapshot of how much sugar is present when your
body isn’t processing food. The fasting insulin test gives insight on how your
pancreas is functioning while you’re not eating.

Unstable blood sugar can masquerade as anything from fatigue to panic

attacks to ADHD. These symptoms reveal that the body is overloaded and
struggling to “put away” ingested sugars. Therefore, understanding your blood
sugar control can help identify the root causes of several physiologic
symptoms. Making dietary and lifestyle changes to combat the blood sugar roller
coaster can heal a startling number of diseases. Amazingly, according to some field
research, even diabetes can be reversed in a little over a month 4!

These findings can help you heal your relationship to starches and natural
sugars and to understand their health properties relative to processed forms.

Optimal values:
✦ Hemoglobin A1C: 4.8 – 5.2%
✦ Fasting glucose: 70 – 85 mg/dL
✦ Fasting insulin: below 6 μIU/mL

5 Copyright © 2018 – Kelly Brogan MD

5 Vitamin D
Most Americans are deficient in this critical hormone-vitamin 5. Vitamin D is
important for proper nutrient absorption, cognition, and immune function 6. Lack of
sun exposure and high food levels of pesticides can lead to Vitamin D deficiency.

I test my patients for Vitamin D – called 25(OH)D clinically – as well as its activated
form (called 1,25). The optimal levels for 25(OH)D are between 50 – 80 ng/mL,
coupled with an assessment of 1,25 to determine whether it is above the normal
reference range.

Recent interesting work has called these recommended ranges into question. Dr.
Chris Masterjohn shows that optimal Vitamin D levels may depend on ethnicity
and nutrient status 7. For example, non-Caucasians have lower levels of 25(OH)D
than Caucasians, but they have no adverse effects 8. Additionally, hunter-gatherer
populations have 25(OH)D levels that would be considered deficient, though they
enjoy plenty of sun exposure and healthy lives 9.

Therefore, I’ve found that measuring other biological markers is helpful to

determine how Vitamin D is being used in the body. Testing for parathyroid
hormone (PTH) and calcium, along with 25(OH)D, gives a more accurate picture
of Vitamin D metabolism. Read this article for a more detailed explanation of
the mechanisms.

Overall, it’s important to know how Vitamin D is working in your body before

taking supplements, as excess Vitamin D supplementation can be harmful (10). To
optimize Vitamin D levels, I recommend getting outside and eating nutrient-rich
foods. Foods such as organ meats and oily fish contain healthy fats and
micronutrients, including magnesium, that combat Vitamin D toxicity.

6 Copyright © 2018 – Kelly Brogan MD

What if your doctor won’t order these tests?
You can choose to engage a comprehensive healing effort to see whether your
symptoms can completely resolve within one to two months before pursuing
these diagnostics.

But if you have worked through a program and are still stuck, these blood tests are
a great way to begin to learn more about your physiology. Some doctors are
hesitant to order these tests. They may tell you that they’re unnecessary. A
naturopath or functional medicine doctor is more likely to understand these tests
and order them for you.

If you feel that you have unresolved symptoms, you must advocate for
yourself and demand this baseline assessment. Many of these tests are covered by
insurance or are not terribly expensive. Don’t be afraid to push back if your doctor
is dismissive. The moments of awkwardness are worth understanding what’s
happening in your body. You may need to go elsewhere for these blood tests –
or even order them on your own. Information revealed in these tests will help
identify the best support for your healing.

References
1. https://www.ncbi.nlm.nih.gov/pubmed/19188531
2. https://www.ncbi.nlm.nih.gov/pubmed/21037214
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820143/
4. https://www.ncbi.nlm.nih.gov/pubmed/6373464
5. https://www.ncbi.nlm.nih.gov/pubmed/19543765
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821804/
7. https://www.ncbi.nlm.nih.gov/pubmed/17145139
8. https://www.ncbi.nlm.nih.gov/pubmed/18458986
9. https://www.ncbi.nlm.nih.gov/pubmed/22264449
10. https://www.ncbi.nlm.nih.gov/books/NBK56070/

7 Copyright © 2018 – Kelly Brogan MD