What Blood Tests Should You Get When Starting a Ketogenic Diet?

What Blood Tests Should You Get When Starting a Ketogenic Diet?

I have gotten this question asked to me many times over in the Ketogenic Training room and I have resisted posting this for a few reasons.  The most important reason is that I truly believe that most of us do not need any tests to safely start this way of eating.  You are going to start giving your body what it needs to thrive and I don’t want anyone hesitating to start eating a healthy diet because they are waiting on a blood test.

However, it is pretty cool to see how this way of eating looks on an objective test result page.  I still remember the time I got a test back and every single number was in range for the first time in my life.  My Metabolic syndrome had disappeared, my A1C was down, and my blood lipids were all in the right place.  It was such a huge confirmation that I was on the right track.  3 years later and 200 lbs lighter, I know I’ve found the way that works.

In order to organize these tests into a way that will be most helpful for everyone, I am going to list this in multiple sections with the most important tests that you should really consider doing at the top and the less important ones at the bottom.  Almost all of these tests can be ordered without a doctor’s visit through Life Extension  and more information about these tests and more can be found at Lab Tests Online.

Most Important Tests for Newcomers to the Ketogenic Diet

NMR Lipid Profile

This is a more comprehensive cholesterol test than the standard Lipid profile you will usually get from the doctor.  Instead of just telling you the total HDL, LDL, and Triglyceride numbers, it breaks out the total particle counts for those lipids.  This way you can see how much of your LDL articles are the small dense LDL particles that have been shown to lead to Cardiovascular disease.  This test can be taken once a year.  An LDL-P that measures lower than 1.000 is considered ideal with a result of 2.000 and over considered at risk.  Another important value to look at is the ratio of Triglycerides to total HDL.  A TG:HDL ratio of less than 2 is ideal with a ratio above 4 being too high.

Hemoglobin A1C (HbA1C)

The A1C test gives you a 3 month average reading on how efficiently your body uses glucose and how insulin resistant you are.  An A1C between 4-5.5% is considered normal, between 5.6-6.4% is pre-diabetic and north of 6.5% means you are diabetic.  This test can be taken every 3 months.

Vitamin B12

This test checks your Vitamin B12 levels.  This test should be taken once a year. Normal levels are between 200-900 pg/ml.

High Sensitivity C-Reactive Protein (hsCRP)

An hsCRP test measures the level of systemic inflammation in your body, a key predictor of cardiovascular disease as well as most chronic diseases.  This test should be taken once a year. A reference range below 1 mg/L is considered very low risk, between 1-3 mg/L is normal risk and north of 3 mg/L is considered high risk.

Fasting Glucose and Insulin

This test will provide a “snapshot” of the level of glucose and insulin in your bloodstream at the time of the test.  The best way to take this test if possible is fasting, then 2 hours after eating to get a good picture of how the body responds to food.  Having a fasting blood glucose level of 100 mg/dl is considered ideal. A fasting insulin level of under 25 mIU/L is ideal and 2 hours after eating you want it between 16-166 mIU/L

Less Important Tests

These tests should be done either once a year or every few years strictly as a diagnostic tool to avoid any new health issues or as a response to existing health issues.

Thyroid Function

There is a complex relationship between Thyroid hormones and your weight that is too much to get into here.  If you feel you have Thyroid issues, my recommendation would be to read the book The Paleo Thyroid Solution as this book walks you through a comprehensive plan to repair thyroid function.

Cortisol Levels

High Cortisol levels indicate high stress levels or an overactive pituitary gland and can cause excess weight gain around the midsection.  Reference levels are between 10-20 ug/dl.

Vitamin D

Vitamin D levels are a common problem.  A Vitamin D test will give you a 25(OH)D level that you want between 20-100 ng/mL.


Magnesium is another common mineral deficiency.  You want the reference range to be between 1.7-2.2 mg/dL.  I use Magnesium supplements from Pure Vitamin Club and have been very happy with them.

I hope you find this article informative and helpful.  If you have any questions, leave them in the comments and I will answer as best I can.

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