Dhru Purohit Show
The Labs You Need Your Doctor to Run to Know if Your Metabolically Healthy
Mon, 26 May 2025
This episode is brought to you by Square, Branch Basics, and Manukora Honey. When we’re told our labs are “normal,” that doesn’t always mean they’re optimal—especially considering that over one-third of Americans are prediabetic and 47 million have metabolic syndrome. Metabolic health is the foundation of true longevity. Without actively supporting it, the risk of chronic diseases like cardiovascular disease, cancer, and type 2 diabetes increases. The good news? Prioritizing metabolic health through simple lifestyle changes can lead to long-term vitality and meaningful transformation. Today on The Dhru Purohit Show, we’re bringing you a special compilation episode featuring Dhru’s conversations with top experts on the most underrated blood tests for metabolic health and how to decode optimal lab markers. Dr. Tyna Moore breaks down the science behind metabolic dysfunction and its connection to chronic disease. She shares the essential labs to order, how often to test, and what optimal results should look like. She also offers practical tips for beginners on getting started with resistance training. Dr. Ben Bikman dives into how elevated fasting insulin contributes to insulin resistance, fat storage, and challenges in sustainable weight loss. He also explores how genetics play a role in weight gain and why lowering insulin—not just counting calories—should be the first step in any effective weight-loss strategy. Dr. Tyna Moore is a board-certified naturopathic and chiropractic physician and the founder and owner of Core Wellness Clinic in Portland, Oregon. She specializes in non-surgical pain management, natural pain solutions, and regenerative injection therapies for orthopedic and musculoskeletal conditions. Dr. Ben Bikman is a metabolic research scientist and author of Why We Get Sick, which explores insulin resistance as a root cause of many chronic health issues. With a PhD in bioenergetics and postdoctoral work in metabolic disorders, he now serves as an associate professor at BYU, where he studies insulin’s role in obesity, diabetes, and mitochondrial health. In this episode, Dhru and his guests dive into: Metabolic health and disease pathways (2:10) Key lab tests and optimal levels (4:25) How and why to start resistance training (20:49) The most underrated blood test for metabolic health (33:57) Optimal reference ranges for fasting insulin (37:45) The two primary factors contributing to weight gain (44:22) The role of fat cells and ethnic differences (53:09) Final thoughts (1:01:34) Also mentioned: Full episode with Dr. Tyna Moore Full episode with Dr. Ben Bikman Want Dhru’s Lab Ranges Cheat Sheet? Sign up for the Try This Newsletter and we’ll send it straight to your inbox! This episode is brought to you by Square, Branch Basics, and Manukora Honey. Get everything you need to run and grow your business, without any long-term commitments with Square. Right now, you can get up to $200 off Square hardware at square.com/go/DHRU Right now, Branch Basics is offering 15% off the Premium Starter Kit; just go to branchbasics.com and use coupon code DHRU. Make 2025 your cleanest, healthiest year yet with Branch Basics! Upgrade to the creamiest honey, packed with antioxidants and prebiotics. Just go to manukora.com/dhru to get $25 off the Starter Kit and boost your energy, immunity, and digestive health today! Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What does 'normal' really mean in lab tests?
Hi everyone, Drew Perrault here. Every year, millions of us head to the doctor's office for our annual checkup. We get our basic labs done, maybe a couple extra tests if we're lucky, and we're told, hey, everything looks normal. Keep doing what you're doing. But here's the thing, normal doesn't mean optimal. In fact, it doesn't even mean healthy always.
Today, more than one third of Americans are pre-diabetic and over 47 million people are living with metabolic syndrome. Yet, So many of these people are being told that their labs are fine or normal. So what are we missing?
In today's compilation episode, we're taking a deep dive into metabolic lab markers, starting off by speaking with Dr. Tina Moore, naturopathic doctor and chiropractor who's been on the front lines of metabolic and chronic disease for decades. In our conversation with Dr. Moore, she walks us through the labs that she orders personally for her patients and
how often she runs them, and the actual optimal ranges she's looking for. Then I switch over to my conversation with Dr. Ben Bickman, a renowned metabolic research scientist and popular speaker on human metabolism and nutrition. And he's dedicated his career to understanding why we get sick, particularly through the lens of insulin resistance.
Dr. Bickman helps us decode how hormones and fat cells interact and why lab values, especially fasting insulin, can tell you so much more about your future risk of disease than your fasting glucose or even your A1C, both of which, of course, are very important. But first, let's listen in to my conversation with Dr. Tina Moore.
It doesn't matter what drug you use, what intervention, if you are not metabolically healthy, you are never going to be stepping into true longevity, true health, true health span, true lifespan. So first and foremost, everything comes back to metabolic health. And largely, that is lifestyle interventions that get us there. Is that true? Yes, 100%. So let's expand on that a little bit further.
What is metabolic health and how does somebody listening today know if they have it or if they don't have good quality metabolic health?
Well, metabolic health, just this most simplistic definition of metabolism is that when you take in calories in whatever form, in carbohydrates, fats, or proteins, that your body will hopefully metabolize them into cellular energy. in its most basic form and convert them into the building blocks that we need inside our body. So some of it gets converted to energy.
Some of it gets reformatted into new proteins, which is what all of our organ systems are made up of. And in some of it, you know, the fat goes down the right pathways and we have myelination around our nerves, we have the building blocks of our brain and cholesterol and our steroid hormones. So the idea is that that system would work efficiently.
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Chapter 2: What labs should be ordered for metabolic health?
So folks do have a lot of times folks will have a great normal blood glucose, fasting glucose, but their A1C is high. And I'm like, you've been cheating. You know, something is awry or something's off because that's the three-month marker. It's a little bit more sensitive look into how they've been behaving the past three months. And again, it can be off for various reasons.
But I like that at or below 5.5. I think 5.5 is where I draw the line. Another marker I like to look at is fasting insulin. And not a lot of doctors will run that. In fact, a lot of doctors will give you a lot of grief if you ask for it. They're like, you're not diabetic. I'm like, yeah, but most people are on the way. So maybe we should all check that.
So fasting insulin, I like between two and five. Below two or close to two is actually a sign of pretty severe burnout. And it's not great. I used to run at one to two when I was really, really burned out. And I've been there. It sucks. You're not even making any insulin.
Were you also on like an extreme low carb diet? Yeah.
Yeah. It's, it can, I'm just, that's a little bit not, I mean, some people say, oh, that's fine. I'm like, I don't know. Most people feel like when they're down there, like in general, like I felt like all the time. And then, you know, above five, we don't want that. So we want a fasting insulin. I have seen insulin though.
Insulin's really sensitive to where your other hormones are at and it's insensitive to your estrogen. It's sensitive to your cortisol. So not to say that's an excuse to ride with an elevated insulin, but we got to look further beyond that. We don't just stop there.
If that's elevated, if those three things are off, yes, lifestyle intervention is 100%, but also I think a prudent doctor should look a little further and consider how old is this person? Is it a woman who's walking into menopause? What are the other factors? What are some other markers I like?
I love running a high sensitivity C-reactive protein that just gives us, it's a nonspecific marker for inflammation. It doesn't tell us where the inflammation is. It just tells us if they're inflamed. And I think that's nice to have. I like to run a SED rate as well because it gives us a little bit different look at inflammation.
And so between those, I'll see high SED rates and low C-reactive proteins or vice versa. you know, I want to know, are they inflamed? That's at the end of the day, are we dealing with an inflamed body?
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Chapter 3: How often should you get lab tests done?
Chapter 4: What are the optimal fasting insulin levels?
Were you also on like an extreme low carb diet? Yeah.
Yeah. It's, it can, I'm just, that's a little bit not, I mean, some people say, oh, that's fine. I'm like, I don't know. Most people feel like when they're down there, like in general, like I felt like all the time. And then, you know, above five, we don't want that. So we want a fasting insulin. I have seen insulin though.
Insulin's really sensitive to where your other hormones are at and it's insensitive to your estrogen. It's sensitive to your cortisol. So not to say that's an excuse to ride with an elevated insulin, but we got to look further beyond that. We don't just stop there.
If that's elevated, if those three things are off, yes, lifestyle intervention is 100%, but also I think a prudent doctor should look a little further and consider how old is this person? Is it a woman who's walking into menopause? What are the other factors? What are some other markers I like?
I love running a high sensitivity C-reactive protein that just gives us, it's a nonspecific marker for inflammation. It doesn't tell us where the inflammation is. It just tells us if they're inflamed. And I think that's nice to have. I like to run a SED rate as well because it gives us a little bit different look at inflammation.
And so between those, I'll see high SED rates and low C-reactive proteins or vice versa. you know, I want to know, are they inflamed? That's at the end of the day, are we dealing with an inflamed body?
Um, are we now in bonus territory or C-reactive protein is like, you're even recommending for our audience that's listening.
Everyone should run a C-reactive protein. SED rates are cheap. SED rates are really cheap too. Uh, so I think that Both.
Okay.
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Chapter 5: How do lifestyle factors affect metabolic health?
Chapter 6: What are the primary factors contributing to weight gain?
Chapter 7: How can resistance training improve metabolic health?
So a morning cortisol is really helpful to look at in conjunction with a morning AM fasting glucose.
What's your preferred way to look at that? Is that like a Dutch test?
No, just blood tests.
Blood tests.
Yeah, just ask your doctor for an AM cortisol and a fasting glucose because the glucose is going to be on there anyway because they're looking at a comprehensive metabolic panel. A hemoglobin A1C is a three-month marker of how sugared up your red blood cells are. So it's a nice marker to have. And let's go back to the glucose. I want that at or below 90. 90 is the number.
If you're at 90, something is starting to go a little haywire. But if you have that AM cortisol, you can gauge it. And what I want that as, that depends. I'm not going to give you straight numbers on that, but... If it's high and it's on the high end of normal, you're probably driving up your AM glucose with that cortisol. You're probably stressed the F out and you need to reevaluate your life.
And you're probably not sleeping well.
One morning, my fasting insulin is usually around like three and a half, four, somewhere right around there. I think that's considered like good, optimal. Good is anything below five, right? Insulin, yeah. We'll get to that in a second. But I'm bringing it up because one morning I was dealing with like all this stuff.
I was running around and I went in for like my normal quarterly blood work and my fasting glucose that morning showed up as like 110. even though my insulin, which you're going to talk about in a second, was in a good position. So that's also just a heads up to people that it's good to have multiple markers or a continuous glucose monitor because you don't want to be making...
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