Next Blood Draw — Early April 2026
Timing: Early April (post-Lent, ~7 weeks into OMAD) Prep: 12h+ fast, morning draw (~8am) Previous draw: March 10, 2026 (Quest)
Tier 1 — Core Metabolic Tracking (repeat from March)
These are your monthly tracking markers per the Lent protocol.
| Marker | Why | March Result | Target |
|---|---|---|---|
| Fasting insulin | Primary metabolic metric | 25.4 | <15 by Pascha |
| Triglycerides | Metabolic syndrome indicator | 143 | <100 |
| Fasting glucose | IR proxy | 110 | <95 |
| HbA1c | 3-month glucose average | 5.8% | <5.7% |
| Cystatin C + eGFR | Kidney function (quarterly) | 1.02 / eGFR 84 | Stable |
Tier 2 — Genome-Informed (NEW)
These are new tests motivated by your 23andMe analysis from March 18.
| Marker | Why | Genetic Basis | Est. Cost |
|---|---|---|---|
| Serum AAT (alpha-1 antitrypsin) | Pi*Z heterozygous carrier (rs28929474 CT). Could explain chronic ALT elevation via hepatocyte ER stress. | SERPINA1 het | ~$20-30 |
| Methylmalonic acid (MMA) | Functional B12 tissue marker. Serum B12 is unreliable given your TCN2 het + MTRR het stack. | TCN2, MTRR, FUT2, CBS hets | ~$30 |
| Homocysteine | Functional B12/folate marker. Also cardiovascular risk. Elevated = methylation bottleneck. | Same B12 pathway stack | ~$20-30 |
| Serum B12 | Baseline, but less informative than MMA. Get it anyway for completeness. | TCN2 het | ~$15 |
| Folate (serum or RBC) | Pairs with homocysteine. MTHFR A1298C het = mild folate metabolism effect. | MTHFR A1298C het | ~$15 |
Tier 3 — Liver Deep Dive (follow-up)
| Marker | Why | March Result |
|---|---|---|
| ALT | Track trend | 39 (best ever) |
| AST | AST/ALT ratio for staging | 28 |
| GGT | Recommended March 7 but never ordered. Best NAFLD progression marker. Sensitive to alcohol, meds, bile duct issues. | Never tested |
| Ferritin | Tracking rebound post-donation | 152 |
Tier 4 — Nice-to-Have
| Marker | Why |
|---|---|
| TSH | Subclinical hypothyroid can mimic metabolic syndrome. Never been checked. |
| Free T3, Free T4 | Full thyroid panel if TSH is abnormal |
| Vitamin D (25-OH) | Genetic tendency toward lower levels (VDR/GC variants) |
| Uric acid | Track trend (was 7.9 Jul → 7.0 Mar) |
| C-Peptide | Repeat to track beta cell function (was 2.93) |
Ordering Notes
- OwnYourLabs / Quest — most of these are standard. MMA and AAT may need to be ordered individually.
- JustLabs — used for cystatin C last time (~$34). Check if they have MMA/AAT.
- Fasting: 12h minimum for insulin/glucose/trigs. MMA and homocysteine are also best fasted.
- Total cost estimate: Tiers 1-2 together probably $150-250 depending on ordering platform.
What We’re Looking For
- Insulin trajectory — need to see continued decline toward <15. If it’s still >20 after 7 weeks OMAD, we need to intensify (longer fasts, add metformin discussion).
- MMA + homocysteine — if either is elevated, start methylcobalamin + methylfolate immediately. This could be an independent driver of your IR.
- AAT level — if low (<100 mg/dL), it confirms the Z allele is functionally relevant and partly explains ALT history. Would warrant hepatology follow-up.
- GGT — filling a gap. If elevated, suggests ongoing hepatobiliary stress beyond what ALT shows.
- Trig/glucose — confirm March improvement wasn’t a fluke.
Updates from March 18 Genome Deep Dive
Removed:
Lp(a)— Both rs10455872 and rs3798220 are wildtype. Lp(a) is genetically determined and barely modifiable; both risk SNPs are clear. Not worth the cost.
Added to Tier 4 (Nice-to-Have):
| Marker | Why |
|---|---|
| HDL-C | CETP B2B2 genotype predicts naturally higher HDL. If HDL is low despite this, it’s a strong environmental signal. |
New Context for Interpretation:
- 9p21 CHD risk (het): This risk is NOT lipid-mediated. Even if lipid panel is perfect, cardiovascular risk is ~1.3x baseline from this locus alone. Anti-inflammatory markers (hsCRP if available) would be informative.
- 8q24 CRC risk (GG): Colonoscopy at 45, don’t defer. Not blood-draw related but flagged here for the annual screening calendar.
- *CYP2C9*1/3: If any NSAIDs are being used, lower doses are advisable. Also relevant if warfarin is ever prescribed.