The Upstream Revolution

“The standard of care is downstream.”

Dr. Christian Jenski’s revelation cuts to the heart of what’s wrong with modern medical testing. While conventional medicine waits for diseases to fully manifest before taking action, the real story of metabolic dysfunction is being written upstream—in the early changes that predict and drive the conditions doctors eventually recognize.

If you’ve been following how the metabolic syndrome gang operates and understand why mitochondrial dysfunction is the master controller, you’re ready for the crucial next step: learning how to detect these problems before they become established diseases.

Jennifer’s case perfectly illustrates this backwards approach. Her lab report looked reassuring enough: A1C of 6.2, officially “pre-diabetic” but not alarming. Her doctor recommended Metformin and weight loss—the standard protocol for someone hovering at the edge of diabetes. Case closed.

Except Dr. Jenski doesn’t close cases that easily. When Jennifer came to see him, he ordered the tests her previous doctor never considered: fasting insulin, leptin, adiponectin, and a comprehensive hormone panel. The results revealed a completely different picture.

Her fasting glucose was 84—optimal. Her fasting insulin was 6.5—also optimal. Her metabolic markers were actually excellent.

“I tell that patient, your pre-diabetes is not completely predicated on the fact that your metabolism and your insulin sensitivity is off. There are other players. What are those other players? It’s usually cortisol, so stress, it might be thyroid dysfunction or low testosterone. So hormones play a role.”

Jennifer’s elevated A1C wasn’t about insulin resistance at all—it was about cortisol dysregulation from chronic stress and undiagnosed thyroid dysfunction. The Metformin would have been not just unnecessary, but potentially harmful to her already-optimal metabolic function.

This is the upstream revolution: catching dysfunction before it becomes disease, understanding the root causes before they manifest as the symptoms your doctor recognizes.

“Below 5.7 is not normal,” Dr. Jenski explains about A1C ranges. “Technically it is, but it’s not optimal. Early insulin resistance starts at 5.4.” But even that misses the point—because by the time insulin resistance shows up in your A1C, you’ve missed years of opportunities to address the upstream causes.

Dr. Aaron Hartman takes this detective work even further: “If someone has anything on this list, all of a sudden I’m looking for all the buddies… I’m doing organic acid testing, your oxalates are elevated, your uric acid levels are 7.7, you snore a little bit at night and all of a sudden it’s like the picture fits.”

The picture fits because they’re looking at the right picture—not the downstream flood, but the upstream broken dam.

Most doctors are trained to wait for disease and then treat it. Functional medicine practitioners look upstream to prevent disease before it starts. But even within functional medicine, there’s a spectrum of sophistication in testing strategies.

As Dr. Jenski puts it bluntly: “If you have one of the conditions or suspect you have one of the conditions on this list and your doctor hasn’t done a deeper dive on your metabolic dysfunction, then you need to see somebody else.”

This isn’t about ordering more tests for the sake of more tests. This is about understanding the metabolic story your body is telling, before that story becomes a tragedy.

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The Downstream Deception:

Why Your ‘Normal’ Labs Are Lying

The fundamental problem with standard metabolic testing is that it’s designed around populations that are already metabolically compromised. When “normal” ranges are based on sick people, “normal” results can hide years of developing dysfunction.

“This condition, this diagnosis, this criteria, didn’t exist when we were in medical school,” Dr. Jenski recalls about metabolic syndrome. “It’s developed over time, secondary to all the trends that we’ve seen in lack of exercise and sedentary lifestyle, poor diet, not managing stress, not managing other hormones, not sleeping appropriately.”

But here’s the crucial insight: the criteria developed to diagnose metabolic syndrome are based on this same deteriorating population. “The range is too big because it’s predicated on the general population, which is overweight and obese or overweight and diabetic and metabolically inflexible, and so that’s a problem.”

The Optimization vs. Normal Gap

Take fasting glucose as the perfect example of this backward thinking. The official cutoff for concern is 100 mg/dL, but Dr. Hartman points to more revealing research: “If your fasting glucose, I believe it’s 86, if it’s over 86, for every point it goes up over 86, you have a 6% increased chance of developing diabetes in the next 10 years.”

So while conventional medicine waits for you to hit 100, your diabetes risk is already climbing significantly at 87, 88, 89. You could spend years in the “normal” range while your metabolic health steadily deteriorates.

The triglyceride story reveals even more dramatic gaps between normal and optimal. “Triglycerides greater than 150 for us, greater than 70 is deemed to be too much,” Dr. Jenski explains. “I mean, really this is the difference between normal and optimization. If you have triglycerides less than 150 you don’t meet diagnostic criteria for metabolic syndrome. In my practice, it’s not optimal. We want those less than 70.”

This means you could have triglycerides of 145—technically “normal”—while being more than double the optimal level for metabolic health.

The Area Under the Curve Problem

A1C testing illustrates another fundamental flaw in downstream thinking. Most people think A1C represents their average blood sugar, but it’s actually more complex. “A1C represents the area under the curve,” Dr. Hartman explains. “So it’s not just if you can imagine a graph… when you have a low level glucose, then it bumps up with a meal and it comes back down and it does that three times during the day. That is the area under the curve that the A1C represents.”

This means you could have perfectly normal fasting glucose but dangerous post-meal spikes that take hours to normalize. Your A1C captures this dysfunction, but standard testing misses the meal-response story entirely.

“You might have normal fasting sugar, but what does your meal look like? You’re pushing it up and it takes you four hours to normalize?” Dr. Hartman asks. This post-meal dysfunction often appears years before fasting glucose becomes abnormal, representing a massive missed opportunity for early intervention.

The solution is deceptively simple: “People can just get an AccuCheck and check it fasting in the morning… an hour after breakfast, before lunch, an hour after lunch, before dinner, after dinner.” But most doctors never suggest this revealing assessment.

Understanding these gaps becomes crucial when you realize that mitochondrial dysfunction is already damaging your cellular energy production long before standard markers become abnormal.

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The Tests That Reveal Your Metabolic Truth

Upstream testing requires a completely different approach—one that looks for early dysfunction rather than established disease, optimal function rather than population averages, and root causes rather than downstream consequences.

The Core Metabolic Intelligence Panel

The foundation of upstream metabolic assessment starts with the tests conventional medicine either ignores or misinterprets.

“If you’re not looking at a fasting glucose, if you’re not looking at a fasting insulin both upstream of this, if you’re not looking at a fasting leptin and adiponectin both upstream of that, then you can’t see that full continuum of what’s going on metabolically with that person’s glucose control or lack thereof,” Dr. Jenski explains.

Fasting Insulin and HOMA-IR represent the most important metabolic markers most doctors never check. While glucose tells you what happened, insulin tells you what’s happening. “Early insulin resistance starts at 5.4” for A1C, but insulin resistance can be detected years earlier through elevated fasting insulin levels.

The HOMA-IR calculation uses both fasting glucose and insulin to estimate insulin resistance. “You typically want that less than two,” Dr. Jenski notes, but optimal function requires even lower levels. This single calculation can reveal metabolic dysfunction years before A1C becomes abnormal.

Leptin and Adiponectin provide even earlier warning signs. These hormones control appetite, fat storage, and metabolic flexibility. “You want leptin low, adiponectin high,” Dr. Jenski explains. When this ratio becomes disrupted, it predicts metabolic dysfunction that won’t show up in standard testing for years.

Advanced Glucose Assessment goes beyond fasting levels to understand your metabolic flexibility. Post-prandial (after-meal) glucose testing reveals how well your body handles the metabolic stress of eating. “Oh, I’ll have oatmeal… your sugar goes up,” Dr. Hartman notes, describing how supposedly healthy foods can reveal metabolic inflexibility.

The Inflammatory and Cellular Energy Markers

Upstream testing also includes markers that reveal the inflammatory and cellular energy dysfunction underlying metabolic problems.

“I get a uric acid on every single patient,” Dr. Jenski states definitively. Uric acid isn’t just about gout—it’s an early marker of metabolic dysfunction and cellular energy problems. “If uric acid level is greater than six, you’re still accumulating in your tissues whether or not you have flares,” Dr. Hartman adds.

LDH (Lactate Dehydrogenase) provides insight into cellular energy production. Elevated levels can indicate that your cells are struggling to produce energy efficiently, often years before this manifests as fatigue or other obvious symptoms.

Inflammatory markers like hs-CRP and ESR reveal the systemic inflammation that both drives and results from metabolic dysfunction. These markers can be elevated long before metabolic syndrome criteria are met, providing early warning of developing problems.

The beauty of this upstream approach is that “these are all things that you can get through a basic lab,” Dr. Jenski notes. You don’t need exotic testing to begin understanding your metabolic story—you just need doctors who know which basic tests to order and how to interpret them properly.

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Catching Each Gang Member:

Targeted Detection Strategies

Once you understand the gang mentality of metabolic dysfunction, testing becomes a sophisticated detective operation. Each condition requires specific strategies to catch early dysfunction before it becomes established disease.

PCOS: The Autoimmune Metabolic Storm

PCOS testing reveals why standard approaches miss so much dysfunction. Beyond the basic hormone panel, Dr. Hartman’s approach recognizes PCOS as “an autoimmune spectrum disorder” requiring comprehensive immune and inflammatory assessment.

“Complete hormone panel: testosterone, SHBG, FSH, LH, progesterone, estradiol” provides the foundation, but the real insights come from understanding the autoimmune connection. “Thyroid antibodies: TPO, anti-thyroglobulin” often reveal the immune dysfunction underlying hormonal chaos.

“I’m looking for ANA, I’m looking for celiac markers, anti-gliadin markers. I’m looking at your hs-CRP,” Dr. Hartman explains. The inflammatory markers often tell the real story of what’s driving the hormonal dysfunction.

But perhaps most importantly: “How many young ladies do you see have SIBO? Most of them,” Dr. Jenski responds. The gut-hormone connection means SIBO testing becomes essential for understanding and treating PCOS effectively.

Environmental toxin assessment adds another crucial layer. “40% of women diagnosed with PCOS have evidence of elevated BPA levels,” Dr. Jenski notes, highlighting how chemical exposures contribute to hormonal dysfunction.

Fatty Liver: Beyond the Incidentaloma

Fatty liver disease testing illustrates the downstream mentality perfectly. “We used to call these things incidentalomas,” Dr. Jenski recalls. “Somebody would come to the ER… get a CT scan… Oh, by the way, we saw incidentally that you have fatty liver disease, follow up with your primary care doctor.”

“That should be a flare gun going off saying, Hey, we gotta do something about this,” he continues, but conventional medicine treats it as a curiosity rather than a warning.

Advanced fatty liver assessment goes far beyond standard liver enzymes. Elastography testing can measure liver stiffness and fibrosis, providing objective measures of structural damage. “I’ve had patients have their elastography testing normalize, have their [liver function] normalized,” Dr. Hartman notes, proving that structural liver damage can be reversed with proper intervention.

The key insight is understanding fatty liver as part of the continuum: “All the way to the left, no liver problems… then you start to have a little bit of liver injury patterns… then there’s fat deposition… then you start to see a little bit of early scar tissue we call fibrosis… then you’re cirrhotic where your liver’s failed.”

Testing allows you to identify exactly where you are on this continuum and intervene before irreversible damage occurs. The complete reversal protocols are detailed in the comprehensive treatment approach.

Gout and Kidney Stones: The Crystal Connection

The connection between gout, kidney stones, and metabolic dysfunction reveals another area where standard testing falls short. “If uric acid level is greater than six, you’re still accumulating in your tissues whether or not you have flares,” Dr. Hartman explains, but most doctors only check uric acid after gout attacks occur.

Comprehensive metabolic panels become essential for understanding the full crystal connection. Beyond uric acid, “you can get oxalate levels” through urine testing or “organic acids testing” to understand kidney stone risk and metabolic dysfunction.

The gut connection appears here too: “The other source of oxalates can actually be yeast in your GI tract,” Dr. Hartman explains. “So when you see people with elevated oxalates, I’ve had patients who’ve had that and have their gut testing shows, your yeast levels are high.”

This means comprehensive gut assessment becomes part of kidney stone prevention and metabolic optimization.

Cardiovascular: The Inflammation Story

Cardiovascular risk assessment illustrates the power of upstream testing most dramatically. “Half the people who go to the ER with the first heart attack have normal cholesterol,” Dr. Hartman points out, revealing how standard lipid panels miss the real story.

Advanced lipid testing includes particle size analysis, apolipoprotein B, and LP(a)—markers that reveal cardiovascular risk invisible to standard cholesterol panels. Inflammatory markers like Lp-PLA2, myeloperoxidase, and oxidized LDL provide insight into the immune dysfunction driving cardiovascular disease.

But structural assessment provides the most valuable information: “Get all those things normal and you’re chasing numbers,” Dr. Jenski explains. Calcium scoring and CIMT (carotid intimal-medial thickness) testing reveal whether you actually have cardiovascular disease or just cardiovascular risk factors.

“If you have risk, don’t you want to know if you have early disease?” Dr. Jenski asks. This approach allows you to focus resources where they’re needed most—addressing real disease rather than just managing numbers.

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Next-Level Intelligence:

Tests Your Doctor Doesn’t Know Exist

The most sophisticated upstream assessment goes beyond standard labs to functional testing that reveals the deeper story of metabolic dysfunction.

Mitochondrial Function Assessment

“You can see macronutrient metabolism through the TCA cycle into mitochondria,” Dr. Jenski explains about organic acids testing. This functional assessment reveals how well your cellular powerhouses are actually working, often providing insights unavailable through any other testing method.

Understanding how mitochondria control your metabolic fate makes this testing crucial for getting to the root of metabolic dysfunction.

“Lactate and pyruvate ratios” can be obtained through basic labs and provide immediate insight into cellular energy production. Dr. Hartman shares a patient example: “His pyruvate at one point in time was sky high. Now it’s normalized… it was kind of cool to see that and to see it clinically correlate with him feeling better.”

Free and total carnitine levels reveal another piece of the cellular energy puzzle, while “you can get LDH through a basic lab” provides additional insight into energy metabolism dysfunction.

Environmental Toxic Load Assessment

Understanding the petroleum distillate and chemical assault on mitochondrial function requires specific testing for environmental toxins. Heavy metals panels, mycotoxin testing for mold exposure, and chemical panels for petroleum-derived toxins provide crucial information for treatment planning.

“93% of glyphosate ingredients are petroleum distillates,” Dr. Hartman reminds us, highlighting why environmental testing becomes essential for understanding metabolic dysfunction in the modern world.

Gut-Metabolism Axis Analysis

The connection between gut health and metabolic function requires sophisticated assessment beyond basic stool testing. SIBO breath testing, comprehensive stool analysis with attention to beneficial bacteria populations, and intestinal permeability assessment provide insight into the gut-metabolism connection.

Short-chain fatty acid production markers reveal how well your gut bacteria are supporting mitochondrial function throughout your body—a connection most doctors don’t understand but that’s crucial for metabolic recovery.

Understanding how your gut bacteria communicate with mitochondria makes this testing essential for comprehensive metabolic assessment.

Hormone Comprehensive Intelligence

Standard hormone testing misses the dynamic, rhythmic nature of hormonal function. 24-hour cortisol rhythm testing reveals stress hormone patterns invisible to morning-only testing. Complete thyroid panels including TSH, T3, T4, reverse T3, and antibodies provide insight into metabolic regulation far beyond TSH-only screening.

“Hormones play a role in that A1C elevation,” Dr. Jenski notes, highlighting why comprehensive hormonal assessment becomes essential for understanding metabolic dysfunction that appears to be purely about glucose regulation.

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Reading the Metabolic Story:

What Your Numbers Really Mean

The sophistication of upstream testing is only valuable if you understand how to interpret the results properly. This requires a fundamental shift from thinking about individual lab values to understanding patterns and relationships.

The Optimal Ranges Reality

“Normal is way too low” for many markers, Dr. Jenski notes, highlighting the gap between population-based ranges and functional optimization. Understanding optimal ranges requires clinical experience with what levels actually support metabolic health rather than just avoiding obvious disease.

• A1C: <5.3 vs. <5.7 (standard)
• Fasting insulin: <5 vs. <25 (standard)
• Triglycerides: <70 vs. <150 (standard)
• Uric acid: <6 vs. <7 (standard)

These differences represent years of additional metabolic health and the opportunity to prevent dysfunction before it becomes disease.

Pattern Recognition Mastery

“You’ll find your oxalates are elevated, your uric acid level’s 7.7, you snore a little bit at night and all of a sudden it’s like the picture fits. The picture fits,” Dr. Hartman explains. This is pattern recognition medicine—understanding how seemingly separate markers create a coherent story of metabolic dysfunction.

Multiple “normal” values at the high end of ranges create concerning patterns. Trending changes over time reveal dysfunction in progress even when individual values remain in normal ranges. The gang signs in laboratory values become apparent when you know how to look for relationships rather than isolated abnormalities.

Understanding these patterns becomes crucial when you realize that multiple conditions travel together as a coordinated gang rather than occurring as isolated problems.

Red Flag Combinations

Certain combinations of results reveal hidden dysfunction invisible to standard interpretation:

• Normal A1C + high insulin = early insulin resistance
• Normal cholesterol + high inflammation = cardiovascular risk
• Normal weight + metabolic obesity markers = hidden visceral fat dysfunction
• Normal individual hormones + disrupted ratios = functional hormonal dysfunction

The upstream detection advantage allows intervention years before downstream consequences become apparent to conventional medicine.

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Getting the Tests You Need:

A Patient’s Strategic Guide

Understanding what tests to request is only valuable if you can actually get them ordered and properly interpreted. This requires strategic thinking about how to work with healthcare providers and when to seek alternative approaches.

The Practitioner Litmus Test

“If you have one of the conditions or suspect you have one of the conditions on this list and your doctor hasn’t done a deeper dive on your metabolic dysfunction, then you need to see somebody else,” Dr. Jenski states bluntly.

This isn’t about demanding every possible test from every doctor. It’s about finding practitioners who understand upstream medicine and can appropriately assess your individual situation. The questions you ask can quickly reveal whether your doctor understands upstream thinking:

• “Can we check my fasting insulin along with glucose?”
• “What do you think about checking inflammatory markers?”
• “Have you considered the connection between my symptoms?”

Their responses will tell you whether they understand the gang mentality of metabolic dysfunction or are stuck in downstream, symptom-focused thinking.

Insurance and Access Strategy

Many upstream tests are covered by insurance when properly requested and justified. Understanding which tests are typically covered helps you prioritize appropriately and build the case for comprehensive assessment.

Direct-pay lab options provide access to testing when insurance or providers create obstacles. The investment in upstream assessment often prevents far more expensive downstream treatment of established disease.

Building the Case for Comprehensive Testing

The key to getting upstream testing is helping your healthcare provider understand the connections you’re seeing and the potential for early intervention. Coming prepared with symptom patterns, family history, and specific questions demonstrates that you’re seeking comprehensive assessment rather than random testing.

The return on investment for upstream detection becomes clear when you consider the cost of treating established diabetes, cardiovascular disease, fatty liver disease, or hormonal dysfunction compared to preventing these conditions through early intervention.

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Your Upstream Intelligence Mission

The upstream revolution in metabolic testing isn’t just about getting different lab tests—it’s about fundamentally changing how you think about health assessment and disease prevention. Instead of waiting for problems to develop and then treating them, you can identify dysfunction years early and address root causes before they create the conditions conventional medicine recognizes.

Immediate Assessment Steps

Start by reviewing your recent lab work against optimal ranges rather than normal ranges. Look for patterns and relationships between different markers rather than viewing each result in isolation. Identify missing upstream markers that could provide valuable insight into your metabolic story.

Build your case for comprehensive testing by tracking symptoms, energy patterns, and family history that suggest metabolic dysfunction. Come prepared with specific questions and test requests that demonstrate your understanding of upstream medicine.

The Comprehensive Testing Strategy

Work with practitioners who understand the gang mentality of metabolic dysfunction and can appropriately prioritize testing based on your individual situation. Consider direct-pay options when insurance or provider limitations prevent appropriate assessment.

Most importantly, understand testing as part of a broader strategy for metabolic optimization rather than just diagnosis of disease. The goal is understanding your metabolic story well enough to write a better ending.

Moving from Testing to Treatment

Once you have comprehensive upstream testing results, the real work begins. Understanding what’s wrong is only valuable if you know what to do about it. The sophisticated protocols for reversing metabolic dysfunction are detailed in the complete treatment approach that addresses root causes rather than just managing symptoms.

The upstream revolution represents a fundamental shift from reactive to proactive medicine, from symptom management to root cause resolution, from waiting for disease to preventing dysfunction. When you understand what upstream testing can reveal, you gain the power to take control of your metabolic fate before it’s written by downstream consequences.

Remember that mitochondrial dysfunction is the master controller connecting all these seemingly separate problems. Your testing strategy should always include assessment of cellular energy production and the factors that support or undermine mitochondrial function.