Wednesday, January 31, 2018

Wisdom Wednesday: Laboratory Trends

During the months of December, January and February we reduce our lab fees to encourage patients to run a yearly profile. The profile changes from year-to-year but basically has become more extensive over the years.

This year’s standard tests include a hemoglobin A1c, comprehensive metabolic profile (fasting glucose, kidney and liver function, electrolytes, etc.), iron profile, ferritin, serum lipids (total cholesterol, triglycerides, HDL, LDL), CRP (C Reactive Protein), homocysteine, thyroid profile, CBC, vitamin D, and urine analysis.

I often add tests like a PSA for men or TPO (thyroid peroxidase) and thyroid auto-antibodies for Hashimoto’s thyroiditis, if the history indicates the need.

As January ends, I’ve spent hours reviewing lab tests and making nutritional recommendations. I typically use laboratory tests to confirm indications from QA testing but also find them valuable to see disease development in the early stages, when it’s relatively easy to correct.

Every year I see patterns emerge from my patient population. When you review 4-5 tests in a day, you can’t help but see certain trends developing. I thought you might enjoy seeing these trends through this clinician’s eyes.

The eGFR or glomerular filtration rate is a measure of kidney function. It’s a relatively new test and I wrote a blog about it last fall. Initially, the test results were only listed if the result was less than 60. This indicates kidney damage. However, levels between 60 and 90 indicate loss of kidney function. Now that most labs actually list the test results, I am finding a higher and higher percentage of patients in that fall in that 60 to 90 range. They are losing microcirculation to the kidney which may be the result of some aspect of metabolic syndrome, especially insulin resistance. However, the more medication a patient takes, the more likely their eGFR will be below 60.

TIBC (total iron binding capacity) and ferritin – the first is just what is says, the second is the storage form of iron. I added these tests three years ago when I switched from Quest to a cooperative group using Lab Corp to reduce the price of testing. The first year I rarely saw any abnormalities, unless the patient was anemic. However, I gradually began to see a low TIBC and high ferritin in patients with chronic inflammation and/or chronic infection. This predisposes patients to autoimmune disease. Recent research indicates that high doses of vitamin D and bio-available vitamin B12 (methylcobalamin) can help support the immune system to overcome these issues.

Low total cholesterol ( less than 150) and low LDL ( less than 70) – this is a cardinal sign of statin drug use. Unfortunately, statins do not always lower the CRP. Most primary care physicians are not even running the CRP, so even with low serum lipids, the patient’s risk of CVA (cardiovascular accident) can remain high. Additionally, these patients typically have endocrine disorders, like “low T” and hypothyroidism because they don’t have enough cholesterol to manufacture hormones.

High normal MCV (mean corpuscular volume) and high homocysteine – the first is a measure of the average size of a RBC (red blood cell) and the second is a cardiovascular risk factor (and much more). The medical norms for MCV can be 97 to 100. However, levels above 92 can indicate a vitamin B12 and/or folic acid deficiency and will often correlate with elevation of the homocysteine.

The Bottom Line:
Standardized lab tests offer a wealth of information for disease prevention. You just have to look at the patterns. Please ask your primary care physician to run these tests annually and request the list that I posted at the beginning of this blog.

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