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.

Folic Acid

This is the first in a series of blogs about vital aspects of nutrition, not necessarily making headlines in the news.

Folic acid or folate is one of the B vitamins. As the name implies, it is found in foliage. It is probably best known as the main ingredient in prenatal vitamins where its use early in pregnancy prevents neural tube defects. These are severe birth defects associated with underdevelopment of the brain and spinal cord. Folic acid is vital for cell reproduction. It needs to be present in large quantities as the fetus grows to ensure that the spinal cord develops properly.

In adults, cell reproduction rates vary dramatically. The liver replaces every cell once in seven years. However, the epithelial lining of the digestive tract is replaced, in total, every 24 to 48 hours. Again, this process requires a lot of folic acid. If folic acid is deficient, the lining of the gut quickly breaks down allowing bacteria and undigested food into the blood stream. This, in turn, creates and immune response and ultimately an autoimmune response as well.

Burn victims frequently suffer from this process. When large portions of the skin are burned the need for folic acid skyrockets as the body attempts to replace the burned tissue. Folic acid is quickly depleted and the gut lining breaks down with 1 to 2 days. As the bacteria enter the blood stream from the digestive tract, life threatening infections often occur in distant locations like the lungs. For years, hospitals tried various antibiotics only to find that they just could not control the number of potential infections. Today, burn centers utilize folic acid and L-glutamine to support repair of the digestive tract.

Folic acid and folate are not used by the body in their food form. Instead, they are absorbed into the lining of the digestive tract and converted to 5-methyltetrahydrofolate, the bio-available form, before being released into the blood stream. Think about that loop for a moment – the lining of the digestive tract needs folic acid to reproduce but the body needs the lining to make the folic acid bio-available. You can see how fragile the system is to folic acid deficiency.

Genetic defects in folic acid conversion are quite common. Eight percent of the population can not covert folic acid into 5-methyltetrahydrofolate. These people are always anemic as folic acid is essential in the production of red blood cells. Twenty-five percent of the population carries a genetic impairment from just one parent. At times they can convert folic acid, but when the body is under stress, they often are unable to convert to the bio-available form efficiently. That is one out of every four patients that walks into my office! Fortunately, 5-methyltetrahydrofolate is available as a supplement. Adding it to the diet of someone with a genetic defect can be life changing.


Folic acid, vitamin B6, and vitamin B12 work together in many chemical pathways in the body. A deficiency of one can impair the function of another. All three have to be converted in the gut to their bio-available forms and all have the same genetic defect issues.

THE BOTTOM LINE:
If you have digestive issues, fatigue, or a history of anemia look at the lab report for your CBC (complete blood count). Find the MCV (mean corpuscular volume). If that number is 93 or higher, you are deficient in folic acid and/or vitamin B12.