Updated Labs and Gut Health

I didn’t get everything tested – just the basics, which is what I could afford right now.  Here they are, with the current results in RED.

3/27/2012 11/14/2012 9/6/2013 12/30/2013
Units Ref
Glucose 98 98 117 114 mg/dL 65-99
Hb A1C 6.4 <7.0
Uric Acid 5.9 5.2 5.4 5.4 mg/dL 2.5-7.1
BUN 19 25 18 18 mg/dL HIGH 6-24
Creatinine 0.69 0.73 0.57 0.6 mg/dL .57-1.00
eGFR 108 101 113 111 mg/dL >59
BUN/Creat Ratio 28 34 32 30 HIGH 9-23
Sodium 138 139 139 138 mmol/L 134-144
Potassium 3.8 3.8 4.5 4.1 mmol/L 3.5-5.2
Chloride 1.3 104 103 104 mmol/L 97-108
Calcium 9.3 9.2 9.4 9.2 mg/dL 8.7-10.2
CO2, Total 28 20 mmol/L 19-28
Phosphorus 3.6 4.1 4.0 3.4 mg/dL 2.5-4.5
Protein, Total 6.8 6.9 7.2 7.1 g/dL 6.0-8.5
Albumin 4.3 4.4 4.4 4.1 g/dL 3.5-5.5
Globulin, Total 2.5 2.5 2.8 3.0 g/dL 1.5-4.5
A/G Ratio 1.7 1.8 1.6 1.4 1.1-2.5
Bilirubin, Total 0.2 0.3 0.3 0.3 mg/dL 0.0-1.2
Alkaline Phosphatase, S 63 64 70 62 IU/L 25-150
LDH 142 137 137 143 IU/L 0-214
AST (SGOT) 20 14 12 15 IU/L 0-40
ALT (SGPT) 25 17 18 20 IU/L 0-32
GGT 14 14 27 20 IU/L 0-60
Iron 66 81 116 88 ug/dL 35-155
WBC 8.7 x10E3/uL 3.4-10.8
RBC 4.36 X10E6/uL 3.77-5.28
LIPIDS
Cholesterol, Total 222 297 270 274 mg/dL HIGH 100-199
Triglycerides 107 203 288 312 mg/dL HIGH 0-149
HDL Cholesterol 54 56 43 46 mg/dL >39
VLDL Cholesterol 41 58 mg/dL HIGH 5-40
LDL Cholesterol 147 200 169 166 mg/dL HIGH 0-99
T. Chol/HDL Ratio 4.1 5.3 6.3 6.0 HIGH 0.0-4.4
Estimated CHD Risk (Tot. Chol/HDL) 1.4 1.8 HIGH 0.0-1.0
OTHER
Vitamin D 34.2 67 (on 11/11/13) ng/mL 32-100
Insulin, Fasting 27.9 uIU/mL HIGH 2.6-24.9
hs-CRP 8.65 8.12 13.58 mg/L HIGH 0.00-3.00
THYROID 3/27/2012 11/14/2012 6/19/2013 12/30/2013 Units Ref.
TSH 1.7 4.01 1.55 2.92 uIU/mL 0.450-4.500
Thyroxine (T4) 4.1 8.9 7.4 6.9 ug/dL 4.5-12.0
T3 Uptake 32 25 27 24 % 24-39
Free Thyroxine Index 2.5 2.2 2.0 1.7 1.2-4.9
T4, Free (Direct) 1.04 0.97 ng/dL 0.82-1.77
Reverse T3 20.9 10.2 ng/dL 9.2-24.1
Triiodothyronine (T3) 126 120 ng/dL 71-180
Thyroid Peroxidase TPO Ab 10 8 IU/mL 0-34
Antithyroglobulin Ab <20 <20 IU/mL 0-40
Free T3 2.9 2.8 pg/mL 2.0-4.4

The first two columns (3/27/12 and 11/14/12) are when I was eating low carb with about 5% of my diet being carbohydrates for the first, and 10-15% for the second.  The third column (9/6/13) I was floundering around, trying on various diets/lifestyles.  At that time, about 20% of my diet was carbohydrate.  In November I started paying attention to Ray Peat and I increased my carbohydrate consumption to 40-50%, most in the form of simple sugars/fruit.  My blood sugars started soaring though, so a few weeks later I switched from simple sugars to starches and cut the quantity down to about 30%, while increasing protein.

So how am I doing?

Blood sugar – fasting glucose is high (but not over 126), HbA1C is not ideal, but is not in the diabetic range, and fasting insulin is high.  These factors suggest to me that I am more likely VERY insulin resistant, but not necessarily diabetic yet.  The fact that my body is still pumping out that much insulin is a good thing.  My pancreas isn’t dead yet.  I’m certainly very close to type 2 diabetes, if I’m not there yet…and I know I need to take this very seriously.

Thyroid – I was hoping eating carbs would help thyroid function.  However, if TSH is a reliable marker (and Ray Peat says it is) it looks like I did best with some carbs but not many.  Of course my triglycerides were happiest with none, but you can’t please everyone.

Lipids – OMG, I’m so about to die of a heart attack.  Triglycerides absolutely not going in the right direction…HDL was highest on low carb, LDL a bit better now than it was last winter but still not good.  I have been taking very small doses of T3 every day (6mcg), but that clearly isn’t enough to have an impact on cholesterol.  Will have to increase it.

Other – That CO2 number is terrible.  What happened there?

My ability to interpret labs is limited – please feel free to add your interpretation in the comments.

And in other news, I’ve decided my gut is completely torn up from 2 rounds of antibiotics this year, and that’s why I’m having trouble tolerating the potato starch.  I’ve decided I’m going to mix it with all kinds of junk and make it into BIONIC FIBER.  (<– Imagine I said really loud with an echo.)   I’m on day 3 of probiotics.  I’m going to fix my gut biome, dammit!  But most importantly, I have baseline data for my Resistant Starch Experiment.

15 thoughts on “Updated Labs and Gut Health

  1. Well you already know what I am going to say. The co2 says it all. Your little furnaces aka mitochondria have slowed down considerably. Zero out your PUFA. Get your TSH down to 0.5 or less …slowly… I wouldnt worry about TG. It will come down when the TSH does. Aspirin, progesterone, niacinamide, coffee and red light. The very same things will also help your pre diabetes.

  2. I’ve cut way back on PUFA, taking aspirin about 650mg/day, taking progesterone 20mg/day, taking niacinamide 500mg/day, coffee is out because of it’s effect on blood sugar but I do take magnesium (200mg/day) and caffeine (100mg/day). Red light coming. I’m not sure if this stuff helps or not but I’ll continue.

  3. I am not a doctor but did have severe case of insulin resistance probably still do. Luckily I did not have any inflammation ( CRP < 1). So my writing is based upon my own experience in dealing with it. I am also male so in my case testosterone is the hormone not estrogen.

    The numbers from ADA are arbitrary. I worried a lot about FBS and A1C and pushed it very hard to be in 85 mg/dl and 5.4 range. Latest A1C few weeks ago is 6.1 by adding more carbs in the form of fruits and I was drinking OJ for a while.

    I wouldn't worry too much about it now because that is indicative of other problems. Mainly how the energy production is taking place within cell. Triglyceride is a proxy of NEFA ( non essential fatty acids) High NEFA is responsible for insulin resistance. Excess presence of NEFA within cell blocks glucose metabolism and cells down regulate the insulin receptors, once that happens insulin can not help in getting glucose within cell. It creates a vicious circle and raises insulin levels more than they should be. That is probably why your insulin levels are so high a clear case of hyperinsulnemia ( High fasting insulin, actually higher than mine) that is indicative of severe Insulin resistance. Higher level of insulin around means you must be gaining weight. The excess nutrients in the blood are converted to fat and stored. It is a really very tough situation. While cells are starving for glucose, can't get it , making the person feel very tired while fat deposits are releasing more NEFA due to excess fat making person even more insulin resistant and that is adding to more fat storage.

    I solved this problem by going very low Carb and walking 4 miles a day for two months. I lost around 25 lbs ( 137 to 112) in 12 weeks. That got rid off insulin resistance for most part but raised cortisol and lowered testosterone (not sure about the real cause) and also raised reverse T3 ( hypothyroidism) and I started gaining weight again and pretty much back to where I started now. Peat is right. Forced weight loss occurs in stress full condition and creates hypothyroidism and elevated levels of cortisol ( that partly explains my lower testosterone, there is is an inverse relation between the cortisol nd testosterone) That is why I am trying to follow Peat even though my A1C went up from 5.4 to 6.1 and FBS from 85 to 110 mg/dl

    You don't have numbers for Cortisol ( stress) and Free T3 and reverse T3 ( thyroid) and Estrdiol?( Estrogen) So how do you know that you have hypothyroidism?

    It is hard to tell why you have such a high CRP. Could it be because excess fat? Excess Fat cell could become inflammatory.

    If you have excess weight than lowering it will definitely help in improving all these markers. They all go up in the wrong direction together.

    One thing you could do is cut all cooking oils out and use only Coconut oil. Refined Coconut oil for cooking and few tablespoon of unrefined in any form a day. At first it is nasty but one can get used to it slowly. It has a different fatty acid profile than other fats and metabolizes differently than other fats that have long chain fatty acids. This is one thing that low carber and ray peat totally agree upon.

    You really don't have much choice on what you can eat. Most of the food are off limit because they are adding to the problem. Also, eating really have to be moderate. Just enough to satisfy hunger.

    You need to go back on metformin. It helps in losing weight. 1.5 to 2 g/day.

    You may have to do some walking every day. It lowers blood glucose levels and improves insulin sensitivity. Some muscle cells can absorb blood glucose without help of insulin. Some small amount of weight lifting could help too.

    I don't know much about fixing thyroid issues. You may have those too. Because type 2 diabetes really is caused by endocrine system disruption that starts with reduced metabolism rate. Causes are difficult to figure out but in general stress and lifestyle that is unhealthy is the real cause.

    This thing already got so long. There are so many things and so many angles to look at. One thing for sure you have metabolic syndrome ( Dr Reaven), inflammation ( DR Weil) and most likely hypothyroidism( Dr Peat) and possibly high estrogen ( Dr Peat).

    Possible solution. Moderate diet with only coconut oil as fat, moderate exercise and metformin. Only a suggestion not a medical advice so make sure you consult your docs before you floow anything.

  4. Javed – thanks for taking the time to write all that! Lots of great thoughts there. To answer your questions:

    1. Yes, I am gaining. I’ve gained 4 or 5 pounds on Peat eating – it seems to have stabilized since I cut carbs back again.

    2. My latest cortisol labs are here:
    https://sanscarbs.wordpress.com/2013/07/10/adrenal-stress-index-results/

    They’re about 6 months old, but I try to prioritize the labs that I need the most in the moment because I have to pay cash for all of them. No insurance coverage for non-essential labs.

    3. Estrogen/hormone labs – I haven’t had them done for 8 or 9 months, and at that time I was taking hormone replacement (including estrogen). I’ve stopped that. Before then my estrogen and progesterone both tested very low, but estrogen labs aren’t a reliable way to tell how much is in the system because it hides in tissues.

    4. Latest thyroid labs are listed in the post above – from June 2013. Reverse T3 was low. I don’t know that I’m hypothyroid. My thyroid labs indicate T3 is low-normal range. When I started taking T3 my AM temp was 96.9. That plus high cholesterol suggested to me that I could possibly benefit from taking thyroid supplement.

    5. I don’t think high CRP is from fat. Unless it’s because of estrogen stored in fat. There are people much fatter than me with lower levels of inflammation.

    6. I’ve never been on metformin, but I might. I have been reluctant to go to a doctor about all this because then it will be part of my official “record”. Prior to this year, having a medical history like mine would blackball me from getting insurance (and it has). Now I could probably do it. Thanks, Obamacare.

    7. I’ve been off of all cooking oils except for coconut oil and a little olive oil for months. My only sources of PUFA now are non-pastured eggs and occasionally chicken. Those will be gone now too.

    8. Yes, I’ll be walking or biking (indoors) every day.

    I really do appreciate your help, and I’m really looking forward to see how things go for you taking Peat’s recommendations even with higher BG.

  5. “I solved this problem by going very low Carb and walking 4 miles a day for two months. I lost around 25 lbs ( 137 to 112) in 12 weeks. That got rid off insulin resistance for most part but raised cortisol and lowered testosterone (not sure about the real cause) and also raised reverse T3 ( hypothyroidism) and I started gaining weight again and pretty much back to where I started now.” sound familiar? Makes sense if you look at it from a Peat perspective. I am sure the LDL also went up during this time. The low testosterone is part and parcel of the problem where lack of T3 prevents cholesterol from entering the pathway. Although all the Peat knowledge doesnt explain why some people can do it and not others.
    http://www.cbc.ca/news/canada/manitoba/winnipeg-grandfather-loses-more-than-half-his-body-weight-1.2481440

  6. I am not well versed in dealing with hormones but had enough reading in low carb paleo stuff. Your number show a sign of metabolic syndrome and the person who researched it thoroughly is Dr Reaven from Stanford University. He wrote a book

    http://www.amazon.com/Syndrome-Complete-Nutritional-Program-Resistance-ebook/dp/B00DNL2ZXI/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1388879651&sr=1-1&keywords=syndrome+X

    explaining this and some suggestions how go about curing it. The diet in the book is pretty mainstream.

    I think eating healthy that is avoiding junk process food and moderately not over indulgence and active life style is good way to go about it.

    I would consider metfromin for few months. In fact with your sugar numbers you may not even qualify for it but high fasting insulin indicates insulin resistance and metfromin should help there.

    Another thing that helps is stress reduction. How one goes about that is another tricky thing. In my case long walks. I my case walking 4 miles in weather like this works. I am sure you will find something that works for you. If nothing else then 20 minutes of idle sitting and concentrating on breathing in and out kicks in the well known relaxation response researched by Dr Benson at Harvard ( http://www.health.harvard.edu/blog/using-the-relaxation-response-to-reduce-stress-20101110780)

    Dr Peat also builds his case around stress so reduction of this should help. Even bag breathing might work if done twice a day.

    My LDL, TGL went down and HDL went up. I had perfect lipid profile and sugar profile after long time after losing the weight. It probably is up since I gained most of the weight back. I will not worry about cholesterol but triglycerides only. Triglyceride and HDL are inversely related. TGL to HDL ratio I think serves as a proxy for insulin resistance. Same way there is an equation that uses fasting insulin and fasting glucose to calculate insulin sensitivity, which is opposite of insulin resistance.

  7. Thanks, Javed. I just read a book from 2001 on insulin resistance (got it at the local used book store) and they recommended 7g of protein being combined with every 15g of carb, and no more than 30g of carb within any 2 hour period of time. That’s similar to the diet that was prescribed to me when I had gestational diabetes 4 years ago. Is this book similar in it’s recommendations? I actually tried this and I felt good but my blood sugar numbers were too high. I can’t handle that many carbs, even combined with protein.

  8. You have plenty of insulin so no need for c-peptide test. The chart I have seen shows that it takes 8-10 years of serious insulin resistance to blow up pancreatic production of insulin and a type 2 to become a type 1 disease. That is zero insulin production. Type 2 may go back and forth. That is lose some insulin production and then gain some back. That shows. Only one in four Type 2 diabetics eventually go on to take insulin injections to manage their BG. There are still 3 in 4 type 2 who stay with oral hypoglycemic agents.

    There is lots of data here on this http://www.nlm.nih.gov/medlineplus/diabetestype2.html

    You don’t have type 2 diabetes but a very severe case of Insulin resistance and that could be improved with proper combination of diet and exercise and hypoglycemic agent like metformin. You will be surprised to know that people lose weight on metformin while they gain weight on taking insulin injections and some of them develop hypothyroidism while on it. High levels of insulin either endogenous or injected exogenously are not health promoting. I think that is why low carb works because it reduces the need for insulin secretion. Once insulin resistance drops people can up their carb load. Like I could now. I can tolerate way more carbs now than I did 3 years ago.

  9. Actually, DR Bernstein recommends 30 g a day carb to start shared between three meals.

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