2

votes

Question for DR K and OTHERS regarding Tests

Answered on August 19, 2014
Created February 20, 2011 at 5:56 PM

If I go for a physical and present this to my Dr. What test should I ask for to get a baseline on Cholesterol (including showing the puffy type of ldl) Vit D, Omega balance or lack there of etc..

I have been on for over 30 days and mostly do not have trouble balancing this lifestyle with NON Paleo eaters (i am going to convince them with visuals and go from there). I want to continue but probably need to check and get some baseline numbers.

Ab19df3ededa28f7bf7daeba8435b205

(1471)

on June 12, 2011
at 09:24 PM

Like what $$ amount?

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:58 PM

@Theresa: Perhaps you should look at this thread: http://paleohacks.com/questions/324/blood-tests-paleo-indicators/5155#axzz1EbhAxUyK

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:31 PM

If you feel sick, lab test will help identify the problem. I believe this applied to everything except the standard screening tests (Pap smears, colonoscopies, mammographies, etc)...

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:29 PM

@Theresa: My advice would be to get the standard lipid panel (along with the metabolic panel and perhaps complete blood count [CBC] the MD may order) because those things are measured more frequently so the numbers are more likely to be reliable and comparable across labs. Sometimes too much information can lead to spurious conclusions. My family medicine lectures drummed into me how the best predictor of someone's health is her sense of well-being. If you are honest with yourself and don't feel that you are ill, lab tests will at best confirm that. (Things like cancer, God forbid, aside).

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:25 PM

@Theresa: It is a very good idea to get it all done at once. To disclose my bias, I side with Dr. Harris that many tests give a false sense of control by focussing on things that are easily measured but causative factors in the underlying pathology.

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:23 PM

@Dr. K: I don't mean to push you on this but I think your answer confuses the words 'sensitive' and 'specific' which, I'm sure you know, have very different meanings. I think you mean HS CRP is a more SPECIFIC marker of mitochondrial dysfunction. It is also 'simple clinical medicine' to precede SPECIFIC tests with SENSITIVE tests because jumping right to the SPECIFIC test will admit too many false negatives. That is you will tell too many people that they are fine when they aren't. That is why CRP should precede HS CRP or why finger sticks precede HbA1C.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 21, 2011
at 06:03 AM

CRP does not equal HS or cardiac CRP and they are quite different. That is what I meant. HS CRP is very specific for cellular level inflammation at the mitochondrial level....anything that causes our mitochondria to be leaky cause disease and aging. You can have a normal CRP and markedly abnormal HS CRP. Its far more sensitive marker. I never use CRP. Justification? Funny. If you dont measure you have no idea of intensity of impact or results of therapy....and you need a baseline. Pretty simple clinical medicine. People who want to be optimized measure. Its not requirement its choice.

Ab19df3ededa28f7bf7daeba8435b205

(1471)

on February 21, 2011
at 02:22 AM

43, 5' 7" 230 at beginning and 221 now. Last check my Cholesterol was 199 but i dont remember the break down but it was supposedly good. BP 112/80. This is all I know since I am terribly afraid to get blood work. I have to really psych myself up to get anything except a pin prick done...I already need blood work for OBGYN so I want to get it all done at once!

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 01:57 AM

@Theresa: Can you tell us a bit more about yourself & your baseline?

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 01:52 AM

@Dr. K: I must confess that I don't understand your recommendations. Screening tests should be sensitive and confirmatory tests specific. Perhaps you miswrote 'non specific[sic]' and 'Highly sensitive'? Furthermore, what is the justification for all these tests?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:51 PM

Too many docs out there in obesity clinics and anti aging clinics try to put everyone on the same plan because its doable and easy for their management from the doc perspective. I dont buy that at all. Obesity Fitness and nutrition is highly variable between siblings much less non relatives so to optimize yourself you need a doc who understands that clinical utility. All that being said......its very hard to find these days because of cost and location. Sometimes you have to go Ala carte with several practioners......suboptimal but financially necessary.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:47 PM

I disagree with the above quoted numbers initally......Patients are on a continuum. We got from morbid obese train wrecks to a a 5% fit cross fitter who is in great shape..........Most people fall in between. The key is to have a doc who custom fits a program to where you are on this continuum. So giving you goal numbers right now is premature.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:46 PM

I also will add chemistries and hormone panels if I think they are necessary based upon history and interview. Obviously I cant give you a custom answer cause I dont know you but this at least gives you a start on what you should be looking for in a doc.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:45 PM

CRP is not the best choice....very non specific. You need Highly sensitve CRP Vit D level specifically the 25 di OH vit D levels. You need a lipid panel basic and VAP, omega six/three index levels, HbA1C, I also would want you to buy a glucose meter and start a month long blood check q 15 minutes after a meal up to ninety min tosee how you respond to foods and a journal food log to correlate it. I do quite a bit of labs initially and I repeat them all quarter the first yr.

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2 Answers

1
64433a05384cd9717c1aa6bf7e98b661

(15236)

on February 20, 2011
at 06:19 PM

you should include C-reactive protein (CRP) - it is a marker of systemic inflammation. If you have an infection this level will be elevated as your immune system is fighting it, but when there is no infection present, it can be an indicator of inflammation present in other places (intestines, etc.) should be less than 1.0 mg/dl'

triglycerides - a measure of circulating blood fats, if they are high it would actually indicate too much carb intake and poor insulin sensitivity. 50-80mg/dl is good

A1C (also called Hb1Ac) - a good measure of blood glucose levels over the past 3-4 months. . should be less than 5

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 01:52 AM

@Dr. K: I must confess that I don't understand your recommendations. Screening tests should be sensitive and confirmatory tests specific. Perhaps you miswrote 'non specific[sic]' and 'Highly sensitive'? Furthermore, what is the justification for all these tests?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:45 PM

CRP is not the best choice....very non specific. You need Highly sensitve CRP Vit D level specifically the 25 di OH vit D levels. You need a lipid panel basic and VAP, omega six/three index levels, HbA1C, I also would want you to buy a glucose meter and start a month long blood check q 15 minutes after a meal up to ninety min tosee how you respond to foods and a journal food log to correlate it. I do quite a bit of labs initially and I repeat them all quarter the first yr.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 21, 2011
at 06:03 AM

CRP does not equal HS or cardiac CRP and they are quite different. That is what I meant. HS CRP is very specific for cellular level inflammation at the mitochondrial level....anything that causes our mitochondria to be leaky cause disease and aging. You can have a normal CRP and markedly abnormal HS CRP. Its far more sensitive marker. I never use CRP. Justification? Funny. If you dont measure you have no idea of intensity of impact or results of therapy....and you need a baseline. Pretty simple clinical medicine. People who want to be optimized measure. Its not requirement its choice.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:46 PM

I also will add chemistries and hormone panels if I think they are necessary based upon history and interview. Obviously I cant give you a custom answer cause I dont know you but this at least gives you a start on what you should be looking for in a doc.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:47 PM

I disagree with the above quoted numbers initally......Patients are on a continuum. We got from morbid obese train wrecks to a a 5% fit cross fitter who is in great shape..........Most people fall in between. The key is to have a doc who custom fits a program to where you are on this continuum. So giving you goal numbers right now is premature.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on February 20, 2011
at 06:51 PM

Too many docs out there in obesity clinics and anti aging clinics try to put everyone on the same plan because its doable and easy for their management from the doc perspective. I dont buy that at all. Obesity Fitness and nutrition is highly variable between siblings much less non relatives so to optimize yourself you need a doc who understands that clinical utility. All that being said......its very hard to find these days because of cost and location. Sometimes you have to go Ala carte with several practioners......suboptimal but financially necessary.

4e40d2b9e1a762949a25b958762aa10d

(762)

on February 21, 2011
at 03:23 PM

@Dr. K: I don't mean to push you on this but I think your answer confuses the words 'sensitive' and 'specific' which, I'm sure you know, have very different meanings. I think you mean HS CRP is a more SPECIFIC marker of mitochondrial dysfunction. It is also 'simple clinical medicine' to precede SPECIFIC tests with SENSITIVE tests because jumping right to the SPECIFIC test will admit too many false negatives. That is you will tell too many people that they are fine when they aren't. That is why CRP should precede HS CRP or why finger sticks precede HbA1C.

0
Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on June 12, 2011
at 08:32 PM

My initial battery is awfully extensive.

Ab19df3ededa28f7bf7daeba8435b205

(1471)

on June 12, 2011
at 09:24 PM

Like what $$ amount?

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