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Hack my labs - any insights appreciated

Answered on September 12, 2014
Created June 01, 2012 at 1:41 PM

Ok, so I??ve had some tests done by my MD. She??s not worried about any of the results but we know I??m not well, so any insights are helpful. I??m female, 34 years old and overweight with a history of sugar addiction. I??ve been eating lowish carb paleo for over six months and I??m so so tired and I haven??t lost any of my excess weight.

  • B-SR 10mmh/h (0-20)
  • kB-CRP 11mg/l (0-10)
  • fp-Glucose 5,7mmol/L (3-7)
  • blood pressure 118/80
  • P-Potassium 4,1mmol/L (3,5-4,4)
  • P-Creatinine 54 (50-90)
  • B-Hb 129g/L (117-153)
  • B-Leukosytes 9,9 10(9)/L (3,5-8,8)
  • B-Trombocytes 318 10(9)/L (150-350)
  • B-EVF 0.41 (0.35-0,46)
  • B-MCV 92fL (82-98)
  • S-Haptoglobin 0,9g/L (0,2-1,9)
  • P-Ferritin 96 (7-120)
  • P-Kobalamin 552pmol/L (190-700)
  • fP-Folate 40nmol/L
  • T4 (free) 14pmol/L (10-22)
  • TSH 1,4mlE/L (0,4-5,0)
  • S-Cortisol 500nmol/L (180-640) (morning, blood)
  • B-Erytocytes 4,5 10(12)/l (3,9-5,2)
  • B-MCHC 315g/L (317-357)
  • B-Neutrophil gran 5,8 10(9)/L (1,7-7,5)
  • B-Lymphocytes.x 3,1 10(9)/L (1,1-4,8)
  • B-Monocytes.x 0,6 10(9)/L (0,0-0,6)
  • B-Basophil granx 0,1 10(9)/L (0,0-0,2)
  • B-Luccelles 0,2 10(9)/L (0,0-0,2)

Any insights appreciated!

EDITED to add: I have several food intollerances (dairy, gluten, eggs, soy...) and am recovering from a lifetime of sugar addiction. For the last six months I??ve been sugar free and eating three balanced lowish carb paleo meals + 1 snack a day. I do yoga and walk everywhere, I also meditate. Even though it hasn??t been great before the fatique has been a major issue for the last three months or so.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 03:19 PM

Thanks Dragonfly. My sleep is good, I think, mostly around 8h.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 02, 2012
at 01:08 PM

And how is your sleep?

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 02, 2012
at 01:06 PM

Doesn't mean a thing. Ideally your level would be between 50-60 ng/ml (60-80 ng/ml if you are dealing with inflammation/autoimmune issues.) You won't know if you don't test. Best not to supplement blindly.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 12:55 PM

I must admit that the anemia interperation appeals to me because the thought of autoimmune issuse is so much more frightening and complicated. But I´m not going to stop here, I know somethings off and I want, and need, to get to the bottom of this wether it´s autoimmune or anemia or whatever it might be. Thanks to both of you!

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 12:49 PM

I´ll definatley push to have some more tests done. I spoke to mum about the inflammation markers and she immediatly thought of my grandma (paternal). And yes, she did have RA. Thanks!

5e92edc5a180787a60a252a8232006e9

(345)

on June 02, 2012
at 10:00 AM

You're wrong about your interpretation. The apparent anemia is exactly what you'd see with Hashimoto's and autoimmune diseases like RA. The low to low-normal WBC is typically what you'd see and it's confirmed by being ANA+ or TPO/TG positive. Also SR is not normal: being in the middle of the range isn't "normal" just like you wouldn't claim to be normal when your TSH is smack int he middle. There is a sweet spot and there are slippery slopes toward autoimmune encroachment. You gotta stop looking at reference ranges to detect "normalcy". Why, even PCPs can do that.

5e92edc5a180787a60a252a8232006e9

(345)

on June 02, 2012
at 09:53 AM

Yes, but you could still be hypo if you are + for hypothyroid antibodies and/or your FT3 is low due/your RT3 high. If you have symptoms then blood markers just serve to confirm. Plus, you may not necessarily test + for arthritis when young but carry antibodies that may anticipate future development. I'd get checked for ANA, RA factor, especially if your gma had RA (vs. OA).

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 09:46 AM

As far as thyroid is conserned the T4 and TSH is within nomal range.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 05:29 AM

We didn´t test it but I´m supplementing.

121a16aded2bed8dca492d3c9662ef4c

(1327)

on June 01, 2012
at 10:38 PM

I am beginning to think that iron deficiency can actually cause arthritis, because I have seen a few cases where persistent arthritis resolved after iron replacement. This has the paradoxical effect of initially decreasing ferritin, as the joint inflammation subsides.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:29 PM

My grandmother had arthritis and I tested negative for it when I was younger. Thanks for taking the time to answer.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:27 PM

Sure, weightloss would be great but this fatigue is the major issue and I have a feeling it´s connected somehow. My body has changed but I´m still the same size, no change in clothing size.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:23 PM

Yes, I have joint pain and I did supplement with iron during march because the levels were low so anemia caused by inflammation is definatley something to consider. Thank you for your insights.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 03:44 PM

I´ve added more info.

Ddfdaa75ac9f47e01fc71162dd0d38dc

on June 01, 2012
at 03:28 PM

Yup, get a thyroid panel.

Ebb10603524dd22621c1155dd7ddf106

(19150)

on June 01, 2012
at 02:21 PM

It sounds like you may get more insights from people if you describe your history, and current diet and exercise. Lab results only help to understand the bigger picture.

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5 Answers

1
121a16aded2bed8dca492d3c9662ef4c

on June 01, 2012
at 04:20 PM

Despite the reports of food intolerances, I don't think this looks autoimmune. For one thing, the ESR is totally normal, the CRP is only moderately elevated, and most of the white blood fractions are normal. Hashimoto's is exceedingly unlikely -- the TSH would be high.

Let's do an inventory of the parameters that look off:

  • CRP
  • Hb
  • leukocytes
  • thrombocytes

CRP: This is slightly elevated. This could be the result of an infection, or subtle inflammation, which could have any number of causes. Do you have joint pain?

Hb: By the book, this is "normal", but nobody would ever say a man with this Hb is normal. Personally, I think the reference range for Hb is set too low -- remember, these reference ranges are determined from a population distribution. Some people feel fine with an Hb this low, but you obviously don't, so we shouldn't ignore this. Your ferritin level is slightly higher than one typically sees in a woman, but since you have indications of inflammation, it is likely elevated and probably doesn't accurately reflect your iron status. One would need to do another test to differentiate. Because your Hb isn't spectacular and you feel rotten, I'd want to see those tests done. Ask for serum iron, total transferrin or total iron binding capacity and a repeat ferritin.

leukocytes: Your total white blood cell count is actually elevated: you are showing signs of an infection, so it's not surprising you feel lousy.

thrombocytes: Your platelet count (thrombocytes) is inching up. The reference range on this varies wildly -- some labs set it at 450. Another indicator of inflammation. Another thing that can trigger thrombocytosis is iron deficiency anemia (it's funny how that keeps coming up).

mean corpuscular hemoglobin concentration (MCHC): yet another indicator that all is not right with your blood. It's just outside the reference range, but you are showing signs of infection or inflammation, so I wouldn't ignore this, either. This value is calculated from your hematocrit and the Hb.

Despite the apparently "normal" red blood cell count: this hints at anemia caused by inflammation.

Things I'd want to see:

  1. You didn't provide an RDW (red cell distribution width). Was one calculated?
  2. serum total IgE -- to see if this inflammation is an allergic response.
  3. You might want to consider a serum 25OHD3 (serum vitamin D, or calcidiol). I don't know who is paying for this, some public insurers won't cover it. Even if they won't, it costs maybe 50 dollars, and it's worth it.
  4. serum iron, total transferrin OR total iron binding capacity. (I was iron deficient with a ferritin of 95 ??g/L). When there's a hint of anemia, I'd suspect iron insufficiency as the cause first (your B12 and folate levels are normal) - it's simply the most common and most likely cause, especially in women. Anemia like this can also be caused by infection, but before you go that route, check the nutrition first.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:23 PM

Yes, I have joint pain and I did supplement with iron during march because the levels were low so anemia caused by inflammation is definatley something to consider. Thank you for your insights.

121a16aded2bed8dca492d3c9662ef4c

(1327)

on June 01, 2012
at 10:38 PM

I am beginning to think that iron deficiency can actually cause arthritis, because I have seen a few cases where persistent arthritis resolved after iron replacement. This has the paradoxical effect of initially decreasing ferritin, as the joint inflammation subsides.

5e92edc5a180787a60a252a8232006e9

(345)

on June 02, 2012
at 10:00 AM

You're wrong about your interpretation. The apparent anemia is exactly what you'd see with Hashimoto's and autoimmune diseases like RA. The low to low-normal WBC is typically what you'd see and it's confirmed by being ANA+ or TPO/TG positive. Also SR is not normal: being in the middle of the range isn't "normal" just like you wouldn't claim to be normal when your TSH is smack int he middle. There is a sweet spot and there are slippery slopes toward autoimmune encroachment. You gotta stop looking at reference ranges to detect "normalcy". Why, even PCPs can do that.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 12:55 PM

I must admit that the anemia interperation appeals to me because the thought of autoimmune issuse is so much more frightening and complicated. But I´m not going to stop here, I know somethings off and I want, and need, to get to the bottom of this wether it´s autoimmune or anemia or whatever it might be. Thanks to both of you!

1
5e92edc5a180787a60a252a8232006e9

(345)

on June 01, 2012
at 02:44 PM

Good thing you're more discerning than your MD. You seeem to have inflammation issues: high CRP and SR. Also, high normal Ferritin, higher than ideal BG, and low overall WBCs. I'd get tested for autoimmune diseases: Rheumatoid Arthritis, Hashimoto's.

I'd just go straight to a rheumatologist or endocrinologist and ask for antibody tests for autoimmune diseases. That CRP elevation is the most serious one. If you retest and it's still that high, you need to track down where your inflammation is coming from. Also, rule out prediabetes/diabetes with HbA1c.

Ddfdaa75ac9f47e01fc71162dd0d38dc

on June 01, 2012
at 03:28 PM

Yup, get a thyroid panel.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:29 PM

My grandmother had arthritis and I tested negative for it when I was younger. Thanks for taking the time to answer.

5e92edc5a180787a60a252a8232006e9

(345)

on June 02, 2012
at 09:53 AM

Yes, but you could still be hypo if you are + for hypothyroid antibodies and/or your FT3 is low due/your RT3 high. If you have symptoms then blood markers just serve to confirm. Plus, you may not necessarily test + for arthritis when young but carry antibodies that may anticipate future development. I'd get checked for ANA, RA factor, especially if your gma had RA (vs. OA).

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 12:49 PM

I´ll definatley push to have some more tests done. I spoke to mum about the inflammation markers and she immediatly thought of my grandma (paternal). And yes, she did have RA. Thanks!

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 09:46 AM

As far as thyroid is conserned the T4 and TSH is within nomal range.

0
A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on July 01, 2012
at 11:21 AM

Thank you everyone for your input! I had some more tests done but they´re not making us any wiser. I am getting a second opinion from another MD but maybe you guys have more ideas?

  • S-Haptoglobin: 1.2 g/L (0.2-1.9)
  • T3, free: 4.3 pmol/L (3.3-6.0)
  • P-TPO-ak: <10 klE/L (0-35)
  • S-Orosomuciod: 1.0 g/L (0.5-1.29)
  • S-IgA: 1.7 g/L (0.9-1.2)
  • S-IgG: 11 g/L (7-15)
  • S-IgM: 2.0 g/L (0.3-2.1)
  • S-Albumin: 41 g/L (36-48)
  • S-Antitrypsin: 1.3 g/L (0.9-1.9)

I also tested negative for lyme disease and reumathiod arthritis.

Thanks again for all your insights!

0
Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 01, 2012
at 10:41 PM

Unless I missed something, I didn't see the key test (in my book, anyway). What's your 25(OH)D level?

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 05:29 AM

We didn´t test it but I´m supplementing.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 02, 2012
at 03:19 PM

Thanks Dragonfly. My sleep is good, I think, mostly around 8h.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 02, 2012
at 01:06 PM

Doesn't mean a thing. Ideally your level would be between 50-60 ng/ml (60-80 ng/ml if you are dealing with inflammation/autoimmune issues.) You won't know if you don't test. Best not to supplement blindly.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 02, 2012
at 01:08 PM

And how is your sleep?

0
81fca18329e68e227cdfef3857bfef96

(1320)

on June 01, 2012
at 04:59 PM

If you have health concerns and are unhappy with your current treatment, please go see another doctor for a second opinion.

This board is well meaning and some people who are members are actually MD's, BUT PLEASE GO TO ANOTHER DOCTOR.

That being said, your goal is weight loss. If you had been running a calorie deficit for over 6 months, you would have fat loss. I would start there. Consider that increased activity levels may haved increase lean mass. Have you gone down in clothing sizes?

As far as feeling sluggish, low carb diets and eating at maintenance levels can lead you to feeling sluggish. Compare your total calorie intake to calorie expenditure and consider adding more carbs for energy.

A8df99c4074c843ed4188a4dcbd5d0b1

(0)

on June 01, 2012
at 07:27 PM

Sure, weightloss would be great but this fatigue is the major issue and I have a feeling it´s connected somehow. My body has changed but I´m still the same size, no change in clothing size.

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