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It looks like I've developed mild -- maybe not so mild... pancytopenia. I'm wondering whether my CR, which really isn't extreme these days, might be part of the explanation? Has anyone on CR ever had white blood cell counts as low as mine (see below)? As for anemia, that also could be CR, secondary to CR-induced low testosterone. After reflecting on the recent Longo paper, I think I'm going to try a "4:2" diet (not 5:2, because the irregularity of the 2, then 3 days of feasting makes me nervous -- I could also call my diet "2:1": 2 days of feasting, 1 of quasi-fasting). I think Michael's right that there's no evid. in Longo's work that any kind of fasting that doesn't also reduce energy-intake overall will slow aging, but, at this point, I'm just trying to get some food-restriction benefits, while not feeling so weak....

 

 

Name --------------- me -------- units ------- reference range

 

Albumin. ----------- 42 ---------- g/L --------- 36-45

Antitrypsin. -------- 1.1 --------- g/L ---------- 0.9-1.9

Orosomucoid ------ 0.3* ------- g/L ---------- 0.5-1.2

Haptoglobin ------ <0,05* ------ g/L ---------- 0.2-1.9

IgG ----------------- 7.5 ---------- g/L ---------- 7-15

IgA ------------------ 2.7 --------- g/L ----------- 0.9-4.5

IgM ----------------- 1.2 ---------- g/L ---------- 0.3-2.1

 

(Got tired of writing in the units here -- but just look at the ref. range.)

 

Leukocytes -------- 2.1* -------- 3.5-8.8

Erythrocytes ------ 3.8* ----- 4.2-5.7

Hb ------------------ 121* ----- 134-170

EFV ---------------- 0.37* ----- 0.39-0.50

MCH  -------------- 32 -------- 27-33

MCV  --------------- 97 ------- 82-98

MCHC  ------------- 328 -------- 317-357

Thrombocyte ----- 127* ----- 145-348

Neutrophils ------- 1.1* ------ 1.7-7.5

Esonphil. ---------- 0.00 -------- 0.0-0.6

Basophil. ---------- 0.00 ----- 0.0-0.2

Lymphocytes ----- 0.8* ----- 1.1-4.8

Monocytes -------- 0.20 ----- 0.1-1.0

Reticulocyte -------- 64 -------- 26-124

Rtc-MCH ---------- 33 ------- 24-36

 

The low haptoglobin with normal reticulocyte count was a head-scratcher for the doctors. Bone marrow biopsy yielded no signs of cancer.

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Hi Zeta,

 

[Note: I just spent 30min composing a reply and this darn interface gave me an error message about invalid credentials and dumped my post - very frustrating to have to start again...]

 

As I said on the other thread, I'd never heard of either pancytopenia or haptoglobin before today. Pancytopenia is defined as "deficiency of all three cellular components of the blood (red cells, white cells, and platelets)."

 

As my data shows, I've had low white blood cell (WBC) and red blood cell (RBC) counts for virtually the entire time I've been practicing CR. I've always figured the low WBC count is a result of CR's downregulation of immune response. In the past my doctor has been concerned as low WBC is often a sign of being immunocompromised. But I haven't been sick in many years, not even a cold or flu, so I figure my body knows what its doing on this front. Both me and my doctor have come to accept low WBC as par for the course for me, and not something to worry about.

 

I've never been sure whether my chronically low RBC count (along with chronically low hemoglobin, ferritin and the two bouts of anemia I've had in 2002 and 2013) were a result of CR, my strict vegan diet, or a combination.

 

But since I started taking one of these NatureMade iron supplements per day (361% RDA) I haven't had any trouble with anemia symptoms. Yes, 361% of the RDA on top of the food I eat is a lot of iron, but my hemoglobin and ferritin (measure of stored iron level) remain at or below the reference range despite the megadosing. I will say that despite getting >100% of the RDA for iron from my diet (albeit in non-heme form), when I haven't supplemented iron on top of my dietary intake I've slipped into anemia on several occasions. It appears my body can't/won't absorb or store a whole lot of iron. 

 

Do you supplement with iron? In the past, taking one (and ocassionally two) of the above referenced supplements per day for a few weeks has cleared up my anemia symptoms - weakness (aka 'heavy legs' feeling), out of breath exercising / climbing stairs, and low hemoglobin level.

 

--Dean

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Most of this post is probably redundant because everyone is aware of it.  But perhaps it is worth emphasizing that the reason for low levels of WBCs in most people on CR is the CR-induced absence of inflammation/infection.  So the WBC count is a very poor measure of effective immune function.  Rather, it is usually an inverse measure of general health.  That said, unusually low levels ("unusually" might mean below the inter-quartile range of people here with a BMI of ~=19?) of WBCs should probably be investigated.

  

Good immune function depends on the ability of the *bone marrow* to produce and circulate WBCs promptly when inflammation or infection is detected.  But is there a test to check for this?  It would be very nice to have one.  Might it be possible to intentionally infect a patient with a harmless microbe the body would recognize as of foreign origin, and then measure the WBC response?  My guess is that people on CR might very well show a stronger response to a test of this kind than those not on CR. 

 

Immune function becomes of huge importance with age (e.g. cancer, pneumonia).  So for those interested in objective measures of their state of health, such a test would be very helpful to track the inevitable, age-related, decline in immune function, and to compare one's own performance with that of others of similar age.  And also perhaps to check the effectiveness of 'treatments' of various kinds - including dietary interventions - aimed at enhancing immune function.

 

Rodney.

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Rodney,

 

Quite right! I wouldn't be worried if I didn't have pancytopenia. Not sure whether the test you suggest is normally done, but in a situation like mine the normal next step is a bone marrow biopsy.

 

Dean, yeah, I've lost long messages here at times as well. I now compose all but the shortest of replies in Word first.

 

I'm going to continue to study your data -- which, I stress again, is extremely useful to me, and I'm sure to many others -- but a quick response about iron. I didn't post the data but all my values related to Fe status are strong, and the hematologist said there'd be no point in even trying an iron supplement. But I might do it nonetheless.

 

More in a couple days when I've done more research.

 

- Zeta.

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Yes, B12, folate, homocysteine, all very good. (I'm struggling with OCR software and slowly working towards doing a massive post of data -- though I may put it up on WellnessFX first. More as soon as I finish organizing everything....)

 

Zeta

Edited by Zeta

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Most of this post is probably redundant because everyone is aware of it.  But perhaps it is worth emphasizing that the reason for low levels of WBCs in most people on CR is the CR-induced absence of inflammation/infection.  So the WBC count is a very poor measure of effective immune function.  Rather, it is usually an inverse measure of general health.  That said, unusually low levels ("unusually" might mean below the inter-quartile range of people here with a BMI of ~=19?) of WBCs should probably be investigated.

  

Good immune function depends on the ability of the *bone marrow* to produce and circulate WBCs promptly when inflammation or infection is detected.  But is there a test to check for this?  It would be very nice to have one.  Might it be possible to intentionally infect a patient with a harmless microbe the body would recognize as of foreign origin, and then measure the WBC response?  My guess is that people on CR might very well show a stronger response to a test of this kind than those not on CR.

 

This is an interesting test idea. I'd love to know if your hypothesis is correct that healthy WBC is a poor indication of immune function and one should test in response to an infection. An obvious practical way to implement something close to your idea seem to me to be to test WBC after a flu shot. (No need for intentionally infecting people with things they wouldn't want.) Maybe Luigi Fontana could assign someone to do a quick simple study?

 

And as someone else suggested, I would love to know the normal range for WBC stratified by BMI.

 

 

Sorry to dig up a somewhat old discussion. I'm still reading some old topics since starting to dive into these forums recently. My WBC has been low for years and I'm not even explicitly trying to do CR, just trying to eat healthy. My BMI isn't even particularly row by the standards here. Most recently 2.3 WBC at 21.3 BMI. And my WBC was low even when I had quite a bit higher BMI than this (eg, 2.9 @~24 BMI circa 2005-06).

 

If I had great health all the time like Dean says he does, then it wouldn't be an issue, but in my case I do not. I'm historically more ill than my friends & family in response to a particular cold or flu that makes the rounds, and I have a long history of getting nasty secondary infections (sinusitis, bronchitis, pneumonia) more frequently than those around me who eat much less healthily than I do and exercise little or not at all.

 

-Karl

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Karl,

 

An obvious practical way to implement something close to your idea seem to me to be to test WBC after a flu shot. (No need for intentionally infecting people with things they wouldn't want.) 

 

I too would love to see the anecdotal evidence that CRers have a strong(er) immune system despite low WBC counts, as evidence by the rarity of illness that people often reported as a benefit of CR.

 

But I'm not sure what WBC level after a flu shot would tell us. Would it be an indication of an effective immune system to react strongly to the flu vaccine with a greatly elevated WBC count after the shot? Or would it be a better sign if the immune system took the vaccine in stride (i.e. no elevated WBC count) but nonetheless developed the required antibodies to combat later exposure to a strain of flu in the vaccine?

 

It seems the only definitive test would be to give a group of CRers and ad lib eaters a flu shot, and subsequently challenge them both with exposure to one of the flu strains in the vaccine, to see which group can more readily ward off the virus.

 

I'd be willing to volunteer for such an experiment in the name of science, if there is some researcher who'd be willing to conduct it.

 

--Dean

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I didn't post the data but all my values related to Fe status are strong, and the hematologist said there'd be no point in even trying an iron supplement. But I might do it nonetheless.

 

This is a case of my blindly listening to my doctor. "Strong" is a matter of interpretation, but among the myriad of lab results I was flooded with a few months ago, I didn't bother even registering my Fe-related values after my hematologist said, "Iron is definitely not the problem."

 

But here are the values:

 

Test ---------------------------- me -------- reference range

 

Ferritin ------------------------- 24 -------- 20-250

Fe ------------------------------ 11 --------- 9-34

Transferrin saturation ------ 0.21 ------- 0.15-0.60

 

Everything within the reference ranges, to be sure, which might be why the doc said what he did. But I wouldn't exactly call those values "strong". So maybe an iron supplement is worth a try. (But not now: I need to determine the effect of other independent variables first.)

 

Zeta

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What the heck Zeta? 

 

Let me get this straight. Your hemoglobin is low, your iron stores are very low normal, and you're suffering from symptoms of anemia.

 

Why wouldn't you consider starting an iron supplement immediately?

 

Seems like a no brainer to me.

 

Dean

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I know, I know, but my docs wanted to rule out other things (including heavy metal poisoning and effects of sulfasalazine, which I'm finally off), and I figured I'd humor them for a few months.

 

BUT, also: 1) aren't low hemoglobin and low iron (all Fe-related measures) typical for CR? So that wouldn't explain the symptoms; 2) I'm pretty sure I have my mother's really frightening heart disease genes, so if I can keep my iron low, and feel good, I'd prefer that.

 

But mainly, I don't want to be messing around with too many independent variables at once. (Well, I don't know if that "mainly" is entirely accurate. The main thing might be a mild sort of irrationality that sets in after several years of frustration with bizarre health problems.)

 

Zeta

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Zeta,

 

Yes, relatively low hemoglobin, iron and ferritin are frequently associated with CR, it seems. But I'm an example of someone who has experiencing taking that too far, and suffering from anemia as a result.

 

I've fortunately found that with judicious supplementation of iron, I can keep my iron status on the low side of normal, and avoid the debilitating effects of anemia.

 

Remember, as Michael has pointed out before, anemia not only impacts quality of life, but has deleterious health effects as well.

 

If your anemia isn't debilitating, then I can see testing for other, potentially more serious, causes first. But I know how sucky life can be when suffering from anemia, and wouldn't wish living in that state on anyone for very long...

 

Honestly, I'm surprised your doctor hasn't recommended trying this obvious remedy first, but I don't know your whole health situation, so obviously I'm in no position to second guess your or his/her decisions.

 

--Dean

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I have only just seen kpfleger's response to me earlier (12 September 2015) in this thread where he said:  "I'd love to know if your hypothesis is correct that healthy WBC is a poor indication of immune function."

 

You will have realized there is ambiguity in that sentence.  The ambiguity is how do you define "healthy WBC"?

 

I suppose you had meant "healthy WBC" to mean *high* WBC. 

 

Trying to clarify this: 

 

A)  In the absence of serious disease, low WBC reflects freedom from inflammation/infection which, of course, is good and 'healthy'.

 

B)  It would also be good and 'healthy' for the immune system to provide a very effective immune response to a detected pathogen.

 

C)  I suspect, but it is not proven, that a pathogen would encounter a more effective immune response from someone on CR with low WBC, than from someone with a BMI of 30 and a much higher WBC, as is suggested by the relative immunity those on CR appear to have to the common cold virus.  In this case the virus appears to be snuffed out without the immune system seeming to do much at all. So as Dean pointed out (thanks Dean, point taken) a large increase in WBC might not be a good indicator of an excellent immune response.

 

(It is well known that most of the symptoms people experience with a common cold infection are not those resulting from damage caused by the virus, but the effects of the immune system attacking the virus.  So in the case of the common cold it seems rather clear that a very effective response is one that produces absolutely no symptoms.)

 

But as you say, we would all love to know if this hypothesis is correct.

 

Rodney.

 

============

 

"The unverified conventional wisdom is almost invariably mistaken."

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Rodney,

 

Great point. I agree with your hypothesis that WBC on the low side of normal, or even below normal, might be an indication of a healthy immune system.

 

I've modified the CR Cold and Flu Survey to ask participants about the WBC level, to see how / if it correlates with the degree of CR, and with the frequency they get colds & flu.

 

Hopefully everyone will take the survey and we'll get some interesting data! Citizen science at its best.

 

--Dean

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Hey gang,

Finally got my test results. I was curious about two things, primarily: 1) whether the anemia would improve if (a) I ate more (more precisely: how MUCH it would improve -- I knew eating more would improve it at least a bit) and (b) I stopped taking sulfasalazine (messy to test two independent variables at once, but so be it), and 2) whether my lipid markers are OK on the massively high-fat (and, perhaps more importantly, high-calorie, for me) diet, a diet that seems to be the only one I've so far tested that doesn't give me IBD symptoms.

- 1) The anemia has indeed improved. Not hugely, but decidedly. On the whole, not good news, not because it's not good, but because it's not news: dial back the CR, have more blood cells -- a well-known phenomenon. CR causes non-pathological, mild anemia that generally has no symptoms. I had, and still have symptoms (though they've improved, I realized a couple weeks ago: am stronger going upstairs, for example; legs less "heavy"). The effect of going off sulfasalazine will take longer to show (and I'm not even 100% off; am tapering very slowly, but am down to 125 mg. every other day, which is nearly nothing), and I'll be redoing the tests in a month or two. I had been hoping for a complete or near-complete recovery of normal blood values. That way, at least I'd know that it was the CR or the sulfasalazine (or possibly both) that was causing the anemia, and not a THIRD thing, such as heavy metal poisoning, MDS, etc. As it is, a third cause can't be ruled out, at least not yet.

- 2) My lipid markers are fine! Not stellar like they might be on CR, but definitely good. So I'll keep eating biblical quantities of nuts (and most importantly: no grains or added sugars - this has been key, I think, to the positive changes in my IBD). Not sure about the lp(a), which I don't know much about. It's mostly affected by genes, not environmental factors, as I understand it. But the overall LDL picture is positive: mostly big and fluffy particles.

I probably should have ordered testosterone and IGF-1. But I think I can get those done for free in a couple weeks. (And I'll be redoing the haptoglobin and reticulocytes.)

 

So:

Summary of a few values for which I can make comparisons.

Typical values in years past:
Moderate CR, 30-40% fat, 2004-2011:
Cholesterol: 174
Triglycerides: 52
HDL: 74
LDL: 90
BP: 110/65
Fasting glucose: 70 (always; very little variance)
Can't get below 1250-1500 mg sulfasalazine/day without getting IBD symptoms within 1-2 days.

 

2012-10-20:
Cholesterol: 178
Triglycerides: 43
HDL: 70
LDL: 81
Homocysteine: 8.0
BP: 115/65

Sometime here around 2012: sudden andropause-like changes -- loss of hair on legs, reduced libido, etc. Weight drops over the course of a year or so from 62 or so kg to 55 with no "effort". Not tracking calories carefully then, unfortunately. But "going by feel" always had resulted in a stable, lowish weight in the past. Loss of weight was both fat and muscle. Number of push-ups and chin-ups I could do just kept dropping.

 

Starting 2013 or so, typical values:

Fasting glucose: 83 (very little variance). It sort of jumped up and stayed up, like I moved one step (of many) towards metabolic syndrome, then stayed there.
BP: 115/65 (But BP stayed good -- for me.)

 

2015-11-18 (from attached tests):

Cholesterol: 185
Triglycerides: 38 (or a bit more, from the other lab)
HDL: 83
LDL: 91
Fasting glucose: 83
BP: 132/77 (non-labile, unlike the BP of others in my family)

 

So, current diet is good in all ways, it would seem, except that the curse of familial hypertension has reared its ugly head. This is a problem. 132/77 isn't a huge problem, but no longevist should be content with BP like that.

 

The pancytopenia would still appear to be partly caused by something other than CR. But the coming months will shed light on that. (Plus, I have lots of weird symptoms that likely have nothing to do with the pancytopenia, but that's a different, longer story.)

 

Zeta

 

P.S. Yes, I got the VAP and the NMR!

And the test was done on a fasting day. So, two days before, Nov. 16, I ate 4400 calories (though see coming post about chewing and true calorie intake – it's clear I don't chew thoroughly, which means my "real" energy- – and likely other nutrient- – intake is much lower), at 70% fat; one day before, Nov. 17: 3900 calories, 60% fat. Stopped eating around 21:00 night before (Nov. 17). Blood drawn 15 and a half hours later, 12:30-ish, Nov. 18, after a two-hour drive. Was mostly sedentary in the morning before the drive.

 

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Edited by Zeta

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I've fortunately found that with judicious supplementation of iron, I can keep my iron status on the low side of normal, and avoid the debilitating effects of anemia.

 

But do you see a change in your markers of anemia (aside from the directly iron-related ones), or just a change in symptoms? It would be nice to know hwether there will be objective measures of an improvement if/when I try iron supplements.

 

Honestly, I'm surprised your doctor hasn't recommended trying this obvious remedy first, but I don't know your whole health situation, so obviously I'm in no position to second guess your or his/her decisions.

 

Actually, you're in a pretty good position, given that our CR challenges have been somewhat similar. And your intelligence -- to say nothing of your unusual benevolence and open-mindedness -- makes want to have you present as these experts (my hematologist, for example, is world-renowned) debate various hypotheses when I meet with them!

 

Zeta

 

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Zeta,

 

Thanks for sharing your blood tests. We need all the objective data we can get on the blood parameters of serious CR practitioners, IMO.

 

First off, I can't speak to the VAP/NMR results, but your regular cholesterol numbers look pretty good (esp. given your genetics...), and given your increase in calories and fat in your diet. I'm sure you're relieved. Your BP is obviously higher than you'd like. Maybe you need to add some natto to your diet  ;)xyz .

 

Not sure about the lp(a), which I don't know much about. It's mostly affected by genes, not environmental factors, as I understand it.

 

I've twice had my Lp(a) tested, several years apart, with little change to my diet or lifestyle in between. The first time it was very high (60 mg/dL) even by the "lax" standards of normal at that time (< 37 mg/dL), and the second time it was 12 mg/dL, which was normal by the standards in place at that time, but would be considered borderline high by today's standards (< 10mg/dL). Your Lp(a), at 16 mg/dL, is also above normal.

 

I looked into it at the time, and discovered (as you have) that there doesn't appear much you can do about it, and that it is mostly genetic, and a risk factor for heart disease. My dad had to have quintuple bypass surgery at about my age, and died 20 years later of a heart attack at 70 - but he had an extremely bad diet & lifestyle, and smoked for many years. Study [1] provides more objective, non-anecdotal information about the relationship between Lp(a) and CVD risk. Quoting from the abstract:

 

The robust and specific association between elevated Lp(a)
levels and increased cardiovascular disease (CVD)/coronary heart disease (CHD)
risk, together with recent genetic findings, indicates that elevated Lp(a), like
elevated LDL-cholesterol, is causally related to premature CVD/CHD. The

association is continuous without a threshold or dependence on LDL- or
non-HDL-cholesterol levels.

 

Oh joy, isn't that good news...

 

Mechanistically, elevated Lp(a) levels may either
induce a prothrombotic/anti-fibrinolytic effect as apolipoprotein(a) resembles
both plasminogen and plasmin...

 

Again, this suggests natto (and its nattokinase) might be good for you Zeta, and for me, with our elevated Lp(a), due to its blood thinning and clot busting properties, as discussed here:

 

Nattō itself may contain multiple proteases, [refs] one of which (Bacillopeptidase F) also confers potent fibrinolytic and anti-thrombus forming properties (which are the main claims of nattokinase).[refs] Nattokinase appears to be the most well researched of the proteases, and nattō is one of the few fermented food sources that have been found to contain fibrolytic enzymes

 

Continuing quoting from the abstract of [1]:

 

 ... or [elevated Lp(a)] may accelerate atherosclerosis because, like LDL, the Lp(a) particle is cholesterol-rich.

 

But other than the less-than-welcome news about your Lp(a), and your elevated BP, your bloodworks looks surprisingly good - particularly given how bad you report feeling, and how many symptoms you exhibit (some of which you haven't shared) of something being seriously wrong. 

 

I note here that your hemoglobin and RBC are both close to the low-border of normal, which is good to see. I'll address iron and anemia in a followup post below.

 

--Dean

 

-------

[1] Eur Heart J. 2010 Dec;31(23):2844-53. doi: 10.1093/eurheartj/ehq386. Epub 2010

Oct 21.

Lipoprotein(a) as a cardiovascular risk factor: current status.

Nordestgaard BG(1), Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, Ginsberg
H, Amarenco P, Catapano A, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA,
Lesnik P, Masana L, Reiner Z, Taskinen MR, Tokgözoglu L, Tybjærg-Hansen A;
European Atherosclerosis Society Consensus Panel.

Author information:
(1)Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University
Hospital, University of Copenhagen, DK-2730 Herlev, Denmark. brno@heh.regionh.dk

AIMS: The aims of the study were, first, to critically evaluate lipoprotein(a)
[Lp(a)] as a cardiovascular risk factor and, second, to advise on screening for
elevated plasma Lp(a), on desirable levels, and on therapeutic strategies.
METHODS AND RESULTS: The robust and specific association between elevated Lp(a)
levels and increased cardiovascular disease (CVD)/coronary heart disease (CHD)
risk, together with recent genetic findings, indicates that elevated Lp(a), like
elevated LDL-cholesterol, is causally related to premature CVD/CHD. The
association is continuous without a threshold or dependence on LDL- or
non-HDL-cholesterol levels. Mechanistically, elevated Lp(a) levels may either
induce a prothrombotic/anti-fibrinolytic effect as apolipoprotein(a) resembles
both plasminogen and plasmin but has no fibrinolytic activity, or may accelerate
atherosclerosis because, like LDL, the Lp(a) particle is cholesterol-rich, or
both. We advise that Lp(a) be measured once, using an isoform-insensitive assay,
in subjects at intermediate or high CVD/CHD risk with premature CVD, familial
hypercholesterolaemia, a family history of premature CVD and/or elevated Lp(a),
recurrent CVD despite statin treatment, ≥3% 10-year risk of fatal CVD according
to European guidelines, and/or ≥10% 10-year risk of fatal + non-fatal CHD
according to US guidelines. As a secondary priority after LDL-cholesterol
reduction, we recommend a desirable level for Lp(a) <80th percentile (less than
∼50 mg/dL). Treatment should primarily be niacin 1-3 g/day, as a meta-analysis of
randomized, controlled intervention trials demonstrates reduced CVD by niacin
treatment. In extreme cases, LDL-apheresis is efficacious in removing Lp(a).
CONCLUSION: We recommend screening for elevated Lp(a) in those at intermediate or
high CVD/CHD risk, a desirable level <50 mg/dL as a function of global
cardiovascular risk, and use of niacin for Lp(a) and CVD/CHD risk reduction.

PMCID: PMC3295201
PMID: 20965889

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Zeta,

 

Regarding anemia:

 

 

I've fortunately found that with judicious supplementation of iron, I can keep my iron status on the low side of normal, and avoid the debilitating effects of anemia.

 

But do you see a change in your markers of anemia (aside from the directly iron-related ones), or just a change in symptoms? It would be nice to know whether there will be objective measures of an improvement if/when I try iron supplements.

 

Hmm... I'm not quite sure what you are looking for. I consider serum hemoglobin and ferritin to be two of the most important objective makers of iron-deficient anemia, and both of them are iron-related. Here is more info on the criteria for an anemia diagnosis. As you know, my blood tests are an open book, and you're welcome to look at them for other signs of objective improvement subsequent to my two episodes of anemia diagnosis and treatment with supplemental iron, one starting on 3/18/02, and the other on 4/18/13. See the footnotes at the bottom of the (massive) table for descriptions of my diet, lifestyle and symptoms at the time of certain key blood tests, like those two.

 

Subjectively, my symptoms of anemia (generalized fatigue, windedness after climbing stairs, pale gums) improved markedly after a couple weeks of intensive iron supplementation (e.g. Niferex-150 3x per day) post anemia diagnosis. Note that on 5/10/13, three weeks after the second anemia diagnosis and commencement of iron supplements, the footnote (#11) indicates that my anemia symptoms had improved considerably, but my hemoglobin and ferritin were still low.

 

Overall, given your latest bloodwork, I still don't see any reason not to try supplementing iron. It may allow you to correct your anemia(-like) symptoms without adding so many calories / fat to your diet, as you're currently doing.

 

Just a thought...

 

--Dean

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But do you see a change in your markers of anemia (aside from the directly iron-related ones), or just a change in symptoms? It would be nice to know whether there will be objective measures of an improvement if/when I try iron supplements.

 

Hmm... I'm not quite sure what you are looking for. I consider serum hemoglobin and ferritin to be two of the most important objective makers of iron-deficient anemia,

 

First, it's not at all clear I have iron-deficiency anemia. My hematologist thinks it's very unlikely I have iron-def. anemia, in fact (though that's mostly based on his analysis of the bone marrow scan, which analysis is frustratingly subjective).

 

I actually see a slight worsening in some of your values shortly after the first round of iron supplementation. In 2013, for example, several of the red blood cell related values from 2013-05-10 look worse, though maybe it takes time to kick in. And hemoglobin went up in July of course.

 

Anyway, what I mean by objective non-Fe-related markers are things like hematocrit and hemoglobin. Obviously, everything that has to do with red blood cells is related to Fe in some way. But I'd want to see values improving that aren't obviously going to improve with iron supplementation. Your iron levels will go up. That's obvious. Ferritin will likely go up. But will MCV and MCH go down, as they should, if the anemia is improving? In your case, the post-supplementation changes seem mixed. But I admit I still have a lot to learn about hematology!

 

 

Subjectively, my symptoms of anemia (generalized fatigue, windedness after climbing stairs, pale gums) improved markedly after a couple weeks of intensive iron supplementation.

 

Ah, wait. In the past you've spoken of "heavy legs". Is "windedess" another way of saying heavy legs, or is it a different symptom? I'm not winded in the slightest going upstairs, but my legs feel like they're filled with molten lead. As I've noted before, I suspect -- well, more than suspect -- I have several things going on. The heavy legs -- combined with massive, ALS-like fasciculations, could be "benign fasciculation syndrome" (ALS has in fact been ruled out, by the way), and could ultimately be related to an autoimmune channelopathy.

 

Either way, I do have some symptoms of anemia, and if I could go back on CR, therewith get my safer BP back, and take iron supplements to deal with the anemia, then that might buy me an extra couple decades of life! You've convinced me it's worth a try. But I'm going to wait until I meet with the hematologist team in a couple weeks to see if they want to do another bone marrow test first.

 

Windows tells me my computer is now ready to upgrade to Windows 10. Bad sleep last night, so might as well go for it since I'm too tired to work. Might be gone for a bit... hopefully not, like, a month or something....

 

Zeta.

Edited by Zeta

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 But will MCV and MCH go down [as a result of iron supplementation], as they should, if the anemia is improving? In your case, the post-supplementation changes seem mixed. But I admit I still have a lot to learn about hematology!

 

Both have always been high for me, whether I've been suffering from anemia (or the symptoms thereof) or not. I've always blamed the high values on CR, and haven't been concerned about them. In particular, they are both high for me now, and I'm feeling very well, quite the opposite of anemia feeling. So I"m not sure that at least for CR'ed folks, high MCV or MCH should be considered objective measures of anemia, or at least clinically relevant measures of anemia. 

 

In the past you've spoken of "heavy legs". Is "windedess" another way of saying heavy legs, or is it a different symptom?

 

I categorize them as different. "Heavy legs" is characterized as generalized low-energy - likes it's hard to get up the energy to do very much physically. When exercising, "heavy legs" for me results in the inability to run very fast, but not being out of breath. I think your "molten lead" legs after climbing stairs is what I consider "heavy legs". I've found heavy legs to be exacerbated by anemia, but can also be a symptom of (too) severe CR.

 

I've found full-blown anemia (as measured by quite low hemoglobin i.e. around 10), does typically result in being out of breath climbing stairs or exercising, in addition to the heavy legs feeling. But being low in my iron status can result in heavy legs without associated windedness as well, as it sounds like you may be experiencing.

 

In short, I still think you may be suffering from symptoms of mild anemia, and I don't see what harm could come from supplementing iron for a month or two to see if your symptoms (or bloodwork) improves.

 

Windows tells me my computer is now ready to upgrade to Windows 10. Bad sleep last night, so might as well go for it since I'm too tired to work. Might be gone for a bit... hopefully not, like, a month or something....

 

I found the upgrade to Windows 10, at least from Windows 8, to go amazingly smoothly, even when Windows 10 first came out. So hopefully it will go well for you too!

 

--Dean

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Dean,

 

Thanks for the reply

 

I'm heading off for Thanksgiving celebrations, but I just wanted to note a couple things while I'm thinking of them.

 

 

 But will MCV and MCH go down [as a result of iron supplementation], as they should, if the anemia is improving? In your case, the post-supplementation changes seem mixed. But I admit I still have a lot to learn about hematology!

 

Both have always been high for me, whether I've been suffering from anemia (or the symptoms thereof) or not. I've always blamed the high values on CR, and haven't been concerned about them. In particular, they are both high for me now, and I'm feeling very well, quite the opposite of anemia feeling. So I"m not sure that at least for CR'ed folks, high MCV or MCH should be considered objective measures of anemia, or at least clinically relevant measures of anemia. [Zeta's emphasis.]

 

We're dealing partly with a semantic issue. Either way, I wonder how common macrocytosis is among CR practitioners. PubMedding [ Fontana L[Author] macrocytosis ] yields nothing. (Not the broadest/best search parameters, I know; will look more post-Thanksgiving.)

 

 

 

In the past you've spoken of "heavy legs". Is "windedess" another way of saying heavy legs, or is it a different symptom?

 

I categorize them as different. "Heavy legs" is characterized as generalized low-energy - likes it's hard to get up the energy to do very much physically. When exercising, "heavy legs" for me results in the inability to run very fast, but not being out of breath.

 

Those are still two different descriptions for me (unless there's a typo?), which makes me think we're experiencing slightly different things. 1) I've had generalized low energy (though, as I write those words, I realize it really has improved!) 2) But that's often been entirely separate from the heavy legs feeling. In other words, during my generalized low-energy periods, there are still windows (brief, alas) when I have a lot of energy -- normal amounts, where I feel great. But I still have the heavy legs feeling going upstairs. I feel like I could go upstairs forever!! ... if only I could use appendages other than these damn molten-lead-filled legs...

 

Zeta

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Zeta,

 

I think we're agreeing. I think there may be three separate symptoms - 'windedness', low energy / generalized fatigue, and 'heavy legs'. Windedness I've found to be closely associated with serious anemia. Both generalized fatigue and 'heavy legs' I've experienced at times of severe CR but when I wasn't suffering from overt anemia. But I've also found anemia exacerbates both generalized fatigue and heavy legs.  

 

It seems to me that your heavy legs and generalized fatigue may be indicators / symptoms of borderline anemia / low-iron status, without the 'windedness' associated with a more overt case of anemia.

 

--Dean

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We're dealing partly with a semantic issue. Either way, I wonder how common macrocytosis is among CR practitioners. PubMedding [ Fontana L[Author] macrocytosis ] yields nothing. (Not the broadest/best search parameters, I know; will look more post-Thanksgiving.)

This is odd: I certainly have the strong impression that high MCV is very widespread amongst CR folk, including those (like me and Dean) who've looked for anemia, and even used to include that in the "tell your doctor not to freak out about this" list when people would sign up for the abortive CR Society citizen science project, the CR Society Cohort Study. However, I see no actual data on this, either in the WUSTL studies or in the omnibus Biosphere II paper; looking on PubMed, I see  nothing relevant for anorexia, and the closest things are a finding of elevated MCV in Japanese RA patients doing a vegan fasting regimen (PMID 2372715) and two contradictory studies in birds (9568315 & 1043457).

 

However, I did find a thesis paper from Daniela Omodei, a PhD student supervised by Fontana, which clearly formed the basis of the highly suggestive "Immune-metabolic profiling of anorexic patients reveals an anti-oxidant and anti-inflammatory phenotype" (PMID: 25500208) posted and analyzed by Dean:

 

Dr. Daniela Omodei.

Calorie Restriction and Anorexia Nervosa: Molecular markers and pathogenetic mechanisms.

EUROPEAN SCHOOL OF MOLECULAR MEDICINE

SEDE DI NAPOLI

UNIVERSITA’ DEGLI STUDI DI NAPOLI FEDERICO II

Ph.D. in Molecular Medicine – Ciclo VIII/XXVI

Human Genetics

 

... and Table 3 does report, without further comment, a statistically significant (P=0.04) elevation in MCV for AN (n=15) vs control (n=20).

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fwiw: my MCV has always been a couple of percent above the high end of the reference range.  At the time this number was originally found, my excellent GP investigated it with multiple additional tests and found nothing amiss.

 

Rodney.

 

===========

 

"The unverified conventional wisdom is almost invariably mistaken."

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