Request to review my latest/first Blood test

[Amar]

Hello everyone. I got my first blood test 5 months after I started quantifying my diet. I hope I have included most of the basic tests required.

I seem to be successfully quantifying my diet but from the results it is quite evident that I am falling short in a few aspects ( I track my food intake using cronometer).

I may have inadvertently overlooked a few results but highlighted some. Please review further by giving your valuable comments and advise course corrections that I need to make to lead a healthy(/heathier) lifestyle.

Test	Result	Units	Reference interval
Complete Urine Analysis
Colour	Pale Yellow
Appearance	Slightly Turbid
Specific Gravity	1.025
pH	6
Reducing Sugar	Nil
Protein	Negative
Blood	Negative
Ketones	Negative
Bile Pigments	Negative
Bile salts	Negative
Urobilinogen	Negative
Nitrite	Negative
Pus Cells	2 to 4	/HPF
RBCs	Nil
Epithelial Cells	2 to 3	/HPF
Crystals	Nil
Casts	Nil
Others	Nil
Folate, Serum	1.9	NG/ML	Indeterminate: 3.38 - 5.38
			Normal: > 5.38
Homocysteine, Plasma	24.4	micro mol/L	3.7 - 13.9
Prostate Specific Antigen (PSA)	0.48	NG/ML	0 - 4
Vitamin B12, Serum	926	pg/mL	210 - 910
Vitamin D 25 Hydroxy	19.43	NG/ML	Deficiency:<6
			Borderline:6-20
			Adequate :21-100
			Toxicity :>100
Zinc, Serum	132.8	micro g/dL	70.0 - 114
Erythrocyte Sedimentation Rate (ESR)	5	mm	Female 0 - 20
			Male 0 - 15
Iron Deficiency Anaemia Profile
Iron, Serum	75	micro g/dL	Adult Male: 65-175
			Adult Female:37-145
Ferritin, Serum	159.5	NG/ML	Female 22 - 322
			Male 10 - 291
Unsaturated Iron Binding Capacity (UIBC), Serum	235	micro g/dL	55 - 550
Transferrin Saturation	24.1	%	Male 15 - 50
			Female 12 - 45
Lipid Profile
Cholesterol, Total	120	mg/dL	< 200 mg/dL: Optimal
			200-239 mg/dL: Borderline High
			> 240 mg/dL: High
Cholesterol, HDL	36	mg/dL	Male: 29 - 71
			Female: 35 - 85
Cholesterol, LDL	71	mg/dL	<70: Optimal for a very high risk person
			<100: Optimal for a high risk person
			100-129: Optimal for a low risk person
			130-159: Borderline
			160-190: High
			>190: Very high
Cholesterol, VLDL	13	mg/dL	5 to 40
Cholesterol, Total/HDL Ratio	3.33		< 4: Desirable
			4 - 6: Borderline
			> 6: High
Cholesterol, LDL/HDL Ratio	1.9		1 - 3.6: Desirable
Triglycerides, Serum	63	mg/dL	< 150: Optimal
			150 - 190: Borderline High
			> 190: High
Kidney Profile Extended
Blood Glucose, Random	85	mg/dL	60 - 140: Normal
			> 200 with symptoms: Diabetic
Blood Urea Nitrogen, Serum	6.1	mg/dL	8 to 22
Creatinine, Serum	0.8	mg/dL	>20y 0.6-1.4
Sodium, Serum	142	mmol/L	135 - 145
Potassium, Serum	4.1	mmol/L	3.5 - 5.1
Chloride, Serum	104	mmol/L	101 - 111
Bicarbonate, Serum	24.9	mmol/L	21 - 31
Calcium, Serum	9.7	mg/dL	8.4 - 10.2
Phosphorus, Serum	5.2	mg/dL	2.5 - 4.6
Magnesium, Serum	2.1	mg/dL	Adult:1.30-2.10
Total Protein, Serum	7.3	gm/dL	> 7Y < 60Y 6.4-8.6
Albumin, Serum	4.3	gm/dL	5Y < 60Y 3.5 - 5.3
Complete Blood Picture (CBP)
RBC count	4.79	Millions/cumm	Females: 3.5-4.5
			Males: 4.5-5.5
Hemoglobin	15	gm/dL	Female 11.5 - 16
			Male 13 - 18
Haematocrit (HCT)	44.3	%	Female 35 - 47
			Male 35 - 54
Mean Corpuscular Volume (MCV)	92.6	fL	82 - 98
Mean Corpuscular Hemoglobin (MCH)	31.3	pg	26 - 34
Mean Corposcular Haemoglobin	33.8	gm/dL	31 - 38
Concentration (MCHC)
RDW-CV	13.4	%	11.5 - 14.5
Total Leucocyte Count (TC)	8130	/cumm	4000 - 11000
Platelet count	1.73	Lakhs/cumm	1.5- 4.0
DIFFERENTIAL COUNT
Neutrophils	71.4	%	40 - 75
Lymphocytes	20.4	%	20 - 40
Monocytes	5.1	%	2 to 10
Eosinophils	2.2	%	1 to 06
Basophils	0.8	%	0 to 1
PERIPHERAL SMEAR STUDY
RBCs	Normocytic Normochromic
WBCs	Normal Count And
	Differential
	Adequate in Number
Platelets	Normal in
	Morphology
Hemoparasites	Not Seen
Impression	.
Thyroid Profile
Total Triiodothyronine (TT3)	72.23	ng/dL	> 15Y < 100Y 70 - 204
Total Thyroxine (TT4)	9.6	micro g/dL	> 10Y < 100Y Female 7.3 - 15.0
			> 10Y < 100Y Male 4.6 - 10.5
Thyroid Stimulating Hormone (TSH)	1.04	micro IU/mL	Adult: 0.35 - 5.00
Liver Function Test (LFT) With GGT
Bilirubin, Serum (Indirect, Direct & Total)
TOTAL BILIRUBIN	2.1	mg/dL	0.2 - 1
DIRECT BILIRUBIN	0.4	mg/dL	0 - 0.2
INDIRECT BILIRUBIN	1.7	mg/dL	0 - 0.8
Alanine Aminotransferase, Serum (ALT/	14	IU/L	10 to 40
SGPT)
Aspartate Aminotransferase, Serum (AST/	24	IU/L	10 to 42
SGOT)
Alkaline Phosphatase, Serum	83	IU/L	32 - 92
Gamma Glutamyl Transferase (GGT)	10.6	U/L	Males: 10 - 50
			Females: 7 - 35
Total Protein, Serum	7.3	gm/dL	> 7Y < 60Y 6.4-8.6
Albumin, Serum	4.3	gm/dL	> 5Y < 60Y 3.5 - 5.3
Globulin, Serum	3	gm/dL	> 0D < 60Y 2.2-4.0
Albumin/Globulin Ratio, Serum	1.43

 

[mccoy]

First of all, Iron/ferritin is pretty good and that's a good start...

[mccoy]

The homocysteine/folate unfavorable pair needs some further discussion, I'll try and post some relevant material here. Suffice to say that I had high homocysteinemia as well. My son also, which is maybe a sign of an unfavorable polymorphism in the genes regulating methylation. L-methyl folate seems to have been good for my son, whereas I didn't do further measures.

L-methyl folate also crosses the hematoencephalic barrier; high homocysteine appears to be unfavorable to brain health, besides epithelial cell health.

Edited June 6, 2022 by mccoy

[Amar]

Thank you. As you mentioned in one of your posts previously, are you supplementing with choline to get down your homocysteine levels? In 2020 you mentioned hcy was similar to that in 2018. Any changes now?

I would not want to go for choline supplementation (which you were cautious about in one of your previous posts) till I take care of my folate and B6 (not tested but have around 100pc rda) levels. I wonder why I have low folate levels even though I compulsarily get a minimum of around 150pc of RDA through food daily.

Vitamin D is low. I shall take care of it now regularly with supplementation.

But B12 and zinc are very high. I take B12 supplementation but not zinc and I get just 70 pc of zinc rda through food. Being a vegan on calorie deficit, I wonder how my zinc levels are high (over and above the upper bound of reference range).

Edit: I took zinc (13.2mg) in the form of zinc methionine daily for around 15 days as i got only around 7mg from food (as per cronometer.. i wonder if there is some issue with cronometer in tracking zinc too.) till two days before the day i went for the blood tests. I also wonder if the methionine has some affect on hcy levels.

Is the high bilirubin a concern? I have read some posts mentioning people new to CR have high bilirubin but the seniors have stabilized or even have low bilirubin. But i am unable to get the connection between the two (cr and bilirubin).

My wife's got B12 around 530 (for reference range of 200-900), optimal folate levels but high homocysteine and low ferritin levels (with normal iron levels).  Any inputs?

Edited June 7, 2022 by Amar

[IgorF]

hello, my few cents on the tHcy

I had it also 20+ before I started diet tunings, the last time I surpsisingly have it less than 8, this happened after recovering from some b12 target miss happened because I had 500mcg for 3 months and the first signs of anemia warned me that something is not ok, changed to 1500 and after 3 weeks to 1000 seems got me to the current situation that I am almost happy with (my b12 is almost 400, mma test is expensive so I am not doing it yet)

I have some metilation-related polimorfizms that make me less efficient, so my scheme is perhaps not directly applicable, such thing requires personal tuning and research

Chris Masterjohn has some useful stuff on the topic, but beside this I read many articles that blind supplementation with b6-b9-b12 in many cases fixed the tHcy levels but didn't changed the all cause mortality or cardiovascular events. No idea how reliable these sources are, maybe the studies are just not well-designed from the mechanics perspective of metabolism of such things.

 

My scheme that formally fixed me is like - my metilation efficiency based on Masterjohns calc tool is reduced 70% or something like this

- I take one choline caps targeting 50% rda and another 50% are from foods, based on cronometr. I suspect the real picture is different and I have more from foods

- no idea how much betaine I have from food. I am supplementing 1-2g of glycine and every second day a caps (250) of glutathione - this is to less taxing the surroundings of the metilation processes and this is a blindshot, things are so complicated that maybe this makes very little sense if at all. My glutathione is improved from sligtly underranged to good enough but this is a different topic at all.

- b12 is supplemented with mecobal 1000mcg w/o folic acid (as a backup for missing targets I have also1000mcg  pastilles unfortunately with folic acid and used them rarely). When I ate some seafood I used to go w/o b12 supplements but I had no idea if this was ok or not, blood b12 levels is not a reliable indicator of possible deficiency.

- for the main "fill the potential gap multivit" I had once in 3 days Kirkman's child caps that is constructed with 5mthfr (a special precursor thought to fit better than folic acid for people with SNPs) but I resigned from it now to get rid of even small preformed retinol doses. In any case, the things from it seems are not in amounts high enough to make a difference for the methilation.

I personally was able to hit the folate target with diet very easy, just eating regularly some broccoli/cauliflower/lentils/sprouts and other sources. This was confirmed by special blood test for folate in the RBC, when I had it available for me, my results were higher that the lab refrange, tried to search if there could be unwanted consequences but failed . I just hope it is ok.

I would recommend to invest some time, take 23and me test or dedicated one to get to know if you just have it unbalanced (your magnesium seems ok, so b6 should work, so folate in this triade is a target and it should work well from food) or also inefficient and in this case - control choline, decide if you are convinced that avoiding folate as folic acid worse a try and thus - design your scheme and fly with it.

Few more words about b12 - I would lower the supplementation dose to get into rather 500 than 900, see somewhere here some nice stat video created by M.Lustgarten, that is pure numbers crunching, w/o taking into account all the underlying complexity but still could be useful to have it in mind as an aggregation.

 

Regarding vit d.

It seems there are 2 different things to target, d in the circulation that should be fixed by supplement, I used to have 5000IU almost the entire year and the entire year not well studied but suspected as important k2. Another thing "d in tissues" in other words - where it is created by sun exposure. My imho the first one can't work instead of the second one, and relying just on the second could suck it from skin for some reasons (far behind this topic) and this could be unwanted. I used to have a lot of tests for this area and I continue to shoot periodically ca, pth, d, mg to see if I am not getting into troubles (I had urolithiasis episode and this forced me to research a lot because the experience is astonishing).

 

Br,

Igor

[Amar]

On 6/10/2022 at 7:09 PM, IgorF said:

mma test is expensive

Can we rely on serum B12 and homocysteine levels to estimate B12 levels? Is B12 above the reference range harmful?

[IgorF]

On 6/14/2022 at 8:41 AM, Amar said:

Can we rely on serum B12 and homocysteine levels to estimate B12 levels? Is B12 above the reference range harmful?

If I understand the topic good enough - nope. For B12 only MMA is representative and B12's level itself could mislead. Also AFAIR the analysis technology itself could suffer from biotin supplementations, so one should plan it carefully, I used to search in the past vendor's papers and I remember labs in my location running the affected assays, so I usually planned the 3rd-4th day w/o my small 500%rda biotin in the multivit capsule and people sometimes have 2000%rda for it.

Regarding tHcy with B12 levels - the topic is complicated and I suspect not deeply studied. But there are some like https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725715/ that concludes that high B12 could be observed in actually deficient states, so if money is not a concern or there is a possibility to refund the MMA analysis it could make a sense to do it. Otherwise I would have folate and b6 (+magnesium) levels from foods to be  calculated with cronometer to have them 200%rda or higher, this should fullfil the met-triade into a working balance, maybe decreasing b12 supplementation 25% from the current daily dosage (scheduling the next test in 1-2months and then again the same, also blood morphology could be useful as an additional tool and is very cheap).

Br,

Igor

 

 

[Amar]

On 6/10/2022 at 7:09 PM, IgorF said:

I personally was able to hit the folate target with diet very easy, just eating regularly some broccoli/cauliflower/lentils/sprouts and other sources. This was confirmed by special blood test for folate in the RBC, when I had it available for me, my results were higher that the lab refrange, tried to search if there could be unwanted consequences but failed . I just hope it is ok.

I hit my folate(and B6) targets easily on cronometer daily but the test result did not show the same. I wish to look into this assuming this to be the main cause for the high homocysteine levels. But then again my wife's folate, B12 test results  (and B6 on cronometer) are fine, but same Hcy is a cause of worry.

Edited June 17, 2022 by Amar

[IgorF]

So in this case perhaps there some known or unknown SNPs are in effect, thus the main path that transfers the constructed methyl groups to b12 are in effect, so it is something "upstream" the b12 since there is a lot of it but it does not feed the homocystein downstream.

I recommend Chris Masterjohn's episode 46 as a source of the later research, there are useful links provided and some explanation model for the things. Maybe it worse to try the second pathway - ensuring there is enough glycine and choline or bethaine, so this can compensate the lower activity of the MTHFR.

Also it could make sense to get to know which SNPs are in effect, a small subset of people have a combination that requires more aggressive management of this condition. For me it is not the case and I followed a conservative supplementation approach for glycine (1-2g) and choline (50%rda) and a very low 5mthf in the multivit (but it is just to avoid folic acid, it is hard to find a good conservative multivit completely free of folate that I do not need).

Br,

Igor

 

[IgorF]

Choline

finally got my urine tmao test results: 56 mg/g creatinine in the range <70 and the lab defined a "gray zone" as 39-70.

If I understand the things correct my result maps to "moderate" of 6.2-9.9 mmol in the units used in US.

I supplement daily with a cheap local brand 250mg choline (with inositol), similar to swanson and now foods. Two days before the test I had it total at around 700 per day.

No beets, only plants, so I assume I had no large betaine sources before the test. I do not supply other things that are also widely known as precursors for tmao conversion.

From some readings I came to conclusion that since the conversion to tmao depends on particular things in the intestine this n=1 case does not shed a lot of light on the topic, on the other hand it can give a hint for me to switch to every other day supplementation, or get rid of it completely and recheck if thcy changes. Also maybe a phosphatidilcholine is worse a try.

I also think Masterjohns choline calc that suggests large doses of choline for folate-related SNP holders should be used carefully.

For non holders perhaps targeting up to 600mg daily is a good tradeoff as many people argued.

Br,

Igor

 

quoting https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213596/

 

For adults, the AI for choline was set at 550 mg/day for men and 425 mg/day for women. These values were based on the amount (7 mg/kg/day) that prevented hepatic alteration in men, defined as elevated alanine aminotransferase concentration in serum [7], and reference body weights of 76 kg and 59 kg for men and women, respectively [8].

 

So, perhaps for lean people with body weights 60+kg the target for choline is rather 400-450 and not 600 mg/day, and maybe ALT could be used as a rough marker, keeping in mind it could oscilate or be raised due to plethora other reasons.

 

 

Edited July 25, 2022 by IgorF
edited to add

[mccoy]

On 6/7/2022 at 3:29 AM, Amar said:

Thank you. As you mentioned in one of your posts previously, are you supplementing with choline to get down your homocysteine levels? In 2020 you mentioned hcy was similar to that in 2018. Any changes now?

I'm no more supplementing choline and did not do any other analyses. My concern has been focused on my son who had the same problem. After supplementation with L-methyl folate his values went back into range. however, the supplementation was concurrent to a major dietary change, from an institution-based regime to a home cuisine very rich in fibers and vegetables and healthy food.

The benefit of L-methylfolate with respect to other forms of folate seems to be that it goes thru the hematoencephalic barrier, so the brain benefits as well from the reduction in homocistein.

[IgorF]

And a few more cents on the topic of tHcy

 

I stopped supplementing choline, left with dietary-only sources for a approx. 3 weeks. The last few days I had 400-450mg/day and a week before ~300mg/day (traveling changes the sources a bit) according to cronometer.

My tHcy is 7.33 in the lab's range of 5,75-12,61 mmol/l. I don't know if there is a kind of hysteresis and the result will be different in the months, who knows. I also expect to have very high folate levels, I can't test them now in an extended way (serum/blood/hematocrit/platelets) but I suspect they are higher than lab's normal ranges.

I also found some articles that described what I mentioned earlier regarding the mortality correlation - fixing tHcy with b6-b9-b12 supplementation was not found to fix the mortality but the studies are limited and I personally think it makes sense to fix the levels and keep them low as early as possible, intuitively this should lower the chances to damage the vessels.

Usually the whole triad b6-b9-b12 is supplemented but in many trials there are weak designs (e.g. no check for Mg status which can decrease b6 effect, no SNPs control, unclear if b1 levels is really sufficient becasue it can mangle the things far earlier, etc.).

---------------------------------

https://www.nejm.org/doi/full/10.1056/nejmoa055227

We did not find that secondary intervention with folic acid (plus vitamin B12) and vitamin B6, alone or in combination, decreased the risk of complications and death from cardiovascular causes among patients with a recent myocardial infarction, despite a substantial reduction in plasma total homocysteine levels in patients receiving folic acid. Contrary to expectations, there was a trend toward an increased rate of events among patients receiving B vitamins, in particular the combination of folic acid, vitamin B6, and vitamin B12.

https://www.nejm.org/doi/full/10.1056/nejmoa060900

In our study, daily administration of the combination of folic acid, vitamin B6, and vitamin B12 lowered homocysteine levels significantly but did not reduce the incidence of the primary outcome — the composite of death from cardiovascular causes, myocardial infarction, and stroke — during a mean follow-up period of five years.

 

---------------------------------

 

It looks like folate and b6 have stronger effect on tHcy levels and I see in the analysis serum folate at very low levels.

I think fixing this is a first priority. Having no idea if it is just a dietary factor or some SNPs are in effect I suggest to try to increase it and track it for some time. For me it took 3-6 months with diet experiments and then platelet level skyrocketed with increase of dietary folate intake (cruciferous vegs, lentils, some nuts and seeds but not in the high ammounts). During this time serum folate was at the same level (around 10ng/ml), only platelets levels were getting higher. THcy dropped from anomalous 20x to the "upper normal" (which is not desired also). Then few more months serum level also started to increase (to ~20ng/ml), tHcy went into the midrange, platelet level is not known for me due to lack of lab on my premises.

 

Br,

Igor

 

 

 

[IgorF]

Just got a second TMAO test, this time I am running completely w/o choline supplementation for months.

My choline intake according to chronometer is 400 mg/day for the three days before the test. No beetroots taken, so no natural betaine boost. I am also taking a teaspoon of glycine and a teaspoon of collagen daily and 250mg of gluthatione every second day, these 3 things are to address possible inefficiencies due to mild mthfr variant I have.

betaine                9.2 mg/g creatine    4-21
choline                2.4 mg/g creatine    1,7-4
creatinine                0,78 g/l            0,36-2,37
trimethylamine             64 mg/g creatine    <200, gray zone 121-200
trimethylamine-N-oxide     59 mg/g creatine    <70, gray zone 39-70

Previously the lab reported only TMAO and it was 56 with 250mg/day of supplemented choline.

 

I assume in my case it makes no sense to supplement with choline, my tHcy measured between these two tests is 7.33 which is a good value for my case. No idea why my TMAO is so high, that is a different story that will require more investigation.

As a conclusion - a decent variability of plant choline sources seems enough to address the things for a mild mthfr inefficient metabolism, no need to get big choline caps. If decision is to take 500mg/day choline as supplements then I think getting tma+tmao test before/after is a tuning tool of choice.

 

Br,

Igor