Repent for past sins

If the food temptations of the holidays got the best of you, and you're now 5, 10, 15 lbs or more over your pre-holiday weight (our record is 18lbs!), then it's time for serious action.

One easy method to regain the control you may have lost is to pick some period, say, 3 days. During those three days, eat nothing but vegetables--no breads, meats, dairy products, certainly no cookies, cakes, pasta, etc., not even fruit. Follow this routine and weight drops rapidly. Vegetables are wonderful but sometimes boring, so use healthy condiments to spice them up: mustards (hot, brown, yellow, horseradish); healthy salad dressings, which are olive or canola oil-based; salsas, a fabulous garnish with no nutritional downside whatsoever; pesto; tapenades; horseradish added to other condiments or even by itself (wasabi).

Of course, fasting in one of its several variations is another rapid method to regain control. My favorite is to use soy milk in a modified fast, usually 4-6 glasses of a low-fat, low-sugar soy milk per day, along with plenty of water. (Please refer to the precautions detailed in the recent Track Your Plaque Special Report, Fasting: Fast Track to Control Plaque , particularly if you fast 5 days or longer or take blood pressure or diabetic medication.)

Of course, yo-yoing your weight--up during the holidays, down after their conclusion--is not good for you. It does raise the likelihood of diabetes, not to mention cultivate the patterns that contribute to coronary plaque growth, especially small LDL. But if temptation got out of control and you need to regain lost ground, these two strategies work fabulously well for most people.

If you've gained, say, 10 lbs during the holidays, but simply resume your usual habits, chances are you won't lose the weight. Year after year, this can add up to an enormous weight gain. The time to act is now. It's easier to lose the 10 lbs of weight you gained recently, rather than the 50 lbs you've stacked up over the past 5 years.
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Boycott LabCorp

Boycott LabCorp

Track Your Plaque Members have been following this conversation on the Track Your Plaque Forum.

A good number of people have had their blood drawn for NMR lipoprotein analysis through laboratories operated by the Laboratory Corporation of American, or LabCorp. When the results were returned, the very important page 2 of the report was withheld. Many of us have communicated with the company, only to be given some corporate-speak about internal policy.

I have personally expressed my dissatisfaction, my outrage, at this silly policy. Why would laboratory results that you or your insurance paid for be denied to you? It is my understanding that, on request, you are legally entitled to the information. The page 2 information is provided by the laboratory (Liposcience, Inc.) that actually performs the testing. LabCorp does nothing more than draw the blood, prepare the specimen, then convey and dilute the results that Liposcience reports to them.

My personal suspicion is that the LabCorp people do this to 1) make the results appear that they actually performed the tests and not farmed to an outside laboratory (Liposcience), and 2) not further confuse and befuddle the bungling primary care physician who barely understands cholesterol issues to begin with. "LDL, HDL, triglycerides . . . What now--a bunch of new information, bars even!?

To me, this LabCorp policy is criminal. In fact, I wonder if this has the substance to justify a class action lawsuit against LabCorp. I believe that we can easily make a case that crucial health information is being systematically denied to people.

If this has affected you, or if you share in the frustration of many people who have had watered down lipoprotein results provided, write to:


Ken Younts, VP of Sales at LabCorp. Yountsk@labcorp.com


Or, write to:

Tom MacMahon
Chairman of the Board

David P. King
President and Chief Executive Officer

Laboratory Corporation of America Holdings
358 South Main Street
Burlington, NC 27215



Thanks to the Track Your Plaque Members who have already participated in this campaign and written to the LabCorp people. And thanks to our Members who uncovered the contact information.

Until then, please BOYCOTT LABCORP LABORATORIES. Please do not use LabCorp Laboratories if you can avoid it. Simply ask the laboratory staff who operates the lab and they should tell you. It is your right to know.

Comments (13) -

  • Anonymous

    8/27/2007 3:48:00 AM |

    Can you get the page 2 result directly from Liposcience?

  • Dr. Davis

    8/27/2007 4:04:00 AM |

    We've tried and encountered resistance.

    The Liposcience people have deferred to LabCorp when the results were delivered via LabCorp. I believe that  Liposcience is honoring the terms of a contract. LabCorp is serving its own misguided purposes.

  • Anonymous

    8/27/2007 7:48:00 PM |

    Dr. Davis,

    When you get VAP results from  Quest all the info is included,to include the ApoB100.

    LabCorp reports almost all the info except the ApoB100 number. So, they don't include one line not a whole page.  I realize this may not help LabCorp much and may just be more fuel to the fire, but I thought you should know.

    The nice thing about VAP is that you get Lp(a) without having to pay for an additional test like you do if you want NMR and Lp(a).

    Thanks and keep up the good work!

  • Anonymous

    10/26/2007 2:58:00 PM |

    As a former employee of LabCorp, I would like to offer another possibility, they just screwed up.  The aim of top management has been to run up the stock price (and the value of their stock options)at the expense of their clients and employees.  The IT department in particular has been hard hit by corporate corner-cutting that has turned the flow of information from client to lab and back again into a nightmare. Losing a page of data from patient results is a very real possibility. MacMahon et. al. have been made aware of these problems in the past and yet continued their destructive policies.  I seriously doubt they will pay any attention to your complaints now.  Protect yourself and just go elsewhere.

  • Anonymous

    4/13/2008 6:05:00 PM |

    As another former employee, I tried sharing similiar concerns about issues like this, and they ended up firing me. Take your business elsewhere!

  • Labcorp Sucks

    4/27/2008 2:38:00 AM |

    LabCorp Sucks! I have had so many problems with them that I finally got fed up and created a website just to document all the complaints that people have against this sorry excuse for a clinical lab company, www.labcorpsucks.com. We will be taking all the complaints and providing them to investigative agencies in government. While they have some very nice people working for them, the majority of their mid-level managers are incompetent. Maybe after they are all unemployed they will "get it". Al - www.labcorpsucks.com

  • Anonymous

    5/23/2008 9:31:00 PM |

    Hi Dr. Davis, we've got the same problem, except it's with a hemochromatosis test that was just run. When we get my husband's blood iron count levels tested at the Red Cross, the nurses always raise their eyebrows, and say, my goodness! You have a LOT of iron in your blood!
    My husband was adopted in NC, which is THE hotspot for JH (juvenile hemochromatosis) in the United States. He has all the symptoms, has suffered them since he was very little, and they've become increasingly worse over the years. Doctors have looked him over and have never been able to figure out what is wrong. Some even told him he was simply lazy! We finally stumbled across this website for JH one day... and said, Eureka! That's EXACTLY it! He feels a million times better after he's bled... which gradually worsens over the next day or two, but for that little while, he's free of pain and loves life.
    So we went to get him tested, and guess what... the results came back "negative." What the heck does "negative" mean? There are numbers for each test, right? We are looking for an independent blood lab with a commitment to quality... do you have any suggestions? We fear that the damage to his organs is so great that he needs help NOW, if you have any suggestions, we'd love to know! The tests are total iron binding count, serum iron and serum ferritin.

    I must confess that I have worked at the Burlington location of LabCorp and have witnessed lab techs goofing off instead of watching the tests done, some of them timed precisely to give the accurate reading. Many of the people there are hired because of nepotism or cronyism and do not have the skills necessary or the lab degrees that they should, but have been "grandfathered" in. I know others who have worked there who ran microbiological testing and would screw up entire batches of gram pos/neg tests because they couldn't run the machine right... HUNDREDS of tests to be run again. If they sit too long, you get false positives and negatives... way to go... you could be dying, and you won't know! Way to go!

    We're thinking about suing them if we get independent lab tests done and they come back positive (which they should... it's just a classic case). It's a fatal disease and he needs immediate help.

  • Anonymous

    6/26/2008 3:23:00 AM |

    You need to have an unsaturated iron binding capacity done, all of the other test could be negative but very few labs calculate this test.  It is the most important when testing for hereditary hemachromatosis.  I broght  it up to our lab manager about a month ago and we started running it with all of our iron profiles.  We are starting to see more positives of this test along with the negatives on the total iron, tibc and iron saturation.  This test really makes a difference.  Feel free to email me, I would be happy to give you some advice.  cjpirkle@hotmail.com

  • Anonymous

    1/16/2009 1:46:00 AM |

    I have even a more serious complaint with this lab. I am a patient of a doctor for chronic pain and nasty panic attacks.

    It cost me $240 cash to have a drug test to prove to my doctor I AM taking both my pain and nerve meds. It's true, the UNINSURED people are the ones paying the price, we get charged the FULL RATE, medical insurance will negotiate a much lower price (I tried and they laughed at me!!) Well people, I hate too tell you this, but my results were NOT accurate and it may very well cost me my sanity and even my job if I have no meds during a work related panic attack I will be unable to work and likely will end up in the hospital, still with no medical insurance. I did everything I was supposed to to as told and directed.

    The medication not detected was Klonopin (Clonazepam)- I have needed and taken this medication along with my pain killers for years, and now my life is much better and I can once again work for a living. Because of this screwed up test result my life now is in the hands of LabCorp and my doctor. - Most likely I will end up in a hospital if my doctor cuts me off. I’m in shock over this. I’m innocent. I can not understand what the problem is with the lab not detecting this particular nerve/panic med, but I have read that it’s happening to others too.

    I have found much evidence that shows how the most expensive drug testing labs can go by NOT detecting Klonopin (Clonazepam)in patients that take it- and you can bet I have submitted all of such information to my doctor. This is my life as I know whats at stake here, (A LOT!!) and for $240 one would think a lab could find a med I was taking every single day for years, and even on the day of the drug test.

    I had to pay CASH $$ for my drug test, so I hate their rates AND their screwed up lab work. My life as I know it is in the hands of a bunch of people that can screw up my life for a very long time. I suggest NOBODY uses this drug testing company.

    Now I have to worry about real life nightmares hitting me while I drive, all because of a drug test that was wrong and a doctor that places too much faith in such tests. I’m not very happy, and I’m broke. I did nothing wrong and I fear there must be many others just like me in the same boat. Doctors should not place so much faith in these drug tests- they can be WRONG!

          ME

  • buy jeans

    11/2/2010 7:41:06 PM |

    To me, this LabCorp policy is criminal. In fact, I wonder if this has the substance to justify a class action lawsuit against LabCorp. I believe that we can easily make a case that crucial health information is being systematically denied to people.

  • Anonymous

    4/2/2011 9:28:39 PM |

    As a fromer employee and department manager for Labcorp I do now that from a Legal standpoint we are a third party that is contracted with your primary care physician to do you lab work.  If you ahve not received all of the information on a lab report then you need to bring thast up with your primary care physician.  We are only aloowed to release information directly to them in most cases, becasue we are a third party.  More often than not the final page of a report does not have anything on it but Labcorp information and nothing related to your test results.  As I said before the best option would be to go to your primary care physician and find out if they have the second page you are looking for and if not get them to request the page you are looking for or get a form of permission from your Dr to release this information to you.  The second part of this could take a little while becasue of our legal responsibilities in our contracts with the Dr's.  The lab that Iworked in was very thorough and caring about their patients and would have taken the time to explain why we could not release these results directly to you.  It is unfortunate that the lab you worked with did not take then time to help you further in your quest.  As with most compnaies some locations are not run as well as others.

  • pjnoir

    4/19/2011 7:27:52 PM |

    okay its 4/2011    has anything changed?   I need to get this test done. what are my options?  I do get the numbers I need, right?

  • dr. mason

    2/27/2013 1:36:14 PM |

    Feb 2013
    LabCorp in Palo Alto on Middlefield Rd.  was shocking.  I thought I was in the third world.
    Understaffed, specimens sat overnight, specimen box on floor outside on sidewalk, rude and very
    stressed staff person working alone and doing the job of 3 people taking it out on the customers.
    Our medical system is the worst of all the developing countries and the most expensive.    Blood
    analysis is the heart of that system and if its completely deteriorated and no monitoring agency is
    able to enforce standards, then what hope is there?  something is terribly wrong.

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Treat the patient, not the test

Treat the patient, not the test

"Treat the patient, not the test."

That is a common "pearl" of medical wisdom often passed on during medical training.

It refers to the fact that we should always view any laboratory or imaging test in the context of the live, human patient and not just treat any unexpected value that doesn't seem to make sense.

I raise this issue because it recently came up on a discussion on the Track Your Plaque Forum. A Member with a high heart scan score of around 1100 was advised by his doctor that it should be ignored, because he'd prefer to treat the patient, not the test. The patient is apparently slender, physically active, and entirely without symptoms, with favorable cholesterol values as well. The high heart scan score didn't seem to jive with the appearance of the patient, as viewed by this doctor.

This common phrase is meant to impart wisdom. It is a reminder that we treat real people, not just a jumble of laboratory values.

But the unspoken part of the equation is that judgment needs to be applied. A well looking person who shows an unexpected rise in white blood cell count could just have a screwy result, or could have leukemia. Liver tests (AST, ALT) that top 400 could represent a fluke, or dehydration incurred during a long workout, or hepatitis from a long ago blood transfusion.

Yes, treat the patient. But don't be an idiot and entirely dismiss the signficance of an unexpected laboratory or imaging test. A heart scan score of 1100 should be as readily dismissed as discovering a white blood cell count of 90,000 (normal is less than 12,000), or a 5 cm mass in the lung. The absence of symptoms or the failure of conventional risk factors to suggest causation is insufficient reason to dismiss the concrete findings of a test.

In this particular person, dismissing the significance of the heart scan finding by suggesting that the doctor should treat the patient, not the test, is tantamount to:

--Colossal ignorance
--Malpractice
--A certain sentencing of the hapless patient to future major heart procedures, heart attack or death (20-25% likelihood every year, or a virtual certainty over the next 5 years).

There is an ounce of wisdom in this old medical pearl. But there's also plenty of room for a knuckleheaded doctor to misconstrue and abuse its meaning for the sake of covering up his/her ignorance, laziness, or lack of caring.
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Handy dandy carb index

Handy dandy carb index

There are a number of ways to gauge your dietary carbohydrate exposure and its physiologic consequences.

One of my favorite ways is to do fingerstick blood sugars for a one-hour postprandial glucose. I like this because it provides real-time feedback on the glucose consequences of your last meal. This can pinpoint problem areas in your diet.

Another way is to measure small LDL particles. Because small LDL particles are created through a cascade that begins with carbohydrate consumption, measuring them provides an index of both carbohydrate exposure and sensitivity. Drawback: Getting access to the test.

For many people, the most practical and widely available gauge of carbohydrate intake and sensitivity is your hemoglobin A1c, or HbA1c.

HbA1c reflects the previous 60 to 90 days blood sugar fluctuations, since hemoglobin is irreversibly glycated by blood glucose. (Glycation is also the phenomenon responsible for formation of cataracts from glycation of lens proteins, kidney disease, arthritis from glycation of cartilage proteins, atherosclerosis from LDL glycation and components of the arterial wall, and many other conditions.)

HbA1c of a primitive hunter-gatherer foraging for leaves, roots, berries, and hunting for elk, ibex, wild boar, reptiles, and fish: 4.5% or less.

HbA1c of an average American: 5.2% (In the population I see, however, it is typically 5.6%, with many 6.0% and higher.)

HbA1c of diabetics: 6.5% or greater.

Don't be falsely reassured by not having a HbA1c that meets "official" criteria for diabetes. A HbA1c of 5.8%, for example, means that many of the complications suffered by diabetics--kidney disease, heightened risk for atherosclerosis, osteoarthritis, cataracts--are experienced at nearly the same rate as diabetics.

With our wheat-free, cornstarch-free, sugar-free diet, we have been aiming to reduce HbA1c to 4.8% or less, much as if you spent your days tracking wild boar.

Comments (21) -

  • Anonymous

    3/25/2011 3:19:26 AM |

    Dr. Davis,

    Can someone have a good HbA1c but still have an undesirable amount of small particle LDL? ..Like perhaps someone with FHC that has their LDL particles floating around longer in the bloodstream and hence exposed longer to oxidants.

    Thank you.

    John M.

  • Tyler

    3/25/2011 3:51:56 AM |

    I love your blog but I have to clarify on this point. Check out the post by chris kresser: http://chriskresser.com/blog/why-hemoglobin-a1c-is-not-a-reliable-marker/

    a1c is not reliable for many people because of the variation in RBC life length. healthy people's red blood cells may live as over 4 months whereas diabetic's live only as 60 days. This results in vast discrepancies.

    For example my fasting BG averages 77 and postprandial peak is 85-90, but my hemoglobin A1c is 5.7

    This doesn't make sense unless you account for differences in RBC lifetime.

  • Kris @ Health Blog

    3/25/2011 11:45:32 AM |

    I'm wondering what your opinion is of glycation and aging.

    I've been reading that a major part of the aging process might be caused by glycation of proteins in the body, mostly caused by elevated blood sugar.

    Do you believe that practically, one could expect a longer life expectancy to correlate with lower blood sugar levels?

  • Larry

    3/25/2011 12:09:46 PM |

    The other day on the tv show, "The Doctors", they profiled a young woman concerned about her FBG.
    She said that Diabetes ran in her family.
    They did a bloodtest and announced that her FBG was 111.
    The scary part was when they told her that reading was okay.
    With that FBG, one can assume that everytime she eats, her post-prandial FBG is heading into dangerous territory.
    But they told her not to worry.
    She was right about her concern...as Diabetes will continue to run in her family.
    Especially with that advice.

  • Jonathan

    3/25/2011 2:44:03 PM |

    I found Walmart carries a Bayer at home A1c test kit that gives results in 5 minutes.  It came with two test cartridges so I was able to take one when I started lowcarb and another one 4 months later to see how much it came down.  (I came down from 8.3 to 5.2 in 4 months)

  • revelo

    3/25/2011 4:45:55 PM |

    What is HbA1c for those long-lived okinawans with their rice-based diet, or those long-lived cretans with their wheat-based diet?

    Wouldn't a lean healthy body (especially if there is occasional fasting) eventually clean up glycated and otherwise damaged proteins?

  • Might-o'chondri-AL

    3/25/2011 6:22:18 PM |

    Glycation picks on the amino acid valine "wing" on the molecule of haemoglobin's B-chain portion. Aldehydes, both glucose aldehydes and non-glucose ones can become bound to that valine.

    This can occur several ways. Glucose oxidation yields a byproduct, called gly-oxal; this is what most people monitor. In the glyco-lytic pathway called Embden-Meyerhof triose-phosphate drives gly-oxal into the molecule methyl-glyoxal (MG).

    Type 1 diabetics have circulating methyl-glyoxal (MG) levels that are +/- 6 times greater normal. MG is a glycation end product.

    Tyler's comment links to a discussion of fructosamine monitoring. This is from a non-enzyme driven reaction, called Amadori, where fructo-selysine and the fructos-amine 3 kinase cascade generates 3 De-oxy-glucos-ane (3DG); another glycation end product.

    Enzymatic glycation occurs in pathological states. Macrophage activity spins off  the enzyme myelo-peroxidase; this generates hypo-chlorite. Hypo-chlorite pulls in the amino acid serine and then together they cause the formation of certain advanced glycation end-products; namely glyco-aldehyde and glycer-aldehyde.

    Yet another non-enzyme chain of events can generate advanced glycation end products. This is when the molecule per-oxy-nitrite (ONOO-)gets stalled inside the cell and it induces the formation of gly-oxal/gluco-sone/aldehyde molecules that can contribute to glycation.

    ONOO- normally is part of healthy cell signaling. When a metabolic processes is under sustained "stress" it (ONOO-) can't shift the cell function over to what it (the cell) needs to do (in order to adapt and cope). Instead of briefly signalling, signing off and going away ONOO-
    lingers in the cell; a situation that may also be related to ageing.

  • Anonymous

    3/25/2011 7:10:22 PM |

    I wonder if Dr. Davis can comment on situations where carb intake is reasonable and the patient has a decent HBA1c, yet still has higher than normal triglycerides and small LDL?

    My own HBA1c has been in the 4.5-4.6 range, yet my trigs hover around 140-150, and I still have more small LDL than I'd like.

    If restricting carbs doesn't work, D levels normalized, etc. what else could be the cause of higher than optimal triglycerides?

    I know people with HBA1cs in the 5.4+ range, eat many more carbs than I do, yet still have lower trig numbers.

  • Might-o'chondri-AL

    3/25/2011 8:58:10 PM |

    Hi Revelo,
    Vitis vinifera leaf inhibits advanced glycation end product (AGE) formation. That is what many cultures, like Crete, eat wrapped around their cereal grain; we call it Grape Leaves in English (ex: stuffed grape leaves, a.k.a. Dolma in Greek).

    Japan researchers (2009?) took 1 kilogram of dried grape leaves in 20 liters of water and stirred it for 3 hours at 80*Celcius. They administered the decoction in various dosages and found it can reduce the AGE of 3DG (3 de-oxy-gluco-sone) and also a marker of AGE in kidney disease, pentosidine, down to 1/5th the level from that study's AGE control levels.

    The same study experimented with Anthemis nobilis using the same extraction technique detailed above. They propose the active ingredient responsible for the AGE inhibition is the compound called chamaemoliside.

    Chamomile is the name of this plant in English; I suspect it is drunk as a tea in Crete. In the range of AGE inhibitors that they tested Chamomile was better acting than any other; grape leaves efficacy came in second.

    Plants studied that inhibit AGE forming, in no particular order of effectiveness may interest you. These are: Crataegus oxyacantha (English = Hawthorn berry), Houttuynia cordata (English = Chameleon plant) and Astragalus membranaceous (English = Astragalus). Chameleon plant is a regular condiment used in Vietnamese and some south-east asian food; it smells kind of "fishy".

  • revelo

    3/25/2011 9:02:19 PM |

    According to Steven Gundry MD, it is MEAT which is the primary cause of AGE's. (He doesn't cite any references for this in his "Diet Evolution" book.) He recommends Atkin's style low-carb/high-protein to lose weight, then low-fat (15% of calories from fat) as the maintenance diet. He is not too keen on grains, tubers or fruit, but rather emphasizes green vegetables.

  • Tyler

    3/25/2011 9:50:41 PM |

    Thanks for the nice explanations Might-o'chondri-AL

  • Might-o'chondri-AL

    3/25/2011 10:46:23 PM |

    Diabetic nephro-pathy (ie: kidney complication), and kidney disease have elevated AGE. These are monitored as pento-sidine, gly-oxal, methyl-gly-oxal and 3 de-oxy-gluco-sane; which the body tries to excrete as carbonyly compounds.

    Carbonyl compounds are hard to get through the kidney filters and cause an increase in uric uremia, which can be toxic. Too many carbonyls can cause, the so called, "carbonyl stress" of diabetic nephro-pathy.

    Diabetic patients' kidneys eventually can't excrete enough sodium (Na); and that contributes to the high blood pressure (hyper-tension) diabetics tend to suffer from.

    Ketones merit mentioning too. One of the markers for AGE in the kidneys is N-carb-oxy-ethl-lysine; which may (or may not) be a side effect of ketones. Type 1 diabetics do show elevated ketone levels incidently.

    I am not able to offer any perspective on ketogenic diets and AGE however. However, vitamin C is known to decrease ketone bodies. (In the previous post, "Battery acid ...", more
    diabetic responses to vitamin C appears among the comments.)

  • Anonymous

    3/26/2011 4:46:17 AM |

    I've been eating low-carb (basically paleo) for the last 4-5 mo and just got my lipid panel results.  They sky-rocketed.

    Cholesterol 300
      
    Triglyceride 150  
        
    HDL          33
        
    LDL             237


    Every number got worse.  The part that really sucks, is that the diet makes me feel great and nearly all my body fat is gone.  I'm 37, 5'11, 180 lbs and probably about 9% body fat.  Now I'm wondering what kind of trade-off I'm making.  Any thoughts, doc?

  • Peter

    3/26/2011 12:55:22 PM |

    Testing different foods one hour after meals, it seems like a good rule of thumb for me is that each ounce of carbs raises my blood sugar about 10 mg,and that the kind of carb doesn't matter nearly as much as the quantity.

  • Might-o'chondri-AL

    3/26/2011 6:31:09 PM |

    Paradoxical low carb yet relatively high HbA1c & higher carb but relatively lower HbA1c is reported by Annon. Doc assuredly deals with cases like these and has to resolve their enigma one by one.  

    The gene HFE (human hemochromatosis protein, nicknamed High Fe  where iron = Fe)can have a variation (reference code = HFE rs1800562). This variation is seen in +/- 5% of Caucasians, but is not found in East Asian nor African genes.

    More hemoglobin is in circulation for those having this HFE genetic variation. In this case, the same amount of blood sugar that can contribute to glycation of hemoglobin has more hemoglobin surfaces to glycate. Think of it as the glycation has to spread itself thin; the dilution of it's effect makes the % of Hb1Ac less (ie: lower Hb1Ac % measured in the blood sample).

    On the other hand, genetic variation rs855791 of the gene TMPRSS6 (trans-membrane protease, serine 6)is implicated in anemia. In these individuals Hb1Ac readings range higher; there is less hemoglobin relative to the glycation potential in their blood stream. Think of it as the relatively low proportion of hemoglobin which has to bear all the glycation burden
    (ie: Hb1Ac % is higher in their blood sample).

    Anemic (hemolytic) tendency is also driven by variation of gene HK1 (hexo-kinase 1). This enzyme modulates how glucose inside the cell goes through  it's processing pathways.

    This gene (HK1) codes for the unique iso-form of erythrocytes; erythrocyte configuration can figure in to low hemoglobin. In other words it is also a factor in high Hb1Ac readings; glycation potential in the blood over burdens the limited amount of hemoglobin around.

  • Dr. William Davis

    3/26/2011 6:34:23 PM |

    In response to several questions about the potential disconnect between small LDL/triglycerides and HbA1c: Yes, there are people in which one measure is more resistant. It varies based on the mix of underlying genetic predispositions, so it's hard to generalize.


    Might-o'-chondri-AL--

    Great discussion. Thanks, as always. You bring an incredibly sophisticated perspective!

  • Dr. William Davis

    3/26/2011 6:35:48 PM |

    Jonathan--

    Spectacular! And within an unusually brief timeline for HbA1c.


    Revelo--

    Might-o'chondri-AL is referring to endogenous glycation. You are citing a discussion about exogenous glycation, two separate phenomena.

  • Might-o'chondri-AL

    3/27/2011 1:31:59 AM |

    Might Jenny's observation and Nigel's study reference be reconciled somewhat ? I'll tag on my disclaimer of being unqualified to judge low carb or specific diets; since I've never struggled with weight or diabetes, and am not a doctor.

    The study Nigel linked was done with all Kuwaiti subjects. In that country co-sanguinity in marriage is practised by +/- 54.3 % of Kuwaitis. And 1 in 5 are reported to be diabetic.

    The data is very admirable; my suggestion is that the data trend may not exactly transfer to a modern Caucasian population; which is essentially interbred from migration and war (rape). This may be why Jenny sees a +/- 6 month plateau among her respondents and the co-sanguine Kuwaitis saw changes continue for a year +.

    Genetic poly-morphisms influence fasting glucose (GCK, G6PC2 and MTNR1B), are implicated in Hb1Ac, triglyceride levels, HDL levels & so on. That said, I personally would try the low carb approach if I was diabetic.

  • Might-o'chondri-AL

    3/27/2011 1:32:47 AM |

    oops posted this in wrong thread

  • Anonymous

    3/27/2011 3:12:44 AM |

    Re: Anonymous with Cholesterol 300,  Triglycerides 150,  HDL 33 ...

    Suggest you try a technique many dieabetics find helpful to understand food consumption influence on their blood sugar profile,"eating to your meter".
    For a few days, record your blood sugar level immediately before eating a "normal" meal, and then after the meal get 1-hour and 2-hour post-meal blood sugar readings. Separate meals by at least 4 hours. Concentrate on monitoring your main meals and ignore snacking for the first go around. Better however, if you can actually avoid all snaking during period of the testing. Also you will want to add to your journal the foods, ammount consumed, and time it was consumed. If post-meal blood sugar values are high, then to determine a pattern folllowing a meal do a series of hourly post-meal readings until you reach 85 mg/dL or so. As a graph, these results should be helpful to you. Expect that the results will be revealing to you with unexpected high blood sugar values even after following a paleo diet. And if so, it does mean that paleo is not for you, only that you need to more discriminating in what and how much you actually consume.

    I would be interested in hearing about your findings. By the way, you did not mention the blood glucose or HbA1c results of your recent lab tests.

    My regards and good luck ... spo

    BTW: practice good technique with the finger sticks. Do a quick but good hand wash using soap and a warm water rinse prior to a stick. Dry hands well. Dont squeeze hard at the site to encourage blood flow. The original stick should be sufficent to raise a drop of blood for the test strip. Using alcohol swabs and changing out lancets is not necessry when only working on youtself. Keep the test strip vial tightly closed other then when removing the current test strip. If you encounter an "extreme" value, retest for confirmation but clean hands again prior to the retest. My experiences regarding unexpected readings seems to usually invovle hand and finger contamination of some form.

    Finally, on Amazon.com I am able to purchase unexpired test strips in 50 strip lots for my old AcuCheK Confort Curve meter for less than $0.16 or so a strip and often with free shipping. You just have to broswe around a bit.

  • Jonathan

    3/30/2011 2:47:32 PM |

    @ Anonymous with 300 TC
    I would say it could possibly be your liver cleaning itself out (it could have been getting fatty).  The higher Trig might be a sign you are getting too many carbs from somewhere (at least till your sugar stores empty some and insulin sensitivity goes back up) but it could be the liver cleaning out as well.  I think HyperLipid posted something about this once.

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Iodine deficiency is REAL

Iodine deficiency is REAL

Like many health-conscious people, Kurt avoids salt. In fact, he has assiduously avoided salt ever since his heart attack back in 1995.

Lately, Kurt had become tired, often for little or no reason. His thyroid panel:

TSH 4.2 mIU/L (0.27-4.20)
Free T3 1.74 pg/ml (2.50-4.30)
Free T4 1.05 ng/dl (0.9-1.7)

Kurt's TSH of 4.2 mIU/L is sufficient to increase LDL cholesterol by 20-30% and increase the (relative) risk for heart attack 3-fold.

Kurt's thyroid was also palpably enlarged. While it was just barely visible--just a minor bulge in the neck (in the shape of a bowtie), it could be clearly felt when I examined him.

I asked Kurt to add 500 mcg of iodine every day. Three months later, another thyroid panel showed:

TSH 0.14 mIU/L (0.27-4.20)
Free T3 2.50 pg/ml (2.50-4.30)
Free T4 1.1 ng/dl (0.9-1.7)

Kurt's thyroid function normalized to nearly ideal levels just with iodine replacement. (The free T3, while improved, remains low; an issue for another day!)

I see this response with some frequency: low-grade goiter and apparent hypothyroidism (low thyroid function) that responds, at least partially, to iodine replacement. In Kurt's case, iodine replacement alone normalized his thyroid measures completely.

With improved thyroid measures, Kurt also felt better with renewed energy and a 22 mg/dl reduction in LDL cholesterol.

Make no mistake: Iodine deficiency is real. While most of my colleagues have dismissed iodine deficiency as a relic of the early 20th century and third world countries, you can also find it in your neighborhood.

Comments (30) -

  • Sabio Lantz

    8/21/2009 11:01:05 AM |

    What source do you recommend for iodine and what maintainance dose?

    I started my paleo diet/lifestyle on Jan 5, 2009 and got labs done TSH: 2.790 (0.270-4.200) Someone commented that I may need Free T3 & T4 for further eval.  I would like to try inc. my iodine since I don't use salt.

    Thank you  (my full labs are here -- I am also looking into the cholesterol)

  • Jenny

    8/21/2009 11:11:36 AM |

    Dr Davis,

    I was supplementing with kelp until I read about the arsenic levels found in kelp supplements. Arsenic is a known contributor to diabetes.

    I contacted the supplement company and they gave me a run around about the arsenic level. They wouldn't deny it but tried to make it sound like it wasn't anything to worry about.

    I wasn't at all happy about this, especially since so many supplements are contaminated with a lot of other substances since they aren't regulated.

    Is there any way to get iodine that doesn't expose us to unnecessary amounts of arsenic?

  • Dr. William Davis

    8/21/2009 11:57:30 AM |

    Hi, Jenny--

    There are many iodine supplements, such as potassium iodide drops, available widely in health food stores.

    Alternatively, of course, you could make a habit of eating kombu or wakame, rich seaweed sources of iodine widely consumed in Japan and available in Oriental food stores or even Whole Foods.

  • steve

    8/21/2009 3:04:48 PM |

    would be very interested in hearing your thoughts on Free T3 measurement.  Many doctors will measure Free t4, and only total free T3 saying there is not much difference between Free T3 and total T3 measurements.  Small protein binding or something to that effect.  Thanks.

  • Nameless

    8/21/2009 4:38:46 PM |

    Would the RDA levels of iodine in multivitamins be enough to defend against a deficiency?

    Are there absorption issues from this form?

  • Ross

    8/21/2009 9:49:06 PM |

    I bought some technical grade potassium iodide, some 99.9% metallic iodine and a dropper bottle and made some 50% strength Lugol's iodine.  The recipe is: 2.5g iodine, 5g potassium iodine, add water to total weight of 100g.  I found the full strength solution wasn't dissolving so went for half strength, which still took about a day to finish dissolving.

    This makes for about 3.25mg effective iodine per drop (which is quite a bit).  I add one drop of 50% Lugol's to the milk I use to take my vitamins at breakfast.  After three months of that, my dropper bottle is barely lower, but my thyroid panel is notably healthier (was at the bottom edge of "normal" T3/T4).

    Also, this stuff is CHEAP!  The $30 worth of iodine/potassium iodide that I bought (100g I2, 200g KI) will make about 4 liters of 50% Lugol's (~80,000 drops).  I've got enough to give myself and my wife a drop a day for the rest of our lives, and have enough left over to make a few dozen 10-day anti-radiation KI courses (130mg/day or 1.3g/course).

    I2 is picky about the container (teflon or glass with an airtight seal) but dry KI just needs to be kept dry and cool in a small tupperware container and it's shelf life is "indefinite".

  • Dr. William Davis

    8/21/2009 11:45:48 PM |

    Steve--

    Free T3 deficiency will, I believe, prove to be among the most important factors acting as a coronary risk factor.

    Plenty more on this issue to come in future.

  • ChloeJ

    8/22/2009 4:40:51 AM |

    Taking your ideas to heart about iodine deficiency, I thought I would try seaweed snacks (now I wish I remember where I read about them) and ordered from Amazon based on reviews...Long story short:  Love them.

    So much I love them, I just signed up for the 5 box (24 in a box)monthly automatic delivery (2 of the boxes go to my household assistant who has a number of foreign exchange students over the years as part of the church ministry she belongs to, and one student from Korea introducted her to these dried, salted seaweed called nori or kim).  We did a taste test by buying from a local asian/Korean grocery and I was dismayed to find all 5 kinds we bought had corn oil listed as an ingredient, so we are sticking with the Amazon delivery as it is nori, sesame oil, and sea salt. Low carb, low calorie, I think low sodium (60 mg) for whatever floats your diet boat.  

    Still I will look into Lugol's or pharmaceutical grade potassium iodine.  One concern:  An upper limit to iodine intake?  I have not seen any data. Thanks.

  • JD

    8/22/2009 12:17:21 PM |

    Off topic but wonder if you have seen this study?

    http://www.sciencedaily.com/releases/2009/08/090820124038.htm

    Type 1 Diabetes Linked To Immune Response To Wheat

  • Dr. William Davis

    8/22/2009 3:54:04 PM |

    The upper range of dosing for iodine is a hotly-contested question.

    For example, take a look at what Dr. David Brownstein (put his name in Google) says. He uses doses of 50 mg (50,000 mcg) or more.

  • TedHutchinson

    8/22/2009 4:24:03 PM |

    Organic versus Inorganic Arsenic in Herbal Kelp Supplements
    Although the report has several methodologic shortcomings, the most serious flaw is the authors’ failure to recognize that the arsenic most commonly found in seaweed and seafood products is relatively nontoxic.
    This is in contrast to inorganic arsenic, which has well-documented acute and chronic toxicity.
    Amster et al. (2007) did not discuss the possibility that the arsenic measured in the kelp supplement was in the organic form, nor did they address the great variability in toxicity among arsenic compounds.
    These two oversights lead to the unsupported conclusion that the arsenic found in kelp is responsible for the unique set of medical conditions observed in their patient.


    The full text is online and it is worth reading.

  • TedHutchinson

    8/22/2009 4:51:49 PM |

    Sorry I meant to add
    this is the form of kelp I use $3.76 and code WAB666 would save you $5 if you ordered something else as well.
    How about being really extravagant and ordering a years 360 X 5000iu Vitamin D3 olive-oil based gelcaps for $14.98
    2 years supply of iodine + 1yrs vitamin d3 for less than $20.
    UK readers may be interested to know the cheapo German supermarket Lidl does iodised salt for 15p pack, it's probably worth decanting it into a airtight container as kitchens can be humid and iodine in salt will not be stable over time so Salt Pigs are possibly not the best way to retain the iodine in iodised salt.

  • Nameless

    8/22/2009 6:13:17 PM |

    I'm going to ask my doctor for a script for an iodine test next time I see him. I think a 24 hour, urine test is the only way to measure it properly. Serum isn't so accurate, if I remember right, although it certainly would be less of a hassle.

    Anyone know what is the optimal level of iodine status? Top of normal range, or anywhere in range?

  • David

    8/22/2009 7:49:25 PM |

    I take a couple drops per day of an iodine supplement called "Iosol," and I really like it. It's only 12 bucks a bottle (1,830 mcg per drop, 610 drops per bottle). You can find it here: http://www.iherb.com/TPCS-Iosol

    It's not potassium iodide, but rather a combination of iodine (extracted from kelp as unbound iodine) and ammonium iodide. Some think this is better than potassium iodide. You can read why here: http://www.byronrichards.com/index.php/thyroid_leptin/entry/what_is_iosol_iodine/

  • billye

    8/22/2009 8:20:10 PM |

    Hi Jenny,

    I supplement with 325 mcg Kelp caps from Now.  Amster et al. 2007 reports that the arsenic most commonly found in seaweed and seaweed products is relatively non-toxic. For example,the level of concern for total arsenic in crustaceans is 86 ppm,a concentration 10 times higher than  the amount found in kelp supplements.  I had diabetes type 2 for 20 years.  My last 3 A1c tests indicated levels of 4.7, 4.8 and 5.0.  So much for contribution to diabetes.

  • Daniel

    8/23/2009 6:59:47 AM |

    Thank you for making light of this!

    Iodine & Vitamin D supplementation is making a dramatic difference in the way I feel. Mood and concentration have improved, not to mention my blood pressure has normalised (especially around meal time).

    Get your levels tested and if in doubt!

  • Dr. William Davis

    8/23/2009 2:30:19 PM |

    Thanks, Ted. Great summary of the evidence.

    Also, the Japanese include kombu, wakame, and other seaweeds in their daily diet in quantities that far exceed a kelp tablet or two without arsenic toxicity.

  • David Gillespie

    8/24/2009 1:42:57 AM |

    you might be interested in this article on the relationship between increased fructose consumption and iodine deficiency: http://www.raisin-hell.com/2009/06/why-iodine-is-being-added-to-your-daily.html

  • Gloria Ives

    8/24/2009 3:22:59 AM |

    Can you address sea salt use? I've steered completely away from table salt and into sea salt. Some sea salt, such as the pink Himalayan variety, boasts something like 80 some odd minerals present in it. Is there adequate iodine in sea salts, if any?

  • steve

    8/24/2009 1:35:55 PM |

    would be interested in hearing from Chole J which of the healthy seaweed snacks she gets from Amazon

  • homertobias

    8/25/2009 1:16:15 AM |

    My take on Nori:  It is basically a potatoe chip from the sea.  So it has iodine in it, so the arsenic may not be harmful.  So.....what oil did they use?  Sesame oil is not that good for you.  Did they keep the oil below it's smoke point?  How often do they change it?  Where did the seaweed come from?  Downstream from the Chinese Drywall factory? Even sushi grade Nori smells rancid to me.  No thanks, I just don't think it is a health food.

  • Sabio Lantz

    8/25/2009 2:10:54 AM |

    This site info is great !  Thanx all.  In case you plan to make your own mixture (I do, eventually), people may think you are actually a trouble maker and not a health nut:  I learned that Iodine is use illegally to make d-methamphetamine.  Here is a govt site telling of that issue.   Who'd have guessed !
    Smile.

  • Anna

    8/25/2009 4:21:39 PM |

    You can buy "wild crafted" seaweed from domestic sources in remote California or Maine sources if you want to avoid unknown sources from overseas.

    I have a variety of hand harvested and naturally dried seaweed products from Mendocino Sea Veggetable Company (www.seaweed.net).   They sell a small booklet with recipes, too.  

    We especially love the Mendocino Miracle Mix (ground mixed seaweeds) sprinkled over our morning eggs.  I put MMM in everything from homemade condiments (mayonnaise, ketchup, mustard and salsa) to soups.  MMM is also great mixed 30/30/30% with coarse Mendocino or Atlantic sea salt  and sesame seeds for a great seasoning shake.

    There is another company I haven't yet tried, but it is also recommended by a Mendocino friend, Ocean Harvest Sea Vegetable Company http://www.ohsv.net/ .

    I add some kombu to my homemade bone broths and often add crunchy dried seaweed to salads instead of croutons.  Some seaweeds can be soaked  a few minutes to plump back up and tossed into a salad.  When I make sashimi I also serve a salad of just seaweed with a ginger-(wheat-free) raw tamari vinaigrette.   Once you get over the unfamiliarity with sea vegetable it becomes quite ordinary and not much different to eat than land vegetables.

  • Melissa

    9/1/2009 8:16:38 PM |

    I ended up with hypotension from cutting out salt in my paleo diet and it was not fun. I now eat seaweed, but you have to be careful with that too. A seaweed-loving friend of mine now has hyperthyroidism!

  • Sabio Lantz

    9/1/2009 9:56:15 PM |

    Yeah, thanx Melissa -- everyone is tempted to recommend a "one-size-fits-all" diet but I bet it is more complicated than that.
    All this feedback is very helpful.  
    One person says take tons of iodine, the next says it can cause thyroid disorders, we must be very careful when taking advice on the internet (or anywhere else, for that matter).

  • trinkwasser

    9/10/2009 3:04:27 PM |

    Thanks for the reminder, I've been trying various seaweeds and sea vegetables but ran out while the local samphire was in season (I think it was a previous post by Anna that turned me on to these), I just put them on tomorrow's shopping list.

  • kris

    11/2/2009 11:52:41 PM |

    Dr. Davis,
    I dont know where to put this article, which is  helpfull in the times of H1N1. I am just going to copy it here and leave it for you to decide the place for this please.
    Vitamin D is also is major immune system booster.
    http://www.starfireresearch.com/health/topics/swineflu.html

    Iodine: the Forgotten Weapon
    Against Influenza Viruses


    David Derry, MD, PhD
    332 – 425 Simcoe Street
    Victoria BC V8V 4T3

    Correspondence: Dr. David Derry dderry@shaw.ca


    Background: After the 1918 Influenza Pandemic which killed an estimated 30 million people, governments financed research on the Pandemic’s causes. Over 25 years, influenza viruses were isolated and methods for killing them with various agents discovered. Iodine was the most effective agent for killing viruses, especially influenza viruses. Aerosol iodine was found to kill viruses in sprayed mists, and solutions of iodine were equally effective. In 1945, Burnet and Stone found that putting iodine on mice snouts prevented the mice from being infected with live influenza virus in mists. They suggested that impregnating masks with iodine would help stop viral spread. They also recommended that medical personnel have iodine-aerosol-treated rooms for examination and treatment of highly infected patients. Current methods of dealing with influenza infection are isolation, hand washing, antiviral drugs, and vaccinations. All of these methods can be improved by incorporating iodine into them. When impregnated with iodine, masks become much more effective, and hand washing is more effect when done with mild iodine solutions. Isolation techniques coupled with aerosol iodine would make them safer for patients, medical personnel, and all persons working with the public. Public health authorities could organize the distribution of iodine and at the same time educate the public in the effective use of iodine. Oral iodine might also boost body defense mechanisms in the upper oral and respiratory mucus. Conclusion: Iodine incorporated into masks, solutions, aerosols, and oral preparations could help to kill influenza viruses and fight off an H1N1 Pandemic.

    Keywords. H1N1 • Influenza virus • iodine • aerosols • immunization • isolations • masks • prevention

    Derry, D.: Iodine: the Forgotten Weapon Against Influenza Viruses.

  • A C

    5/18/2010 5:21:46 PM |

    I wonder if eliminating gluten would clean up that T3 issue. Yesterday I read that Celiac Disease can cause hypothyroidism.

  • buy jeans

    11/3/2010 12:23:22 PM |

    Kurt's thyroid function normalized to nearly ideal levels just with iodine replacement. (The free T3, while improved, remains low; an issue for another day!)

  • Katie

    8/4/2011 8:45:17 PM |

    Jenny!
    I just started the NOW kelp w/ dulse caps, 325mcg iodine.  How do they work for you?  The supplement world is soooo confusing and overwhelming!!  I'm wondering if I can take two of these a day, one in am and one in pm?
    Thanks for any insight you can provide!
    Katie

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Cholesterol is dead!

Cholesterol is dead!

I saw a patient in the office yesterday. He came to me for an opinion regarding his high heart scan score of 525, putting him in the 90th percentile (5% annual risk of heart attack).

His doctor had been puzzled because his LDL cholesterols had ranged from 110 to 131 mg--actually below average. (The average LDL for the U.S. is 132 mg.) Likewise, HDL was a favorable 63 mg.

Lipoprotein analysis told the story loud and clear. His LDL particle number, a far more precise measure of LDL, was 2448 nmol/l. This means that his true LDL was more like 240-250 mg! (You can get a sense for what the true LDL is from LDL particle number by dropping the last digit: 2448 becomes 244.) Conventional LDL was therefore inaccurate by over 100 mg.

He also had a severe small LDL particle pattern. The cause of his coronary plaque was a large excess of small LDL particles. LDL cholesterol (and total cholesterol, likewise) didn't even hint at this pattern. Nor did his favorable HDL.

Think of LDL particle number as an actual count of LDL particles per volume, e.g., number of particles per cc of blood. This makes it easier to conceptualize. LDL particle number is the measure you get when you have an NMR lipoprotein profile, our preferred method of lipoprotein testing. If this is unavailable to you, apoprotein B is a reasonable second choice, though not as accurate in my view. More info on NMR is available at their website, www.lipoprofile.com.
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