Self-directed health: At-home lab testing

I have a prediction.

I predict that more and more healthcare can and will be obtained directly by the individual--without doctors, without hospitals, without the corrupt profit-at-any-costs modus operandi of the pharmaceutical industry. I predict that, given the right tools, Joe or Jane Q. Public will have the choice to manage his or her own health using tools that are directly accessible, tools that include direct-to-consumer medical imaging (CT scans, ultrasound, MRI, etc.), nutritional supplements (a loosely-defined term, to our advantage), and direct-to-consumer laboratory testing.

Done responsibly, self-directed healthcare is superior to healthcare from your doctor. While no one expects you to remove your own gallbladder, you can manage cholesterol, blood sugar issues, vitamin D, low thyroid, and others--better than your doctor.

As everyone becomes more comfortable with the notion of self-directed health, you will see new services appear that help individuals manage their health. You will see prices for direct-to-consumer medical imaging and lab testing drop due to competition, something that doesn't happen in current insurance-based healthcare delivery. People are being exposed to larger deductibles and/or draw money from a medical savings account and will seek more cost advantages. Such direct-to-consumer competitive pricing will meet those needs. Overall, the presently unsustainable cost of healthcare will decline.

To help accelerate the shift of human healthcare away from conventional paths and divert it towards the individual, we have launched a panel of direct-to-consumer at-home laboratory tests that we are making available on the Track Your Plaque website.

On your own (except in California, which requires a doctor's order or prescription; and NY, the only state in the nation that prohibits entirely), you can now test, in the comfort of your own home with no laboratory blood draw required, parameters including:

--Thyroid tests--Free T3, free T4, TSH
--Lipids
--C-reactive protein
--Vitamin D
--Testosterone
--Progesterone

and others.

As the technology improves, more tests will become available for testing at home. (Lipoproteins are not yet available, but will probably be available within the next few years. That would be an enormous boon to those of us interested in supercharged heart disease prevention and reversal.)

Anyone interested in our at-home testing can just go to the Track Your Plaque lab test Marketplace.

When I first began the Track Your Plaque program around 8 years ago, I saw it as a way for people to learn how to control or reverse coronary atherosclerotic plaque, and I'd hoped that physicians would begin to see the light and become patient advocates in this process. But I have lost hope that most of my colleagues are interested in becoming your advocate in health. They are too locked into the "call me when you hurt" mentality. I now see Track Your Plaque as a way for people to seize control over coronary plaque with minimal assistance from their doctors. Indeed, some of our Members have achieved reduction of their plaque in spite of their doctors.

This is just the tip of the iceberg of what's to come. Brace yourself for a cataclysmic shift in returning health to you and away from those who would profit from your misfortune.

Comments (20) -

  • Jenny

    3/29/2009 4:14:00 PM |

    Dr. Davis,

    As someone who has used home A1c tests and home Cholesterol tests and found them to produce results so far off lab test results as to be worthless, I wondered if you could show us the data about the accuracy of these tests, some quite expensive, compared to tests run at a hospital lab.

    For example, the home A1c tests told you that the result was accurate to between plus or minus .5%, but you didn't learn this until you'd purchased the test, and that margin made the test useless to those of us who control our blood sugars. There is a huge difference between 6.0% and 7.0% but it was possible to have an actual, lab 6.5% and get either result with that home test.

    So what are the margins of error in the tests you provide?

  • JPB

    3/29/2009 4:23:00 PM |

    Excellent post!  I totally agree with your prediction but there are several things that will need to happen for it to occur:

    1.  People will need to take responsibility for their own health and decisions regarding maintaining that health.
    2.  The correct information needs to be available.  The amount of bad info and bias in nutritional recommendations is unbelievable plus the drug companies have been busy promoting and selling products that have questionable benefits at best.
    3.  The for-profit model of medical care must be abandoned. It is obscene for someone to profit from another person's medical problems. (I am not talking about paying decent salaries to doctors and medical care workers but rather, profits to shareholders and top executives.)  

    Our current medical care system is a disgrace but there will be many howls of protest from the vested interests when these changes are even suggested.  Unfortunately this system will fail unless reforms are made.  We cannot afford the relentless rise in costs anymore nor the overall deterioration of our citizens' health!

  • Anonymous

    3/29/2009 9:59:00 PM |

    I agree that this will catch on. Costs for self-directed testing are already coming down due to laboratory competition, and will fall even further with the rise of home testing.

    I think that taking control of your diet and overall health, a la Track Your Plaque, naturally leads to a desire for more information, without the added hassle and cost (and potentially, resistance or refusal) of a doctor's involvement up-front.

    How lucky am I then, to have moved from New York, where your home testing is not available, to California, where it's also not available.

    Fortunately, there are alternatives, at least in California, such as www.directlabs.com, www.mymedlab.com and www.medlabusa.com.  You have to go through an extra step of going in for a blood draw, but at least  you can get the testing.

  • rabagley

    3/29/2009 9:59:00 PM |

    When will LabCorp release the subfraction data to non-doctor requested NMR lipid panels?

    Supposedly it's the best lipid test out there, but I can't get to all of the results because of a policy that I'm completely and utterly unable to get to the bottom of.

  • Dr. William Davis

    3/29/2009 10:13:00 PM |

    Hi, Jenny--

    We've had the same problem with many of the at-home tests.

    For that reason, all the testing now offered is run at ZRT Labs with data and quality essentially identical to that obtained through conventional laboratories. In other words, while the samples are obtained at home as finger stick blots on paper, the tests are not run at home but at ZRT Labs.

    Their quality control policies are listed athttp://www.zrtlab.com/Page.aspx?nid=413.

  • Rich

    3/30/2009 1:27:00 AM |

    Jenny -

    While I've heard that a number of the home tests are not very accurate, there is a least one A1C test (which you mail into a lab) which is quite accurate.

    It is from Heritage Labs, and is sold as "ReliOn A1C" by Walmart for $9.00:
    www.walmart.com/catalog/product.do?product_id=10575934#ShortReviewTitleBar

    or by the name "Appraise Diabetes A1C Test" in other drug stores, such as CVS, etc. (usually around $19.00 - so Walmart is much cheaper).

    It is the same fingerprick test under both names.

    David Mendosa blogged about this test and its accuracy here:
    www.mendosa.com/blog/?p=339

    Heritage Labs is certified by the National Glycohemoglobin Standardization Program (NGSP), and they have only certified 78 labs worldwide.  Only 4 Quest labs in the US are certified (none that my blood goes to) and no Labcorp’s at all. The list of NGSP certified labs can be found here:
    www.ngsp.org/prog/labs.pdf

    I did the ReliOn bloodspot test and mailed it in to Heritage Lab in Kansas, and my 5.2 result was consistent with Labcorp and Quest A1c's from the past few years.

    During my appointments in the past with Dr. Bernstein, he tested my A1C using a device in his office also, but at the time I was still relatively diabetically-uninformed, so I did not take note of model he used.

    Rich

  • Anonymous

    3/30/2009 10:01:00 AM |

    I think this collection of tests are a wonderful addition to TYP.  Thanks for offering them.  I enjoy taking control of my health and when possible staying away from the doctor's office too.  It's frustrating going to the hospital.  Medical personal all to often try to make me feel like I'm the low man on the totem pole for my health care - even though I'm the customer!  I will be taking advantage of the home test.  

    I also enjoy spreading the word about TYP and had an idea about that.  Many companies offer company shirts.  It's basically free advertising for the firm.  Just a humble idea to pass along, thought it would be neat if TYP offered shirts that listed  different main concepts of the TYP program.

  • Dr. William Davis

    3/30/2009 11:32:00 AM |

    Thanks, anonymous. Great idea.

  • Anonymous

    3/30/2009 12:53:00 PM |

    Barkeater here.

    I would like to see more patient empowerment, and availability of good patient controlled testing is crucial.  Power to you, Doc.

    But, I am concerned that the future may not be bright.  California and New York have restrictions.  We are at this moment in a postion when more regulation seems like a great answer to all problems, rather than more freedom.  Certainly, that is coming in health care.

    The other 48 states probably have not made a careful decision to not regulate, but rather they are not as "advanced" in their thinking as Cal and NY.  

    Then, of course, there is the problem of insurance.  If only I could use my health care dollars as I see fit, but right now I spend $17k per year for insurance to participate in a system that often frustrates me.

    I can afford another few hundred to buy good health, but others aren't so lucky.

    Barkeater

  • Trinkwasser

    3/30/2009 3:25:00 PM |

    I once had the thought that if I won the lottery I'd start a business called The NHS PLC with a fleet of vans set up with lab test equipment which could come round door to door in the way that you can get your car serviced in your own drive.

    Yours is probably a better plan!

    They have just announced this

    http://news.bbc.co.uk/1/hi/health/7968734.stm

    almost certainly a cut off at the knees version, in many places the tests you supply are unavailable for cost reasons already, like officially I can only get TChol when I need the Full Lipid Panel, a friend can only get TSH when she needs T3 and T4.

    It seems these guys

    http://www.grassrootshealth.net/

    accept oversease customers, any chance of you doing the same?

  • mike V

    3/30/2009 3:56:00 PM |

    Dr Davis:
    My own doubts about the limits of curative medicine began to take root in 1962 when in hospital for six months (in the UK) with a fractured femur. There was a 13 year old boy in the ward who had in addition to polyomyelitis, a resistant Staph infection. (even then!)
    The treatment available was to cycle him through the available antibiotics of the time. He was given less than a year to live.
    My next need for a hospital came in 1993 when I needed to get rid of my gall bladder (some say this may have been one of the results of the "low fat" dietary era.)
    I realized around this time that I knew more about maintaining my high mileage cars than I did about personal nutrition and wellness, and resolved to make a change.
    I can report that since that time (1993) I have not had a single infection, and have reduced colds and flu essentially to zero. I have seen doctors only for "routine inspections".
    In my opinion, hospitals are one of society's  major health hazards, and here we all recognize that prescription drugs are a very slippery slope. (obviously one has to make exceptions for major trauma.)

    Many friends and contemporaries have been lost to or damaged by MRSA and other resistant infections in recent years.

    I very much appreciate the endorsement and weight you, your patients, and your members bring to healthy preventive measures, many learned independently over years by some of us.
    The close associations between heart disease, diabetes, auto-immune disease, Alzheimer's disease, hormonal disfunctions and lifestyle variables suggest that you are absolutely on the right track. Many of the responses to your blog posts reflect this.
    My close friend of 30 years now has simultaneous cardiomyopathy, diabetes, and AD with at times the mentality of a (terrible) 2 year old. What a difference TYP prevention might have made.

    Has it perhaps occurred to you that TYP may also be a surprisingly sensitive indicator of general health status?

    I would like you to know that your ethics and a genuine concern for your fellow man shine through, in all your writings.

    Thank You.
    Mike V

    Re: Home testing update. FYI:
    My first Grassroots Health 25(OH)D result was 50 after about 4+ months at 6000 iu Carlson's. Age 73. Location South Carolina. Winter UV exposure minimal.

  • Dawn

    3/30/2009 5:03:00 PM |

    Another option for ordering tests, where you go to a lab located near you is HealthCheckUSA. And for a few more dollars, you can also request a doc to do an interpretation of your results as well.

    http://www.healthcheckusa.com/

    BTW- LOVE LOVE LOVE your blog.

  • Dr. William Davis

    3/30/2009 6:18:00 PM |

    Thanks for the encouragement, Mike V and Dawn.

  • Anonymous

    3/30/2009 8:05:00 PM |

    Dr.
    This will never happen and will actually be illegal when this Universal Health care scheme becomes law.
    What you have described here Dr. Davis is about freedom and UH is the total opposite of freedom.

    Oh, and how long do you think it will be before nutritional supplements are illegal without government prescriptions? I predict within a year of UH as law.

  • Dr. William Davis

    3/30/2009 9:49:00 PM |

    Mike V--

    You make an important observation that we have also made in the TYP experience: Many of the strategies employed--vit D, omega-3 fatty acid supplementation, wheat elimination, etc.--lead to marvelously improved overall health, in addition to correction of cholesterol patterns and reduction of heart disease risk.

  • katherine

    4/1/2009 12:51:00 AM |

    Dr. Davis,

    I wanted to let you know about a positive experience with the Biotech brand D3 5000 IU capsules.  My latest test showed 80 ng/ml after supplementing for approximately 4 months with 10,000 IU daily (started with 5000, bumped it up to 10,000, will now go back to 5000 to maintain).  This is up from 34 ng/ml.  I know you generally recommend the gelcaps but these seem to get the job done as well.

  • Dr. William Davis

    4/1/2009 2:57:00 AM |

    Katherine--

    Thanks for the feedback. That's helpful.

  • darwinstable

    4/6/2009 4:36:00 AM |

    What a great post. I totally agree and in some respects have done that myself. I just turned against the mass media and did what I knew as an evolutionary biologist was the best thing to do. I can now see the results and this is something I could never have done with weight watchers, jenny craigs, current medical advice etc.

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    4/23/2009 5:04:00 AM |

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  • Nursing homes chennai

    1/6/2011 10:15:07 AM |

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Making sense out of lipid changes

Making sense out of lipid changes

Maggie had been doing well on her program, enjoying favorable lipids near our 60-60-60 targets (HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less). Last fall, her last set of values were:

Total cholesterol: 149 mg/dl
LDL cholesterol: 67 mg/dl
HDL cholesterol: 73 mg/dl
Triglycerides: 43 mg/dl

The holidays, as with most people, involved a frenzy of indulgent eating: Christmas cookies, cakes, pies, stuffing, potatoes, candies, etc.

Maggie returned to the office 6 pounds heavier with these values:

Total cholesterol: 210 mg/dl
LDL cholesterol: 124 mg/dl
HDL cholesterol: 57 mg/dl
Triglycerides: 144 mg/dl

In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol.

What happened?

At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy.

Having done thousands of lipoprotein panels, I can tell you that, beneath the surface, the following has occurred:

--Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood.
--Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via cholesteryl-ester transfer protein (CETP) activity.
--Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL.

The critical factor is carbohydrate intake. This triggered a domino effect that is often misintepreted as excessive fat intake or a genetic predisposition. It is nothing of the kind.

I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future and will revert promptly back to her 60-60-60 values.

Comments (9) -

  • Rick

    1/27/2009 4:37:00 AM |

    Wow. I hadn't realised that a short period of over-eating could trigger such big changes.

    Is there any danger from triglycerides going much below the target of 60?

  • Diana Hsieh

    1/27/2009 5:23:00 AM |

    Dr. Davis --

    What might cause a substantial rise in LDL, while triglycerides and HDL are lower than ever?

    Here's what happened with my tests over the last year and a half:

    ** Summer 2007, eating the standard American diet **
    Total Cholesterol: 266
    Triglycerides: 109
    HDL: 79
    LDL: 165

    ** Summer 2008, just a few weeks into my new diet (no processed foods, no grains, no sugars, no vegetable oils) **
    Total Cholesterol: 225
    Triglycerides: 63
    HDL: 72
    LDL: 140

    And now, January 2009 (same diet as before):
    Total Cholesterol: 341
    Triglycerides: 55
    HDL: 99
    LDL: 231

    My triglycerides and HDL are better than ever, but my LDL has gone way up.  I didn't overindulge over the holidays, but I was losing weight (slowly) when I got that latest test.

    I know -- thanks to your blogging -- that inferred LDL values are highly unreliable.  And I also know that there's a difference between small LDL (bad, caused by eating high carb) and the bigger, fluffier (okay) LDL.  The LDL number doesn't differentiate between those values.  Or might something else be the cause?

    My doctor wants to do a cholesterol recheck next month -- and I'm thinking that I ought to ask for a measured LDL value and a particle size test.  Does that seem reasonable to you?  

    BTW, my heart scan from six months ago is totally clear.  So I don't care how much my doc pushes, I absolutely refuse to go on any kind of cholesterol-lowering medication.

    Also, thanks to you, I got a vitamin D test -- and my values were excellent.  (I do supplement.)  Yeah!

  • Jenny

    1/27/2009 2:19:00 PM |

    Dr. Davis,

    While it is true that overindulging in carbs causes all the changes you cite here, if your patient really wants to stick with the program life-long, she'll do better learning how to carb up a bit at the holidays, and then correct afterwards, rather than getting into a lifestyle of self-denial that will build up an undercurrent of feelings of deprivation that will eventually blow her completely off course.

    I've been there, done that. Three family holiday seasons without eating any of our traditional foods left me depressed and miserable. Food is a complex issue with deep emotional roots.

    Something like a family death or a cancer diagnosis can trigger binges that derive from that deprivation and really derail the diet.

    I have found it much better to build in safety valves into the diet, here and there.  The lipids will recover very fast once she goes back to eating the low carb diet.  

    I've been doing a low carb lifestyle for going on 11 years now, and I attribute its success to the safety valves. Yes, I do gain a few pounds over the holidays, but I take them off in January.  

    The psychology of successful dieting is often to accept "good enough" rather than perfect. Perfect has a nasty way of ending up in disaster.

    If you doubt this, just read the low carb diet boards where for every person who has maintained perfectly for 5+ years there are 25 people back after catastrophic regains caused by being too stringent.

  • Alan S David

    1/27/2009 3:36:00 PM |

    Is it carbs in general or should we be more consciously eliminating the wheat and corn products?  
    I eat quinoa,oatmeal,  buckwheat,beans,brown rice, etc. Not to excess but as a part of my usual diet.
    Just wondering?

  • Grandma S.

    1/27/2009 4:51:00 PM |

    Question: I understand no wheat and what it does to the LDLs, but does that include potatoes? Thank you!

  • Anonymous

    1/28/2009 5:57:00 AM |

    Dr. Davis,

    I have a similar issue as Diana Hsieh.  

    My Total Cholesterol: 258
    Triglycerides : 60
    HDL : 61
    LDL- 181

    I've been on a low carb diet avoiding wheat, rice, starches, sugar, high fructose corn syrups and fruits for the last 6 months.  I've lost 35 pounds and reduced my triglycerides from 296 to 60.  Taking fish oil and slo-niacin. I have been eating alot of saturated animal fats (rib-eye steaks, baby back pork ribs, eggs) Is eating the saturated animal fat causing my total cholesterol to be too high?  Is total cholesterol above 200 dangerous if Triglycerides and HDL are in the 60's?

  • vin

    1/28/2009 10:11:00 AM |

    I am trying for last three years to get my HDL numbers high. So far without success. I have tried exercise and cutting out wheat but without significant improvement. I have now added 4000iu vitamin D. Will do a follow up blood test after about two months to see if HDL level increases.

    Any other tips?

  • Jmuls

    1/28/2009 12:34:00 PM |

    Dr. Davis,

    Is there often a direct correlation between low triglycerides and a greater proportion of large LDL particles?  Thanks

    - John

  • Trinkwasser

    2/8/2009 2:08:00 PM |

    Here were my lipids on a Heart Healthy (sarcasm) Diet

    Trigs 380
    HDL 25
    LDL 165

    Add simvastatin

    Trigs 185
    HDL 33
    LDL 75

    Here they are on a low carb diet with my BG more or less normalised
    (70 - 90 and postprandials mostly below 110 and seldom over 120)

    Trigs 39
    HDL 47
    LDL 105

    Adding more saturated fat

    Trigs 62
    HDL 55
    LDL 94

    Spot the reversal of HDL to LDL

    IME low carbing decimates the trigs and tends to increase HDL and LDL both, tinkering with the fat content and type adjusts the balance between these BUT there's a lot of individual variation as to exactly how this works. Some people just seem to have high LDL whatever they do, maybe a long term change from years of insulin resistance and hyperinsulinemia, maybe genes which would respond to a different balance of fat types in the diet.

    My #1 weapon has been BG testing

    http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

    which is deprecated in the UK. Lipid breakdowns are often unavailable and Full Lipid Panel is deprecated in favour of TChol which is pointless but cheaper. The money saving is probably to pay for the blanket prescription of statins, and it also serves to conceal the toxic nature of the diet

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    here's the diabetic version

    http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Food_and_diabetes/Balancing_your_diet/

    I feel like part of a eugenics experiment

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