Can you get the page 2 result directly from Liposcience?

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.

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!

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.

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! 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

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.

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

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

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.

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.

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?

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.

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.

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.

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?

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.

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)

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?

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.

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.

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".

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.

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

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.)

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?

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.

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.

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!

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 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.

oops posted this in wrong thread

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.

@ 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.