Lab Test True Confessions
My Adventure in Evidence-Based Living Continues
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It was annual physical examination time.
Although, my health plan said I wasn't due for a new lipid panel for another 3 years--because my last one was just fine--I asked my physician if I could please have a cholesterol test run, anyway. Curiosity was getting the better of me. I wanted to know how this plant-based no-oil diet was working for me. I write a health blog, for goodness sakes--and others want to know, too!
Where I work, the annual physical is your qualifying exam if you want to keep your eligibility for the Gold Level health insurance rebate. $$$ saved!
All your health numbers have to be in order. Cholesterol in the healthy range, a BMI of less than 26, no hypertension, no smoking, no diabetes, and no out-of-control asthma (I think). That's pretty much it. It's all about keeping any chronic conditions in check. Can't argue with that.
Either you figure out a way to do it without drugs--or if you want the big discount, these markers need to be managed with prescriptions. I prefer to do it without diet--not drugs.
Since I've been eating plant-based for 4 years now, I asked my physician for a B-12 test, and if I could have my vitamin D level tested as well.
Cholesterol Must Be Good for Something, Right?
What About That Cholesterol Test?
Believe it or not, this is an improvement over my July 2010 scores. Take a closer look! My LDL's dropped 6%. My HDL's increased 41%. The LDL:HDL ratio is 1.35 Not too shabby.
Of course my Total Cholesterol went up, but that's just because my HDL's jumped up 23 points & your total cholesterol is just the sum total of LDL's + HDL's + 1/5 of Triglycerides. In my case: that's 201. No worries.
I'm resigned to never having those low-low LDL's that some people get on a plant-based diet. Not without drugs---and no one's suggesting that I need them, thankfully. Doesn't concern me a bit. My body just makes more cholesterol naturally, and that's normal for me. And the cardiovascular disease story is really more about inflammation, anyway.
I already know where I'd be if I were still eating animal products, oil, & less fiber: probably with a total cholesterol of over 269 by now, weighing 15 pounds more, and taking blood pressure meds. So for me, the choice is simple. I'd rather lower my LDL's, keep my inflammation low, and keep my blood vessels healthy with my diet, rather than with drugs.
And besides, I know from a previous HS-NMR Lipid Profile that my LDL's are mostly the light and fluffy kind. Again, no worries.
As for the increase in HDL's, I'm guessing that comes from two changes I've made since July 2010. Nuts & exercise. I exercise a lot more, I eat walnuts & chia everyday, & I use cashews in cooking, occasionally. I figure one of those two things are probably responsible for the HDL rise.
Bottom line, the HDL story is still a research puzzle in progress and numbers don't tell the whole story anyway. Remember the "Efflux Capacity" of HDL wrinkle? Nevertheless, I'm thrilled with my LDL:HDL ratio of 1.35.
So what if my numbers don't go as low as I was hoping they'd go on a plant-based no-oil diet? I asked Dr. Esselstyn two years ago.
Dr. Esselstyn stressed that the health of my blood vessels is dependent upon what I'm eating--in spite of the numbers. If I'm really eating 100% plant-based, no-oil, all whole grain, very heavy on the greens, beans, fruits, & legumes--no problem! He says my blood vessels should be thanking me by now.
Turns out, even the Tarahumara Indians, who had no heart disease to speak of--had LDL levels from 80-115 (my range)--and some had HDLs as low as 26--the kind of numbers that might make a cardiologist pull out a prescription pad.
They were eating only beans, squash, & corn--not a bit of oil. Their LDLs were the light fluffy kind and they weren't causing a bit of damage. And their lower HDLs weren't a problem either, because the Tarahumara's weren't eating anything that was going to turn their LDLs into the small dense dangerous bad guys.
If you aren't eating any inflammatory endothelial-damaging foods like fats, oils, and animal products---and you're loading up on high anti-oxidant greens you've reached the most important goal of all! Your numbers will probably reflect this--but don't worry if they don't.
OK, 'nuff said about that.
Moving on to Vitamin D & B-12
What About That Vitamin D Test?
My Vitamin D level is now 42.9. RIght were I want it to be.
The last time it was tested it was 34.3, back in February 2010. Turns out, back then it was measured by a less accurate radioimmunoassay test, which I now know was inflated by about 23%--so it was actually lower than I thought--more like a 26!
If you follow the Vitamin D research, the "sweet spot" for health benefits seems to fall in the 40-60 ng/mL level. Right where I've finally landed. Those benefits include stonger bones, less infections, breast cancer prevention, decreased mortality, less obesity, diabetes prevention, & cardiovascular benefits. To read what the top vitamin D docs say about benefits of the sunshine vitamin, click here and here.
To be honest, this is still an emerging area of research, and the jury isn't in yet, but far more studies show health benefits at the higher, rather than the lower end of the spectrum.
Frankly, I was surprised that I "weighed in at" 42.9. It's summertime & I've been taking 4000 IU's (the Institute of Medicine's upper limit)--yes, you read that right--every single day now for over a year. Rainbow Light Sour Lemon Gummies. My daily treat. The only vitamin I actually enjoy taking.
Looks like it was a good thing that I've been taking the 4000 IU's. That works for me, but it may be too much or not enough for you. Everyone is different and unless you get tested, you have no idea where you're at. Your weight, your skin color, your age, where you live, your sun exposure, your health conditions & what you eat, all make your blood level of vitamin D unique to you!
New More Accurate Vitamin D Test
Here's the reason why my latest vitamin D level was lower than I expected. My hospital is now using a better vitamin D test, that's much more accurate than what they previously used.
The new test is a liquid chromatography-tandem mass spectrometry test with results about 23% lower than previous tests. The one previously used was a radioimmunoassay test (RIA).
Here's the note on the lab test: "On May 3, 2011, we have transitioned from a radioimmunoassay (RIA) method to a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.
For most patients, the LC-MS/MS method will provide approximately 23%
lower results than seen previously with the RIA method, due to improved
The reference range for the RIA was 19.6-83.6 pg/mL.
The reference range for the LC-MS/MS is 15.0-60.0 pg/mL.
Reference range applies to VitD 1,25 DiOH Tot only."
About That High B-12 Test?
If you're eating a vegan diet you need to take a vitamin B-12 supplement. The amount in a multivitamin isn't enough. The amount in nutritional yeast or enriched non-dairy milk, is not enough. You need a supplement. No ifs, ands, or buts.
A prominent vitamin B-12 researcher advised Dr. Esselstyn early on to recommend a dose of 1000 mcg of vitamin B-12 to anyone who is following his plant-based diet. So that's what I take. I used to remember to take one about 3 times a week, but once I started to leave the bottle in my car I remembered to take one every day.
There are plenty of good reasons to take B-12, even if you aren't planted-based, especially if you're over age 50. Preventing dementia & brain shrinkage are two pretty good reasons, for starters. I've written a lot on this subject, so if you want a quickie review on who should take vitamin B-12 & why, click here and here.
Last December 2011 I was fortunate enough to hear Dr. Donald Jacobsen of the Cleveland Clinic interviewed on Dr. Ronald Hoffman's radio show--and here's what he had to say:
1. All vegans need to take 1000 mcg of B-12 a day in the form of cobalamin, methylcobalamin is not necessary.
2. Take it sublingually for the most absorption. It's a safe vitamin & you cannot take in too much--any extra is excreted in the urine.
3. We only absorb 10% of B-12--which gives an actual net dose of 10 mcg.
4. B-12 taken intramuscularly is not necessary & that's been proven with research studies.
5. For the most accurate test of B-12 deficiency Jacobsen recommends the MMA (methylmelanic acid test). Note: results are inaccurate in the presence of kidney disease.
6. Jacobsen says the common Serum B-12 test is not an accurate measure because of the way B-12 binds to proteins in the blood. It can say you're level is normal, when it is not.
7. A newer B-12 test, the Holotranscobalamin Test may be a good choice--but, more research is needed. You can listen to the interview here--just 17 minutes long.http://podcast.wor710.com/wor/3231275.mp3
Turns out my hospital's lab doesn't use the MMA (methylmelanic acid test) that is recommended as the most accurate way to assess vitamin B-12 levels. Oh, well, I've got to make due with less than perfect testing, which casts some doubt on my over-the-top test results.
The hosptial uses the common serum B-12 test--so honestly, I have no idea if I need to cut back my daily dose or not. I feel fine, and according to vegan dietitian Jack Norris, if you're regularly supplementing with B-12, and you're not experiencing any symptoms, like fatigue or tingling--don't even bother getting tested in the first place--the test results are just not that accurate, in the first place. According to Norris, if you're supplementing--assume you're OK. Too bad I found that out after my test. To read more about B-12 from Jack Norris, click here.
Bottom Line: I Plan to Just Keep on Doing What I've Been Doing
Eating plant-based no-added oil (& no sugar) has helped me to lose weight & allows me to eat as much as I want to eat.
It's lowered my blood pressure, and encouraged me to eat a wider variety of vegetables, fruits, grains, & legumes. High Nutrient-Density/Low Caloric Density has become my mantra. It's upped my anti-oxidant intake immeasurably, which is a sure-fine way to curb inflammation.
I'm sticking with my 4000 IU's of vitamin D, for now. It's got my vitamin D level right where I want it.
As for Vitamin B-12--I'm not sure yet what I'll do. If it's safe, and you can't get too much, it may not matter if I continue to take it daily, but, I'll likey drop down to just 5 days a week. I'll ask my doc what she suggests.
What about you?
Have you had your B-12 or vitamin D levels tested recently?
Is anybody else eating a plant-based no-oil diet (w/o cheating) and getting a cholesterol test like mine?
I have a theory that women's cholesterol levels don't decrease with diet as much as men's do, & that's OK. Has that been your experience?