What you should expect Dr. Jogi to tell you about your labs.
Labs to interpret your metabolic state: fasting insulin, lipids, AST and ALT.
1) Triglyceride to HDL ratio is important
Less than 2.5 Caucasians and Less than 1.5 African Americans is the goal.
2) Fasting insulin is important
3) High LDL is not always bad and statin not always needed.
The small dense is strongly associated with cardiac disease. The large floating ones are less harm associated. You can reduce the small dense with high insoluble fiber diets combined with carbohydrate restriction.
The doctor has to order fasting NMR lipid profiles for getting the particle information.
QUEST ADVANCED LIPOPROTEIN LABS INTERPRETATION
LDL Particle number:
Relative Risk: Optimal <1138; Moderate 1138-1409; High >1409.
Male and Female Reference Range: 1016 to 2185 nmol/L.
Relative Risk: Optimal <142; Moderate 142-219; High >219.
Male Reference Range: 123 to 441 nmol/L; Female Reference Range: 115 to 386
Relative Risk: Optimal <215; Moderate 215-301; High >301.
Male Reference Range: 167 to 485 nmol/L; Female Reference Range: 121 to 397
Relative Risk: Optimal >6729; Moderate 6729-5353; High <5353.
Male Reference Range: 4334 to 10815 nmol/L; Female Reference Range: 5038 to 17886 nmol/L.
Relative Risk: Optimal Pattern A; High Pattern B. Reference Range: Pattern A.
LDL Peak Size
Relative Risk: Optimal >222.9; Moderate 222.9-217.4; High <217.4.
Male and Female Reference Range: 216 to 234.3 Angstrom.
Adult cardiovascular event risk category cut points (optimal, moderate, high) are based on an adult U.S. reference population plus two large cohort study populations. Association between lipoprotein subfractions and cardiovascular events is based on Musunuru et al. ATVB.2009;29:1975. For additional information, please refer to http://education.QuestDiagnostics.com/faq/FAQ134 (This link is being provided for informational/educational purposes only.)This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics Cardiometabolic Center of Excellence at Cleveland HeartLab
Risk: Optimal <90 mg/dL; Moderate 90-119 mg/dL; High >= 120 mg/dL;
Cardiovascular event risk category cut points (optimal, moderate,high) are based on National Lipid Association recommendations-Jacobson TA et al. J of Clin Lipid. 2015; 9: 129-169 and Jellinger PS et al. Endocr Pract. 2017;23(Suppl 2):1-87.
Risk: Optimal <75 nmol/L; Moderate 75-125 nmol/L; High >125 nmol/L.
Cardiovascular event risk category cut points (optimal, moderate, high) are based on Tsimika S. JACC 2017;69:692-711.
LABCORP ADVANCED LIPOPROTEIN LABS INTERPRETATION
** INTERPRETATIVE INFORMATION- PARTICLE CONCENTRATION AND SIZE
<--Lower CVD Risk Higher CVD Risk-->
LDL AND HDL PARTICLES Percentile in Reference Population
HDL-P (total) High 75th 50th 25th Low
>34.9 34.9 30.5 26.7 <26.7
Small LDL-P Low 25th 50th 75th High
<117 117 527 839 >839
LDL Size <-Large (Pattern A)-> <-Small (Pattern B)->
23.0 20.6 20.5 19.0
Small LDL-P and LDL Size are associated with CVD risk, but not after LDL-P is taken into account.
INSULIN RESISTANCE MARKER
<--Insulin Sensitive Insulin Resistant-->
Percentile in Reference Population
Insulin Resistance Score
LP-IR Score Low 25th 50th 75th High
<27 27 45 63 >63
LP-IR Score is inaccurate if patient is non-fasting.
4) ALT more than 25 indicates you have a fatty liver
5) Fix fatty liver
Labs to evaluate diabetes mellitus type 1: hemoglobin A1c, CBC, lipids and microalbumin to creatinine ratio, and AST and ALT and creatinine, and CGM
See section about metabolism above
If any of the metabolic markers above are off, then a type 1 patient may have developed metabolic syndrome on top of their type 1 lack if endogenous insulin. Diet Diet Diet is the best intervention. Exercise is useful.
Hemoglobin A1c is a 3 month average of your blood sugars:
A1c should be less than 7.0-% in patients with diabetes less than 10 years who do not have heart disease. Less than 8.0% in patients with CAD and more than 10 years of diabetes or those with advanced age or limitations on the ability to handle hypoglycemia. Also the goal in type 2 diabetes to cured the diabetes with a1c less than 5.5% without medication, using dietary changes alone. The A1c can be wrong in certain patients especially if a patient's hemoglobin is abnormal or if the creatinine is elevated.
A1c alone is not a great indicator of a patient's health or blood sugar control.
Urine microalbumin to creatinine ratio more than 30 suggests a problem with kidneys
Higher than usual ranges suggests that your blood pressures or blood sugars have been too high, leading to early changes of kidney failure. Changes in diet and medications, such as adding ACE inhibitors or ARB medications can repair the kidney.
Continuous glucose monitoring is the safest way to monitor blood sugars while on insulin.
Dr. Jogi believes a continuous glucose meter is mandatory for all patients on insulin and patients that are afraid of wearing the device need to rethink their priorities. Also once on insulin the only way to change your diet to get off diabetes medication is with a CGM like dexcom or libre.
GAD and fasting c-peptide tell us the future
If your GAD antibody is positive it means a patient is at higher risk to develop an autoimmune reponse to the pancreas leading to a lack of insulin production and resultant type 1 diabetes. A nonfasting cpeptide of less than 0.9 with concurrent blood sugar more than 150 is a sign that you are on the way to having type 1 diabetes. Less than 0.1 means you probably do have type 1 diabetes.
Labs to evaluate diabetes mellitus type 2: hemoglobin A1c, CBC, lipids and microalbumin to creatinine ratio, and AST and ALT and creatinine, and CGM
Metabolic syndrome is probably the root cause.
If you have type 2 diabetes, even if you are not fat then you really need to pay attention to the section on metabolic syndrome.
Read everything in section on Type 1 diabetes, it applies
List of some lab abnormalities that Dr. Jogi will refer to other doctors
CBC testing abnormalities. Usually a primary care doctor or a hematologist will help determine the causes of CBC abnormalities:
Low MCV (RDW tells similar information) levels:
1) Iron Deficiency. The most common cause of low MCV is iron deficiency anemia. Work up by PCP or gastroenterologist
2) Anemia of Chronic Disease. ... work up by PCP or hematologist
3) Thalassemia. ... work up by PCP or hematologist
4) Copper Deficiency. ... Worked up after the Gastro work up is negative, by a hematologist or PCP
5) Vitamin A Deficiency. ...Worked up after the Gastro work up is negative, by a hematologist or PCP
6) Lead Poisoning. ...Worked up after the Gastro work up is negative, by a hematologist or PCP
High MCV (RDW tells similar information) levels
Causes of high RBC.
1. Low oxygen levels:
The body might make more red blood cells as a response to conditions that result in low oxygen levels. These might include:
Congenital heart disease in adults
COPD (chronic obstructive pulmonary disease) - the blanket term for a group of diseases that block airflow from the lungs - including emphysema.
Hemoglobinopathy, a condition present at birth that reduces red blood cells' ability to carry oxygen.
Living at high altitudes.
Pulmonary fibrosis - a disease that happens when lung tissue becomes damaged and scarred.
Sleep apnea - a condition in which breathing stops and starts many times during sleep.
Nicotine dependence (smoking)
2. In some people, cancers or pre-cancers that affect the bone marrow can cause too many red blood cells to form. An example is Polycythemia vera
3. Misuse of drugs to improve athletic performance
Certain drugs boost the making of red blood cells, including:
Shots of a protein known as erythropoietin.
4. Higher red blood cell concentration
5. Other diseases
Rarely, in some kidney cancers or after kidney transplant, the kidneys might produce too much of the hormone erythropoietin. This causes the body to make more red blood cells. Red blood cell counts also can be high in nonalcoholic fatty liver disease.
The basic cholesterol panel gives some information but there is a better panel called the advanced lipoprotein profile or NMR lipid profile
Total cholesterol - not helpful
Triglycerides - higher than 700 can cause pancreatitis. Higher than 150 is usually due to excess carbohydrate intake. High levels can also be genetic
HDL - usually the higher the better. Below 40 is not ideal and usually indicates insulin resistance
Triglyceride to HDL ratios are useful. Read here about insulin resistance.
LDL - can help predict cardiac disease somewhat correlated. Think of the LDL as the cargo carried by particles. There are two types of LDL particles: small dense and large floaty.
The LP-IR score is a laboratory developed index that has been
associated with insulin resistance and diabetes risk and should be
used as one component of a physician's clinical assessment.