Blog

0

Ok, so I´ve had some tests done by my MD. She´s not worried about any of the results but we know I´m not well, so any insights are helpful. I´m female, 34 years old and overweight with a history of sugar addiction. I´ve been eating lowish carb paleo for over six months and I´m so so tired and I haven´t lost any of my excess weight.

  • B-SR 10mmh/h (0-20)
  • kB-CRP 11mg/l (0-10)
  • fp-Glucose 5,7mmol/L (3-7)
  • blood pressure 118/80
  • P-Potassium 4,1mmol/L (3,5-4,4)
  • P-Creatinine 54 (50-90)
  • B-Hb 129g/L (117-153)
  • B-Leukosytes 9,9 10(9)/L (3,5-8,8)
  • B-Trombocytes 318 10(9)/L (150-350)
  • B-EVF 0.41 (0.35-0,46)
  • B-MCV 92fL (82-98)
  • S-Haptoglobin 0,9g/L (0,2-1,9)
  • P-Ferritin 96 (7-120)
  • P-Kobalamin 552pmol/L (190-700)
  • fP-Folate 40nmol/L
  • T4 (free) 14pmol/L (10-22)
  • TSH 1,4mlE/L (0,4-5,0)
  • S-Cortisol 500nmol/L (180-640) (morning, blood)
  • B-Erytocytes 4,5 10(12)/l (3,9-5,2)
  • B-MCHC 315g/L (317-357)
  • B-Neutrophil gran 5,8 10(9)/L (1,7-7,5)
  • B-Lymphocytes.x 3,1 10(9)/L (1,1-4,8)
  • B-Monocytes.x 0,6 10(9)/L (0,0-0,6)
  • B-Basophil granx 0,1 10(9)/L (0,0-0,2)
  • B-Luccelles 0,2 10(9)/L (0,0-0,2)

Any insights appreciated!

EDITED to add: I have several food intollerances (dairy, gluten, eggs, soy...) and am recovering from a lifetime of sugar addiction. For the last six months I´ve been sugar free and eating three balanced lowish carb paleo meals + 1 snack a day. I do yoga and walk everywhere, I also meditate. Even though it hasn´t been great before the fatique has been a major issue for the last three months or so.

flag
It sounds like you may get more insights from people if you describe your history, and current diet and exercise. Lab results only help to understand the bigger picture. – greymouser Jun 1 2012 at 14:21
I´ve added more info. – AEA Jun 1 2012 at 15:44

5 Answers

2

Despite the reports of food intolerances, I don't think this looks autoimmune. For one thing, the ESR is totally normal, the CRP is only moderately elevated, and most of the white blood fractions are normal. Hashimoto's is exceedingly unlikely -- the TSH would be high.

Let's do an inventory of the parameters that look off:

  • CRP
  • Hb
  • leukocytes
  • thrombocytes

CRP: This is slightly elevated. This could be the result of an infection, or subtle inflammation, which could have any number of causes. Do you have joint pain?

Hb: By the book, this is "normal", but nobody would ever say a man with this Hb is normal. Personally, I think the reference range for Hb is set too low -- remember, these reference ranges are determined from a population distribution. Some people feel fine with an Hb this low, but you obviously don't, so we shouldn't ignore this. Your ferritin level is slightly higher than one typically sees in a woman, but since you have indications of inflammation, it is likely elevated and probably doesn't accurately reflect your iron status. One would need to do another test to differentiate. Because your Hb isn't spectacular and you feel rotten, I'd want to see those tests done. Ask for serum iron, total transferrin or total iron binding capacity and a repeat ferritin.

leukocytes: Your total white blood cell count is actually elevated: you are showing signs of an infection, so it's not surprising you feel lousy.

thrombocytes: Your platelet count (thrombocytes) is inching up. The reference range on this varies wildly -- some labs set it at 450. Another indicator of inflammation. Another thing that can trigger thrombocytosis is iron deficiency anemia (it's funny how that keeps coming up).

mean corpuscular hemoglobin concentration (MCHC): yet another indicator that all is not right with your blood. It's just outside the reference range, but you are showing signs of infection or inflammation, so I wouldn't ignore this, either. This value is calculated from your hematocrit and the Hb.

Despite the apparently "normal" red blood cell count: this hints at anemia caused by inflammation.

Things I'd want to see:

  1. You didn't provide an RDW (red cell distribution width). Was one calculated?
  2. serum total IgE -- to see if this inflammation is an allergic response.
  3. You might want to consider a serum 25OHD3 (serum vitamin D, or calcidiol). I don't know who is paying for this, some public insurers won't cover it. Even if they won't, it costs maybe 50 dollars, and it's worth it.
  4. serum iron, total transferrin OR total iron binding capacity. (I was iron deficient with a ferritin of 95 µg/L). When there's a hint of anemia, I'd suspect iron insufficiency as the cause first (your B12 and folate levels are normal) - it's simply the most common and most likely cause, especially in women. Anemia like this can also be caused by infection, but before you go that route, check the nutrition first.
link|flag
Yes, I have joint pain and I did supplement with iron during march because the levels were low so anemia caused by inflammation is definatley something to consider. Thank you for your insights. – AEA Jun 1 2012 at 19:23
I am beginning to think that iron deficiency can actually cause arthritis, because I have seen a few cases where persistent arthritis resolved after iron replacement. This has the paradoxical effect of initially decreasing ferritin, as the joint inflammation subsides. – Stephen Jun 1 2012 at 22:38
You're wrong about your interpretation. The apparent anemia is exactly what you'd see with Hashimoto's and autoimmune diseases like RA. The low to low-normal WBC is typically what you'd see and it's confirmed by being ANA+ or TPO/TG positive. Also SR is not normal: being in the middle of the range isn't "normal" just like you wouldn't claim to be normal when your TSH is smack int he middle. There is a sweet spot and there are slippery slopes toward autoimmune encroachment. You gotta stop looking at reference ranges to detect "normalcy". Why, even PCPs can do that. – Mambo Jun 2 2012 at 10:00
I must admit that the anemia interperation appeals to me because the thought of autoimmune issuse is so much more frightening and complicated. But I´m not going to stop here, I know somethings off and I want, and need, to get to the bottom of this wether it´s autoimmune or anemia or whatever it might be. Thanks to both of you! – AEA Jun 2 2012 at 12:55
1

Good thing you're more discerning than your MD. You seeem to have inflammation issues: high CRP and SR. Also, high normal Ferritin, higher than ideal BG, and low overall WBCs. I'd get tested for autoimmune diseases: Rheumatoid Arthritis, Hashimoto's.

I'd just go straight to a rheumatologist or endocrinologist and ask for antibody tests for autoimmune diseases. That CRP elevation is the most serious one. If you retest and it's still that high, you need to track down where your inflammation is coming from. Also, rule out prediabetes/diabetes with HbA1c.

link|flag
Yup, get a thyroid panel. – GurlzLuvSteak Jun 1 2012 at 15:28
My grandmother had arthritis and I tested negative for it when I was younger. Thanks for taking the time to answer. – AEA Jun 1 2012 at 19:29
As far as thyroid is conserned the T4 and TSH is within nomal range. – AEA Jun 2 2012 at 9:46
Yes, but you could still be hypo if you are + for hypothyroid antibodies and/or your FT3 is low due/your RT3 high. If you have symptoms then blood markers just serve to confirm. Plus, you may not necessarily test + for arthritis when young but carry antibodies that may anticipate future development. I'd get checked for ANA, RA factor, especially if your gma had RA (vs. OA). – Mambo Jun 2 2012 at 9:53
I´ll definatley push to have some more tests done. I spoke to mum about the inflammation markers and she immediatly thought of my grandma (paternal). And yes, she did have RA. Thanks! – AEA Jun 2 2012 at 12:49
0

If you have health concerns and are unhappy with your current treatment, please go see another doctor for a second opinion.

This board is well meaning and some people who are members are actually MD's, BUT PLEASE GO TO ANOTHER DOCTOR.

That being said, your goal is weight loss. If you had been running a calorie deficit for over 6 months, you would have fat loss. I would start there. Consider that increased activity levels may haved increase lean mass. Have you gone down in clothing sizes?

As far as feeling sluggish, low carb diets and eating at maintenance levels can lead you to feeling sluggish. Compare your total calorie intake to calorie expenditure and consider adding more carbs for energy.

link|flag
Sure, weightloss would be great but this fatigue is the major issue and I have a feeling it´s connected somehow. My body has changed but I´m still the same size, no change in clothing size. – AEA Jun 1 2012 at 19:27
0

Unless I missed something, I didn't see the key test (in my book, anyway). What's your 25(OH)D level?

link|flag
We didn´t test it but I´m supplementing. – AEA Jun 2 2012 at 5:29
Doesn't mean a thing. Ideally your level would be between 50-60 ng/ml (60-80 ng/ml if you are dealing with inflammation/autoimmune issues.) You won't know if you don't test. Best not to supplement blindly. – Dragonfly Jun 2 2012 at 13:06
And how is your sleep? – Dragonfly Jun 2 2012 at 13:08
1 
 Thanks Dragonfly. My sleep is good, I think, mostly around 8h. – AEA Jun 2 2012 at 15:19
0

Thank you everyone for your input! I had some more tests done but they´re not making us any wiser. I am getting a second opinion from another MD but maybe you guys have more ideas?

  • S-Haptoglobin: 1.2 g/L (0.2-1.9)
  • T3, free: 4.3 pmol/L (3.3-6.0)
  • P-TPO-ak: <10 klE/L (0-35)
  • S-Orosomuciod: 1.0 g/L (0.5-1.29)
  • S-IgA: 1.7 g/L (0.9-1.2)
  • S-IgG: 11 g/L (7-15)
  • S-IgM: 2.0 g/L (0.3-2.1)
  • S-Albumin: 41 g/L (36-48)
  • S-Antitrypsin: 1.3 g/L (0.9-1.9)

I also tested negative for lyme disease and reumathiod arthritis.

Thanks again for all your insights!

link|flag

Your Answer

Not the answer you're looking for? Browse other questions tagged or ask your own question.