Lab Results – The Good, The Bad and The Ugly

I started writing this last week and then got sick so finally getting back to it.  I also realized it was way too long and so I’ve cut out a lot and posting something shorter and will probably do some other posts on some of the stuff I cut out.

When I went for my routine gynecological visit at the end of December, they decided to just run a routine panel of blood tests.  I’ve been pretty healthy the past few years so the last time I had had that done was in December, 2011.  I got the results and some of them have….startled me.  Some results were good, some were bad, and some were just flat out perplexing.

The Good

HDL Cholesterol – 53

Triglycerides – 104

VLDL – 21

Triglycerides/HDL Ratio (calculated by me) – 1.96.

Cholesterol/HDL Ratio (calculated by me) – 4.5

Fasting Blood Glucose – 84

The Bad

TSH (Thyroid-Stimulating Hormone) – 3.41

Total Cholesterol – 225

LDL Cholesterol – 151

The Ugly

Vitamin D – 8.7 ng/ml

A1C – 5.9%

So, what does that all mean for me?

Vitamin D

My Vitamin D level is shockingly low.  It was tested in 3 1/2 years ago and was normal.  I did some research on this and found that low Vitamin D levels are very common.  I don’t think it is common to have them as low as mine are, but apparently lots of people don’t have levels that are high enough.  And, it is really hard for me to get enough Vitamin D from food and many people don’t get enough from the sun.  Also, as someone older I don’t make as much Vitamin D from sunlight as would someone younger.

Given that, it isn’t surprising to me that my Vitamin D is low.  What is surprising is that it is so severely low.  It is especially surprising since it was normal 3 1/2 years ago. That huge drop does bother me.

I did some reading about Vitamin D and low Vitamin D is associated with a host of things. It is not entirely clear to me what the direction of casuality is, but it certainly seems well worth it to get my Vitamin D levels back to a good range.

One that I found interesting was an association with fatigue.  For the past few months, I’ve been very tired a lot. I thought it was because my sleep was deficient, since I’ve had so much trouble getting to sleep.  And, that may indeed be part of it.  But, I wonder now if the Vitamin D deficiency might be part of it as well.

I have been prescribed a fairly high supplement dosage for awhile and then will test again.  I am really hoping that after doing this, I won’t feel as tired. Also, I’ve previously been diagnosed with osteopenia, so I really don’t want to have low Vitamin D.

Thyroid

My gynecologist’s office recommended that I take a low dose each day of Levothyroxine to try to improve my thyroid function.  I read that if your TSH is high, that can be a sign of a low thyroid.  When I was 19 I had surgery for a thyroid adenoma (a benign tumor) so for years I often had tests of thyroid function done, but it was always normal.  Back in June, 2011, my TSH level was 1.58 and results I have from before that were normal.  But, 3 1/2 years later it is now at 3.41!

There is some controversy apparently as to what is a normal level of TSH.  Some think a normal level is around 3, while others think that 4.5 or so is the level.  Even if above that, some apparently feel that no treatment is needed unless TSH goes even higher.  Others, on the other hand, think that normal should be set at a lower level.

After looking it, I decided that while it could be debated whether to treat someone with a level of 3.41, in my case I wanted to try treating it.  I am supposed to take a small dose each day and go back in 4 weeks for a blood test to check my thyroid.

Cholesterol

This has a lot complexity for me.  I know there is a lot of controversy about Cholesterol levels and when to be concerned about high total cholesterol and high LDL and when not to be concerned.  My gynecologist’s office told me to see my primary care physician about this.

In the current results, my total cholesterol and LDL cholesterol are a little high.  On the other hand, my triglycerides are only 103 and my HDL is 53 which are both good.  My triglyceride/HDL ratio is good.

In the past due to high total cholesterol levels and high LDL levels, I took a very low dose of Lipitor and it had a dramatic effect on lowering my total cholesterol and LDL cholesterol and I personally had no negative side effects from it.

In June of 2011, my prescription had expired so I hadn’t been taking it for awhile when I did some routine blood work.  At that time, I was in the middle of losing weight and was at about 175 pounds (down from 207 pounds).  I was following Weight Watchers so was restricting how much I ate, but wasn’t trying to eat a specific type of food.  My total cholesterol was 182, HDL was 45, LDL was 111 and Triglycerides were 128.  At that time my fasting blood glucose was 98 (which concerned me a bit).

I decided that rather than go back on Lipitor at that time, I would try low carb eating.  So, I ate very low carb for a while, then slowly added back in some carbs.  (I avoided refined carbs and the only fruit I typically ate was berries).  By the end of 2011, I was eating about 80 to 100 carbs a day or about 40 to 60 net carbs (carbs minus fiber).  I went back and had my cholesterol and blood glucose checked again.

My total cholesterol had gone up to 205 and my LDL had gone up to 141.  My HDL was almost unchanged at 46.  My triglycerides, though, had gone down to 90.  And my somewhat concerning 98 fasting blood glucose had dropped like a rock to 82.  My doctor wanted me to to go back on Lipitor.  I took it for a little while, but after a couple of months stopped taking it.  We moved and I haven’t had any blood work done until now.

My gynecologist’s office drew my attention to the current 225 total cholesteroal and 151 LDL numbers and recommended that I check with a primary care doctor.   If I do, and if a statin is recommended I would be uncertain about doing it.  It is possible that a new doctor (need a new one since I moved away from where my old one was located) wouldn’t recommend statins. On the one hand, I never had any worrisome side effects from a low dose of of Lipitor  On the other hand, I’ve read that statins are associated with a risk of increased likelihood of raised blood sugar levels and diabetes.  I don’t want that at all.  So it would probably take a lot for me to want to take on that risk at this time.  Of course, I think that this is something where the individual situation is important in weighing the risks and benefits.  At this point, I will just wait and see what happens when I consult a primary care doctor.

Blood Glucose

This is the really scary, but perplexing area.  On the one hand, my fasting blood sugar was 84, which is actually good.  And, my triglycerides were only 103.  I have some medical records of fasting blood sugar tests from some years ago.  Often my results were in the mid to high 90s, which I realize now was not exactly stellar.  No doctor ever said anything to me about it though.  Back in June, 2011, I had a fasting blood sugar of 98.  By the end of 2011, after reducing my carb consumption and avoiding refined carbs in particular, my fasting blood glucose was 82, which is not very different from what it was with this test.

Over the 3 years since then, I raised my carbs a bit (when following Weight Watchers) or by a lot (when I wasn’t watching what I was eating at all).  During 2014, I was watching what I was eating, and my carb consumption was a little higher than it was at the end of 2011, but was still only about 118g a day average carbs for the year (96g net carbs).

I feel that my fasting blood sugar of 84 and my triglycerides of 103 really did reflect what I would expect particularly as compared to my December, 2011 numbers when I was eating a bit more low carb. Basically, those current numbers make sense given now how I was eating at the time.

That is why I was totally perplexed by a fasting HbA1C of 5.9%.  That is prediabetic range and would suggest a much higher average blood glucose level than I would have expected from my fasting blood sugar and my triglycerides.  An A1C of 5.9% apparently equates to an average blood glucose level of 123. Yes, I know that average blood glucose would be different than fasting glucose since it would include blood sugars after meals as well as fasting. Yes, I understand the A1C is meant to show your average blood glucose over a 2 to 3 month period while fasting blood sugar is more of a snapshot in time.  But, as it turns out, my carb consumption over the 3 days before I had the fasting blood glucose test was very consistent with my carb consumption over the 3 month period.

I wouldn’t have been confused if my A1C was 5.9% and my fasting blood glucose had been high normal or prediabetic.  Or, if my triglycerides were high.  But, none of that was true.  The A1C just seems a mismatch. I know that the A1C does have a margin for error, so maybe that result reflects that.

In the end, I guess it doesn’t matter.  When I had researched fasting blood glucose when mine was near 100 I had thought about what I would do if it continued to go up (which it didn’t).  I knew that if I was ever prediabetic my approach would be to frequently test my blood sugar to see what foods raise my blood sugar and to then avoid those foods or determine if they could be modified in some way so they wouldn’t raise my blood sugar.

So, even though the A1C result is a bit perplexing to me, I recognize that could be the accurate result.  So, I have bought a meter and will start testing to see what kind of results that I get and will modify my diet accordingly.  I will discuss with my doctor and in 3 months, I plan to get another A1C test.

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