Takin’ a Peek Under the Hood; Hackin’ My Bloodwork

“Human beings have an inalienable right to invent themselves.” – Germaine Greer 

I recently decided, in an on-going effort to better quantify an n=1 sweet-zone within my health vs performance continuum, to have an in-depth blood panel examined by Austin’s premier Ancestral Wellness savvy practitioners, the Merritt Wellness Center, and specifically by their resident nutritionist and bloodwork guru, Holly L’Italien.  Holly’s grasp of bloodwork analysis from an Ancestral Wellness prospective is unsurpassed.  She’s an as-yet undiscovered rockstar in the larger Paleo community, and yet another reason why Austin can tout itself as *the* epicenter of Physical Culture.  As we’ll see in this ongoing series, she possesses a laser-sharp insight into the nature and inter-workings of what is an extremely complicated weave of genetic and epigenetic cause, effect and (at times, and at first glance, misleading) correlation.

So what, at a thirty-thousand-foot-view, did my bloodwork reveal?  Well, it begins to tell the story of someone who’s pushing the friggin’ hairy-edge of the health vs performance continuum, that’s what.  Big surprise, huh?  I’ll turn this over to the resident expert for a more in-depth analysis in just a moment, but what we can see aligning here are indications of elevated cortisol  beginning to jack with overall health-indicator parameters in some not-so healthy ways.  What might this elevated cortisol result from?  Well, for starters, how about a recently-turned 47 year-old who insists on training (and for the most part, living) as if he were still a bullet-proof, 20 year old collegiate football player.  Add to that already-volatile mix, an exhilarating (though friggin’ taxing)  24/7 professional life, and a personal life that has endured every major stressor you can imagine — marriage, divorce, a high-stress prior gig (in Big Pharma, for God’s sake!), the raising of teenagers (four of ‘em!!), a complete, utter and drastic career change, moving cross-country, the buying and selling of homesteads in a beyond-shitty market, the passing of a daughter… and hey, those are just the biggies.

So did I do like any normal human being would, and take my foot off of the gas pedal during all of this?  Yeah, right.  Is moderation in my vocabulary, even now?  Uhhhh, no.  Hell, if anything, I just mash the pedal even more when I’m stressed, in some kind of manic (obsessive?), feed-forward loop.  It’s my wolverine/honey badger nature to do just that.  Red-lining workouts and/or pushing physical limits has always been what makes me feel most “alive”.  So am I addicted to the adrenalin rush that being in the extreme produces?  Yeah, probably so.  And I have been ever since I was a kid, so I guess I can blame it on a genetic hard-wiring thing.  But the question now is this:  do I need to back off?  And if so, where?  And, maybe even more importantly, can I restructure things so as to satisfy my psyche, as well as my health?

So what follows is the give-and-take between Holly (italicized) and I; the hacking of Keith’s bloodwork.  Feel free to join in the fray.

First up, let’s look at the hard numbers as reported by the blood-draw lab.  The draw was completed following a 12-hour fast, and 24-hour exercise fast:

And now for some insightful analysis, here’s Holly:
In reviewing Keith’s bloodwork lab values, the two things that stand out are the BUN and Total Cholesterol (301 mg/dl) values.  In Keith’s case, the BUN (Blood Urea Nitogen, 25 mg/dl) and creatinine (1.25 mg/dl) are most likely elevated due to strenuous exercise.

Regarding cholesterol, the pattern that we are seeing here is indicative of Familial Hypercholesterolemia (FH).  FH is a genetic lipid disorder that causes abnormal lipid values. There are five types of FH and they each require different management strategies. On Keith’s mother’s side there is a family history of heart disease, so this is something we will want to keep an eye on.

However, the ratio of HDL (66 mg/dl) to triglycerides (64 mg/dl) is good. Typically this means that if we took a look at the breakdown of Keith’s LDL (222 mg/dl) into the different sub-particles, we would likely find there are more of the good light fuffly kind, and few of the small dense kind that can signal a risk for heart disease. Keith’s c-reactive protein (.22 mg/L) looks great, which is another indicator that his relative risk for heart disease is low.

From a ‘wellness’ or functional perspective, functionally low protein (6.8 g/dl) and phosphorus (3.4 mg/dl) suggests low stomach acid affecting the ability to digest protein. Stomach acid will decrease in times of stress. Sodium (141 mmol/L) is elevated according to functional ranges. This, in conjunction with low LDH (69 IU/L) and an A1c (5.4), suggests there may be some adrenal fatigue wherein the adrenals are unable to keep up with changes in blood sugar.  Low calcium (8.7 mg/dl) is often an indicator of thyroid issues, and the low thyroxine (T4, 5.8 ug/dl) supports this.

His white blood cells are functionally low (4.7 x10E3/UL), which can also be indicative of chronic stress, or possibly a hidden infection.

So it’s important to see that all these things are inter-related: impaired adrenal function is often associated with impaired thyroid function. Both are affected by stress. Cholesterol can be elevated in the presence of a sluggish thyroid. Cholesterol can also elevate in adrenal stress in the body’s efforts to produce more cortisol to handle the stress. LDL cholesterol– the ‘bad’ cholesterol– is necessary for life and is the precursor to all the sex and stress hormones. And finally, stress and the resultant high cortisol can impact thyroid function.  So — in classic chicken-egg scenario drama — which happened first?

If we were just looking at the labs, we would have recommend following up with a more in depth thyroid panel which looks at the free (active) thyroid hormones T3 and T4. We would also want to see if there are thyroid antibodies present. We might also order a lipid phenotyping panel to see which of the five FH patterns Keith has. Finally, we might want to see a VAP panel to ascertain what Keith’s LDL is comprised of– more of the light fluffy, or a proliferation of the small dense?

However, it is said that the patient interview is 80% of the diagnosis. When we had a chance to sit down with Keith and learn a little bit about his lifestyle, we learned that he was working very long hours, and burning the candle at both ends. This is a significant cause of stress all by itself, made much worse because Keith often doesn’t eat anything until 3 or 4 in the afternoon. This is a huge stress on the body because the adrenal glands have been working hard all night producing cortisol to balance blood sugar during the sleeping hours. By forcing the adrenal glands to keep producing cortisol all day as well instead of eating is an additional burden that can only be sustain at the expense of other organ systems.

Keith says he is not hungry in the morning, which makes sense given the stress his body is under. In times of stress, your body goes into the ‘fight or flight’ mode, shutting down the ‘rest and digest’ systems. One of the results of this is low stomach acid, one of the symptoms of this is no appetite or even nausea in the morning. The functionally low protein and phosphorus on his blood test support a diagnosis of low stomach acid.

Given that stress and cortisol has such wide ranging impact, we elected not to pursue the thyroid and cholesterol panels at this time. Instead we’ll take a closer look at what is going on with Keith’s stress hormones with a salivary hormone test which require Keith to provide samples four times a day. This will show us not only the amount of stress hormones he is producing, but will also show us how his hormones are cycling (circadian rhythm).  Finally we’ve asked him to make some lifestyle changes to support adrenal health and take some of the stress of his system:

1) Eat breakfast!
2) Eat a little something every 2-3 hours before he gets hungry. Hunger is an indication that the blood sugar is already low and the adrenal glands are already forced into action to produce cortisol to bring the blood sugar up.

Then we will retest in about 3 months to see how dealing with this major stressor affects his labs. At that time we will also follow up with whatever tests necessary to feel confidant that Keith’s health is optimal.

~

So I’ve taken Holly’s advice and have begun eating a small, protein & fat-heavy breakfast in the morning.  I have to say that this small step does have me feeling better (in a “more energy” kind of way) during the day.  I am eating more often too, though maybe not at a frequency of every 2 – 3 hours — my client load and personal training schedule doesn’t normally allow for such — but I’d say that I’m now at about a 5x/day frequency, with maybe 2x prior to noon (remember, though, that I begin each day at approximately 4 AM), and 3x thereafter, with my last meal of the day (about 8 PM, most evenings) still being the largest.  Bedie-bye is usually not until about 10 PM.  I know a couple of more hours of sleep per night would go a long way toward keeping cortisol at bay but, realistically, that’s just not going to happen anytime soon.

This is a perfect example of n=1 manipulation of what many consider to be a Paleo/Primal lifestyle “given” — the daily 5 (ish)-hour, compressed, evening feeding window.  Of course it could certainly be argued that the 5-hour feeding window is the gold standard, and that I’m leaving behind a much healthier option to “cover” for my 90 mile-an-hour lifestyle and intense training regimen.   As an epistemocrat, I’ll weight these options, best I can, free of my own confirmation biases.

And I do have the salivary hormone test kit on hand, but haven’t yet drawn or submitted my samples.  Of course, these readings will now be skewed a bit from my original “blood-draw baseline”, since I have already implemented Holly’s two suggestions, and we’ll have to take that into consideration when the results are in.  So what’s keeping me from jumping right on this test?  Meh, I have to be caffeine free for the entire day.  If you know my proclivities toward a heavy daily joe intake, you can see right off where this is a bit of a problem 🙂 Seriously though, I intend to get on this test in the very near future.

So that’s it, folks — let’s begin hacking this kids bloodwork.  Your ideas and/or comments are encouraged!

…and as you can see, I’ve already begun taking it easy 🙂

In health,

Keith

72 responses to “Takin’ a Peek Under the Hood; Hackin’ My Bloodwork

    • Skyler — yep, this is PFX12 material. I was quite sure we’d get a wide range of quality opinions here — especially for a blood profile that is not exactly “normal”, taken from someone who’s lifestyle is anything but normal. “Normal”, of course, being in reference to the prevailing culture.

    • Shit bro, your looking to burn out or what? How much of a wake up call do you need to change your lifestyle and start eating healthy?

      You think a Dr Atkins style diet is healthy just cos its loaded with organic coffee? lol!

      You want to look like Loren Cordain or Sally Fallon?

      You want to get bitch tits like Mark Sisson from roids?

      Get back on the carbs and ditch the animal protein. Look up Dr McDougall before you kill yourself brah.

  1. I love that she talks about checking your daily hormone rhythm. Have you read “Mastering Leptin” (3rd Ed.)? They go into the daily hormone cycles in depth in that book! I highly recommend!

  2. Keith, please slow it down! I have always enjoyed your posts. I am a twice/week, 8 minutes per workout Body By Science kinda guy. Just turned 47 as well. And work in big pharma of all things (Safety and Health professional, I’m not pushing the stuff). I’m 5’11” 165 lbs 8% bf. You could break me in half! Haha. If you went to a short, twice weekly BBS style workout, do you think your numbers would improve?
    Also, what the heck were you doing all those years in big pharma? I’ve always meant to ask you.

    • Not sure the numbers would budge much with a way reduced workout load. In any event, my psyche would suffer greatly & not be worth the cost 😉

      I was in in drug manufacture validation. A liaison, of sorts, between the FDA and the manufacturing pharmaceutical company.

  3. Unsurpassed for ancestral blood work? I have to object since Dr Lane Sebring has been doing Paleo based medicine even before Cordain published the book in 2002. In all likelihood, Dr Sebring’s clinical application of Paleo constitutes the single largest data set of case studies. Cordain & Sebring were both part of the late Robert Crayhon’s Boulderfest annual gatherings where Paleo came to life. Dr. Sebring is located down the road from Austin in Wimberley, Texas. Your blood panels would have been a page or two more with his comprehensive analysis.

  4. Keith

    Firstly, thank you for being brave enough to share this data with everyone. At last I now have a dataset of significance with which to compare my data and others. Thank you.

    Secondly, I am trying to find out what this data says about your insulin sensitivity, as I read elsewhere that this is one of the more prominent indicators of our metabolic fitness.

    • Hello,

      With regard to insulin sensitivity, we look at patterns of several markers: fasting blood glucose, triglycerides, cholesterol, uric acid, HDL, LDL, hemoglobin A1C, LDH as well as lipid phenotype if the situation warrants.

      Although his triglycerides, cholesterol & LDL are elevated, his blood sugar & A1c are normal, and lactic acid dehydrogenase (LDH) is functionally low. Low LDH is a pretty good marker for hypoglycemic issues. Glucose has a 24 hour window and may look normal, but the LDH comes from glucose and represents a better long-term view of glycmeic condition. So this test would indicate that Keith does not have an issue with insulin resistance — which is great — but still may blood sugar management challenges due to low blood sugar.

      Holly

  5. Keith,

    In response to your post, I plan to make this weeks BBS WOW about this topic.

    My only recommendation is to wad this thing up into a ball and throw it away. Holly is basically reading tea leaves here. To draw conclusions off of values that fall within the normal range of a given test is absolute folly. The normal values are based on population statistics AND the precision of the test itself (precision=repeatability of the test’s performance). Applying population statistics to an individual in order to infer the presence or absence of a health condition is not just dumb….it is not possible. This error is only amplified when you infer derangements in upstream/downstream metabolic processes. Drawing conclusions about Thyroid function from a phosphorus level that falls dead center of the normal range is silly. No matter how much linking data you collect, you cannot call something “functionally low” when it falls dead center in your population statistics as well as your measuring instruments precision/margin of error.

    More importantly, when we want to use a test’s sensitivity to test for disease, this is predicated on this presence of disease. If a disease is not present, then the test is worthless…it is like tossing a two-headed coin. There MUST be disease present….there MUST be a high pre-test probability before doing a test for the results to have ANY meaning. As an obviously healthy individual without any disease symptoms there is nothing on this panel that is useful to you. This concept is one that I fight with admitting internists on a daily basis. “Why did you order a basic metabolic panel instead of a comprehensive/”….My answer: “Because the patient had no disease symptoms to suggest a pre-test probability that would make any information gathered meaningful”. Remember, test sensitivity can only occur in the presence of disease…No disease=No Sensitivity=test data is meaningless.

    A few specific comments: Your BUN and Creatinine are high because you have a lot of muscle mass. BUN is the nitrogen from protein turnover in your muscles. Creatine is the metabolite of creatinine. Both of these agents have a constant rate of turnover, so they are presented to the kidney at a constant rate and therefore are eliminated at a constant rate (first order kinetics). For this reason you can infer kidney function. If your kidneys fail and BUN/creatinine are produced continuously, they will stack up and read high on your blood work. However, your baseline level will be proportionate to your muscle mass. A 100 pound woman will have a base line creatinine of 0.6, a muscular male will have a creatinine of 1.4.

    Your cholesterol has nothing to do with anything. You have no symptoms of cardiovascular disease, so there is NO pre-test probability and no conclusions that can be drawn (especially that you may have familial hypercholesterolemia). You have a lot of circulating cholesterol because your are metabolically and hormonally active. Hemoglobin A1C also for similar reasons. You are releasing a lot of stored glycogen into the blood stream with every metcon event.

    You should not be eating breakfast when you are not hungry based on these results whatsoever. I would agree that you may have some degree of adrenal fatigue, but not because of any data on your labwork. Instead, I suspect it because of the volume of high intensity work that you do. You are simply on the part of your health performance curve that pushes that envelope somewhat. But who cares? You knew that anyway, and that is where you want to leave.

    My advice. Keep doing what you are doing. Throw away this labwork, and for goodness sake DO NOT do any further testing based on results of this test. This is the slippery slope that this sort of testing begets and it is where the real harm lies. For instance (this is a common one): don’t go get 250 chest x-rays worth of radiation to find out what your coronary artery calcium score is because your total cholesterol was 300….sheez!

    • Hi Doug,

      Thanks for taking the time to respond to Keith’s post! I’m glad to see we agree on many things: BUN and creatinine are high due to exercise and muscle mass, and you’re right — using phosphorus to evaluate thyroid would not make sense (though functionally low calcium can be secondary to thyroid dysfunction which is what I mentioned), that there may be some adrenal fatigue here, and that Keith’s cholesterol is unlikely to lead to cardiovascular disease.

      Regarding the tools we use to evaluate labs – the wellness values aren’t arbitrary. They are established by endocrinologists and functional medicine practitioners, and are recognized as values a healthy individual would tend to have, rather that what a “not obviously sick” individual would have. This is the difference between lab values and wellness values. For lab values to make sense, you would have to live in a black and white world, where there’s only sickness and wellness, with nothing in between. So I’d have to politely disagree that “As an obviously healthy individual without any disease symptoms there is nothing on this panel that is useful to you.” as I’m not interested in waiting until Keith is sick and has symptoms to THEN run a lab test to figure it out.

      As you probably already know, lab ranges vary from lab to lab, between lab companies, differ depending on areas of the country, and are based on values that clearly indicate pathology. We look at values that are indicative of wellness. And because we understand that one person’s ‘normal’ can be different that the general population’s ‘normal’ we tend to look at the entire test and the patterns of the results rather than a single line item’s value. That’s the value of running larger, more comprehensive tests.

      When we met with Keith we did discuss the advantages and disadvantages of further testing. We told Keith that the lipid phenotyping panel may be an interesting panel to run, but the drawback of this panel is that it will assign the patient into one of five categories– there is no ‘does not apply’ category. So if you run this test, it will always come back as the patient having one of these five FH patterns. And then you are faced with what to do with the information. Certainly if the patient is doing well in all other aspects like Keith is, we would not recommend any dietary changes, but we would know what treatment approach to use should his situation change down the road. Keith’s decision to go with the Adrenal Stress Index was largely for the purposes of discussion and to evaluate the theory that adrenal stress was having an impact on his lab results. Chest x-rays are another thing we agree on — they certainly are not helpful in predicting anything : )

      It’s great news that eating breakfast is giving Keith more energy– Keith needs it for his marathon workdays and workouts, which are certainly not typical for your average Paleolithic man! Exercise and a great food choices are serving him well. And if he ends up saving a little money at the coffee shop, his wallet and his adrenals will be that much better off!

    • Definition of multiple hypothesis testing. The level of deviation accepted as significant must be held to a more and more stringent standard as you start fishing for more hypotheses. If a bag is full of 1000 blue green balls and 1 red would you be more impressed if you pulled out a red with one pull or with 900?

      Don’t fish in lab values without calling up the esteemed Dr. Bonferroni first 🙂

  6. Thanks to Doug McGuff for his analysis of Keith’s blood panel.

    The state of the art with medicine does exactly what McGuff says; it tests for known disease. Critics in the biomedical field of genetic/molecular biological exercise physiology, however, go a step further. Most diseases tested for are secondary and tertiary results of metabolic erosion occurring undetectable to testing, and for years in development. Many are still regarded as if they were stand alone conditions rather than members of the family of chronic degenerative disorders. Portman & Ivy’s recent popular book Hardwired for Fitness is perhaps the best layman’s introductory guide – using metaphors of circuits and switches to communicate concerning metabolic pathways and the circadian (genetic based) cycles occurring within the 24 hour day. On that basis they deem breakfast the most important meal of the day – as it always has been for me.

    Hardwired for Fitness stresses the importance of daily activity, and uses the NEAT metaphor to make the point: non-exercise activity thermogenesis. Exercise can be a component to NEAT, while NEAT should be considered as a demand throughout each day, not confined to salutary occasional activity under the rubric of ‘exercise.’ Maybe that’s why those successful examples of longevity such as Bill Pearl, Red Lerille, and Jack La Lanne include working out six days weeklyas part of their NEAT solutions.

    It should be added that Ivy & Portman stress our Paleolithic genetic roots, and that their studies began as exercise physiologists charged with attainment of peak performance by athletes. They found the same natural rules of fitness and nutrition apply equally to non-athletes in quest of improved health.

  7. Keith,

    I had a bit of “lysdexia” in the 4th paragraph. Creatinine is a metabolite of Creatine. When creatine is metabolized to creatinine it moves to the bloodstream and is eliminated through the kidney.

    Ken,

    My comments are not really predicated on the state of the art of medicine and its wrongful focus only on disease. Rather, it has to do with the nature of testing and the laws of reality. Sensitivity (detecting something awry) is dependent on the presence of the thing you are looking for. If you have no good evidence of its presence then you really cannot use the test. You are like the guy looking for his car keys under the lamp post “because that’s where the light is” even though they were lost in a dark alley.

    WRT medicine’s focus on disease. It is not just that doctors are a bunch of knuckle draggers who operate under “when your only tool is a hammer, your only tool is a nail”…it’s that there is so damn much business on the pathological end of the spectrum. There is such a crush of people with their “wheels falling off” that there really isn’t much room for anything else. I recently saw (I shit you not) an 80 lb 4 year old with an ear infection. In the middle of a busy ER I spent an hour educating the mother on dietary and activity modifications she could make for her child. I spent another half hour typing out an instruction sheet for her. When I came back to give her the information, her other child (about 10 months old) was drinking Mountain Dew from a bottle that had a nipple that screwed on to the soda bottle. So to the critics in academia can do as Col. Jessup said…grab a rifle, climb up on the wall and man the post for a while. It is not simply that we are operating under the wrong paradigm….we are buried by it.

    • Doug:

      I’ve taken to polling audiences regarding the other side of the coin: how many of you have had ‘health education’ in school? The real surprise came a month ago when lecturing at University of Texas Medical Branch in Galveston to a group of med students and faculty. The question drew a blank stare. Not a one of them had. As both physicians and physicians-to-be, there was no indication of a moment of insight, of the emergence of an ‘aha’. Being shameless, I went on to flesh it out in context that the best part of 35 major diseases constituting a current/growing pandemic are non-infectious, non-communicable degenerative disorders – bringing staggering social costs in terms of preventable individual and social angst and burdening our economy.

      Thanks to Keith’s recommendation I’m thoroughly enjoying Rebecca Castro’s The Watchman’s Rattle, a book about gridlock resulting in catastrophy, while the way out of the trap amplifies Jonas Salk’s meta-biological evolution as survival of the wisest. I’m convinced a grassroots evolution in health/Darwinian fitness education is called for. My most recent blog entry concerns The Genomic Fitness Literacy Project: your insights born of hand to hand fighting in the trenches are most welcomed!

  8. Great stuff, thanks for posting so much in depth info on yourself Keith.

    While I think Doug does have a point, there’s also no harm in doing self experimentation. If you are eating when you aren’t hungry and it has positive effects, keep doing it. I once tried a mandatory breakfast experiment and found it disastrous, so I stopped doing it.

    You really can never stop tinkering with yourself.

  9. “When I work them up, I find no medical emergency, just what I have
    come to call “diatensionolesity”—type II diabetes, hypertension, a screwed-up blood-lipid profile, and obesity.” – Dr. Johnathon Sullivan, MD, PhD. http://startingstrength.com/index.php/site/barbell_training_is_big_medicine

    Adding to this, I agree with Dr. McGuff. We are truly burred by the wrong paradigm. As a firefighter and paramedic assigned to a busy rescue (ambulance) unit for the past 10 years, not only do I see all to often what Doug described of the fat kid and his sibling downing soft drinks but, the very people providing the damn service in the first place, i.e. fat doctors, hunched-back nurses and, out-of-shape firefighters “sitting” right around the corner from a heart attack. I try every day (well, every third day) to have a voice and educate people on the same principles that we all share here; that of the likes of Ken, Doug, Keith, Skyler, Robb Wolf, etc. The problem I run into though, is that I think it’s going to take more than just a grassroots movement. Allow me to have a bit of an ego for a moment here (ala DeVany-ish), and say that I look like and am the epitome of health. I spend my days educating and talking people’s ears off about healthy living, eating, exercising, etc. I’ve written exercise programs, nutritional guidelines and provided endless sources for many friends, family members and mostly co-workers who all have asked countless questions over the years about said subject. Everybody tries my suggestions and advice for a time (never long enough) and then bows out… either searching for an easier way or returning to old habits. Then of course, I get the regular push-back and the conventional “wrong paradigm” touting, “No body eats like that. You can’t work out that little (or that much) and sustain it. What are your credentials, you’re only a fireman! I But, Dr. Oz says grains are healthy.” You get my drift. Then, to top it all off, another bodybuilding co-worker steps in, gets everybody on Jacked-3d and eating all kinds of crap and everybody feels great and seems to be “making gains” (or so they think). But, I digress. Given this, I’m sure my cortisol is somewhat elevated as well, given the amount of studying I do, as I’m currently completing my education (in conventional medicine) to move into a field where I can have more autonomy, more of a voice and, hopefully more time with patients in educating them on optimizing their health and well-being. 15-20 minutes in the back of a rescue unit bouncing up and down the pot-holed streets of the nation’s oldest city good ol’ St. Augustine, FL surely isn’t enough.

    • I’m going to quote Doug’s former employee Terry Carter here:

      “Knowledge is for your own use.”

      Knowledge into action matters only for the user. To anyone else knowledge without action is just noise and if they’re not in a position to hear your advice you’re better off saving your breath.

      If they really want the info, let them bother you a few times before you give advice.

    • Doug says it best: “It is not simply that we are operating under the wrong paradigm….we are buried by it.”
      Where did that paradigm originate? in labs? With Pasteur? Nope. With the strategic planning of John D. Rockefeller and the Carnegies to dominate medical education and research with their pharmaceutical industry monies, creating several monopolies (see Lily Kay’s Oxford University Press monograph The Molecular Vision of Life: Caltech, the Rockefeller Foundation, and the Rise of the New Biology for an historical study devoid of conspiracy theorist nonsense. Dr Bortz in his Next Medicine informs us that 18% of the DNP is the health care system; how much more is the cartel of Industrial ag-ec and livestock? Our domestic economy is invested in making us sick, degenerative, disabled, with concomittant suffering and financial disarray. “we are buried by it” both metaphorically and physically!

      When I put together the Wimberley Valley Think Tank to come to grips with what “health, wellness, healing, and fitness” mean in a multi-disciplinary, whole systems orientation, the ground rules included an etiquette of disagreement, an orientation to resolving differences by means of nurturing a new paradigm. It’s worked. I’m’ not bragging. I’m inviting others to envision and imagine along those lines.

      My ideal fantasy would be to get together some of you – some with whom we have some history of major disagreement! – worthy allies! To form a think tank pursuant to the business of paradigms, the business of health education. My last blog entry, The Genomic Fitness Literacy Project is such an invitation. A several day blues sky strategic planning session would be ideal. Second best is establishing a website to do something similar given the wonders of the web for bringing folks separated by miles and bound in a passion of the possible together. Even Skype meetings. Our differences are of fundamental importance in a think tank – we not only sharpen each other but expose where the dominant paradigms’s Emperor has no new clothes. Intended outcome? First, a website organized as a meta-model for public educations. Second, an incubator center for developing new paradigm businesses. Rockefeller & Carnegie, along with all that’s followed, demonstrate what Lee Iococa said: don’t get mad, get even.

      Why am I so passionate? We’re at an evolutionary crossroads, a time of whole systems melt down – look only at the pathetic evidence reported out of Washington daily. Pure cognitive gridlock, pure dispassion, the archetype of a constipated elephant. All efforts aim at individual responsibility being the key. Nonsense. Both individuals and bigger systems (e.g., Congress) are deadlocked in an inability to think forward. With a multidisciplinary, synergistic meeting of heart/minds, learning to work together, shamelessly challenging inadequate paradigms, we can do it – making it our business, making ourselves necessary. Most of us will NOT succeed by ourselves – we’re fragmented, without an espirit de corps.

      I have an advantage most of you don’t. But I don’t want things to get to the point where in 20 years you’ll say the same thing. I’m 67, with 53 years training experience. Things have gotten so horrible with the pandemic and whole systems paradigmative failure, one kept alive by greed and narcism, we’ve got a chance never before known in my life. Being 67 is an advantage how? First, all bets are off on longevity or heretofore accomplishments – my orientation as an elder is on generations to come, perpetuity of our species rather than gaspingly slow extinction due to misdirection. My passion is for the species and with no concern for making a name for myself or such bullshit. Can I pass that passion for perpetuity by means of survival of the wisest to y’all. Can we
      invent ways of becoming a business and educational force. Can we make our vision, our inspiration, our passion – make it necessary rather than dismissed as marginal.

      As Doug said: It is not simply that we are operating under the wrong paradigm….we are buried by it.

      Let’s resurrect ourselves from the tyranny of stupdity and institutional ignorance.

  10. The following is some insight from Dr. Jack Kruse (http://jackkruse.com/jacks-blog/), via Facebook:

    I looked at it and I am sorry to say I don’t see things the way Holly does. Without more data there is no way to tell. I think his labs reveal elevated cortisol and not a fatigue pattern and his WBC’s fit this perfectly. I completely disagree with her assessment there. I think his LDL lipid panel is indicative of these things being likely…..elevated cortisol at night, high rev T3 causing a reactive lowered T3. Once you fix the rev T3 the LDL cholesterol will drop, This is also why his HDL is not higher based upon his TG levels. A relative “lowered HDL” will reveal (upon better testing) a lower than normal DHEA Causing poor sleep and proved by elevated IL-6), low free and total testosterone levels because of lowered conversion of LDL to pregnenolone and due to a steal by the altered cortisol rhythm. this in turn will cause altered salivary progesterone(rarely tested in men but results in poor cognition and memory recall on testing due to lower BDNF) and a major lack of pregnenolone. The relative lowered HDL shows he has a serious “leaky gut” not caused by an infection, but by altered ultradian rhythm in cortisol, pregnenolone and leptin and likely prolactin release. I bet Keith’s blink test would fail under my exam and I bet his dopamine levels are poor. His HDL should be way higher based upon his other numbers because his diet appears clear due to lowered HS CRP. The real tell in his whole exam to me is the serum ferritin elevation. That is a potent clinical sign of acute liver stress as it is an acute phase reactant made in the liver in elevated cortisol cases. It also is shown in his elevated fasting BG at 91. HIs predicted FBG with his TG level should be below 85 and its not because he has increase gluconeogenesis happening. His sleep is definitely not close to optimal and I bet his night time EEG would show low voltage and poor REM cycling. Moreover, he would not have more than two cycles of sleep and those cycles would be seriously shortened in duration. I also would predict a lower than normal IGF1 level and a lowered vasopressin level. I do agree with her that his ultradian rhythm for pepsin is off and this will effect his ability to absorb protein later in the day and his body comp will never get to optimal because of it. Moreover his brain wont be optimal in sleep, sex or cognitive function because of the cumulative effects of a problem in the liver, protein absorption and complete circadian breakdown. His neolithic life needs to be reintroduced to his paleolithic epigenetics. That is what I see.

    More food for thought…..Here is a word diagram of cortisol release relative to brain structures. Cortisol is great for short term adaptation to situations. Detriment occurs with long-term cortisol disruption of proper signaling:
    • Disruption of immune response (the reason for his altered WBC shift)
    • Protein loss (surprise two!)
    • Growth and reproductive disruption (sex steroid crashed)
    • Bone loss
    • Brain deterioration

  11. If you ever want help kicking the coffee habit (or is that blasphemy to even mention?) I know a great hypnotherapist in Austin. Thanks to her I haven’t had a drop of caffeine in almost 7 months.

    Good luck with the breakfast thing. I hope that habit turns things around.

    • See Doug’s post about huckin’ the ol’ fix over for a stout cup o’ joe… 🙂

      Yeah, on a serious note, it probably would hurt any to cut back a bit, if no other reason than to test my will power.

  12. Keith,

    AAARRRRGGGGGGGHHH!

    Your WBC’s are fine. THEY ARE WITHIN THE TEST’S NORMAL REFERENCE RANGE AND THAT IS ALL YOU CAN SAY. The “low” reading may be due to imprecision of the measuring instrument alone. This is true of everything with an up or down arrow beside it, except for your total cholesterol, and I hope you know not to worry about that!

    If we were to take 20 comprehensive panels such as this and 20 random asymptomatic people and blinded the interpreters of this data to the background info of the people that the bloodwork was drawn from, the ability of the interpreters to match the data sets to the appropriate people if given their background AFTER THE FACT would be no better than a random matching (and if it were it would not be statistically significant-exceeding chance alone). Therefore, interpreting anything from the “patterns” in the labwork is also not possible.

    My advice is to go have a great workout at EE and then huck your fixie on down to Thunderbird for a nice double shot red-eye.

  13. Keith, awesome post, and discussion all around.

    One thing I wanted to point out that no one else seems to taken notice of … your Vit D levels are awesome!

    Assuming its accuracy, I’m sure you expected nothing less, but thought it was worth pointing out anyway, even here to “the choir”.

  14. Buried by the wrong paradigm…well stated Doug. I would like to reserve the right to use that in the future 😉

    Unfortunately, there are literally those buried six feet deep because of the focus on the wrong paradigm.

    Practitioners should wake up and follow the money trail that leads back to opportunists capitalizing on the “fix” in pill form for any number of misleading problems.

    I am hopeful for the momentum and impact of the new paradigm – Thank you Keith, Doug, Ken, Lane, Skyler, and the many other contributors on the right track.

  15. Awesome discussion here — and a big thanks to everyone for their input! Just the sort of lively give-and-take that I was hoping for.

    A couple of things that I should have included in the original post, but didn’t think of at the time:

    1) My sleep, though short (usually 6 to 6-and-a-half/night) is rock solid. Maybe too solid? I rarely remember dreams, if that means anything (blunted cycles?). When left to my own devises (weekends/etc.), I usually sleep about 8 hours/night. I am always refreshed when I wake up, though the thought of grabbing more Zzzzzs *is* appealing for the first few moments after waking…before that first cup of joe, anyway 😉

    2) I don’t *think* I show any outward signs of diminished sex hormones — my drive is still teenager-ish, and my muscle mass/hardness has only been greater when I’ve trained specifically for such. My mood is generally up, and my training is as strong as ever. If this is low T, for God’s sake keep me away from the injectables 😉

    • Since you mentioned it, I’ve looked through the report several times not finding testosterone volumes – nor homocysteine. I do find the report a little challenging for readability but don’t think I missed either. Can’t imagine for you whey either were omitted.

      Rock solid is subjective. Ivy & Portman include a chapter about it, including how average length of nightly sleep has decreased in the past quarter century, inversely mirroring increased obesity. Think you’re undersleeping unless napping or with advanced mindfulness skills.

      Remembering dreams is a whole art of practice in and of itself, and can culminate in lucid dreaming – gaining skills in being wakeful within the dream. After all, parts of you do the casting, scripts, costumes – in short, you’re the whole production company of your dreams. Dream recollection can be a useful skill.

      • Oh, I *know* I’m undersleeping. As for hormone levels, I didn’t order that panel — increased cost with no outward indication of need. Something I may consider in the future, though — food for thought, if nothing else.

  16. Keith,

    None of the interpretations of your bloodwork seem to match the reality of your experience. Pay attention to this fact. Whether normal ranges are based on (as Holly says) healthy subjects or not obviously sick subjects, it is still a range defined by the population you are measuring and the precision of the instrument, and you are within that range on every test that Holly has marked with an up or down arrow (except your total cholesterol). I guess you should be a nervous, pudgy twit with erectile dysfunction.

    I also doubt the reference ranges are anything special. They look just like standard Labcorp labs to me. The reference ranges are the same as those used at my hospital. That said, I bet I can find a set of labs in a patient that match the improvements that these experts would like to see….and I bet I can find them in blood drawn from a patient in cardiac arrest.

    I have actually had internists not want to admit a patient because their labs were “stellar”. The patient was so sick I would not leave the bedside. While holding the portable phone I was able to conclude my argument by saying “never mind the patient just went into cardiac arrest”.

    • Excellent. I guess I should note as well, that I would never have had my labs done if I were going strictly by how I feel. Yeah, there are some days where I’m burned-out, and I think that I need to slow down — always fixed, by the way, with a relaxing weekend off and/or a day or two of *not* going gangbusters. Imagine that! 😉 I do have to say, though, that getting back to eating a little something in the AM has been a game-changer for me. Put that one in the “duh!!” category, I suppose 🙂

    • Doug:
      In related matters, Frank Booth (Biomedical Center, U of Missouri) holds that control groups of fit persons should be established in relation to a random general population the Lion’s share of which is sedentary. Given your backgrounds in both medicine and fitness, I’m eager to learn your insights into this one. Thanks in advance.

  17. Keith,

    I could tell you that you are probably overtrained without taking a drop of blood from you. However, you are a special breed that should enjoy their gift. For example: you could definitely make it as a Navy Seal or Air Force PJ. When I was in the Air Force I helped develop an animal lab to teach emergency procedures to the PJ’s. To a man, they all acknowledge that their ” physical training” was not done to improve their physical condition, but instead to identify who amongst them had the constitution to survive extreme “behind the lines” conditions. You either have that or you don’t. If you are one of these folks, you also adapt quickly to changing exercise demands.

    It does not take bloodwork or rocket science to say that you might benefit from backing off for a while or perhaps eating breakfast (remember it is INTERMITTENT fasting). However, I also vote that you should not back off for too long. You have the gift and you should enjoy it to the fullest. You only get so many workouts in this lifetime. Keep on rockin’ brother.

    • Thanks, Doug. What’s interesting is that the first couple of weeks of football camp operates under the same premise of initial special forces training, with the object being that of weeding-out, *not* making better athletes/soldiers. Unfortunately, some training programs (not mentioning any names 😉 ) model themselves after those “weed-out” periods rather than what those same S&C or military camps look like following the initial wash-out period, when the emphasis then shift to refining inherent athleticsm/warrior ability.

  18. You know, it’s sort of a head scratcher why the suggestion that eating breakfast is being meet with such violent opposition. Which leaves me wondering if perhaps there are some misunderstandings here…

    Could it be that I tackled Keith while he was sleeping and took a blood sample against his will to analyze for my own evil purposes? Nope. Keith is a friend who asked if I could do a thorough blood work evaluation and ‘report everything I see’ for the purposes of this blog.

    Maybe we are proponents of making lab ranges lower so that more people fit into disease labels, like what was done by the pharmaceutical industry with cholesterol values? No to this one as well. However, we are also not proponents of the ‘wait and see’ attitude that is practiced by allopathic medicine when they will wait until a patient is obviously sick and then write a prescription.

    And we do see our fair share of patients whose labs look “stellar” and yet they are struggling with some health issue. That is why we don’t rely on labs alone — we actually talk to our patients. Yet another difference between what we do and allopathic medicine. We don’t always suggest additional testing — only when it seems relevant.

    Keith’s labs did have values that stood out — you can see them — they are in bold and in fact, literally stand out. I never suggested that this indicated that he was sick and required medical intervention. But they are clues to how his body is functioning, and given his family’s heath history, it would be prudent to at least acknowlegde the cholesterol. But again, I never suggested medical intervention. More importantly, as the patient, Keith has the right to know what these values might indicate. It’s our job as practitioners to educate the patient so that they can make informed decisions about their own health.

    By our measure, the other values mentioned do suggest some degree of stress, but I never suggested that Keith reduce his workload or cut back on his workouts. Instead we looked for an area that was likely to be another source of stress, one that Keith could easily fit into his lifestyle. Breakfast. By suggesting breakfast, I am not defiling the holy grail of imtermittant fasting here. I am simply saying that Keith’s health — wonderful as it is — could impove without fasting every single day given his exceptionally busy life.

    So I could have looked at his labs, given him a slap on the ass and told him “great job, don’t change a thing as there’s absolutely no way you could do better than you are”, which I essentially did, minus the ass-slap and the proclaimation that this was as good as it gets.

    And look, Kieth is practicing n=1, giving breakfast a whirl and seeing benefits. What could be better than that?

  19. Very well put, as a movement that started as a rebellion against blind conventional dogma, the Paleo crowd has to be very careful not to start worshiping it’s own false idols(not eating breakfast, only working out once a fortnight, avoiding all dairy and starches, etc etc).

    One thing I love about this blog is that Keith isn’t afraid to tear down or challenge these sacred cows, because in the end it’s not about being right on an internet message board but trying to save peoples lives. This nation and soon this entire planet is basically in a state of painful decay rather than vibrant living.

    I think it’s important to recognize that as a broad model, the Paleo lifestyle is pretty damn kickass, but also, on an individual level you can tinker with tons of different variables. There are guys out there like Keith Norris or Jaime Lewis who do keto style Paleo dies *and* work out 6-10 times a week, just like there are guys like Anthony who have fine tuned their workouts and diet as well. The fact that both Anthony and Keith are in peak shape at nearly single digit body fat levels is inspiring to those of us who have failed using cookie cutter programs and dare to personalize programs and diets for ourselves.

    Very often those who espouse the program, diet, or lifestyle just want to send all the blame outward rather than except that for some people a little bit of change goes a long way. (I’m also thinking of Tim Ferriss’ success with the slow-carb diet, which pissed off a lot of anti-legume Paleo folks). I’m far more concerned with optimization then simply validating the Paleo methodology.

  20. Holly (and All),

    I hope that I have not come across as mean-spirited as that is not my intention. I think the true value that you offer is that you listen to your patients. I in no way object to the suggestion for Keith to eat breakfast, I just object to the notion that this recommendation can be made based on looking at his labwork. You simply cannot make any conclusions based on patterns that fall within the reference range of any test. Humans are pattern seeking animals, so much so that we can see patterns that don’t truly exist.

    One of the hallmarks of reliable testing is inter-observer reliability. With this in mind check out the comments from Dr. Kruse: “I looked at it and I am sorry to say I don’t see things the way Holly does. Without more data there is no way to tell. I think his labs reveal elevated cortisol and not a fatigue pattern and his WBC’s fit this perfectly. I completely disagree with her assessment there. ” He then goes on to detail even more disagreement based on looking at the exact same data that you did.

    This is like kids laying on their backs looking at clouds…”look that one looks like a dog”, “no it doesn’t it looks more like a bear”. Once again I do not object to any of the recommendations you made for Keith. I simply object to the notion that any of his labwork “suggests” the numerous things that you listed or that they were the basis for recommendations that could have been made simply by talking to Keith.

    • Let’s pretend that a bloodwork evaluation was not Keith’s primary request and he had come in for a health evaluation…

      We would have had the exact same patient interview where we listen to the patient’s concerns, symptoms, goals, lifestyle, eating habits, etc., and then had the exact same conversation with him regarding breakfast.

      So Doug, correct. Labs were not necessary to give Keith the suggestion of breakfast. But he *wanted* them. And we find labs to be a very important part in being able to help folks meet (and exceed) their goals with their health. Not ordering labs is in our view like never looking at your vehicle’s instrument panel until the day your car won’t start.

      But perhaps we’re off topic here. Keith’s objective here, and one that we haven’t discussed much, is “to better quantify an n=1 sweet-zone within [his] health vs performance continuum”.

      In my opinion, Keith is in the sweet-zone, his hard-driving lifestyle is supported by the excellent dietary choices. Is his health ‘perfect’? Perfection is pretty hard to define, and is at best a moving target. Breakfast seems to be improving on an already damn good thing, and is in my opinion, solid preventative maintenance.

  21. Can someone define what “breakfast” is? Is there a minimum number of calories required? Does it have occur right after waking?

    I have coffee and heavy cream at 6am and again at noon, but don’t eat a “meal” until 6pm. Some might say I am “fasting” others might say I have had a small breakfast and lunch.

    So what would be the minimal effective calorie dose at this “breakfast” to minimize cortisol and would there be specific macronutrient requirements?

    • “Breakfast” says what it is; i.e. “breaking the fast.” Obviously, at night, while we’re all “supposed” to be asleep, we are not eating and hence not taking in any calories so, we are basically fasting from the time period of our last meal until we eat/drink again. Martin Berkhan over at http://www.leangains.com/, says something like consuming anything <50 calories is still considered fasting and I believe he even uses coffee with cream and even diet soda as examples. However, this is his definition and may be his own little n=1 experiment. There is no sole calorie requirement for breakfast or any other meal for that matter. I know Robb Wolf is a proponent of getting most (if not all) of your calories from solid food sources rather than liquid. So, in my opinion, coffee with heavy cream doesn't "really" constitute a true breakfast. However, if you wake, have your coffee early in the a.m. and then again at noon and are performing and feeling great, maybe you don't need to change a thing. But then again, look at Keith. He obviously was performing and feeling great by having just coffee early on and not eating until later in the day as well but, with a simple adjustment of including breakfast, appears to be feeling even better throughout the day now. Don't worry about the minimum effective calorie dose. Just concentrate on eating healthy and nutritious foods when you're hungry and stopping when you're full. I'm getting ready to eat breakfast myself (post-workout) which will consist of 6 free range eggs, cheese, about 8 pieces of bacon, and a big bowl of full-fat Greek yogurt with a bunch of berries, pecans, a banana, coconut flakes, coconut oil, cinnamon and vanilla extract. If I worried about the amount of calories and saturated fat content of that meal… Yikes!

  22. I also had medical tests done after I went through my lifestyle change of eating all organic foods. What I found is that my cholesterol went from 229 to 175; my triglycerides went from 140 to 50; and my blood pressure went from slightly high (I had to take a high blood pressure medication pill each night) to normal and no pills. Besides that, I never get sick anymore! It’s great!

  23. Holly,

    There is no problem looking at labs in the right context. But when values fall within the reference range, that is about all you can say. I simply do not believe that you can make the interpretations out of the labwork that are in the original post. Lots of people want tests from me as well (lab tests, CT scans etc), but many times I do not grant them because it is not the right thing to do. Instead I have to explain how the test may be irrelevant in the given context or even cause harm through unintended consequences. Sometimes that harm is just the morbidity of unnecessary worry.

    Your instrument panel analogy is a good one. Much of what is on the instrument panel is like labwork. If the check engine light is not on, that is all you can say…and the outcome is no different than if you hadn’t looked.

    Ken,

    WRT your question, what I have said above also applies. Collecting reference data on the exceptionally fit/healthy population would probably not produce anything helpful. I doubt that extreme fitness would cause lab values to fall out of the range of a “normal” population AND even if the bell curves tightened up somewhat you may end up with a situation where the limitations of the lab tests precision was actually greater than the variation in the population.

    Prior to about 1978 there were no “system multi-anylizer” machines for doing lab work….you could not get a SMA-7, or SMA-18 out of a single machine. You had a single tech and machine for Sodium, another for Potassium, another for creatinine and so on. Back then you actually had to think about what you needed to know and order only what was relevant based on pre-test probability. Once machines came available to quickly perform “shotgun labs” everything changed.

    (Interesting side note: Medicare used to pay for tests as they were done individually and continued to do so for about a decade after shotgun labs became available, making pathologists that ran clinical labs very rich. Pathology became a very lucrative specialty. Pathology became a very competitive specialty and went from a 3 year to a 5 year residency. When the government payors finally caught up there were a lot of pathology residents in their 5th year of training who got to watch their dream of riches evaporate.)

    Anyway, once the shotgun labs became available the “tea leaf reading” began. We began to see patterns in all this data that were not really patterns. More data is almost never the solution. A very limited amount of the right data is much better. Too much data either results in “tea leaf reading” or “paralysis by analysis”.

    • Doug: Thanks. Very interesting.
      Speculating, it would then seem the next wave for detection of onset of degenerative conditions will be applications based on specific genomic and proteomic concentrations based on emerging profile differences between sedentary and active persons. Work identifying disease and activity SNPs would be that predisposition to disease could more accurately be predicted on an individual basis and preventative orescriptions made. Discerning the interaction between disease-susceptible genes and disease- or inactivity-predisposing genes, while challenging, would be a powerful tool – deciphering the mechanisms by which inactivity alters the expression of disease susceptibility genes and the biological threshold that’s passed to result in overt clinical disease.

      Humans are always going to ‘find’ patterns whether in tea-leaves or Mayan prophecies for 2012 (Y2K +12 chicken little forecasts!). I’ll refrain from mounting my soap box advocating grassroots health/Darwinian fitness education. You ought to do a consumer advocate book on this topic – especially since you write well.

    • The fact remains that we evaluate labs based on wellness ranges everyday. It’s one of the many tools we use that have helped thousands of patients. It is not uncommon our clinic to be a last ditch effort for people after having been told by MD after MD that their labs are fine, and that there’s nothing wrong with them. We are able to look at the same set of information and offer these patients real solutions to their health challenges. Call it reading tea leaves if you like, but our patients get very real results.

      I’m equally certain that you have helped many patients using your methods as well. I see no conflict in the different ways that we use labs — we all have the same goal, which is helping as many people as possible. And based on the state of health and healthcare in the United States currently, there are plenty of people out there for us all to help.

      • Holly:
        You perked my attention with a single word: wellness. Our multidisciplinary, whole systems oriented think tank has grappled with what four words might mean: health, wellness, healing, and fitness. Accordingly, please share with us what your work means with the word ‘wellness.’ This isn’t a trick question, rather an interest to learn how you’re using that term. Thanks in advance.

  24. Holly,

    I really don’t think it is that you read the labs differently that makes the difference (even if you believe it is so). I think it is much more that you understand that labwork that is “fine” does not mean there is nothing wrong with them.

    It is very common for people with completely normal labs to die right in front of my eyes. That degree of meaninglessness is profound….but it is equally so in your case. It may be one of many tools that you are using, but it is not one (with the rare exception) that is helping your patients.

    It is the lifestyle interventions that matter. These can be done with NO labwork to point the way. For an excellent example, hop on over to Richard Nikoley’s site at http://www.freetheanimal.com.

  25. Just playing devil’s advocate here: on the one extreme of the testing debate we have the opinions of Dr. Jack Kruse, here: http://jackkruse.com/what-are-the-optimizing-labs/, and on the other, the opinions expressed by Dr. (Doug) McGuff. Holly sits somewhere in the comfortable middle (test as testing is warranted). As for myself, I tend more toward the woo-woo-sphere — how do I look, feel, perform…what does my gut tell me. Maybe there is no one suitable answer for everyone, but only an n=1 appropriate answer.

    Also, I’d just like to clarify that I went to Holly to request these tests, just out of curiosity (and for blog fodder) — she never suggested that I *needed* these tests. Had I gone to her complaining of my “symptoms”, I’m sure she would have told me to just slow my dumb-ass down a bit, and friggin’ eat something in the AM.

  26. Holly,

    I was not being patronizing. The intended tone can be lost over the internet. I intended to show that I value what you do for your patients. However, I disagree that you can make interpretations about Keith’s stomach acid from a “functionally low serum protein and serum calcium” for instance. Both values fall within the reference range, so the pattern may be purely coincidental. A serum calcium that is not fractionated into ionized and unionized forms really cannot tell you if it is functional.

    Keith,

    I understand your intentions and don’t fault Holly for doing what you asked. It was indeed good blog fodder and (IMO) has been very instructional for both sides of this issue.

    • Here’s a question (not just for Doug, but for anyone), re: serum protein, serum calcium and stomach acid – what would be the outward signs of a reduced ability to digest protein? I have no digestion issues that I know of, and naturally gravitate to a high fat/protein & very low carb diet. My appetite seems to track my activity/intensity levels spot-on, and my body comp. seems not to be suffering (my DEXA results will be posted Monday). If I were to continue following my decidedly “woo-woo” intuitive path of self diagnosis, what — if in fact my stomach acid *were* low — would that intuitive self “notice”?

      And by the way, Doug, I do hope that you’ll be a part of the PFX12 speaker line-up! People are hungry for this kind of insight and civil debate. It can only serve to move the Paleo/Primal movement further into the mainstream consciousness.

    • Also, Doug, can you expound upon the accuracy of the individual tests? Maybe siting an example or two? I certainly get your point. A rough analogy here would be me timing a prospective young defensive back’s 40 time with a watch only accurate to 0.3 seconds. The results from the same run might indicate a potential phenom, or a kid who needs to find another sport 🙂

  27. Keith,

    I wouldn’t have even wasted my breath suggesting you slow that thing down! A big component of how stress affects the body is the attitude one has when facing life’s challenges. With your positive attitude, I suspect it would be more stressful to you to slow down right now. You’ll slow down when you’re ready. Just eat breakfast in the meantime. 🙂

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