“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 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:
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
Theory to Practice 