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Hi there,

I just received the results of my first round of blood work and, of course, I'm really unsure of what they might mean. The ones that i have questions about are the few that are out of the "normal" reference range. I could use a little help in interpreting them:

CBC with Differential:

RBC 4.52 M/uL = Low Reference Range: 4.7-6.1

MCV 103 fL = High Reference Range: 80-99

Liver Function Test:

Alk Phosphate 125 u/l in range but high Reference Range: 38-126


Vitamin D 1, 25- Dihydroxy = 77 pg/ml High Reference Range: 15-75

Vitamin D, 25 Hydroxy = 21 ng/ml Low (Hypovitamosis) Reference Range: 32-80

I recall seeing a thread, I think from Jimmy Legs, that explained many of these tests and provided some acceptable ranges. I'm unable to find that thread again. Anyway, I appreciate any help. Thank you.

Vitamin D needs to be a lot higher. More supplements or get out in the Sun in order.

More specifically, a good number for the 25 hydroxy form of vitamin D3 is around 60 ng/mL.


NHE

hiya, i don't think i have a post about those tests really, other than 25(OH)d3, but i will have a look into why your 25(OHd3 could be low while 1,25(OH)2D3 was high. you aren't using any kind of pharmaceutical product on your skin are you? i only ask because the only time my 1,25(OH)2D3 was high, that was the reason - a specific ointment.

Reference ranges are obtained in the most absurd way. By law a lab has to force 95% of the people analyzed the previous years to fit inside the reference range. So only the 2.5% with the highest and lowest values fall outside the range. Since most helathy people are not analized and most of the people analized are sick, this is crealy nonsense.
After seeing hundreds of blood tests, I have created my own ideal ranges, which are much narrower than the reference ranges and which allow me to obtain a lot of information from blood tests.
For example, my ideal range for MCV is 93 to 97 and since yours is 103 (your red cell are too big and you have few of them, so you have megalocytic anemia) in my opinion you're probably low in folate or vit B12, the former being the more common one in MS and both being very important for nerve function.

ALP is a poor indicator of liver function, since it is also produced in bones when bone is being lost (because of low vit D in your case). My ideal range is 55-72, so yours is quite high in my opinion. To get a good picture of liver function other enzymes should be analized along with ALP, such as GGT, ALT, AST, etc,

Do you have uric acid, calcium, phosphorous, etc,?

oh mcv i didn't spot that, good catch search. did you mean the latter, by chance? i think the b12 would be worth looking into. since its deficiency is one ddx for ms. and it is part of the klenner protocol for ms. and mcv increases when b12 is down. (in the case of b12 that is how the bottom end of the 'normal' range was decided on - low enough for mcv to rise, never mind everything cognitive that goes out the window on the way down to that level)

i thoroughly agree with you about reference ranges being nonsense.

Vitamin B12 and folate concentrations in serum and cerebrospinal fluid of neurological patients with special reference to multiple sclerosis and dementia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC488275/

just ran across this connection between zinc status and mcv

Increased serum copper and decreased serum zinc levels in children with iron deficiency anemia
http://www.ncbi.nlm.nih.gov/pubmed/9522044
"positive correlation between mean corpuscular volume (MCV) and serum zinc level in patients"

Thanks for the response folks. To answer a couple of questions that were posed:

@ Jimmy Legs: I am not, nor ever have I, used a pharma product on my skin. Also regarding the B12, is that in a suite of tests, or a specific test that I can ask for? Also you mention " (in the case of b12 that is how the bottom end of the 'normal' range was decided on - low enough for mcv to rise, never mind everything cognitive that goes out the window on the way down to that level)". Would you explain about the cognitive component?



@ Search I am currently not taking any uric acid, calcium, phosphorous, etc

My daily supplements that I'm currently taking :

5 ml of Fish Oil

1 Tablet of HI-B-100 Sustained Release. Natures Life brand. This includes 100 mg of B1-6, 400 MCG of Folate, 100 MCG of B -12

2 -325mg St. John's Wart

4,000 IU of D-3

1,000 MCG of Methyl B - 12

Also, I have been shifting my diet and did a two week elimination diet. Felt awesome, but due to travel the last two weeks I have faltered a bit. Preparing to begin again.

Between school and work I'm finding it difficult to find the time to educate myself as much as I want. So,thanks for the information folks. Preparing to begin Avonex in two weeks. Little steps at a time....

hey there JS

all right so pharma's not why your 1,25 is high. good to know.

B12 is a single test. just serum cobalamin. easy researchers have studied b12 and cognitive function in all kinds of things like alzheimer's, senile dementia, down to impaired cog function in vegan or vegetarian adolescents, eg
Signs of impaired cognitive function in adolescents with marginal cobalamin status
http://www.ajcn.org/content/72/3/762.short

mind you many other things are involved in optimal cognitive function too, so if there's something cognitive going on with you, you might be wise to cast a broader investigative net for just one example, zinc has been a problem for me in the past, eg gave me some difficulty assessing distances and relative speed etc.

as for why your 25(OH)D3 is low, i would hypothesize that you're not processing your 4000IU d3 optimally, quite likely due to absent complementary mineral supplementation. personally when i took 4000IU d3 for a long time, first i noticed that i had no magnesium left in my system, and a pharmacist set me straight re timing of intakes. i'll tell you more if you want to hear it. next i noticed that i had no zinc left in my system. it wasn't all the d3's fault- i had a stupid diet for years prior - but it tipped me over the edge as far as those other important minerals went.

curious if you would be able to get calcium, magnesium, and zinc tested? that could help you decide what kind of mineral boost is needed and for how long, then re-measure minerals and the d3 metabolites, and then re-introduce d3 supplementation, with modifications to amounts if needed.

if you just want to get a cal-mag-zinc blend and see what happens, that's an option too but if symptoms don't clear, it's hard to tell without testing whether you need to eat more mineral-rich foods and/or take more supplements and epsom salts baths, or look for a different solution.

anyway that's all for now

Thanks Jimmy Legs. I should have stated that I have been taking those supplements about 4 weeks, and did not begin until after my blood work was completed. I'm planning on buying a Cal - Mag - Zinc supplement tomorrow. I need to read more so that I can understand the relationship between those minerals and specific vitamin levels.

ah ha! okay. good to know how long you've been on stuff, in relation to test timing etc. so basically your d3 level could be a bit higher now. but as for the mineral side, at least you've only been doing straight d3 for 4 weeks instead of years, and at least you've got the precautionary info ahead of time unlike me good stuff!

fyi if your cal-mag-zinc supplement recommends to take 2 pills per day, then take one at the same time as you take the d3, and one separately. that's what my pharmacist told me to do, divide my daily doses, b/c i had been taking it all at the same time and the d3 sucked up everything and left me no minerals for other important body functions.

and yes reading is very important. for me, the best thing about getting this dx was the learning curve it kicked me onto!

1) Ca antagonizes Mg, while Mg boosts Ca retention and vit D inreases Ca absorption, so I would not take Ca supplements if I were taking Mg and vit D, lest Ca rise dangerously and negate the benefits of Mg supplementation. I would analyze Ca and try to keep it within the ideal range of 8.7 to 9.3 and analyze P and try to keep it between 3.5 and 4.
Doctors almost always provide Ca with vit D, which defeats the main purpose of vit D, which is increasing resoprtion of Mg in the distal tubues of the kidneys, so that in turn Mg increases Ca and K retention (both of which are abundant in a good diet but are lost if Mg is not abundant in tissues).

2) I don't understand what you mean by 100 mg vit 1-6, does that mean 100 mg vit B1 and 100 mg vit B6?, which is a toxic dose of vit B6 if taken long term.

3) St. John's wart is toxic and will eventually cause photophobia and other major problems.

4) Most multiple supplements have Zn oxide, which is insoluble and not absorbable (the same as magnesium oxide or hydroxide, which is also widely use, because it is so cheap) and ZnO contains Cd which is a main culprit in MS, make sure it is a soluble, pure form of Zn and Mg, such as citrate, gluconate, etc,

5) 1,000 mcg=1mg, which is a toxic dose of methyl-B12

i agree calcium supplementation is not for everyone. it is a usual recommendation but it doesn't work for me. i just take magnesium and vit d3, and there happens to be calcium in my multivitamin/mineral.

it means 100mg each of vits b1 thru b6, i'm guessing. 100mg is the max intake over the long term. can't recall if that's the max from supplements or the max combined supplements and diet.

when i first had major improvements i took the approx equivalent of a b-100 complex 4 times a day, but only for a few days and then i was so much better i could stop. now, when i'm behaving, i'll take either b50 or b100 every other day.

can you reference that toxic dose of methyl b12 statement? i would be interested in seeing links to the research on that one.

js if you decide to go the extra mile, mag glycinate or mag citrate both come in powder form, i've seen glycinate in capsule form and citrate loose. zinc citrate i've seen in powder capsule form too. i've used or am currently using all of those. if you supplement zinc at higher doses, look for a product that is balanced with a little copper. it's complicated out there!

Zn in high doses blocks Cu absorption, so even if you take Cu it won´t be absorbed.
Everything in excess is toxic, even water.
Bye

i suspect the balanced zinc and copper combo pill is formulated to provide the zinc with some copper to interact with in the short term, so it doesn't pull it from your system to a dangerous extent in the long term.

ah well, if you do happen to stumble on research re methyl b12 toxicity at some point, i'd be happy to check it out!

i do know there are MSDS sheets with LD50s for both methylcobalamin and water, so if you want to find out what single dose will kill half your collection of rats, the info is out there :S