Category Archives: In The Lab

Cholesterol: How To Read The Lipid Panel Blood Test

There are three general types of large molecules of which our body is composed. There are PROTEINS, essential components of the Nanomachines that power of our bodies, the CARBOHYDRATES which can form structures, as well as provide and store nutrients, and LIPIDS, which can function as a storehouse of nutrients.

Lipids, unlike carbohydrates and proteins, are essentially nonpolar, that is they have no profusion of charged molecules. The main characteristic of lipids is that they do not dissolve in water, thereby allowing for domains and structures to develop in the cell and beyond.

Cholesterol is a lipid that is essential to our cell membranes, and therefore to life. As people get older, however, cholesterol tends to accumulate and get stored in unwanted places, such as under the lining membranes of blood vessels. In this location, they can cause blockages that threaten the very life for which they are essential.

All of the lipids measured in the comprehensive lipid panel measure lipids in different forms that have different functions and significance in the body. The only one of the lipids that is almost always good, or at least neutral, is the high density lipoprotein, the HDL. The level of this lipoprotein is under genetic control and is increased by EXERCISE and FISH OIL, among other things.

“Good Genes”, healthy diet and exercise will help keep down the bad lipids, especially the LDL, and elevate the main good lipid , HDL.

Coronary artery disease and strokes are the main killers in mid and into later life, and are therefore very important to control. Many people do not seem to have the self-discipline that healthy diet and exercise requires. Fortunately, we have a miracle drug. the HMG- CoA inhibitors, the “statin” drugs, which most people tolerate without the muscle pain and myolysis side effect.

I have taken the statin drugs for years, ever since I discovered my cholesterol was 220, above the optimal level. Fearful of muscle effects, since I am a heavy exerciser, I started out on 1/2 of the lowest dose, 2.5 mg., of Rosuvastatin. This amazingly took my cholesterol level all the way down to 180, and my LDL down below 100, a powerful medication indeed.

My most recent Lipid panel results are below:

                                      Result value.              Ref. Range

Triglycerides.                    51 mg./dL.                <150 mg./dL

Cholesterol.                        186 mg./dL.                <200 mg./dL

HDL.                                    90 mg./dL.                  > 60 mg./dL

LDL direct.                          95 mg./dL.                  <100 mg./dL.

The authorities have lowered the normal range a couple of times during my lifetime. It is true that even lower values than mine show ever more benefit.

It is best to keep your lipids under control with diet and exercise, so stay healthy!

—Dr. C.

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Vitamin D: Importance Of Knowing Blood Levels

Vitamin D Blood levels are seldom ordered by doctors, or demanded by patients, in spite of the fact that it is the “vitamin of the decade”.

Vitamin D is the sunshine vitamin, since the UVB light normally converts skin cholesterol into vitamin D. The white skin of peoples who migrated into temperate zones such as Europe was very likely a survival factor due to the low amount of sunlight in northern climates  compared to the African tropics, and white skin permits increased vitamin D production.

Vitamin D is most famous as the factor that prevents the childhood bone disease “rickets”. The industrial revolution resulted in kids being in factories, getting insufficient sun exposure, and having an epidemic of rickets.

The Covid pandemic resulted in orders of magnitude more deaths among the elderly, especially those in sunless retirement homes. Eventually, vitamin D became implicated in immune deficiency, and the ability to survive Covid.

Vitamin D Is suspected as a factor in multiple sclerosis, tuberculosis, and even seasonal affective disorder, where there is a great increase in depression during the dark months of winter in extreme northern climates.

The NFL, ever striving to keep their players in top physical condition and accelerate recovery from injury, now supplements their players, and, I hear, requires blood levels of 60 ng./ml and above, more when they are injured. Vitamin D thought to improve muscle strength, and the rate of repair in muscle injury.

A lot of studies have failed to show the benefits claimed for vitamin D, but  a recent large study from Harvard showed that the beneficial effects of vitamin D occur only among thinner individuals with a BMI of less than 25, which is a shrinking percentage of our population. It seems that already healthy people who are not overweight are the only recipients that can benefit from vitamin D, a fat soluble vitamin, which may be tightly held by the excess fat of overweight people.

Although I am waiting for more and better studies, I obtain yearly vitamin D blood levels. in fact, I was rather worried recently that my 5000 i.u./day supplementation might be excessive. Not so; it came back as 51 ng/mL The normal level is now considered to be above 30 ng/mL. This was determined in part by finding that the parathyroid hormone blood level was elevated with lower levels of vitamin D, and reached normal only at 30 ng.

How much is too much? It has been documented that most lifeguards in the summer have levels above 100.ng/ mL and there has never been Vitamin D toxicity based on with sun exposure as the sole source of elevation in vitamin D level. “

Getting your vitamin D by sun exposure can lead to skin cancers in later life, however, and my opinion is that VITAMIN D BY ORAL SUPPLEMENTATION IS SAFER.

Checking  your blood vitamin D level should be done at least twice. Once to check the baseline, and, since most people in our mostly inside, sunscreen-using population will not have an adequate level, a second test to be sure that you are adequately and not excessively, supplemented.

My recent results:

Result Value: 51 ng/mL (Vitamin D, 25 Hydroxy)

Reference Range: 30-100 ng/mL (1 ng/mL =  0.83 IU/mL)

Deficiency is  < 20  ng/mL.                 

Insufficiency     20-29  ng/mL

Sufficiency         30-100 ng/mL

—Dr. C.

Tests: The Comprehensive Metabolic Panel Report

This is a big one, and produces a lot of information.

Your metabolism is the workhorse of your body, and this panel measures certain critical chemicals and waste products that make metabolism and life possible.

Sodium -The main element in the fluid outside your cells. It draws water into vessels, supporting blood pressure. Drinking water is critical to life, and a recent study used the serum sodium as a proxy to indicate whether you are drinking an adequate  amount. If the level is below 142 mmol/dl,  you are adequately  hydrated and your life expectancy is higher.

Potassium – The main element in cells. There is a pump in the membrane of the cell that pumps potassium into the cell, and sodium out, to maintain a critical electrical charge across the cell membrane. Even small deviations in serum potassium can be worrisome.

Chloride – The anion that Electrically balances sodium and potassium. Can be important in acidosis.

Glucose – The major Energy source of the body. Too little, and you pass out. Too much is a long-term stress on the body, as in diabetes.

Carbon dioxide – As bicarbonate, important in adjusting the acidity of fluids outside the cell.

Anion gap – an important check for doctors.

BUN – A Measure of excess protein in the diet, and can be very elevated in kidney disease. I usually have an elevated BUN, because I eat a lot of protein due to  my age. My creatinine is always normal.

Calcium – important for bones, and many other processes, including cellular signaling.

Albumin – An important blood protein that supports blood pressure.

Creatinine – A waste product that is used as a measure of kidney function.

AST (SGOT) – A liver enzyme used to measure inflammation of the liver.

ALT (SGPT) – A counter check to the AST.

Estimated GFR – Based on creatinine, it is a measure of kidney function.

Total protein – Includes albumin + the amount of globulin. The latter includes proteins involved in immunity, measured by subtracting the albumin from the total protein.

The metabolic panel is used to give clues to a whole host of diseases such as diabetes, liver disease, Kidney disease, immune deficiencies, endocrine diseases, vitamin and mineral deficiencies, and the like. It is so useful that Medicare pays for it, usually.

—Dr. C.

Screening Tests: What Makes Up A Urinalysis?

The urinalysis is a very good screening test, and therefore often ordered with an annual physical examination. It gives insight into a very vital organ, the kidney.

It is the definitive test for a urinary tract infections, which are very common particularly in women, with their short urethras, and is also very good at reflecting abnormalities in the body of various sorts.

Urine color– very helpful in many conditions, such as liver disease, hemolytic anemia, porphyria, and Homocystinuria. When I had my bladder cancer bleed, the urine was red in color of course.

Clarity – The presence of many small particles, such as white blood cells or bacteria will make the urine cloudy.

Urine specific gravity – Will be high if you’re drinking insufficient water.

Urine pH — Will be out of range in several conditions, such as urine infections and somatic acidosis, which can happen in diabetes.

Urine protein – Gets into the urine in some kidney conditions such as nephrosis.

Urine glucose – Is positive mainly in diabetes, which was very important to follow when I was practicing in order to follow the diabetes. It is still important in the early pick up of diabetes and people that didn’t know they had it. Blood sugars are much more used these days to follow diabetes.

Urine ketones – Can indicate out of control diabetes. Can also Occur with certain very low carbohydrate diets; keto diets are named for this effect.

Urine blood -A counter check to the microscopic examination for red blood cells.

Urine nitrite – Elevated with urinary tract infections, a check on microscopic white blood cells.

Urinary Urobilinogen – Elevated in certain liver diseases.

Urinary leukocytic esterase -A check on urinary white blood cells

Urinary microscopic examination:

Urinary RBC – Elevated in urinary tract bleeding in certain  kidney and bladder diseases.

Urinary WBC – Elevated with urinary tract infections

Transitional epithelial cells – Sometimes have significance to doctors

Urinary bacteria – Of course Indicates urinary tract infection

Urinary yeast and hyphae – May indicate a fungal infection.

The urinalysis I obtained when my red urine due to my bladder cancer alarmed me showed Red urine color 30 mg/dL urine proteins, large amount of blood, 10-15  red blood cells, (elevated) and a few bacteria and yeast, a spurious finding.

When you go in for a general physical, assuming that you are well, it is always comforting to have a negative urinalysis, a broad screening test for all kinds of different problems.

— Dr, C

RESEARCH: ‘SINGLE DROP’ BLOOD TESTING ADVANCES

“Even more importantly, we’ve shown you can collect the blood drop at home and mail it into the lab,” said Michael Snyder, PhD, director of the Center for Genomics and Personalized Medicine and senior author on the research, which was published in Nature Biomedical Engineering on Jan. 19.

Stanford Medicine (January 19, 2023) – Researchers at Stanford Medicine have shown they can measure thousands of molecules — some of which are signals of health — from a single drop of blood.

Unlike finger-prick testing for diabetes, which measures a single type of molecule (glucose), multi-omics microsampling gives data about thousands of different molecules at once.

finger prick
A single drop of blood can yield measurements for thousands of proteins, fats and other biomarkers, researchers at Stanford Medicine found.

The new approach combines a microsampling device — a tool used to self-administer a finger prick — with “multi-omics” technologies, which simultaneously analyze a vast array of proteins, fats, by-products of metabolism and inflammatory markers.

Covid-19: China Approves The First Inhaled Vaccine

The vaccine, called Convidecia Air, changes the liquid form of the vaccine into an aerosol using a nebuilzer. The vaccine can then be inhaled through the mouth using the nebulizer machine. The needle-free vaccine “can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” Cansino said in a statement.

In July, Chinese scientists published a pre-print study showing that people who received one booster dose of Cansino’s inhaled vaccine after two doses of the inactivated jab from Chinese maker Sinovac developed more antibodies than people who received three Sinovac shots. Four weeks after receiving the inhaled booster, 92.5% of people had developed neutralizing antibodies for Omicron.

Those who got three doses on Sinovac’s jab did not demonstrate any neutralizing antibodies for Omicron, either four weeks or six months after getting a booster.

Read more

COMMENTS:

Spray vaccines will be our best chance to stop Covid.

However, there are two big problems that have to be solved.

The first problem is keeping up with the blitzkrieg mutation capacity that Covid has. Our best chance to do that is with the mRNA technology, which permits vaccine generation with minimal delay. However, mRNA vaccines are too fragile to be suitable for a nasal or oral spray. The particles would be destroyed before they could activate the mucosal immune system.

But it is still possible, using laboratory technology to convert this mRNA into peptides and proteins suitable for use as a spray. Using AI to generate three dimensional shapes, surely a  stable molecule of suitable configuration and stability could be eventually generated.

The second appears to have been partially solved by the Chinese, according to the Fortune  article, namely getting an injectable vaccine into a suitable form and dose to survive the bodies mucosal clearance mechanisms and enzymes, designed to keep foreign sprays and mists out of the body, in enough concentration to stimulate the mucosal immune system.

Our bodies have developed a parallel Defense system using a unique immunoglobulin, IGA, and  special support cells. When stimulated, immunity bristles as a first line of defense to deny incoming viruses entrance to the body. This is what is needed to prevent infection from occurring in the first place, so extremely important for a highly infectious and potentially lethal virus such as Covid.

The Chinese, with their autocratic system,  have a better chance of making everybody take this vaccine, even though it requires a cumbersome liquid nebulizer to generate the mist.

Better would be a handheld inhaler, and, hopefully, this is what some dozen pharmaceutical corporations, working on a nasal or inhaled vaccine , are aiming for.

—Dr. C.

Research: The Search For A Universal Vaccine (2022)

Vaccines are one of the greatest scientific discoveries in human history. They eradicated a disease, smallpox, that killed 300 million people in the 20th Century. They save countless lives every year, protecting against diseases caused by viruses like polio, measles and yellow fever. But some viruses are particularly difficult to target with vaccines.

We need a flu shot every year because the virus mutates so much previous vaccines may no longer be effective. Scientists are closer than ever before to developing what are known as universal vaccines. These vaccines would protect against many variants of a given virus, and potentially against entire virus families. Viruses are constantly mutating, but only some of those mutations are important.

For example, a change in the shape or chemical properties of the spike protein a virus uses to infect a cell could make the virus more transmissible. It could also mean antibodies developed from previous infection or vaccination wouldn’t be able protect against the current virus. But, there are some sites on viruses that don’t mutate as much, or at all. These sites are often vital to the virus’ survival. Scientists are using powerful technologies to identify antibodies that target these sites.

They’re called broadly neutralizing antibodies and are capable of protecting against multiple viral variants. Now, researchers are working to design shots that get our bodies to produce broadly neutralizing antibodies. Meaning someday soon, vaccines for HIV, flu and coronavirus might be enough to effectively ward off these viruses for the better part of a lifetime.

Cardiac Tests: B-Type Natriuretic Peptide (BNP)

B-type natriuretic peptide (BNP) belongs to a family of protein hormones called natriuretic peptides. These natriuretic peptides have an important role in regulating the circulation. They act on blood vessels, causing them to dilate, or widen. They also work on the kidneys, causing them to excrete more salt and water. In addition, the natriuretic peptides reduce the production of various hormones that narrow blood vessels, boost the heart rate, or affect fluid retention; examples include adrenaline, angiotensin, and aldosterone.

Blood Tests: What Is A ‘Basic Metabolic Panel’?

1. Glucose

Glucose is the type of sugar that your body uses for energy. 

What’s normal: 70 to 99 mg/dL (after 8 to 12 hours of not eating).

  •  What’s normal: 70 to 99 mg/dL (after 8 to 12 hours of not eating).
  •  What abnormal results can mean: If there’s too much, then it can mean diabetes or prediabetes. If there’s too little, it could mean hypoglycemia.

2. Calcium

Calcium is needed for many body functions, including building bones, heart function, muscle contraction and nerve signaling. 

  • What’s normal: 8.5 to 10.2 mg/dL.
  • What abnormal results can mean: Kidney/liver problems, bone disease, thyroid disease, cancer and malnutrition

3. Electrolytes

Electrolytes are minerals that maintain fluid levels and chemical balance in your body. 

  • What’s normal: Bicarbonate (total) 18 to 30 mEq/L; Chloride: 98 to 106 mEq/L; Magnesium: 1.8 to 3.6 mg/dL or 1.5 to 3.0 mEq/L; Phosphorus: 3 to 4.5 mg/dL or 1.8 to 2.3 mEq/L; Potassium: 3.5 to 5.5 mEq/L; Sodium: 135 to 147 mEq/L.
  • What abnormal results can mean: Dehydration, kidney disease, liver disease, heart failure and high blood pressure.

4. Blood urea nitrogen (BUN)

Blood urea nitrogen (BUN) is a waste product that kidneys filter out of your body.

  • What’s normal: 6 to 20 mg/dL.
  • What abnormal results can mean: If there’s too much, then it can mean kidney disease, heart failure or dehydration. If there’s too little, it could mean liver failure or malnutrition.

5. Creatinine

Creatinine is a waste product that kidneys filter out of your body.

  • What’s normal: For men, 0.7 to 1.3 mg/dL. For women, 0.6 to 1.1 mg/dL.
  • What abnormal results can mean:  If there’s too much, then it can mean kidney disease, muscle breakdown or dehydration. If there’s too little, it could mean malnutrition or low muscle mass.

“Metabolism involves any way your body converts or uses energy,” says Dr. Allan. “That includes digestion, breathing, circulation, and functioning of your organs, muscles and nervous system.”

COVID-19: A REVIEW OF THE BEST RAPID AT-HOME TESTS

New high-tech Covid-19 tests promise better and earlier detection of the virus—similar to a PCR test. WSJ’s Joanna Stern (and her mannequin clone) tried out the Detect Covid-19 Test and Cue Health Monitoring System to see how they compare with rapid antigen tests. Photo illustration: Ryan Trefes/ WSJ