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Blood Chemistry

I have a tough case of a 23-year-old obesity outpatient with recurrent pineal cysts, which started after trauma to the sacral area. And even after multiple surgeries and acne, she has very mild gut issues if any. She’s borderline anemic, low normal MCH, MCV, MCHC, hematocrit, and RBC. Her HbA1c was low at 4.3. Should be high with iron-deficiency anemia (although I have seen a lot of variation with HbA1c in anemias and that’s one of the problems with that marker). And low ferritin at 19. Considering Medihoney for the cysts and a Paleo diet with A, D, and K2 supplementation. All other tests normal, B12, hormones. TSH, fasting glucose normal, kidney function good. She can’t afford testing yet, but I was wondering if you could provide direction on this presentation. Looking forward to your thoughts.

Chris Kresser: Yeah, that is a difficult case. Let me see if anything springs to mind just after first glance....

Female patient with anemia. Here are test results according to the ranges for iron you provided, she’s on the lower end. What dose of iron would you recommend? And how long?

Chris Kresser: So her RBC was 3.98, which is low, her hemoglobin, 11.9, is low, hematocrit, 37.3, is low, her...

As a dietician can you please share which blood test you get your patients to do compared to Chris’s blood chemistry panel? And do you request to have these done before seeing patients yourself?

Laura Schoenfeld: All right, so I do have an article on my own site about the lab tests that I...

Iron deficiency addressed with iron-repletion protocol minus the alcohol. Should we add in liver support?

Chris Kresser: Yeah, definitely no alcohol here. I don’t really recommend alcohol as a main strategy for repleting iron. It’s...

In my book on, in his book on B12 deficiency, Chris says a high serum B12 does not necessarily rule out functional active B12 deficiency. In fact, I’ve come to view high serum B12 in the absence of supplementation as a potential red flag for active B12 deficiency. Can you explain a little bit more about what the mechanisms are here?

Chris Kresser: I don’t know that that’s fully understood, but I have seen it mentioned in the scientific literature. One...

If the Cyrex shows red for all dairy markers, so that includes casein, cow’s milk, casomorphin, butyrophilin, but it’s green for whey protein. Should the patient try introducing whey protein? The patient has low glutathione and may benefit from whey.

Dr. Amy Nett: I think it’s reasonable to try introducing whey protein. So if there are no antibodies out of...

I often get conflicting findings when I order serum MMA, B12, homocysteine and CBC MCV. Can you help me understand what to do when MMA is low and other markers are higher, vice versa?

Chris Kresser: Yeah, so good, that’s par for the course. I also get conflicting markers there. I don’t know that...

We haven’t covered lipids yet in the blood chem unit but curious if you have protocol for decreasing LDL particle number in a 62-year-old male patient following Paleo template diet. Lab values: total cholesterol, 266; HDL, 77; triglycerides, 78; LDL, 173; LDL particle number, 1,879; gut test pending; DUTCH, high nighttime cortisol and cortisone, low testosterone, high estrogen.

Chris Kresser: Yeah, so hang tight. We’re going to go into detail on that in the lipid section of blood...

When discussing zinc/copper imbalance I noticed you did not mention pyroluria. Can you comment on your thoughts re: this biobalance Dr. Walsh protocols.

Chris Kresser: It’s hard to comment on because there’s no, it doesn’t really, it’s a condition that doesn’t really exist...

Naturally high vitamin D level of 75, male, 45, eats relatively clean diet with fatty fish or seafood once every two to four weeks. Rarely eats organ meats, some bread and pasta at times, active in outdoor pursuits, but careful to use sunscreen due to multiple BCC. Not supplementing with cod liver oil or vitamin D. Is it possible to have vitamin D, 25(OH)D level of 75? Would you consider this normal or not?

Chris Kresser: There are some studies that were done on lifeguards in Israel, where they had pretty high vitamin D...

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