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I appreciate if you can shed some light on possible causes for high albumin but low globulin in a 14-year-old girl presenting with weight loss and secondary amenorrhea but no psychological features of typical anorexia nervosa. She moved to the country at the beginning of the year and since then has lost almost 20 percent of her body weight, with changes in gut symptoms including constipation, fullness after meals, stomach aches. She has low T3 but normal TSH and T4, which left her conventional endocrinologist stumped because he can’t give thyroxine in a weight loss patient. I’m going through gut testing and other blood markers, but her previous doctors have already done some standard tests and found high chloride, low liver enzymes, raised albumin, low globulin, normal hemoglobin, which is why I’m curious as to why albumin is high in a patient with poor oral intake. She eats animal protein but can’t stomach the quantity as before.

Dr. Amy Nett: Good question. So in terms of the high albumin, I would think about dehydration, particularly given that...

What about 2-methoxy-E1 low but methylation activity is high? I also see the opposite, 2-methoxy-E1 high and methylation low. What do we want to see with these two markers?

Dr. Amy Nett: Okay. So again, what you’re looking for here is not so much the absolute numbers. What you...

Homocysteine of 11, TPO, or thyroid peroxidase, antibodies at 245. She has been diagnosed with Hashimoto’s and is on 100 mg of Synthroid. Her thyroid markers are all in the functional ranges. Her vitamin D is low at 29.5, She also has low-normal iron stores, trying to focus on organ meats. Her chief complaints are are fatigue, body aches, weight. She had an ablation. She believes she’s still premenopausal which make sense since the estrogen markers are normal, sort of high normal. Progesterone is low normal. Testosterone is below normal. DHEA is low normal, with DHEA-S in range at the lowest. She has High 5-alpha-reductase activity.

Dr. Amy Nett: Interesting. Because DHEA actually upregulates 5-alpha-reductase activity. So I would’ve expected with low DHEA that she would...

From the Oregon State University study, the anemia of iron deficiency is usually characterized as microcytic and hyperchromatic, i.e., red blood cells are measurably smaller than normal and their hemoglobin content is decreased such that they are more pale than normal. I was under the impression that red blood cell width increased in iron deficiency. What am I missing or confusing here?

Dr. Amy Nett: Yeah. So I think you’re talking about RDW. So the RDW increases in iron deficiency, but RDW...

Ferritin goes up in times of inflammation and infection because the body up regulates hepcidin, which gets the body to store the iron and ferritin to sequester iron from the potential pathogens and starve them of iron so they can’t thrive. As a side effect of this is that in the storage form it’s unavailable to ourselves too, and we can become anemic. Is that correct or have a oversimplified?

Dr. Amy Nett: Okay, so I think very generally, yes. What you’re saying is correct. There’s probably a little more...

If I’ve understood this correctly, with metabolic syndrome, iron stores increase so hepcidin increases, which causes more iron to be stored, which is obviously a very unhelpful move by the body. Why might this be?

Dr. Amy Nett: Okay, so I think what you’re saying is again there is an association between high ferritin and...

Going over last week’s material, and I see it says women with PCOS, lupus, and diabetes have similar rates of heart disease to men. What they have in common is they are all associated with increased iron levels. I’m curious about this because many of the women I know of that have been diagnosed with PCOS tend to lean more towards anemia. Potentially because the anemia isn’t iron deficiency related. But there are so many I can’t believe none of them are. What is the connection between PCOS and increased iron levels?

Dr. Amy Nett: Okay, so as you mentioned though, you’re right. Anemia is not always due to iron deficiency and...

I’m struggling with the blood chemistry unit to make sense of the results. Quite often the results come without showing the units they’re measuring, which is obviously something I need to consult whoever is giving the results. But when I turn to the Kresser course material, specifically week 20, part two of the functional medicine Blood Chemistry unit, we get conventional ranges and functional ranges on the chart. But again it doesn’t list the units which are being measured. I can work out often which they probably are, but sometimes it’s actually impossible. So I can’t tell if the results I’m looking at are in range or way out. Can this be remedied? Can you write the units that a result is measuring? When it comes to the reference guide you’re giving us in an app, will it be possible to clarify this? It’s so time consuming to try working this out instead of just being able to get on understanding the material.

Dr. Amy Nett: So the charts that you’re talking about. So for example on week 30, part two, what we’re...

Aside from inflammation and iron overload, what other factors can elevate ferritin? I seem to recall learning that elevated testosterone is one possibility.

Dr. Amy Nett: I don’t think I know of other causes of elevated ferritin other than high iron and inflammation....

With iron-deficiency anemia, how long do you recommend supplementing before retesting?

Dr. Amy Nett: It depends on the severity. I normally like to supplement for about three to four weeks and...

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