4 ms·

Is it too much to ask that anyone promoting low-carb based on personal experience post bloodwork? I think it's pretty clear no one on here is well-versed in nu

Is it too much to ask that anyone promoting low-carb based on personal experience post bloodwork? I think it's pretty clear no one on here is well-versed in nutrition as we're all programmers, so maybe it'd be good to have some intellectual integrity. I'm interested in prolactin, thyroid, liver, cholesterol, CO2.

deleted 7y ago
[deleted]
- deleted 7y ago
  [deleted]
MrBuddyCasino 7y ago
I wanted to get bloodwork done to get some hard data, but I'm not sure which data points are the most important ones. Cholesterol and liver I understand, why prolactin, thyroid and CO2?
- deleted 7y ago
  [deleted]
lhl 7y ago
I've gone through several thousand papers the past year or two so I feel like I'm more well-versed in nutrition than most nutritionists/dieticians at this point, certainly in my understanding the recent clinical/research literature. I rarely post any nutritional/health related statements without citations to peer-reviewed work (see: https://news.ycombinator.com/threads?id=lhl https://news.ycombinator.com/threads?id=lhl ) I think most people don't publish labs because they view it as personal, but I did a write-up last year, which includes (IMO) basically all my relevant markers: https://randomfoo.net/2019/09/17/1-year-personal-health-intervention-summary https://randomfoo.net/2019/09/17/1-year-personal-health-inte... A very strange set of lab markers you're interested in btw - prolactin has very little clinical value for men (and is almost never tested), but I tested my testosterone at the one year mark (it's fine, 772ng/dL, I have not sequential tests). I had a thyroid panel last year as well and TSH, FT3, and FT4 were all in range. My CO2 has stayed the same regardless of diet - I don't know why that would be relevant at all. For people looking to track their metabolic health, the bloodwork I think is most useful to track over time: CMP, CBC w/ diff, basic lipid panel (fasted 12h), A1c, fasting insulin, Vitamin D, hsCRP. I also was getting a full iron panel, and it was interesting to see my ferritin remained elevated last year (but is within range now - likely a marker of resolving MetS). The thing that almost no one gets measured that is almost criminal IMO is fasting insulin - while it's highly mobile, it's also dirt cheap ($8 more than FBG+A1c direct-to-consumer price), allows calculating the best IR indices, and is a 10-15y leading indicator for chronic metabolic disease. At home, waist circumference to height ratio (WHtR, WSR) is the best simple marker for tracking metabolic health. Ashwell, Margaret, and Sigrid Gibson. “Waist-to-Height Ratio as an Indicator of ‘Early Health Risk’: Simpler and More Predictive than Using a ‘Matrix’ Based on BMI and Waist Circumference.” BMJ Open 6, no. 3 (March 14, 2016). https://doi.org/10.1136/bmjopen-2015-010159 https://doi.org/10.1136/bmjopen-2015-010159.
- hoka-one-one 7y ago
  This is really cool and I think you're doing more due diligence than any HN user I've ever seen. The confounding variable is that you lost a lot of weight, of course, and I think many people who lose weight will be healthier at least in the short term. A question I've had in my head for a while is whether someone who has to stay on a ketogenic diet to be a healthy weight has "healed" or has just masked the underlying issue. Would be interested to see your thyroid numbers as you continue on your ketogenic/fasting diet. "In range" does not necessarily mean optimal, and in general I'd be worried about T3 uptake going from 33 to 23 even though both are in range. The liver converts T4 to T3 in response to glucose availability -- this happens in many tissues, but they all depend on a liver enzyme, and most of the conversion occurs in the liver. Low CO2 is a sign of kidney stress and acidosis. I also believe it's a marker of a low metabolic rate, much like thyroid. Prolactin is a longer discussion I don't want to get into here (much like you on your LDL-C :)) but I'll definitely be following your posts as I think you're doing your part and have done more research than I have so maybe I'll comment on your blog sometime. Put very briefly I believe high prolactin in men can be a sign of chronic stress and calcium deficiency. It's been linked to gynecomastia, for example, which makes a lot of sense. In general I like to look for tests that show whether something's wrong, rather than what's specifically wrong. Someone might have alright D but still have issues properly metabolizing calcium.
  - lhl 7y ago
    I'd argue that weight loss isn't a confounding variable, as resolving dyslipidemia and MetS is actually one of the main points of the intervention. As for "masking the underlying issue" - let's face it, if you go back to regularly eating a terrible diet, yes, you'll become unhealthy again, but the same would go be true for any chronic insult. Personally, I'm a believer in metabolic flexibility and I do take time off (vacations, parties and special events, or just when I feel like it) to indulge. The difference now is that I am more acutely paying attention to how the food is making me feel (turns out for example when I have excess bread/sugar, I end up getting a pimple or two that I had originally never connected to being driven by dietary excesses), having a framework to think about how the food will affect my health (what do I think my liver glycogen levels are at?), and much pickier in general about how much I'll eat (my "worth it" taste bar is much higher - if it doesn't taste good I can now just stop). I also feel like I now have effective tools to pull various metabolic levers, whereas before I didn't. Regarding thyroid numbers, IMO taking about what is "optimal" is actually much trickier than "in range" (which are just standard deviations) because they need to be taken in the context of how you actually feel and if you present any symptoms (for hypothyroidism that would be fatigue, increased sensitivity to cold, weight gain, muscle weakness, etc) - which may be another reason people don't post numbers. Surrogate markers are most useful 1) sequentially per individual and 2) need to be considered with whether those numbers actually correlate with symptoms/reflect pathophysiology. Some are pretty obvious, but thyroid numbers seem to be one of those that requires a lot of careful nuance, but seems not worth the trouble (tracking TSH, T3, T4, rT3, rT4, TPO, Tg) unless you're presenting. For kidney issues, eGFR is something you'd look at, you'd want to take a look if any of your CMP numbers are out of wack, but I personally wouldn't be worried about acidosis - it's almost never a problem for non T1Ds (would be a sign of a major insulin:glucagon issue at least) but you'd definitely know (and need to know) if it were an issue well outside of regular bloodwork. If metabolic rate is a concern, I think RMR and DXA are a much better combo for tracking, btw. As for prolactin, if that's something you want to track and can use as a long term marker that is actionable for you, great, more power to you. It looks like it's only $60 out of pocket, so not terrible, but just recognize that if you throw it out there as something that a number that people should know or care about, or that you want to compare with, it simply won't be. For chronic stress, I'd suggest 24h cortisol, and maybe some inflammatory markers (I use hsCRP as my one catch all canary, but other common ones include ESR, IL6, TNFa), but for most people, you'd probably get more value day to day from mood and sleep tracking (especially ones that can track HRV or CNS values like the EMFIT). Calcium is measured via the CMP and deficiencies would I suppose show up in a DXA as well (eg if your bone density Z-score was quite low), but again, I think that's a thing where you'd only be worried about it if you were presenting symptoms (extreme fatigue, hair and nail issues, sleep issues, etc). I do think that if you are trying to track down nonspecific issues (eg "fatigue") you're going to have to do a bunch of detective work, which may involve more and more esoteric labs, but I'd also posit that most of those could probably also be addressed by relatively simple lifestyle interventions, starting with an appropriate/nutrient-dense diet and the most basic mood/energy tracking (eg:1-5 phone app like MySymptoms or Daylio correlated with interventions), and an engineering mindset.
1_player 7y ago
For what it’s worth I’ve had blood tests recently after 3 weeks zero carb (pure carnivore) Everything in the norm, high cholesterol but low triglycerides, glucose (HbA1c) bang on in the middle of the normal scale. Blood pressure going down, heart rate quite high that resolved itself after a few days (due to fat adaptation) Eating probably 10g of salt per day, lower now that my body went past the adaptation phase. (My BP medication has a diuretic in it, so I need more than other people I guess) No more stuffy nose, not feeling hungry at all, eating below or at my TDEE. Surprisingly Vit D3 in the norm, and I don’t get any sun at all. No palpitations I had when doing keto, no bloating, perfect bowel movements every 2 or 3 days. YMMV.

deleted 7y ago

[deleted]

deleted 7y ago
[deleted]

MrBuddyCasino 7y ago

I wanted to get bloodwork done to get some hard data, but I'm not sure which data points are the most important ones. Cholesterol and liver I understand, why prolactin, thyroid and CO2?

deleted 7y ago
[deleted]

lhl 7y ago

I've gone through several thousand papers the past year or two so I feel like I'm more well-versed in nutrition than most nutritionists/dieticians at this point, certainly in my understanding the recent clinical/research literature. I rarely post any nutritional/health related statements without citations to peer-reviewed work (see: https://news.ycombinator.com/threads?id=lhl https://news.ycombinator.com/threads?id=lhl ) I think most people don't publish labs because they view it as personal, but I did a write-up last year, which includes (IMO) basically all my relevant markers: https://randomfoo.net/2019/09/17/1-year-personal-health-intervention-summary https://randomfoo.net/2019/09/17/1-year-personal-health-inte... A very strange set of lab markers you're interested in btw - prolactin has very little clinical value for men (and is almost never tested), but I tested my testosterone at the one year mark (it's fine, 772ng/dL, I have not sequential tests). I had a thyroid panel last year as well and TSH, FT3, and FT4 were all in range. My CO2 has stayed the same regardless of diet - I don't know why that would be relevant at all. For people looking to track their metabolic health, the bloodwork I think is most useful to track over time: CMP, CBC w/ diff, basic lipid panel (fasted 12h), A1c, fasting insulin, Vitamin D, hsCRP. I also was getting a full iron panel, and it was interesting to see my ferritin remained elevated last year (but is within range now - likely a marker of resolving MetS). The thing that almost no one gets measured that is almost criminal IMO is fasting insulin - while it's highly mobile, it's also dirt cheap ($8 more than FBG+A1c direct-to-consumer price), allows calculating the best IR indices, and is a 10-15y leading indicator for chronic metabolic disease. At home, waist circumference to height ratio (WHtR, WSR) is the best simple marker for tracking metabolic health. Ashwell, Margaret, and Sigrid Gibson. “Waist-to-Height Ratio as an Indicator of ‘Early Health Risk’: Simpler and More Predictive than Using a ‘Matrix’ Based on BMI and Waist Circumference.” BMJ Open 6, no. 3 (March 14, 2016). https://doi.org/10.1136/bmjopen-2015-010159 https://doi.org/10.1136/bmjopen-2015-010159.

hoka-one-one 7y ago
This is really cool and I think you're doing more due diligence than any HN user I've ever seen. The confounding variable is that you lost a lot of weight, of course, and I think many people who lose weight will be healthier at least in the short term. A question I've had in my head for a while is whether someone who has to stay on a ketogenic diet to be a healthy weight has "healed" or has just masked the underlying issue. Would be interested to see your thyroid numbers as you continue on your ketogenic/fasting diet. "In range" does not necessarily mean optimal, and in general I'd be worried about T3 uptake going from 33 to 23 even though both are in range. The liver converts T4 to T3 in response to glucose availability -- this happens in many tissues, but they all depend on a liver enzyme, and most of the conversion occurs in the liver. Low CO2 is a sign of kidney stress and acidosis. I also believe it's a marker of a low metabolic rate, much like thyroid. Prolactin is a longer discussion I don't want to get into here (much like you on your LDL-C :)) but I'll definitely be following your posts as I think you're doing your part and have done more research than I have so maybe I'll comment on your blog sometime. Put very briefly I believe high prolactin in men can be a sign of chronic stress and calcium deficiency. It's been linked to gynecomastia, for example, which makes a lot of sense. In general I like to look for tests that show whether something's wrong, rather than what's specifically wrong. Someone might have alright D but still have issues properly metabolizing calcium.
- lhl 7y ago
  I'd argue that weight loss isn't a confounding variable, as resolving dyslipidemia and MetS is actually one of the main points of the intervention. As for "masking the underlying issue" - let's face it, if you go back to regularly eating a terrible diet, yes, you'll become unhealthy again, but the same would go be true for any chronic insult. Personally, I'm a believer in metabolic flexibility and I do take time off (vacations, parties and special events, or just when I feel like it) to indulge. The difference now is that I am more acutely paying attention to how the food is making me feel (turns out for example when I have excess bread/sugar, I end up getting a pimple or two that I had originally never connected to being driven by dietary excesses), having a framework to think about how the food will affect my health (what do I think my liver glycogen levels are at?), and much pickier in general about how much I'll eat (my "worth it" taste bar is much higher - if it doesn't taste good I can now just stop). I also feel like I now have effective tools to pull various metabolic levers, whereas before I didn't. Regarding thyroid numbers, IMO taking about what is "optimal" is actually much trickier than "in range" (which are just standard deviations) because they need to be taken in the context of how you actually feel and if you present any symptoms (for hypothyroidism that would be fatigue, increased sensitivity to cold, weight gain, muscle weakness, etc) - which may be another reason people don't post numbers. Surrogate markers are most useful 1) sequentially per individual and 2) need to be considered with whether those numbers actually correlate with symptoms/reflect pathophysiology. Some are pretty obvious, but thyroid numbers seem to be one of those that requires a lot of careful nuance, but seems not worth the trouble (tracking TSH, T3, T4, rT3, rT4, TPO, Tg) unless you're presenting. For kidney issues, eGFR is something you'd look at, you'd want to take a look if any of your CMP numbers are out of wack, but I personally wouldn't be worried about acidosis - it's almost never a problem for non T1Ds (would be a sign of a major insulin:glucagon issue at least) but you'd definitely know (and need to know) if it were an issue well outside of regular bloodwork. If metabolic rate is a concern, I think RMR and DXA are a much better combo for tracking, btw. As for prolactin, if that's something you want to track and can use as a long term marker that is actionable for you, great, more power to you. It looks like it's only $60 out of pocket, so not terrible, but just recognize that if you throw it out there as something that a number that people should know or care about, or that you want to compare with, it simply won't be. For chronic stress, I'd suggest 24h cortisol, and maybe some inflammatory markers (I use hsCRP as my one catch all canary, but other common ones include ESR, IL6, TNFa), but for most people, you'd probably get more value day to day from mood and sleep tracking (especially ones that can track HRV or CNS values like the EMFIT). Calcium is measured via the CMP and deficiencies would I suppose show up in a DXA as well (eg if your bone density Z-score was quite low), but again, I think that's a thing where you'd only be worried about it if you were presenting symptoms (extreme fatigue, hair and nail issues, sleep issues, etc). I do think that if you are trying to track down nonspecific issues (eg "fatigue") you're going to have to do a bunch of detective work, which may involve more and more esoteric labs, but I'd also posit that most of those could probably also be addressed by relatively simple lifestyle interventions, starting with an appropriate/nutrient-dense diet and the most basic mood/energy tracking (eg:1-5 phone app like MySymptoms or Daylio correlated with interventions), and an engineering mindset.

1_player 7y ago

For what it’s worth I’ve had blood tests recently after 3 weeks zero carb (pure carnivore) Everything in the norm, high cholesterol but low triglycerides, glucose (HbA1c) bang on in the middle of the normal scale. Blood pressure going down, heart rate quite high that resolved itself after a few days (due to fat adaptation) Eating probably 10g of salt per day, lower now that my body went past the adaptation phase. (My BP medication has a diuretic in it, so I need more than other people I guess) No more stuffy nose, not feeling hungry at all, eating below or at my TDEE. Surprisingly Vit D3 in the norm, and I don’t get any sun at all. No palpitations I had when doing keto, no bloating, perfect bowel movements every 2 or 3 days. YMMV.