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A1C, Vitamin D, Thyroid, Cholesterol
Old 01-28-2015, 12:30 AM   #1
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A1C, Vitamin D, Thyroid, Cholesterol

I had routine lab tests come back and some of the results where a bit perplexing. The main results:

The Good
HDL Cholesterol - 53
Triglycerides - 104
VLDL - 21
Triglycerides/HDL Ratio (calculated by me) - 1.96.
Cholesterol/HDL Ratio (calculated by me) - 4.5
Fasting Blood Glucose - 84


The Bad

TSH (Thyroid-Stimulating Hormone) - 3.41
Total Cholesterol - 225
LDL Cholesterol - 151

The Ugly
Vitamin D - 8.7 ng/ml
A1C - 5.9%

The 4 issues are Vitamin D, Thyroid, Cholesterol and -- of most concern -- blood glucose.

Background

My last lab testing was in 12/2011 after I had been eating low carb for 6 months. Prior testing was in 6/2011 right before I started eating low carb. I'll post about those results as relevant in the specific sections.

I've been losing weight over the past few years and have a lost a total of 49 pounds. I am currently 11 pounds away from a normal BMI. I currently eat a low-ish carb diet, some might call it low moderate. I record everything I eat. During 2014 I averaged about 118g of carbs a day (96g net carbs, subtracting out fiber only).

Talking about each one:

Vitamin D - My Vitamin D level is really severely low. I am a bit surprised it is so low since I was normal in June, 2011. I don't go aside a ton (just for walking mostly and only during good weather). So it doesn't surprise me to be low, but surprises me to be that low. With these results I'm now taking 50,000 units of Vitamin D weekly for 12 weeks.

I searched and read a prior thread awhile back and saw several people had low Vitamin D. I do have some fatigue the past several months so I am hoping the supplement may help with that. Am curious for those who had low Vitamin D and took supplements, whether you could tell any difference in how you felt? If you did, how long did it take?

Thyroid - I know there is controversy about whether my result would be considered abnormal or not. My doctor's office likes it to not be above about 2.5 and so I am now taking a low dose each day of Levothyroxine. Back in 2011 my TSH level was 1.58 and results I have for prior years were below 2. So, increasing to 3.41 in 3 years really is quite a jump for me.

Cholesterol - I know this is also controversial. I am reasonably OK with my results. I am happy with the triglycerides/HDL ratio. Back in 6/2011 (I had lost maybe 30 pounds at that time), my results were:

Total Cholesterol - 182
HDL - 45
Triglycerides - 128
LDL - 111

After eating low carb (very low carb at the start, eating about 80 to 100 g a day after 6 months - 40 to 60 net carbs a day), my results in 12/2011 were:


Total Cholesterol - 205
HDL - 46
Triglycerides - 90
LDL - 141

So my current results are better on the HDL, a little higher on everything else.

I have taken Lipitor (10mg only) off and on over the years. Back in 2000, my total cholesterol was 248, HDL 54, LDL 175, triglycerides 97. I took Lipitor for awhile which had a dramatic effect. In 2004, I had stopped Lipitor and total cholesterol was 256, HDL 43, LDL 174, triglycerides 195. I went back on Lipitor for a few years then had stopped it for several months before I was tested in June, 2011.

I know all about the issues of LDL particle size/number. From what I've read my current triglyceride/HDL ratio would suggest I likely have large, fluffy LDL particles.

So, I wouldn't be that concerned particularly ...except for 2 things. I'm adopted and know nothing of paternal medical history. I do have contact with my biological mother and we were talking recently and found out that she has high cholesterol (untreated years ago it reached to nearly 300). She says that it runs in the family. She is thin so this isn't an obesity thing. She does take statins. On the other hand, she is a pretty healthy 85 year old.

The other thing is that I developed small cholesterol deposits on my eyes (xanthelasma). I was in my mid-50s when I developed them. I've read that people with xanthelasma have a higher risk of cardiac death (independent of their blood cholesterol level). Apparently having them shows an abnormality in how the body handles cholesterol.

So - given those two things I might be more friendly to the idea of statins. I never had any negative side effects when I took Lipitor. I know some people do have them, but I didn't. But, I have also read that they increase the risk of diabetes and that really scares me. So...just not sure. If it wasn't for the familial history and the xanthelasma I wouldn't worry about my cholesterol at all really. But, with those two things, I'm less sure.

Blood Glucose

I am perplexed by the 5.9% A1C which apparently equates to an average blood glucose level of 123. This was the first time I've had an A1C. My current fasting blood glucose is 84 which is fine. In 12/2011 (after eating low carb), my fasting blood glucose was 82. In June, 2011 (before low carb) it was 98. Looking back over old records I had some other results in the mid-90s.

From what I've read, it seems like usually people with that kind of A1C have high triglycerides...but I don't. Basically the A1C number doesn't seem to match up with my 84 fasting blood glucose or with my 103 triglycerides.

I do know that the A1C is an average over time while the fasting number is more a snapshot in time. But, I went back and checked my food records. I ate very similarly in the 3 days before the fasting blood glucose was taken compared to how I ate over the 3 month period.

My plan is to use a meter and test my blood glucose each morning and 1 and 2 hours after eating to find out (1) how my blood glucose is changing after eating and (2) finding out which foods are raising it and then avoiding those foods. I plan to get the A1C tested again in 3 months.

I really didn't expect to see that kind of A1C number -- I thought I would have one that would go with my fasting blood glucose number and that would match my triglycerides so I'm surprised that it didn't.

I really don't want to develop diabetes (I know this may not be totally under my control). My adoptive mother has Type II diabetes and I really want to avoid it if possible. I think that the best plan is to test and find out what foods raise my blood sugar and to then avoid those foods or modify them so they don't raise my blood sugar.

Appreciate any words of wisdom anyone has on this.
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Old 01-28-2015, 06:16 AM   #2
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5.9 A1C doesn't seem all that bad to me. I wouldn't stress about it, since you should easily be able to get it down enough to alleviate your worry. Mine was 5.4 about five years ago, so I changed my diet and it was down to 5.0 a year later.
Quote:
For someone who doesn't have diabetes, a normal A1C level can range from 4.5 to 6 percent.
Quote:
When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes.
A1C test Results - Tests and Procedures - Mayo Clinic
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Old 01-28-2015, 07:37 AM   #3
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Since you seem to have researched most of this quite thoroughly (and well, BTW), I can add only this to the discussion:


Stop the Thyroid Madness™ - Hypothyroidism and thyroid mistreatment

Quote:
Thyroid Madness Definition:

  1. Treating hypothyroid patients solely with T4-only meds.
  2. Dosing solely by the TSH and the total T4, or using the outdated "Thyroid Panel".
  3. Prescribing anti-depressants in lieu of evaluating and treating the free T3.
  4. Telling thyroid patients that desiccated natural thyroid like Armour is "unreliable", "inconsistent", "dangerous" or "outdated".
  5. Making labwork more important than the hypo symptoms which scream their presence.
  6. Failing to see the OBVIOUS symptoms of poorly treated thyroid, and instead, recommending a slew of other tests and diagnoses.
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Old 01-28-2015, 07:54 AM   #4
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A 5.7 A1C places you in the pre-diabetic range. I think you can easily get that down via diet and exercise. What you don't want to do, is have it increase into the diabetic range which if I think is 6.4

I am diabetic and my A1Cs after getting things reasonably under control are generally either 5.4 or 5.5, however my fasting results are not nearly so good, being around 114+. I seem to suffer from what is known as dawn phenomena that makes my fasting results high despite what I do.
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Old 01-28-2015, 09:07 AM   #5
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Try to lower your triglycerides even more. Aim for a HDL/Triglyceride ratio around 1.

You should continue monitoring / supplementing your Vitamin D level after your 12 week program. Not sure what target you are looking to achieve, but somewhere around 60 is reasonable. Look into taking K2 along with your D supplementation.

As far as a more comprehensive strategy, look at Davis's new book, Wheat Belly Total Health. Pretty good advice there. (about $9 on kindle)

Good luck...
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Old 01-28-2015, 09:08 AM   #6
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Originally Posted by Katsmeow View Post


Vitamin D - My Vitamin D level is really severely low. I am a bit surprised it is so low since I was normal in June, 2011. I don't go aside a ton (just for walking mostly and only during good weather). So it doesn't surprise me to be low, but surprises me to be that low. With these results I'm now taking 50,000 units of Vitamin D weekly for 12 weeks.

I searched and read a prior thread awhile back and saw several people had low Vitamin D. I do have some fatigue the past several months so I am hoping the supplement may help with that. Am curious for those who had low Vitamin D and took supplements, whether you could tell any difference in how you felt? If you did, how long did it take?
I had low Vitamin D (28ng during my last exam), although the good range is above 30 my doctor would like to see it around 50 or higher so I've been taken 5000IU Vitamin D supplements a day as he suggested. Haven't been retested yet and can't really say if I feel any different. I live in Arizona and spend a lot of time out in the sun (golf 3-4X/week) but always use sunscreen which seems to block the vitamin D absorption. I'm not willing to risk the problems of skin damage from the sun for the additional Vitamin D so I have a feeling Vitamin D supplements will become a regular part of my daily routine.
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Old 01-28-2015, 09:08 AM   #7
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I don't think TSH should be used as the sole metric in determining the need for treatment. Did you have T3 and T4 checked as well? Is your iodine level adequate?

I have the "Thyroid Madness" book and some of it is informative but iMHO it relies too much on anecdotes. The second book is an attempt to legitimize the first and has chapters written by "experts".

It is put away in my stack of books bought and forgotten about.

I have achieved the best results by always taking my medication on an empty stomach and using brand name. I have tried generic inadvertently and suffered.


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Old 01-28-2015, 09:15 AM   #8
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Statins: Are these cholesterol-lowering drugs right for you? - Mayo Clinic

It would be interesting to stop taking statins to see if the blood sugar numbers retreat.
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Old 01-28-2015, 09:15 AM   #9
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Originally Posted by zinger1457 View Post
I had low Vitamin D (28ng during my last exam), although the good range is above 30 my doctor would like to see it above 50 or higher so I've been taken 5000IU Vitamin D supplements a day as he suggested. Haven't been retested yet and can't really say if I feel any different. I live in Arizona and spend a lot of time out in the sun (golf 3-4X/week) but always use sunscreen which seems to block the vitamin D absorption. I'm not willing to risk the problems of skin damage from the sun for the additional Vitamin D so I have a feeling Vitamin D supplements will become a regular part of my daily routine.
vitamin d: Uses, Side Effects, Interactions and Warnings - WebMD

Quote:
It’s amazing how quickly adequate levels of vitamin D can be restored by sunlight. Just 6 days of casual sunlight exposure without sunscreen can make up for 49 days of no sunlight exposure. Body fat acts like a kind of storage battery for vitamin D. During periods of sunlight, vitamin D is stored in fatty fat and then released when sunlight is gone.

Nevertheless, vitamin D deficiency is more common than you might expect. People who don’t get enough sun, especially people living in Canada and the northern half of the US, are especially at risk. Vitamin D deficiency also occurs even in sunny climates, possibly because people are staying indoors more, covering up when outside, or using sunscreens consistently these days to reduce skin cancer risk.

Older people are also at risk for vitamin D deficiency. They are less likely to spend time in the sun, have fewer “receptors” in their skin that convert sunlight to vitamin D, may not get vitamin D in their diet, may have trouble absorbing vitamin D even if they do get it in their diet, and may have more trouble converting dietary vitamin D to a useful form due to aging kidneys. In fact, the risk for vitamin D deficiency in people over 65 years of age is very high. Surprisingly, as many as 40% of older people even in sunny climates such as South Florida don’t have enough vitamin D in their systems.
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Old 01-28-2015, 09:39 AM   #10
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Note that the standard, inexpensive vitamin D test measures only the 25D precursor. Your 25D level can be low if your body is depleting it by excessively converting it to its 1,25D form, which is the form the body actually uses. In such a case, paradoxically, you are actually high in vitamin D. The symptoms of hypovitaminosis D and hypervitaminosis D are very similar. The proper way to check if you are truely deficient is to follow-up a low 25D test by one for 1,25D. The 1,25D test is done less often because it is more expensive. Supplementing D when you are high in 1,25D can be dangerous. There's much more info online, such as this PubMed article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/
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Old 01-28-2015, 09:49 AM   #11
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Your TSH was normal. Why would your doctor put you on thyroid replacement? Taking thyroid hormone in pill form will just get your body to shut off its own thyroid hormone production. Doesn't sound like a good plan.
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Old 01-28-2015, 10:08 AM   #12
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Your TSH was normal. Why would your doctor put you on thyroid replacement? Taking thyroid hormone in pill form will just get your body to shut off its own thyroid hormone production. Doesn't sound like a good plan.
+1
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Old 01-28-2015, 10:20 AM   #13
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Your TSH was normal. Why would your doctor put you on thyroid replacement? Taking thyroid hormone in pill form will just get your body to shut off its own thyroid hormone production. Doesn't sound like a good plan.
Apparently it's not that simple these days...

What Is a Normal Thyroid Stimulating Hormone Level?
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Old 01-28-2015, 10:56 AM   #14
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5.9 A1C doesn't seem all that bad to me. I wouldn't stress about it, since you should easily be able to get it down enough to alleviate your worry. Mine was 5.4 about five years ago, so I changed my diet and it was down to 5.0 a year later.
I think 5.9 is terrible. I am not at all happy about being in a prediabetic range. The other part to me is trying to understand it since it seems a mismatch with my fasting blood glucose (84) and my triglycerides (103).

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You should continue monitoring / supplementing your Vitamin D level after your 12 week program. Not sure what target you are looking to achieve, but somewhere around 60 is reasonable. Look into taking K2 along with your D supplementation.
It was indicated that after the 12 weeks is over, I should take 4000 Units a day.
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I don't think TSH should be used as the sole metric in determining the need for treatment. Did you have T3 and T4 checked as well? Is your iodine level adequate?
This test was just TSH. I've had the T3 and T4 checked at other times in the past.

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Statins: Are these cholesterol-lowering drugs right for you? - Mayo Clinic

It would be interesting to stop taking statins to see if the blood sugar numbers retreat.
Haven't taken a statin since early in 2012 for a couple of months.

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Note that the standard, inexpensive vitamin D test measures only the 25D precursor. Your 25D level can be low if your body is depleting it by excessively converting it to its 1,25D form, which is the form the body actually uses. In such a case, paradoxically, you are actually high in vitamin D. The symptoms of hypovitaminosis D and hypervitaminosis D are very similar. The proper way to check if you are truely deficient is to follow-up a low 25D test by one for 1,25D. The 1,25D test is done less often because it is more expensive. Supplementing D when you are high in 1,25D can be dangerous. There's much more info online, such as this PubMed article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/
That is interesting and will look at the article and research this. I don't really see how I could be high in Vitamin D though. I don't go outside much, cover up when I do (I am fair skinned and burn easily), and I don't eat a lot of the foods that are high in Vitamin D (natural or supplemented).

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Your TSH was normal. Why would your doctor put you on thyroid replacement? Taking thyroid hormone in pill form will just get your body to shut off its own thyroid hormone production. Doesn't sound like a good plan.
As Meadbh points out the determination of what is normal TSH is not that clear. The endorinologists have gone back and forth on the issue. They changed to saying 3.0 was the highest normal then a a couple of year ago went back to a higher level (and some feel they shouldn't). http://thyroid.about.com/cs/testsfor...a/newrange.htm
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Old 01-28-2015, 11:20 AM   #15
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Can the A1C test result in a different diagnosis than the blood glucose tests?

Yes. In some people, a blood glucose test may indicate a diagnosis of diabetes while an A1C test does not. The reverse can also occur—an A1C test may indicate a diagnosis of diabetes even though a blood glucose test does not. Because of these variations in test results, health care providers repeat tests before making a diagnosis.
People with differing test results may be in an early stage of the disease, where blood glucose levels have not risen high enough to show on every test. Sometimes, making simple changes in lifestyle—losing a small amount of weight and increasing physical activity—can help people in this early stage reverse diabetes or delay its onset.
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Old 01-28-2015, 11:25 AM   #16
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I don't recall where I found the link above. I just had labs and had high glucose, 110, but my AC1 number was 5.6 and I was Vit D deficient also. He said that the AC1 was surprising, but that apparently my body handled the higher sugar level just fine. My doc wanted me to add 800-2000 D3 and change my diet. Apparently double bacon cheeseburgers and two bowls of ice cream aren't cutting it any more. I know my biggest issue has always been sugar in desserts, but it is amazing/amusing to find so much sugar in so many products that we consume. O.J., yogurt, etc
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Old 01-28-2015, 11:27 AM   #17
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He also suggested warming up on the golf course without sunscreen and then putting it on for the round. I have had a couple of basal cell spots removed. He was not concerned as we all need some sunshine.

I was concerned from the posts above whether a K2 supplement would be helpful if I take the D3. Not sure whether to take one without talking again to the doc.
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Old 01-28-2015, 11:30 AM   #18
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Apparently double bacon cheeseburgers and two bowls of ice cream aren't cutting it any more.
Are you saying that large portions of fat/protein and bowls of sugar are equally unhealthy... or did you mean in combination? <chuckle>
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Old 01-28-2015, 11:34 AM   #19
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I know! And I believe he had other typo's . . . something about exercise? Sheeesh!
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Old 01-28-2015, 11:37 AM   #20
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I think 5.9 is terrible. I am not at all happy about being in a prediabetic range. The other part to me is trying to understand it since it seems a mismatch with my fasting blood glucose (84) and my triglycerides (103).
If your fasting is always near 84 (which may not be the case), it seems you are probably spiking after meals in order to average 123. Your plan to get a meter and measure your blood sugar before and after-meals should give you very useful information.
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