Asking For Blood Test?

[B12again]

I haven’t had a blood test for over a year so I want to email my doctor to request one. What should I ask for (maybe include iron) ie the correct description of the tests. I have hypothyroidism and undiagnosed PA, I SI EOD and my doctor knows this and has no problems with it. I am in an ongoing positive discussion with him about getting them to supply my ampoules, not quite there yet though 😎. Thanks.

[Nackapan]

I ask for vitamin D Ferritin as well as iron

I don't ask for folate as done with b12 !

Otherwise full bloods include alot and term they use.

I've recently found out b12 deficiency can cause high cholesterol.

Mind ax been monitored for years ax rum on the high side.

Genetic I think

[Jo5454 in reply to Nackapan]

Ah thats interesting about cholesterol thanks Nackapan! Mine was 3.9 and shot up to 5.3 since being off b12 inj. Be interesting to recheck after loading dose to see what happens,not sure how long it'd take to lower tho...

[Nackapan in reply to Jo5454]

I don't understand why .Mine has crept up on regular b12 injections but could be age ??

Could he genetics too.

I've always eaten well.

Home grown food ect

I can't do the some exercise.

But its odd I've been building it up mainly walking in the time span its gone up.

I also have found some doctors look at the total number.

Some pay more attention yo the ratio.

My ratio is fine??

There are also genetic causes.

Not sure how they know who affected and why.?

Theye are such contradictions on fats too.

Brains need cholesterol

Arteries can get clogged up.

Butter in vogue then out of vogue

Fat fill you up so overall you eat less.

And so it goes on .......

B12 supplementation does affect metabolism.

Probably whacks other things out of balance.

[Jo5454 in reply to Nackapan]

Yes,yes,yesQuite agree! It tends to read higher after winter anyway I find and know in past when I got to having good vit d levels cholesterol lowered.I listened to a great series online recently by cardiovascular experts and they talked about cholesterol. They mentioned it being linked to thyroid/hormone or digestive issues if certain elements were raised,wish I'd taken better notes now,but very unwell at timr! Mentioned mold could potentially raise it too?

It seems cholesterol was pounced upon & thoughts to be an answer, abt sane time as raised homocysteine levels. One theory got built upon, the other didn't! I'm sure it has its place, and for some maybe more than others,butbwhilst clinging to.one idea we may be losing sight of others do you think?

Like you,I eat well, cook most things from scratch,enjoy growing own with no sprays,eat organically where I can. I'm introducing eveb more good fats like nuts. already eat avocados, flaxseed,

seeds,good oils, oily fish, there's only so much we can do isn't there.

Yes,so much fuss about fats! I personally believe & many nutritionists have advised it over yrs that good grass fed butter wrapped in paper in moderation & used alongside good oils is better than any of these margarine we were advised to swop to! No doubt developed to last longer, with the added bonus of being in plastic tubs which must do.us the world of good! Unfortunately I somehow developed a milk intolerance along way,but am doing best to.eliminate what little dairy free marg I use.

Yes, good fats give us energy & keep.us full. If I compare eating a single chicken fillet to a piece from a whole cooked chicken I know what keeps me fullest!

Plus need enough fats to absorb the essential fat soluble vitamins don't we!

As you say, and so it goes on, now I've gone on enoughnprob! Nice talking....

[Technoid in reply to Jo5454]

Phew, a lot here 😅 but I'll try to cover. In terms of a genetic effect on cholesterol, there are quite a few SNP's which can affect the big three: LDL-C, Triglycerides and HDL-C.

For LDL there are approx 10 relevant SNP's (Single Nucleotide Polymorphisms). The most severe case is called "homozygous familial hypercholesterolemia (FH)", and this can cause extremely high elevations of LDL and may result in cradiovascular events very early in life. If you have this, you would know it as your doctor would pop a sprocket if he sees your lipid panel and you are not already on medication to reduce it.

Less severe is heterozygous FH but this is still serious and probably needs both lifestyle modifications and cholesterol-lowering medications.

Then there are in-between cases where people have a couple of the relevant SNP's but not enough to put them into FH ranges although they still end up with a bit higher LDL-C than is ideal but lifestyle may be able to get this under control.

The most important lipid marker to measure risk is ApoB. Total Cholesterol is a reasonable ballpark figure but for more serious investigation, you really are better off looking at LDL-P (the number of LDL particles) or ApoB. The ratio doesn't matter much and a physician who displays an interest in your ratio is not really up to date.

The brain needs cholesterol but all the cells in your body can make cholesterol and there is no dietary requirement (or benefit to your brain or any other organ) to consuming cholesterol.

Butter hasn't been in vogue with nutrition scientists for decades. There were New York Times and Time magazine articles talking about "Butter is Back", but this was just to get eyeballs, butter was not back and never will be.

For more on that story see: web.archive.org/web/2020111...

No reasonably educated dietitian would advise consuming significant quantities of butter - there are many good alternatives, nut butters, hummus, even vegetable margarines.

The issue with margarines was that decades ago they used to contain trans fats, which are even worse than (most) saturated fats for raising blood cholesterol, but trans fats are now banned in most countries so you would only find traces now.

Lots of good fats already mentioned above so I won't repeat but good suggestions there, don't forget also canola/rapeseed oil which is very low in saturated fats.

No reason usually to reduce total fat unless its part of reducing excess calories - in general better to just swap some bad fat sources for some good.

[Jo5454 in reply to Technoid]

Thanks very much Technoid for taking the time to explain that. So it takes further testing to work out familial cholesterol levels? My mum's levels are higher weve other family members too,but /theyve never been offered further testing, just offer of statins. She can't eat any healthier, they can't fault her diet. Can familial type higher cholesterol develop later on in life or is it generally there all along, due to the genes? Seem to be reading more ways in which other things like b12,thyroid,digestive,liver issues can affect it recently, what do you feel about that?

I shall read the link thank you. Sorry didn't mean to imply butter as the bees knees! Was advised a little now and then alongside as you say bountiful good fats, was OK. Doesn't apply to me personally as since catching a sickness bug after dealing with an outbreak whilst teaching, any milk gives me a fever and worsens sinus probs & tested intolerant since.

Yes I enjoy nut butters too, & use good oils in baking, in mash, on crackers,general cooking,etc but due to price of olive oil have used more rapeseed lately. Eat seeds daily too, oily fish 3 times wk,yet did an omega 6:3 test recently whilst trying to work out why am feeling so unwell and its 18:1!

Maybe the rapeseed has more 6 than olive oil & I am a bit liberal with it as due to being underweight nhs dietician advised bulking up with oils?

Have introduced fish oil supplement, triglyceride form,and trying to eat more of the little fish as would prefer to get it right via diet if poss...any thoughts on that much appreciated thank you...

[Technoid in reply to Jo5454]

In the case of homozygous FH, cholesterol would be so high that an FH diagnosis would be possible without genetic testing. For heterozygous, with all risk factors controlled, cholesterol remaining high would raise suspicion. For the in-between cases where several relevant SNP's combine to elevate cholesterol but not massively, genetic testing would probably be required to confirm which SNP's are contributing. Unless FH is suspected I doubt any NHS doctor would bother with genetic screening for cholesterol metabolism issues as the result would not make any difference to the treatment (but would be interesting to know certainly).

It wouldnt develop later in life, if present, FH will always be there. The problem is it's the lifetime exposure which generates the risk. Having an elevated ApoB for a week is not going to do a whole lot, but over decades, the risk of developing atherosclerosis goes up, and unfortunately, by the time its noticed when symptoms develop, the person is much older and has advanced plaque development. A statin at that stage is better than nothing but it would be better for someone to control their risk as early in life as possible to prevent the plaque build-up in the first place - it is difficult to reverse advanced plaque - statins will reduce risk but cannot eliminate it. In the case of FH, lifestyle may be insufficient and medications will likely be necessary.

Cholesterol levels are affected by many lifestyle factors and co-existing diseases for sure, not just genetics or nutrition although these are very important.

You are right that in small amounts, butter may not be harmful, especially in the context of an overall healthy diet. Although certainly not a health food, as long as total saturated fat intake is below 10% or so, the risk from butter is probably not that high. Now, as a vegan, I cannot say that anyone should or needs to eat butter, but it would also not be true to say that any amount is harmful to health - the overall, diet pattern is what matters.

So, on the Omega 3 : Omega 6 ratio : I wouldn't be too concerned about high intake of Omega-6, as long as they are mostly from whole foods or moderate amounts of healthy oils and fats. I can rummage for some studies but, contrary to popular misconceptions, high intake of Omega-6, provided it's from healthy sources, is associated with better health outcomes.

The important thing is to ensure Omega-3 intake is adequate - you already mentioned flax seeds, which are a good source, broken or ground, but I note you also eat oily fish 3 times a week which likely means you are also getting enough of the long chain omega-3's, EPA and DHA. Because I don't eat fish I personally take an EPA/DHA algae oil supplement to reach about 1 gram combined EPA/DHA per day but it sounds like you are getting enough from your regular fish consumption that you might not need an EPA/DHA or fish oil supplement at all.

In terms of content in the oils, Olive Oil is mostly mono-unsaturated fat, containing 71% Oleic acid (an Omega-9) and about 10% polyunsaturated fat - Linoleic Acid (an Omega-6). It does also have some saturated fat but I havent seen any outcome data that suggests that this is a concern.

Rapeseed/Canola Oil is also mostly mono-unsaturated fat - 62% Oleic Acid (an Omega-9) and 18.6% polyunsaturated fat - Linoleic Acid (an Omega-6). But it also has 9% Alpha-Linoleic Acid (an Omega-3), the same healthy fat which flaxseeds are often praised for.

Flaxseed Oil is the king for Omega-3 PUFA, with 53.4% Alpha-Linoleic Acid, but this shouldn't be heated and stored in the fridge after opening, so its not a cooking oil replacement, more for salad dressings - as with the seeds it also has the same potential issues with conversion to EPA/DHA so a direct form of EPA/DHA is still preferable.

With regard to bulking up a bit, one thing I found useful was to have a protein shake/smoothie midway between meals as it helps to get a ton more calories in, which can be a challenge when you eat a lot of unprocessed low-calorie plant foods. But healthy oils are calorie dense so this is also an option.

[Jo5454 in reply to Technoid]

Thank you very much once again, all so very interesting and helpful. I may come back to you with a bit more on cholesterol another time please? The Dr just did a general check this time, but I’ll prob do a bit more detailed one & be interested to see if it lowers once getting other levels better along with general health.

That’s a relief about omega 6, itbwas baffling me. I’ve always been healthy eater, but due to latex allergy diagnosis 25 yrs ago and being aware of gloves, packaging seals, machinery, etc processed or mostbready made snacks treats are off menu anyway, so yes most omega 6 would be from good sources.

I used to have cold pressed flaxseed oil daily, been having tbsp seeds daily for a while instead, but maybe should consider going back to some oil again. I think I need to gen up and learn more about the make ups of oils as that’s all very interesting but makes me realise I need to understand more! I’ve been a bit nervous about eating nuts, been fine with almonds, as some foods cross react with latex, but have challenged myself to try a new type each week. Brazil nuts & walnuts ok so far, tho know the issues surrounding brazils, selenium, radioactivity, so maybe not bother with those so much. Just bought cashews today. Thought nuts may help to provide good things & calories! I love almond butter, so could then include cashew butter too.

That’s a good idea adding shakes in, can I ask what you include please?Am bit wary of protein powder as know little about it. Do you add nut butters in for extra calories? Yes a challenge to keep much weight on it seems, and guess absorption type issues with these autoimmune conditions doesn’t help.

Thank you again for your time and patience!

[Technoid in reply to Jo5454]

With regard to Brazil nuts and radioactivity, although brazil nuts do often contain more radioactive elements than many other foods, you would have to eat a huge amount to even reach the levels of natural background radioactivity we are exposed to.

Via this german website:

bfs.de/EN/topics/ion/enviro...

two brazil nuts a day for a year provide a radiation exposure of about 160 microsievert per year. The normal background radiation exposure is 1,000-10,000 microsievert so this intake doesn't even reach background radiation levels.

Selenium toxicity will be an issue with overconsumption of Brazil nuts way before their radioactivity becomes an issue. Via a reddit thread, the lethal dose of Brazil nuts based on their radiation levels is 40,000-50,000 nuts.

reddit.com/r/NoStupidQuesti...

The Selenium toxicity would get you way before you managed to consume that much 😆

One Brazil nut a day is fine, maybe 2 but thats enough if you're eating them daily. I will eat them now and then but often I just supplement the Selenium RDA instead, the amount in Brazil nuts can vary a lot.

I don't eat much bread, so don't use much nut butters, although I started baking it again recently, I mostly eat wholegrains - so unprocessed oats, spelt, einkorn, kamut, emmer, barley, rye - I cook them up in a pressure cooker mixed with different beans,

When I do eat bread it will usually be hummus I choose as a spread.

My smoothie contains:

Banana

35g 50/50 Soya Protein/Pea Protein

1 teaspoon Maple Syrup

1/4 teaspoon vanilla powder

1 teaspoon cocoa powder

110ml No Added Sugar Soya Milk (fortified with Calcium, B12, B2,D2)

1/4 teaspoon Ceylon Cinnamon powder

1/4 teaspoon Ground Cloves

2-3 handfuls of mixed berries (blueberries, blackberries, raspberries)

Small handful of spinach leaves

Nothing to fear about protein powder - I am currently weight training with a progressive overload program so I aim to reach 1.6/kg protein per kg bodyweight which is easier to hit with the smoothie, so that I can reach my training goals.

[Jo5454 in reply to Technoid]

Thanks so much for all of the info and recipe...really appreciated. I like nut butter on oatcakes or a spoon in porridge,etc, haven't eaten bread for 6 months due to reacting to what I believe tapioca in gluten free bread I was having. Seems it can react with latex allergies and seems to have moved up.ingredient list. I used to bake own soda bread when on a yeast free diet, but must find a good gluten free recipe to add a bit of bread in soon!Thank you again...

[Wheat]

hello, I would have tests as Nackapan posts. Full iron panel, folate and B12, vitamin D . Full Blood Tests. Maybe thyroid ?, or perhaps you prefer to have private test as nhs test is only tsh now. ☹️

Information that I've recently learnt: undertreated (hypothyroidism) thyroid increases thyroid antibodies., also increases cholesterol.

Best of luck re. B12 ampoules🤞x

[Nackapan]

No point in having a b12 test as you inject frequently. Once on injections b12 levels will be high