Hey ,

I am not familiar with the company, but I see this panel checks fasting insulin as well. They do have some iron markers added in this panel (but unfortunately no iron!) which with low stomach acid doesn’t hurt to retest after March.

You asked what the difference was between active B12 and B12: Active B12 is when B12 is bound to a transport protein called Holotranscobalamin. It is called ‘active’ because Holotranscobalamin transports B12 into cells by binding to specific receptors. Around 25% of B12 is bound to this protein (see also this article). MMA (or Methylmalonic Acid) gives us insight if B12 was actually in the cell or not. This is therefore a marker that would provide us with more certainty.

Unfortunately, when we try to choose lab tests at companies we often don’t find our unique combination of labs, but this test has a few bonuses: fasting insulin & the iron markers. Maybe you could ask the company to evaluate iron as well since they do test iron in other panels!

We usually choose Red Blood Cell(RBC) markers above serum markers because serum markers are often a reflection of what you have eaten the last 2-3 days. A lot of mineral RBC markers usually can give us insight into what happened with mineral intake in the last few months. Serum zinc & selenium markers are less ideal, but If you eat in a way that reflects your normal diet the markers for selenium and zinc would be more representative.

By the way, make sure you don’t supplement with biotin the few days before testing since this will influence the thyroid test!

Hey ,

Let me first advise you on the MMA. MMA is usually a bit more expensive and it gives you insight into B12 metabolism, but…

the bigger picture is that we would like to bring homocysteine and hemoglobin back in balance. We would like to test if the production of red blood cells has normalised a bit. You will have to retest does markers anyway. If those markers improve we might not need the MMA test, so maybe focus on the thyroid markers first.

With the thyroid panel, you have basically 2 options. Let’s discuss the options in terms of goals:

Option 1: Choose a panel that can rule out (or confirm) the possibility of neuropathy.
A full thyroid panel and fasting insulin might help us.

Option 2: Choose a panel that can do the same and provide us with more details about thyroid nutrients.
A full thyroid panel, fasting insulin, iron, ferritin, RBC zinc, RBC selenium and many more options are there.

Both options are fine. Option 1 is least cost expensive, but can give us information about the status of your thyroid. It also will give us a general direction when your thyroid turns out to work slower. The test will give us back if the problem is
• stress related, 
• autoimmune related 
• conversion related – possibly due to nutrient deficiencies or conversion problems in other tissues.

Option 2 will give us direct extra information what nutrients are missing if nutrients turn out to be the problem.

The difference in advise between option 1 and 2 is if we suspect nutrients deficiencies with option 1 we will give you a more general advise on what nutrients you need to focus.

Both options are fine and will help you find out if a slow thyroid is contributing to your problem!

Hey ,

I have posted the PDF format of your test results, just to make them more accessible (I can’t open the .rtf format on my browser).

I will give you a more detailed response later today![7.10.22 Blood Test Results.pdf]

Hey ,

Thank you for sharing your lab tests. Tell me: how do you feel about these results?

Let me tell you what I see. I have been comparing some numbers from March, August and October tests. To keep thing clear, I will write down the numbers as follow:

Marker: Value [lower acceptable traditional value – upper acceptable traditional value]

March 24 2022 – Panel from Functional Blood Test
Vitamin B12: 432 ng/l [200 – 1100]
Hemoglobin: 125 g/L  [132 – 171]
Iron: 17.3 umol/l [5.91 – 34.55]
Ferritin: 73.1 ng/ml [30 – 400]

August 20 2022 – Panel from Family Doctor Blood Test
Hemoglobin: 114 g/L [130 – 168]

October 7 2022 – Panel from Family Doctor Blood Test
Vitamin B12: 429 ng/L
Hemoglobin: 113 g/L [130 – 168]
Iron: 17 umol/l [12 – 31]
Ferritin: 26 ng/mL [20 – 300]

Let me first point out that since we are looking at 2 panels from 2 different companies, values aren’t directly comparable. Different labs use different equipment and make therefore their own errors. This means for example that if we look at the value of hemoglobin it has dropped. But we can’t directly compare the numbers. Let’s for example take hemoglobin from March & October. We can say hemoglobin dropped if we compare the lab panel from Functional Blood Test with Family Doctor Blood Test. But how big the drop is, is not so simple as just talking the difference between the numbers. The difference in how you feel between March and October provides the extra context.

Could you

Comparing Iron
With that in mind, let’s compare iron from March with October. We are again comparing 2 labs. The iron values are both around 17. They probably aren’t exactly the same since we are comparing 2 labs – that are also using 2 different kinds of reference ranges. The only conclusion I would draw from this is that since March your serum iron didn’t change much. Your iron levels are below ideal, but I would like to point out that they aren’t super bad either.

Since with low stomach acid, iron absorption is hard, this is actually good news.

We do see however that the storage form of iron in the body called ferritin has dropped significantly. It is in my opinion just a matter of time before your ferritin drops even lower causing serum iron levels to drop as well.

In earlier posts, we mentioned that Thalassemia (a genetic iron disease causing impairment in hemoglobin production) might be a good thing to rule out if you would like to use iron supplements. Having Thalassemia while using iron supplements is not without risk.

What this has to do with your thyroid panel choice?
Since we are suspicious of low iron (and low selenium if we believe your hair test post) because we are 2 months further now, I would keep the number of tests as low as possible. The test should confirm (or rule out) a slow thyroid. If the thyroid is slow, we would like to know if there is an autoimmune component to it. The Reverse T3 is interesting because it makes visible if there is a stress hormone component to it. Perhaps we would like to make it visible if there are conversion issues from TT4 to fT4 or TT3 to fT3. Conversion issues can be caused by nutrient deficiencies – which we already know there are.

But we are going to recommend you add in selenium for sure. With iron – like I said – we would like to be careful. Rule out Thalassemia first. But focusing on iron-rich foods and vitamin C can already be helpful.

At this point fasting insulin might provide us with some additional information on finding a root cause for your gastroparesis.

Perhaps a good plan to go on forward now would be:
1.   Continue to focus on gut healing.
2.   Rule out Thalassemia & add in selenium-rich foods
3.   Focus on adding Iron into the diet.
4.   If you are negative for Thalassemia we can advise you on what to do with iron supplements.
5.  Do a thyroid test and at least make sure you have been adding in selenium for a while so we know that selenium isn’t a limiting element for your thyroid hormone conversion.

I hope this helps