Hey ,

Interpreting lab values can be quite overwhelming! It is true that with lab values we can do more targeted recommendations. But lab values can also often create a false sense of security. The thought that since we have measured labs and therefore solid answers can now be given often isn’t possible since we don’t treat lab values, but persons.

Stepping back and asking yourself: who is this person? What are their symptoms? What are their lifestyles and food choices? And why are they choosing these choices? These questions often help you to get started.

Since I don’t exactly know your sister’s symptoms, I will give you the best possible answer based on the lab values you gave. If you would like more targeted advice, it would help to know what symptoms are present. Here are some questions you can ask her:
• Is she fatigued? And if she feels fatigued, does she feel it in the muscles? Or in the mind?
• Does she feel fatigued after dinner? Especially after lunch or dinner?
• Does she experience bloating? Gas? Constipation, Diarrhea?
• How does she feel when she eats bread, pasta, and other gluten-containing products?
• Is she losing hair?
• Does she look pail?
• Does she experience tingling sensations in her body? Are they in her arms or legs?
• Is she feeling cold? Is she experiencing cold hands & feet? Or is it her total body?
• Was she sick recently?
• Does she notice blood in her urine?
• Does she feel or felt recent pain in her side and back, below the ribs?

Interpretation of labs is also related to lifestyle factors:
• Is she on a ketogenic diet?
• How is her self-care? Does stress impair self-care?
• How does she sleep? Does she wake up with energy?
• Does she take time to eat? Does she chew? Can she do this without time pressure?
• Is she choosing a nutrient-rich diet?
• Does she see the sunlight enough?

All these questions will help to interpret her lab values. All these questions could already give you a sense of where to start as well!

Low hanging fruits
From these labs you could already work on a few things:
• Ask a doctor to evaluate her kidney health. Her labs show white and red blood cells in the urine. Her uric acid is elevated. These are indications for something is going on there. Ask your sister about complaints related to kidney stones for example. But definitely advise her to see a doctor on this topic and find out what is going on.

Here is a little extra tip: If kidney stones are at play, reducing oxalates in foods (here is a list!) can help since most kidney stones are crystals made from calcium oxalate. Ensuring enough vitamin K2 is in her diet before raising her serum vitamin D (more on vitamin D later!) since K2 helps transport calcium to bones. Hydration with kidney stones is important as well. If her kidney health allows (and only if) – supplements like magnesium can help her as well. But again, I would recommend finding out what is at play with her kidney health first.
• Remove gluten. Her labs indicate she is allergic to them. A second reason to remove gluten is she shows other autoimmune issues as well. But the gluten allergy can cause inflammation in her gut. The inflammation in the gut can lead to damage to her gut lining causing an enhanced intestinal permeability or often called a ‘leaky gut’. In the presence of autoimmune issues I often recommend to remove milk products as well.
• Raise her vitamin D levels. Either with supplements or sunlight. I personally aim with my clients for serum vitamin D levels of 120 nmol/l. Raising Vitamin D can reduce autoimmune symptoms. Vitamin D also helps to close the doors or ‘tight junctions’ in the gut lining, making the gut lining less ‘leaky’.
 We do have a vitamin D handout. Just click here!
• Raise vitamin B12. Personally, I aim for serum B12 levels above 600. Your sister’s levels are on the lower side of the reference range. 

Optimizing the gut for iron and nutrient absorption.
We talked about vitamin D in relation to the gut. The next values need a little more thought. I have noticed that her iron, her iron storage (ferritin) and her iron transport saturation values are borderline low or low. 70% of the body’s iron is used to create hemoglobin to transport oxygen. Most of the red blood cell markers are ok. But once iron levels drop further, it wouldn’t surprise me that her capacity to transport oxygen will be influenced.

Iron needs stomach acid to absorb. The enzymes in the stomach that digest iron need vitamin C as well to function. Stress influences the production of stomach acid negatively. The absence of zinc in her diet as well. A slow thyroid can also cause stomach acid to be low… but I will come back to that.

Low stomach acid can give rise to an overgrowth of a bacteria that often live in small amounts in the stomach: H. Pylori. This bacteria overgrowth is often asymptomatic but can cause ulcers. We do have a video on how to deal with an H. Pylori infection. Just click here.

The next part of iron absorption happens in the gut. Inflammation caused by coeliac disease can cause the iron (but also her B12) to be malabsorbed. If you like to learn more about how to correct an iron deficiency, just click here.

Insulin resistance
Elevations in uric acid, even when blood sugars appear to be normal can be an indication of insulin resistance. Elevations in uric acid can also be indicative of gout and kidney problems, including kidney stone formation. Ask your sister if she sees experiences pain in her side and back, below the ribs. Since her labs show blood in the urine, you could ask her about the color of her urine as well. If she feels worried about these symptoms, advise her to get help from a doctor.

Back to the topic: insulin resistance.

Here we can see that timing of the lab draw gives us more information as well. If these labs have been taken in a fasting state (and my guess is that they are – but this is something I would always like to have confirmed by my client and I advise you to do the same) here insulin levels are quite high. Even if they are in the reference range. In this video, Bernadette explains it perfectly!

According to her labs, your sister produces a certain amount of ketones. These levels can be because of insulin resistance, but these levels could also be caused by fasting or a ketogenic diet.

The Blood sugar regulation course will give you a lot of tools on how to approach insulin resistance. I would advise you to at least watch Meet the players: PAAL, Blood sugar regulation: how it works, blood sugar regulation: how it dysfunctions, Summary: evaluating daily function and What is the best diet?

The most impact on reversing insulin resistance is by changing the diet. But supplements can help as well. In the library, we do have videos on that as well, but since her kidney markers are elevated I would be cautious

Thyroid Health
The labs show elevated thyroid antibodies. Right now, her free T3 and her free T4 look normal, although her TSH (the pituitary hormone that tells the thyroid to make thyroid hormones T4 and T3) is a little higher where we would like her TSH values ideally to be – but still in the reference range.

Here I would again ask your sister about symptoms since stress can cause her T3 hormone to be blocked by reverse T3. If you want to find a comprehensive list of symptoms I would advise you to watch this video. Insulin resistance can also impact thyroid health, which is explained right here.

There is more to say about her values, but I hope this gives you a good feeling of where to start.

I can share with you a more detailed response, once I know the doctor’s opinion on her kidneys, and her possible other symptoms and once I know more about her food choices, sleep and stress levels!

I hope this helps!

,

With rebalancing her iron I would use a cautious approach. Her tests show she is allergic to gluten. This means every time she eats gluten her body creates inflammation in the gut. When the gut is inflamed, iron absorption gets blocked. If you want to learn more about correcting an iron deficiency, just click here.

Right now I am assuming her labs were taken in the morning after an overnight fast. If this assumption is correct and if clients would come to me with these labs and symptoms you describe I would assume insulin resistance is at play. 

Let me explain: although her blood sugar looks ideal and even her HbA1c shows no alarming signs, her insulin levels are in the upper half of the reference range. But for a fasting state, this is quite elevated. If you like to evaluate signs of insulin resistance, we do have an excellent video on this as well, just click here. Just be aware that the units used in your sister’s labs are different. The ideal reference range for insulin in the fasted state is between 2-6 uIU/ml. This is 14 pmol/L – 42 pmol/L

Another clue is that in your sister’s labs, you can see she is producing ketone bodies. Ketones are typically produced by cells when they don’t get sugar. This is for three reasons:
• On a ketogenic diet (which your sister is not)
• Fasting
• Insulin resistance

I hope you have a clear idea of where to start. Judging from what you have described I would probably start this way:
• Remove at least gluten from her diet, but with autoimmune we would like to remove milk products as well
• Avoid foods that will get her constipated. If your sister alternates between constipation & diarrhea this could also be a sign of an overgrowth of bacteria in the small intestine (SIBO). Addressing SIBO involves a diet that could feel overwhelming to her at this stage. Just be aware that we do have some documentation for that (just click here)
• Focus on foods that can heal her gut – (click here for another video that can help you with that)
• Adress her H. Pylori overgrowth (as I mentioned in my previous reply)
• Adress her insulin resistance (as I mentioned in my previous reply)
• Get her vitamin D up

And most importantly – celebrate every win with her!

There are many more things you can do with her, but right now this might be already a lot for her.

Let us know if you need more help!
 

Hey ,
 
Yes, quite a bit actually. My primary focus although wouldn’t be really on TSH though. I look at it as a reflection or a ‘symptom’ of what is going on in the body, not a cause.
 
Her TSH is elevated when you compare the values to the ideal reference range. Perhaps you remember from the thyroid course that TSH is a ‘brain hormone’ that tells the thyroid to make thyroid hormones. What this means is that her brain ‘feels’ there is not enough thyroid hormone to function optimally.

It elevates TSH in an attempt to let the thyroid work harder.

There could be several reasons for that. 
• Insulin resistance could drive this. Since with insulin resistance, the cell’s energy production is slowed down, the brain might try to ‘speed up’ the metabolism by telling the thyroid to work harder.
• Her body might experience stress (for example, as a reaction to eating gluten). This can lead to elevations of reverse T3 which looks like the most potent thyroid hormone T3, but actually blocks the action of T3. Unfortunately, this panel didn’t measure reverse T3. 
• Or at the cellular level, the cell decides to convert T3 to something else.

Helping your sister by making her more insulin-sensitive and reducing stressors could already make an impact on her thyroid health. 

But what we didn’t discuss in more detail was the presence of thyroid antibodies indicating there is an autoimmune reaction going on – which is not the only autoimmune reaction since your sister’s labs also show elevated antibodies that are indicative of coeliac disease.

For healthy thyroid function, it is important to address this. 

The perfect storm for autoimmune issues is often a combination of a weakened immune system, leaky gut, genetics and an environmental trigger. There you could help her a lot.
• Give support to the immune system by making sure your sister has the nutrients in the diet. Make sure she has enough vitamin D, vitamin A, zinc (a zinc deficiency could also lead to hair loss), folate and B12 in her diet
• Focus on gut healing. Remove gluten for sure, since gluten will lead to inflammation and possibly more damage to the gut lining. Inflammation in the gut can also reduce iron absorption.

With healing autoimmune issues I often recommend removing dairy and gluten-containing grains, but preferably all grains for a while. I didn’t mention this earlier since you mentioned that your sister was still struggling with self-care & food.

Supplements/foods that can help heal the gut are Zinc carnosine, Aloe Vera, bone broth, and L-glutamine… There are many options. Multi formulas like that from designs for health’s GI revive (with Glutamine) and Pure Encapsulations DGL Plus(without Glutamine) or Thorne’s GI Relief(also without Glutamine) could be really helpful here.
• Nutrients that play a role in thyroid health are of course iodine, but zinc, selenium, iron, vitamins A & D and protein (in particular the amino acid tyrosine needs to be available in the diet).

My focus would mostly be on these things first and see how symptoms improve and work from there.

I hope this helps!

, just one last tip, although it probably isn’t necessary since you probably have experience enough.

Your sister might be highly motivated. All these tips can also be overwhelming. Let her pick something that is within her reach to work on. 
• Removing the bad stuff can already make her feel less fatigued.
• Reducing insulin resistance can improve her energy levels as well.
• Adding in the nutrients could be done with a simple multivitamin and a vitamin D supplement.
• You can start the gut healing, but staying off gluten is a higher priority because of the inflammation.
• Addressing autoimmune issues takes a longer time and takes more consistency.

You don’t need to start with everything at once. I hope this helps you a bit with how to prioritise everything.

Good luck!