Useful Tests Continued - from “Diabetes Solution” by Richard K. Bernstein, M.D
Renal Risk Profile
Chronic blood sugar elevation for many years can cause slow deterioration of the kidneys. If caught early, it may be reversible by blood sugar normalization, as it was in my own case. Unless you think frequent hospital visits for dialysis might be a nice way to meet people, it’s wise to have periodic tests that reflect early kidney changes. It is also wise to have all these periodically performed together, as the results of each can clarify the interpretation of all.
Several factors cause false positive results in some of these tests, so you should keep them in mind when your doctor schedules the tests. You should avoid strenuous or prolonged lower body exercise (which would include motorcycle or horseback riding) in the 48 hours preceding the tests. Additionally, if on the day the tests are to be performed you are menstruating or have a fever, a urinary tract infection, or active kidney stones, you should postpone the tests until these conditions have cleared. A basic renal risk profile should include the following tests.
Urinary Kappa Light Chains
If early diabetic kidney disease is present, this test reports “polyclonal kappa light change present.” This means that small amounts of tiny protein molecules may be entering the urine, due to leaky blood vessels in the kidneys. Because these molecules are so small, they are the first proteins to leak through tiny pores in the blood vessels of the kidneys that may have been affected by disease.
This test requires a small amount of fresh urine. I the test report states “monoclonal light chains present,” there is a possibility of treatable malignancies of certain white blood cells.
This less costly test can now be performed qualitatively (by dipstick) in your doctor’s office, or quantitatively at an outside laboratory. It, like the urinary kappa light chain test, can also reflect leaky vessels in the kidneys, but at a later stage, since albumin is a slightly larger molecule.
A quantitative measurement requires a 24-hour urine specimen, which means you’ll need to collect all the urine you produce in a 24-hour period in a big jug and deliver it to you physician or laboratory. Given the potential embarrassment of carrying jug full of urine around at work, you might want to schedule your test on a Monday and collect the urine while at home on Sunday. Many of the women patients report that it’s easier to collet urine initially in a clean paper cup, and then pour it into the jug. An easier screening test is the measurement of the albumin-in-creatinine ration in a first morning urine sample.
24-Hour Urinary Protein
This test detects kidney damage at a later stage than the preceding two tests; it also requires a 24-hour urine collection. As with the other tests, false positive results can occur following strenuous lower body exercise, as previously noted.
Creatinine is a chemical by-product of muscle metabolism, and is present in your blood stream all the time. Measuring the clearance of creatinine from the body is a way of estimating the filtering capacity of the kidneys. Test values are usually higher than normal when a person is spilling a lot of sugar in the urine, and eventually lower than normal when the kidneys have been damaged by ears of elevated blood sugars. It is not surprising to see an appropriate drop in creatinine clearance when blood sugars are normalized and urine glucose vanishes.
The creatinine clearance test required a 24-hour urine collection, and your lab will simultaneously draw a small amount of blood to measure serum creatinine. The most common cause of abnormally low values for this test is failure of the patient to collect all the urine produced in a 24-hour period. Therefore, if other kidney tests are normal, tests with low values for creatinine clearance should be repeated for verification.
A low creatinine clearance without excess urinary protein suggests a non-diabetic cause of kidney impairment.
When it is impractical to make a 24-hour urine collection, a crystatin-C test requiring a small amount of blood can be performed. Crystatin-C is believed to be a more accurate measure kidney function that creatinine clearance, but unfortunately many insurers still consider this test to be “experimental” and won’t pay for it.
25-OH Vitamin D-3
This is the standard test for vitamin D-3. Normal values range from 50 to 80 mg/ml. People who are not regularly exposed to sunlight are usually deficient in this essential vitamin, which can be replaced by supplements. A deficiency can cause insulin resistance.
Serum Beta, Microglobulin
This test is a very sensitive test for injury to tubules of the kidneys, which pass urine filtered from the flood. As with fibrinogen levels, elevated values can also result from inflammation of infection anywhere in the body. Thus an isolated elevation of serum beta, microglobulin without presence of urinary kappa light chains or microablumin is probably due to some sort of infection or inflammation, not to diabetic kidney disease. Such elevation is commonplace in people with AIDS, lymphoma, and immunodeficiency disorders.
24-Hour Urinary Glucose
This test too requires a24-hour collection of urine, and is of value for proper interpretation of creatinine clearance. As indicated under “Cardiac Rick Factors,” significant kidney damage may also be accompanied by elevations of serum homocysteine and fibrinogen.
Other Tests - from “Diabetes Solution” by Richard K. Bernstein, M.D
Insulin-like Growth Factor 1(IGF-1)
Rapid correction of very high blood sugars can, on occasion, cause exacerbation of a common complication of diabetes called proliferative retinopathy. This condition can cause hemorrhaging inside the eye and blindness. Such exacerbations are usually preceded by an increase in serum levels of insulin-like growth factor 1. A baseline level of IGF-1 in the blood should be measured in people with proliferative retinopathy. Repeat determinations should be made every two to three months. I levels increase, blood sugars should then be reduced more slowly.
R-R Interval Study
The purpose of this study is to test the functioning of the vagus-nerve, and it should be part of your initial diabetic physical examination. It is performed like an ordinary electrocardiogram, bit it requires fewer electrical leads (i.e., only on the limbs, not the chest).
The vagus nerve is the largest nerve in the body, running from the brain to the lower body. It’s the main neural component of the parasympathetic nervous system, or that part of the nervous system that takes card of vegetative, autonomic functions, the functions that run more or less on ”automatic pilot” and that you don’t actively have to think about to make happen. These include heart rate and digestion.
If the vagus nerve is working properly, there should be a considerable difference in heart rate between inhaling and exhaling. By measuring the variation of your heart rate with deep breathing, we can get a picture of just how much the function has been impaired. In non-diabetics, the heart rate increases when they inhale deeply and slows when they exhale fully. So a twenty-one year-old non-diabetic’s heart rate might typically slow as much as 85% from inhaling to exhaling. This may drop to about 30% for a seventy-year-old non-diabetic.
Additionally the digestive disorder of gastroparesis can be and frequently is one of the most difficult barriers to blood sugar normalization, and can even make blood sugar normalization virtually impossible in some people who require insulin. A low heart rate variability on the initial test can be a good indicator that the patient is likely to have a problem with delayed stomach-emptying. It can also give clues as to causes of other problems that a patient may be experiencing – sexual dysfunction, fainting upon standing when arising from bed, and so on.
From Dr. Rosedale:
Leptin: 4 to 6 ng/dL
Fasting Insulin: 10 IU/mL and below
HbgA1c: 4.5 percent or less
Glucose: 70 to 85 mg/dL
Free T3: 2.2 to 3.0 pg/mL
Basal Body Temperature: 96.8 to 97.5 degrees F and below
IGF-1: 90 to 360 ng/mL (normal for those aged forty and over)
Norepinephrine: 250 to 350 pg/mL (the lower end of the range is optimal)
Highly Sensitive C-Reactive Protein: less than 1.0
Triglycerides: 100 mg/dL
Homocysteine: less than 6 umol/L
Blood Urea Nitrogen: 17 mg/dL
Creatinine: 0.7 to 1.0 mg/dL
Uric Acid: 3 to 7 mg/dL
Liver Enzymes: ALP 44 to 147 IU/l, ALT 5 to 30 IU/l, AST 10 to 34 IU/l
Cholesterol: HDL higher than 40 mg/dL, high proportion of large LDL to small dense LDL
Last edited by Cryptocode; 07-30-2013 at 08:00 PM.
Ooooooooohhhh! Today was bad. Right after lunch I became badly bloated and gassed. (Last night wasn't good either.) This is the worst I've been since I started PB. I don't think it was all caused by the SAD dinner, there had been signs (the BM) before. I think something was building up and the dinner really set it off. Maybe my body didn't like my playing around with Mg and P so much, as if I know what I'm doing. Ha!
B - Bone broth
L - Greek Yogurt, eggs scrambled in butter
S - Beef & barley soup from a can
D - Red Snapper, Yam, Green beans, Butter on all.
- - - - - -
3 Probiotic, 3 Omega-3, a packet Damage Control, 2 Glucosamine, 1 iron
Last edited by Cryptocode; 04-03-2013 at 09:34 PM.
Hi Cryptocode, what a varied journal you have begun. Motivations for adopting primal, food log, interesting links and info etc. I hope you keep it up - the journal, I mean. But I also hope that you keep on getting good results from your primal diet.
I do think it makes sense to change one thing at a time. For me, I started exercising before I found primal. When I did, I jumped in boots and all. Now I feel so fit and healthy all the time it's hard to remember how I felt a year or so ago - bloated and lethargic without really realising it. I've really got to know myself a lot better and to enjoy life even more than I already did.
Hope to see you round.
B - 2 bacon, 2 eggs
L - sauerkraut, salami
D - beef ribs, rice, asparagus, chocolate chips
- - - - -
3 Probiotic, 3 Omega-3, a packet Damage Control, 2 Glucosamine, 1 iron, 1 GABA
Today I felt bad this morning and have been slowly improving thoughout the day. At the end of the day there's still a little gas but comparatively it's hardly noticeable.
Morning, the sun backlights the mist and fog slowly rising from the desert valley. Birds sing paeons to it's rise. The morning paper tells me Cancer and Heart disease are the biggest killers but Alzheimers is the most expensive. The P.O. delivers "Homemaking in Old Virginia", Pub. 1875 and highly recommended by Pres. Rutherford B. Hayes. The first chapter is on Bread and recommends spreading the flour on a baking sheet and putting it outside to sun and air.
My grandmother never did that. If I did it the smaller birds would eat what the crows didn't poop on. What a kick! I bought it to learn how my great grandmother cooked. If we have forgotten what they knew maybe I can stil learn some of it. I expect some translation needed from The Tidewater to The Upper valleys of the Majove desert.
B - 2 bacon, 2 eggs scrambled, 3 coffee w cream & honey
S - strawberries & cream
L - Mustard greens sauteed in CO w chopped anchovies, beef jerky
S - Walnuts
D - sauteed carrots, Ham
- - - - -
3 Probiotic, 3 Omega-3, a packet Damage Control, 2 Glucosamine, 1 iron, 1/2 GABA, MOM
This afternoon I fell asleep, how nice. That hasn't happened for a long time. Last night was the first time I've slept through in months, 6 hours. Maybe this is the GABA, or it's the walnuts for the afternoon.
I found a grocery that sells Raw Milk. Tomorrow morning I'm off to get some.
Last edited by Cryptocode; 04-05-2013 at 09:34 PM.
No Sleep and No poop. Terrible day. Very frustrated, fatigued and despondent. GABA is a neurotransmitter inhibitor. I thought it would slow my brain. It did, I notice lowered response to stimulus or none, some mental fog. But what I didn't think of was the rest of my body, particularly the colon. It deadened the nerves in the colon resulting in slow or no peristalis. No poop. Even with MOM - I did poop later in the day, but it was not a normal MOM response.
I didn't have the energy to drive the distance to get the Raw Milk.
Lots of cheating today. I feel like giving up. It seems to be impossible to both sleep and poop, I've only been able to achieve one or the other.
B - 2 bacon, 2 eggs
L - 1 raw turnip, sliced beef, cheese
D - beets, beef ribs
- - - - - - - -
3 Probiotic, 3 Omega-3, a packet Damage Control, 2 Glucosamine, 1 iron, 50 mg 5-HTP
There's still a few things to try. Don't know if I'll stay on primal though. No sleep - no motivation.
Last edited by Cryptocode; 04-07-2013 at 02:35 PM.
Why would you not want to continue with primal? Is it not the most delicious and simple way to eat, with at least enough benefits to be worth continuing?
Sorry you so despondent and wishing you a brighter day tomorrow.
Well, I won't do that again. 5-HTP is an anti-anxiety or mood-elevator. The label says it can cause stomach upset, don't take it if you have a -list of digestive ailments. It did cause considerable upset, pain, discomfort and bloody diarreah like stools. Not good at all.
I did sleep though.
Next I'll try L-Tryptophane - an old bottle not used after it was recalled because it causes some bad thing. At the time, many years ago, it worked for me and didn't cause any problems. But note it has an e on the end; what is sold today does not that that e.
"The disorders fructose malabsorption and lactose intolerance cause improper absorption of tryptophan in the intestine, reduced levels of tryptophan in the blood and depression.
In bacteria that synthesize tryptophan, high cellular levels of this amino acid activate a repressor protein, which binds to the trp operon. Binding of this repressor to the tryptophan operon prevents transcription of downstream DNA that codes for the enzymes involved in the biosynthesis of tryptophan. So high levels of tryptophan prevent tryptophan synthesis through a negative feedback loop and, when the cell's tryptophan levels are reduced, transcription from the trp operon resumes. The genetic organisation of the trp operon thus permits tightly regulated and rapid responses to changes in the cell's internal and external tryptophan levels."
I was so discouraged yesterday I was ready to quit. I wanted to go back to my old way of eating but when I though about what to eat, nothing was appealing. And when I walked through the store my reactions were all negative. Eating toxic non-food just isn't appealing.
B - 2 eggs in CO (can't face bacon this morning)
L - sauerkraut, tuna fish.
D - Lamb Leg Steats, asperagus, rice.
- - - - - - - -
3 Probiotic, 3 Omega-3, a packet Damage Control, 2 Glucosamine, 1 iron, MOM, 750mg Valerian Root
Before lunch I walked to the corner, slowly.
Last edited by Cryptocode; 04-07-2013 at 02:14 PM.
That is a surprising response to 5-HTP, never heard of that before. I've never had any digestive issues with it.
L-Tryptophan was recalled in the early 90's, if I recall correctly from the book "The Mood Cure", because of a bad batch that had been corrupted by something else. I have taken it instead of 5-HTP for help with my anxiety and depression, but I take it in the morning instead of night. I don't know if it helps with the sleep or not, but I imagine it would.
I'm starting a colostrum powder as a supplement today. I'll let you know how it goes.
Oh no, now you'll have to carry on with primal, you've been spoiled for anything else. Hope you can find something wholesome to pique your appetite.
Originally Posted by Cryptocode