“Conventional” versus “Bariatric” Wisdom

On November 11, 2010, in Tests, by Andrea

So I recently had a blood draw done at my PCP.  And I really like my PCP because he’ll draw what I want and really not fuss too much about it.

This last time, I got a copy in the mail with no notations.  I’d already looked at it, noticed what needed to change, planned those modifications (ie my vitamin K needs to go up) and moved on.

While in Texas, apparently, I got another copy, this time with notations by my PCP, who, obviously means well but knows nothing about vitamins.  As a point, when I was bruising he told me to discontinue ALL vitamin K supplements as they would make my bruising worse.  Umm, hello?

Let me give you my numbers below, and I’ll notate the ones he marked that I disagree with his notes on:

  • PTT – 21.7 (22.0 – 35.0); marked L on lab, checked OK by Doc, and NO
  • PT – 11.0 (11.8 – 12.7); marked L on lab, checked OK by Doc, and NO
  • Ferritin – 9.4 (under 10, iron stores are considered depleted, even though ref range is below 10); marked OK and ref range CIRCLED, and just HELL NO
  • B12 – 1584 (211 – 946); marked H on lab, which we all know is a GOOD level for bariatrics; written to lower B12 supplement and just HELL NO
  • PTH – 12 (15-65); marked L on lab (which is actually GOOD!!); circled on sheet and NO I’m not changing a thing.  I like my bones, thanks.

This is why we must be proactive in our health and learn about how our bodies work, why these labs are vital, and how to read them.  Because if I were to listen to this suggestion, my ferritin could drop further, my B12 could go low, and these are just not things we want to sacrifice.

It also drives home the point that great medical doctors simply do not know nutrition.  If so, I would not have to explain B12 or vitamin K to my doc.  Instead, I do.

It’s not always easy to say “No” to a white coat.  I get it.  But we’ve got to learn in order to take charge of our own health.  I hate confrontation.  I know it doesn’t appear that way from this blog, but I really do.  It tears me up inside with these feelings of creepy crawly ickiness.  But if I can do it?  You can, too.  Because not only does your health depend on it?  So does the health of our entire community.  You standing up and helping to train your doc will help them treat other WLS patients better the next time they are faced with one of us — possibly one who can’t stand up for themselves for one reason or another.

Be an advocate for yourself and for your community.  We need you.

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3 Responses to ““Conventional” versus “Bariatric” Wisdom”

  1. Jen says:

    thanks for all you do giving us the info on vitamins. I have your list of Labs that you said we sould recommend to the Doc’s to draw—do you have what the accceptable numbers are for those for us with RNY?

  2. Andrea says:

    Most of the ranges are the same between normies and us. There are a few notable differences — b12, ferritin, vitamin D — but only because we know the actual science, and not really because our guts are different.

  3. Julia Ziobro says:

    It’s critical to remember that reference ranges are NOT determined by the range of what’s acceptable for good health, or even the numbers that indicate normal levels of any given substance in the blood or urine.

    Rather, they represent the range that 80-85% of all patients tested by that lab have. For example, let’s look at Vit D 25-hydroxy (a test we must all have at least twice a year; you want your healthy number to be 75 or greater; in large studies, there was no observed toxicity until 750 even though many doctors will panic and say you’re toxic at 250): 2, 5, 7, 9, 10,
    20, 13, 15, 65, 90, 4, 9, 11, 15, 20, 21, 19, 22, 30, and 25.
    The average of these 20 test results is 20.6.
    The lab reference range you’d arrive at from this list is 5 – 30 (that’s the middle 80% of the results). But again, this has ABSOLUTELY no relationship to the actual healthy range of 50-100.

    For many things such as potassium, iron, PTH, and calcium that the body self-regulates because only a narrow range allows normal life, the 10% of folks who are high and the 10% who are low probably really are in trouble and should be flagged via lab test results.

    For things like vitamin B-12, magnesium, and Vitamin D3 where HUGE percentages of the American adult population are demonstrably deficient in a way that impacts health, that 80% reference range is really not very helpful. (Estimates and studies say that the following percentages of American adults are deficient: B-12: 30%, magnesium: 70%, and Vitamin D3: 60% of whites and 90% of blacks).The reference range will include people at the low end who are really not well, and it will set a high end that’s much too low for good health.

    The American B-12 range, set by the 80% measure at most labs, is usually 210-800. In the rest of the world, where lab normals ARE based on what’s believed to be best for health, normal serum B-12 levels are considered to be between 600 and 1200. This is significant because heart, brain, and nerve damage begin at B-12 levels below 450, and pernicious anemia is very common at levels below 300… both numbers considered NORMAL in the USA!

    I keep meaning to get a set of labs pulled while I’m working in Taiwan. I’d have to pay for it out of pocket, but I’d love to see what lab normals are for various things. Maybe I will talk to my friends there and see if they will share the reference range portion of their lab tests with me; that would get the common ones, anyway.

    Julia
    RNY 09/17/01
    still at goal

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