Thursday, February 13, 2020

4 Scenarios When Detailed Testing Makes Sense

medical testingWe have unparalleled abilities to peer inside our bodies and take detailed snapshots of physiological processes and the state of our health. We can measure the hormones in our blood, the cholesterol in our veins, the nutrient deficiencies we may have. We can go deep. But it doesn’t always make sense to take that deeper, more detailed look at the numbers. It gets expensive, for one. It gets intrusive. Our doctors may be resistant. And it can provide a bit too much of a close look when a broader view might suffice.

When do more detailed tests make sense, though? What kind of scenarios call for a second, deeper look at our numbers?

“You’re fit as a fiddle, you’ve clearly lost a ton of weight, but your cholesterol’s a little high. We better get that handled.”

This is the classic scenario seen time and time again in the Primal and keto community.

Killing it in the gym.

Leaner than you’ve been since your teens.

Off all meds.

Pre-diabetes trend reversed.

More energy than ever.

Just feeling great overall.

But your LDL’s a little high. Or a lot. And the doc’s recommending that, while all these improvements are great, we do something about the cholesterol. Before you “take action,” let’s confirm you actually have elevated LDL.

If your triglycerides are under 100, and your LDL is calculated using the Friedewald equation, it will significantly overestimate your LDL numbers.

Say they directly measure your LDL-C and it’s still high. What then?

Then you should measure your LDL particle number. Elevated LDL particle number is what many “progressive” lipid experts say is the true cause of atherosclerosis—by increasing the number of particles in circulation, you increase the number that will penetrate the arterial wall and trigger an atherosclerotic lesion. ApoB is another measurement to take; it’s roughly analogous to LDL particle number, as each LDL particle contains an ApoB protein.

If your LDL-P or ApoB is still high and in the “danger zone,” what do you do? Do you go back on everything that worked for all the other health barometers?

I honestly don’t know. The question of elevated LDL particle number as an independently sufficient cause of heart disease is far from settled (and I suspect there’s more to it than that). But at least with more detailed testing you’re better equipped to have that conversation.

“Your TSH is normal. I don’t know why you’re feeling rundown all the time, but it’s not the thyroid.”

For most people, TSH is the best barometer of thyroid function. After all, if thyroid-stimulating hormone is normal, then your body feels like it’s getting plenty of thyroid hormone. There’s no “emergency.” If TSH is elevated, then your body doesn’t feel like it’s getting enough thyroid hormone. That’s how it usually works. In theory.

But what if your TSH is normal, not elevated, but you’re still feeling all the symptoms of low thyroid activity? What if you can’t get up in the morning, you’ve been gaining weight, you’re freezing all the time, and you generally feel very low energy?

What you don’t want to do is take the “expert” opinion at face value. No, that person who isn’t you doesn’t have unique and superior insight into how you’re feeling. No, the number doesn’t negate your subjective experience of symptoms. If you’re feeling bad, you need to do further testing.

Okay, so what should you test?

You’ll want to start with T4. T4 is “inactive” thyroid hormone that gets converted to “active” thyroid hormone (called T3) throughout the body. The thyroid gland makes mostly T4 and some T3 directly. In most people, a normal T4 means normal thyroid function.

Can you have normal TSH, normal T4, and still have underactive thyroid function? Yes.

If your peripheral tissues that normally convert T4 to active T3 aren’t doing it, you will effectively have poor thyroid function. The thyroid hormone is there, the tests look good; it’s just not doing its job.

Okay, so then you test T3 in addition to T4 and TSH. All good, right?

It’s better because it gives you an idea of active thyroid hormone in circulation, but it might not be enough. Even if your T4 and T3 levels are good, if they remain bound to the protein carrier that delivers them around the body, they can’t perform the jobs we all expect our thyroid hormones to perform.

You may need to test Free T3 and Free T4. Those are “unbound” thyroid hormones. They are the truly active ones.

Another test to consider is the thyroid antibody test. This helps determine whether your thyroid dysfunction is caused by an autoimmune response, and it can help you map your response.

“You’re pregnant.”

You hear these words and time stops. It’s really happening. You’re actually building an entire human being from start to finish—inside your body.

At least, I imagine that’s probably what it feels like. I wouldn’t know from personal experience. Being a father (and now grandfather) is powerful enough.

But it’s a big deal. And it’s a lot of responsibility, especially as a health-conscious individual who reads nutrition blogs and forks out cash for grass-fed meat and avocado oil mayo will understand. You know how important each day of your pregnancy is. You know how the food you eat and the nutrients you are and are not deficient in can affect the trajectory of your baby’s development.

Vitamin D is one of the more important things to test as a pregnant lady. Ideally you’d do this well ahead of time, so you go into it with good vitamin D levels, but testing early in the pregnancy is also a good move. Emerging evidence suggests that vitamin D deficiencies during pregnancy can increase the risk of ADHD in the child.

It isn’t standard. You’ll have to request it. But it might be worth the trouble if you think you’re deficient, especially since it’s an easy fix.

“Your testosterone is normal. I don’t know why you think you might need HRT.”

You can have normal testosterone and still have symptoms of low-T.

Lack of energy. Reduced libido or absent morning wood. Middling results in the gym. Decreased motivation and drive. These aren’t “serious medical conditions,” and many doctors will disregard them if your numbers turn out normal. That doesn’t help you, though, does it? These symptoms are no small matter. They seriously impact your quality of life, productivity, relationships (with yourself and with others), and they presage warning signs for your health down the road (muscle, insulin sensitivity, etc).

If your testosterone looks normal but you still have symptoms, what you need is a full panel that at the very least checks:

  • Free testosterone: active testosterone. Just like thyroid hormone, you can have normal testosterone levels but if it’s all bound up and inaccessible, you may have symptoms of low testosterone. Free T gives you a good picture.
  • Sex hormone binding globulin: high levels can bind to your testosterone, rendering less of it “free” and bioavailable.

Once you have good information, you can figure out a plan of attack to address your testosterone situation.

That’s it for today, everyone. Can you think of any other situations that call for detailed testing? Let me know down below!

References

Ahmadi SA, Boroumand MA, Gohari-moghaddam K, Tajik P, Dibaj SM. The impact of low serum triglyceride on LDL-cholesterol estimation. Arch Iran Med. 2008;11(3):318-21.

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Meal Prep Lunches – 1 Week Meal Prep Plan

This meal prep lunches plan will give you a full week of lunches to take to work, plus some extra to store in the freezer!

Taking a healthy meal to work for your lunch break is critical to sticking to a great meal plan. But prepping those lunches can sometimes be a pain. Especially when you are trying to make them each and every day.

Meal Prep Lunches - Four images of each of the meals and dressing used in this meal prep plan.

I will say up front, that I’m a huge believer in taking dinner leftovers for lunch the next day. In fact, it’s pretty rare that I will take a few hours out of my weekend to specifically prep lunches. But it does  happen on occasion, and it doesn’t have to be hugely complicate.

The time allotment for this meal prep plan calls for 2 1/2 hours of prep and cooking time combined. But there is a very good chance that you can get this done in less time than that. The important part is to prep all the veggies ahead of time. You can save even more time by preparing them ahead of time, or even by purchasing already chopped veggies (for some of them. Not all will be available pre-chopped).

You can also cook the pasta ahead of time (maybe make double the pasta on a pasta night, and then save half for this meal prep plan). Do little things to cut down on prep time and prep day will go super quick and efficiently.

A NOTE ON THE DRESSING:

The dressing is not specifically used for these recipes. However, I included it here for several reasons.

  1. You can use it to quickly prepare a green salad to accompany any of these lunches.
  2. You can make it to keep on hand for marinating chicken for dinner some night.
  3. You can use it to add extra flavor to any of these dishes, but try it first to make sure you like the combos before you mix a bunch in.
  4. I believe in always having some sort of dressing or sauce in the fridge because it totally expands what you can prepare for just about any meal.

NOTES ON FREEZING:

The quinoa salad freezes the best. The sweet potato should not be frozen, so make sure that if you prep it on Sunday, you eat it by Wednesday at the latest. The turkey vegetable pasta will freeze, but not for long. The max is about 1-2 months. So make sure you use that up first. It’s not great for freezing overall, but will freeze in a pinch.

NOTES ON THE SERVINGS:

This meal prep plan is for one person. If you have more people you are feeding with this, make note of the number of servings each recipe provides, and adjust as needed for the number of people you are feeding. Remember to adjust your shopping list as well!

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RECIPES USED FOR THIS MEAL PREP PLAN:

Monday: Turkey Vegetable Pasta Salad
Tuesday: Quinoa salad
Wednesday: Stuffed sweet potato
Thursday: Turkey Vegetable pasta salad
Friday: Quinoa salad

MEAL PREP LUNCHES DOWNLOAD

CLICK HERE TO DOWNLOAD THE MEAL PREP PLAN PLUS THE SHOPPING LIST – PRINTER FRIENDLY

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MEAL PREP LUNCHES

1 Full Week Of Lunches - Meal Prep Plan

Total Time

1 d 2 hrs 30 mins

 

For this meal prep plan, you will have want to eat the pasta salad while leaving any leftover servings of the quinoa salad for the freezer. You may want to have one or two nights where you eat the rest of the pasta salad so that it doesn’t go bad. If you have more mouths to feed than just yourself, adjust accordingly as to what goes in the freezer and what doesnt.

The sweet potato recipes makes one serving. So if you are making this for multiple people, you’ll want to multiply that particular recipe (especially for your shopping list) by the number of people you are feeding.

The quinoa salad can be frozen. So anything that won’t be eaten can be saved for future meals.

Course: Main Course

Cuisine: American

Yield: 5 lunches + some for the freezer

Author: The Gracious Pantry

Ingredients

Turkey Vegetable Pasta Salad

  • 1/2 small red onion (chopped)
  • 1 medium orange bell pepper (chopped)
  • 1 tbsp. coconut oil (any oil will work)
  • 1 lb. ground turkey
  • 1 tbsp. garlic powder
  • 1 tbsp. onion powder (yes, on top of the fresh onion.)
  • 2 tsp. dried thyme
  • 2 medium tomatoes (chopped)
  • fresh basil (chopped or sliced thin for garnish)
  • 1/2 lb. whole wheat rotini pasta (cooked to package directions)
  • parmesan cheese (optional)
  • salt and pepper to taste

Hummus Stuffed Sweet Potato

  • 1 medium sweet potato
  • 1/4 cup prepared hummus (no sugar added)
  • 1/4 cup cooked black beans
  • 2 tbsp. fresh, chopped cilantro (optional)
  • 1 cup cooked quinoa (about 1/2 a cup dry, cooked to package directions)
  • 15 oz. can diced tomatoes (look for low or no sodium)
  • 15 oz. chickpeas (rinsed and drained or homemade)
  • 6 medium garlic cloves (minced)
  • 1/2 small English cucumber (diced fine)
  • 1/2 cup diced red onion
  • 2 tbsp. fresh, chopped basil
  • 1 tbsp. Italian seasoning
  • 2 tbsp. apple cider vinegar
  • salt and pepper to taste

Garlic Lemon Vinaigrette Recipe

  • 3/4 cup oil (extra virgin olive oil or grapeseed oil work well)
  • 1/4 cup lemon juice
  • 1/4 cup pure maple syrup
  • 1 tbsp. apple cider vinegar
  • 1 tsp. garlic powder (use 2 tsp. if you like a strong garlic flavor)
  • salt and pepper to taste

Instructions

  1. Set the pasta to cook in a large, separate pot. Wash, dry and bake the sweet potato at 350 for about 50-60 minutes, or until soft an easily pierced through with a knife.

  2. Chop or slice all vegetable as instructed by each recipe.

  3. In a large skillet, sauté the onion and bell pepper in the oil until translucent.

  4. Add the turkey, garlic powder, onion powder and dried thyme to the skillet and scramble, stirring until the meat is fully cooked.

  5. Drain the pasta and rinse with cold water to cool.

  6. In a large mixing bowl, toss the meat mixture with the raw tomatoes, fresh basil, cooked pasta and top with parmesan cheese and/or salt and pepper as desired.

  7. Remove the potato from the oven (don't burn yourself!) and cut it open.

  8. Layer on the toppings and pack up in a lunch container and store in the fridge.

  9. Collect and prep all your ingredients for the Italian quinoa salad, then simply mix them all together in a large mixing bowl. This can be served warm or cold, as a side dish or vegetarian main meal.

  10. Place all the salad dressing ingredients in a blender and blend until smooth and well combined.

Recipe Notes

Please note that the nutrition data available on individual recipe pages. Click links above to find them.



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