Blood Work Analysis and Optimization: Part 1

My New Year’s resolution for 2023 is to optimize my bloodwork. With a history of chronic disease in my family - particularly diabetes, cardiovascular disease and cancer - I want to keep a close eye on my bloodwork as a preventative measure to make sure that I can catch and correct anything before it becomes an issue. 

This is why I decided to invest in InsideTracker because, unlike most lab results, it indicates “Optimal” as well as “Needs Work” and “At Risk” ranges. Often patients will only be made aware of a worrying trend once it enters “At Risk” territory, but with optimal ranges, I can make sure that I am tracking towards my healthiest self.

InsideTracker was founded by leading experts in aging, genetics and biometric data. The team at InsideTracker regularly reviews the latest research to make sure they offer recommendations based on the most up-to-date science, so I use them as a resource to benchmark my biomarkers.

Areas for Improvement

At Risk: Vitamin D

18(ng/mL)

70-97% of the Canadian population is considered to have insufficient vitamin D levels, so my vitamin D deficiency did not take me by surprise. 2 Living in Toronto, I can only make Vitamin D from the sun, our body’s primary source, 277 days during the year - and from February to June, I am covered in clothing head to toe.

Common advice is to take vitamin D supplements to rectify this deficiency, however, I am a little wary of supplementation (although I used to take vitamin D regularly). I believe that our body will work best when aligned with nature as a general principle - this works with our body’s design and lets us take advantage of natural synergies. 

Since our bodies have not been exposed to vitamin D drops until quite recently, I worry that my body may not be able to manage it in a healthy way. In addition, vitamin D is not actually a vitamin - it is a hormone, which makes me even more cautious of supplementing with it. 

And I am in good company - a recent study from the American College of Cardiology recommends optimizing vitamin d status through food and modest sunlight exposure instead of supplementation due to the lack of benefit demonstrated in randomized control trials. 5

For this reason, I not only try to avoid supplementation, but I also try to avoid foods that have been fortified with vitamin D, like some kinds of milk, cereals, and orange juices. Avoiding vitamin d supplementation and fortification is my own opinion - and I am going against the grain of mainstream advice. I am not a doctor, and I advise you to consult a trusted doctor if you want to address a vitamin D deficiency.

I am not entirely deprived, despite my avoidance of vitamin d supplementation. I know my body stores vitamin D in my fat tissue and slowly releases it when I need it, such as during the wintertime. 1 Since I know my body can store vitamin D, I want to stock up on it when the sun is shining during the warmer months. 

To help me stay on top of my vitamin-d-making potential, I have an app that I downloaded called Dminder, which estimates how much vitamin D you are making based on the time of year, your skin tone, and the time you spend outside. I plan to prioritize sun exposure at noon during my lunch break as the sun reemerges, which is the best time of the day to create vitamin D from the stronger UV rays.

Unfortunately, based on my geographic location, my ability to make even tiny amounts of vitamin D from the sun will only begin in February. Even then, I will be covered head to toe in winter clothes. In the meantime, I am upping my consumption of grass-fed butter and eggs from free-range chickens with outdoor access, which offer small amounts of vitamin d. It’s important to ensure that the cows and chickens also have opportunities to go outside in the sun for their milk and eggs to be rich in vitamin d.

Harvard advises that the most widely recommended dietary allowance for vitamin D is 600 IU for adults up to age 69 and 800 IU for those 70 and up. The US Government's FoodData Central estimates the following vitamin d levels for the average stick of butter and egg:

Butter Stick Salted (100g, or 0.44 cups) - 16 IU

Whole Egg (100g, or two large eggs) - 91 IU

Since most animals are raised indoors with little access to sun, I hope that my products chosen from pastured animals will be a little higher in vitamin D than the US averages listed above.

In addition to food sources, I plan to boost my winter vitamin d levels with a two-week trip down to a warm destination, where I can soak up some sun. I will be testing my levels right before I leave and then again a few months later, and I will be interested to see if there are any changes.

At Risk: HDL

45 mg/dL

HDL is commonly known as the “good” cholesterol. According to InsideTracker, my HDL was very low and landed in the “At Risk” range. According to WebMD, and more mainstream ranges that do not provide optimal zones, I still fall within the healthy range, above 40 mg/L. 11

Low HDL is generally associated with a higher risk of heart disease. However, heart disease can be present in people with normal HDL levels, and people with low HDL levels can have healthy hearts. 11 Because I exercise regularly, maintain a healthy weight, and do not have high blood pressure, I am not overly concerned with my HDL levels right now. However, I will be sure to maintain a healthy lifestyle and keep my ears open to any information about low HDL that I may come across through my research.

At Risk: Hematocrit

34.9%

My hematocrit falls into the reference range's low end, just barely below the optimized zone. Hematocrit measures the portion of your blood that contains red blood cells. Hematocrit levels generally fall in line with levels of hemoglobin, and are addressed the same way. (See below for how I plan to optimize my hemoglobin levels)

Needs Work: Triglycerides

101 mg/dL

Triglycerides are a type of fat that is found in your blood. Elevated levels of triglycerides may be a sign of hypothyroidism and metabolic syndrome (high blood pressure, obesity and high blood sugar - which increases the risk of heart disease). 10 Since I am at a healthy weight and have low blood pressure, I am not too worried about falling into this category.

High triglycerides are also often an early sign of diabetes and can be an indicator even before it is reflected in your HBA1C. (HBA1C is a measurement that shows your average blood sugar over the past 2-3 months, commonly used to test for prediabetes and diabetes) Triglycerides can be affected before HBA1C because it takes more insulin to regulate fat than glucose. 8

Overall, I will keep my eye on my triglyceride number, especially since it is related to a few diseases that run in my family. I found it interesting that while I am in the middle of the “Needs Work” range in InsideTracker, I am well under the upper limit of the “Normal” range on most medical sites (Normal is generally considered under 150 mg/Dl according to the Mayo Clinic) 

Of course, I purchased InsideTracker to track myself against optimal ranges, so I will try to improve my triglycerides, targeting the optimized range. Triglyceride levels can be improved with regular exercise, avoiding refined carbohydrates and sugars, and limiting alcohol. 10

Needs Work: Ferritin

36 ng/mL

Ferritin is a way to measure iron levels in the body - it is a storage protein for iron produced in the blood in response to iron in the diet. Iron is crucial for several essential roles in the body such as the production of red blood cells and hemoglobin, protein synthesis, immune function, and energy. 9

According to InsideTracker, my ferritin levels were just below the optimized zone - so something to keep an eye on and try to improve. Noting that changes in ferritin levels can take weeks or months, I undertook the following strategy to try to improve my iron within 2.5 months:

1. Time tea consumption at least one hour around meals. Teas contain a lot of tannins, which are actually really good for you as they have antioxidant properties. Unfortunately, they also inhibit the absorption of nonheme iron.

2. Soak beans in water and apple cider vinegar overnight. I picked up this trick from the Nourishing Traditions Cookbook. The acidity of the apple cider vinegar is supposed to help make the nutrients in beans more available, which are naturally high in nonheme iron. I add a few tablespoons to a bowl of beans and water soaking overnight.

3. Increase consumption of chlorella. Chlorella is a type of algae naturally high in B12 and iron - mixed with a bit of lemon juice for increased iron absorption. Admittedly, I haven’t kept this one up as much as I would have liked - it's not my favorite thing to drink.

4. Boost consumption of leafy greens paired with vitamin C. I’ve increased my consumption of spinach, often sauteing a few handfuls in butter and garlic drizzled with a bit of lemon juice. The lemon juice's vitamin C helps boost nonheme iron absorption by up to 6 times. 9 I also pair my chlorella with a splash of lemon juice.

Needs Work: Hemoglobin

12.2 g/dL

Hemoglobin is the main protein in your blood cells, responsible for carrying and delivering oxygen throughout your body. If hemoglobin and hematocrit levels are low, one is generally considered anemic. According to InsideTracker’s ranges, I was barely out of the “At Risk” range for Hemoglobin and barely fell into the “At Risk” category for hematocrit. Based on these numbers, I appear to be borderline anemic. 11

There are several common symptoms of anemia - such as lightheadedness, fatigue, shortness of breath and chest pain - however, my only symptoms that align with this diagnosis are cold hands and feet. 

I have a couple factors that make me prone to developing anemia. I have eaten a vegetarian diet for ten years, and while there is non-heme iron available through plant-based sources, it's not as easily absorbed as heme iron from animal flesh. I also have a regular menstrual period, meaning I lose blood (and iron) every month. 

Folate and vitamin B12 deficiencies are also associated with a type of anemia called “Vitamin Deficiency Anemia.” As noted below, B12 levels, although not “At Risk,” could be improved. Folate was not included in this blood test prescribed by my doctor so I cannot tell if my folate levels are also tied to my hemoglobin levels.

My strategy to address my low hemoglobin is the same as my strategy to increase Ferritin levels, as both of these markers are associated with low iron levels. I will also increase my attention to consuming more B12.

Needs Work: Vitamin B12

255 pg/mL

Vitamin B12 is a vitamin that is made from bacteria - our bodies cannot make it ourselves. Animal products contain B12 because of the bacteria in the digestive system of the animal. It is commonly said that you cannot get B12 naturally without animal-based products. I was surprised to learn that this is actually not true. Chlorella, a type of algae, is actually quite high in B12, so this is a good source for vegetarians and vegans as well as anyone who is attempting to boost their B12 levels. 

Lack of vitamin B12 can lead to vitamin deficiency anemia, as mentioned above, so it is possible my sub-optimal B12 levels are influencing my hemoglobin levels. B12 is important for forming red blood cells and DNA, as well as supporting the function and development of brain and nerve cells. 1

Conclusion

Ensuring that I am building the foundation to live a long and healthy life is a top priority for me. As they say - “health is wealth.” In that spirit, for the next few months, I will focus on eating a healthy diet of whole foods rich in blood-boosting nutrients like iron and b12 and maintaining consistent exercise habits. Being able to track how the changes I make to my lifestyle affect my biomarkers is motivating, and I look forward to discovering the healthiest version of myself this year.

Disclaimer:

The information on Better Health Project is intended for educative and informational purposes only and is not intended to serve as professional or medical advice. The content of this site is not written by a medical professional. Always seek the advice of a trusted and qualified healthcare professional before making health changes.

Sources

1. Harvard Health. (2021, September 13). Vitamin D and your health: Breaking old rules, raising new hopes. https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes

2. Schwalfenberg GK, Genuis SJ, Hiltz MN. Addressing vitamin D deficiency in Canada: a public health innovation whose time has come. Public Health. 2010 Jun;124(6):350-9. doi: 10.1016/j.puhe.2010.03.003. Epub 2010 Apr 21. PMID: 20413135.

3. FoodData Central. (n.d.). https://fdc.nal.usda.gov/fdc-app.html

4. FoodData Central. (n.d.-b). https://fdc.nal.usda.gov/fdc-app.html

5. Michos ED, Cainzos-Achirica M, Heravi AS, Appel LJ. Vitamin D, Calcium Supplements, and Implications for Cardiovascular Health: JACC Focus Seminar. J Am Coll Cardiol. 2021 Feb 2;77(4):437-449. doi: 10.1016/j.jacc.2020.09.617. PMID: 33509400.

6. Understanding Your Iron Group: What Results Mean for Each Biomarker. (n.d.). https://blog.insidetracker.com/understanding-iron-group-results-mean-each-biomarker

7. Anemia. (2022b, Nov 2). WebMD. https://www.webmd.com/a-to-z-guides/understanding-anemia-basics

8. My Approach to Triglyceride Levels in Specific Patient Scenarios. (n.d.). PracticeUpdate. https://www.practiceupdate.com/content/my-approach-to-triglyceride-levels-in-specific-patient-scenarios/65261

9. Got fatigue? Increase Your Ferritin! (n.d.). https://blog.insidetracker.com/got-fatigue-increase-your-ferritin

10. Triglycerides: Why do they matter? (2022, September 3). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186

11. Hoffman, M., MD. (2008, August 25). HDL Cholesterol: The Good Cholesterol. WebMD. https://www.webmd.com/cholesterol-management/guide/hdl-cholesterol-the-good-cholesterol

12. Understanding Your Iron Group: What Results Mean for Each Biomarker. (n.d.-b). https://blog.insidetracker.com/understanding-iron-group-results-mean-each-biomarker

13. Vitamin B12. (2019, June 4). The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/vitamin-b12/