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Meg Mangin R.N.
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Posted: Wed May 21st, 2008 17:59 |
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There is a special forum for posting test results. You can find it by clicking on this link:
http://curemyth1.org/forum5/
In order to help the study site nurse moderators interpret your D-Metabolites tests, please post the following information with your test results by starting a new topic with your name:
Briefly list your diagnosis or symptoms. (around 2 lines at the most).
-The date the blood was drawn
-Which lab did the tests?
-Was the 1,25-D sample was frozen for shipment?
-How long have you been avoiding foods with vitamin D in them?
-How long have you been avoiding sun/lights?
-List all meds, supplements (both prescription and OTC) you have been taking and why.
-When and for how long have you taken prednisone or any other immunosuppressant in any form?
-When and for how long did you take Vitamin D supplements (including any vitamin-mineral supplements), omega-3 supplements and/or any kind of fish oil?
-Were you taking Benicar when the sample was drawn?
-Were you taking an ARB or or an ACE inhibitor when the sample was drawn?
- Please add the required signature line
When we analyze the results, we take all of the above into account.
Include the measurements for both tests, 1,25D & 25D, noting either ng/ml and pg/ml or the metric equivalent; nmol or pmol.* (ug/l = ng/ml)
Do not accept the term "normal range" for the results, we need the actual numbers.
It is helpful if you convert metric measurements to pg/ml and ng/ml.
You may convert your Vit D test results with this online calculator.
http://mp.behindthepage.com.au/
.....................................................................................
Lab ranges
There is no need to include lab ranges for the D-metabolites tests.
1,25-D results that are within normal lab ranges may still be abnormal because high levels are not used to diagnose any illness. Therefore, lab ranges are determined without considering that a large percentage of patients getting this test are ill with undiagnosed Th1 inflammation, thus skewing the 1,25-D range upward. The Merck Manual 1,25-D range of 20-45 pg/ml is a more reliable indicator of the 1,25-D normal range.
Clinicians have yet to recognize the reason for low levels of 25-D and usually recommend supplementation with vitamin D. Thus, lab ranges for 25-D are being skewed higher and higher by the increasingly prevalent use of dietary supplementation.
See What Does a 'Normal Range' Mean?
D ratio
The D ratio is a guide to the amount of systemic Th1 inflammation based on the unaltered levels of 25-D (no supplementation of vitamin D) and accurate, measurement of 1,25-D (unaltered by medication). It is only meaningful under certain conditions before any of the aspects of the MP are started.
It was previously thought that a low 25-D indicated a rapid conversion of this pre-hormone to 1,25-D. Dr. Marshall's recent research found that high levels of 1,25-D inhibit the conversion of vitamin D into 25-D. Thus, the D ratio (ratio of 25-D to 1,25-D) is not a sufficient indicator of vitamin D dysregulation, especially when 25-D levels rise above 15 ng/ml. Moderators will base D ratio assessment on their knowledge of the complete metabolism.
Now that we know more about the molecular activity of vitamin D metabolism, the D ratio carries less significance. Pre-MP, it is an adequate clinical guesstimate of Th1 inflammation (but an inadequate scientific analysis) if it is able to be interpreted accurately. The D ratio has no value after the MP has begun.
How to obtain your lab results
Your doctor's office personnel can read you the exact numbers with measurements over the phone but we recommend you get a printed copy of the lab results. The clinic cannot give out this information until you sign a release of information form.
Call your clinic's "Release of Information Office" or Medical Records to find out what their procedure is to obtain medical records. You should be able to do this all via the phone and mail. Once your release form is on file, you can just call them and have them mail you copies of the doctor's clinic note and test results after each visit. A proactive patient knows exactly what is in his/her medical record.
If you would like us to comment on other lab tests, you must include the lab ranges in addition to the test result. See Policy regarding posting other lab test results.
For more information, please see: What do my lab tests mean?
If you have not yet tested, please review D-Metabolites tests
See also:
How often should I test D levels? What are the target numbers?
Measurement of D2 and D3
Do I need to get my 25-D down before I start the MP?
There is a special forum for posting test results. You can find it by clicking on this link:
http://curemyth1.org/forum5/
Normal lab ranges
Laboratories establish a 'normal' range for the D metabolites results based on the average of all the 'healthy' persons who are tested. Since Th1 inflammation is underdiagnosed, the lab ranges are skewed high because it is assumed that it is normal for some people (who are actually sick) to have a level as high as 60pg/ml. The Danish 1,25-D population study, which is the largest study and the most reliable we have, found that the mean value for 1,25-D in a normal population was 29 pg/ml.
D-metabolites results that are within normal lab ranges may still be abnormal because high levels are not used to diagnose any illness. Therefore, lab ranges are determined without considering that a large percentage of patients getting these tests are ill with undiagnosed Th1 inflammation, thus skewing the 1,25-D range upward. The Merck Manual 1,25-D range of 20-45 pg/ml is a more reliable indicator of the 1,25-D normal range. 25-D ranges are skewed high by dietary supplementation.
Sigma
Sigma is a statistical term. A sigma value is a description of how far a sample or point of data is away from its mean, expressed in standard deviations. A data point with a higher sigma value will have a higher standard deviation, meaning it is further away from the mean.
The starting point of these statistics is the Danish Population study. Although online Pubmed abstract is uninformative, the complete text shows that for non-smokers the average 1,25-D level is 29.0 pg/ml and the standard deviation 9.5 pg/ml.
Merck Manual's normal range for 1,25-D
We use ranges from the big Danish study on Smoking/Non-smoking, which also line up with Merck's Physicians' Handbook and the data we have from 1700 patients at the University of Toronto.
The Danish 1,25-D population data, which is the largest study and the most reliable we have, found that the mean value for 1,25-D in a normal population was 29 pg/ml with a standard deviation of 9.5. By plugging a value of (42-29)/9.5 = 1.37 as z into an online statistical calculator you can find the percent of the population that would have a lower value.
Many of labs list ridiculous ranges for 1,25-D. The Merck manual reports the maximum value for 1,25-D is 45 pg/ml.
On 15 Oct 2006 Merck Manual of Diagnosis and Therapy
printed info regarding 1,25-D under Vitamin D Deficiency and Dependency online. It is no longer available online but is reprinted here:
25(OH)D3 and other vitamin D metabolites may be measured in plasma. In healthy persons, levels are 25 to 40 ng/mL (62.4 to 99.8 nmol/L) for 25(OH)D3 and 20 to 45 pg/mL (48 to 108 pmol/L) for 1,25(OH)2D3. In nutritional rickets and osteomalacia, 25(OH)D3 levels are very low, and 1,25(OH)2D3 is undetectable. A low serum phosphorus (normal: 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]) and a high serum alkaline phosphatase are characteristic. Serum calcium is low or normal, depending on the effectiveness of secondary hyperparathyroidism in restoring serum calcium to normal. Serum PTH is elevated, and urinary calcium is low in all forms of the disease except those associated with acidosis. In hereditary vitamin D-dependent rickets, laboratory findings vary.
Last edited on Thu Oct 23rd, 2008 04:55 by Meg Mangin R.N.
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