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c/bloodwork·posted 1 year ago by u/lipid_panel_larry

how much of what we believe about eGFR actually comes from A1c threads

Baseline Clean Column ×6 Slow Clap ×2

how much of what we believe about eGFR actually comes from A1c threads. Searched first, found three threads that contradict each other, hence the post.

ApoB counts atherogenic particles rather than the cholesterol they carry, which is why it can diverge from LDL-C and why it is the addition most worth making.

Why so many single values look alarming and turn out to be nothing.

A reference interval is built to contain about 95% of a healthy reference population, so one test in twenty falls outside one by construction. Add biological variation, assay imprecision, fasting state and time of day, and a genuinely stable person will produce occasional out-of-range results.

That is why repeat testing before acting is standard. Regression to the mean handles most of it. None of which means an out-of-range value should be ignored — it means it should be repeated and taken to somebody who can put it in context, which is emphatically not a ranked feed.

The confounding problem, stated plainly, because this board keeps stepping on it.

Substantial weight loss moves lipids, liver enzymes, insulin sensitivity markers and several others in its own right. If you are losing weight while taking something, any change in those markers has at least two candidate explanations and you cannot separate them from your own panel.

What you can do is standardise, take a baseline, keep the series long, and be honest in your posts about what is and is not attributable. The threads that say "this compound did X to my TSH" almost never have the design to support the claim, mine included.

Screenshot none of this. Read the whole thread, including the parts where I am told I am wrong.

2,455 up / 527 down82% upvoted35 commentsid 13sij823 Dec 2024

35 comments

26 in this archive, depth 6

best — the order this archive was captured in

u/kofi_balogun433 points·1 year ago

Substantial weight loss independently moves lipids, liver enzymes and several other markers. Attributing a change to a compound while losing weight is confounded by design.

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u/cormac_roos299 points·1 year ago

Cosigning on baseline. The panel I regret most is the one I did not take before starting.

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u/ahmed_fonseca214 points·1 year ago

Is that the same assay, or did the lab change platforms?

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u/a1c_arcT2D199 points·1 year ago

Agreed on assay changes. A lab switching platforms between your draws is invisible unless you ask.

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u/lipid_panel_larryOPbloodwork232 points·1 year ago

Correction: that marker is reported in different units by different labs, which explains the tenfold difference you are seeing.

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u/yara_mensah150 points·1 year ago

do not change three things and then read the panel

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u/kenji_kimani77 points·1 year ago

That is a non-fasting value and the interval you are comparing it against is a fasting one.

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u/sanne_novak202 points·1 year ago·edited

do not change three things and then read the panel

Disagreeing with this bit: that change is confounded by the weight loss itself and cannot be attributed.

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[deleted]137 points·1 year ago

[deleted]

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u/liver_enzyme_liz220 points·1 year ago

How to make a panel worth comparing, which is most of the value people leave on the table.

Standardise the conditions: same lab, same fasting state, same rough time of day, same point in the week, similar hydration. Take a baseline before you change anything. Repeat any surprising value before acting on it. Change one thing at a time if you want to attribute anything to it.

Do that and a year of panels is a trend. Skip it and a year of panels is a collection of unrelated mornings, which is what most of the alarmed posts here are actually describing.

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u/lipid_panel_larryOPbloodwork123 points·1 year ago·edited

Compared two draws across two labs and spent a week worrying before finding out the assays were different.

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u/kaia_kuusela84 points·1 year ago

Yes. Repeat before you react. Almost every alarming single value I have posted here regressed on the repeat.

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u/intent_to_treat71 points·1 year ago

Same view — ApoB if you add one thing. It answers a question the standard panel only gestures at.

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u/skip_week_sceptic43 points·1 year ago

assay method matters, especially between different labs

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u/liv_okafor34 points·1 year ago

the trend line matters more than any single value

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u/lipid_panel_larryOPbloodwork13 points·1 year ago

Small fix — a reference interval is not a treatment target, and the post above uses them interchangeably.

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u/signe_grimaldi8 points·1 year ago

I would not draw a line through two points, especially when the second was taken at a different time of day.

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u/emil_okwuosa90 points·1 year ago

Fasting or not, and what time of day?

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u/micro_bump_mick81 points·1 year ago

Repeat testing before acting is standard practice for a reason: regression to the mean does a lot of work on single outlying values.

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u/gustav_cardoso61 points·1 year ago·edited

Careful — that is a question for whoever ordered the panel, and nobody in this thread can answer it responsibly.

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u/lina_almeida36 points·1 year ago

one measurement is a point, two is a line, three is a trend

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u/freya_baptista29 points·1 year ago

bring the numbers to someone qualified to read them

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u/edit_for_clarity-11 points·1 year ago

lab reference ranges are not treatment targets

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u/nabila_bakken30 points·1 year ago

Nobody here can interpret your panel and this comment is not doing so. What a board can usefully do is help you ask better questions of somebody who can.

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u/anders_vermeulen7 points·1 year ago·edited

a single hs-CRP outside range is a reason to repeat, not to panic

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u/a1c_arcMOD12 points·1 year ago

Retitled — the original asserted a causal claim the post does not support.

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About c/bloodwork

What to measure before you start, what to re-measure, and how to interpret movement without panicking. ApoB over LDL-C, HOMA-IR as a crude free tool, ALT and the fatty-liver story, eGFR noise during rapid loss, and the deficiencies that a 1,100-calorie appetite will hand you.

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