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c/bloodwork·posted 2 years ago by u/diego_sorensen

[PSA] lipids are not what most of this community thinks it is

Concerning Well Actually ×9 Clean Column ×1 Cold Box ×1

The one-line version is the title: lipids are not what most of this community thinks it is. The rest is why.

Brought the whole set to my clinician rather than one flagged value. Completely different conversation.

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.

Panicked about a single result, posted here, got told to repeat it, repeated it, and it was fine.

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

6,834 up / 811 down89% upvoted35 commentsid 2d04sp21 Nov 2023

35 comments

30 in this archive, depth 6

best — the order this archive was captured in

u/a1c_arcMOD1.1k points·2 years ago

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

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u/neha_rahimi-13 points·2 years ago

Time of day, fasting state, hydration and recent exercise all move common markers. Standardising the draw conditions is free and it removes most of the apparent variability.

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u/ismael_eriksen1 point·2 years ago

What did the repeat show?

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u/diego_sorensenOP1 point·2 years ago

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

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[deleted]1 point·2 years ago

[deleted]

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u/skip_week_sceptic1 point·2 years ago

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

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u/janek_ferrari1 point·2 years ago

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

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u/jarno_karlsen568 points·2 years ago

Different laboratories use different assay platforms with different calibration. Comparing across labs adds a systematic offset that is invisible on the report.

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u/customs_seizure_sid299 points·2 years ago·edited

How many weeks between the two measurements?

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u/chidi_abubakar84 points·2 years 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/diego_sorensenOP37 points·2 years ago

Do you have a baseline from before you started?

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u/valeria_karlsen165 points·2 years ago

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

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u/iman_falk92 points·2 years ago

weight loss itself moves several of these independently

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u/thermal_mass_tom198 points·2 years ago

Disagree with reading anything into that. One value, one morning, and you changed two other things in the same window.

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u/nnt_nate81 points·2 years ago

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

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u/peptidemeter_pat21 points·2 years ago

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

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u/nabila_bakken30 points·2 years ago

bring the numbers to someone qualified to read them

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u/greta_chukwu18 points·2 years ago

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

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u/diego_sorensenOP30 points·2 years ago

Have you taken this to whoever ordered it?

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u/lina_almeida692 points·2 years 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/vito_chowdhury406 points·2 years ago

fasting state and time of day change more than people expect

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u/tidy_vialdrawer_watch166 points·2 years ago

This. Reference ranges are population intervals, not targets, and conflating them causes a lot of unnecessary alarm here.

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u/bence_zamora39 points·2 years ago

Took a baseline the week before starting purely because this board told me to. Best five minutes I have spent on this.

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u/ahmed_fonseca24 points·2 years ago

Took a baseline the week before starting purely because this board told me to.

Adding the obvious one — take it to whoever ordered the panel. This board cannot read it for you.

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u/emil_agyeman221 points·2 years ago

Fasting or not, and what time of day?

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u/heart_rate_bump82 points·2 years ago

Not convinced by the attribution. Weight loss alone moves that marker and you have no way to separate the two.

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u/jonas_cardoso49 points·2 years ago

Not convinced by the attribution.

heart_rate_bump is right that a reference interval is not a target. It is a description of a population.

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u/coldchain_karencold chain18 points·2 years ago

Agreed. The trend is the signal. A single value is a snapshot of one morning.

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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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