It’s July 2024, I’ve been on a low vitamin A diet for 19 months now, and this is my second check-in. My previous blood results were December 2023, 12 months in. I’m 42 years old.
There will be some TMI in this thread. At the end, I link to my diet and a spreadsheet with ALL of my life’s blood work, with the ages and diet strategies I was on at those times. My first tests were at age 34. I’m completely drug-free. I go to LabCorp but some older tests are Quest.
Let’s get to it.
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VITAMIN A and RBP-4
Aside from what’s in beef, I’ve been very actively avoiding vitamin A and plant carotenoids for 1.5 years. So surely, by now, I’m vitamin A deficient, right?
Haha, nope:
- Retinol: 45, down from 49.6 (goal is under 20)
- RBP-4: 5.0, down from 5.4 (goal is under 2 or so)
LabCorp’s reference range is 20.1 – 62.0 for retinol / Vitamin A, and 1.6 – 6.1 for RBP-4, so I’m still in the upper half of these ranges.
At this point, I can definitively say that NOBODY in America is ‘accidentally’ low in this stuff. If your numbers are low and you’re not an alcoholic or anorexic, you’re likely severely protein or zinc deficient, and/or already have hypervitaminosis A with a broken liver.
Two points doesn’t indicate a trend, but the good news is that I may be on my way down. I still find these numbers hilarious, and semi-demoralizing. How long will this crap be pumping out of my liver? At least 2 more years, probably 3-4 though. It’s a slog, but I’m in for it.
Chances are, if you’re on the fence with this substance… you’ve had more than enough of it. If nothing else, you don’t need to actively supplement more or eat any amount of liver.
Let’s continue.
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VITAMIN D
Similarly, I went off the Vitamin D3 / cholecalciferol starting January 2023, after understanding its role in soft tissue calcification and considering my growing joint pain, specifically in the knee (extreme hypercalcaemia is how/why it’s used as rat poison in products like D-Con and TeraD3).
Dropping D3 is the biggest “quality of life” confound for me on this diet. I have no more knee pain and my shoulders are actually functional, despite too much time at a desk with admittedly bad posture. How much of that can be attributed to vitamin A reduction or D3 removal, we’ll never know.
I’ve never had a Vitamin D test before, so I figured I’d start now and get another in the winter. A note about me is that I’m Italian/Sicilian American, and can get VERY tan in the sun, to the point of looking rather “ethnic”. I can get sunburnt, but it takes considerable effort and is minimally painful compared to others.
- Vitamin D, 25-Hydroxy: 42.6
I came into this test decently tan, but hadn’t had serious sun for about a week.
Many will say this level needs to be higher, I’ve seen some absurd numbers, but I think this is fine. Goal is generally over 30, 50+ may be optimal.
One thing I’ll admit is that I feel noticeably more energetic with sunshine, and start to notice reduced energy if I’ve gone a few days without. I don’t recall having this happen when on the D3 rat poison, this may be some kind of ‘hack’ that people have gotten used to. I’m quite sun-dependent at this point, and will use a Sperti Lamp if needed over the winter.
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THE BAD: Free Testosterone
This is nothing new for me, but I exhibit the kinda-sucky pattern of:
- Good total testosterone
- High Sex-Hormone Binding Globulin
- Low free testosterone
- Normal estrogen
People like me are pretty easily identified – can train pretty hard, things function well, but we’re just not gonna put on much muscle or crazy strength.
From my research, the ONLY way anyone’s ever solved this is with DRUGS. So I know this going in – at any point, I can pull the ripcord, call up @DrCamRX, and get on some enclomiphene (which would easily be my first decision). But I’m giving it at least a couple years.
- Total Testosterone: 683 (down from 684.2)
- Free Testosterone: 5.4 (down from 7.0) !!
- Sex Hormone Binding Globulin (SHBG): 69.4 (up from 57.8) !!
There’s no way around this – it isn’t good, and it went in the wrong direction. All of my LabCorp values have exhibited this pattern, but this is my worst one.
I’m unsure how Quest’s are different from LabCorp’s, but Free T at Quest in 2019 wasn’t so bad, while LabCorp’s still was.
Was it always like this? I don’t know. This is why I’d encourage young guys to get some blood work, even if it’s just a few different things each year just to see your baselines.
The TMI part of this is that I have a pretty bad varicocele – one that hasn’t hurt a single time since going low vitamin A – so I may indeed have something that just can’t be fixed without chemistry. I’m happy we had a kid, I know some with varicoceles who suffered worse fate.
Coupled with my very high ferritin, which we’ll get to, and I believe I’m working through some liver issues, and they may be causing the high SHBG alongside. Hyperthyroidism may also be a possibility for me, you’ll note that I haven’t had a thyroid panel in a long time, so this is something I might as well check out, even though my diet/lifestyle wouldn’t change much.
Long story short, I want to see if fixing vitamin A and ferritin will fix SHBG, and thus fix free testosterone. I’ll give it at least 3 more years. Worst case, I get on Maximus’ enclomiphene when I’m ready to throw the towel in, but I’m not there yet.
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THE UGLY: Ferritin
Total Iron Binding Capacity (TIBC): 259 (previously, 258) [prefer 250-350]
- Unsaturated Iron Binding Capacity: 183 (previously 152) [prefer 111-343]
- Iron, Serum: 76 (previously 106) [prefer 40-140]
- Iron Saturation %: 29% (previously 41) [prefer 15-40%]
- Ferritin, Serum: 722 (previously 772) [prefer 30-70] !!
OK, so the good news is that my ferritin came down a fair bit, and my formerly-highish iron saturation came into range. But no doubt, this is still very high.
How long was it this high? Absolutely no clue, I was 42 the first time I got a ferritin test! Hear my pleas, young guys. Get a random few labs once in a while.
Since I don’t have “iron overload”, what’s the deal? Again, this points to some kind of liver problem or inflammatory condition. I socially drank HEAVILY from ages 17 through 30, so I’m not pretending I didn’t screw things up.
The first thing many will do in this case is to try donating blood, “dumping iron” a la @Mangan150 – Why didn’t I do that?
Well… I tried to, at the church blood drive. But when I got there, some frail old lady was in the process of nearly dying, and by the time they got her out of there and into the ambulance and the commotion was over, it was time for me to go pick up my kid.
So I took that as a “sign” that I’d wait a bit… then never got around to it, and figured I’d wait to see what happened at this round of labs. We saw modest improvements, good, but I’m now scheduled to donate blood next month to see
- How I feel
- What happens with ferritin
If I feel good, I’ll keep doing it. If I feel bad I will not, even if numbers improve.
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The GOOD(?): LIPIDS
Now it’s time for everyone’s favorite: lipid panel!
To set the stage, I’ve had some well-documented articles with in my lipids, as I exhibited a @realDaveFeldman style “Lean Mass Hyper Responder” (LMHR) profile when I was regrettably keto and near-carnivore.
Two articles I wrote that went viral are here:
- “My LDL Cholesterol is High, But I’m Not Worried. Here’s Why.“
- “How I “Fixed” My Cholesterol Levels with a Low-Carb Diet“
The TL;DR is that I had high LDL, but also high HDL and low triglycerides, putting me in good ratios. However, I made the numbers look even better when going to ~75-100g carbs per day.
That was in 2019, and then I stopped giving my blood to anyone or letting them poke me with a needle for a few years…
Fast forward to today, and my profile looks quite different:
- Total Cholesterol: 155 (down from 169)
- LDL Cholesterol: 93 (down from 108)
- HDL Cholesterol: 47 (down from 49)
- Triglycerides: 79 (up from 61)
- LDL/HDL Ratio: 1.98
- Cholesterol / HDL Ratio: 3.30 (want this under 4.5, under 4.0 even better)
- TG / HDL: 1.68 (want this under 2.0, under 1.2 even better)
- HbA1c: 5.5 (down from 5.6)
- Glucose: 94 (down from 96)
OK, so per the Framingham study, my numbers still give me in the lowest mortality odds ratio, and have been ever since adding carbs back in to get LDL down a bit.
However, let’s not kid ourselves: while I’m still “low triglyceride” and “high HDL”, both of these went in the wrong direction since 7 months ago. My triglycerides went up especially, and I think I got a bit TOO out of control with the sugars/carbs. To put it nicely, I enjoyed a spoonful or two of maple syrup.
At the same time, as we’re re-learning that LDL cholesterol carries RETINOL once the liver and RBP-4 is overloaded (this has been known since the 1970s but nobody likes to talk about it), we’re seeing that vitamin A toxic individuals can have extraordinarily high LDL. I’m pretty sure that’s where my egg heavy, keto/carnivore diet (that included some organs blended into my ground meat) was putting me.
Keto / LMHR dieters justify it like I used to, with the low TG and high HDL, but once the retinol wins in the end and breaks the liver, many of them have to go off or move to full carnivore. I believe I have a far better solution.
So for me, I think the LDL drop is continued progress towards my low vitamin A goals. But with that said, I can probably lay off the sugar a bit better, and snack protein better.
Regarding HbA1c, 5.3-5.4 is what I want, so I’m nearly happy there. I prefer fasted glucose under 95 as well, I’m basically right on the edge of my insulin resistance.
NOTE: I stopped taking niacin a week before this test. Didn’t want it to bork my test (sorry @DrSteveGoeddeke), I get plenty in my meat, and I don’t like flushing anyway. I may go back on like 25-50mg.
Fun one, feel free to debate.
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Comprehensive Metabolic Panel (CMP)
I don’t want to paste everything, it’s in the spreadsheet linked below, but a couple things to note:
My Blood Urea Nitrogen (BUN) has ALWAYS been high. It’s 21, down from 24, reference range is 7-20 but optimally it’s 13-18.
This could just be from my higher-than-average protein intake, but maybe it’s connected to the other issues. I don’t know.
Also, potassium. In my spreadsheet, which was copied from @NutriDetect, potassium is shown ideally at 4.0-4.5 (this was from a functional medicine course he took), but the LabCorp reference range is 3.5 to 5.2. I used to be on the LOW end in my 30s, now I’m a bit on the high end, 4.6 down from 4.9. Not sure it matters.
Thanks for reading
Thanks for reading. Comments appreciated.
Next steps:
- Donate blood
- Re-Test Ferritin
- Get a thyroid panel while at it
- (any other suggestions I’ll take, within reasonable costs)
THE LIFE BLOOD WORK SPREADSHEET:
https://docs.google.com/spreadsheets/d/1q4B8aHJZQd31oKmoI_6kqEMFdzjmbGqrQdsqgastHiY/edit?usp=sharing
Feel free to make a copy of this and use it for your own numbers!