Tommy Wood Blood Results Transcript

Written by Christopher Kelly

Nov. 5, 2015

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive Podcast. My name is Christopher Kelly and today I'm joined again by Dr. Tommy Wood. Hi, Tommy.

Tommy:    Hi, Chris.

Christopher:    I've got a really interesting and unusual situation for you here today. As I've mentioned previously on the podcast, Tommy and I are doing a clinical coaching program that we're calling O2 Boost that consist of blood testing and optionally urinary organic acids testing. And this week Tommy went to the lab. Tommy lives in Norway. Just this week he was in Seattle so we sent him to the lab to get his blood tested.

    Today we're going to do what looks a little bit like one of our consultations once the results come in. But obviously, it's a bit different because we are recording this as a podcast and because I know Tommy a lot better than I would know a normal person that I work with. I think it's going to be really fun just to hear a doctor and someone as talented as Tommy talk about his own test results. What was your initial impression when you saw these results, Tommy?

Tommy:    Yes. There's a lot of things. They're far from ideal in certain areas. Actually, I've sort of gone through them and I think that I can both figure out where I need to improve but also I can explain certain results that are maybe outside the normal range which we'll talk about. But kind of what I thought will be interesting to do is that you and I have both done consultations that have turned into podcasts with various people and it's always this kind of thing where because both parties know they're being listened to nobody wants to necessarily be completely honest.

    You sort of downplay the bad things that you do or you sort of up play the good things that you do or you have an excuse for everything. In addition to trying to work through these as an example of what we try and do with somebody on the O2 Boost program, I'm going to try and let you go for it and you can ask for whatever you like and I'll be completely honest and then in the future I can retest and see how I've done.

Christopher:    Yes. So you gave me a great deal of information here on the questionnaire, which we get everybody to do. I've seen a lot of this now. The health assessment questionnaire, in particular, I've seen a lot of them. Yours is really, really good. Really good. But your situation is not perfect. Maybe we should talk about your situation because it's very unusual and it's very stressful as well.

Tommy:    Yeah. So I think I was forced to think about this a lot more after looking at my blood results. But it's something that I've been thinking about increasingly over the last few weeks. So basically, I'm a Ph.D. student which is more than a full time job in terms of the hours that I spend in the lab and the projects that I'm working on, which are both in Norway and in the UK, which is fine. That's part of the deal.

    But then on the side, I work with people like you, I write articles, I blog, I podcast. That's something that I'm really passionate about and it's something that I constantly try to stay on top of in terms of all the information that's coming out and all that. I constantly feel like I don't have enough time there but that basically takes up every spare moment that I have. But in addition to that, my girlfriend Elizabeth lives in Seattle. So she's nine time zones behind me. This is the woman that I'm going to spend the rest of my life with so I have to make sure that I have enough time for her.

    It's usually just Skype or FaceTime or whatever and then, obviously, traveling to see her. She just started a new job so she can't travel so I have to go and see her. The combination of those three has been increasingly stressful over the last few months just because I've got about a year left in my Ph.D. and I just got a lot to do. I think that's starting to take its toll.

Christopher:    Yeah. And when I read this questionnaire and I look at this blood chemistry, I'm thinking about how well you're holding it together actually, looking at your circumstances. I mean, it's not just what's going on now. I mean, you think about your recent past, I mean, how long has it been since you've been working as a junior doctor?

Tommy:    That was two years ago.

Christopher:    Okay. I mean, that's notorious for destroying people's health, right?

Tommy:    Oh, yeah. I was a pretty -- So in my first year as a junior doctor, I trained and competed in the first ever 24-hour off road Ironman distance triathlon, which was brutal. Like more than half the field didn't make it. And it just training for it and doing it was a real toll on my body. And then the year after that, I became very heavily involved in CrossFit. So I was training all the time outside of my hours of work. I've punished my body a lot actually and I'm trying to cut back on that. That's been something -- Particularly in terms of the training area, it's something that I really improved upon while I'm in Norway.

[0:05:05]

Christopher:    Okay. So this sounds like an awful lot of stress to me. And there's something on the blood chemistry that kind of immediately pops out. You look a lot like the people I test that have adrenal fatigue. Sometimes I get the opportunity to compare side by side the saliva cortisol test and the blood chemistry and I see this pattern of low or normal sodium and then elevated potassium. And the connection is this mineralocorticoid hormone called aldosterone, which is made in the same gland, at least.

    But I don't want to fall into a trap of making a mistake here. So what do you think? You also could have been -- So there's lots of reasons. That's the problem with the blood chemistry is it gives you hints but usually it's not very specific. So you're left to do some detective work yourself. And so there's lots of reasons why potassium could be elevated on the blood chemistry. It may not be low cortisol, low adrenal fatigue, or whatever you want to call it. So what are your thoughts on the sodium to potassium ratio before we get any further?

Tommy:    Yeah. So I think that there are actually a few markers on this that show I was dehydrated and I actually expected that because I tend to -- I sweat a lot so I drink a lot of water. And sleeping on a fairly warm room, the blood test was sort of slightly later in the morning but I'd gone up, taken the dog for a walk, all that kind of stuff and hadn't had any water, which is actually unusual for me. I just hadn't thought about it because we were rushing around a bit. So I think there is certainly an amount of dehydration. But looking at my potassium and sodium ratio, I thought something very similar.

Christopher:    Okay. Yeah, I know. It's interesting that the sodium is actually not very low, is it?

Tommy:    No. Actually, it's right in the middle of what you call the normal range.

Christopher:    So you don't think this is a cortisol thing? You think it's just dehydration?

Tommy:    No. I think it could be. I think it might be one on top of the other potentially.

Christopher:    That's the other problem, is you could have multiple things going on. There's another something else. You could have -- There's something happen to the cell. So there's more potassium inside of the cell than outside. So if something happens to that cell then its contents are going to be spilled out into the blood where they could be measured. So that's a possibility too.

Tommy:    Yeah, absolutely. Because I was there having my blood taken and I've taken a lot of blood in my time and I know what sort of causes the potassium to be elevated on a blood draw and the nurse I had was very good and very efficient, so I don't think it's hemolysis, what we call hemolysis. I don't think it's that.

Christopher:    Okay. Yeah, I know. The one I have is an absolute wizard as well. He's like the best guy I've ever had. I go to the lab quite a lot and get stuff done. He's amazing. You're in and out there in literally 30 seconds, unbelievable. Before I go any further, do you mind me publishing this on the website so people can look at the numbers that we're talking about?

Tommy:    That's fine.

Christopher:    Okay, cool. That will make things easy. So what do you think about blood glucose then? Your fasting blood glucose is 97 and hemoglobin A1c is 5.7. What do you think about those? They seem kind of high to me.

Tommy:    Yeah, they are slightly high. And so the fasting blood glucose is high for me as well because I usually measure it at least once a week and it's usually in the lower 90s or the high 80s. So I don't really have a good reason for that actually. But maybe occasionally I do get that thigh. But the hemoglobin A1c I was slightly surprised by because 5.7 is just right at the top of the normal range. And I eat a fairly low carb diet. Many days I eat under 50 grams of carbs. I usually only eat my carbs after training. It's very rare that I'll eat more than 200 grams of carbs a day, which in the low carb community is a lot of carbs.

    But after a heavy set of squats, I'm fairly sure that most of those go into my quads. So I was slightly surprised by that. And that's another thing that made me think of sort of a chronic stress problem. So basically, if I've got any level of cortisol dysregulation or an activated sympathetic nervous system because I'm stressed all the time, which happens frequently or I'm not sleeping properly, then my glucose response to meals and at various times of the day could be increased and then you obviously chart that over a period of time and you get an elevated A1c. So that was kind of what I thought was going on.

Christopher:    Right. Yeah, I think to look at it as an average is not very helpful at all, is it?

[0:10:01]

    Because there's no way that your average blood sugar is 126 milligrams per deciliter.

Tommy:    No, absolutely not. What I think happens is that when I do eat carb, a big, big spike, and then that causes some glycation then it comes down because obviously I spend more than half of my hours fasting and my fasting blood glucose is always under 100. So actually, this reminds me of a physiology experiment I did back when I was an undergrad. It was my first or second year of undergrad. So this is ten years ago now almost.

    We had to fast overnight. At that point, I was rowing and I was eating all the time and I had terrible blood sugar regulation which since improved a lot since going on a much lower carb diet. Because I don't get hungry in between meals or anything like that. I don't get hungry in between meals than I used to. But what I noticed -- so we had to fast for a long period of time and [0:11:04] [Indiscernible] and we tracked our blood sugar.

    And what happens is my blood sugar shot up but then it also came down very quickly. So I think that's just something -- I thought that would have improved by now that my glucose would have improved because I take a better approach to my training and nutrition now. But maybe it's just, for me, that I just get big spikes in blood glucose after a carb load.

Christopher:    And then the A1c test is standardized around a red blood cell living for certain amount of time and there's a chance that yours are living longer which means there will be more time for the sugar to become stuck to the cell. And so you might see an elevated A1c for that reason too.

Tommy:    Yeah, absolutely. That's a real nice excuse for me to have, thank you. But I think that there are the markers that I might -- My CRP is very low. It's 0.17.

Christopher:    It's almost non-existent.

Tommy:    So it's very likely that my blood cells will live a lot longer than the average person because I just don't have that level of inflammation going on. That's another good point.

Christopher:    Yeah, exactly. So CRP, for people that don't know, C-reactive protein. It's an acute phase reactant. So that means that your liver produces that protein in response to inflammation. And Tommy's is super duper low. And then your liver enzymes or the transaminase enzymes, AST and ALT are extremely low as well.

Tommy:    Yeah. I mean, that suggests that if I was somebody who was creeping towards a pre-diabetic or type II diabetic state, then we'd start to see those creep up. They're also thankfully low.

Christopher:    Yeah, I know. They're not crazy low. Sometimes you'll see these really, really low. And it's because they are B6 dependent enzymes I believe.

Tommy:    Yeah. So if you're B6 deficient then you might see them drop out the other end of the range.

Christopher:    Right. But that's not what I normally see. Normally I see them elevated into the high 20s, early 30s, even the 40s sometimes. Yeah, that's not good news. It's funny. We did a podcast on the anion gap.

Tommy:    Yeah.

Christopher:    And you're one of these people that's got an anion gap of nearly 20 that's been emailing me saying, "Am I going to die if I've got an acidosis because my anion gap is so high."

Tommy:    Yeah. Well, if they listen to the podcast, and I remember that I said, "No, you're not going to die."

Christopher:    No, I don't think so either.

Tommy:    I think at that level, and I think we kind of covered that in the podcast. So my anion gap is 19.4, which is just above the standard range, which they give a 16. It does depend on what your lab does and how it's calculated, how they calculate the electrolytes. But I assume I'm going to slightly stay at ketosis at this point. I probably haven't eaten for 16 hours or something.

Christopher:    Right.

Tommy:    I don't really actually worry about the anion gap. I think it's only really useful when you actually are certain you have an acidosis. And I don't think I do.

Christopher:    Yeah, exactly. So you know there's an acidosis, you're trying to figure out where, why there's an acidosis.

Tommy:    Yeah, exactly. And then the anion gap is very useful.

Christopher:    So the other thing that we just had a podcast on is iron overload.

Tommy:    Yeah.

Christopher:    What do you think about -- So your ferritin is definitely high and we've already said -- So the ferritin, we have to watch out for this because it's also an acute phase reactant, which we said that high sensitivity C-reactive protein also is. But we said that CRP is very low and the ferritin is elevated and then globulin is a negative acute phase reactant. That means that globulin is low when there's inflammation. And that's true for you as well. Your globulin is very low.

[0:14:59]

Tommy:    So my globulins are very low. And that includes antibodies that your B cells or plasma cells make. And all your other globulins like the hormone-binding globulin or thyroid hormone-binding globulin. And some people say that it's due to something like inflammation in the gut. I mean, it's possible. I've never had any gut issues. So I'm not really sure why my globulin is low. I have no good reason for that. I mean, we have no other suggestion.

    So if ferritin was high and CRP was high and -- where is it? And fibrinogen was high, then those would all suggest inflammation, chronic inflammation. But my fibrinogen, if anything, was at the bottom end of the normal range. My CRP is low. I don't have a good reason for that actually. I think what I might need to consider doing is doing a subfraction of globulin so you can look at all your different antibodies and see whether [0:16:08] [Audio Glitch] is efficient.

Christopher:    You can do a fancier test where they do a fractionated version of the globulin. What do you think about the iron markers?

Tommy:    Yes. So, my ferritin is 193, which is much, much higher than I want it to be. And my total unbinding capacity is right at the bottom end of the normal range, which suggests I've got a lot of iron on board. And my transference saturation is probably slightly higher than we wanted to be, which again is just I got a lot iron on board. When I was -- until the end of med school, I regularly donated blood. Not for this reason back then. I just did it because I thought it was a good thing to do.

Christopher:    On top of all the other good things that you were doing.

Tommy:    Well, but also it was -- the blood bank was in the hospital. So like I'd literally walk out of lectures or two lectures and the blood bank is right there. And so you can walk in. And they gave me free biscuits.

Christopher:    Oh my goodness.

Tommy:    For my blood glucose. But, yes. But I haven't done that for four years. I haven't done that since I finished med school. So I have a suspicion that I'm definitely on the way to some iron overload. So I will go and find a blood bank and donate blood.

Christopher:    Yeah, it's tricky for people living abroad, they don't -- especially if you're from the UK. They think that everybody's got mad cow disease and they don't want your blood.

Tommy:    Yeah. Hopefully. I haven't looked into it but I am certain, I'm certain I'll be able to donate blood here in Norway. I can also sell myself as Icelandic and they love -- All Scandinavians love each other. When I moved here, when you're registering for like a tax or social security number, there's a box to tick if you're from a Nordic country and then everything gets processed much faster.

Christopher:    That's awesome.

Tommy:    That made my life easier. So I will hunt out and, obviously, my work is right next to one of the big hospitals in Oslo, two big hospitals in Oslo, so I'm sure I could find somewhere to donate blood.

Christopher:    That's good. And have you done the 23andMe test?

Tommy:    No, I haven't. I haven't. I need to do that.

Christopher:    I think you should, yeah. That will be super interesting for you anyway, wouldn't it?

Tommy:    Yeah.

Christopher:    I mean for this reason.

Tommy:    That could be a good follow-up. Definitely, I mean, right now I'm not necessarily sure it's that much of an issue because my other markers of inflammation aren't that high. But if I want to optimize blood glucose and insulin sensitivity and all that stuff, then long term I definitely need to get that ferritin then.

Christopher:    Yeah, I know. Absolutely. We went into detail on that on the podcast. I think that was a really great podcast. I really enjoyed that myself editing. I listened to it afterwards. So what about your total cholesterol. It's over 200. Are you going to prescribe yourself a statin?

Tommy:    Absolutely not. So it's 228, which is above the arbitrary normal range of 200. We should, for the European audience, we can convert this to -- I haven't converted them to the normal measurements that would work within the UK. But no, I'm not worried about my cholesterol at all actually. My cholesterol is 228. My triglycerides are 83, LDO is 150, which has gone up since I last tested it actually. We did some blood test on each other as junior doctors because that's something that you can do.

    And my LDL has gone up, but I've also probably drastically increased my saturated fat intake since then just because I've gone low carb or relatively low carb. So I think that would explain it. My HDL is 61. So my triglyceride to HLD ratio, which is probably the only thing that I really think about in terms of these numbers, is 1.36, which is fine.

[0:20:06]

Christopher:    And then your fasting insulin is very low as well, right?

Tommy:    Yeah. That's one thing that's good. I have a fasting insulin of 4.6. Anything under five really in terms of your -- It's not a great marker, again, of looking at dynamics of insulin or glucose, let's say, in response to a carbohydrate meal. There's obviously something that we missed from a test like this. But if your fasting insulin is under five then regardless of a number of other factors your risk of heart disease or cardiovascular disease is very, very low. So that's reassuring.

Christopher:    Let's talk about the thyroid. The TSH of 1.0 is kind of low. This is a bit like your brain saying let's just slow things down a bit here. And the free T3 is 2.7, which is also a kind of, is a touch low. It's almost like your metabolic rate is quite slow and your brain is just fine with that. I mean, that could be a number of things but I'm just wondering whether you're eating enough food.

Tommy:    Particularly when I'm eating low carb, which I have done more of recently, I sort of reduced my carbohydrate intake or my carbohydrate loads, I know I eat less. I'm just not hungry. And then I did this particularly at a very, very stressful week. Two weeks ago and I was in Seattle last week and by the end of that week I was just completely finished. But then I flew the trans-Atlantic flight and I fasted for that flight just because it's just easier than having to navigate crappy food.

    So over the last few weeks, definitely my calorie intake is probably lower than what somebody would say is ideal for somebody of my size and activity. So I think that's a natural reduction in metabolism. And I'm not sure that's necessarily pathological. I think when people go on a very low carb diet or a ketogenic diet, they'll often see that their T3 drop a bit. As long as it's going in line with TSH, then rather than the TSH going up and saying actually we need more thyroid but the body is not making for whatever reason.

Christopher:    Right.

Tommy:    So that's kind of, I think I've under eaten and that's just like a natural--

Christopher:    Your body responding accordingly. So let's go into the homocysteine then which is -- First of all, I mean, who better than you to explain what homocysteine is? It's an inflammatory molecule, right?

Tommy:    Yes. Basically, it's a molecule that's right in the middle of the whole methylation pathway. And it's in the -- You almost need to look up a cycle, but basically it's converted from methionine and used to get methyl donors off either into the folate cycle or often to be used for like methylation of DNA and things like that. And homocysteine goes up for a number of potential reasons. So it could be that I have a defect in one of my methylation genes, which is possible. We don't know about that. Homocysteine appears to go up in iron overload.

Christopher:    Interesting. I didn't know that.

Tommy:    Yeah. So it could be that I'm iron overload and that's part of it. My folate was slightly low, which will impair my ability to recycle homocysteine so it could be that I need more 5-methyltetrahydrofolate, which interestingly you can't buy in Norway.

Christopher:    Oh, interesting.

Tommy:    I went to the [0:23:59] [Indiscernible] this morning because I saw my numbers and I thought I should go and buy some bioavailable folate and you can only buy a folic acid in Norway interestingly.

Christopher:    Well, let's just send you some next time you're in the US.

Tommy:    Yes. So I can acquire some of that. So basically, I think that potentially my folate is low, which, I mean, I've got a very good vegetable intake. I eat a reasonable amount of [0:24:23] [Indiscernible] and things like that. So I was slightly surprised by that. But it could be like you. You have to supplement with folate even though you have a good dietary intake of it. So maybe that's just something I need to do. And that could again be something genetic. So that's another reason why my homocysteine could be high.

    I also eat a fair amount of meat, which has a high methionine content. And if you have a high methionine intake and you can't then recycle homocysteine for whatever reason, say because you've got a problem with B12, folate or glycine intake or something like that, then that can also increase your homocysteine. So it could be any of those. I mean, I don't have an excessive meat intake but I do eat a reasonable amount.

[0:25:11]

Christopher:    Right, right. Yeah. And so, of course, B12 is involved in this cycle that we've been talking about too, which is why I mentioned you might be deficient. But yeah, technically, on the blood testing, you are inside the optimal range.

Tommy:    Yeah. And also if you look at my MCV, my mean corpuscular volume, which is your red blood cell size, if you're deficient in B12 or folate then that number tends to creep up. And I'm sort of the bottom end of the optimal range.

Christopher:    I never see that. Do you know what? This is almost the first time I see one in the 80s inside of the optimal range. It's weird that you start to -- You see so many patterns you get to the point where you start to question. You're like, "Where did this guy even come up with this range? I've never seen one inside the range." And that's really going on is you're just seeing the same person over and over again. They're not physically the same person but they're the same avatar over and over again.

Tommy:    Yeah.

Christopher:    On your chemistry, there is an elevation of the red blood cell distribution width. That's the average size of a red blood cell. That hints of nutritional deficiency too.

Tommy:    Yes. So that is a little bit high which basically suggests that even though -- So my average red blood cell is a normal size, within that optimal range. I do occasionally have red blood cells -- This doesn't say whether they're bigger or smaller but it's likely that they're bigger than the average, sort of have quite a wide range of sizes of red blood cells. The optimal range that they give for folate on here is 15 to 25 and I was 8.6. And actually, if you're talking about traditional medicine, they'd say you're not really going to be functionally deficient in folate. And so it's sort of less than three. But it could be that I'm sort of creeping towards a functional folate deficiency and it's time to sort of top that up.

Christopher:    It's really hard to know though with the blood test. We've talked about this offline before that just because you have a bunch of B12 or folate floating around in the blood where it can be measured on the blood test, it doesn't necessarily mean that it's inside of the cell where it needs to be used to do whatever it does.

Tommy:    Yeah, absolutely. That was what I was going to say because my MCV isn't high, that would kind of suggest that at least up until those last two or three months I've had enough folate on average. So then that's where you sort of, the difference between chasing a number on a blood test versus actually chasing what that nutrient is meant to be doing. Because you can take a load of crappy B12 and it will increase your B12 on the blood chemistry but that doesn't mean that it's actually doing anything useful.

Christopher:    Right. And that's where the organic acids, I think, come in pretty cool because there's a couple of organic acids that are measured in the urine sample that they build up when there's insufficient -- There's a caveat even with that, isn't it? Because it shows the need for adenosylcobalamin, which is--

Tommy:    Yeah. [0:28:05] [Indiscernible]

Christopher:    Let's talk about your vitamin D.

Tommy:    Yeah.

Christopher:    Let's talk about -- with the guy that lives in Norway where it's probably darker 3:00 or 4 o'clock in the afternoon already, isn't it?

Tommy:    Yeah. We have a long -- The days are long in the summer but then as soon as you get into September, the day shortens very rapidly. So my vitamin D is 29.2, which is just -- So on here, you have the optimal range is 50 to 90. I'm not sure I really agree with that. I think once you're above 40, I think you're probably pretty safe depending on what else you've got going on. But I think -- I eat a lot of grass fed dairy. I take some cod liver oil. And I haven't supplemented. So this was something else I didn't mention. My alkaline phosphatase was low, 53, which I think in me potentially is zinc deficiency.

Christopher:    Right.

Tommy:    And I used to take zinc when I was training very heavily and that's something that my dad has had to do as well because we both, genetically, we just sweat a lot. And you can lose a lot of zinc in sweat as an athlete. So I used to take zinc but I haven't done for a long time. I think maybe I should be doing that too. And I also used to supplement vitamin D3 but I haven't done that for a while either. And last time I checked again, so [0:29:32] [Indiscernible] I was going to check my vitamin D and I think it was between 80 and 90, somewhere on there. Living in Norway has made it drop precipitously. I need to do something about that too.

Christopher:    Yeah. I would agree. I'm just surprised. Do you think -- You're not going to get that much vitamin D from food though surely.

Tommy:    No. You're not going to get a huge amount but you will get some.

[0:30:00]

    It's a difficult thing where everybody is talking about having high vitamin D to prevent all these diseases but I think you and I have also talked about the fact that low vitamin D tends to come alongside inflammatory conditions. And it might be that the vitamin D that we're measuring is actually forced lower by inflammation. So it's not that the low vitamin D is causing these diseases. If you do something -- like autoimmune diseases are very tightly associated with low vitamin D. But if you supplement vitamin D in deficient people with autoimmune disease, it doesn't do anything for their symptoms. And it could be because this is actually part of an inflammatory process or at least that's part of it.

Christopher:    Yeah. You have to be really careful about treating the test results with instances like that without understanding why it was so that the vitamin D -- But I mean, there's good cause, isn't it? I mean, if you spend a lot of time indoors, in the lab and you live in a place where there's not that much chance to get the sun anyway?

Tommy:    Yeah, absolutely. And in athletes they have shown that you get an improvement in performance if you supplement people who are deficient in vitamin D. I went out this morning and I brought myself some vitamin D3 I'll start to supplement with.

Christopher:    And then what about your total white blood cells? I thought that was interesting as well that the total white blood cells were very low.

Tommy:    Yes. So this is interesting. So my total white blood cells are three. And traditionally, we'd say that the normal range for white blood cells is four to 11. So it could be that, for some reason, my body just isn't making enough white blood cells or that it's not getting excited about stuff, that it's not out there doing things. But if you actually look at the -- Rather than this report, which we're looking at, where you sort of put the test into a calculator and you sort of calculate ideal range and stuff, if you look at the real baseline results--

Christopher:    The raw data.

Tommy:    You look at the raw data, none of my, except for my neutrophils, which are just outside the normal range, all of my white blood cells are happily within the normal ranges. So it's just the fact that all of my white blood cells are at the bottom end of the normal range and then when you add them all up, then they're outside the ideal range. And on here, on the calculator, it says the optimal range is 5.5 to 7.5. But I've seen plenty of people talking about the fact that actually our normal range for white blood cells should probably be lower than what they are because it shows that your body isn't actually actively fighting stuff off.

    Because any large stress, and that could be lifting weights in the gym, it could be an infection, it could be stress, physical or emotional stress, can drive up your white blood cells. So most of these normal ranges come from a generally sick population. So it could just be that actually my white blood cells are fine and it's the normal range that's wrong. But it could also be that maybe I'm chronically stressed, then that's driven my white blood cells down. So it could be both. And I'm sort of considering my general lifestyle and the fact that my vitamin D is low. It's possible that I sort of driven down my white blood cells. But I don't think that they're that far -- I don't think that was far out of the normal range as this calculator would suggest.

Christopher:    Right. And you're not worried about some monocytes. Monocytes are a type of white blood cell that go on to become macrophages or big eater cells, cells that eat things. And you're not worried about the elevation of those?

Tommy:    Yes. So what the elevation is, is that my monocytes make up 11% of my total white blood cells. And it says that it should be 0% to 7%. But the reason why it's elevated is just because my total white blood cells are low. So it's not that I have lots of monocytes kicking around. I don't have very many at all, actually. It's just because the total is low so the percentage is then relatively higher. I'm not particularly worried about that at all. I don't have high monocytes.

Christopher:    Yeah. It would be nice, wouldn't it if the software had the absolute numbers as well as the percentages.

Tommy:    Yeah. I don't know why it does just the percentages. I'm not sure that's -- I don't think that's a useful metric at all actually.

Christopher:    Interesting. I should probably talk to Dicken Weatherby and ask him about that.

Tommy:    Yeah. Because I actually didn't really think about that in depth until I was looking at mine and I looked at the difference in the raw data and the output on this report, which don't necessarily line up for that reason.

[0:35:02]

Christopher:    Yeah. The report really comes into its own when you do the second test.

Tommy:    Yeah.

Christopher:    And then you can see that the trends -- And inside of the software, I'm actually able to generate other reports too. So you could just look at a single marker like your fasting insulin and then show a time series, which is also kind of nice too. Especially when we know that the standard ranges are all kind of up in the air a little bit. You talked about sick people going to the doctor and doing the test more often and healthy people and so the range ends up being a bit wonky. So to compare against yourself, I think, is super interesting.

Tommy:    Yeah, absolutely. I think that's the most useful thing, which is great.

Christopher:    When I look at this, like I say, I think here's a guy that's doing a really great job of managing a difficult situation. So there's really nothing -- You talked about your diet and your lifestyle. You're doing a lot of work and in some respect I'm sure that's stressful. There's probably some things that you do that I don't know about that you find annoying or difficult. But I mean, for the most part, you love what you do and not everybody can say that about their work.

Tommy:    Yeah, that's true.

Christopher:    Yeah, I mean, when you do long hours, I'm sure a lot of it is kind of fun, hopefully.

Tommy:    Yeah. When you sort of get into things, there's lots of things that get piled onto my plate just because it's ended up to the point where I'm the most senior person in the lab.

Christopher:    Because the others have died?

Tommy:    Yeah. We did have a [0:36:41] [Indiscernible] of physiology professors not expiring in our department. But, yeah, things stock up, which is a problem. But hopefully, as I start to separate myself out and finish my thesis and all that stuff, then I can sort of -- Those extra bits can start to fall by the wayside. So I'm hoping that within the next six months that will start to die down.

Christopher:    There's nothing here in this blood chemistry that made you make a decision to change your diet in any way?

Tommy:    No. My diet could obviously be better, if you want to call it that. I do have the occasional chocolate in the evening or ice cream with my girlfriend. And I can't really see that it's necessary for me to stop those things because I think most of the issues come from lifestyle based things and potentially stress and all that kind of stuff. I'm traveling all the time so I'm constantly jetlagged. I'm on three different time zones. None of that helps.

    You and I talked a lot about how diet really isn't the only thing that feeds into stuff like blood glucose regulation and insulin sensitivity. And I think I'm, just based on knowing myself -- Yeah, I could absolutely tidy up with my diet but I don't think that's what's going to make the real difference. I think that's going to be lifestyle based.

Christopher:    So you're just going to keep it tight and then hopefully in the couple of years time things will have settled down a bit. Actually, that's not true, is it? Are you going to do another residency in the US?

Tommy:    Yes. So I'm going to move to the US and then start residency. So basically, I'm going to be in damage limitation mode for the next decade or so. But once I'm in one place and I'm not traveling as much, which I won't be then luckily, I think there's a lot of things that I can fall into a real routine. So I think there's many things that I can do better even if I got a stressful job on the outside.

Christopher:    Are you doing anything to manage the stress levels? Have you looked at guided meditation or anything?

Tommy:    Yes. So I did start doing Headspace, which I really enjoyed. But I have to admit that I gave up on it. Not for any particular reason. It just never became a habit. And now I'm sort of -- I just haven't done it. When my brain kind of zones out in the evening, I tend to just watch something crap on Netflix. This is again something that I knew you bring up. It's almost certainly something that I should be doing, which I'm not.

Christopher:    I think it's almost certainly something everybody should be doing because when you don't have anything like you'll still think of something to be stressed about.

Tommy:    Yeah, absolutely. There's always. They'll always be something. And I think that's something that I'll try. I'll make it sort of a bedtime habit and do something before I go to sleep because then hopefully it will help me sleep better.

[0:40:00]

Christopher:    Yeah. I mean, there are a couple -- So there's a couple of things that made me chuckle in the health assessment questionnaire. I hope this is not getting too personal. But when you are someone -- In the past seven days, I felt like a failure. Someone like you with your academic past and the success you've had in your career and the things you got to look forward to in the future, if you think about being a failure ever, then god help the rest of us. It's crazy.

Tommy:     I think all problems that people have are relative to their baseline. So any time -- I'm writing papers for my Ph.D. and I'm very ambitiously aiming for some really top journals to send my first paper to. I got rejected from all of them just because my field is slightly niched and these are large, very general journals. So they're just like, "It's not really for our audience." So then, I guess, when you're used to doing well at stuff then anything that isn't good just has to come along with a failure. So it's kind of like a first world problem thing probably rather than being a real failure.

Christopher:    Yeah, I know. There's tons of things like that when you look at it like, "Wait, is this going to matter in even two weeks time let alone five years time?" And at that point, you're like, "Yeah, I probably shouldn't be worrying about this at all."

Tommy:    Yeah, absolutely. But any time that kind of stuff creeps in, it's generally how well I'm juggling all the various things I'm doing and whether I'm neglecting something. If I'm spending more time preparing for podcast with you then I'm neglecting my job or if I sort of get really into something and I don't have much time to spend with my girlfriend then I'm sort of failing her. So it's just a juggling task but sometimes it doesn't work out.

Christopher:    And is it the juggling task that drives anxiety?

Tommy:    Yeah, absolutely. There's always more that I could be doing. And I always make, increasingly make a really concerted effort to sort of not -- If there's something I really can't do anything about then there's no point of me dwelling on it. But still, these sorts of projects pile up and there's lots of stuff that I need to do. Everything just gets done at the last minute. So you're sort of constantly chasing the tail. But people don't probably [0:42:36] [Indiscernible]. I don't think I'm that different from the majority of people that have a family and a job and a hobby. This is just, if you have kids running around and you got to work 12-hour shifts or night shifts and you can't sleep, I think this is something that's surprising.

Christopher:    Yeah. Those are the people I really feel for. I've worked with quite a few people doing night shifts or swing shifts or something weird and you're really up against it then at that point. I think that's almost worst than being a professional -- Well, it's definitely worse than being a professional athlete and trying to get 25, 30 hours of training in a week. You take away the sleep and you're in big trouble.

Tommy:    Yeah, absolutely. And I think that's one of the problems with the way that society is structured nowadays. It's just there's so many people that are like that.

Christopher:    And you did mention that there was -- your sleep is far from perfect not just because of the jetlag but just because of the physical environment of your bedroom. But, I mean, you told me about all the hacks and tricks that I know to improve that situation already so it's not really like you can do much about that.

Tommy:    Yeah. I'm trying to do all the best with the light and blue blockers and red LEDs and turning off my wifi and all that stuff. But, yeah, I live a very busy area. I've got trams going past until 1:00 a.m. and then it's starting at 5:00 a.m. And if I don't open my windows then I'll literally shrivel up into a raisin overnight because just the building is so hot. That's just the balance of all those things. Generally, if I have enough time to sleep, I will sleep very well. But if I can't give myself the nine, ten hours in bed which often I can't then it gets cut short.

Christopher:    Okay. That's weird. I think I've experienced that in a lot of Scandinavian and in Norway as well probably. Because it's so cold outside, the buildings are hermetically sealed. They have triple and quadruple glazing and then an amazing heating systems. And then the houses end up being really, really hot. Whereas in where I am now in California, actually it works really nice.

[0:45:01]

    So even now -- I hate to do this to people. It's near the end of October as we're recording this, it's still 82 degrees outside in the afternoon. But then as soon as the sun goes down, it gets really cold. And none of the houses are insulated nor do they have heating and so it gets really cold in your bedroom at night, which is kind of what you're on really, isn't it?

Tommy:    Yeah, that's perfect. And then if you're cold you can add another blanket but it's very difficult to take off less in a very hot building. At least I'm used to it in Iceland where the buildings are very well insulated. But also energy is free essentially. Hot water comes out of the ground for free.

Christopher:    Literally.

Tommy:    Literally. People in Iceland that are in the UK where every house is damp and drafty and nobody wants to turn heating on because it's so expensive, they just don't understand it. Yeah, the Scandinavians are very good at keeping their homes warm.

Christopher:    Well, did we miss anything? This has been a really interesting conversation.

Tommy:    Did we miss anything? Oh, yeah. I guess, we should mention if people will actually look at these tests, you'll see that my creatinine is high.

Christopher:    Oh, and that's because your -- So the creatinine is a breakdown product of creatine and you're supplementing with creatine.

Tommy:    Yes. So I take creatine, which will increase my creatinine but also I have a higher than average muscle mass which will also increase my creatinine. And I was dehydrated so I think the combination of those three has probably driven up -- and it was a little bit high the last time I checked it whenever it was, two years ago, but I'm not really worried about kidney disease yet.

Christopher:    No. So the EGFR is a calculated number. It is on the bottom of the optimal range. The bottom is standard range as well actually. But it's easy to explain that.

Tommy:    Yeah, absolutely. So if I wasn't taking creatine, certainly it would be back up in the mid of the normal range.

Christopher:    This is super interesting to me actually. Here's a guy. He's got an undergraduate degree in biochemistry, he's a medical doctor, he's a Ph.D. fellow and he's only taking two supplements and one of them is creatine. That's kind of interesting, isn't it? The other one is cod liver oil.

Tommy:    Yeah.

Christopher:    So yeah. That in itself is really interesting information.

Tommy:    Yeah. This is again -- Certainly you and I talked about not publicly necessarily but I just think creatine is such a great supplement. There's a huge amount behind it. Not everybody gets benefit from it in terms of athletic performance. I mean, that's probably -- And that might be to do with their methylation capabilities or how much creatine they just have, a baseline for whatever reason, maybe for other genetic reasons.

    But it's neuroprotective. It can improve glucose handling, mainly in people who have diabetes both type I and type II, which I don't. But it increases, can increase alertness. I noticed when I take it before bed, actually I sleep worse. And I think there's some cool reasons for that. And it improves performance in the gym. It improves your performance on the bike. And it costs nothing.

Christopher:    Just be careful though. I've become a bit more worried about possible contamination with cheap creatine supplements. I did a little bit of research yesterday and found one study that showed that 50% of the analyzed product exceeded the maximum level recommended by the EFSA for at least one contaminant. So they looked at heavy metals and other junk that shouldn't be in there. And also breakdown products. So they look for the creatinine. So you show that some of the creatine has broken down which is probably less harmful. But it certainly doesn't do you any good.

Tommy:    Yes. So I've ordered some better quality creatine since we've talked about that. I think that's an important thing to people. People [0:49:11] [Indiscernible]. That's a good point.

Christopher:    Yeah. I've also tried to pull -- I talked to Douglas Labs and I'm trying to get the certificate of analysis for the creatine that I sell. It must be something they can't just give me immediately because it's taken them a few days to do it.

Tommy:    They should have it just available.

Christopher:    Yeah, that's what I thought, it would just be there and it would be--

Tommy:    They should have every batch analyzed so you just have it on file, you scan it or photocopy it.

Christopher:    Right, yeah. So it will be interesting to see how that plays out. And then I did the same for Thorne as well. I said, "Hey, could you send me a certificate of analysis for this batch of the multivitamin?" And my guy at Thorne is really good. I'm hoping to see that soon too. I think that's an interesting test.

Tommy:    Yeah. I think that's a good point especially if you're recommending supplements to people. As you know, you can't actually get access to the certificate of analysis on the show.

[0:50:04]

    There's no nasty stuff in there because cheap. They've done huge number of studies looking at cheap sports supplements and the amount of stimulants and hormones and other contaminants that end up in there is probably, is worrying. So that's definitely something people need to be wary off. But even if you get your creatine from Douglas or Thorne and they give you a certificate of analysis, it's still not very expensive.

Christopher:    Right. Exactly. It's one of the cheapest supplements there is. Presumably because so many people take it and it is so well studied and so well known.

Tommy:    Yeah. And not that I know anything about it, actually it's very easy to synthesize.

Christopher:    Well, this has been really interesting, Tommy. Thank you.

Tommy:    Welcome. I think it's good because everybody, even if they supposedly know what they're doing, can still improve on stuff.

Christopher:    Yes. So if you would -- I should probably just end it here and mention that if you want us to look at your blood chemistry we can do that now. We have an O2 Boost program. I'll link to the website in the show notes. You can order your own test and we will send you a requisition form. You just go to Lab Corp and get your blood drawn. And then the results come back to us electronically. And I'll send you the written report like the one we're talking about right now that again will be linked in the show notes. You can see what the report looks like.

    Yeah, usually the main thing we're looking for is like ways to optimize your red blood cell production, which I'm seeing is always sub optimal in endurance athletes. Maybe we'll find something else that you need to deal with too like iron overload or vitamin D deficiency. Yeah, far better, I think, just to do the test and deal with this stuff now rather than waiting until it becomes maybe more serious problem later on.

Tommy:    Yeah, absolutely. And I think that there's a definite possibility that we'll see some things that people need to go and see their doctor about, which they just weren't aware of. So if somebody hasn't had blood test done, this is a fairly cheap way to do it and get a lot of information. And even for me, I've learned a huge amount and know what I'll need to work on.

Christopher:    Yeah. I mean, I have health insurance now but I know there's no way that I can go see, go register for primary care physician, go through all the intake process, have them order the blood chemistry. I'm going to get a billing statement back from my insurance company. There's no way it's going to work out cheaper than $500. And it's a lot more hassle, right? With this, you just get the PDF requisition, you go straight to LabCorp, it's done in 15 minutes.

    For me, even now, it's like I've been to the lab this morning. It's just not worth it to try and persuade a primary care physician that they want to measure my C-peptide. There's nobody interested, right? Why would they care? Cool. Okay. Thanks very much, Tommy.

[0:53:08]    End of Audio

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