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pgeek
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Posted: Sun Jan 31st, 2010 06:18 |
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25-D 33.4 nmol/l . 1-25D: tests not available anywhere in this part of China AFAIK.
EDIT: I just realised MP usually uses ng/ml NOT nmol/L!
Multiplying by 0.4* gives: 25-D 13.4ng/ml.
-Was the 1,25-D sample was frozen for shipment?
N/A
-How long have you been avoiding foods with vitamin D in them?
~2 months
-How long have you been avoiding sun/lights?
It's been cloudy/polluted here, but I haven't made any special effort to do this (until yesterday - eyes only).
-List all meds, supplements (both prescription and OTC) you have been taking and why.
Nothing (consistently).
-When and for how long have you taken prednisone or any other immunosuppressant in any form?
N/A
-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?
I haven't supplemented with vitamin D for several years (& then only at multivitamin pill levels) but did eat fish & eggs daily until about 2 months ago.
-Were you taking Benicar when the sample was drawn?
No
-Were you taking an ARB or or an ACE inhibitor when the sample was drawn?
No
* as per http://mpkb.org/doku.php/home:tests:25d#units_of_measurement
glad I didn't have to try to fumble my way through the molecular weight & avogadro's constant! :p
Last edited on Sun Jan 31st, 2010 06:49 by pgeek
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Joyful
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Posted: Mon Feb 1st, 2010 23:40 |
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Thank you pgeek. 
Looks like you have already found out what you need.
See also: http://mpkb.org/doku.php/home:tests:vitdinterpretation
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eClaire
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Posted: Tue Feb 2nd, 2010 02:14 |
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Congrats on the 25D levels already being in the therapeutic range for the MP. Don't forget to have all of the light protections in place before starting the MP.
Best to you, Claire
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38mo on MP; CFS FMS MCS COPD hypermob. IBS/GERD osteopor.; 125D48 25D<4;
NoIRs during most daylight outings & covered up; home w/o NoIRs
Ph1.Dec06 * ModPh2.Jun07 * AbxBrk.Mar-May08 * Ph2.Oct-Nov08 * Ph1.Jan2009
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pgeek
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Posted: Tue Feb 2nd, 2010 13:12 |
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Ok, this is what the calculator Joyful linked to tells me when I put in 33.4 nmol/L for 25D and leave 1-25D blank:
Feedback on vitamin D results
25-D: 13.36 ng/ml converted from international into standard units
Steroids/TNF drugs: No
Olmesartan: No
The primary mechanism depressing 25-D levels below 14ng/ml is Th1 inflammation. The 25-D metabolism will be driven to even lower values as the inflammation becomes more widespread. Conversely, the presence of ingested Vitamin D from milk, food, and supplements will counteract this trend. Assessment of the degree of inflammation involves assessment of both the sources of ingestion and the measured 25-D level. This level of 25-D is in the therapeutic range. This is a good place from which to initiate therapy concomitant with continued avoidance of ingested Vitamin D.
The 1,25-D is below the level normally expected in a sick individual. If there are signs or symptoms of Th1 disease present, then this low value for 1,25-D usually indicates that a lab other than Quest Diagnostics has been used to process the bloodwork, and it has not been frozen in transit. A therapeutic probe might well allow a definitive diagnosis of Th1 disease.
So I guess it's the bugs, not me that should be congratulated for 25D levels in the therapeutic range! (My avoidance of D hasn't been incredibly assiduous - I sometimes eat biscuits which must contain egg, and some of the frying oil includes sunflower.)
The "low 1-25D value" referred to was actually a blank field; perhaps someone should recode the calculator so it distinguishes between blank and zero - this could be confusing...
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paulalbert
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Posted: Tue Feb 2nd, 2010 19:06 |
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Pgeek,
Bugs are everywhere, aren't they? In you, in the vitamin D calculator....
Anyway, I fixed it so that you do not get an interpretation if you do not enter a value for 1,25-D. Thanks for pointing that out!
Best,
Paul
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eClaire
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Posted: Tue Feb 2nd, 2010 19:09 |
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pgeek wrote: So I guess it's the bugs, not me that should be congratulated for 25D levels in the therapeutic range!
You would have to go and get technical on me!
Still, you are not, like many, working to get your D level down and so what you see, in regard to your response to the MP, is what you get. At least there will be no surprises connected to the dropping 25D level. Have to be thankful for small favors!
Claire
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38mo on MP; CFS FMS MCS COPD hypermob. IBS/GERD osteopor.; 125D48 25D<4;
NoIRs during most daylight outings & covered up; home w/o NoIRs
Ph1.Dec06 * ModPh2.Jun07 * AbxBrk.Mar-May08 * Ph2.Oct-Nov08 * Ph1.Jan2009
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pgeek
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Posted: Tue Feb 2nd, 2010 22:53 |
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Paul - fast work! Maybe because you're bug free ;-)
eClaire - indeed... unless further drops in D could cause changes?
It did occur to me that perhaps I should try to increase my benicar level very gradually, eg going from 20mg 4x per day to 40 4x over a couple of weeks. Perhaps this is a bad idea for some reason though?
& isn't there a risk my 25D levels could rise when I start olmesartan? Do people ever see this?
(If blockage of the 1-25D receptors is upregulating the enzymes that convert 25D to 1-25D. When the VDR is activated these downregulate, reducing the conversion rate. Depending on the new balance of 'inflows' of ingested vitamin D with outflows into 1-25D, this should result in a slower rate of decline of 25D levels, & result in an increase in 25D levels...)
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eClaire
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Posted: Tue Feb 2nd, 2010 23:25 |
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pgeek wrote:
... unless further drops in D could cause changes?.... & isn't there a risk my 25D levels could rise when I start olmesartan? Do people ever see this?
I don't think you need to be searching for things to be concerned about as you start the MP. Follow diet recommendations and what you have expressed concern over is unlikely.
In regard to the rest of your post about olmesartan dosing:
If you have read the Phase 1 guidelines, you know that you are supposed to start olmesartan 40mg q6h.
From the guidelines (underlining and bold mine):
"Patients experiencing intolerable immunopathology from Olmesartan alone, whose
immunopathology is not controlled by more frequent dosing or sublingual bolus, should allow time for hormonal rebalance, discontinue supplements, abstain from vitamin D, protect their eyes (even indoors), and fully avoid outdoors exposure. An Olmesartan dosing regime of 20mg every 6 hours may be used as a temporary aid to help the patient’s immune and hormonal systems to achieve stability. Palliation with either Quercetin or Guaifenesin should be attempted before deciding to temporarily lower the dose of Olmesartan.
The danger from using a lowered dose of Olmesartan is that its organ protective actions are most effective when the dosing cycle does not exceed 4 hours. This is because the pharmacodynamic half-life of organ protection is lower than the half-life of the VDR activation activity (and subsequent immune system activation). Thus, if the patient suffers an acute cardiac, pulmonary, or renal, crisis the full organ-protective actions will not be available from the lowered Olmesartan dosing regime. Consequently it is important to move to the suggested 40mg per 6hr dosing as soon as practical."
AND
"Lowering the Olmesartan dose is a measure of last resort, and should only be contemplated after allowing time for hormonal rebalance, discontinuing supplements, abstaining from vitamin D, and fully avoiding outdoors exposure. Palliation with either Quercetin or Guaifenesin is preferable to reducing the Benicar dose."
NO part of the above text suggests that anyone should ramp olmesartan when starting the MP. To be clear, ramping olmesartan in the way you have described is NOT part of the protocol.
Hope this helps, Claire
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38mo on MP; CFS FMS MCS COPD hypermob. IBS/GERD osteopor.; 125D48 25D<4;
NoIRs during most daylight outings & covered up; home w/o NoIRs
Ph1.Dec06 * ModPh2.Jun07 * AbxBrk.Mar-May08 * Ph2.Oct-Nov08 * Ph1.Jan2009
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pgeek
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Posted: Wed Feb 3rd, 2010 09:09 |
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I don't think you need to be searching for things to be concerned about as you start the MP. Follow diet recommendations and what you have expressed concern over is unlikely.
eClaire - I'm not exactly searching for things to worry about - though I can see how you might think that! It might sound cliched, but MP in China is complicated in different ways to MP in the west...
Basically I'm not sure when I'll be able to get a 25-D test next. I got the last one at a children's hospital - the only place I could find where the test is offered in this city (of 6m people!). Because I'm an adult they wouldn't officially allow me register. So I couldn't do the test there until I found out that a friend of a friend's mother was a nurse there. She got a doc to complete the test chit without me having to register. But she's a student nurse & just finished her internship...
My understanding is that when the olmesartan kicks in, by stimulating the VDR it'll reduce conversion of 25D into 1-25D. So even with a constant intake of vitamin D, 25D levels might starting to rise. I didn't know if this risk was theoretical or real, so I didn't know how important it would be for me to get retested. From what you say, it sounds like as long as I maintain my current dietary restrictions it's not too critical (until the weather improves perhaps...)
Re ramping up, the phase I guidelines you've helpfully quoted are probably be the reason I had in the back of my mind for this being a bad idea! I read them so long ago I guess I forgot the details. Thanks for the reminder!
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eClaire
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Posted: Wed Feb 3rd, 2010 11:26 |
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I would have responded that too! I ought to have taken the time to be clearer as to why you ought not worry.
If you consciously restrict D in your diet and protect your skin from sunlight and eyes from bright light, you probably will not have any problems with the 25D, as most do not; instead, 25D often drops below what most labs measure over time. From what I've seen, 25D often does rise a wee bit initially or does not drop quite so quickly after beginning the olmesartan. But for most, this is only a temporary experience (though frustrating if you are waiting for your 25D to drop in the therapeutic range), and since you are down in the therapeutic range, it is likely you will not feel an affect from a slight rise.
While we do want to keep a check on 25D if possible, after someone's gotten her 25D down into therapeutic range, keeping it down is usually not a problem and so frequent checks are often not necessary.
I would continue to work on getting a connection at that hospital that would allow you to do an occasional check (at least every 6 months if possible) just so you know you are continuing to be on target, but try not to worry because, like you said, you are facing considerable challenges trying to do the MP in China.
Best, Claire
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38mo on MP; CFS FMS MCS COPD hypermob. IBS/GERD osteopor.; 125D48 25D<4;
NoIRs during most daylight outings & covered up; home w/o NoIRs
Ph1.Dec06 * ModPh2.Jun07 * AbxBrk.Mar-May08 * Ph2.Oct-Nov08 * Ph1.Jan2009
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pgeek
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Posted: Wed Feb 3rd, 2010 12:13 |
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I ought to have taken the time to be clearer as to why you ought not worry.
Not at all - for people in most circumstances what you said was perfectly reasonable...
I'll go back to the hospital after spring festival to see if they'll give me a test. That might give me time to find another connection if necessary... Thanks for the reassurance about this - one less thing to worry about!
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