Your Biomarker Questions

Answers to commonly asked questions about biomarkers from the AMA feature in the software.

• What do the terms MID and GRAN refer to on a laboratory report?
• Elevated Folate RBC - Is this something that needs more workup? Could it be from B Complex supplementation?
• Is the vitamin (25 OH) for D3, D2 or Total value?
• Regarding the different methods of measuring 25-OH (hydroxy) vitamin D (LCMS versus immunoassay), is there a benefit to ordering the LCMS?
• Besides a tumor, what would cause hyperaldosteronism while DHEA, ACTH and cortisol are normal?
• What is the significance of elevated bilirubin on a dipstick?
• What are the best ways to measure dehydration with blood biomarkers?
• What is Leukocyte (WBC) esterase?
• Why would a patient have high eos% and low absolute?
• Why have optimal ranges for platelets decreased recently?
• When working with athletes and bodybuilders, what would you consider to be the main markers to analyze when wanting to optimize metabolic conditions for hypertrophy? Other than testosterone.
• What are the differences between CRP and hs-CRP?
• Why is the hsCRP optimal for men different from that of women (0.55 vs 1.0 mg/L)?
• Converting between different WBC and RBC units
• What is Estimated Plasma Glucose?
• What is LDL Pattern? The client has Pattern B
• Almost every patient I see has an elevated anion gap and a "need for thiamin." Can you explain why this is so common?
• Can you please explain the discrepancies often seen in reference ranges from different labs using the same measurement, e.g. lipase?
• What is B Type Natriuretic Peptide(NT-pro-BNP)? What is the optimal range?
• What is the relationship between 16-OH E1 and low vitamin D levels?
• What does it mean to have an NRBC with a normal/optimal CBC? NRBC was checked and was 1 considered High.
• Can bacteria in the gut hydrogenate fatty acids in the intestines despite the diet being free of trans fats? Can you explain this process and how we can change that physiology?
• What would be possible reasons why an adult male would have severely low DHT levels (less than 3ng/dl) and testosterone is normal (700-800+ng/dl)?
• Should Sex Hormone Binding Globulin (SHBG) be ordered for females or just males?
• Have you considered adding the Vitamin D metabolite calculator comparing 1,25 and 25OH to look at immune function and the relationship to inflammation and low vitamin D?
• What is meant by 2nd generation Testosterone?
• Patient with elevated homocysteine that is not responding to MTHF/B12. Is there any research on how renal insufficiency affects homocysteine levels?
• Which are the best antibodies to test for Graves?
• Is there any clinical information on muscle atrophy/breakdown in relation to thyroid conversion issues?
• Can G6PD deficiency create chronic lab abnormalities? I'm suspicious that chronic G6PD deficiency (no acute insult) created mild elevations of GGT, Iron, Ferritin, Lipids, etc.
• Can a person have Graves Disease without the TPO or thyroglobulin Antibodies being elevated or could we have another process going on here?
• What is the current thinking on APO B, should it be included in a standard cardio metabolic screen?
• Is Free PSA and/or % free PSA included in the software?
• What does a healthy keto diet (and nutritional ketosis) tend to do to a patient’s NMR?
• Is there evidence indicating that the AST / ALT ratio is applicable even when the values are well within the functional range? If so, can you provide any details?
• Which Sex Hormones are essential for assessing thyroid and general female hormone imbalance (for a post-menopause female lab panel).
• What are some of the reasons for a low TIBC and a Low UIBC?
• Converting Lipoprotein (a) units
• What the heck is "Urate"?
• Could you help explain the relationship between globulin levels and GI function? Could you please guide me to some information regarding this biomarker and hypochlorhydria?
• Is there a connection between serum phosphorous and bone pain? I had a patient with low phosphorous and bone pain. I'm wondering if there is a connection.
• A client had Fasting insulin of less than 0.4 µIU/ml - can this be caused by fasting for 24 hrs instead of the usual 12 hrs before lab draw? Or should we consider compromised pancreatic function.
• Is there any correlation between low serum iron and intestinal parasites?
• Is there a conversion for a urine MMA to blood MMA, given we are testing the same thing?
• We have seen a scenario of high Ferritin levels with low serum Iron saturation and low transferrin saturation in a few of our male patients. What is going on here most likely?
• What biomarker changes are we seeing, if any, for those who have received the Covid Vaccine? How might we support the body post vaccination?
• What are the optimal values and purpose of testing normal CRP in comparison to Hs-CRP?
• What biomarkers have you seen that can typically be out of optimal range in high performance athletes? I'm a high performance athlete, have elevated AST &ALT, decreased creatinine, on plant-based diet
• What would be your recommended biomarkers to identify the root causes of a drop in energy and sport performance in endurance runners?
• Which biomarkers would you look at to identify the root causes of muscle spasms and/or muscle twitching in different parts of the body?
• When patients have a high B12 level (over 2000), it is mentioned that this could be due to impaired tissue utilization of the B12. How Do we go about correcting this pattern?
• What is the difference between RDW-SD and RDW-CV?
• Can you explain how Alk Phos can be low and RBC Zinc levels be normal?
• Why is calculated anion gap result in the software often different than the result on the original lab test? ...the lab comes up with a different value than the software
• Do you have any suggestions on how to increase HDL levels, while other lipids profiles are in optimal range? HDL is always around 39-40
• Hepatitis B Virus Biomarkers: In your view, what should be the complete list of biomarkers to monitor for those already diagnosed to have the Hepatitis B virus & how often should they be monitored?
• Fatty Liver Biomarkers: In your view, what should be the complete list of biomarkers to monitor for those who already have fatty liver and how often should they get tested on these biomarkers?
• I have a client with high ferritin, and low hemoglobin, and a history of low iron levels. What, other than iron deficiency, could cause high ferritin levels?
• Is a high level of Apolipoprotein A-1 necessarily bad?
• AST and ALT are optimal. Why is their ratio high?
• What would cause an increase in MCV from 92 to 97.2 if the patient is on a B complex?
• Question about the Alk Phos reference range
• The reticulocyte value is reported in x10 9/L but the ODX software lists reticulocytes as %. How am I to document this?
• AMA Episode 1
• AMA Episode 2
• AMA Episode 3
• How do I calculate the anion gap correctly?  I wondered when I got a result of "4" twice.  I did the calculation for my last patient, and her anion gap is 8.1.
• AMA Episode 4
• In Australia, we always see ‘urea’ referred to in results how do I enter that into the software?
• Is a low LDH (115 IU/L) related to glucose metabolism even if fasting glucose and HbA1c are in optimal ranges?
• Can you provide some clarity on the ODX LH & FSH ranges?
• Is serum zinc a better way to assess for suboptimal zinc levels compared to RBC zinc?
• What causes elevated folate?
• Could Ferritin be elevated in a fasting test due to a fast of longer than 13 hours?
• What is driving elevated levels of serum B12 when other markers indicate a B12 need or B12 deficiency?
• In the Blood Test History it shows; HOMA2-%B, HOMA2-%S and HOMA2-IR. What are these?
• When I run the reports I don’t see the HOMA2 calculation on the report. Are there specific markers (such as Fasting Glucose, Fasting Insulin, and/or C-peptide) that need to be on the report?
• On Liver, bile markers. If all markers are within range, but AST/ALT are elevated (and lipids), what should I look for?
• How can I convert Prolactin from miu/L into nmol/L?
• Why does LOW molybdenum lead to a LOW uric acid level?
• Could you explain the difference between Lp-PLA2 and Lp-PLA2 Activity?
• Can you provide some info on the Testosterone to Cortisol ratio?
• If someone gets a DHEA test, vs DHEA-S can we still add it to your report?
• Is TIBC the same as Transferrin?
• Why is High BUN associated with Hypochlorhydria, which would lead to low protein? Is this related to dysbiosis?
• Elevated Glucose-6-phosphate dehydrogenase (G6PD)
• Alk Phos Pediatric Values
• Serum Magnesium vs RBC Magnesium
• Why are the female hormone optimal ranges so variable and not related to the female menstrual cycle?
• Lab Biomarker Discrepancies
• Why are the DHEA-S optimal ranges so high?
• I am inquiring about the cortisol result. It gives a total rather than an am and pm reading. My question is how do I record that?
• What is the difference between TIBC and UIBC?
• Question: "What result on the Free T3: Reverse T3 ratio is suggestive of conversion issues? Your range seems to be 100X larger than the one I was taught!"
• Why is the ODX range for IGF-1 so much less than what I'm seeing in my lab panel?
• Discrepancies in Thyroid Antibody Ranges
• What biomarkers are associated with an increased risk of biliary insufficiency?
• What are your thoughts on assessing testosterone in a Postmenopausal patient not on Testosterone replacement, is the LS/MS [LC-MS/MS] methodology recommended?
• Elevated TSH and FT3:FT4 ratio
• How do I know if a person on hormone replacement is becoming estrogen or testosterone resistant? And would the level of SHBG reflect this?
• Why is Calcitriol (1,25 Vitamin D) Not a Biomarker in ODX?
• What would be potential causes for a female to have low total testosterone and high free testosterone?
• Can a low fibrinogen be associated with recurring miscarriages?
• What if lipoprotein (a) is increased, but the cholesterol is within normal limits?
• Are the optimal ranges relevant in pregnancy and do these ranges change with each trimester?