Blood Samples

Lab work

All required test will be from your medical healthcare professional or after consultation with Myrna Haag. 

Laboratory testing are not included in nutrition counseling or program fees.

"Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a medical doctor physician or registered dietitian nutritionist (RDN)"

Main Tests

  • cholesterol

  • triglycerides

  • HDL

  • LDL



A complete cholesterol test — also called a lipid panel or lipid profile — is a blood test that can measure the amount of cholesterol and triglycerides in your blood.   A cholesterol test can help determine your risk of the buildup of plaques in your arteries that can lead to narrowed or blocked arteries throughout your body (atherosclerosis).

A complete cholesterol test includes the calculation of four types of fats (lipids) in your blood:

  • Total cholesterol. This is a sum of your blood's cholesterol content.

  • High-density lipoprotein (HDL) cholesterol. This is called the "good" cholesterol because it helps carry away LDL cholesterol, thus keeping arteries open and your blood flowing more freely.

  • Low-density lipoprotein (LDL) cholesterol. This is called the "bad" cholesterol. Too much of it in your blood causes the buildup of fatty deposits (plaques) in your arteries (atherosclerosis), which reduces blood flow. These plaques sometimes rupture and can lead to a heart attack or stroke.

  • Triglycerides. Triglycerides are a type of fat in the blood. When you eat, your body converts calories it doesn't need into triglycerides, which are stored in fat cells. High triglyceride levels are associated with several factors, including being overweight, eating too many sweets or drinking too much alcohol, smoking, being sedentary, or having diabetes with elevated blood sugar levels.


When to order test

  • over the age of 18 and consuming western diet


Additional facts about

  • No sign and symptoms indicate you are at risk for stroke, or cardiovascular disease

  • Western diet is large contributing factor for risk

  • The dependency on cholesterol lowering drugs indicates you are at risk for cardiovascular disease and that taking cholesterol lowering drugs only decreases risk more than not taking the drug.


Nutrition Therapy

Studies support the proper diet can reduce  plaque buildup, made from fatty deposits, that narrows arteries reducing blood flow and potentially causing a heart attack or stroke.   Diet has shown to be the largest contributing risk factor for cardiovascular disease.   

Lipid Panel     ~Requires fasting





A1c is a test that shows the average level of blood sugar over the past 2 to 3 months. The A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar. The higher your A1c level, the poorer your blood sugar control and the higher your risk of diabetes complications.


Fasting Glucose test indicates the amount of sugar in your blood that is controlled by a hormone called insulin. Abnormal fasting glucose levels  can indicate diabetes, because the body doesn’t make enough insulin or the insulin produced doesn’t work properly, which causes the elevated blood glucose. Increased levels of blood sugar can lead to severe organ damage if left untreated. low glucose levels can indicate hypoglycemia.  Type 2 diabetes can be prevented and in many cases reversed with a proper diet.

When to order test


  • Once every year if you have predicates

  • Twice a year if you have type 2 diabetes, you don't use insulin and your blood sugar level is consistently within your target range

  • Four times a year if you have type 1 diabetes

  • Four times a year if you have type 2 diabetes, you use insulin to manage your diabetes or you have trouble keeping your blood sugar level within your target range

Fasting Glucose

  • Overweight and obese adults consuming western diet (high fat and sugar dietary choices)

  • Family history of diabetes, and individuals with increased cardiovascular disease risk  

Additional facts about high blood sugar

  • Other factors in addition to poor diet can increase blood glucose levels

    • overactive thyroid

    • pre-diabetes diagnosis

    • pancreatitis – pancreas inflammation

    • high stress also stress  from illness, trauma, surgery

    • steroid medications

  • Elevated glucose levels are a precursor to type 2 diabetes and a major risk factor for: cardiovascular, kidney, eye and neuronal diseases.

  • Obesity and high fat diets contribute to insulin resistance a precursor for type 2 diabetes

    • sugar irregularities are a secondary problem from a high dietary and body fat condition that inhibits muscle sensitivity to insulin.

Medical Nutrition Therapy

         Type 2 diabetes – can be prevented and in most cases reversed through a proper diet.   

         Type 1 diabetes – is controlled with medication and proper diet.

Fasting Glucose & Hemoglobin     ~Requires fasting





Most doctors include this test as part of their regular health examination.  Abnormal values allow physicians to diagnosis illness and or monitor chronic conditions.   Register dietitians are an important part of you health care team and abnormal values may indicate dietary interventions may be needed to support treatment.


Comprehensive metabolic  panel measures the blood levels of albumin, blood urea nitrogen, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, total bilirubin and protein, and liver enzymes (alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase). 


When to order test

Physicians order as regular health examination to help identify any monitor specific conditions  with kidney, liver, blood pressure, and glucose irregularities.  Regular test are typical when taking medications that can impact the liver and kidney function.


Additional facts about

Abnormal laboratory  values may not present with any signs or symptoms. 


Medical Nutrition Therapy

Register dietitians are an important part of you health care team and abnormal values may indicate dietary interventions may be needed to support treatment.

Comprehensive Metabolic Panel










Thyroid Panel  - T3, T4, TSH        


       Physicians  use thyroid tests to check how well your thyroid is working and to find the cause of problems such as hyperthyroidism or hypothyroidism. Thyroid hormones control how the body uses energy, so they affect nearly every organ in your body, even your heart. (National Institute of Health.Govt)


       Doctors may order one or more blood tests to check thyroid function,

which may include  stimulating hormone (TSH), T4, T3, and thyroid antibody tests.


When to order test

  • Physician is interested after further analysis of signs, and symptoms

  • Family history of thyroid disease.

  • Chronic fatigue, weight gain, hair loss, intolerance to cold, goiter, constipation, irregular appetite,                             heart palpitations, poor concentration, depression.  


Additional facts about

  • Can be related to a mineral deficiencies (iodine, selenium, magnesium)

  • Thyroid diseases predominantly affect women; their incidence is 5-20 times higher in women than in men.

  • The prevalence of most thyroid diseases increases with age. Consequently, thyroid gland autoimmunity, hypothyroidism, nodular goiter, and cancer occur most often in postmenopausal and elderly women. 

  • Gastrointestinal issues are associated with thyroid disease.

  • High cholesterol is associated with thyroid disease  


Medical Nutrition Therapy

         Studies support deficiency in iodine, selenium and protein can be a cause for thyroid dysfunction.   Thyroid irregularities require nutrition intervention regarding associated gut issues, weight gain and weight loss, and proper balance of vitamin, minerals and macronutrients for prevention and treatment. 







Thyroid Antibody Tests   (Thyroid peroxidase and thyroglobulin antibodies)


      The presence of Thyroid antibodies are tested to diagnose an autoimmune thyroid disorder.  Thyroid antibodies are made when the immune system  by mistakes attacks the thyroid gland.   most common diagnosis are for Graves disease a hyperthyroidism and Hashimoto’s hypothyroidism


When to test

  • Goiter

  • Patient reports of signs and symptoms of unexplained fatigue, weight gain, hair loss, irritability, foggy brain, intolerance to cold.

  • Currently taking thyroid medication for hypo or hyper

  • Thyroid disease diagnosis

  • family history of thyroid disease and thyroid autoimmune- (graves, hashimotos)

  • Your doctor may also order a TPO antibody test if you are pregnant and have an autoimmune disease, especially one that involves the thyroid, such as Hashimoto's disease or Graves' disease


Additional facts about

  • Iron, calcium, antiacids, soy and certain vegetables can interfer with absorption of thyroid medications, need to be properly timed with meds.

  • Can have thyroid antibodies independent of hypothyroid or hyperthyroid conditions.


Medical nutrition therapy

     Medical nutrition interventions for the treatment of thyroid autoimmune requires different dietary protocols  than thyroid disease without autoimmune, therefore it is important to get tested if autoimmune is suspect or patient has thyroid disease.

    Some physicians may not see a need to test for thyroid antibodies because there is no pharmacueitcal treatment protocol, which is not the case with medical nutrition therapy, where dietary choices and supplementation can significantly improve symptoms and has shown to decrease the expression of antibodies. 

    Clinical evidence supports thyroid disorders can be from poor dietary choices, specifically the lack of thyroid dependent minerals, such as iodine, selenium and other vitamin and mineral cofactors required to produce thyroxine.   Inadequate nutrition can cause dysfunction in the thyroid and over time can trigger antibodies.  Once the antibodies are present iodine supplementation needs to be decreased and monitored. in other-words, in thyroid disorders recommended supplements can help but with the antibody it can be harmful.

    For some individuals they can present with antibodies and have no thyroid dysfunction.   The presence of antibodies and thyroid disease can present together or as two separate conditions.  In many cases if caught early enough thyroid dysfunction can be reversed with diet and supplements and the wait and treat with drugs is not needed.   Antibodies present a different condition where diet may not reverse but can significantly reduce symptoms.




Comprehensive Blood Count     


Most doctors include this test as part of their regular health examination. A complete blood count (CBC) is a blood test used  to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia.

A complete blood count test measures several components and features of your blood, including:

  • Red blood cells, which carry oxygen

  • White blood cells, which fight infection

  • Hemoglobin, the oxygen-carrying protein in red blood cells

  • Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood

  • Platelets, which help with blood clotting


Abnormal increases or decreases in cell counts as revealed in a complete blood count may indicate that you have an underlying medical condition that calls for further evaluation. (



When to order test

Physicians order as regular health examination to help identify any monitor specific conditions related to anemia, autoimmune, bone marrow problems, cancer, immune disorders that will require further investigation form your physician.


Additional facts about

Abnormal laboratory  values may not present with any signs or symptoms. 



Medical Nutrition Therapy

Hemoglobin and hematocrit  disorders have many causes and can be related to low levels of certain vitamins, iron and malnutrition.   Register dietitians are an important part of your health care team and abnormal values may indicate dietary interventions may be needed to support treatment.




Other Specialty Tests

Gene Tests

Lp (a) -"Lipoprotien a"


Lp(a) lipoprotein – is a gene variant of the APO A-1 (HDL)  a protein that carries the good cholesterol in the blood. The Lp(a) carries a small dense form of the HDL through the blood, but the reason why it is a risky gene variant is because unlike the HDL-good cholesterol the Lp(a) small dense particles make them more sticky in vessel walls increasing risk for heart disease.  The Lp(a) is more characteristic of an LDL -bad cholesterol.

The Lp(a) is called the widow maker because people do not know they are a carrier and it is responsible and can be the reason for unexplained early-age heart attacks.  It also puts carriers at an increased risk for thrombosis, (blood clotting), and associated with calcific aortic valve disease (CAVD) in which carries are at increased risk for pro-inflammatory and pro-calcific oxidized phospholipids.

Individuals can have lipid panel in range or slightly elevated and still be at risk.  

    Statins will not help Lp(a) because statins work on LDL cholesterol.

When to order test to determine Medical Nutrition Therapies:

·   family history of heart disease with mildly elevated lipids.

·   heart disease when there is only mildly elevated levels

·   inherited high cholesterol levels

·   linked to decreasing estrogen levels, women greater risk with menopause,

    which is an increased risk factor for cardiovascular disease for women

·   high HDL levels, mildly or high levels of LDL



Additional facts about Lp(a)

o   Can have normal LDL levels and still be at risk with this gene.

o   Elevated levels increase heart attack risk at young age. Can develop severe artery disease without other risk factors.

     Can have normal cholesterol and still have an attack.

o   Statins can lower LDL but will not matter for Lp(a). Statins have no effect on Lp(a).

o   exercise will decrease risk

Medical Nutrition Therapy –

        Lowering LDL cholesterol helps reduce risk.  Studies support that LDL cholesterol is increased with poor dietary choices.  Individuals with the Lp(a) carrier are at an increased risk than non-carriers from poor dietary choices.  Proper meal planning can improve LDL cholesterol which can reduce Lp(a) risk. Studies also support taking Niacin (B-3) can reduce risk by 40%.  





APOE is a lipoprotein that is responsible for packaging cholesterol and other fats and carrying them through the bloodstream and  the APOE is the principal fat carrier for the brain and is associated with Cardiovascular disease and Alzheimer’s disease.

APOE gene has three major alleles: APOE 2, APOE 3, APOE 4. Each parent provides one allele, which includes 6 different gene variations, (APOE 2-2, APOE 2-3, APOE 2-4, APOE 3-3, APOE 3-4, APOE 4-4)  Diet protocol is based on gene variation.

When to order test to determine Medical Nutrition Therapies:

For Nutrition therapy I advise everyone should know their risk of APOE 2,& 4. 

Studies support diet can have an impact on future gene expression.


·   Have trouble clearing fat and metabolizing carbohydrates – prone to diabetes

·   Tend to crave carbohydrates which can put them at risk for increase gut issues due to dysbiosis from poor bacteria


·   Higher than normal risk of premature vascular disease with diabetes , thyroid disease and steroid use.

·   with the APOA-5 si9W gene- this gene is a cofactor in E2-2 genes, which is a greater risk for  hypertriglyceridemia.

    Without APOA-5 gene normal lipidemic

·   increases risk for hyperlipoproteinemia type III, which is indicative of cholesterol and fatty acid accumulation

Medical Nutrition Therapy

·   Monitor sugar balance in meal planning and adjusts fats based on laboratory values and other risk factors

·   If diabetic with the APO2 meal planning ratio for the Myrna Method is 1:1 (carbohydrates to protein and fiber ratio)

·   suggested test Hp-2 if diabetic and APOE 2, 4 – Hp-2 increases cardiovascular risk if diabetic- also increases gut

    dysbiosis being a precursor of Zonulin gut bacteria – diet will require gluten elimination

APO E- 3                    

·   neutral gene type- lowest risk factor – Mediterranean diet – (20-25% protein, 30-35% fat, 40-50% carbs)


Increases risk for Alzheimer disease.  Research speculates this gene variation is associated with an increase in brain protein clumps called amyloid plague that causes death in brain neurons which contributes to the progression of the disease resulting in impaired cognitive function.  Having both alleles puts you at greater risk, APO 4-4

Not all people with the APOE4 allele develop Alzheimer’s disease, it is an associated risk,  Also not all people with Alzheimer’s have the APO4 gene. Studies support dietary consumption can be beneficial or harmful.

APO4 alleles  are at an increase risk for cardiovascular disease, due to increased chance of accumulation of fatty deposits.  It is also associated with age related macular degeneration and an increase of lewy bodies in the brain (dementia),

APOE 4 Allele facts

·   Carriers, 25% of population are at risk for CVD and Alzheimer’s.

·   APOE-4 carriers need to monitor cholesterol especially LDL – greater risk for increase LDL– for APOE 3-4 & 4- 4.

·   APOE-4 have higher rates of intestinal absorption of cholesterol.

·   There is protection from high intensity exercise

·   APOE-4 have reduced ability to detox heavy metals, (mercury, lead)- selenium will detox mercury.

·   APOE-4 can’t transport mercury out of the brain.

·   High doses of DHA supplementation increases total cholesterol in APOE-4 carriers – fish oil supplement not 


·   Increase in inflammation CRP with SFA (saturated fatty acids) with APOE gene.

·   APOE gene 3-4 & 4-4 have increase LDL small particles sizes with higher fat diets, especially saturated fat.

·   Alcohol consumption has a greater increase in triglycerides for APOE 3-4 & 4-4 carriers.Paleo high fat diet has a

    determent effect on APOE-4 carriers, LDL and cholesterol will increase on this diet- 25% of population. High fat diet not

    advised for APOE4 gene


Medical Nutrition Therapy

        Recommendation is Low fat diet, plant based with a daily monitor of sugar in meal plans. Monitor lipids, limit alcohol, administer detox food and supplements.  Increase low inflammatory foods and Myrna Method detox program and increase high intensity exercise.




APOE -"Lipoprotien"




Heptoglobin Gene (HP) 


Heptoglobin 2 is a precursor molecule for Zonulin, bacteria that is formed in the gut from the consumption of dietary gluten (a wheat protein from grass grains).  Often gluten sensitivity from zonulin does not display as gut related sign and therefore symptoms such as, mental fog, depression, fatigue, joint pain, and headaches go undetected as a food related cause and are treated with pharmaceutical agents instead

zonulin is the only regulator of intestinal permeability known to be reversible, which makes it valuable in monitoring dietary  therapeutic interventions. Several autoimmune, inflammatory and neoplastic diseases have been associated with elevated levels of zonulin or evidence of increased intestinal permeability, which can be identified by the Serum Zonulin test. (Evexia Diagnostic Labs

When to order test to determine Medical Nutrition Therapies: 

  • ·       Type 1 diabetic

  • ·       cardiovascular disease with elevated glucose levels

  • ·       IBS and elevated glucose levels

  • ·       obese adults with glucose intolerances

  • ·       obese adults with metabolic syndrome

  • ·       multiple sclerosis

  • ·       rheumatoid arthritis

  • ·       inflammatory bowel disease

  • ·       celiac disease

  • ·       juvenile non-alcoholic fatty liver disease

  • ·       extensive corticosteriod use


Detailed Information from Evexia diagnostic labs

      Circulating zonulin is a clinically useful marker of intestinal permeability. Zonulin is a protein, synthesized in intestinal and liver cells, that reversibly regulates intestinal permeability. High levels of zonulin have been associated with increased intestinal permeability, as zonulin induces the breakdown of the tight junctions between intestinal epithelial cells. Several autoimmune, inflammatory, and neoplastic diseases have been associated with elevated levels of zonulin or evidence of increased intestinal permeability.

     These include celiac disease, type 1 diabetes, and juvenile nonalcoholic fatty liver disease. In addition, evidence is accumulating to support an association with multiple sclerosis, rheumatoid arthritis, asthma, and inflammatory bowel disease. Zonulin levels may be higher in obese adults and in adults with glucose intolerance. Elevated serum levels of zonulin and increased permeability are commonly observed in patients at risk of developing Crohn’s disease or type 1 diabetes prior to the onset of symptoms.

Zonulin levels may increase with corticosteroid use. Cellular receptors for zonulin are present in the small and upper large intestines, the heart, and the brain. Zonulin release from the epithelium may be triggered by gliadin fragments or by the adherence of bacteria to the epithelial cell surface. Simple sugars, sodium, emulsifiers, the food additive microbial transglutaminase, and nanoparticles are known to disrupt intestinal barrier function. Restoration of the gastrointestinal mucosal barrier may include dietary changes, treatment of dysbiosis, digestive supports, and anti-inflammatory therapies.

      These may include supplements such as quercetin, vitamin C, curcumin, gamma-linoleic acid, omega-3 fatty acids (EPA, DHA), and aloe vera. Other nutrients such as zinc, beta-carotene, pantothenic acid, and L-glutamine may provide some support for rejuvenation of the GI mucosa. Consider a Comprehensive Stool Analysis to further investigate potential causes of increased intestinal permeability. Zonulin expression in the small intestine occurs when a chemokine receptor is stimulated by gliadin or chemokines and induces proinflammatory signaling pathways in gastrointestinal epithelial cells.

      The released zonulin activates the cell-signaling pathway via protease-activated receptor 2 and epidermal growth factor, which causes disassembly of the tight junctions between the GI epithelial cells. The loss of the tight junctions increases intestinal permeability and allows polypeptides and other macromolecules to pass between epithelial cells into the lamina propria layer of the gut wall. The macromolecules and polypeptides induce an antigen response and promote proinflammatory cytokine production in the enteric immune system.

     Zonulin is a prehaptoglobulin—levels are modulated by the presence or absence of haptoglobin (HP) gene. When zonulin is cleaved by intestinal tryptase IV, it is converted into haptogloblulin, a protein with heme (iron)-binding and antimicrobial properties. HP-1-1 genotypes have zero (null) copies of the HP gene. HP-2-2 genotypes have two copies of the gene, and HP-1-2 genotypes have one copy of the gene. HP 1-1 (null) genotypes may have zonulin levels in the normal range, even if the presence of inflammatory or autoimmune disease is confirmed by other biomarkers. Zonulin levels may increase in nephrotic syndrome (Hp2-1 or 2-2 phenotypes).

Medical Nutrition Therapy

      Dietary recommendations involve removing gluten, specific supplementation, and a more restrictive approach in balancing sugar.  Other suggested lab test – omega-3, and F-2 Isoprostane when cardiovascular disease risk factors are present. The presence of inflammatory markers and HP gene requires additional lifestyle and dietary protocol than just removal of gluten.

Inflammatory Markers

TMAO Trimethylamine N-Oxide Bacteria


    TMAO is a new blood test that measures levels of (trimethylamine-N-oxide) — a metabolite derived from gut bacteria which can be a powerfully predictor of future risk for heart attack, stroke, and death in patients who appear otherwise healthy, according to pioneering Cleveland Clinic research.

    The new test — TMAO — measures blood levels of TMAO, a compound produced by the liver after intestinal bacteria digest certain nutrients: L-carnitine (found in red meat) and lecithin (found in egg yolks, meats and full-fat dairy products). Lecithin is also pumped into the intestines as a component of bile, so all individuals, regardless of diet, feed their gut microbes lecithin and have potential for elevated levels of TMAO.

“The higher someone’s level of TMAO is, the more susceptible that person is to accumulation of cholesterol in the artery wall. This increases the risk of a heart attack or stroke,” reports Stanley Hazen, MD, PhD., Vice Chair of Translational Research at the Lerner Research Institute.

    In 2011, a research team led by Dr. Hazen discovered that elevated blood levels of TMAO are linked to increased risk of heart attack, stroke, and death. Their studies showed that TMAO directly contributes to the narrowing of artery walls through plaque build-up — findings hailed by the American Heart Association and American Stroke Association in 2013 as one of the top 10 advances in heart disease and stroke science.

Two of these studies, published in New England Journal of Medicine in 2013, and Nature Medicine in 2013, found that TMAO successfully predicted future cardiac event risk, even in patients not identified through traditional risk factors or other blood tests.

    The team found that study participants with the highest levels of TMAO had 2.5 times increased risk for a major cardiovascular event (heart attack, stroke, or death) than those with the lowest levels during three years of follow-up. TMAO still predicted risk even after adjustments were made for risk factors such as diabetes, high blood pressure, and diabetes.

     To study the role of gut bacteria in forming TMAO, people were asked to eat two hard-boiled eggs (egg yolk is high in lecithin) and a capsule of synthetic heavy isotope-labeled lecithin. Shortly afterwards, their blood levels of TMAO, and to a greater extent isotope-labeled TMAO, increased. However, when the same volunteers were given a brief course of poorly absorbed oral antibiotics to suppress their gut bacteria, no TMAO was observed, indicating gut microbes play a critical role in TMAO production. In another study, the team linked a structurally similar nutrient, L-carnitine (which is abundant in red meat), to TMAO production, and heart attack and stroke risk.

“These are very exciting discoveries that help solve the mystery of why eating red meat and full-fat dairy products contribute to inflammation and development of arterial disease  in certain patients,” says Amy Doneen, DNP. ARNP, Medical Director of the Heart Attack & Stroke Prevention Center in Spokane, Washington.

When to order test to determine Medical Nutrition Therapies:

  • cardiovascular disease diagnosis with typical western diet history

  • high protein low carb diet history, (Adkins, paleo, keto) with metabolic syndrome and, or obesity

  • High protein low carb diet history with elevated lipid panel

Additional facts about TMAO

  • High levels of TMAO in the blood are associated with cardiovascular risk even with normal laboratory values

  • TMAO alters cholesterol metabolism making it more harmful to artery walls decreasing cholesterols removal.

  • Bacteria in the human gut converts carnitine & lecithin found in red meat & eggs into TMAO and certain people are more prone.

  •  Lecithin, choline and carnitine are sold as supplements and in processed foods as a dietary benefit for memory, fat burning , and lecithin as a food stabilizer.  The health benefits form these compounds may not out way the cardiovascular risk for certain people.

  •  associated with Low Vitamin B6, Vitamin B12, folate, and homocysteine.


Medical Nutrition Therapy

Remove meat, eggs, high fat dairy, methylated supplements, probiotic, and follow the Myrna Method detox protocol with portion control and sugar balance.  Retest in 3 months, if not lower, follow a Myrna Method dietary plant base plan.





Consuming an adequate daily amount and correct ratio of certain fats is critical for optimum health.  If the ratio of omega 3 fats (walnuts, fish, flax seeds) is not in an appropriated ratio to omega 6 fats (butter, oil, cheese, chips, meat) it can cause low-grade systemic inflammation.   The problem with low-grade inflammation is that it can be non-symptomatic (we are unaware it is present). 

Inflammation is the culprit of many diseases, such as heart disease, cancer and autoimmune conditions.  As for example, cardiovascular disease, certain individuals are more susceptible to the increased oxidative stress that results from consuming a higher ratio of certain dietary fats.  This can result in formation of oxidized LDL particles which are risk factors for atherosclerosis (plaque in arteries), and vasoconstriction (high blood pressure).

if elevated levels consider F-2 Isoprostances test to estimate blood vessel vascular inflammation

Fat facts

  • The amount of fat required for healthy individuals is less than 35%.  The typical dietary fat percentage in an American diet is 50%.

  • Excess dietary fat contributes to an inflammatory gut bacteria called LPS- lipopolysaccharides, Studies support LPS gut bacteria can travel from the gut to other areas associated with illness and inflammation

  • LPS bacteria are associated with depression and anxiety


When to order test to determine Medical Nutrition Therapies:

  • obesity

  • metabolic syndrome

  • diabetes

  • fatty liver disease

  • dietary history of high protein/low carb diet (paleo, Adkins, Keto)

  • cardiovascular disease

  • elevated lipid panel

  • other abnormal inflammatory biomarkers

  • autoimmune, rheumatoid arthritis, inflammatory bowel disease, cancer, Alzheimer’s


Medical nutrition therapy

           Reduce omega 6 fats, supplementation or dietary omega3 fats.

Monitor daily dietary fat amounts and ensure adequate percentage of omega 3 to omega6

Retest in 3 months after adhering to dietary fat protocol




Omega 3:6 ratio


F2 isoprostanes are  unique hormone like compounds that are formed with the oxidation of free radical compounds, specifically, but not limited to, the oxidation of arachidonic acids (omega 6 fats).  The test measures the free radical damage and indicates if patient is following healthy lifestyle habits. the F2 test measure the rate of aging and risk for cardiovascular disease and cancer due to poor life style choices. 

F2-isoprostanes as markers of oxidative stress in vivo: an overview. Authors: Milne GL1, Musiek ES, Morrow JD.

Numerous studies carried out over the past decade have shown that these compounds are extremely accurate measures of lipid peroxidation and have illuminated the role of oxidant injury in a number of human diseases including atherosclerosis, Alzheimer's disease and pulmonary disorders.


F2- facts

  • High risk for lung disease.

  • Increased risk of high blood pressure and blood clots.

  • High risk factor for cancer and other age-related diseases.

  • Indicates high inflammatory condition.

  • Correlation of elevated F-2 Isoprostanes and oxidized LDL fats in type2 diabetics

  • Any type of stress produces free radicals like extreme exercise. Studies support that participation in ultra-marathons has caused long-term heart damage.

  • Caused from free radicals compounds that are increased with processed food fat choices.

  • High sugar fatty processed foods, cooking with fats, transfats, omega 3:6 imbalance 


Medical nutrition therapy

    Monitor daily fat amounts and omega 3:6 ratio.  High vitamin and mineral supplementation with NO2 rich foods.  inadequate vitamin and minerals can cause elevated levels of F2.

Portion and sugar controlled diet – monitor body fat- increase in body fat increases F2 risk.

Retest in 3 months after adhering to healthy lifestyle program.

F2 -Isoprostanes












homocysteine is a protein that is produced in the blood when the body has inadequate levels of B12, B6 and folate.  High levels of homocysteine can contribute to arterial damage, and blood clots and have been linked to cancer, autoimmune, diabetes, stroke, atherosclerosis, and neural tube defects



  • High levels of homocysteine in blood is a risk factor for heart disease and stroke.

  • Comes from eating red meat and having low levels of certain B vitamins, or un-methylated B6, B12, and folate for MTHFR genotypes.

  • Homocysteine decreases function of the liver’s detoxification system (glutathione) leading to toxic build-up and susceptibility to chemicals.  18

  • Results in poor conversion of an amino acid methionine, increasing risk for degenerative diseases, depression,       and anxiety

  • Copper, B6, B12, and folate work together as co-factors – needs all three to be effective.


when to order test to determine medical nutrition therapies

  • poor food choices, processed foods

  • elevated lipid panel with metabolic syndrome

  • poor omega 3 ratio

  • high protein diet low vegetables and beans

  • has the MTHFR gene

Medical nutrition therapy

methylated folate, B6, B12, magnesium, 3-4 cups greens, I cup beans, balance meals and sugar control.

Lp - PLAC2


Lp-PLAC 2 is an enzyme  that plays a role in the inflammation of blood vessels and promotes plaque.  the Lp-PlAC-2 blood vessel enzyme is attached to low-density Lipoproteins (LDL) and is therefore associated with elevated LDL levels.   High levels indicate increased inflammation in vessels. An Independent marker for CVD. This inflammatory marker is specific to cardiovascular disease.


 Lp-PLA2 appears to be associated with inflammation/immune activation, but also with anti-thrombotic effects. Lp-PLA2 may represent a valuable early biomarker of CVD risk in the immune compromised before subclinical atherosclerosis can be detected, as studies show with HIV infected individuals


Lp-PLA2 facts

  • Indicates high risk there is plague formation that is dangerously inflamed.

  • Elevated levels important bio-markers in detecting vulnerability of heart attack from plaque formation.

  • High levels after treatment for CVD indicates if treatment medications are effective in preventing a heart attack or stroke.

  • All other inflammatory biomarkers can be normal range and LP-PLA2 high – independent marker for inflamed vessel disease.

  • Periodontal disease can elevate.

  • Elevated levels in high concentrations can indicate plagues that are ready to rupture leading to heart attack and stroke.

  • Correlation of low testosterone with abnormal LP-PLA2.

  • LP-PLA2 is directly correlated with atherosclerosis and can lead to abnormal lipid levels.1,2,3,4,5,6


when to order test to determine medical nutrition therapies:

  • immune compromised with abnormal LDL and cholesterol levels

  • periodontal disease and abnormal LDL and cholesterol levels

  • low testosterone levels and abnormal LDL and cholesterol


Medical nutrition therapy

Low fat  plant based diet, (no animal foods),  antioxidant supplementation, high soluble fibers, plant sterols, omega 3, and turmeric for inflammation.  follow gut health protocol – probiotics, and consumption of prebiotic rich foods. Retest in 3 months








Myeloperoxidase Antibody


myeloperoxidase (MPO), is a protein secreted by white blood cells that is intended to kill harmful bacteria, but the presence of the MPO antibody may instead inflame the body's arteries and cripple protective substances in the blood, according to a study published in the July 10, 2007, issue of the Journal of the American College of Cardiology (JACC). As a result, long before conventional risk factors set off alarms, elevated MPO levels signal that harmful plaque has been building up.


American College of Cardiology. "Blood Protein Offers Clues To Heart Attack In Seemingly Healthy People."

    Not only does MPO change low-density-lipoprotein (LDL) cholesterol into a harmful oxidized form that can cause atherosclerosis, the "bleach" produced by MPO damages the arteries directly, causing cell death and erosion of the arterial lining, a process that can create unstable plaques. MPO also hampers the protective effects of high-density-lipoprotein (HDL) cholesterol and reduces the availability of nitric oxide, a natural chemical that relaxes the blood vessels.

    Elevated MPO levels signaled increased risk even in those with acceptable levels of LDL cholesterol, HDL cholesterol or C-reactive protein, a widely acknowledged marker of inflammation.

     Christopher Cannon, M.D., F.A.C.C., who  is an associate professor of medicine at Harvard Medical School, Boston, MA. "One fascinating aspect of this study is that this marker of inflammation precedes by nearly a decade the development of clinical coronary disease," he said. "This suggests MPO could be used to catch the disease in a very early stage and help in true prevention of CAD.

"Another interesting aspect of MPO is that it may be a marker for unstable plaque. Even more than the number or severity of coronary plaques, we want to know the risk of plaque rupture, and this evolving new marker may help in that regard. More study is needed, but among the hundreds of markers tested to date, MPO looks like a "keeper" that will one day become part of clinical care," Dr. Cannon said.

MPO facts​

  • Obesity is correlated with increased MPO enzyme activity.

  •  Elevated Myeloperoxidase is associated with up to a 91% increase in heart disease and used as a predictor of the disease.

  • Elevated levels of MPO independently predict future heart attacks.

  • 2.5 tX likely to die from stroke with MPO enzyme.

  • 2 tx likely to experience death from cardiovascular disease with MPO enzyme.

  • An increased risk of MPO damage to vessel walls with elevated hsCRP8 biomarker.4,5,9

  • Test measures the amount of myeloperoxidase enzyme in the blood which the body releases with infection. Normally localized at the site of an infection, but 2 out of 50 people have a gene variant where it becomes elevated throughout body.

  • Worse and most dangerous inflammatory marker for people with this gene.

  • Produces highly oxidized compounds that make all cholesterol bio-markers more inflammatory.

  • Causes HDL to turn into an inflammatory cholesterol.

  • Interacts with hydrogen peroxide in blood to produce hypochlorous acid which makes it easier for tears in vessel walls and plaque formation.

  • Decreases body’s ability to make nitric oxide – which helps protect the vessel lining.

  • High risk- 2.5 tx more likely to die from stroke

  • Can be elevated with normal cholesterol levels.

  • Independent marker for CVD and worse if MPO -463 GA/AA is present

  • Anti-MPO antibodies may also be found from patients with other diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and autoimmune thyroid disease


when to order test to determine medical nutrition therapy

  • family history of early heart disease, stroke.

  • obese and elevated LDL with family history of stroke 

  • cardio vascular event - Body releases this inflammatory enzyme when artery walls have been damaged

  • chronic infections, autoimmune conditions (SLE, RA and thyroid)

Medical nutrition therapy 

Supplements -antioxidants, arginine NO2, plant based (no animal) low fat <15%.  weight loss – maintain ideal body weight, calorie restriction through myrna method portion control and sugar balance for meal planning.  retest for LDL levels




Thyroid Peroxidase and Thyroglobulin Antibodies


Thyroid peroxidase (TPO), is an enzyme  normally found in the thyroid gland, plays an important role in the production of thyroid hormones. A TPO test detects antibodies against TPO in the blood.

The presence of TPO antibodies in your blood suggests that the cause of thyroid disease is an autoimmune disorder, such as Hashimoto's disease or Graves' disease. In autoimmune disorders, your immune system makes antibodies that mistakenly attack normal tissue. Antibodies that attack the thyroid gland cause inflammation and impaired function of the thyroid.

Your doctor may also order a TPO antibody test if you are pregnant and have an autoimmune disease, especially one that involves the thyroid, such as Hashimoto's disease or Graves' disease.

Medical Nutrition Therapy


Most physicians do not see a need to test for thyroid antibodies because there is no pharmacueitcal treatment protocol, which is not the case with medical nutrition therapy, where dietary choices and supplementation can significantly improve symptoms and has shown to decrease the expression of antibodies. 


The typical medical protocol is to wait until the thyroid becomes dysfunctional and then treat with drugs.   Although the pharmcuetical treatment for thyroid dysfunction with or without antibodies is the same, the diagnosis is different.   When antibodies are present this indicates an autoimmune condition which requires a different dietary and supplement protocol than when not present.


Clinical evidence supports thyroid disorders can be from poor dietary choices, specifically the lack of thyroid dependent minerals, such as iodine, selenium and other vitamin and mineral cofactors required to produce thyroxine.   Inadequate nutrition can cause dysfunction in the thyroid and over time can trigger antibodies. Once the antibodies are present iodine supplementation needs to be decreased and monitored. in other-words, in thyroid disorders recommended supplements can help but with the antibody it can be harmful.


For some individuals they can present with antibodies and have no thyroid dysfunction.   The presence of antibodies and thyroid disease can present together or as two separate conditions.  In many cases if caught early enough thyroid dysfunction can be reversed with diet and supplements and the wait and treat with drugs is not needed.   Antibodies present a different condition where diet may not reverse but can significantly reduce symptoms.


Medical nutrition therapies for thyroid dysfunction alone versus with antibodies involves different dietary and supplementation protocols.

when to order test to determine medical nutrition therapy

·   standard blood test that  reflects abnormal or subclinical thyroid function

·   currently taking thyroid medication for hypo or hyper thyroid

·   family history of hashimoto and graves autoimmune diseases

·   unexplained fatigue and weight gain 


    • coaching process 

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