Test Results 8605 SW Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636 info@zrtlab.com www.zrtlab.com D2015 03 02 002 SB Samples Arrived: 03/02/2015 Samples Collected: Saliva: 02/15/15 06:45 Date Closed: 03/06/2015 Saliva: 02/15/15 12:03 Saliva: 02/15/15 18:23 Saliva: 02/15/15 22:37 Blood Spot: 02/15/15 07:00 Getuwell 8605 Southwest Creekside Place Beaverton, OR 97008 321 Fake St Aloha, OR 97007 BMI: 31.6 Height: 5 ft 5 in Menses Status: Postmenopausal Last Menses: Unspecified Weight: 190 lb Gender: Female DOB: 7/11/1953 (61 yrs) Patient Ph#: 555 555 5555 Waist: Unspecified Test Name Result Units Range Estradiol (Saliva) 1.8 H pg/ml 0.5-1.7 Postmenopausal (optimal 1.3-1.7) Progesterone (Saliva) 25 pg/ml 12-100 Postmenopausal Ratio: Pg/E2 (Saliva) 14 L Optimal: 100-500 when E2 1.3-3.3 pg/ml Testosterone (Saliva) 24 pg/ml 16-55 (Age Dependent) DHEAS (Saliva) 4.6 ng/ml 2-23 (Age Dependent) Cortisol (Saliva) 6.6 ng/ml 3.7-9.5 (morning) Cortisol (Saliva) 1.5 ng/ml 1.2-3.0 (noon) Cortisol (Saliva) 2 H ng/ml 0.6-1.9 (evening) Cortisol (Saliva) 1.5 H ng/ml 0.4-1.0 (night) Free T4 (Blood Spot) 1 ng/dl 0.7-2.5 Free T3 (Blood Spot) 2.4 L pg/ml 2.5-6.5 TSH (Blood Spot) 5.5 H µu/ml 0.5-3.0 TPO (Blood Spot)* 200 H IU/mL 0-150 (70-150 borderline) Insulin (Blood Spot) 16 H miu/ml 1-15 (optimal 2-6) Hemoglobin A1c (Blood Spot) 6.1 H % < 6% Vitamin D, 25-OH, D2 (Blood Spot) <4 ng/ml <4 if not supplementing (< 10 nmol/l) Vitamin D, 25-OH, D3 (Blood Spot) 15 L ng/ml 32-100 ng/ml (80-250 nmol/l) Vitamin D, 25-OH, Total (Blood Spot) 18 L ng/ml 32-100 *For research purposes only. Therapies None Page 1 of 5
ZRT Laboratory Reference Ranges Disclaimer: Supplement type and dosage are for informational purposes only and are not recommendations for For a complete listing of reference ranges, go to www.zrtlab.com/reference-ranges. Test Name Estradiol (Saliva) - pg/ml Progesterone (Saliva) - pg/ml Ratio: Pg/E2 (Saliva) Testosterone (Saliva) - pg/ml DHEAS (Saliva) - ng/ml Cortisol (Saliva) - ng/ml Free T4 (Blood Spot) - ng/dl 0.7-2.5 Free T3 (Blood Spot) - pg/ml 2.5-6.5 TSH (Blood Spot) - µu/ml 0.5-3.0 TPO (Blood Spot) - IU/mL Women 0.5-1.7 Postmenopausal (optimal 1.3-1.7); 1.3-3.3 Premenopausal (Luteal); 0.8-12 Estrogen Replacement (optimal 1.3-3.3); 0.5-2.2 (Synthetic HRT, Contraceptive); 0.5-1.7 Premenopausal (follicular) 12-100 Postmenopausal; 12-100 Premenopausal (Follicular); 75-270 Premenopausal (Luteal); 30-300 Oral Progesterone (100-300 mg); 200-3000 Topical, Troche, Vaginal Pg (10-30 mg); 10-53 Synthetic Progestins (HRT, Contraceptive) Optimal: 100-500 when E2 1.3-3.3 pg/ml 16-55 (Age Dependent) 2-23 (Age Dependent) 3.7-9.5 (morning); 1.2-3.0 (noon); 0.6-1.9 (evening); 0.4-1.0 (night) 0-150 (70-150 borderline) Insulin (Blood Spot) - miu/ml 1-15 (optimal 2-6) Hemoglobin A1c (Blood Spot) - % < 6% Vitamin D, 25-OH, D2 (Blood Spot) - ng/ml Vitamin D, 25-OH, D3 (Blood Spot) - ng/ml Vitamin D, 25-OH, Total (Blood Spot) - ng/ml 32-100 <4 if not supplementing (< 10 nmol/l) 32-100 ng/ml (80-250 nmol/l) Page 2 of 5
**Category Symptom None Mild Moderate Severe Hot Flashes Night Sweats Vaginal Dryness Incontinence Foggy Thinking Memory Lapse Tearful Depressed Heart Palpitations Bone Loss Sleep Disturbed Headaches Aches and Pains Fibromyalgia Morning Fatigue Evening Fatigue Allergies Sensitivity To Chemicals Stress Cold Body Temperature Sugar Craving Elevated Triglycerides Weight Gain - Waist Decreased Libido Loss Scalp Hair Increased Facial or Body Hair Acne Mood Swings Tender Breasts Bleeding Changes Nervous Irritable Anxious Water Retention Fibrocystic Breasts Uterine Fibroids Weight Gain - Hips Decreased Stamina Decreased Muscle Size Rapid Aging High Cholesterol Swelling or Puffy Eyes/Face Slow Pulse Rate Decreased Sweating Hair Dry or Brittle Nails Breaking or Brittle Thinning Skin Infertility Problems Constipation Rapid Heartbeat Hearing Loss Goiter Hoarseness Increased Urinary Urge Low Blood Sugar High Blood Pressure Low Blood Pressure Numbness - Feet or Hands Breast Cancer Metabolic Syndrome 77.8 Hypometabolism 68.0 High Cortisol 43.6 Low Cortisol 41.4 High Androgens (DHEA/Testosterone) 38.3 Low Androgens (DHEA/Testosterone) 37.1 Estrogen Dominance / Progesterone Deficiency 54.7 Estrogen / Progesterone Deficiency 38.6 **Category refers to the most common symptoms experienced when specific hormone types (eg estrogens, androgens, cortisol) are out of balance, i.e., either high or low. Page 3 of 5
Lab Comments Estradiol is high for a woman not using any supplementation (none indicated). Symptoms of estrogen dominance may be noticed (e.g. mood swings, fibrocystic/tender breasts, water retention, weight gain, heavy menstrual bleeding). Estradiol levels may be high because of decreased metabolic clearance through the liver (i.e. poor methylation) and/or bowels (i.e. constipation). Estradiol promotes a healthy distribution of fat in hips, thighs, breasts, and subcutaneous tissue, but when estrogen levels are elevated, it can contribute to weight gain in these same areas. Adipose (fat) tissues contain the enzyme aromatase (plus six other enzymes) that converts androgens (testosterone) to estrogens, so maintaining a healthy weight can also decrease your risk of estrogen stimulated conditions like endometrial hyperplasia or breast cancer. For women who need to lose weight, estrogen levels may drop as weight drops; so a reduction of estrogen dominance symptoms may appear as you achieve your weight loss goals. Progesterone is within range. As the body's production of progesterone decreases with age, stress, and fluctuating hormones, insulin is released more rapidly and more often. This triggers sugar cravings and overeating. It may be worth discussing bio-identical progesterone supplementation with a health care provider. Testosterone is within range. Adequate testosterone is necessary to build and maintain lean muscle mass which is directly tied to metabolic rate and calorie burning to help with weight loss. Muscle building exercise can help stimulate testosterone production and boost the metabolic rate. DHEAS is low-normal. DHEA partners with testosterone as an anabolic hormone to build bone and muscle mass, libido, and immunities. Adequate DHEA (and testosterone) contributes to increased lean muscle which boosts metabolic rate and calorie burning to help with weight loss. DHEA may also enhance insulin sensitivity and naturally increases serotonin, which helps to control satiety and appetite. Cortisol is within range in the morning and at noon, but levels are high in the evening and at night. Cortisol increases blood sugar levels, breaks down fat, and as necessary, will increase appetite to meet energy demands in stressful situations; thus chronically high levels can result in increased food intake and weight gain. Excessive cortisol production stimulates enzymes in fat cells which promote abdominal fat storage and also, insulin resistance with weight gain in the waist typical. Developing a strategy to minimize stressors that raise cortisol is a key to weight management. Free T4 is within range. Free T3 is low and low T3 is commonly associated with symptoms of low thyroid. Low T3 may be due to medications (e.g. dexamethasone, lithium, amiodarone), high cortisol, non thyroid illness, starvation (carbohydrate restriction), as well as frank hypothyroidism. TSH is elevated consistent with hypothyroidism. TSH values will change months to years prior to any appearance of abnormalities in free T4 or free T3. The TSH will change 100 fold for every 2-fold change in free T4. Since the TSH "set point" appears to be individual, ideal management would include monitoring subtle fluctuations or changes in an individual's results. Supplementation with T4 and/or a combination of T4 and T3 may be beneficial. Based on symptoms of adrenal imbalanced despite a normal morning cortisol, adrenal support may be beneficial in addition to thyroid supplementation. Adding thyroid supplementation increases the metabolism of all hormones including cortisol and if the adrenals are not able to compensate by producing more hormones, the cortisol level could drop causing a worsening of symptoms. TPO is high suggestive of autoimmune thyroiditis. TPO antibodies are auto-antibodies to the thyroid peroxidase enzyme. This enzyme is active in every thyroid gland cell where it functions to attach iodine to tyrosine to form the thyroid hormones. Antibodies to this enzyme may cause a great increase in immune function around the thyroid; increasing inflammatory cytokines, decreased conversion between T4 and T3 and increased T cells and NK cell function. T Helper cells actually destroy the thyroid cell, releasing its stored amount of thyroid hormones (possibly creating a hyperthyroid picture) and encouraging the formation of autoimmune antibodies. However, this release is followed by fibrosis of the tissue. As a result, depending on the number of antibodies, a small or large amount of damage may take place. This damage is irreversible and eventually causes most patients to become hypothyroid. Of interest, is the research investigating selenium and its ability to decrease antibody levels. There is also a strong correlation between gluten antibodies and hashimotos. The use of glandular thyroid preparations (OTC and/or Desiccated thyroid) should be used with caution to assure that antibody levels do not elevate. Fasting Insulin is high and is consistent with insulin resistance. Patients with insulin sensitivity may find that they get jittery, extremely fatigued, extreme foggy thinking, and/or anxious after eating simple carbohydrates - cookies, cakes, breads, juices, pop, candy. Many individuals will also complain of "hypoglycemia" which is the reaction of the body from having very high glucose levels drop, even into a normal range. The most common causes of insulin resistance are excessive consumption of carbohydrates, sedentary lifestyle, smoking, lack of stress management (high cortisol), unbalanced hormone replacement, and genetic predisposition. Exercise, stress reduction, weight reduction, dietary modification (higher protein, lower carbohydrate), and creating a better hormonal balance with bio-identical hormone replacement therapy have been shown to be effective NATURAL ways of treating insulin resistance. A fasting glucose is recommended to rule out diabetes - ideal glucose levels should be less than 100. Page 4 of 5
Hemoglobin A1c is slightly high suggesting sub-optimal blood sugar control. This suggests an average blood sugar of 130 mg/dl. The hemoglobin A1c measures your average blood sugar levels over the last 3 months. High levels are suggestive of insulin resistance and developing diabetes. Discuss having your fasting bloodsugar levels drawn to determine if fasting blood sugars are qualifying of diabetes. Watching your diet, increasing exercise, natural therapies and medications, can all help you maintain normal glucose levels wihich is optimal for health. Vitamin D is low. Vitamin D deficiency has been closely associated with a wide range of conditions and diseases, which include cardiovascular disease, stroke, osteoporosis, osteomalacia, cancer, and autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and diabetes (types 1 and 2) (for review see: Holick MF. NEJM 357: 266-281, 2007). Lack of adequate sunlight resulting from geographical location (northern climates), excessive clothing, working indoors during daylight hours, purposely avoiding sunlight with clothing and sunscreens, and aging of the skin contribute to low vitamin D levels. Vitamin D3 may be increased by eating foods high in D3 (fish), exposing the skin to sunshine without sunscreen during mid-day for 15-20min (latitudes below Boston, MA), use of a UVB light, and/or supplementation with Vitamin D3. Page 5 of 5