2007-04-21 Reply 2, from jrfoutin Member Advocate
Joined: Mon Aug 8th, 2005
Location: Orem, Utah USA
Posts:2814
Dec99:Sarc, Sep00:offPred, Mar05:no-D+lo-light+NoIRs, 8/09/05:125D=61|25D=12;P1, 10/6/05ModP2, 12/31/05P2, 6/28/06:125D=40|25D=under4, 7/11/06P3 10/19/06:125D=37|25D=under4

Here are some other links you might appreciate:
Hypervitaminosis-D Symptoms, listed

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You might also appreciate these excellent simple explanations about the MP.

Getting a Vitamin D Test
http://www.marshallprotocol.com/forum2/366.html

The D METABOLITES consist of two tests:
1,25 dihydroxyvitamin -D
25 hydroxyvitamin - D

Please make sure that both tests are ordered, not just the commonly done 25-D. Be sure the sample for the very sensitive 1,25-D assay is sent to the performing lab frozen. You may need to remind the technician at the drawing (satellite) lab to freeze the sample for shipping.

Note: Some Quest drawing labs have inaccurate information in their printed manuals. There has been no change in the need to freeze the 1,25-D sample for transport.

To facilitate correct handling of the blood sample for 1,25-D and to avoid your having to tell the drawing lab how to do their job, you can ask your doctor to sign and staple the following instructions to the lab order:

-Please perform the following Vitamin D tests: 1,25-D and 25-D.
-Please ensure that collection staff arrange for centrifuging and freezing of the 1,25D sample. (only)
-The sample should be allowed to settle and clot at room temperature for at least 30 minutes (but no more than two hours) and then centrifuged. Do not hold on dry ice prior to centrifuging.
-After centrifuging, freeze at between -2 and -10 C.
-The sample must be transported on dry ice in order to remain frozen until it reaches the testing lab.

We do not recommend using Labcorp for your D metabolites tests. ...

If your doctor (or HMO) believes that the tests cannot be justified, point out that:
-the FDA has approved 1,25-dihydroxyvitamin D for testing kidney function.
-these tests are also approved for investigation of the risk of osteporosis.
-anyone who has been on prednisone is at risk of osteoporosis.

Coverage of IL2R will vary by insurance company.
Here is a paper showing it as an effective diagnostic tool for sarcoidosis, so Doc might take the position that he is trying to rule out sarcoidosis:
http://tinyurl.com/3uywe
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db
=pubmed&dopt=Abstract&list_uids=12928233

Consider the whole picture
When assessing the D-levels, one must evaluate and compare the two measurements, 25-D, the precursor and 1,25-D, the active metabolite. The clinical picture must be considered also.

Lab ranges
D-metabolites results that are within normal lab ranges may still be abnormal because high levels are not used to diagnose any illness. Therefore, lab ranges are determined without considering that a large percentage of patients getting these tests are ill with undiagnosed Th1 inflammation, thus skewing the 1,25-D range upward. The Merck Manual 1,25-D range of 20-45 pg/ml is a more reliable indicator of the 1,25-D normal range. 25-D ranges are skewed high by dietary supplementation.

Explanation of NORMAL LAB RANGES and explanation of sigma high.

If necessary, convert metric results using this formula:
1,25D (pmol/L) - divide pmol/L by 2.4 to get it in pg/ml 25D (nmol/L) - divide nmol/L by 2.5 to get it in ng/ml

D ratio
Before beginning the Marshall Protocol, the ratio of 1,25 D to 25 D can help assess the significance of the D levels. It is only meaningful before the MP is started.

To determine the D-ratio, divide 1,25-D pg/ml by 25-D ng/ml.

The D-ratio suggests the rate of conversion in the inflammatory macrophages of 25-D into 1,25-D. The concentration of the former goes down and the latter goes up. This is reflected in the D-ratio more quickly than in either of the components individually. It has a normal value of 1.25, with a standard deviation estimated at 0.5.

However, diagnosis of Th1 inflammation is impossible using the D-ratio, unless the 25-D is below 20ng/ml.

After Benicar and antibiotics have been started the D ratio is no longer significant because these medications alter both levels of D metabolites thus skewing their relationship to each other.

2007-04-29 Reply
Ruth Goold, Member in Phase 2
Joined: Thu Oct 19th, 2006
Location: Nanaimo, British Columbia Canada

Vitamin-D testing
MDS Burnaby Reference Laboratory
3680 Gilmore Way, Burnaby, B.C. V5G 4V8
Main Switchboard 604-431-5005
Within B.C. call no charge 1-800-663-9422
Kevin

I assume that you are talking about the freezing of the 1,25 D sample for transport? If you are using an MDS Metro Lab, the test is run in the Victoria regional lab for all of BC. MDS beleives that the samples are stable for 24 hours and so does not freeze samples from Vancouver Island and the lower Mainland (just ships them over to Victoria on ice and freezes them on arrival). However, from all other locations, they are supposed to freeze the samples for transport because they may not arrive soon enough.

... Actually, a relative of mine just had the Parksville lab agree to freeze his sample before shipping although I never did in Nanaimo. Kevin arranged for me to have my sample done just before the courier pick-up of samples from my lab and then it was driven to Victoria on ice and frozen on arrival. You seem to be managing things well but I do have one small bit of advice. When talking to the lab about how to handle your sample, never (ever!) say that you (or worse yet, an American research group) want this or that done. Always say that your doctor wants it done!!