Bummed out some more...

 Do not get it.  My results are super confusing. 

• HS-CRP: so I got the results of the highly sensitive C-reactive Protein... and it was 4.0. That is high. You should have a result under 1.0.  I am really shocked at that. 
• CRP: last time I got blood tests I got regular CRP... and guess what.... my results has gone down since January.  So in January I was at 6.0. Under 8.0 is normal. This time I was down to 4.0.

So, explain this to me will you? 1/2 my inflammation biomarkers come back high, and the other half come back low.  Also, I have lost 20 lbs since January so you would think that would reduce inflammation?

Well some good news..

• IGM: my IGM came back at 277. So that is still normal. Because I have this tested so frequently I am now starting to consider that my IGM just hovers in the high 200s and perhaps... always has. Of course that can be related to my clonal cell but, isn't it possible that we all have different levels of normal? At this same time this kind of worries me... does this, combined with the inflammation mean I have some sort of chronic infection? 

So, my theories. On the day before I got these tests I mistakenly had a lot of sodium. I purchased a can of wax beans forgetting that canned veggies are put in a salt brine.  I ate the entire large can and later learned that it had 3.5 servings at 390 mg of sodium PER SERVING. (1200 mg in the entire can) Since I have eaten a low sodium diet my entire life I may be overly sensitive to salt... I knew it happened right after I ate it because I was soo thirsty.  I suspect that the generalized CRP may take little while to increase while the other inflammatory markers go up immediately.  This to me suggests an acute insult to the body.

In addition, I have really been eating salt with abandon. I even take an electrolyte supplement that is full of salt. Primarily because I was told fasting will deplete it.  But perhaps I have been doing too much. 

Also my ferittin is elevated.  This leads me to believe I might be overdoing it with the red meats. I am having ground beef almost daily and then also having a large steak about 1x per week.  I have always been sensitive to too much iron and now that I am not menstruating any longer I will have to be careful. I did have my iron tested last year and it was right in the middle but still -- need to watch it. 

Once again I have to call out the incompetence of my doctors.. almost every single test that I had elevated -- when I look it up... it says it is related to blood cancer. But do you think my doctors tested any of it? Nope.  All of these simple and cheap blood tests $12.00 for some of them, can give me valuable information, but they SIMPLY REFUSE. They are so f***ing cheap. Thank god I can get my own.

My plan is to flush the system out, reduce my sodium, and retest. If these biomarkers are elevated again.. I will know I have a problem. 

Bummed out... but informed...

This will be a little quick because I need to get to work but I was not happy with my labs. 

• Fasting Insulin: hardly moved at all. From 5.7 to 5.5. I have heard of other people with much lower levels. This makes me think that this level of insulin is just my normal - which kind of makes sense as I have always "fattened easily". I have been fasting and keto since November of 2020! 
• Ferritin: 245. That is high for the lab. Not by a ton (the outer edge of normal is 235) so I looked it up and it can be caused by red meat, but also lymphoma. Of course -- my body is so predictable.  But I do think I have to cut back on the red meat -- even though I am not eating a ton.. just like 1x per week.
• SED rate: WHAT THE????  I just find out that inflammation can progress MGUS and then, my sed rate is through the roof. 28 -- my last one in January was 14. Outer edge of normal is 22. To me this make no sense. I am NOT EATING AT ALL every other day. But my only thought it that on Sunday I mistakenly ingested a ton of sodium.... I had a large can of beans forgetting that canned veggies can be high in sodium and yes... the can told me I took in about 1500 mg just with those veggies. I cooked them in the water in the can. One reason I figured it out was right after dinner I was sooooo thirsty.  I am still waiting on inflammation markers CRP and HS CRP.

The good news...

• Ha1c: Well, that is down to 5.0. Truly that is pretty amazing and a level I haven't seen since I was in my early 30s. 
• Prothrombin time: This measures my clotting and it is right in the middle. It should be between 9.0 and 11.7 and mine was 10.6.
• CBC: Absolutely wonderful again but.... my WBC came back at 4.0 (low for me) and my RBC is high for me (4.7) but, I know that red meat can cause it to go high... and I do understand that eating less seems to push my WBC down lower... I am just not sure if that is a good or bad thing.  This and the Ferritin makes me think I need to give blood again.. only I don't want to.. the company was so aggressive about it I blocked them on my phone.  I also remain very unsure that it won't make MGUS progress.

Blood Tests

I admit ever since getting diagnosed I have been VERY sensitive to my health.  To find out that one part of my body failed.... it makes me worried about the rest of it.  But also, I have long felt that at the age of 50 to 60, almost everyone I know had one major health crisis. This is the age for that... so I feel I have to be guarded.  It truly seems like if you make it past 60 you will be relatively ok.

In the last year, not even because I wanted to, I ended up having:

• Several X-rays
• A Coronary Calcium Scan.
• An abdominal CT
• A Pelvic Ultrasound.
• A colonoscopy
• A Dexa Bone Scan.

All normal, yes! But I think now my poor irradiated body needs a rest.  The good news is that I have discovered that I can purchase my own blood tests. I purchase them from "Ulta Labs" -- and they are honestly, cheaper than going through my doctor.  But I have been very happy to be able to get feedback on my body that my doctor refuses to do. I am also lucky that my Flexible Spending Account pays for these blood tests. I highly recommend that you do at least ONE round of tests on your own.

In the last year I had:

• Fibrinogen- tests your blood clotting.
• Regular (not highly sensitive) C-Reactive Protein: Marker for Inflammation.
• Homocysteine : Marker for Inflammation. 
• TSH - I was going to get the full thyroid panel but my result was very good.
• C-Peptide: marker of insulin resistance.
• Fasting Insulin: Marker of insulin resistance and metabolic syndrome.
• IgF-1: A marker of cancer and growth. 
• GGT: Gamma-glutamyl transferase - a marker of liver health and overall health.
• Iron Panel: Transferrin, Saturation %. 
• ESR: Sedimentation rate. A marker of inflammation.
• At least 3 CBCs: Complete Blood Counts.
• Blood Type: It is O Positive.
• Folate, Vitamin B12, Vitamin D, RBC Magnesium: measures Magnesium in your cells.
• ANA screen: this was negative so it seems likely I don't have auto immune.
• IGM: This is a cheap test and I do it just to monitor my antibodies... in between doctors tests.

I am going on Monday for another round... some of the tests will be redos just to see how fasting has effected them (and I need to get blood for the "Impact" study)  but I am getting:

• C-Reactive Protein (regular)
• Highly Sensitive C-reactive Protein (argued to be a better test for inflammation)
• Ferritin: hear this is a biomarker of health
• Fasting Insulin, A1c.
• IGM
• ESR Sedimentation rate.
• Prothrombin Time (PT): a measure of clotting. 

The location for my blood draw is about 5 minutes from my house... so it could NOT be easier. You go to the lab, check in, your order is already in their system. They draw your blood and usually within a day I have 50% of my results. In fact last year before my colonoscopy I ordered a CBC and electrolytes...  and then a week after my colonoscopy I did another CBC so get a sense if I was bleeding internally or anything.... what a weight off my shoulders to be able to compare and contrast on my own. What a great tool to know if I was fully stocked on electrolytes before I had to take the prep which, of course, cleans you out. And the cost for these tests was minimal... only $30 for both tests.

A very nice part of these tests as well is they don't go on your medical record. Now it is possible that if you had an insurance company demand that you provide all blood tests, you might have to turn them over... but if they don't ask, don't tell. 

Finally a hint at cause and cure.

So just after my last post came out this study came out. Study reveals how long-term infection and inflammation impairs immune response as we age. I have to admit this has me excited. 

First for the relatively long discussion of clonal hematopoiesis (creation of clonal cells). I mean I knew I had a clone but I wasn't aware that it was a "thing".  And it absolutely is a thing that is much more broad and effects far more people than just MGUS.

Clonal hematopoiesis is characterized by the overrepresentation of blood cells derived from a single clone. Clonal hematopoiesis of indeterminate potential, or CHIP, is a common aging-related phenomenon in which hematopoietic stem cells or other early blood cell progenitors contribute to the formation of a genetically distinct subpopulation of blood cells.

So is MGUS just another name for this "Clonal hematopoiesis" except that it is a type of clonal hematopoiesis that just limits the potential end results (MM or WM)? So accordingly it is taken out of the CHIP sub type and given its own name. 

Then there is this:

This common phenomenon known as clonal hematopoiesis (CH) is known to start in early fifties and is frequently associated with loss of function mutations in the DNMT3A gene.

Well that is bang on for me. With mine appearing to start at age 49 and 1/2.  

Then there is this:

CH is associated with a significantly higher risk of blood cancers, cardiovascular disease, stroke and all-cause mortality.

What... wait, my doctor says it is nothing to worry about ! Well, I am suspecting this is because of increased blood viscosity that comes along clonal cells.

But this is where I get excited.

shows for the first time that long-term infection and chronic inflammation drive CH (clonal cell creation) mediated by the loss of Dnmt3a function. . . HSCs (blood stem cells) in mice lacking Dnmt3a gene did not differentiate (form into proper normal cells) much . . . We undertook the current study to test our prediction that defective differentiation (defective normal cell creation) and increased duplication of Dnmt3a HSCs (blood stem cells) allows them to overtake and outcompete normal HSCs when fighting chronic infections or facing long-term inflammatory conditions.

So let's unpack this. Long term infection alone is probably not the precise issue it is only that long term infection causes "chronic inflammation".  It is chronic inflammation that causes Clonal hematopoiesis (creation of clone cells). This says, that in response to chronic inflammation.... it seems that it is your STEM CELLS hematopoietic stem cells (HSCs) break first.  So when your body calls them up to make a plasma cell they are already defective. 

Ok, it is me? This seems to be a MAJOR answer in what and how to prevent progression of MGUS.  And it brings it all together. 

Under the Umbrella of "CHRONIC INFLAMMATION" are many different things.

• Being overweight. 
• Having auto immune.
• Having long term infections.
• Metabolic Syndrome.
• Diabetes.

And we already know that things that reduce inflammation will assist with MGUS

• Tumeric
• Reduction in Auto Immune disease.
• Fasting 
• Keto / Carnivore
• Anti inflammatory foods.

So it appears to me that right now, today, anyone with MGUS should be getting inflammation biomarker tests and doing what they can to reduce inflammation. 

Blood Tests for Inflammation

• CRP blood test (C-reactive protein) - my last result was 5, it should be under 3.
• Plasma viscosity (PV) - never had this test hard to find.
• ESR blood test - my last result was 14, normal is  0-29 mm/hr for women

So this is how I understand Mgus.

I had to explain this to a friend the other day.  Not sure this is right but I thought I would post it. 

The process starts when your body calls for "new" plasma cells. Your body releases a "stem cell" which goes out and finds a group of plasma cells to emulate. What it is supposed to do is follow and learn from the plasma cell and become just like it (differentiate). Sort of like an intern at your job learns to become a good employee. 

But something goes wrong. The stem cell does not quite make it / graduate. It doesn't become a full fledged normal plasma cell. It becomes a "clone" or a clonal cell.  Usually becoming an IGM, IGG, or IGA (kappa or lambda) based on what cell it tries to emulate.  These clonal cells release a protein (M-protein) which is how you know if you have an M protein you could have a clonal cell.  It is not always the case.

To me the best way to understand it is the movie "Multiplicity". In that movie Michael Keaton makes clones of himself. But each clone degrades a little bit more than the last one. Now each clone is functional (so for Mgus the body doesn't destroy the clonal cell because the cell is still functional and the body probably sees nothing wrong with it) but it is "off" and a bit hyperactive. Whereas the normal Michael Keaton reproduces with two children... the clone of Michael Keaton may have 6 kids. (all a little off because they are reproductions of a clone).  The real Michael Keaton may go to work and produce 40 widgets at his job but hyperactive clonal Michael Keaton will produce 150. 

In the same way, the clonal cell may reproduce more than normal cells. And just because you have more clonal cells, and they are a bit hyperactive, they are going to produce more of the type of antibody that they were trained to produce (in my case it is IGM kappa). And with an increase in antibodies, there will be an increase in "light chains" because light chains are essentially a bi-product of antibodies.  So because I am kappa my ratio will likely always go up.  

The clonal cells live in your bone marrow so a way of working backwards and trying to figure out how many clonal cells could be in your bone marrow is by testing the levels in your blood of the "M-Protien", "The Antibodies", and "the light chains".  These give a hint as to how aggressive the replication of the clonal cell is.  

So it seems to me that at its source...  the goal is to keep the clonal cell suppressed and from reproducing too much.  More modern treatments, immunotherapy, are looking to "tag" these clonal cells and tell the immune system to go destroy them. The immune system doesn't generally because, as mentioned, the cells are not recognized as defective. You and I know they aren't right, but they are not wrong enough to activate an immune response. 

And go watch Multiplicity if you haven't seen it. Super funny.

LETS DISCUSS DIET AND MGUS

I believe strongly that *diet* is one of the only things that can stop, reverse, and or slow down MGUS. But every time this question is asked I think they get it wrong.

The question is: can diet effect Mgus? The answer is insanely complex. 

First, people say "no" but that answer is wrong. The correct answer is "NOT THAT WE KNOW OF YET". The studies simply have not been done. For instance, there is one study that says that being overweight will lead to progression of MGUS. But then a subsequent study says it will not.  I am a member of PC Crowd and even there, the questions about diet are so basic - I do not see how they can come to any conclusion.  From my own internal polling of the MGUS Board.... it seems obvious that being normal weight does not keep you from getting MGUS as there are many people on the board with it who are normal weight.  But we don't know if being overweight will cause progression.  Which, it makes send that it could.

Then, it seems obvious that if you have MGUS because of a reason that is unrelated to diet... - diet probably won't help much. For instance... many people with MGUS have auto immune disease. Diet could, but probably won't do much for a serious auto immune disease.  (though there are many people that claim a cure with the carnivore diet) Other people may have MGUS due to poisoning from being in the Military - that damage is probably not going to be reversed by diet.  Finally many people with MGUS have a genetic predisposition (family had it) that probably is not going to be reversed by diet. Though it is possible it can be inhibited.

On the other hand, there is increasing evidence that proliferation of any cancer can be slowed down or reversed due to what you eat.  See How to Starve Cancer: Without Starving Yourself by Jane McLelland. Jane actually had serious lung cancer and cured it with a combination of diet AND off label drugs. Now... you're like, *but the drugs...* but remember she had cancer.. we just have a precursor. If we can keep the precursor under control with diet, we are all set.  We won't need drugs. 

We all also need to discuss exactly what we mean when we discuss "diet" as I think that term has gotten warped lately. I often hear people state that they "eat healthy" well what does that mean?  There really is no evidence as to what is "healthy".  So I hate to hear that.  What we need to be doing is eating an anti cancer diet. A diet that specifically targets proliferation and dysfunction in the body.  

I often hear people saying "sugar" is bad for cancer. Let's clarify. This is an insanely complex subject.  But yes, cancer does not use the normal pathway to make energy. It makes it via "fermentation" - and fermentation requires glucose. It is also very messy - using 60% more energy just to accomplish the same energy as going through the regular process. This is known as the Warberg effect.   So yes, if you are consuming a TON of sugar, your body is going to progress easily. And yes, reducing sugar will reduce the proliferation fo cancer. See "Anyway you can" by Annette Bosworth (keto substantially reduced her mom's leukemia). But it will not stop it alone. Cancer can also switch to feeding of other substances. Such as amino acids. (Glutamine)

It seems to me that there are three things at play.

1. Something causes the cells to break down and proliferate.  To me this seems like this is related to protein and IGF-1. Sugar also has an effect as it activates insulin which increases IGF-1.

2. Once they proliferate -- they don't die as easily because of all the sugar easily feeding it.  To me this seems like it is related to glucose. 

3. for some reason, especially with clonal cells... they are broken but they don't die. Well of course, there is a diet intervention that could cause them to die, called Autophagy. Fasting for a long period of time does cause your body to basically eat itself.  There are people with blood cancers on the books that had big improvements with 21 day fasts -- what could a 21 day fast do for MGUS? -- I am too afraid to find out.  But, hoping I can work up to that soon.

It is my position that if we really wanted to know we would get serious about this and measure on people with MGUS..

- exactly what they ate each day,

- exactly how much exercise they did each day,

- exactly their TDEE each day,

- exactly the drugs they may be taking,

- exactly the supplements they may be taking. 

At the moment the big medical institutions are struggling on the big issues and will not be looking to diet. 

Another Interesting Theory

So I am reading a book that is just blowing my mind. Very interesting. It is by an evolutionary biologist who has spent the last ten years with "hunter gatherers" in Africa. He notes that by and large they have very little cancer, heart disease or other chronic health problems.  They pretty much exercise most of the day while out hunting or with women doing home type work.

His theory: we all believe that excess energy will be turned into fat... but what if some of it isn't? Let's say that we need 1500 calories per day and we eat 2000 calories - constantly. Sure 400 of it may be turned into fat... but 100 will be used by the body before the excess is turned into fat.  It is this chronic excess energy that causes bad things in the body: simply because the body has excess energy and has to do something with it. 

So what does it do? Increases inflammation, increases cell proliferation, causes an overactive immune system, and who knows what else? Essentially we should not be running on an excess energy situation each day.  The excess energy causes the body to have to do something with it - and that something may not be a positive thing.  

This is my commentary but IMHO this makes sense.

• It is well known that Calorie Restriction improves health, longevity, and biomarkers across all species...
• Exercise also has been shown to to improve health, longevity, and biomarkers across all species. But sometimes it doesn't... perhaps due to overeating?
• Part of his theory is what what you really need energy for are "big ticket items" like reproduction. Well, it is well known that people start having health issues in their 40s and 50s... when your body downshifts and no longer needs the energy for reproduction.  I have long stated that if menopause MUST mean something and we should listen to its apparent demand that we eat less... here is some evidence that failure to heed its warnings about less energy will cause problems. 
• Diet interventions that invariably cause less energy to be eaten (or increase the energy needs of the body) are more likely to result in health. E.g., fasting, keto, etc.
• Many diseases of modern calorie excess imho have evidence of an "overactive" body. Sink tags, Acanthosis nigricans, even uterine fibroids - etc. Does your body make these because it has to do something with the excess energy? Are these signs that your body has energy excess? 

What is most interesting about it is that it is kind of like a toggle... when you are younger you have massive energy needs... so you very rarely are in energy excess. But as you age you have less and less energy needs, and, you eat by and large the same (or more) you flip over to a chronic energy surplus which causes complete havoc with the body. 

Another part of his book that is interesting is that he has done extensive studies on it and it turns out that exercise does NOT increase your Total Daily Energy Expenditure.  This is another reason why we have all messed up so badly. He has measured the TDEE with these hunter gatherers and it the same as any person in the modern world. He has also studied it with animals... apes - and a captive ape in a zoo has by and large, a similar TDEE to an ape in the wild.  This number is determined by YEARS of evolution and factors like famine and reproduction. You cannot increase it substantially on a short term basis. 

So you see, people who are exercising may believe they can eat more than they really should be eating.  They may believe they burned off 2000 calories per day because they went to the gym, but they didn't and eating 2000 calories gives them excess energy that they didn't need.