Wednesday, December 10, 2014

Theranos: get labwork done quicker, cheaper, and without needles!

How do you feel about getting blood drawn?  Do you faint at the sight of needles?  Does the cost of laboratory tests make you gasp in disbelief?  Are you a fellow dietitian-nutritionist who is unable to order bloodwork and must wait, instead, for clients to visit their doctors to obtain nutrition-related diagnostic tests (e.g. vitamin D, B12, ferritin)?  What if I told you that a faster, cheaper and less painful lab test is available?

Allow me to introduce you to Theranos,  Theranos is a privately held company that is revolutionizing the way we do blood tests in America.  They take only a small amount of blood, the quantity obtained from a finger prick, and use it to run multiple tests for a cost 50-90% less than the cost of medicare reimbursement rates*.  All of this is done within a couple of hours at your local Walgreens!

*Vitamin D: Theranos $20.35 vs. Medicare $40.70

The traditional method of laboratory testing is to have a nurse stick a needle in your arm and take several vials of blood, usually one for each test, which are then sent off to a laboratory to be tested.  Patients do not usually get the results until a week later.

Theranos was started by Elizabeth Holmes in the fall of 2003 when she was a 19 year old sophomore at Stanford University.  I love this quote from Fortune Magazine's article "This CEO is out for blood."  When her professor asked her why she wanted to start a blood analytics company she replied "Because systems like this could completely revolutionize how effective health care is delivered.  And this is what I want to do.  I don't want to make incremental change in some technology in my life.  I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender."  Elizabeth Holmes is like the Steve Jobs of the health care field.  She is also the youngest self-made woman billionaire on the Forbes 400 list.

But the money isn't what I am most impressed by.  What I appreciate most is Elizabeth Holmes's vision for the future - where patients can purchase lab tests whenever they need them and gain access to actionable health information in a timely manner.  She states in her TedMed talk that "Laboratory information drives 70-80% of medical decisions," but that "disease begins before signs and symptoms appear."  There are many Americans who have pre-diabetes but don't even know it!  When patients are able to engage with information about themselves, it can motivate them to make the diet and lifestyle changes needed to improve health.  I su increased understanding and adherence.  This is what personalized medicine is all about!  Theranos may actually redefine the paradigm of diagnosis.

Unfortunately, Theranos Wellness Centers are currently only located in Palo Alto, CA and Pheonix, AZ according to the searchable map, but they claim that Theranos Wellness Centers will soon be located within Walgreens stores nationwide.  I just sent an email to Theranos asking when they will reach the Washington, DC metro area.  I will provide an update once I receive a reply.

Thursday, December 4, 2014

Should I get my Vitamin D level tested?

This week I attended a Conference on vitamin D hosted by the National Institutes of Health.

While I did not see President Obama (who was on campus Tuesday 12/2 to praise the NIH for its vaccine and treatment research on Ebola), I did see all the big names in vitamin D research, including Micahel Holick and Robert Heaney (speaker bios here).

My expectation going into the conference was to learn the BLACK and WHITE facts to share with clients and colleagues.  What I actually learned is that the science of vitamin D is a lot GREYER than I originally thought!  The conclusion of the conference was "we don't know."


This topic is important, yet the experts seem unable to come to consensus about when, who, and how much to treat.

In the U.S. Preventive Service Task Force (USPSTF) statement published last month, they wrote that "No consensus exists on the definition of vitamin D deficiency or the optimal level of total serum 25-hydroxyvitamin D [25-(OH)-D] (the major form of vitamin D that circulates in the body).  Depending on which cut point is used (usually less than 20 ng/mL or 30 ng/mL) some studies have shown that lower levels of vitamin D are associated with increased risk for fractures, functional limitations, cancer, diabetes, cardiovascular disease, depression and death."

First of all, the definition of deficiency is controversial.
  • The U.S. Institute of Medicine (IOM) report from 2010 stated that "almost all individuals get sufficient vitamin D when their blood levels are at or above 20 ng/mL."
  • One year later, The Endocrine Society released clinical guidelines, defining vitamin D deficiency as less than 20 ng/mL and insufficiency as 21-29 ng/mL.
  • At the conference, I heard Michael Holick say that less than 30 ng/mL is deficient, 40-60 ng/mL is preffered and that up to 100 ng/mL is safe.  This is echoed in his book The Vitamin D Solution.
In addition to varied expert opinion, there exist many uncertainties which confound the investigative process.

Labwork - depending on the detection method used, the measured value of total serum 25-(OH)-D between laboratories vary by up to 15 ng/mL - which can mean the difference between sufficiency vs. treatment!

Individual requirements - vary according to genetic polymorphisms, usually fall within a bell-shaped Gaussian distribution

Effective dosage - studies may not use a high enough supplemental dose to impact initial vitamin D status.

Initial vitamin D status - most benefit is seen when deficiency is corrected (moving from deficient to sufficient).  Without knowing what constitutes "deficient," studies working with populations who already have "sufficient" vitamin D status may not show any experimental impact and vice versa.  There is a big difference between making sick people healthy and making healthy people healthier.

Validated Intermediate endpoint - does not exist (yet?) for vitamin D

There have been 247 new studies on Vitamin D in the last five years, but none of them change the recommendations for chronic disease.  The strongest evidence in support of vitamin D supplementation is in bone health and fracture prevention, yet many family doctors are prescribing vitamin D for depression.  This is partly due to vitamin D coverage in the media, where journalists claim that vitamin D may help with a whole host of diseases.

The USPSTF's Final Recommendation Statement is that "The evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults." In other words, they do not (yet?) recommend screening the general population for vitamin D deficiency.

In the U.S. Preventive Service Task Force (USPSTF) statement published last month, they wrote that "No consensus exists on the definition of vitamin D deficiency or the optimal level of total serum 25-hydroxyvitamin D [25-(OH)-D] (the major form of vitamin D that circulates in the body).  Depending on which cut point is used (usually less than 20 ng/mL or 30 ng/mL) some studies have shown that lower levels of vitamin D are associated with increased risk for fractures, functional limitations, cancer, diabetes, cardiovascular disease, depression and death."

But that won't keep me from encouraging my clients to get their vitamin D levels tested.  Especially if they live above the 40th parallel (for reference, Washington, DC is at 38.9° N, Boston 42.3° N, Seattle 47.6° N), have darkly pigmented skin, shield their skin from the sun with sunscreen and/or clothing, spend most of their time indoors, if their diet lacks dairy products and other vitamin D-fortified foods (orange juice, energy drinks, etc), or if they are obese.

You can get vitamin D from the sun!  Your skin makes it!
One FACT I did learn is that obese individuals need to consume 2.5 to 3 times more vitamin D (through food, supplement, or sun exposure) to increase serum vitamin D levels compared to lean individuals.

As a dietitian, I can help people manage current disease but I prefer to prevent disease in the first place.  In addition to disease prevention, I also support optimum cellular function (i.e. helping you go from "good" to "great!").  That being said, here is my recommendation:

Get tested (insurance willing).  If your vitamin D is less than 30 ng/mL (75 nmol/L), you should probably try to increase your level - through food, supplementation, or sun exposure - until your vitamin D falls between 30 ng/dL and 100 ng/dL.

Updated (12/10/2014): if you visit a Theranos Wellness Center, the cost of a vitamin D test is only 20.35.  Read more here.

Sunday, November 2, 2014


Sometimes we need external motivation to help us achieve our health goals.  Recently, a song by the English indie band Alt J inspired me to do something that I haven't done in many months.

I like the fact that Alt J is different than other bands.  I've never heard them on the radio.  They definitely are not on America's Top 40.  Alt J songs are a combination of instrumental and vocal, but I can't always tell what the vocalists are saying.  The music is great for chilling and most of their songs help me relax.  My favorite is called "Hunger of the Pine."

The music video for "Hunger of the Pine" was released this summer, but I only just watched it this past week.  The video was nothing like I expected.  It starts with a guy running through the woods.  Arrows are flying all around him, whizzing past his body.  He gets hit by one arrow, then another.  But he keeps running!  You won't ever guess what happens at the end!

Once a runner, always a runner.  I used to run competitively in high school and college.  Lately, my rock climbing and yoga have taken precedent, but the urge to run never really goes away.  Ever since I moved into my new place (near the Huntington Metro) in August, I've been wanting to run across the across the Potomac River / Woodrow Wilson Bridge to the Capital Wheel at National Harbor, MD.  Saturday afternoon, I finally decided to do it.

For once in my life I did not look on Google Maps to determine how far it was.  However, I knew from driving that stretch of road many times that I might need a little extra something to keep me going.  So I bought the new Alt J album (This Is All Yours) on Amazon, loaded it onto my ipod shuffle, and ran out the door.

It was a chilly fall day.  Overcast.  Windy.  I don't remember which song played first, but I hadn't been able to exercise in a number of days so my body felt good and the song didn't matter.  I ran east on Huntington Ave, turned left on Richmond Highway, and followed the pedestrian path to S Washington St to arrive at the bridge.  As I started across, I saw other pedestrians wearing hats and gloves.  I tucked my fingers into my long sleeve performance top and kept going.  The view at the top of the bridge was spectacular, Washington DC in the distance and the wind drawing patterns on the water below.  This was the farthest I had ever made it before.  I kept going.

On the east side of the bridge, I followed the switch backs, up and over the steady stream of beltway traffic and then back down the other side to run parallel to the water's edge, the Ferris wheel drawing ever closer.  I had listened to several Alt J songs at this point, maybe six or seven, but still hadn't heard "Hunger of the Pine."  I was beginning to wonder when it would play.  I considered shuffling ahead but changed my mind.  I kept running.

I made it to the Capital Wheel at 34.23 minutes into my run

As I turned around, a gust of wind hit my chest and I realized that I had been running with the wind at my back since I left the bridge.  I groaned internally, looking back at the path from where I came and thinking about my tired legs, my tight hips.  Then my song started playing!  Images of the guy running through the pine trees came flashing into my mind and instantly I was motivated again.  I made a new goal: run negative splits to get home faster than it took me to run out.

I picked up the pace, charged up the switch-backs, breathing heavy as I thought "I'm the female rebel" to myself over and over.  Each time the song ended, I clicked the button to restart.  I probably listened to the song three or four times by the time I reached the top of the bridge.

Starting back down the other side, I felt my hips and calves getting tighter, the bottom of my feet pulsating from the abuse of feet pounding the concrete.  I forced myself to stride out and take longer, lighter steps on the second half of the bridge, down the pedestrian path, left on Richmond Highway, right on Huntington, all the way to my front door.

I finished the run in 68 minutes.

Monday, September 29, 2014

"Sugar free" may not be as healthy as you think!

I have always been an advocate of eating REAL food.  If I am going to indulge with a cookie, I want a REAL cookie made with REAL butter, eggs and sugar - not Crisco, Egg Beaters, and Splenda.

Homemade brownie cookies and berry muffins

Why? First of all, imitation cookies do not taste nearly as delicious as real, homemade treats and, secondly, they might be worse for your health than eating the real deal.  Certainly we've seen this with trans-fat (a.k.a. margarine, shortening, partially-hydrogenated oils).  The verdict is still out when it comes to eggs.  But new evidence shows that artificial sweeteners may not be as health-promoting as originally assumed.

A recent study published in the journal Nature found that, instead of helping people lose weight, consuming artificial sweeteners - such as saccharin, sucralose and aspartame - can alter the gut microbiome which may lead to increased risk of insulin resistance - a factor influencing metabolic dysfunction, obesity, and diabetes.

Read the Washington Post article here (which was sent to me by SmartBrief for Nutritionists on Sept 18).  Read the article from Nature here and an abstract of the actual study here.

In addition to the deleterious health effects, here are some other reasons why adulterated "impostor" foods are on my "Do Not Eat" list:

  1. When people eat foods with a health claim like "fat free" or "sugar free" (which are not calorie-free), they sometimes end up eating more of that food (and more of the calories) than they would have eaten if they had chosen the real deal. You really only need a few bites of a decadent dessert to feel satisfied.
  2. Many of my colleagues believe that, when artificial sweeteners are consumed, the body "interprets" the sweet flavor to mean "calories coming in" but once the body realizes that there are, in fact, no calories in these fake sugars, they body reacts with increased food cravings and consumption later.
  3. Food additives are chemicals which must be processed and eliminated by the body, usually via the liver. High consumption of food additives puts stress on the organs of elimination and can result in toxic build-up in the body. Signs and symptoms of a toxic body include poor elimination, poor digestion, bloated stomach, gas, low energy and fatigue, irritable skin, headaches, brain fog, poor memory, low immunity, low libido, yeast problems, and food allergies. Certainly there are many ways to support the detoxification process, but eliminating food additives (like artificial sweeteners) is a great place to start!
Here is a list of foods that may contain artificial sweeteners:
  • diet soda
  • juice
  • flavored water
  • chewing gum
  • yogurt
  • candy
  • bread
  • coffee creamer
  • ice cream
  • jams and jellies
  • salad dressing
  • pancake syrup
  • meal replacement bars and powders
  • vitamins
  • medications
The only way you can be 100% sure that a product is free of artificial sweeteners is to read the Ingredients.  All of the following are artificial sweeteners:

  • Acesulfame potassium (Equal, Sweet One, Sunnet)
  • Aspartame (NutraSweet, Equal, Twin Sugar)
  • Erythritol
  • Glycerol
  • Lactitol
  • Maltitol
  • Mannitol
  • Neotame
  • Polydextrose
  • Saccharin (Sweet N Low)
  • Sorbitol
  • Sucraole (Spenda)
  • Tagatose
  • Xylitol
Did you find this post helpful?  If so, please let me know by leaving a comment!

Saturday, September 6, 2014

Welcome to Eating with Integrity (re-post)

Not all food is created equal. In addition to the many species and cultivars of fruits, vegetables, grains, and legumes, there are a multitude of processed products that we regularly consume. With billions of choices lining the supermarket shelves, how does the average American decide what to purchase and eat? What makes a food nutritious/healthy, anyway? Is there a “perfect” diet, and if so, what is it?

this is me, Adair (not a-truth)
This blog will strive to answers these questions (and many others) using a mixture of anecdotes, quotes, and facts. As a future dietitian hoping to Revolutionize Health in America (Read: help people eat better) it is my goal to maintain an optimistic tone and provide useful dietary advice for any visitor to this site.