Blood work

[guru]

Hello. I have blood work done at samitivej Sukhumvit every 4 months or so since 2022 and having trouble with my Vitamin D levels and uric acid levels. I obviously get advice from the doc but I’ve come here for any extra tips. 
 

Uric acid: their normal range is quoted as 3.5-7.2. I started at 9.5 and it got down to 7.4 and remained stable for a while but then went back up to 9.4 and now it’s back down to 8.6. No matter how much I reduce my alcohol and chicken consumption I haven’t reached the window and don’t know why it’s fluctuating. Not on any medication and no symptoms at all e.g. gout. 
 

Vitamin D: their normal range is 30-100. I started at 18 in mid 2022 and she put me on 20,000 units of vit D three times a week and a calcium supplement. 6 months later vit D was still only 25 so she increased the dose to 20k units four times a week. It then rose steadily reaching 35 in August and I was in the window. She then reduced the dosage slightly and said no need to take calcium daily now but just whenever I wanted to as a supplement but I never took any.  I’m now back out of the window and down to 25 so she has now increased dosage to 20k five times a week and put me back on calcium. I understand that calcium needs vit D for absorption so it makes sense that when my vit D is low she prescribes a calcium supplement but does it also work the other way round because the only thing I did differently was not take calcium. I can’t find any google literature on this but she said could be. No noticeable symptoms but just been reading the BBC website where they have reported a link between low vit D levels and early onset dementia.
I know about sunlight but my work involves being indoors during the day. I do get out at the weekends though but still cautious. After a reckless sun bathing youth, a recent skin cancer scare on a mole on my back came back negative from the biopsy. 

Cholesterol: this seems to be doing well and my goal is to get off statins eventually. I was  on 20mg daily in 2022 but shes gradually decreased dosage and I’m now down to Atozet 10mg/10mg three times per week. Hopefully next visit gets this decreased further. 
 

Glucose: HbA1c hasn’t budged from 5.7 which she says is just in the  prediabetes window. I blame the rice/noodles everywhere when all I want is meat/fish and vegetables. Not sure what meat I can eat though because  red meat affects cholesterol and chicken affects my uric acid.  Anyway I need to get in control of this by myself. 
 

One last thing, when I had the exercise stress test false positive last year, the CT scan gave 0% calcium in the arteries.  Will all these calcium supplements make their way into my arteries and change my clean record? Samitivej Doc says no but Dr Google suggests otherwise. 

[scubascuba3]

All those things probably can be solved by diet + getting more sun.

 

What do you eat? just noodle soup? you don't say your age? or whether you exercise and how much?

[guru]

46 minutes ago, scubascuba3 said:

All those things probably can be solved by diet + getting more sun.

 

What do you eat? just noodle soup? you don't say your age? or whether you exercise and how much?

Hello scuba and thanks for your reply. 
Age - approaching 50

Exercise - gym every other day 

Weekday sun exposure low - limited by work. Weekend - no limit but don’t sunbathe anymore. 

Weekday lunch- e.g. tuna/egg/salad wholewheat sandwiches. Bread probably doesn’t help glucose levels. 
Week day evenings - e.g. meat/fish/vegetables. 

Weekends - eat at wife’s family house or out. Usually end up with rice/noodles in some form. Need to get on top of that.  

 

[Mike Lister]

2 hours ago, guru said:

Hello. I have blood work done at samitivej Sukhumvit every 4 months or so since 2022 and having trouble with my Vitamin D levels and uric acid levels. I obviously get advice from the doc but I’ve come here for any extra tips. 
 

Uric acid: their normal range is quoted as 3.5-7.2. I started at 9.5 and it got down to 7.4 and remained stable for a while but then went back up to 9.4 and now it’s back down to 8.6. No matter how much I reduce my alcohol and chicken consumption I haven’t reached the window and don’t know why it’s fluctuating. Not on any medication and no symptoms at all e.g. gout. 
 

Vitamin D: their normal range is 30-100. I started at 18 in mid 2022 and she put me on 20,000 units of vit D three times a week and a calcium supplement. 6 months later vit D was still only 25 so she increased the dose to 20k units four times a week. It then rose steadily reaching 35 in August and I was in the window. She then reduced the dosage slightly and said no need to take calcium daily now but just whenever I wanted to as a supplement but I never took any.  I’m now back out of the window and down to 25 so she has now increased dosage to 20k five times a week and put me back on calcium. I understand that calcium needs vit D for absorption so it makes sense that when my vit D is low she prescribes a calcium supplement but does it also work the other way round because the only thing I did differently was not take calcium. I can’t find any google literature on this but she said could be. No noticeable symptoms but just been reading the BBC website where they have reported a link between low vit D levels and early onset dementia.
I know about sunlight but my work involves being indoors during the day. I do get out at the weekends though but still cautious. After a reckless sun bathing youth, a recent skin cancer scare on a mole on my back came back negative from the biopsy. 

Cholesterol: this seems to be doing well and my goal is to get off statins eventually. I was  on 20mg daily in 2022 but shes gradually decreased dosage and I’m now down to Atozet 10mg/10mg three times per week. Hopefully next visit gets this decreased further. 
 

Glucose: HbA1c hasn’t budged from 5.7 which she says is just in the  prediabetes window. I blame the rice/noodles everywhere when all I want is meat/fish and vegetables. Not sure what meat I can eat though because  red meat affects cholesterol and chicken affects my uric acid.  Anyway I need to get in control of this by myself. 
 

One last thing, when I had the exercise stress test false positive last year, the CT scan gave 0% calcium in the arteries.  Will all these calcium supplements make their way into my arteries and change my clean record? Samitivej Doc says no but Dr Google suggests otherwise. 

Your A1C is just fine, it is not pre diabetic.

 

Vit D and Calcium - have you checked your TSH and FT4? Thyroid issues may be involved, I say this having just had mine removed and been through this loop..

[scubascuba3]

12 minutes ago, guru said:

Hello scuba and thanks for your reply. 
Age - approaching 50

Exercise - gym every other day 

Weekday sun exposure low - limited by work. Weekend - no limit but don’t sunbathe anymore. 

Weekday lunch- e.g. tuna/egg/salad wholewheat sandwiches. Bread probably doesn’t help glucose levels. 
Week day evenings - e.g. meat/fish/vegetables. 

Weekends - eat at wife’s family house or out. Usually end up with rice/noodles in some form. Need to get on top of that.  

 

Diet looks ok, why you on statins? what caused it? BMI healthy weight for decades?

[guru]

7 minutes ago, Mike Lister said:

Your A1C is just fine, it is not pre diabetic.

 

Vit D and Calcium - have you checked your TSH and FT4? Thyroid issues may be involved, I say this having just had mine removed and been through this loop..

Hello Mike and thanks for your reply. 

TSH 2.284

Free T4 1.00

Total T4 8.77

 

[Mike Lister]

12 minutes ago, guru said:

Hello Mike and thanks for your reply. 

TSH 2.284

Free T4 1.00

Total T4 8.77

 

Those numbers look good, perhaps check again in say 6 months and look for consistently rising or falling numbers.

[Tropicalevo]

I can only share my experience re Uric Acid level.

Early 20's and having a health check for a new job.

Doc said - how bad is the pain for the gout?

What gout?

You have a very high uric acid level - gout.

From me, nothing. So he put me on a 'special' diet for 6 months including no alcohol.

Uric acid level still the same after six months (hereditary) so I went back to the normal, torrid life of a 20 something year old. (Lots of alcohol.)

Then when I hit my early 60's - gout attacks. Often. Very painful.

A doctor friend recommended allopurinol. Start on a low dose (100 mg) and build up to 300 mg per day.

Since then - zero gout attacks. I still eat and drink everything that I want to. The allopurinol prevents the attacks for the last 12 years.

After my annual health check, doc reads the numbers and I adjust the dosage accordingly. Now down to 150 mg per day.

 

[guru]

18 minutes ago, scubascuba3 said:

Diet looks ok, why you on statins? what caused it? BMI healthy weight for decades?

No unfortunately body weight not always healthy. It used to be but then I tore my ACL and meniscus playing football. I took far too long to pluck up the courage to get down to see Dr Panya at Bumrungrad to have the knee operation. During that time I gained too much weight, not exercising and not eating healthily. After recovery things got better but the trigger for starting blood work was last year when a friend of the same age dropped dead from a heart attack with no prior warning signs. I booked myself in for a health check up and started to self reflect on my lifestyle. All the bad cholesterol numbers were high. I tried diet first but it did not lower significantly so the doc suggested statins. She initially said I would be on them for life but I don’t want that, so since last year she’s gradually took me down from daily to 3 times a week on the lowest dose. She said if I stop cold turkey it would probably rebound to high levels so she said the best way is to gradually reduce the dosage and frequency to try and get off them. I’ve now managed to lose weight, exercise more and eat more healthily. I’m still not where I want to be with my weight but it’s slowly going in the right direction. 

[guru]

51 minutes ago, Tropicalevo said:

I can only share my experience re Uric Acid level.

Early 20's and having a health check for a new job.

Doc said - how bad is the pain for the gout?

What gout?

You have a very high uric acid level - gout.

From me, nothing. So he put me on a 'special' diet for 6 months including no alcohol.

Uric acid level still the same after six months (hereditary) so I went back to the normal, torrid life of a 20 something year old. (Lots of alcohol.)

Then when I hit my early 60's - gout attacks. Often. Very painful.

A doctor friend recommended allopurinol. Start on a low dose (100 mg) and build up to 300 mg per day.

Since then - zero gout attacks. I still eat and drink everything that I want to. The allopurinol prevents the attacks for the last 12 years.

After my annual health check, doc reads the numbers and I adjust the dosage accordingly. Now down to 150 mg per day.

 

Hello tropic and thanks for your reply. 
Oh goodness I hope I can get my uric acid levels down so it doesn’t develop to  gout later. I remember my grandad suffered from gout so it’s interesting that you say your high uric acid was hereditary. 

[Yellowtail]

A lot of otherwise heathy foods can raise your uric level. 

[scubascuba3]

28 minutes ago, guru said:

No unfortunately body weight not always healthy. It used to be but then I tore my ACL and meniscus playing football. I took far too long to pluck up the courage to get down to see Dr Panya at Bumrungrad to have the knee operation. During that time I gained too much weight, not exercising and not eating healthily. After recovery things got better but the trigger for starting blood work was last year when a friend of the same age dropped dead from a heart attack with no prior warning signs. I booked myself in for a health check up and started to self reflect on my lifestyle. All the bad cholesterol numbers were high. I tried diet first but it did not lower significantly so the doc suggested statins. She initially said I would be on them for life but I don’t want that, so since last year she’s gradually took me down from daily to 3 times a week on the lowest dose. She said if I stop cold turkey it would probably rebound to high levels so she said the best way is to gradually reduce the dosage and frequency to try and get off them. I’ve now managed to lose weight, exercise more and eat more healthily. I’m still not where I want to be with my weight but it’s slowly going in the right direction. 

I'm guessing you eat junk food but you haven't mentioned it, pizza, curry, deep fried chips, pastries, cakes, ice cream, chocolate etc? if so how much and how often?

 

anyway, you have to be honest with yourself, big people often seem to eat little, but binge in private.

 

focus on a healthy diet, cut out junk food to once a week or less

[guru]

13 minutes ago, Yellowtail said:

A lot of otherwise heathy foods can raise your uric level. 

Hello yellowtail and thanks for the reply. I’m beginning to think I need to see a nutritionist. I thought I was doing myself a favour by eating chicken, tuna and asparagus but maybe that’s my uric acid downfall. Looking at a range of food on different websites, it’s quite confusing to know what to eat if I want to lower cholesterol, uric acid and glucose. 

[Tropicalevo]

13 minutes ago, guru said:

it’s quite confusing to know what to eat if I want to lower cholesterol, uric acid and glucose. 

For uric acid - eat low protein. It's the high protein stuff and alcohol that cause the problem.

[guru]

54 minutes ago, scubascuba3 said:

I'm guessing you eat junk food but you haven't mentioned it, pizza, curry, deep fried chips, pastries, cakes, ice cream, chocolate etc? if so how much and how often?

 

anyway, you have to be honest with yourself, big people often seem to eat little, but binge in private.

 

focus on a healthy diet, cut out junk food to once a week or less

Yes the consumption of junk food was probably the root cause of it all. Reduced junk food after first blood test but I still couldn’t manage to get cholesterol down just by this. Started statins and further reduced junk food to a pizza etc on Saturdays. Now all cholesterol has been normal this year but I don’t know how much of this normality is from my further reduction of junk food and how much is from the three times a week Atozet 10mg/10mg. 

[scubascuba3]

8 hours ago, guru said:

Yes the consumption of junk food was probably the root cause of it all. Reduced junk food after first blood test but I still couldn’t manage to get cholesterol down just by this. Started statins and further reduced junk food to a pizza etc on Saturdays. Now all cholesterol has been normal this year but I don’t know how much of this normality is from my further reduction of junk food and how much is from the three times a week Atozet 10mg/10mg. 

Eating a healthy diet will reduce cholesterol, if you are still on those drugs then your Dr can advise reducing them

[guru]

2 hours ago, scubascuba3 said:

Eating a healthy diet will reduce cholesterol, if you are still on those drugs then your Dr can advise reducing them

Yes scuba thats’s the goal. I’m on statins three times a week now and will have had blood work done three times by this time next year. I’m hopeful I’ll be off them by then. 

I’m also hopeful that blood sugar will mirror this and decrease for the same reasons. 

I know from past experience that Vit D will increase with the 20k unit supplements so not worried there. 

I do not feel confident that I’m in control of my uric acid though. Doc said reduce alcohol so I didn’t drink for 6 weeks before last blood test but still didn’t reach the window. Will have to do some more research to see what other foods I eat are high in purines. I know about chicken so will reduce that further. 
 

[Sheryl]

@guru

 

First off - you need to see an endocrinologist and have your parathyroid function checked!! Hyperparathyroidism can cause both low Vitamin D and elevated uric acid. It can also elevated blood glucose. Investigating this should be your first priority.

 

If your parathyroid checks out OK then you probably just  need supplemental Vit D for the long term (especially since you must work indoors). You do not mention your age.....  production and metabolism of Vit D decreases with age, raising the requirement to levels many cannot get through food and sun alone.

 

The recommended minimum daily Vit D intake up to age 70 is 600 iu but this increases to 800 iu after age 70 and some experts believe it should be 1,000 at that age.

 

Depending on your age I would suggest rather than these intermittent high doses of Vit D, a daily dose of  400 - 600 iu. depending on your age. This is a completely safe dose. You may have trouble finding this dosage in Thailand (which may be why your doctor had you take intermittent larger doses) but it is easily obtained on iHerb  https://www.iherb.com/pr/now-foods-vitamin-d-3-400-iu-180-softgels/6108

(You can however get these lower Vit D doses in combination with calcium here in Thailand easily enough. See below re Calcium).

 

Whether you also need calcium supplementation depends on your diet, age  and bone health, none of which did you specify, and also whether your paraythroid function is normal.

 

The recommended daily calcium intake is 1000 mg for men aged up to 70 and 1200 mg for men aged 71 or older.  Most adult men can get this from their diet, but of course it does vary. 

 

If you do need calcium supplementation, regarding your concern about it causing calcium build up in your arteries, this can be mitigated by dividing calcium supplementation (if needed at all) into 2-3 doses daily as it is the sudden surge in serum calcium that is hypothesized to potentially cause a problem (still not completely clear as most studies on this involved post-menopausal women -- often ones with osteoporosis or osteopenia -  not men). However best option is just to make sure you get enough from your diet.  See https://healthybonesaustralia.org.au/wp-content/uploads/2022/10/calcium-rich-food-list_en_1_healthybonesaustralia-iof-version-draft-1.pdf

 

Regarding your HB1Ac, I really would not worry about a level of 5.7 especially if you are over 60. Just monitor it periodically (once or twice a year). The "prediabetic" range is 5.7 % to 6.4 % but plenty of people at the lower end of that never progress to diabetics. If it starts inching up (6.0 and above) then more reason to be concerned.

 

Regarding your elevated uric acid, as initially mentioned this might be due to a hyperactive parathyroid. If it is not then:

- what (non-gout) medications are you on? As some can cause this 

- how much beer/wine/other alcohol do you consume? This is a prime cause in many cases (and will also affect your blood glucose)

-is there a family history of gout or uric acid kidney stones?

 

If you have no history/strong family history of uric kidney stones or gout then consensus is that hyperuricemia need not be treated until/unless levels rise above 12. See https://www.ccjm.org/content/ccjom/69/8/594.full.pdf

 

 

 

 

[guru]

2 hours ago, Sheryl said:

@guru

 

First off - you need to see an endocrinologist and have your parathyroid function checked! ! Hyperparathyroidism can cause both low Vitamin D and elevated uric acid. It can also elevated blood glucose. Investigating this should be your first priority.

 

If your parathyroid checks out OK then you probably just need supplemental Vit D for the long term (especially since you must work indoors). You do not mention your age..... production and metabolism of Vit D decreases with age, raising the requirement to levels many cannot get through food and sun alone.

 

The recommended minimum daily Vit D intake up to age 70 is 600 iu but this increases to 800 iu after age 70 and some experts believe it should be 1,000 at that age.

 

Depending on your age I would suggest rather than these intermittent high doses of Vit D, a daily dose of 400 - 600 iu. depending on your age. This is a completely safe dose. You may have trouble finding this dosage in Thailand (which may be why your doctor had you take intermittent larger doses) but it is easily obtained on iHerb  https://www.iherb.com/pr/now-foods-vitamin-d- 3-400-iu-180-softgels/6108

(You can however get these lower Vit D doses in combination with calcium here in Thailand easily enough. See below re Calcium).

 

Whether you also need calcium supplementation depends on your diet, age and bone health, none of which did you specify, and also whether your paraythroid function is normal.

 

The recommended daily calcium intake is 1000 mg for men aged up to 70 and 1200 mg for men aged 71 or older. Most adult men can get this from their diet, but of course it does vary. 

 

If you do need calcium supplementation, regarding your concern about it causing calcium build up in your arteries, this can be mitigated by dividing calcium supplementation (if needed at all) into 2-3 doses daily as it is the sudden surge in serum calcium that is hypothesized to potentially cause a problem (still not completely clear as most studies on this involved post-menopausal women -- often ones with osteoporosis or osteopenia - not men). However best option is just to make sure you get enough from your diet. See https://healthybonesaustralia.org.au/wp-content/uploads/2022/10/calcium-rich-food-list_en_1_healthybonesaustralia-iof-version-draft-1.pdf

 

Regarding your HB1Ac, I really would not worry about a level of 5.7 especially if you are over 60. Just monitor it periodically (once or twice a year). The " prediabetic" range is 5.7 % to 6.4 % but plenty of people at the lower end of that never progress to diabetics. If it starts inching up (6.0 and above) then more reason to be concerned.

 

Regarding your elevated uric acid, as initially mentioned this might be due to a hyperactive parathyroid. If it is not then:

- what (non-gout) medications are you on? As some can cause this 

- how much beer/wine/other alcohol do you consume? This is a prime cause in many cases (and will also affect your blood glucose)

-is there a family history of gout or uric acid kidney stones?

 

If you have no history/strong family history of uric kidney stones or gout then consensus is that hyperuricemia need not be treated until/unless levels rise above 12. See https://www.ccjm.org/content/ccjom/69/8 /594.full.pdf

 

 

 

 

Thank you Sheryl for your detailed response.
 

I just went to see an endocrinologist at samitivej and pointed out my high uric acid/glucose levels and low vit d levels and asked her about ordering a parathyroid test. She disagreed after asking me a list of symptoms all of which I didn’t have.
 

She said she didn’t think it was necessary nor could she  justify ordering a parathyroid function test if using my insurance. She said abnormal parathyroid level results in abnormal calcium levels and she read me a list of symptoms of which I had none. She also said the low vit D could cause a false positive parathyroid result. She suggested taking the 100,000 vit D units per week for 4 months which she estimates will put me up to about 36 which is in the normal range. She said I could then ask for a parathyroid test which would be more reliable.
 

This samitivej endocrinologist disagreed with the samitivej cardiologist that I saw last week regarding calcium supplements. Even though my vit D is low at 25 today’s doctor says I do not need calcium supplements as I will get enough calcium through diet. She also said she doesn’t think it’s necessary to get a calcium and phosphate blood test today but to reevaluate in 4 months after next appointment and blood test. I am overweight and she obviously told me to reduce weight, by 10%. I’m 89kg. I’m hopeful to get that goal achieved this coming year. 
 

I could have not used my insurance and she would order every test I wanted but she said she still didn’t think any were necessary. The parathyroid test was 2400 baht. Calcium was 300 baht and phosphate I think was 400 baht. I have the choice of now waiting to reevaluate at next blood test in 4 months or go somewhere cheaper and pay by myself for the tests. However, I guess the problem is if the parathyroid comes back abnormal, is it a false positive due to my low vit D as warned about today. 

In response to your questions: 

My only current medication are statins and Vit D.
I have never suffered from gout or any effects of high uric acid so no medication. 
Family history of gout is only in maternal grandfather.  

Don’t think I’ve got any bone problems. 
My age - coming up to 50. 
Alcohol: did not drink for 6 weeks before last week’s blood test to see if that would have any significant results on uric acid. It did go down from 9.4 to 8.6. Is that significant? When I did not stop drinking before the blood test last year it went down from 9.5 to 7.5. On average I drink about half a dozen bottles of beer on some Friday nights after work but not every week of the year. 

Finally, she said the high cholesterol and high uric acid could be genetic. 
 

 

 

[scubascuba3]

Amazing to think someone could have low vit D in Thailand unless they cover up or don't spend much time outside, go for walks outside

[scubascuba3]

10 hours ago, guru said:

I am overweight and she obviously told me to reduce weight, by 10%. I’m 89kg. I’m hopeful to get that goal achieved this coming year. 

Check your BMI as it takes account of height as well.

 

Choosing a diet is a minefield, low carb keto type diets are quite popular but I regularly read negatives about these long term by people no longer doing it.

 

Easier to just eat healthier, carbs/starches and very important low fat, so stop the junk processed food or once a week max.

 

I like Dr John McDonald, but there are carb phobics on here that don't. Check YouTube 

[Mike Lister]

33 minutes ago, scubascuba3 said:

Amazing to think someone could have low vit D in Thailand unless they cover up or don't spend much time outside, go for walks outside

Vit D has a binding effect that is important to thyroid performance. Since I had mine removed last month, I'm taking 4,000 mg of calcium per day, and D3 three times a day and I spend a lot of time outdoors.

[scubascuba3]

2 hours ago, Mike Lister said:

Vit D has a binding effect that is important to thyroid performance. Since I had mine removed last month, I'm taking 4,000 mg of calcium per day, and D3 three times a day and I spend a lot of time outdoors.

Yes, unless a health condition you'd think getting enough Vit D in Thailand would be easy

[guru]

4 hours ago, scubascuba3 said:

Amazing to think someone could have low vit D in Thailand unless they cover up or don't spend much time outside, go for walks outside

I thought the same Scuba but then again I leave for indoors work during the week with the only sun exposure being when I walk to lunch. I thought I was getting enough sun by being outside at the weekends but obviously not. I go to the 24km airport bike lane at the weekend which is completely exposed to the sun but I put factor 50+ sunscreen on which is maybe part of the problem? After prior years of reckless sunbathing and sunburn I had a mole go strange two years ago which concerned the doctor. Biopsy was thankfully ok. Maybe it’s psychological on my part now and I’ve been more cautious of the sun since the biopsy and hence that’s when the low Vitamin D problems started. 

 

[Sheryl]

5 hours ago, scubascuba3 said:

Amazing to think someone could have low vit D in Thailand unless they cover up or don't spend much time outside, go for walks outside

Actually due to the harsh sun, low Vit D is especially common here. People tend to walk only in the shade or else early morning/late evening.

 

In addition, as people age their ability to produce Vit D from sunlight decreases. At the same time, by older age most people stop sun-bathing (if they ever did it) due to concerns about skin cancer.

[Sheryl]

15 hours ago, guru said:

Thank you Sheryl for your detailed response.
 

I just went to see an endocrinologist at samitivej and pointed out my high uric acid/glucose levels and low vit d levels and asked her about ordering a parathyroid test. She disagreed after asking me a list of symptoms all of which I didn’t have.
 

She said she didn’t think it was necessary nor could she  justify ordering a parathyroid function test if using my insurance. She said abnormal parathyroid level results in abnormal calcium levels and she read me a list of symptoms of which I had none. She also said the low vit D could cause a false positive parathyroid result. She suggested taking the 100,000 vit D units per week for 4 months which she estimates will put me up to about 36 which is in the normal range. She said I could then ask for a parathyroid test which would be more reliable.
 

This samitivej endocrinologist disagreed with the samitivej cardiologist that I saw last week regarding calcium supplements. Even though my vit D is low at 25 today’s doctor says I do not need calcium supplements as I will get enough calcium through diet. She also said she doesn’t think it’s necessary to get a calcium and phosphate blood test today but to reevaluate in 4 months after next appointment and blood test. I am overweight and she obviously told me to reduce weight, by 10%. I’m 89kg. I’m hopeful to get that goal achieved this coming year. 
 

I could have not used my insurance and she would order every test I wanted but she said she still didn’t think any were necessary. The parathyroid test was 2400 baht. Calcium was 300 baht and phosphate I think was 400 baht. I have the choice of now waiting to reevaluate at next blood test in 4 months or go somewhere cheaper and pay by myself for the tests. However, I guess the problem is if the parathyroid comes back abnormal, is it a false positive due to my low vit D as warned about today. 

In response to your questions: 

My only current medication are statins and Vit D.
I have never suffered from gout or any effects of high uric acid so no medication. 
Family history of gout is only in maternal grandfather.  

Don’t think I’ve got any bone problems. 
My age - coming up to 50. 
Alcohol: did not drink for 6 weeks before last week’s blood test to see if that would have any significant results on uric acid. It did go down from 9.4 to 8.6. Is that significant? When I did not stop drinking before the blood test last year it went down from 9.5 to 7.5. On average I drink about half a dozen bottles of beer on some Friday nights after work but not every week of the year. 

Finally, she said the high cholesterol and high uric acid could be genetic. 
 

 

Good that you saw n endocrinologist and certainly you should be guided by what this specialist advises.

 

Bringing the Vit D levels up to normal and then checking PTH makes sense to me.

 

 

 

[BigStar]

33 minutes ago, guru said:

I thought the same Scuba but then again I leave for indoors work during the week with the only sun exposure being when I walk to lunch. I thought I was getting enough sun by being outside at the weekends but obviously not. I go to the 24km airport bike lane at the weekend which is completely exposed to the sun but I put factor 50+ sunscreen on which is maybe part of the problem? After prior years of reckless sunbathing and sunburn I had a mole go strange two years ago which concerned the doctor. Biopsy was thankfully ok. Maybe it’s psychological on my part now and I’ve been more cautious of the sun since the biopsy and hence that’s when the low Vitamin D problems started. 

 

 

The sun exposure needs to be over at least 1/3 of your body. Yes, sunscreen a possible problem, though I'm advocating overdoing sun exposure. And you could get melanoma or basal cell carcinoma or squamous cell carcinoma w/o sun exposure.

[scubascuba3]

1 hour ago, guru said:

I go to the 24km airport bike lane at the weekend which is completely exposed to the sun but I put factor 50+ sunscreen on which is maybe part of the problem?

Yes it is, i cycle a lot, with many others and none wear sunblock, usually morning cycling back before 12, none have Vit D deficiency 

[scubascuba3]

1 hour ago, Sheryl said:

Actually due to the harsh sun, low Vit D is especially common here. People tend to walk only in the shade or else early morning/late evening.

 

In addition, as people age their ability to produce Vit D from sunlight decreases. At the same time, by older age most people stop sun-bathing (if they ever did it) due to concerns about skin cancer.

They also cover up ridiculously when playing golf, I thought it was more about them not wanting darker skin rather than fear of cancer

[BigStar]

2 hours ago, BigStar said:

 

The sun exposure needs to be over at least 1/3 of your body. Yes, sunscreen a possible problem, though I'm advocating overdoing sun exposure. And you could get melanoma or basal cell carcinoma or squamous cell carcinoma w/o sun exposure.

 

not advocating, that is.