Re: The Truth About Vitamin D (D metabolites test)

For reading this thread in the future, I also found the Marshall Protocal for getting lab tests done.

http://www.marshallprotocol.com/forum2/366.html


D-METABOLITES TESTS

You may post your D-metabolites results in 'Help with understanding D-metabolites tests' for analysis. First, please read carefully 'How to post your D-metabolites tests results'.

Apart from the symptoms or diagnosis being indicative, the way to find out if the Marshall Protocol may be applicable to any person or their disease is to test the D Metabolites.

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.

Labs

For information about which labs to use to ensure that the sample for the 1,25-D test is frozen, see this post.

We do not recommend using Labcorp for your D metabolites tests. Their results have proven unreliable even when the sample was shipped to them frozen. This may be due to a policy of allowing the frozen sample to thaw in the refrigerator before they run the test. These are expensive tests and you would be taking a chance on their accuracy by using Labcorp. If that is your only option, we can tell if the test is accurate only when the result of the 1,25-D is elevated. If it is low, we cannot know if it's a lab error or a true result.

Note: 1,25D levels are very minute. 1 p gm/ml is one millionth part of one millionth part ( pico is 10 raised to the -12 power) and the pathology to measure such levels is extremely sensitive to correct handling. For every gm of Vitamin D taken in barely one part in 1000 ends up as the double hydroxylated 1,25-D.

Diagnostic ICD codes for payment

The best disease codes for 1,25-D and 25-D testing are those for osteoporosis. All sarcoidosis patients are at risk for osteopenia or osteoporosis and most patients with other inflammatory diseases complain of fatigue.
We have had no reports of insurance or Medicare refusing to pay for these tests when these codes are used:

733.00 Osteoporosis, unspecified
733.90 Osteopenia
135 Sarcoidosis
275.40 Unspecified disorders of calcium metabolism
275.42 Hypercalcemia
278.4 Hypervitaminosis D
780.9 Fatigue
CPT codes are as follows:
--Vitamin D (1,25): 82652
--Vitamin D (25OH): 82306

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.

For 1,25-D test data, see:
Marquette General Health System

It is not necessary to fast for these blood tests. The D-metabolites tests can be done whether or not the patient has been avoiding ingested Vitamin D or sun/lights. This information is taken into consideration when assessing the test results. One very small (7 patients), 1982 study demonstrated that the serum concentration of 1,25-D fluctuated with the menstrual cycle. Levels of 1,25-D were shown to be dramatically higher near ovulation in women not on the pill. The higher the level, the more persuasive the evidence will be for your doctor. Therefore, you may wish to have your blood drawn as close to midcycle (day 15) as you can.

OTHER INFLAMMATORY MARKERS

ACE or angiotensin-converting enzyme
"Elevated ACE indicates the same as the 1,25-D and therefore adds nothing to the interpretation, except an increased level of confidence. On the other hand, if ACE is normal (as so many are), the ACE gives a decreased level of confidence. Nevertheless, if cost is not a factor, I always like to see as much data as I can." Dr. Trevor Marshall, PhD

C Reactive Protein are inflammatory markers which, if elevated, return to baseline along with Triglycerides, Alkaline Phosphatase and 1,25D as the MP does its job. These markers typically start to drop after about 6-12 months.

SED rate will (hopefully) go way up in the early stages of the Marshall Protocol indicating that bacteria are being killed, and the body's immune system is dealing with them. Later on (at 12 months or so) the SED rate will remain closer to normal, as fewer organisms are being killed. Eventually it returns to baseline.

Optional tests which may be helpful if affordable

A Complement C3a assay and Soluble Interleukin 2 Receptor (sIL2R) may also be used to measure inflammatory activity. They can help to confirm possible errors in the 1,25-D assay or to confirm that inflammation is not so widespread but it is usually not necessary to do these tests.

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:

1. The D-metabolites can be done nonfasting but it wouldn't hurt to fast. Either way is fine.

2. No food restrictions. Avoiding ingested Vitamin D is recommended as a change in your eating pattern to help you recover your health. It will not change the D-metabolites results unless you've been diligently avoiding Vitamin D for months. We do need to know when you post if you have been supplementing so we can take that into account for the assessment.

3. The test for 25-D is done routinely at many labs and does not require special handling. When the 1,25-D is sent out, the same blood specimen is probably used for both tests and they can both be frozen. Freezing preserves the specimen and will not harm it even if it isn't necessary.