Wednesday, June 8, 2011


In this article, we’ll focus on the most common tests, those that examine the state of our blood and liver functions. While these tests are usually included in every common blood testing procedure, they are no less important than the previously discussed tests in this series. Knowing the state of your blood cells, for example, gives you a clear indication of your oxygen delivery system. Optimal oxygen delivery to tissues of the body translates into maximum energy and efficiency for your workouts.

Knowing the condition of your white blood cells provides information about your immune system status. Unless your immune system is functioning at top level, you will be subject to any disease-causing organism you’re exposed to, including the sundry bacteria and viruses that are ubiquitous in everyday life.

      Having an optimal immune system also helps protect you against the onset of such diseases as cancer. The older you get, the greater your chances of acquiring some type of cancer, and this is directly because of a weakening of immune defenses with age. Certain lifestyle habits are also known to dampen immune response, regardless of age. These negative immune factors include poor nutritional habits; overtraining; smoking; and not getting sufficient rest and sleep.

To fully understand what the complete blood cell count (CBC) measures, you first need a basic course in how the immune cells function.

                                          How the immune cells function

Blood cells are produced in bone marrow, through a process called hematopoiesis. Red blood cell production is regulated by a hormone synthesized in the kidneys called erythropoietin. Anabolic steroid drugs are known to increase the kidney’s production of erythropoietin (EPO), and were formerly used to treat certain kinds of anemia. The use of steroids for this purpose has been superseded by recombinant DNA or artificially produced EPO.

When oxygen levels in the blood decline, EPO stimulates the bone marrow to produce more red blood cells (RBC). Athletes have taken advantage of this by using EPO drugs as a means of blood doping. Since EPO reliably increases RBC, which equals greater oxygen delivery to muscles and less muscle fatigue, the effect of using EPO is similar to that of old-style blood doping. In old style blood doping, some blood was withdrawn from an athlete, and later reinfused before a major athletic event, thereby packing the blood with a surfeit of RBC’s. Unfortunately, doing so may also result in an excess number of blood cells, leading to a pathological thickening of the blood that not only reduces blood flow, but also increases the risks of internal clotting and possible stroke occurrence.

Red blood cells include a protein called hemoglobin that carries oxygen to body tissues. The production of hemoglobin is affected by various nutrients, as is red blood cells themselves. These nutrients include iron, vitamin B6, folic acid, B12, copper and others. Red blood cells normally live for 120 days before being broken down in the liver.

White blood cells (WBC) have a far shorter existence compared to RBC. Although far larger than RBC, white blood cells are outnumbered by RBC by about 1,000 to 1. The numbers of WBC, however, can double within hours, since these are the true soldiers that make up our immune defense. As such, they can be called to action against various types of noxious invaders, or conditions, such as tissue trauma, injury, and inflammation. In fact, WBC participate in the inflammatory process that occurs in muscle following an intense training session. The WBC are drawn to the area by chemicals or cytokines released by damaged tissue.

The various specific types of WBC include the following:

Polymorphonuclear neutrophils- also known as “polys,” they are the first line of defense against bacterial invasion, and work through phagocytosis, a process involving engulfing and removing foreign agents in the body. Once activated, they cruise the blood for about 6 hours, and when they’ve ingested bacteria and other debris, they die and become the main component of pus.

Monocytes- These are the largest of the blood cells, and also work to remove injured and dead cells. When released from bone marrow, monocytes are still immature, and mature only after they enter tissue, when they convert into macrophages. Increased monocytes in the blood is a good indication that the recovery process is going well.

Eosinophils- Found in the skin and lungs, they are involved mainly in inflammatory and allergic reactions. Some scientists think that these particular WBCs were the primary defense against worm infestation in ancient man.

Basophils-Also called mast cells, release heparin and histamine, and are thus the major effector of symptoms evident during allergic reactions. The heparin released from basophils decreases blood clotting, thus allowing other WBCs to circulate easier to damaged tissues.

• Lymphocytes- These WBCs fight bacterial and viral onslaughts into the body. They come in two types: B and T cells. T-cells are so-called because they develop in the thymus gland, located in the center of the chest. B-cells develop in the bone marrow. T-cells are subdivided into various other types, such as killer T-cells, which are particularly active against tumors and viruses; and suppressor and helper T-cells, with the latter being a target of the HIV virus.

                                                     The CBC tests

Here are the various blood cell tests, and what they mean:

Reticulocyte count- Reticulocytes are immature red blood cells. In men, the normal lab value for these cells is 0.5-1.5% of total erythrocytes (red blood cells). The value is higher during infections, liver cirrhosis; folic acid deficiency (folic acid is required for RBC to mature); and during bone marrow failure. The number is also elevated in anemia.

• Hemoglobin-As noted, the hemoglobin level is an indicator of the oxygen-carrying capacity of the blood. The normal values for men are 14-18 grams per deciliter of blood; women, 12-16. Hemoglobin levels drop during iron-deficiency anemia, or during overhydration. A higher than normal level may point to polycythemia, or excessive number of red blood cells, as may occur with use of EPO drugs or blood doping procedures. Higher levels of hemoglobin also may indicate dehydration, shock, or may be an adaptive response to those living or training at higher altitudes characterized by lower oxygen levels. In this case, the body compensates by producing more EPO, which leads to higher numbers of RBC and hence, higher hemoglobin levels.

Hematocrit- This test shows the concentration of RBC, and is an indicator of the thickness or viscosity of the blood. The normal level in men is 40-52%; women, 38-47%.The factors that increase hemoglobin also increase hematocrit. Having too thick a blood level not only interferes with oxygen delivery, but greatly increases the chances of having a stroke. The slower the blood circulation, the greater the odds of internal blood clotting, and these clots may occlude an artery in the brain, resulting in a stroke. An elevated hematocrit, indicative of polycythemia, is the most common side effect seen in men over 40 undergoing testosterone replacement therapy.The effect is rare in younger men. Studies show that this particular side effect is mostly linked to use of long-acting injectable testosterone drugs, especially when used in weekly doses of more than 150 milligrams.

• Mean corpuscular volume (MCV)- This test is an indicator of the size of RBCs. The size of the cells points to possible types of anemia. Normal value is 80-90 microns (men); 82-98 (women).

• Mean corpuscular hemoglobin concentration- (MCHC)- This measures the average level of hemoglobin in a single red blood cell. Normal values, 32-36%. Again, abnormal results point to anemia.

• Mean corpuscular hemoglobin-(MCH)- This shows the average weight of hemoglobin. Determined by dividing total hemoglobin by total RBC count. Normal is 27 to 31 picomoles/RBCAgain, an indicator of anemia when abnormal.

• White blood cell count (WBC)-This measures the number of leukocytes in one cubic milliliter of blood. Normal is 5,000 to 10,000. When low, it points to viral infections;bacterial infection; and toxic reactions to various heavy metals. When high, it could also point to other types of bacterial infections and leukemia, a cancer of the blood. Tissue injuries, such as burns, heart attacks, and others, also increase WBC counts. The greater the increase in WBC, the greater the intensity of infection.

• WBC differential: neutrophil count- This measures neutrophils in the blood. The value is low during infections, and with use of certain drugs. The value increases with other types of infection, such as herpes, gonorrhea. Taking too much thyroid drugs can also increase the neutrophil count.

• WBC Differential: Eosinophil count- Measures eosinophils, which as noted earlier, are the WBCs specific to allergies. Low levels are related to increased insulin levels in the blood;ACTH from the pituitary gland;After surgery;or during mental distress. High levels occur during any type of allergic-related disease, such as asthma,hay fever, or food or drug sensitivity. Interestingly, overtraining also leads to elevated eosinophil counts.

Basophil count- Measures basophils.  Low levels during stress; hyperthyroidism;and during ovulation and pregnancy. Higher levels with cancer; Anemias.

Monocyte count- Low monocytes are rare. High levels point to various types of infection, including hepatitis; and some types of autoimmune diseases.

•Lymphocyte count-Low levels point to stress from burns or tissue trauma; Increased cortisol levels; and during HIV infections. High levels also point to infections, including mumps, influenza, and infectious mononucleosis.Also high during leukemia and excess thyroid release.

The usual common blood tests also measure various electrolytes or minerals in the blood. Potassium is usually kept within a tight range. Either too much or too little can cause heart rhythm disturbances. Some competitive bodybuilders have run into problems with elevated potassium levels after ingesting both a potassium-sparing diuretic, such as Aldactone, along with supplemental potassium at the same time. The drug retains potassium in the body, thereby increasing the levels of the mineral to potentially toxic levels. The kidneys normally rapidly excrete excess potassium.

Certain other diuretic drugs promote the excretion of both sodium and potassium,leading to such symptoms as severe muscle cramps during posing. Taking insulin can also lower blood potassium levels, because insulin pushes potassium out of the blood into cells. Other symptoms of low blood potassium, besides muscle cramps, include weakness, confusion, abdominal distention; nausea; and heart rhythm disturbances.

Elevated blood potassium levels are unlikely to occur, unless potassium-sparing drugs are used with concentrated potassium supplements, or when the kidneys aren’t functioning properly. Crash injuries and burns also result in elevated potassium levels as the mineral is released into the blood from injured tissues. Signs of elevated blood potassium include irritability; nausea; vomiting;diarrhea;confusion;cramping; muscle weakness; slurred speech, and heart rhythm disturbances.

Blood sodium levels can drop during vomiting, excessive sweating, diarrhea, purposely decreased sodium intake. Bodybuilders, aware that sodium promotes water retention, often decrease their intake of sodium to nearly zero. But the body requires a minimum of about 220 milligrams a day of sodium, and without that minimal amount, side effects similar to potassium deficiency, such as muscle cramping, become evident. When sodium levels drop too low, coma and even death can result.

Chloride usually combines with sodium to form a salt. Common table salt is sodium chloride. Although overshadowed by sodium, chloride has its own important attributes. In the stomach, chloride combines with hydrogen ions to form hydrochloric acid, which is required for the initial stage of protein assimilation, as well as mineral uptake into the body. Chloride also helps maintain the vital acid/base balance of the blood, a feature it shares with other minerals, such as potassium. When sodium is low, chloride levels usually are, too, as reflected by blood tests.

Carbon dioxide also reflects acid/base status, as well as the bicarbonate level of blood. Bicarb is the major blood buffer needed to counter elevated acidity in the blood. Elevated levels of carbon dioxide point to alkalosis (excess alkalinity of the blood), while elevated levels indicate acidosis in the blood. Abnormal levels usually call for an arterial blood gas test to determine the root cause of the problem.

Glucose levels are dependent on when you last ate before the test. For best results, don’t eat at least 12 hours before the test. Elevated levels may mean diabetes, while low levels result from insulin usage or other hypoglycemic drugs. A fasting glucose level of over 126 points to the onset of type-2 diabetes. Normal levels are 100 or less, with ideal being about 80. Low blood glucose symptoms begin when the level dips under 60. The primary symptom of low blood glucose is extreme fatigue often accompanied by dizziness. Bodybuilders who have misused insulin injections have plunged into comas, since the primary fuel for the brain is glucose.

Of the common kidney blood tests, BUN and creatinine are included in the usual blood workup. BUN stands for blood urea nitrogen, and reflects the liver’s manufacture of urea, a protein metabolic waste product excreted through the kidneys. When the kidneys aren’t functioning properly, they become less efficient at excreting urea, causing a rise in BUN levels. On the other hand, simply eating more protein than usual--a common practice among bodybuilders and other athletes--can also lead to an elevation of BUN. BUN also increases when you’re dehydrated, as in not consuming enough fluids.

Serum creatinine is a more specific test of kidney function compared to BUN. Creatinine is the major metabolic waste product of creatine, and is produced at a constant rate dependent on skeletal muscle mass. Most doctors are alarmed when they view high blood creatinine levels, since this often means kidney problems. But taking megadoses of supplemental creatine, as occurs during a creatine load phase, may also temporarily increase blood creatinine values, which are reflected in blood tests. As such, it’s prudent to tell your doctor that you are consuming creatine food supplements before you undergo a blood tests that measures creatinine levels. Some hapless bodybuilders have neglected to do so, leading their doctors to suspect impending kidney failure in these patients.

Finally, a word about liver tests. Nearly anyone who regularly lifts weights will show a minor elevation of a liver enzyme called ALT (formerly known as SGPT). While this enzyme is found in the liver, it’s also found in muscle, and when muscle tissue is damaged, as occurs during weight-training, the enzyme is released into the blood. During a blood test, this enzyme will show up as slightly elevated, leading many doctors to suspect liver problems--unless they are aware of the weight-training activity.

Don’t neglect the importance of blood testing. You should ensure that you receive such blood tests during every major physical checkup, or a minimal once or twice a year, more often if you suspect problems or use any type of anabolic drug regime. And you should demand to see the actual results of the tests. Don’t let your health provider patronize you by saying “everything is normal,”which tells you nothing. Such tests are your window into what’s really happening in your body, and can reveal problems that may not be readily apparent. Even more important, knowing how you stand can alert you to possible future problems that can be dealt with now.

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

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