High Serum LDH But Low CRP

[yerrag]

Both Serum LDH and CRP are markers for inflammation. In a test last Saturday I got the ff results:

LDH - 229 U/L; Range 135-225

CRP <6; NEGATIVE

Question: If there is tissue destruction as indicated by the leakage of LDH from tissues, why is the CRP marker negative?

Is it possible that my liver is not producing CRP? Or are there cases where CRP is negative when LDH is high? When does such a situation occur?

 

[Dr. C]

Why did you test for LDH? Just to monitor levels of inflammation? Does not sound like the best idea.

Recheck in a couple of days. If LDH keeps rising, you will need to see a good internal medicine doctor, as a high LDH may be an early sign of cancer.

 

[yerrag]

Why did you test for LDH? Just to monitor levels of inflammation? Does not sound like the best idea.

Recheck in a couple of days. If LDH keeps rising, you will need to see a good internal medicine doctor, as a high LDH may be an early sign of cancer.

I test LDH to monitor tissue destruction. It has consistently stayed on the border of the high range, at times slightly below and at times slightly above.It isn't increasing so far.

I tested LDH isoenzymes to get an idea of the source of tissue destruction. It shows isoenzymes 4 and 5 to be above range. Pointing to skeletal muscles. But isoenzymes 4 is just slightly higher than isoenzymes 5, and I narrowly escape being classified as iso 5 > iso 4, which would require liver tests.

But I still can't understand why ESR is 0 (negative) and CRP, being < 6, is negative as well.

 

[Dr. C]

CRP smaller than six is an unreliable value for the intention you are having. Now you only know that you don't have a bacterial infection.

I only test for hsCRP when looking for silient inflammation. That gives you levels like < 0.3, but some people may have 1.9 or 4.8. These people are having issues but they come back negative in the standard CRP panel.

If you are living a RP lifestyle, you might not have fasted for a long time. Maybe you have lots of senescent cells arround? I personally bent the RP model four times a year and fast for 5 days. That brings down any subclinical inflammation down to like zero.

 

[yerrag]

CRP smaller than six is an unreliable value for the intention you are having. Now you only know that you don't have a bacterial infection.

I only test for hsCRP when looking for silient inflammation. That gives you levels like < 0.3, but some people may have 1.9 or 4.8. These people are having issues but they come back negative in the standard CRP panel.

If you are living a RP lifestyle, you might not have fasted for a long time. Maybe you have lots of senescent cells arround? I personally bent the RP model four times a year and fast for 5 days. That brings down any subclinical inflammation down to like zero.

Thanks for the advice. I should get an hsCRP test then. I'll also test CPK (creatine phosphokinase) to get more clues on the cause of the high LDH.

I'm just beginning a fruit-based diet. I could transition to fasting, starting with a wet fast.

 

[yerrag]

Thanks for the advice. I should get an hsCRP test then. I'll also test CPK (creatine phosphokinase) to get more clues on the cause of the high LDH.

I'm just beginning a fruit-based diet. I could transition to fasting, starting with a wet fast.

I got results from my blood test-

hsCRP - 0.8 Range: <1.00

CPK - 102.74 Range: 55 - 170

It appears there's no inflammation, as based on these values. Yet my LDH is high.

My ESR, in case I failed to mention it, is 0.

So, I'm still clueless with my LDH being slightly above range.

 

[yerrag]

These are my LDH Isoenzymes Results:

LDH 1 = 21.9% (Ref 16.1 - 31.5)
LDH 2 = 31.2% (29.2 - 41.6)
LDH 3 = 23.6% (17.0 - 26.2)
LDH 4 = 11.7% (5.9 - 12.3)
LDH 5 = 11.6% (3.2 - 17.3)

These values can be described as isomorphic. From 001842: Lactate Dehydrogenase (LD) Isoenzymes | LabCorp :

The isomorphic pattern (total LD significantly high with no increase in percentage, of any fraction) is seen with neoplasia, cardiorespiratory diseases, hypothyroidism, infectious mononucleosis, and other inflammatory states, uremia, and necrosis.

However, I do not show symptoms of any of the above conditions, although I would not know what symptoms there are for neoplasia (cancer) and necrosis. Even so, I'm not alarmed yet as my LDH values are only slightly above range, and sometimes skirt in and out of range. But since my issue has centered on hypertension, I'm inclined to look at something related to my kidneys.

I wake up at night often to urinate, about 2-3x each night, and this indicates that my body is still playing catch up with excreting waste. It's not so much as my kidneys trying to achieve acid-base balance, as I have been taking enough bicarbonates to help my kidneys with achieving the balance. It may just be that I'm not getting rid of waste through my urine. My urine is clear, with no sediments where there should be (according to Dr. Morse). I also have seborrheic dermatitis, and I believe this is the result of waste being relieved from my body through the large pores of the scalp.

It could very well be that my lymphatic system is backed up, and maybe my lymph nodes are blocked. There could be inflammation here, and the high LDH could be coming from the lymphs. This would explain why the LDH isoenzyme test is isomorphic or normal, because the lymph eludes classification into any of the LDH isoenzyme categories.

It's good I'm seeing this now, as if my diagnosis is correct, I'm just at an early stage of lymphoma. I'm already taking steps to improve my kidney (and lymph) filtration rate, starting with therapy with an all-fruit diet. I hope to see my LDH values go down as well as see my kidneys' abilities improve, in the filtration rate as well as the ability to filter out waste.

 

[yerrag]

It could very well be that my lymphatic system is backed up, and maybe my lymph nodes are blocked. There could be inflammation here, and the high LDH could be coming from the lymphs. This would explain why the LDH isoenzyme test is isomorphic or normal, because the lymph eludes classification into any of the LDH isoenzyme categories.

I'm thinking that there could be another reason for my high LDH and low CRP: I let my high blood pressure stay high and not take any drugs to lower it.

The way I see it, I had been harboring periodontal aneerobic bacteria in my gums for as long as 15 years, without me knowing about it. This has led to my steadily increasing hypertensive condition. All this time, my body's defenses are working to protect me from the bacteria. The kidneys are a nexus for this bacteria. My serum albumin and uric acid are used to counter the ROS by-product of neutrophils employed to eat up the bacterias and toxins by phagocytosis. This would explain why my uric acid is high, serum albumin is low, and my neutrophils are high.

Because uric acid requires hypoxic conditions to be produced, the constriction of blood vessels in the kidneys allow such conditions. Not taking hypertensive drugs allowed my body to produce enough uric acid to counter the ROS production. Because there is enough supply of endogenous antioxidants, tissue destruction and inflammation is minimized. This is the reason CRP levels are low.

Why is LDH high? It's high enough to be considered barely above range, but low enough to be an early warning. It could also be this high because the issues that are hypoxic still have to produce energy, but because of the air vessel constriction, oxygen is limited and it has to run on anaerobic glycolysis, and plenty of LDH is produced to enable the process.

I've looked at literature and all point to CRP being high in cases of kidney diseases related to periodontal problems. But I'm not in that world, because I chose not to take hypertensive drugs.

 

[Dr. C]

So how did your LDH develop? Did it get up?

 

[yerrag]

So how did your LDH develop? Did it get up?

The first time I tested it two years ago, it was already high. It's not high by cancer standards, which are a magnitude higher. Mine has stayed just in and out of high range, and has been lingering in this tight range. I actually get tired of testing it, as it's just staying in this tight range.

 

[haidut]

The first time I tested it two years ago, it was already high. It's not high by cancer standards, which are a magnitude higher. Mine has stayed just in and out of high range, and has been lingering in this tight range. I actually get tired of testing it, as it's just staying in this tight range.

Mild elevations of LDH can also occur in hypothyroidism and liver disease. Have you done thyroid and metabolic panel (which usually includes liver) tests?

 

[yerrag]

Mild elevations of LDH can also occur in hypothyroidism and liver disease. Have you done thyroid and metabolic panel (which usually includes liver) tests?

This was from August 2016, the last time I did thyroid and liver tests:

Endocrine (no Reverse T3, unavailable):

• T3 -1.89 nmol/l {Normal Value 1.23- 3.07}
• T4 -112.60 nmol/l {66.00 - 181.0}
• Free T3 - 5.70 pmol/L {3.10 - 6.80}
• Free T4 - 17.53 pmol/L {12.0 - 22.0}
• TSH - 0.847 uIU/ml {0.27 - 4.20}

Liver :

• SGPT (ALT) - 22.7 U/L {Reference Value: 0 - 49}
• SGOT (AST) - 21.2 U/L {0 - 46}
• Alkaline Phosphatase - 46.0 U/L {38 - 111}
• Amylase - 137.9 U/L {28 - 180}
• Total Protein - 6.78 g/dL; 67.8 g/L {6.4 - 8.3; 64 - 83}
• Albumin - 3.74 g/dL; 37.40 g/L {3.5 - 5.0; 35 - 50}
• Globulin - 3.04 g/dL; 30.40 g/L {2.9 - 3.3; 29 - 33}
• A/G Ratio - 1.23 {1.2 - 1.5}
• Total Bilirubin - 0.44 mg/dL; 7.50 umol/L {less than 1.4; less than 24}
• Indirect Bilirubin - 0.30 mg/dL; 5.10 umol/L {less than 1.1; less than 19.0}
• Direct Bilirubin - 0.14 mg/dL; 2.40 umol/L {less than 0.30; less than 5.0}

The thyroid test isn't conclusive lacking a reverse T3 component, but my QTc, at less than 440 msec, is confirmed also by my Achilles tendon reflext test, which shows I'm not hypothyroid. My temperature waking up is around 36.8 and during the day goes to 37 C. My heart rate though can be better. I wake up now at 58, but during the day it goes to 75. It's only when I'm on plenty of niacinamide (2100 mg/day, but I've cut it down to 1500 mg per day as I 've felt hypoglycemic effects over time).

Is hypothyroidism being a factor in higher LDH on account of high lactate production, being that LDH is the enzyme enabling the conversion of pyruvate to lactate? I tested my lactate level (although a year later), and my lactate was on the low side of range (0.5 mmol/L, range at 0.4 - 2).

I believe that all this would eliminate hypothyroidism as a cause for my high LDH, but I could still be wrong.

As for liver, I haven't really given it a lot of attention but I should, not that you mention it. My focus has been on the kidneys, but I'll run a liver panel next time. It may uncover something that I've overlooked. Is there anything in particular I have to look at?

 

[yerrag]

Since my LDH is just above or below the high limit, and my hsCRP and ESR are low, it doesn't seem to be consistent with signs of tissue destruction (unless my liver fails to produce CRP, which isn't likely).

But I'm now taking note that I have RBC that's above range, as well as high hemoglobin values. And since red blood cells, having no mitochondria, rely on anaerobic glycolysis for energy production, it uses LDH to enable the conversion of pyruvate to lactate.

Could it be that my high LDH is simply the result of having high RBC's? And if this is true, then there is no tissue destruction going on.

And this should direct my focus on finding out why my RBC and hemoglobin values are high.

 

[Ella]

And this should direct my focus on finding out why my RBC and hemoglobin values are high.

Polycythemia vera?? too many rbcs produced in the bone marrow.

Are you taking steriods - testosterone or EPO? Do you live in a high altitude, this may explain low levels of lactic acid and increase in RBCs.

This is Ray's comments on elevated LDH.

Anemia of Chronic Disease and Leukemia
Estrogen is a stress and crisis hormone, so there’s a steady upward tendency in its effect with age, which is interrupted during the fertile years by progesterone. Progesterone decline usually starts around age 40 because of things interfering with thyroid function. Declining liver function and increasing pituitary activity influence the way problems develop. Oxygen tension is normally low in bone marrow, and stimulates constant cell proliferation, but when estrogen’s oxygen-wasting effect is added, it changes the balance of cell growth; its worst effect is to stimulate fibroblasts and collagen production in the marrow, displacing the red and white cells. Estrogen shifts cells from oxidative production of carbon dioxide to the glycolytic formation of lactic acid, tending to prevent normal differentiation of cell function. The effects of estrogen include the leakage of the lactic acid-forming enzyme LDH into the serum, and the increase of copper in the serum, and these are recognized as signs of CLL, but the genetic-clonal ideology of cancer prevents recognition of the metabolic pattern. Estrogen causes relative hyperventilation, reinforcing the cellular changes. CLL seems to be less common in people adapted to high altitude, where lactic acid formation is inhibited. (Reference)

 

[yerrag]

Polycythemia vera?? too many rbcs produced in the bone marrow.

Are you taking steriods - testosterone or EPO? Do you live in a high altitude, this may explain low levels of lactic acid and increase in RBCs.

This is Ray's comments on elevated LDH.

Anemia of Chronic Disease and Leukemia
Estrogen is a stress and crisis hormone, so there’s a steady upward tendency in its effect with age, which is interrupted during the fertile years by progesterone. Progesterone decline usually starts around age 40 because of things interfering with thyroid function. Declining liver function and increasing pituitary activity influence the way problems develop. Oxygen tension is normally low in bone marrow, and stimulates constant cell proliferation, but when estrogen’s oxygen-wasting effect is added, it changes the balance of cell growth; its worst effect is to stimulate fibroblasts and collagen production in the marrow, displacing the red and white cells. Estrogen shifts cells from oxidative production of carbon dioxide to the glycolytic formation of lactic acid, tending to prevent normal differentiation of cell function. The effects of estrogen include the leakage of the lactic acid-forming enzyme LDH into the serum, and the increase of copper in the serum, and these are recognized as signs of CLL, but the genetic-clonal ideology of cancer prevents recognition of the metabolic pattern. Estrogen causes relative hyperventilation, reinforcing the cellular changes. CLL seems to be less common in people adapted to high altitude, where lactic acid formation is inhibited. (Reference)

Unfortunately, I'm not taking any steroids nor do I live in a high altitude.

I looked back into my as far back as 2002, and my high RBC condition goes way back till then. It's only now that I began to pay attention to it. I suspect strongly that my condition came from my body adjusting to a new state. I was previously hypoxemic due to mercury toxicity. When my mercury toxicity was resolved, after removal of mercury amalgams and subsequent chelation, I was no longer hypoxemic. But my body was already used to low oxygen supply conditions, and it had difficulty adjusting to the new oxygen-rich supply state. This made it unable to expand blood volume, as the previous hypoxemic condition had the effect of limiting vasopressin secretion, and thus the body continues to excrete water and sodium, instead of using it to build blood volume. This is what I see applying to me. The following study shows how just several days of hyperbaric hypoxemia would have such an effect. In my case, I had been on hypoxemia for far longer, for as long as two decades at least.

Prolonged hypobaric hypoxemia attenuates vasopressin secretion and renal response to osmostimulation in men. - PubMed - NCBI

It seems that my new goal would be to reset my osmotic balance, to allow for blood volume expansion. This would lead to lower serum RBC and hemoglobin values. And with the volume expansion of blood, my blood pressure would go down. The current situation explains why I would urinate often at night, despite having good acid-base balance.

I think that with blood volume restored, there would be less need to increase RBC to compensate for low tissue oxygenation arising from low blood volume. With the lower RBC, my serum LDH values would correspondingly decrease.

I wonder if I can get a prescription of vasopressin to try out?

 

[Ella]

Have you ruled out all possible contaminants like cobalt?

Are you supplementing B12 as it contains cobalt. Cobalt increases EPO.

What about other b-vitamins?

Too much iron rich foods?

Are you supplementing with Vitamin C? I think you were.

Are you eating too much heme-protein, red meat, eggs, liver ? Perhaps reducing a little.

Are you supplementing T3?

I saw a dog last year with exactly the same problem. The vet could not find anything wrong. A reduction in the heme-proteins exchanging for white rice brought RBCs and EPO down.

I would start with looking at diet and removing supplements to find the source of contamination.

A diet rich in fruit and dairy will bring bp down. The sodium in the milk will help to maintain blood volume.

 

[haidut]

Since my LDH is just above or below the high limit, and my hsCRP and ESR are low, it doesn't seem to be consistent with signs of tissue destruction (unless my liver fails to produce CRP, which isn't likely).

But I'm now taking note that I have RBC that's above range, as well as high hemoglobin values. And since red blood cells, having no mitochondria, rely on anaerobic glycolysis for energy production, it uses LDH to enable the conversion of pyruvate to lactate.

Could it be that my high LDH is simply the result of having high RBC's? And if this is true, then there is no tissue destruction going on.

And this should direct my focus on finding out why my RBC and hemoglobin values are high.

How high is the RBC? Slight elevations can be due to endotoxin. And yes, elevated RBC can also cause slight elevations of LDH.

 

[yerrag]

Have you done thyroid and metabolic panel (which usually includes liver) tests?

Liver :

• 
  
  
  • SGPT (ALT) - 22.7 U/L {Reference Value: 0 - 49}
  • SGOT (AST) - 21.2 U/L {0 - 46}
  • Alkaline Phosphatase - 46.0 U/L {38 - 111}
  • Amylase - 137.9 U/L {28 - 180}
  • Total Protein - 6.78 g/dL; 67.8 g/L {6.4 - 8.3; 64 - 83}
  • Albumin - 3.74 g/dL; 37.40 g/L {3.5 - 5.0; 35 - 50}
  • Globulin - 3.04 g/dL; 30.40 g/L {2.9 - 3.3; 29 - 33}
  • A/G Ratio - 1.23 {1.2 - 1.5}
  • Total Bilirubin - 0.44 mg/dL; 7.50 umol/L {less than 1.4; less than 24}
  • Indirect Bilirubin - 0.30 mg/dL; 5.10 umol/L {less than 1.1; less than 19.0}
  • Direct Bilirubin - 0.14 mg/dL; 2.40 umol/L {less than 0.30; less than 5.0}

I got my liver test results today. I was surprised to find that my liver values have improved so much. I'm using Dr. Weatherby's optimal values to compare with my values, and my results look optimal. I can at least cross off my liver as a cause for my above range LDH values.

 

[yerrag]

How high is the RBC? Slight elevations can be due to endotoxin. And yes, elevated RBC can also cause slight elevations of LDH.

My RBCs are above range. I'm not sure if the high RBC is caused by endotoxin, as I've been minimizing on fibers for a while, and I eat raw carrots and cooked bamboo shoots, as well as occasionally use activated charcoal. I really think that if I could increase the blood volume, RBC, hemoblogin, hematocrit, and RDW would all come down.

@haidut do you think getting an ADH (vasopressin) test would be helpful? If I find that I'm low on vasopressin (which would make it easy to urinate and not retain water and electrolytes to increase blood volume), what would be the best way to increase vasopressin? Would taking vasopressin be helpful?

It's interesting that back in 2002, my LDH was low at 122, and my RBC, HGB, and HCT were all lower as well. Please see attached.

Incidentally, it seems that my RBC values are getting closer to range, although I have only two data points to work with this year. So it doesn't establish a trend. But I'm hoping that the trend sticks, and that I would have better readings over time. Maybe the LDH would go back to normal as well, and along with it I would see an increase in blood volume, and lower blood pressure as well. Maybe I should just sit this one out and let my body do its own healing.

 

[yerrag]

Have you ruled out all possible contaminants like cobalt?

Are you supplementing B12 as it contains cobalt. Cobalt increases EPO.

What about other b-vitamins?

Too much iron rich foods?

Are you supplementing with Vitamin C? I think you were.

Are you eating too much heme-protein, red meat, eggs, liver ? Perhaps reducing a little.

Are you supplementing T3?

I saw a dog last year with exactly the same problem. The vet could not find anything wrong. A reduction in the heme-proteins exchanging for white rice brought RBCs and EPO down.

I would start with looking at diet and removing supplements to find the source of contamination.

A diet rich in fruit and dairy will bring bp down. The sodium in the milk will help to maintain blood volume.

I was supplementing B12 for a time, but even in those times when I wasn't supplementing B12 for a while, my RBC has been high.
I have been supplementing a b-complex, but again even when I wasn't on the conplex, I saw no difference in my readings.
I have been avoiding cereals that are fortified with iron, but can't avoid getting some iron from meat, although lately I've been eating more gelatinous cuts.
I eat egg once a day, but still eat meat, though my lean meat consumption isn't much.
I tried T3 for a month, but have stopped. But even before I even touched T3, I already have high RBC and high blood pressure.

I was on a fruit only diet for 2 weeks just recently. Perhaps it was too short a time to see any improvements, but my blood pressure wasn't getting any better.

The problem I have with these lifestyle changes is that I see my siblings eat worse than I do, eating the things you tell me to avoid, but they have none of the problems I have. I see my issues having more to do with hypovolemia, related to frequent urination, as if my body isn't wanting to increase plasma volume, and instead wants to throw away all the water and the electrolytes I take. Even to the point of disturbing my sleep with frequent nighttime urination. Ray says the body should produce antidiuretic hormone at night to keep people from urinating at night. But I'm having to wake up 2-3x a night even when my acid-base balance is functioning well. It seems like I'm deficient in antidiuretic hormone or vasopressin.