RDW- An Overlooked Yet Low-Cost Biomarker For Cardiovascular Risk

[yerrag]

Title should be : An Overlooked Blood Marker that is as Effective as It is Low in Cost

About a month ago, I listened to a podcast of Patrick Timpone where he had a guest by the name of Dr. Tom Lewis. Tom Lewis had two interviews with Patrick: Hidden Infections Uncovered, on March 25 2019, and Testing For Chronic Diseases on March 7, 2019. It was an enlightening interview. One of the markers he mentioned that piqued my interest was RDW (Red Blood Cell Distribution Width), which I was vaguely familiar with as it comes as part of the the a more exhaustive CBC (complete blood cell count) test.

I bought his Kindle ebook (Uncovering Chronic Inflammation & Hidden Infections: The Untold Story Behind Chronic Disease Prevention & Reversal" at Amazon and this is what he has to say about it:

Did you know that the diameter of a red blood cell is greater than the diameter of a capillary - the tiny vessels of your circulatory system? This means that your red blood cells must elongate to "squeeze" through them - like a worm working its way through the soil. Doctors view red blood cell distribution width (RDW) as a measure of anemia. However, that is only a small part of the story. This measurement, often ignored in the standard of care (my emphasis- true, I couldn't find it in my past CBC tests from earlier providers, as I was going to see how my values were in my pre-hypertension days) is a profound measurement of your current health risk and future health prognosis. A complete blood cell count with differential includes the RDW data. Some labs are not publishing this data because doctors don't want it included in the reports. Thus the RDW becomes one less thing to explain. It is disappearing in the major medical websites like Mayo and WebMD too.

RDW needs to reemerge as an indicator because of its predictive value for chronic diseases, with cardiovascular diseases leading the list. A PubMed search that includes the term "red blood cell distribution width" in the "title only" yielded 349 articles. Many of the articles discuss the association between RDW and disease. About 42% of the articles tied abnormal RDW and cardiovascular diseases and 15% associated abnormal RDW with early mortality.

Since I have been suspecting that my hypertension is caused by plaques blocking my capillaries, I took a look at my latest CBC test results, and compared the values to the values on Dr. Weatherby's cheat sheet of Blood Chemistry and CBC Analysis, and sure enough my RDW values were outside optimal range (optimal range is tighter than the usual reference range):

RDW - 13.50%; reference range- 11.60-14.60; optimal range <13

I could now envision my red blood cells being squeezed through plaque-filled capillaries, and getting elongated. I could also appreciate why my blood pressure needed to be high in order to allow the red blood cell to squeeze through. You see, I have high blood pressure for the past 15 years. They're not just high, but very high. It went to as high as 240/140, but pressure has now been lowered to 180/120. These values would prompt a nurse at a hospital to be stressed and would make her direct me to the ER ward for some needed intervention. For those who don't know my condition, I have a log on my trials in lowering my blood pressure. I don't encourage you to read it though as it's too long and stands to be whittled down, like the first draft of a book that has no ending yet.

It is a part of my continuing research on my issue that I was happy to learn of the use of this simple and low-cost blood marker. For as low as $4 or less (in Manila), which is the CBC test, I could monitor the progress of my current thrust to lyse the plaque off my arterial blood vessels, especially the capillaries. As my treatment progresses, and as the plaque slowly gets removed, I am expecting to see lower and lower values of my RDW, which from the current 13.5%, would lower to below the 13% threshold of optimality, and continue to work its way down to a low value 0f around 11%, at least that's the hope. This would indicate that the red blood vessels don't need to be squeezed through capillaries at a high pressure to get through, and this would reflect also as lower blood pressure.

I did a search on this and came across this study: High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension

The study was able to make the conclusion that the degree of hypertension increases as the RDW value increases, such as shown in the following table:

 

[yerrag]

@Dan Wich This may be of interest to you.

 

[Dan W]

@Dan Wich This may be of interest to you.

It is indeed, thank you.

For as low as $4 or less (in Manila)

Life Extension is having their annual blood test sale that makes it not-horribly-expensive ($26) in the US for anyone interested.

 

[yerrag]

Glad there are sales there.

The cost of tests run up when we take these tests, and a lot of times in the past, I feel I'm just staring into numbers, unable to make sense of them. And when we really on our doctors, they only rely on reference values, which really don't make sense unless one is already way sick.

It's very helpful to have the optimal values on hand, instead of reference values. The cheat sheet you posted before of Dr. Weatherby with the optimal values of blood tests have become very useful for me. I rely on it a lot. It's not perfect, as many things are in the medicine field (like its take on TSH isn't Peaty or Broda Barnes-y), but its optimal ranges on many others are very useful.

On the subject of the CBC markers, I also found WBC and the differential counts results more easy to unpack and made useful for me, as they would help unmask bacterial and viral infections that mainstream doctors overlook. In my case, I had chronic periodontal infection for 15 years. I didn't know about it because that's the nature of periodontal infections, where anaerobic bacteria breeds under the gum and spew out bacteria and endotoxins throughout the body. But when I go back through my CBC records, I could see that my WBC had gradually increased over this stretch from 4.5 t0 7.5, and neutrophils from 50% to 74%, and comparing this to Dr. Weatherby's optimal range, I could see how I could be alerted to having chronic bacterial infection:

WBC optimal range: 5.0 - 7.5* vs. reference range of my lab: 4.23 - 9.07
Neutrophils optimal range:: 40 - 60 % vs. reference of my lab: 34 - 68%

*Note that on my WBC markers, Dr. Weatherby is actually on the lenient side on the high end of it. Dr. Tom Lewis (see OP) actually has WBC above 6 to already be a flag for some bacterial issues already.

What I've learned is that it's more important to know how to use these tests to be able to piece together a clear picture of what sickness we have, than to go on a spending spree on tests that we can't make any sense of. In the case of the CBC alone, there are markers there which would already alert us, for example, to a developing bacterial issue or to a developing cardiovascular issue. And the CBC is a very common and inexpensive test.

There is a tendency for our doctors to make us go through rounds of tests, and the tests themselves become a financial burden upon which no meaningful diagnosis come out of, and often it's the case that wrong diagnoses and treatment are given. This adds another layer of confusion to fixing what ails us, and we are led down this rabbit hole that we can't seemingly extract ourselves out of.

Some tests are so simple and are in fact free, such as the Achilles tendon reflex test, which Ray speaks of, and which Dan has made a video of in Youtube to promote it, but it seems to me that generally people like to use numbers than to observe, perhaps out of a distrust of their intuitive and judgmental abilities and to prefer to let the numbers do the thinking. So even in this forum where the motto is "Think, Perceive. Act" people do not practice this where it counts, generally.

But I digress. Stepping out of the soapbox. The WBC is a very useful test when one knows how to use it. And it is very affordable.

 

[yerrag]

Glad there are sales for the Memorial Day Weekend!

The cost of tests run up when we take these tests, and a lot of times in the past, I feel I'm just staring into numbers, unable to make sense of them. And when we rely on our doctors, who only look on reference values, it doesn't make sense unless one wants an overhaul of their engine.

It's very helpful to have the optimal values on hand, instead of reference values. The cheat sheet you posted before of Dr. Weatherby with the optimal values of blood tests have become very useful for me. I rely on it a lot. It's not perfect, as many things are in the medicine field (like its take on TSH isn't Peaty or Broda Barnes-y), but its optimal ranges on many others are very useful.

On the subject of the CBC markers, I also found WBC and the differential counts results more easy to unpack and made useful for me, as they would help unmask bacterial and viral infections that mainstream doctors overlook. In my case, I had chronic periodontal infection for 15 years. I didn't know about it because that's the nature of periodontal infections, where anaerobic bacteria breeds under the gum and spew out bacteria and endotoxins throughout the body. But when I go back through my CBC records, I could see that my WBC had gradually increased over this stretch from 4.5 t0 7.5, and neutrophils from 50% to 74%, and comparing this to Dr. Weatherby's optimal range, I could see how I could be alerted to having chronic bacterial infection:

WBC optimal range: 5.0 - 7.5* vs. reference range of my lab: 4.23 - 9.07
Neutrophils optimal range:: 40 - 60 % vs. reference of my lab: 34 - 68%

*Note that on my WBC markers, Dr. Weatherby is actually on the lenient side on the high end of it. Dr. Tom Lewis (see OP) actually has WBC above 6 to already be a flag for some bacterial issues already.

What I've learned is that it's more important to know how to use these tests to be able to piece together a clear picture of what sickness we have, than to go on a spending spree on tests that we can't make any sense of. In the case of the CBC alone, there are markers there which would already alert us, for example, to a developing bacterial issue or to a developing cardiovascular issue. And the CBC is a very common and inexpensive test.

There is a tendency for our doctors to make us go through rounds of tests, and the tests themselves become a financial burden upon which no meaningful diagnosis come out of, and often it's the case that wrong diagnoses and treatment are given. This adds another layer of confusion to fixing what ails us, and we are led down this rabbit hole that we can't seemingly extract ourselves out of.

Some tests are so simple and are in fact free, such as the Achilles tendon reflex test, which Ray speaks of, and which Dan has made a video of in Youtube to promote it, but it seems to me that generally people like to use numbers than to observe, perhaps out of a distrust of their intuitive and deductive abilities and to prefer to let the numbers do the thinking. So even in this forum where the motto is "Think, Perceive. Act" people do not practice this where it counts, generally.

But I digress. Stepping out of the soapbox. The WBC is a very useful test when one knows how to use it. And it is very affordable.

 

[Fractality]

My RDW was 12.8 in 10/2014. It went to 13.4 in 9/2018. Is that concerning?

 

[yerrag]

My RDW was 12.8 in 10/2014. It went to 13.4 in 9/2018. Is that concerning?

Not so much concerned as much as aware, if I were to make a distinction.

It's a red flag, and there's time to act on what is a developing cardiovascular condition, and there is a trend towards it getting worse. It would be hard to open up your capillaries to verify that you have plaque developing, so the question is to ask whether you should assume you have arterial (more like capillary) plaque and it's getting worse, or to wait until there are more outward signs confirming that.

And it's hard to know what signs you can trust: is there high blood pressure? is there thinning hair? is there a diminishment in penile staying power? is there an increase in serum uric acid? I'm speaking for myself though, as all these conditions are what I can cite from my personal experience, as limited as they are and are but a subset of conditions related to plaque.

In my case, the only way to confirm that plaque is being lessened is to monitor my RDW into the future and see if there's a downward trend. And I'd have to take steps to prevent building up plaque as well as take steps to reduce/eliminate/dissolve the plaque that has already formed. And if these steps do lead to an improvement in my RDW over time, then that would confirm that indeed it was plaque that was causing the RDW values to be high.

It does seem to be a circular way of reasoning things out, but sometimes it has to work out that way. I remember taking a numerical methods class in college, and that is one way I find optimal values.

 

[Fractality]

Not so much concerned as much as aware, if I were to make a distinction.

It's a red flag, and there's time to act on what is a developing cardiovascular condition, and there is a trend towards it getting worse. It would be hard to open up your capillaries to verify that you have plaque developing, so the question is to ask whether you should assume you have arterial (more like capillary) plaque and it's getting worse, or to wait until there are more outward signs confirming that.

And it's hard to know what signs you can trust: is there high blood pressure? is there thinning hair? is there a diminishment in penile staying power? is there an increase in serum uric acid? I'm speaking for myself though, as all these conditions are what I can cite from my personal experience, as limited as they are and are but a subset of conditions related to plaque.

In my case, the only way to confirm that plaque is being lessened is to monitor my RDW into the future and see if there's a downward trend. And I'd have to take steps to prevent building up plaque as well as take steps to reduce/eliminate/dissolve the plaque that has already formed. And if these steps do lead to an improvement in my RDW over time, then that would confirm that indeed it was plaque that was causing the RDW values to be high.

It does seem to be a circular way of reasoning things out, but sometimes it has to work out that way. I remember taking a numerical methods class in college, and that is one way I find optimal values.

What is recommended and proven to lower RDW?

 

[yerrag]

What is recommended and proven to lower RDW?

Probably have to do some more research on RDW. Many articles on it on PubMed. I feel that it has a lot to do with plaque, and if you can lessen arterial plaque, you can lower RDW.

 

[yerrag]

Here's a search of RDW on PLOS:

https://www.plos.org/search?q=rdw

A lot of studies that I find relevant and I would sink into it. I think you would too @Fractality

If just knowing how to use the RDW marker alone could give millions of people the equivalent of a canary in a coal mine with regards to chronic kidney disease, and if they could take steps to arrest the decline of their kidneys, what would that do to the dialysis businesses and a large chunk of the antihypertensive drug business? And that's just the kidneys.

Yet, the websites of Mayo Clinic and WebMd, as mentioned in the OP, are removing mention of this marker as part of the CBC. The marker is very affordable, and very helpful, would detect developing cardiovascular problems, would get many people on the right track with respect to their health, would reduce frequent and useless doctor visits, would reduce reliance on maintenance drugs, and most importantly, catches a problem before it develops into a full-blown crisis, and it doesn't take a rocket scientist to figure out why it's being discarded as a marker for diagnosis.

Instead, people at advanced stages of disease would have to find out too late through ultrasound, MRI, and CT-Scans that they are in an advanced stage of disease. At which point the medical establishment plays the hero card, upon which credulous patients fawn over their saviors in their newfound misery, thankful and overjoyed there is someone to help them in their helplessness.

 

[Fractality]

Great, thanks, but I was hoping that podcast/ebook you mentioned had some recommendations.

 

[yerrag]

Great, thanks, but I was hoping that podcast/ebook you mentioned had some recommendations.

I was disappointed that he would not give answers but refer readers to another book he had written earlier, and to some centers he's affiliated with. I would have bought the book, except that it's not available as an ebook, and I didn't want to pay extra for the added shipping charges to mail it overseas.

 

[yerrag]

This is going to be my main biomarker going forward as I try to lower my hypertension, which I suspect to be coming from plaque in capillaries, especially in the kidneys. I won't be testing urine ACR, urine lactic acid, serum albumin, serum uric acid, LDH until this biomarker gets below each milestone. So, currently my RDW is 13.5%. Wlhen RDW goes down to 13%, I'll take the abovementioned biomarker tests. Then 12.5%, then 12, 11, 11.5 11. I'll also be able to note down my blood pressure as I go through each milestone. I'll also note down my heart rate, the condition of my hair (whether it's getting thicker or thinner).

I have some strategies to go about lowering it, but I'll mention briefly: using proteolytic enzymes for breaking down protein in plaque, using magnesium/b6/k2 to decalcify, using cyclodextrin with vitamin E to eat away cholesteryl ester portions of the plaque, and some antibiotics to break biofilms that may be present (minocycline if I can get a doctor to prescribe it for me).

Would also be changing my macronutrient ratio for meals, to go towards the side of more fats (with stearic acid or alcohol) supplementation, so that I would rely more on beta oxidation of long-chain even-numbered fatty acids for energy production, in order to conserve the limited amount of oxygen that can be transported through plaque-filled capillaries. This will also help increate my metabolism, which is needed to improve the circulation, and if my blood pressure should go up, I won't prevent it as it is needed to deliver nutrients to allow plaque to be dissolved.

 

[Fractality]

Do you have a post outlining why you think you developed the plaques?

 

[yerrag]

Do you have a post outlining why you think you developed the plaques?

I do, but my blog is getting long and I'll just tell you how here. Easier for us both. I suspect it's due to 15+ years of a hidden periodontal condition, only discovered lately. In that time, plaque has slowly accumulated due to my body's immune system (white blood cells) continual and chronic fighting off of the bacteria and endotoxins released from the ongoing gum infection. It may just not be that, although that is the main cause. I wouldn't discount that a minor portion of the plaque could be from calcification as well as from cholesteryl esters deposited from earlier years of PUFA consumption.

I suspect my current hypertension results from the reduced capillary cross sectional area due to plaque buildup. The hypertension is a symptom, but not the problem. The problem is the plaque formation. I'm of the belief that allowing the hypertension and not suppressing it is the best way to go, as it allows blood to still get through to the smallest capillaries, to keep them from being exhausted of nutrients and slowly wasting away the organs the capillaries feed.

 

[shepherdgirl]

Hi yerrag, thank you for pointing out the importance of the RDW and WBC - very useful, relatively cheap tests! Wondering if you have considered
capillary flexibility - wouldn't a red blood cell have to deform less if the capillary walls were more yielding?
My understanding of Dr. Peat's article "Phosphate, activation and aging"(raypeat.com) is that too much phosphate (with respect to calcium, i think, but am not positive) results in calcification of the arteries and kidneys.
My questions to you: why do you assume that calcification is not the major problem? Are you saying that the kidney is especially affected by plaque because it has smaller vessels? Isn't it also possible that it would be targeted by calcification because it could be filtering out phosphate? Then again, if you have been keeping phosphate as low as possible for years, calcification should have started reversing by now i would guess. But if you only have one data point, maybe it is not clear. Have you lowered bp with Peat style diet? meds? How do you account for your lowering of bp?

 

[yerrag]

why do you assume that calcification is not the major problem?

I'm only saying this as relative to chronic bacterial infection. If calcification were the major cause, I would be seeing my siblings suffering from hypertension as well, given that we would likely share the same lifestyle in terms of food choices. I have 7 other sibling, and they don't have hypertension. And I've been on a nutrional lifestyle where magnesium and calcium intake has been increased for a while now, and although magnesium has helped lower my bp from its highs, it would seem that further gains are limited already with magnesium. And I consider chronic bacterial infection to be the main cause because it's what sets me apart from siblings. When I didn't have insurance after I left my work, and didn't have regular dental cleaning (a big mistake), it led to the periodontal condition I had. Perhaps if I were aware of the harm of endotoxins, and I were aware of having enough calcium intake then, I would have done well even without regular dental cleaning, but then I was very ignorant health-wise.

 

[shepherdgirl]

It makes sense, if your siblings/parents are eating the same diet as you, and they don't have hypertension, that you would rule out calcification.
I wish you all the best with your treatment program. I hope you keep us updated on what you are trying.
I will get an RDW test soon - thank you for bringing this to our attention!!

 

[akgrrrl]

Yerrag this is such a good post. For those of us who have read or followed your efforts on this self study, this is truly inspiring and laden with good information. Thankyou so much for sharing.

 

[yerrag]

Yerrag this is such a good post. For those of us who have read or followed your efforts on this self study, this is truly inspiring and laden with good information. Thankyou so much for sharing.

I'm glad you found it helpful akgrrrl. I hope I can update this thread with progress on my use of RDW to track my progress in lowering my blood pressure.