Amy Nett: The first one, Amber says, “I just tried to open an account with True Health Diagnostics and was informed that they are no longer in business.” This is true, and it’s so unfortunate. We’ve all been struggling with this as well and how to replace the cardiovascular profile that we were using through True Health Diagnostics. Amber says, “I know Chris has mentioned to use True Health Diagnostics for the advanced lipid panel and metabolic panel. I know we can use the NMR LipoProfile through Quest or LabCorp to replace this, but what about the metabolic panel?”
The metabolic panel, Amber, can be run easily through LabCorp or Quest. I don’t think True Health Diagnostics had any advantages on the metabolic panel. The advantage of the True Health Diagnostics lab really was their advanced cardiovascular disease markers. As far as I know, I think they were the only lab running LDLP [low-density lipoprotein particle number] via electrophoresis rather than NMR. They were also one of the first labs to do oxidized LDL and they did an Lpa [lipoprotein(a)] particle number. What I’ve done personally is I’ve created kind of a set of labs from LabCorp that I now use. I’m a little bit more comfortable with LabCorp for the NMR LipoProfile than I am with Quest at this time. That, of course, may change. This is very much an evolving area to keep an eye on. But what I’m doing is, because again, the metabolic stuff I’m not as worried about, so you also mentioned do you think just ordering the blood chemistry panel with fasting insulin, fructosamine, and post-meal blood sugars is enough. Yes, it depends what your clinical question is. But if you’re focusing on, there, your question is insulin, fructose, post-meal blood sugars, yes, I think you can get those through LabCorp. Again, you’re not missing anything from True Health Diagnostics. In terms of cardiovascular disease risk assessment, what you probably want to think about is the markers that True Health Diagnostics offered that you need to get probably from LabCorp or Boston Heart is the other lab we’re looking at that a lot of practitioners are switching to from True Health Diagnostics, but things to think about are going to be your Lp(a), your PLA, Lp-PLA2 activity, [and] you want oxidized LDL. I also get a fibrinogen [and] myeloperoxidase, and that’s in addition to your NMR LipoProfile. And then, of course, a C-reactive protein, high-sensitivity, or Quest would call that a C-reactive protein, cardiac. Again, LabCorp, you’ll look for C-reactive protein, high-sensitivity and Quest, C-reactive protein, cardiac. But I think you can make do with that. Again, it’s a real bummer we’ve lost True Health Diagnostics. They did have really great cardiovascular disease risk assessment, but I think you can piece it together from the other labs and, again, don’t worry at all about the metabolic panel, the insulin, fructosamine—those are great through LabCorp and Quest. I think it’s more a matter of figuring out at this point how best to assess cardiovascular disease risk. Hopefully, that gives you suggestions in terms of where to start.