Purpose of blood tests?

[Monsoon]

Dear fellow Cohenites,

I have just received a response from my (remote, online) Consultants, following my latest blood test and renewal of contract for another 12 weeks. The response confused me and irritated me, so I wonder if others have had similar experiences and can help me dispel the confusion and feel better.

I will start by saying that I have been doing very well on the programme and I will forever be grateful to have found it. The point of this post is not to question the validity of the science behind it or to discredit the programme in any way. However, I have to make sense of this or the irritation might risk interfering with my motivation

I had my latest blood test about 1 week after returning from holiday and getting back on plan 100%. Those of you who follow my diary will know that I had been away for three weeks and tried to stick to plan as much as possible during that time. Inevitably I deviated in terms of the strict rules of the programme, but mostly in the sense that I was not in full control of my quantities whilst making 'good choices' in restaurants, not in the sense that I had three weeks of eating a million miles from Cohen's. I came back with a 500g loss, and I have lost 2.6 kgs in the 2 weeks since.

My latest blood test, as far as I can see, only tested kidney function - not sugar, not cholesterol. Two values came up very slightly abnormal (sodium and chloride). In response to this, the Consultants - in the name of Dr Cohen - have sent me a comprehensive and generic checklist of questions, of which the following are some examples (you can imagine the rest):

Are you using herbs and spices? Which ones? Ensure that there is no starch, MSG added.

Are you taking any homeopathic remedies? These are often in an alcohol base- sometimes as high as 30% alcohol.

Are you using any fruit that is not specifically mentioned by name on the eating plan, or dried fruit, or fruit juice, or more than your allowance of fruit? Fruit is not a "safe" cheat, because of sugar level.

Are you using lemon-juice as a flavoring in your drinks or food (over and above your fruit allowance)? It is essential to count lemon as part of your fruit allowance; otherwise your sugar intake will be too high.

The checklist is really very long, it covers everything. It came with no further explanation of why it had been sent or what I should do with it. So, what bothers me about it? I assume they are sending me the checklist because they can tell from my blood test results that there has been a deviation somewhere along the way, which would be correct (my holiday). Assuming it is plausible that they can detect a deviation relating to my holidays (given the timing, and given that they only tested for kidney function), this per se does not bother me. But it makes me wonder: is this all that the blood tests are for? To police our deviating? In a broad, impersonal, utterly non-specific way? Is there nothing more specific they can tell me?

My creatinine was too high in a previous set of results, and they told me to increase my water intake - that made sense. But how do marginally low sodium and chloride relate to this checklist? What is the point of having individual blood tests, if all the results are used for is to tell you that you must stick to plan 100%? Don't we know that already?

I can't very well express why, but receiving the checklist offended me somewhat. I want and need to get over this, because I want to continue to feel positive about the plan. I have emailed the Consultants asking them to explain to me the specific relationship between my results and their advice, but from past experience I expect to receive a somewhat robotic reply that won't tell me much.

I wonder if anyone else has had this experience, or what the views of more experienced Cohenites are on this matter.

Thanks for listening

[mcbell]

Well, I don't think I can help too much, but since I am going through all the new posts I will throw in my two cents.

I believe the purpose of the subsequent blood tests (apart from your initial one) is to calculate your refeed programme - how long it is, what is introduced when etc.

Some people also recommend returners to buy a new programme if they need the discipline of having the blood tests, as yes, it seems they can tell if you have deviated....I had one that was described as "borderline" because I had an extra cracker one day because I couldn't count, and then I had a little binge with an extra cracker and an extra piece of fruit. I had informed my consultant so she was aware when the blood test result came through. But in saying that, some people swear they have been 100% on plan and have said that they have been told their test showed evidence of a deviation....

I don't have medical knowledge to explain how the blood test might be able to show any deviations.

If you have told them about your holiday "deviations" (I have to say you did tremendously well) and have emailed to ask why you need to answer the questions, maybe just wait for their response - especially if you feel offended answering them.

Hope someone else can help with the medical side.

[lil_doll]

Hmm, yeh I don't know what the answer is Monica...

But I agree with McB that the blood tests are to somehow calculate refeed. I think partly to test how reactive you are, so they know how fast or slow you can handle the introduction of new foods.

Obviously our kidneys do stuff when we eat (see how medically knowledgeable I am), so it makes sense that they can detect anything not 100% on plan from that one test. Our original blood test is taken and our plan made from the results of that test... I guess our plans are designed, in part, to level out x, y, z... so when we get subsequent blood tests they should be at whatever level Dr C designed our program to make them, and if they aren't level, then we are doing something not-quite-right.

"My latest blood test, as far as I can see, only tested kidney function - not sugar, not cholesterol." But I think the kidney results would show if there was any excess sugar eaten, as our kidneys do react to it.

[Wendy10]

Good morning Monsoon - I have just joined for the second time (yes, there are a few of us here) and checking out posts when I came across yours. I have had the same experience last time. Did my program in 2009 and had a copy of my blood tests sent to my GP also when they were done, just to keep her in the loop. Anyway she called me in to say my sodium chloride levels were at the low end of the range and checked me out. When I explained the details of my program she could not find any issues. She suggested I increase the use of salt in my food as it is essential in the body and that was the only way to increase the level. Also not to go excessive with drinking water as we can overdo this and it can cause a problem (basically pee it all away). My clinic did not send me anything about my low salt levels, only my GP picked it up. I still have low sodium levels and are just at the bottom of the range. Sounds as though they have a general list to send out to cover a variety of variations in the blood tests. Yes, my understanding it is to do with the refeed program. If your clinic does not give you a further explanation then ring another clinic/consultant and see if they have more info re: the list. For peace of mind, see your GP. I know when I am low on salt as I crave it. Yes, our society says eat less salt, but I have to eat more to keep my body healthy. Let me know how you go.

[Monsoon]

Dear Mcbell, LD, Wendy10

thank you for listening and for your responses! I really needed to vent yesterday, I was so irritated .... but feeling better now.

I have received a reply from the online consultants. It basically says

Dr Cohen has asked that you please use the Check List to help you to identify any possible mistakes that you may have been making on the program, he does not provide us with more details regarding the blood test results.

... which is the kind of empty response I had come to expect. I didn't need them to tell me I was deviating - not only did I know (of course), but I had told them, when asked for progress on my weightloss while I was on holiday. I wasn't 'making mistakes', LOL! I find the language really patronizing - that's what it is, the source of the irritation. I guess the online consultancy system is just a little too mechanical and robotic for my taste, and that's all.

Ok, now feeling slightly guilty already for filling up the space with irritation. The bottom line remains that I am really - REALLY - pleased with the programme and what it is doing for me. And really grateful to have found this wonderful forum, which certainly makes up for all of the above, and much beyond, in terms of warmth and feedback.

[Babybear]

Grrrrr I can see how you feel I would feel exactly the same!

[Cazspaz]

I think we all have to accept that this is also a money making, patented program. Dr Cohen has a program that works and he gives us the rules to make sure it works for us - but he is under no obligation in our contracts to explain the science and the details behind it.

I think poor consultants try to hide behind the "Doctor knows best" line and that can be patronising and annoying. In the end a good consultant will remember you reported the deviation and say "This probably won't come as a surprise to you since you told us about your holiday but the blood test results have shown a discrepancy. Here's the generic list of stuff - please do go over it again as we always have to be mindful of it - but it's highly likely it's due to the holiday you have already reported."

Basically you'd expect a good consultant to listen, understand and support the client. Take an interest in how they are going and be personable. I think that's what we'd all like!

I have to say I am lucky - no robotic responses from my consultant! Very personable and seems to really take an interest in how people are doing - she even set up a Sydney specific private facebook group for all her clients and prompts us to share stories and questions us all on how we think about things. She's pretty great and it makes a big difference!

[jlou]

Try to view it from a different perspective - at least the blood tests do pick up when you are going wrong?

Dr Cohen doesn't share the science behind the program because then someone would rip it off. Every refeed is different, Dr C and the clinics make no money from blood tests so they have an important purpose.

I would suggest your issue is with your consultant and maybe take it up with them.

Unfortunately you don't always get great service - but a bad shop assistant at a clothes store doesn't make the clothes bad quality....

[Monsoon]

Thanks Caz and Jlou,

I will start by saying that I have been doing very well on the programme and I will forever be grateful to have found it. The point of this post is not to question the validity of the science behind it or to discredit the programme in any way. However, I have to make sense of this or the irritation might risk interfering with my motivation

This was indeed an issue about consultants rather than the programme - I've wanted to stress this in the posts above too. But I suspect it is an issue with the whole online consultancy system rather than with an individual consultant. From my understanding, others who are doing Cohen's through online consultancy are having exactly the same experience. Caz hit the nail on the head when she wrote the words they could have written - it takes so little, to make a completely different impression!

But perhaps that 'little' is a lot, if at the other end there is a single person dealing with (too) many online customers - hence the standardised responses. I guess the purpose of the online 'support' is simply to be a vehicle for the exchange of hard information (eg the actual programme and programme guide; blood test requests; programme renewals; weightloss recordings) between the customer and the medical team. There's no problem with this at all, it's just that the word 'support' tends to convey other expectations..

[Babybear]

Exactly and the fact that it costs so much and you're suppose to be getting "support" with this which clearly you aren't.

[Antigone]

I think the repeat blood tests are done to ensure that the body is still functioning normally and that there are no adverse effect of the diet. I cannot see how they can decipher from electrolytes, kidney and liver function tests if there has been a deviation - I am inclined to think they base that on the weight loss that month.