Tests to Assess Your Risk for Chronic Disease and COVID-19

Dr. Mercola Interviews the Experts
This article is part of a weekly series in which Dr. Mercola interviews various experts on a variety of health issues. To see more expert interviews, click here.

Thomas Lewis, author of “The End of Alzheimer’s: The Brain and Beyond,” is a microbiologist with a Ph.D. from MIT. He’s done a lot of work on diagnostic testing, and in this interview, we explore how retinal assessment and other laboratory tests can be used to stratify your risk factors for chronic disease and COVID-19. Lewis recently published an excellent paper on this.
We first met almost two years ago at the Academy for Comprehensive Integrative Medicine in Orlando, Florida, where he gave a presentation on how assessment of the retina can be used as a diagnostic tool to evaluate your risk for a wide variety of diseases.
The Eye-Brain Connection

As just one example, glaucoma and Alzheimer’s disease are often linked together, with glaucoma occurring first, as they did in Lewis’ father’s case. His dad developed glaucoma several years before he developed Alzheimer’s.
Glaucoma is “Alzheimer’s disease of the eye,” and Alzheimer’s is “glaucoma of the brain.” Similarly, cataracts are a manifestation of your innate immune response against both acute and chronic infection.
Lewis goes so far as to refer to glaucoma as “Alzheimer’s disease of the eye,” and Alzheimer’s as “glaucoma of the brain.” Similarly, cataracts are a manifestation of your innate immune response against acute and chronic infection. If you are, say, 50 years old and you have early nuclear cataracts, it’s a bad sign, as it’s an indication of a chronic infection.
The infection is what’s causing this unfolded protein response to slowly matriculate in the lens of the eye. According to Lewis, “If you have an early cataract, that’s a bad sign for longevity. Most people with cataracts die of some vascular event fairly young.”
Your Eye Is a Window Into Your Overall Health

Lewis explains the general theory for using the eye as a biomarker for systemic disease:

“When you look at disease, in the allopathic system, you’re either healthy or you’re sick. But we really lie on a continuum of health. I say we live on four different continuums, determinants of health, lifestyle, risks, things like that. For physiological health, we measure blood, stool and urine …
For pathology, which is largely ignored, we do ultrasounds, MRIs and CT scans that assess tissue changes. The eye happens to be particularly good at that because the eye is transparent, and the methodology used to measure the eye is low-cost and noninvasive but highly precise and accurate.
For example, optical coherence tomography (OCT) is much more precise at looking at micro vessels, capillaries, compared to MRI because the wavelength of light they use to create the interference is a much shorter wave length. In other words, it gives much more detail than an MRI.”

OCT is a type of tomography that uses safe, nonionizing light waves. At a cash price of about $50, it’s also an affordable diagnostic tool that can tell you a lot about what’s going on in your body.
I was intrigued with the test and found a local optometrist to perform it for me. I hadn’t had an eye exam for a few decades so thought it would be a good checkup. Well, I had no glaucoma, 20/20 vision, near and far without glasses, and my OCT was totally normal, like that of a young adult. It’s great to know that lifestyle changes work. Next month I will share an article on what they have done for my physical body.
Again, because the eye is transparent, OCT allows you to see all the micro vessels, and whatever is happening in this carotid tissue — the vasculature in your eye — is also happening in the rest of your body, as the carotid is the most vascular tissue in your entire body.

“Whereas the brain uses 10 times more oxygen than most tissue on a per mass basis, the retina, which is constantly converting photons to electrons, uses even more oxygen on a per mass basis. If you’re vulnerable, the eye is potentially a canary for that vulnerability,” he explains.

“That’s why we use this test. It’s so simple to see if there are life risks that are translating into physiological risk and then changing into pathological risks. When you’re changing into pathological risk, a bad ending is getting closer because you have tissue damage, basically.”

The COVID Connection

Many common lab tests can also tell you a lot about your health and the state of your immune system. When COVID-19 broke out, Chinese researchers reported patients had elevated ferritin and erythrocyte sedimentation (SED) rate, among other things. Lewis compared the COVID-19 lab panels with the work he’d been doing for the past 15 years, and found they matched up nicely.

“It’s not about treating COVID-19, it’s about measuring how full your vessel is towards these markers that create the cytokine storm, high inflammation, and kill you, and try to modulate that,” Lewis says.

“Why does the Z-Pak treat COVID-19? It doesn’t. It treats bacterial infection, but we all have a subclinical bacterial infectious burden, and that burden is taking up immune system bandwidth, which makes you less able to fight something as virial as COVID-19. That’s why Z-Pak works …
There’s nothing really special about COVID-19 and our immune response, because our immune response is innate and adaptive. It’s [about] being able to more accurately measure your immune compromised status. And almost everything we measure is reversible through very simple processes, supplementation, lifestyle activities, treating the infection, treating the pre-existing virus.”

Understanding Cytokines

One of the most lethal aspects of COVID-19 is the cytokine or bradykinin storm that can develop. A cytokine is a short-lived signaling protein that has regulatory properties on nearby cells. It could be beneficial or it could be detrimental. It could be proinflammatory, or it could be anti-inflammatory.
So, it’s not so much that cytokines are bad — they’re absolutely necessary and you’d be dead in a few heartbeats without them — but when they get out of control, they can kill you. That’s what’s known as a cytokine storm, which I have discussed extensively in previous newsletters. It is one of the reasons why vitamin D works so well; it aborts most cytokine storms through its modulation of your immune response.
Risk Score Versus Diagnosis

What the retinal assessment and various lab assays can do is identify a brewing problem, which can then be addressed using strategies such as nutritional supplementation and lifestyle changes.

“For the average person, knowing where you are on that continuum would be extraordinarily valuable,” Lewis says, “and that’s the testing we’re doing and trying to promote more broadly.”

The key, however, is not to be within the “normal” reference ranges for disease markers, examples of which include fibrinogen, D-dimer, SED rate or C-reactive protein. What Lewis has done is determine the point at which there’s a statistical increase in early mortality. “That sets a completely different set of normal ranges for biomarkers, which is what we use. These ranges are much tighter compared to normal reference ranges, so you are amplifying the signal your body is projecting about your health. We’re not diagnosing people, we’re risk scoring people,” he explains.
Helpful Lab Tests

Screening tests that can help assess the state of your health and immune system include:

1-25 Dihydroxy vitamin D — This is the activated form of vitamin D. Vitamin D increases antimicrobial peptides (AMPs) and improves the activity of neutrophils (white blood cells that fight bacteria).

RBC magnesium — Magnesium is an important cofactor for the activation of vitamin D. Taking magnesium can actually reduce the amount of oral vitamin D you require to optimize your vitamin D level.

Neutrophil to lymphocyte ratio (NLR) — This marker alone determines prognosis in most solid tumor cancers. Neutrophils go up when there’s a bacterial infection, while lymphocytes are suppressed by viruses. As explained by Lewis, “The NLR is sort of an amplified barometer for your stealth infectious burden. The absolute count should be 1.5 or below.” Anything above 55% neutrophils is indicative of a chronic, likely bacterial, infection.

Red blood cell distribution width (RDW) — Red blood cells are born small and die large. If your RDW is wide, you likely have plaques and inflamed carotid arteries. Above 16 or 17, RDW could be a sign of anemia, but between 12.5 and 16, it’s a pure sign of inflammation.

C-reactive protein — A marker of inflammation. This should be 0.6 or below.

Fibrinogen — As a signaling molecule for tissue repair, fibrinogen is a good marker for how well your body is able to repair itself. If your fibrinogen is between 150 and 285, your repair and recovery is probably meeting or outpacing wear and tear, allowing you to properly heal and recover.
Above 285, you are probably deteriorating more rapidly than you’re repairing. Fibrinogen is also a clotting factor marker, so in COVID-19 and sepsis, for example, high fibrinogen is indicative of a cytokine storm. Pre-cytokine storm levels are also indicative of several chronic diseases, including heart attack and cancer.

Ferritin — Ferritin is an iron transport protein that becomes elevated in COVID-19 and other serious illnesses. Iron catalyzes growth of bacterial pathogens. Typically, when your blood cells are under attack by a pathogen, your body responds by hiding the iron from the antigen (the infection) in the ferritin protein, thereby resulting in anemia (low iron) and high ferritin.
If you have elevated ferritin, the iron may not be available to the pathogen, but it is still available to the cells of your body.
Iron is a powerful oxidant stressor that will radically increase oxidized species, reactive oxygen species (ROS) and reactive nitrogen species, which activates the NRLP3 inflammasome and radically increases inflammatory mediators and cytokines. The solution for high ferritin is to donate blood. If your ferritin is above 100, consider giving blood periodically.

Fasting insulin — Insulin resistance is a foundational contributor to most chronic disease and significantly increases your risk of complications and death from SARS-CoV-2 infection. Fasting glucose is also a useful test that you can easily do at home.

Uric acid — Uric acid is a multifactorial inflammatory marker. It also helps protect against hypoxia.

Homocysteine — Homocysteine is a vascular toxin associated with heart disease that is influenced by your vitamin B levels. As explained by Lewis:

“LabCorp keeps changing their reference normals, and now they’re as high as 17. But the Framingham’s study shows that with a baseline of 9, every five points higher homocysteine leads to a 40% increase in dementia because it’s a vascular toxicity.”

SED rate — The SED rate is a measurement of how fast your red blood cells settle in a test tube. Red blood cells have a repulsive charge on the outside of their membranes (zeta potential) that allow them to remain buoyant. When this repulsive charge is lacking, they settle faster. As explained by Lewis:

“SED rate is a surrogate for how good your electrical system is working, which I then use as a surrogate for your gut and how well it’s doing at digesting and making minerals bioavailable, because it’s the sodium potassium pump that drives the electric potential of cells, among other minerals.”

Ideally, if your zeta potential is good and high, your SED rate should be close to zero. The lower, the better. The higher your SED rate, the worse off you are, as this means the “battery” of your red blood cells are discharged, which will result in systemic problems and overall low energy levels. Typically, your SED rate will improve once you start to heal and rebalance your gut.

Where to Get These Tests

Your primary care doctor can order any and all of these lab tests for you. However, they may not be able to thoroughly guide your treatment based on your results, which is what Lewis and his team specialize in. So, for testing and a comprehensive analysis, consider turning to

“Come through us and we’ll help you solve your problem,” Lewis says. “Under our services tab, we have a COVID-19 service, and there we have five different levels of panels, from just a population screening to a very deep dive. Basically, every marker we talked about today, and more.

Looking at the lipids, the chemistry, liver function, metabolic, all that stuff, is included. We don’t take insurance, but I can order these labs. My team can order these labs anywhere in the country …
We couple the lab test with a highly functional intake survey. What we’ve done, and we were publishing a paper on this, is we’ve created a risk score for every single question and answer that is typically on a functional intake questionnaire, and made it digitized, so it’s online. You take it.
We give you a letter grade, which is sort of a reflection of your total risk portfolio, and then subsections of grades. Then we give you a very detailed color-code report, which really turns into your treatment plan, if you will. We want to ameliorate these different things. And we have health coaches to help you organize them because some things you want to do in series, other things you want to do in parallel. We call this the hierarchy of health.
Anybody who does a blood test gets that. And then our team is trained on how to help you understand your labs from a very detailed chronic perspective, but also look back at the risk factors and show you what risk factors could potentially have led to an elevation in that lab. So, you see a very clear one-to-one correlation.
We give you a letter grade, but there’s a score underneath it. And then we give you what we call our chronic disease temperature, which is the amalgamation of 20 of these important biomarkers into a single score. We have a plot of our chronic disease temperature versus our chronic disease assessment.
It’s a fairly linear thing, showing you that your risks are tied to your physiological health. And then we’ve shown, in populations that we work with, that when we lower their risk grade — just the lifestyle things, cleaning up the teeth, improving the gut, cleaning the diet up, detoxification — as their risk rate goes down, their physiological score goes down, which is a good thing because we want your score as low as possible.

That’s the essence of what we do. We have functional doctors, regular doctors, health coaches.”

Managing Your Expectations

While most health problems can be successfully addressed with nutritional and other lifestyle changes, it’s important to manage your expectations of how long it’s going to take. As noted by Lewis:

“I have a very simple explanation to set expectations up. If it took you 10 years to get into something chronic, it’s going to take you at least 10 months to get out of it. And that’s with diligence, consistency and the proper treatment. When we have really compliant people [working on healing] rheumatoid arthritis, psoriasis, brain fog, we get this major inflection of health improvement at five months.
Why is that? Because everything in nature is log linear. We are wired to understand that implicitly, but society has taught us instantaneous gratification. We think if we do one thing, we’ll get one result. But really everything is an asymptote, going into disease is an asymptote, so you’re incubating, incubating, incubating, and then suddenly things go wrong.
While getting out of that state is the reverse of that, it takes you a long time to move the needle and start feeling better. Then all of a sudden, you reach that inflection point and you feel better.
Everything in nature, including health, it’s a log linear relationship to get to where you want to be … When people understand that and buy into that concept, then they can stay the course and we can actually make them better. It’s not an overnight thing. That’s the only point I’m trying to make.”

More Information

Again, is where you can sign up for your biomarker panel and receive the guidance you need to address whatever problems you may be having. For more information about the eye-brain connection and what your eye health can tell you about your Alzheimer’s risk, which we touched on at the beginning of this interview, see