Spreadsheet to Track Biomarker Targets and Ranges

[circular]

I've been playing with this spreadsheet. Julie likes it. Does anyone else think it would be useful to pursue?

It's basically in the conceptual stage and anything can be changed, from colors (I just tried to match the forum banner image), to whatever. I got to thinking about it when I noticed 'normal' values for some biomarkers were widely divergent between different labs/practitioners. I think it's good to see everything in context, and helpful to have a cheat sheet.

Right now it's in my personal Google Drive, and as far as I can tell I'm able to publish it online and stay anonymous, which is how I want it for now. The biggest drawback to 'publishing', rather than 'sharing', is that I can't freeze the header column and row on the published end so that they are static while the data scrolls by. This is a major drawback when you pan the data and the headers fall off the screen. The only practical way to use it is to zoom way out, lean forward and squint your eyes.

The only way to get the header rows frozen is to host this in someone else's account and 'share' it rather than 'publish' it. In that case I won't be an editor because editors on a shared sheet aren't anonymous. Apoe4.info could set up a non-profit Google account, but they are busy as it is so this may not be ideal. On the other hand the organization could have it's own YouTube channel with subscriptions others could visit, a Google map of member locations etc.

I'm open to any feedback. Think of this as a draft to gauge interest. Any ideas about other ways of hosting it online apart from Google that would support a fixed header row and column would be good.

I also played with adding the members' biomarker spreadsheet as a tab to this spreadsheet, which you can see, so everything would be in one document. Member's would need to request access to add their biomarkers. This can be removed if people prefer.

Really just playing around here, just need to know if others would like to use it as a reference if I continue.

[Julie G]

I like this very much and will do all I can to support the project!

Apoe4.info could set up a non-profit Google account, but they are busy as it is so this may not be ideal. On the other hand the organization could have it's own YouTube channel with subscriptions others could visit, a Google map of member locations etc.

Help this low-tech girl understand. Does a Google account overlap with a YouTube channel? FWIW, we may already have that established as I've previously transferred my talk at The Buck to a private YouTube channel as the old link kept mysteriously disappearing...

Thanks for your patience with us, Circ. You know our team is comprised of an all volunteer staff of E4 carriers- juggling our own lives, health, families, work, etc. Keep throwing ideas out there. The good ones will stick and we can make them happen .

[circular]

No hurry at all. I have a Google alternative to check out later that I think can freeze rows/columns on the public side.

[MarcR]

I really like what you have done here, circular, and I would be happy to work with you to transition it to a non-personal "official" ApoE4.Info, Inc. account so that development can continue and ongoing member biomarker data entry can resume.

Because the choice of account has long-term implications, I'd like to spend some time gathering information and developing a recommendation for Julie. I'll touch base once I think we have a decision on that. A week or so?

[circular]

Okay, sounds good Marc. If I have some time to I'll try to fill in some more during the week. I was looking a bit at Zoho. They have a free level, but if, over the years, apoe4.info started using it for more and more things the usage might bump to the paid level.

I have found it hard to find something that allows people to collaborate/edit without their personal info somehow then being available. What's bothersome about Google is it appears to an outside editor that they are anonymous when they're editing, but if someone with a Google drive opens the spreadsheet in their drive, the editing changes will show along with the name of the editor, even if the spreadsheet is set to not allow downloads. Maybe it only shows other Google users names. Not sure about the details.

On the other hand Google has a lot of other apps that can be used in conjunction with a Google Drive/email. That's where it could be helpful over time.

Other platforms may be similar. I'll be interested to see what you come up with.

[MarcR]

I tested in current versions of Chrome, IE 11, and Firefox, and once I log into any Google account in any tab of one of those browsers, I'm no longer anonymous in Sheets. This does seem likely to trip up people who are trying to maintain anonymity.

The behavior doesn't persist in the incognito (Chrome), inPrivate (IE), and Private (Firefox) browsing modes. Chrome and Firefox offer incognito/Private access to links via the right-click menu. With IE one would have to copy the link and paste it into an inPrivate window.

I agree that Sheets is an attractive solution otherwise. Perhaps we could include something like this as a reminder preamble before any link to the spreadsheet:

"If you would like to add your own information to the spreadsheet without causing your own personal Google account to be visible to other users of the spreadsheet, you can do so by opening the link in a private browsing window."

What do you think?

[circular]

That's great Marc. I didn't know about that trick! That will allow me to keep editing after conversion to an apoe4.info account

I'm starting to get quite interested in the science/business of labs! (Who knew I had that in me! ). I'm thinking we should set up a webinar or some such with someone who is expert in this field and knows the various companies, politics, economics, science and also has no personal connection to any of the labs. Not sure who that would be.

While one doesn't need a Google account to use all the Google apps, e.g., Google maps, I've wondered if there would be a way to have an apoe4.info Google map that plots locations of those who would like to meet-up in person with other e4(s) in their area, but keeps their identity anonymous. There would need to be a way for the plotted people/IDs to be able to contact each other, so it may requires a person to coordinate. Not sure how it would work logistically but thought it might be interesting to look into. It could become part of a local support group feature of some sort. That's for another thread.

[circular]

So I'm moving a topic here that came up in another thread about different omega index measurements.

… good example of why the biomarker lab range comparison chart can be handy. Here's a distinction to note:

HDLabs, now True Health
'HS-Omega-3 Index, (RBC EPA+DHA)'
Optimal is > 8%

Spectracell
'OmegaCheck, Whole Blood EPA+DPA+DHA'
Optimal is ≧ 5.5%

Also nice catch on the possible difference in how Omega-3 is measured on the various tests. SpectraCell uses whole blood as opposed to RBC concentration of EPA & DHA. Given that, it might make sense that the optimal range is lower.

It appears that studies done using the RBC and the whole blood approaches do show different desirable levels depending on the test. We need to find out, if a neurologist recommends a given omega index preference, exactly which index they mean to comment on. So far in the sheet we only have a note for Dr. Isaacson saying the 6:3 ratio for e4s should be 2:1. It's possible this ratio will be more recommended by neurologists based on their own interpretation of ancestral values, as opposed to a commercialized index that might be more recommended by a cardiologist based on studies in the context of CVD.

As noted in a footnote on their results page, True Dxtics uses HS-Omega-3 Index based on a 2004 study using that index. This paper reported on CVD endpoints:

The Omega-3 Index was inversely associated with risk for CHD mortality. An Omega-3 Index of > or = 8% was associated with the greatest cardioprotection.

The abstract only references 'clinical and laboratory tests' and it's not freely available to look at the details.

It clarifies, for me anyway, that:

Red blood cell (RBC) fatty acid (FA) composition reflects long-term intake of EPA + DHA.'

At first I liked that by not using whole blood they are eliminating a potential variable arising from fluctuations in daily intake. But I'm now wondering two things:

• Are the RBC tests (magnesium is another that comes to mind as 'preferable') always about measuring the uptake in tissues, i.e., a measurement of the substance in the RBC membrane?
  
  Is RBC the best way to evaluate omega 3 status compared with Spectracell's OmegaCheck, or just a different approach?

Spectracell says in their report that the risk profiles of their OmegaCheck (TM) are simply the top 75th %ile and the bottom 25th %ile of 'the CHL reference population', which I assumed refers to Cleveland Heart Labs. I then noted that CHL also uses OmegaCheck and the same range. This other 2004 article may provide some insight into the value of using whole blood, but I'm not knowledgable enough to tell:

Since free acids of EPA and DHA are required for most of their biological effects, it appears essential not only to build up stores in the body for release of these fatty acids [the RBC measurement?], but also to provide a sustained uptake of EPA and DHA in the form of ethyl esters [ie, supplemental; the plasma portion?]. In contrast to rapidly absorbed triacylglycerols from fish, ethyl esters are taken up more slowly within 24 h… After withdrawal, EPA and DHA approach baseline values within 10 days.

Is the plasma part of the measurement more reflective of supplemental ethyl esters? I can't get full text but wonder how they measured the blood omegas.

The abstract continues [it's not clear in the abstract whether they used the OmegaCheck test in the study]:

Evidence is summarized strengthening the concept that a low "EPA+DHA level" presents a risk for sudden cardiac death and that the administration of 840 mg/day of EPA+DHA ethyl esters raises the "EPA+DHA level" to approximately 6% that is associated with a marked protection from sudden cardiac death. [Whereas!] For reducing pro-inflammatory eicosanoids and cytokines, a higher "EPA+DHA level" is required which can be achieved with an intake of 2-4 g/day of 84% EPA+DHA ethyl esters. For assessing influences from pro-inflammatory eicosanoids and cytokines, the EPA/arachidonic acid ratio ("EPA/AA ratio") was identified as diagnostic parameter.

The Spectracell and CHL cutoff of ≧5.5% appears to be based on protecting from sudden cardiac death, which is the main use of these laboratory tests at present (AFAIK); while higher %s are needed to reduce inflammation and most likely, according to some neurologists, for AD prevention, where inflammation is a major issue.

I'm not clear whether the study just cited used whole blood analysis.

That study also brings up the importance I haven't heard mentioned in the forum (?) of choosing an omega 3 supplement in triglyceride vs ester form [commercial site].

It also makes me wonder whether the studies done showing e4s don't benefit from supplemental fish oil were based on the the ethyl ester form or the more bioavailable triglyceride form?

Finally, I now wonder whether I should have supplemental omega 3 oil in spite of my good omega 3 ratio (using the RBC measurement) via diet alone. Maybe checking my status using OmegaCheck before and after.

What I like about Spectracell/CHL over True Dxtics is that the former includes research into what levels were needed to quell inflammation markers, which turned out to be more than those needed for reducing the likelihood of sudden cardiac death. It's also notable that one can reduce the likelihood of sudden cardiac death without getting the inflammation markers lower (???).

It would be interesting to see these studied head-to-head WRT 'our' endpoints and with apoe4 genotyped.

Okay, that's enough granularity on that for now, but not for drawing many conclusions!

[Lucy5]

Wow circ, you never disappoint! What a great idea/effort on your part. I believe our community would absolutely benefit from your Spreadsheet concept.

I agree anonymity remains important for many of us. Notifying users to open the link in a private browsing window (such as incognito Chrome) seems like a good solution.

[circular]

I wanted to add that one good thing about Google Sheets, and it may also be true for other online collaborative options, is that it stores revisions. So if someone makes a major error, like sorting columns and it gets saved, they can revert to the revision prior to that.

I'd personally suggest not too many people have their hands in on the main spreadsheet, but rather to use this thread for people to post updates they feel should be added by a small group of editors. It would just help reduce the likelihood of snafus.

If someone wants to add their biomarkers they could request to be invited to the spreadsheet as an editor (I think if they try to edit it will give them a link to request to be invited). However, if the 'targets' and 'results' spreadsheets are in one document like I have them now, then once they're invited, and if there are very many contributors over time, they will all be able to edit the 'targets' spreadsheet too. Maybe it's better to keep the members' results in a separate spreadsheet and link between the sheets?

For now I am going to put in ?s where I know that Drs. Bredesen and Gundry order a given marker (at least in some cases) but don't know their target for it.

Since it looks like with private browsing we can have the spreadsheet with frozen header and row columns, it might make sense to just put the lab prices for them to the far right. It's then easy to scroll right and still see which marker row a price belongs with. This avoids having to enter new items/rows twice, once in the targets/ranges sheet and once in the prices by lab sheet.

Marc let me know when you are ready to copy this over to a new home and I'll stop editing at my end and wait for an invite to the new sheet. I'll PM my email for that.