Health Screening 101 (Part 1 of 3)

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An airman's blood pressure is checked.
U.S. Air Force Staff Sgt. Jessica Roland, 110th Airlift Wing Medical Group, checks Staff Sgt. Sabrina Zimmerman's blood pressure at Air National Guard Base Battle Creek, Mich., June 22, 2011. (Tech. Sgt. David Eichaker/U.S. Air Force photo)

This is the first article in the three-part series of Health Screening 101. The other two articles in the series of Health Screening 101 are the following:

Health Screening 101 – Part 2: Courses of Action to Follow: Diet, Exercise, Medications Recommended

Health Screening 101 – Part 3: Blood Testing

Without a better understanding of health screening tests, looking at blood screening paperwork can be both overwhelming as well as invoke attitudes of apathy for borderline healthy/unhealthy numbers. Here is an email from an officer who is 33 years old who admits he needs to lose a few pounds and is concerned with his recent blood-work numbers:

Stew, I know you are not a doctor, but can you give me your opinion on these numbers? The left column is my most recent numbers from last week (November 2012), and the numbers on the right are the ranges I should be in to be considered healthy. I know I need to eat better, exercise and get more sleep, but where do I start? Should I be overly concerned and start taking medication to deal with this?

Wow, great question. I, too, get overwhelmed when I look at all the different blood-test elements and ranges when some are good, bad or borderline. And, yes, I am not a doctor, but I know several and have interviewed them to help me write this response to your questions. But to help demonstrate where you need to focus, we are going to use the Traffic Light System created by Specialty Health in Reno, Nevada, to help drive home the importance and understanding of these scores. Everyone thoroughly understands the standard traffic light:

(Red = danger, yellow = borderline, green = good)

red light Blood Test (Nov 2012) Acceptable Ranges for Blood Tests
red light BMI – Body Mass Index 33.3 (waist 41”) Greater than 30BMI Less than 25BMI
red light Blood Pressure 148 /​ 84 Greater than 140/​90 Less than 120/​80
red light HDL (good cholesterol) 31 Less than 40 Greater than 60
yellow light LDL (bad cholesterol) 117 Greater than 131 Less than 100
red light Triglycerides 362 Greater than 200 Less than 150
red light LDL – P (Lipoproteins)– see more info below 2231 — determined from NMR – special test Greater than 1000 Less than 1000

Yes, in a nutshell, I would be alarmed with these numbers, but the good news is that they are all completely reversible. E. James Greenwald of Specialty Health concurs but also demonstrates another level of understanding and uses a ratio of triglycerides and HDLs to produce the insulin resistance ratio. Triglycerides divided by HDLs = insulin resistance ratio.

Looking at your TRIGs/HDLs (326/31), you get a ratio of = 11.7 insulin resistance ratio:

Why is this number important? Any ratio score of more than 3.5 means you are insulin resistant.

“When humans become insulin resistant, the glucose receptors of our liver and muscle cells get clogged," Greenwald said. "Insulin has a difficult time allowing glucose to get into the cell. Glucose stays in the bloodstream and blood glucose levels increase, and so do the blood insulin levels as the pancreas keeps pumping more and more insulin to try to keep blood sugar (glucose) levels under control.”

Insulin resistance is a 10- to 15-year precursor to Type 2 Diabetes. Diabetes can lead to blindness, kidney disease and the amputation of extremities. Just in case that does not get you thinking more serious about your present health, other conditions such as heart attack, stroke, cancer and Alzheimer’s dementia are linked to insulin resistance.

You still should seek your personal doctor’s advice before responding to correct these scores with medications. But to answer your question: Adding a workout program, low-carb diet, laying off the caffeine 4-5 hours before sleeping to help with sleep recovery and​ stress mitigation would help you get better scores in as little as a few months.

The LDL-​​P (lipoproteins) test

Notice the patient’s LDL (bad cholesterol) is only 117. This is not a necessarily healthy number but it is outside of the alarming margins, thus only receiving a yellow-light grade. Yes, bad cholesterol is bad, but the way it is transported throughout the body is what makes it dangerous.

“The real risk lies in the number of particles (lipoproteins or LDL-​​P) that carry the cholesterol (LDL)," Greenwald said. "To determine the risk factor requires advanced and sometimes life-saving testing. The NMR (Nuclear Magnetic Resonance) by Liposcience is the test we prefer. An MRI of the blood itself gives us an accurate count of the particles that carry the cholesterol.”

Here is an analogy that will help you bring it home.

“Think of your arteries as a freeway," Greenwald said. "Think of the LDL-P (Lipoproteins) as a car. Now, think of the cholesterol as a passenger in a car. It is the cars on the freeway that cause the problems. When the freeway gets crowded some of the cars exit (into the arterial wall itself) and start the formation of plaque. So it is the not the passengers we should concern ourselves with, but the number of cars that are the danger.”

The standard health screening does not check for the LDL-​​P in blood. You have to ask for the LDL-​​P test using the NMR.

“In this case, a LDL-C of 117 is in the acceptable range," Greenwald said. "However, the LDL-P was 2,231 (sky high), putting this patient at great risk of a heart attack or stroke. Plus he has four of the five markers (red lights) for metabolic syndrome, and that alone doubles his risk of heart attack and increases the risk of Type 2 diabetes by a factor of five.

"Treatment is clearly critical in this case, and we set a goal of an LDL-P of right around 1,000. To get there, he will need medication (statins or Metformin are two possibilities), and follow-up testing is needed to be sure we have achieved the goal.”

Click Health Screening 101 – part 2 to see the recommended courses of action that involve foods to eat, foods to avoid and how to exercise to burn excess fat from the body optimally. Both will have significant changes on the red-light health scores in this test. You have to do something now. You cannot have these types of scores and do nothing to fix them, or you could have a heart attack, stroke or be diabetic within the next decade. In this case, you could have a heart attack in your early 40s. Besides, get moving just to feel better and look better. It will add a quality to your life you cannot put a price on.

Stew Smith is a former Navy SEAL and fitness author certified as a Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association. Visit his Fitness eBook store if you’re looking to start a workout program to create a healthy lifestyle. Send your fitness questions to stew@stewsmith.com.

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