Just because there’s a blood test available doesn’t mean you have to have it. In 2014, the US Institute of Medicine reported that $210 billion was wasted annually on ‘medical overtreatment’ – a short way of saying patients are having tests and procedures they don’t need. Medical overtreatment is a growing phenomenon worldwide. It is making people sicker and poorer. If you doubt it, read US medical journalist Shannon Brownlee’s excellent book: Overtreated – Why Too Much Medicine Is Making Us Sicker and Poorer
One common area of blood testing is to check on cardiovascular risk – to protect you from heart attack or stroke. Here is some advice from a brilliant source I like to call Australia’s answer to Prof Tim Noakes: Dr Peter Brukner. He is a specialist sports and exercise physician, associate professor in sports medicine at Melbourne University’s Centre for Health, Exercise and Sports Medicine at the University of Melbourne, team doctor for the Australian cricket team, and a proponent of low-carb, high-fat dietary regimens. – Marika Sboros
By Peter Brukner*
Picture: FACEBOOK
What blood tests should I have Doc? This is a question I am frequently asked by patients interested in assessing their cardiovascular risk. Traditionally I guess the most popular screening tests have been a full blood count (FBC), fasting blood glucose (FBG) and a serum lipid profile.
In Australia (and most other countries) when you order a serum lipid profile you will receive a number of test results including total cholesterol, LDL-cholesterol, HDL-cholesterol, Triglycerides and they will usually give you the total chol/HDL-chol ratio.
It is now generally accepted that the total cholesterol reading is not particularly relevant.
LDL-chol has always been considered important because of its relationship to cardiovascular disease, but it is too general a measure. Grouped into the LDL-chol level are particles of various sizes from the large fluffy (innocent) to the very small (dangerous) particles. One alternative is to measure particle size and see what proportion of the LDL is the small dense ones.
Dr Peter Brukner
Fortunately there is very good correlation between the levels of small dense LDL particles and triglyceride levels, so it is sufficient to measure triglycerides.
I consider triglyceride levels one of the really important blood tests. The other important lipid measurement is the HDL-cholesterol. Combining these two measurements gives me my favorite measure the Triglyceride/HDL-chol ratio (Trig/HDL).
So my preferred blood tests are:
Triglycerides – Triglycerides have been shown to be a significant risk factor associated with cardiovascular (CVS) disease. As mentioned above they are also a very good surrogate measure of the dangerous small dense LDL particles. Most labs have the upper level of “normal” serum triglycerides at less than 1.5mmol/L (130 mg/dl) or even 2.0 mmol/L (180 mg/dl), but I would recommend less than 1.2mmol/L (100mg/dl).
HDL-cholesterol – Known as the “good” cholesterol, HDL is one of the lipoproteins that transports cholesterol. Levels of HDL- chol above 1.0 (40 mmol/L) are associated with decreased risk of CVS disease.
Triglyceride/HDL-cholesterol – This is my favorite measurement and obviously a combination of the first two. I like the ratio to be 1.2 (if measured in mmol/L) or less. If measured in mg/dl (USA) the ratio should be less than 2.5.
HbA1c – As mentioned above, the traditional measurement to assess blood sugar has been the fasting blood glucose level. This has largely been replaced now by the HbA1c which gives a good indication of the average serum glucose levels over the previous 3 months and is therefore not as susceptible to the fluctuations of serum glucose affected by food intake. HbA1c level should be <5.5%
C-reactive protein (CRP) – CRP is a general non-specific measure of inflammation in the body. As inflammation is now thought to be the instigating step in the development of atherosclerosis as well as involved in a wide range of diseases, the presence of inflammation is important to determine. CRP level should be <2.
Liver function tests (LFTs) – High carbohydrate diets are associate with the development of non-alcoholic fatty liver disease which can be best measured by a range of liver enzymes included in the standard LFT (ALP, GGT, ALT,AST) . The level of alanine aminotransferase (ALT) is the best indicator of fatty liver disease and should be less than 40IU/L.
Other tests
There are a number of other useful blood tests such as full blood count (FBC), fasting blood glucose and ketones, serum insulin, and serum uric acid, but the above are my “essentials”!
Here’s a summary:
Adopting a low-carb, high-fat (LCHF) diet has been shown to improve all the above six blood parameters.
*This blog first appeared on Dr Peter Brukner‘s website, and is republished with permission.
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