Sunday, April 8, 2012

The Nutrition Debate #47: Testing for Heart Disease Risk

“Key tests can reveal problems with a person’s blood sugar and insulin, inflammation level, level of folic acid, clotting factors, hormones and other bodily systems that affect your risk of cardiovascular disease,” says Mark Hyman, MD, the Lennox, MA, practitioner, on a May 2010 blog post.  This last-of-three column on that post will discuss some of these tests and zero in on these prime markers for cardiovascular disease.
“There’s no doubt about it,” Dr. Hyman says, “Inflammation is a key contributor to heart disease. A major study done at Harvard found that people with high levels of a marker called C-Reactive Protein (hs-CRP) had higher risks of heart disease than people with high cholesterol. Normal cholesterol levels were NOT protective to those with high CRP. The risks were greatest for those with high levels of both CRP and cholesterol.”
“Another predisposing factor to heart disease is insulin resistance or metabolic syndrome, which leads to an imbalance in the blood sugar and high levels of insulin. This may affect as many as half of Americans over age 65. Many younger people also have this condition, which is sometimes called pre-diabetes,” says Dr. Hyman.
“Although modern medicine sometimes loses sight of the interconnectedness of all our bodily systems, blood sugar imbalances like these impact your cholesterol levels too. If you have any of these conditions, they will cause your good cholesterol to go down, while your triglycerides rise, which further increases inflammation and oxidative stress. All of these fluctuations contribute to blood thickening, clotting, and other malfunctions – leading to cardiovascular disease.”
“What’s more, elevated levels of a substance called homocysteine (related to our body’s levels of folic acid and vitamins B6 and B12) appear to correlate to cardiovascular illness. Where problematic levels occur, they can be easily addressed by adequate folic acid intake, along with vitamins B6 and B12.” My own internist, who is also a board-certified cardiologist, has had me on a supplement called Homocysteine Modulators (Solgar brand), as well as CoQ10, for years.
“So, heart disease is not only about cholesterol. It is important to look at many factors that contribute to your overall risk.” Dr. Hyman notes, “It seems that insulin and blood sugar imbalances and inflammation are proving to be more of a risk than cholesterol.” If you want to test your overall risk, consider asking your doctor to perform the following tests:
·         Cardio (hs) CRP (C-Reactive Protein): There can be many causes of inflammation in the body, but this marker of inflammation is essential to understand in the context of overall risk. Your CRP should be less than 1.0.
·         Standard Lipid Panel: Total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Pay particular attention to your HDL and triglycerides and the TC/HDL and TG/HDL ratios and work to improve them.  Pay less attention to lowering Total Cholesterol by lowering LDL, an outcome shown to be of dubious value alone. Your doctor can’t write a script for raising HDL and lowering triglycerides. You have to do it yourself by the food choices you make each and every meal.
·         VAP cholesterol test: directly measures LDL (vs. calculated as in the standard lipid test above), also VLDL, LP(a), and LDL particle size and characteristics (small, dense vs. large, fluffy).
·         Hemoglobin (Hb) A1c: This measures your average blood sugar over the last 6 weeks to 3 months. Anything over 5.5 is high. Dr. Richard K. Bernstein, the glucose self-testing guru and leading diabetes expert, considers 5.8 to be full-blown diabetes. Alas, the ADA considers 6.5 (formerly 7.0) to be diabetes and 6.0 to be pre-diabetes. Studies show that CVD risk doubles from an A1c of 5.5 to 6.0.
·         Glucose Insulin Tolerance Test: Measurements of fasting and 1 and 2 hour levels of glucose AND insulin helps identify pre-diabetes and excessively high levels of insulin. Most doctors just check blood sugar and NOT insulin, which is the first thing to go up. By the time your blood sugar goes up, “the train has left the station.”
·         Homocysteine: Your homocysteine measures your folate status and should be between 6 and 8.
·         Fibrinogen: Looks at clotting factors in the blood. It should be less than 300.
And, most importantly, know your test results. Take charge of your health. It’s your life. Make the most of it.

© Dan Brown 4/8/12

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