Your Best Blood Test Ever
MEN SPILL IT, SEAL FRIENDships with it and, if they’re ageing rock guitarists, have it purified at Swiss clinics. But blood also tells a detective story. Just as the amount, colour, odour and feel of the oil on a car’s dipstick offer clues about wear and tear on the engine, your blood can reveal critical details about the running condition of your entire body. Of course, first you need to know what to look for and how to interpret the findings. That’s why we’ve created a guide on how to read the red stuff. Order up all seven of these tests at your next physical and you’ll be doing more than just kicking the tyres.
1. START WITH THE BASICS: THE CBC
“If I had a 30-year-old man coming to me for the first time, I’d order a complete blood count (CBC),” says internal-medicine physician Dr David Perkins. Think of the CBC as an array of baseline numbers for key factors such as red (oxygen-carrying) blood cells, white (infection-fighting) blood cells and platelets (clotting particles). Within the CBC, a haematocrit score indicates the proportion of red blood cells in your total blood volume, and a haemoglobin measurement assesses the oxygen-carrying protein of red blood cells. “If you’ve been following the exercise and nutrition advice recommended in this magazine and are still short of breath while pumping iron, you may have low haematocrit and haemoglobin counts,” says cardiologist Dr John Elefteriades, co-author of Your Heart: An Owner’s Guide. These low numbers may signal anaemia, a blood disorder that can lead to heart arrhythmia if left untreated. If your blood is anaemic The good news is that you can treat some types of anaemia by taking an iron supplement (best absorbed 30 minutes before breakfast with orange juice or vitamin C). Supplemental vitamin B12 or folic acid can also help.
2. LEARN YOUR SUGAR SCORE
Blood tests are like radar for tracking type-2 diabetes. The standard measure is the fasting glucose test. Fasting glucose is a once-off reading, so it’s often paired with the haemoglobin A1c test (or HbA1c) of your average blood-glucose level over the preceding two to three months. It’s a good way to see if your blood sugar levels are stable. But if you score high on either of these tests – above three to five millimoles per litre (mmol/L) on the fasting test, or above six percent on the HbA1c – you should demand an oral glucose-tolerance test (OGTT). Doctors diagnose heart disease with a stress test, not a resting test. An OGTT does the same for the most basic process in your body – metabolism. Dr Keith Berkowitz points out that the fasting measure can still be in the normal range even if post meal numbers are elevated. As for the HbA1c, it can miss some abnormalities because swings from high to low blood sugar sometimes simply average out. Take an OGTT regardless of your fasting-glucose and HbA1c scores if you score 5.5 to 6.9mmol/L or higher on a random glucose test (one you take without fasting beforehand), your belly’s bulging (that is, your body mass index is 30 or higher) or you experience head-snapping slumps after a high-carbohydrate meal. Ditto if you have a family history of diabetes or heart disease. The test can last two to five hours, depending on the version you take. If you hit the two hour mark of an OGTT with a reading above 5.5 to 6.9mmol/L, you’re prediabetic. If it’s above 6.9mmol/L at that point, there’s no “pre” about it.
Tossing walnuts into your yoghurt may raise your good cholesterol by nine nine percent
If you’re one of the 80 to 90 percent of people with type-2 diabetes who are overweight, slashing carbs from your diet and hitting the treadmill for 15 to 20 minutes a day should do the trick while offering the added benefit of increasing your insulin sensitivity.
3. KEEP AN EYE ON FATS, TOO
“The fasting lipid profile is where cardiovascular abnormalities are most likely to appear for the average guy,” says Perkins. Generally, your HDL (good) cholesterol should be between 1.15 and 1.3mmol/L, while your LDL (bad) cholesterol should be below 3.3mmol/L. Triglycerides should fall under 1.7. If you have risk factors for cardiovascular disease – such as past cardiac events, a family history of the disease, hypertension or you’re a smoker – your target LDL may be below 2.5mmol/L. If you’re at high risk, ask your physician about an expanded lipid profile test, which further breaks down the dangerous subtypes of LDL. If your results don’t measure up If your HDL is too low, tossing walnuts into your yoghurt may raise your good cholesterol by nine percent, according to a study in Angiology. If your triglycerides are high, cut back on starches, breads, pasta and other carb-loaded offerings. Even if your LDL levels don’t go down, you can still halve your chances of dying of a heart attack simply by exercising, according to a joint study by the Cooper Institute and Canada’s Queen’s University.
4. LOOK FOR SIGNS OF INFLAMMATION
The process by which inflamed arteries lead to cardiovascular disease is invisible except for a tracer – an elevated level of C-reactive protein (CRP) in your blood. “If your CRP as well as your total cholesterol is high, you’re at an even greater risk of having a heart attack than you would be with either risk factor by itself,” says professor of physiology Dr David Sandmire. Make sure you feel perfectly healthy the day of your appointment: this highly sensitive test picks up all sorts of inflammation, even from a paper cut. That’s a good reason to take it twice, at least a month apart, and average the two scores. Yours should fall under one milligram per litre; if it’s above three, your heart-attack risk doubles. If your score is too high Smokers, take note: “It’s almost certain that CRP levels will decrease after you quit,” says David Johnson, an associate professor in the college of osteopathic medicine at the University of New England and co-author of Medical Tests That Can Save Your Life. If your lungs are already a smoke-free zone, raise a glass. A Spanish study found that red wine reduced inflammation markers by 21 percent.
5. HAVE YOUR PROSTATE CHECKED
More than 2 500 South African men die from prostate cancer every year, so pay great attention to tracking your prostate specific antigen (PSA). Elevation of this marker can signal a problem – at least sometimes. “PSA testing is not an exact science, because factors external to the prostate can cause the marker to rise,” says Johnson. A high PSA reading may point to a benign enlargement of the prostate or even a bacterial infection known as prostatitis. That’s why the trend can be as important as the static number. “Every year I have a PSA test done along with my physical, and compare the result with that of the year before, to see if further investigation is warranted,” says Johnson. “Once you reach 50 years of age (40 if you’re black), your doctor may recommend a PSA test. Don’t hesitate to ask for one if you’re in your thirties, however.” Keep your results in range Eat two Brazil nuts a day, good for 200 micrograms of selenium. The US’s National Cancer Institute researchers found that men with the highest selenium levels who also took a multi-vitamin were 39 percent less likely to develop prostate cancer than those with the lowest levels.
6. DON’T FORGET YOUR THYROID
Thyroid problems hit men as well as women, and stress and poor sleep are often the culprits. Many people don’t sleep as well as they should, so the body overcompensates. With an overactive thyroid, there may be signs of a goitre – a swollen area in the neck. Hyperthyroidism, as it’s called, can also lead to an increased heart rate, anxiety, sleep problems and weight loss. Symptoms of an underactive thyroid (hypothyroidism) may include personality changes, hair loss, weight gain and a cloudy memory. Both thyroid conditions can lead to more serious, life-threatening illnesses when left untreated. The thyroid-stimulating hormone (TSH) test will determine if you have a problem. If your results are off the mark your doctor may order the more specific free T3 and free T4 follow-up tests. Depending on whether your thyroid is overactive or underactive, a beta-blocker or thyroid-hormone replacement drug may be prescribed.
7. CHECK ONE FINAL THING
“Aspirin, although a very old and cheap product, is really a wonder drug,” says Elefteriades. That’s because aspirin reduces the stickiness of platelets, making them less likely to clump together and block a blood vessel. But not all men respond to this treatment – and there’s a test that identifies the ones who don’t. “Aspirin resistance is found in about 20 percent of patients tested,” says Dr Eric Topol, dean of the Scripps School of Medicine in La Jolla, California. For those men who are resistant, aspirin is a waste of time and money. If you’re aspirin resistant cook with virgin olive oil. Three tablespoons a day can help improve arterial blood flow, Spanish scientists found. Your Pretest Checklist Be prepared for the consultation part of receiving more thorough blood testing is convincing the person with the stethoscope that you actually need it. Here’s how to tip the odds your way.
ESCAPE THE “OH, BY THE WAY…” TRAP Researchers from Texas A&M University studied videos of 392 office visits and found that the median number of topics discussed is six. But if one topic dominates the office conversation, the others can get squeezed out. Tell the doctor your number one priority right up front, says Dr Debra Roter, author of Doctors Talking With Patients/Patients Talking With Doctors.
HAVE A CONVERSATION, NOT A CONFRONTATION “Physicians object to patients who throw printouts from the Internet at them and expect them to read through everything,” says Roter. Try using this phrase to kick-start an appointment: “I’m interested in having these markers and tests done. It’ll make me feel more confident about my health if I can track them.”
DO YOUR HOMEWORK If a blood test is deemed necessary, your insurance should cover it. Medical aids rely on medical research to determine if tests and screenings are necessary.
KNOW YOUR FAMILY TREE You’ll have a stronger argument for needing a blood test if first-degree relatives had conditions such as heart disease and prostate cancer. Most medical evidence shows benefits for screening tests because of genetics.