I just turned 34 this year and thought I needed to establish care with a physician. Plus I really wanted to know my numbers. Everyone should know their credit score, their lipid panel, their fasting glucose, their blood pressure, their TSH, and their Vitamin D level. These figures will tell you all you need about your health and what you need to do.

I recommend to all my 30-something friends, go see your doctors and get your numbers! Don't wait for one of these silent killers to strike!

I just got my results back and here they are: (in parenthesis are the goals or normal values)

Total Cholesterol: 184 (<200)
HDL: 44 (males >40, females>50)
LDL: 129 (<160, optional <130)
Triglycerides: 51 (<150)
Chol/HDL Ratio: 4.2 (<5)

BP: 130/70 (<120/80)

BMI: 26.3 (18.5-24.9)

Fasting Glucose: 80 (60-99)

Vitamin D level: 23 (>30)

TSH: 1.74 (1-5)

My impression and plan:

Lipids:

As far as my lipid panel goes. I don't like it. Yes, it falls within guidelines and looks pretty decent. But I like to be more aggressive about cholesterol control. 

If a patient walked in with this lipid panel I would be all over them about lifestyle modification, diet modification, exercise, and I'd give them 3 months to try and make some improvement. If they can't they'd be on a statin. 

In my case, I don't have much wiggle room in terms of lifestyle modification. I weigh at or very close to my ideal body weight, I eat very healthy, I don't eat saturated fat, I exercise like a mad man at least 2-3 times per week, sometimes way more, and I don't smoke or drink. Hence, this is my lipid panel. This is my genetics. In my case, I will probably start a low dose statin and see what happens. Probably a Crestor 5 or a Lipitor 10.

My total cholesterol is 184. I don't like this number. If I were a patient of mine, I would double whatever statin dose I was on, or start one. The guidelines state that a total cholesterol under 200 is ok.... but do you really want to be the guy with the 196? No. Guidelines are good basic information, but we need to strive for better. The guidelines from the NCEP ATP III are slightly outdated and need to be updated anyways. I am not going to be the guy with the cholesterol of 180 and settle for "mediocre".

My HDL (Healthy Cholesterol)  is 44. Sure it's over 40. But,  we like it to be over 45. Crestor and Lipitor can raise your good cholesterol. There are only a few things that raise HDL; exercise, Niacin, and a few statins (Crestor and Lipitor). Otherwise, you're stuck. Since I already exercise, this is another reason to start a statin.

My (Lethal Cholesterol) LDL is 129. The guidelines technically say under 160 if you have minimal risk factors, and under 130 if you have a few risk factors. I don't have any risk factors (obesity, hypertension, smoking, diabetes, family history, age, male sex, etc). If anything, I am a male.... so that is a risk factor. LDL is the primary target of therapy. When treating patients, I like to see it under 100 or under 70 in very high risk patients (diabetics, or already have CAD). So, statins are great at lowering LDL. That's their job.

My Triglycerides were only 51. This is a number I am especially proud of. I have never seen TGs this low before. This usually represents excess sugar that you have floating around in your blood stream. Triglycerides are chains of 3 sugars bound together. People who eat excess carbohydrates will have high TGs. Since, I don't eat carbs (unless they come from fruits and vegetables), this number is very low. Normally, we tell people with high TGs to start taking fish oil or flaxseed oil (Omega 3s) to help bring this down. I have some flaxseed oil pills at home and pop some every once in a while, but not consistently. So maybe that helped a little. Salmon and tuna have the most omega 3 of most fish we can eat.

My Cholesterol to HDL ratio is 4.2. Pretty high. We like it to be under 5.... but 4.2 is too close for me. I like to see numbers like 2.0 or 2.5. Not 4.2!

Blood Pressure:

Mine was 130/70. Pretty good. I had just walked in and barely had a chance to sit down when she took it. I am sure it'd be lower if she waited a few minutes. Not worried about that number. The lower your blood pressure, the longer you live, regardless of anything else. And for every 20/10 that your blood pressure is above 115/75, your chance of having a stroke doubles.

Body Mass Index:

This tells us how much you should weigh in relationship to your height. I'm five foot eight inches and weigh 173 pounds. It is used for males and females. Normal is between 18-24.9. Women should be to the lower end of the scale around 19-22 while men can be a little higher around 23-24. Yes, according to my BMI, I am overweight. Overweight is 25-29.9. Over 30 is obese. And over 40 is extremely obese.

While my BMI is in the "overweight" category, I don't mind. BMI doesn't work for that well for more muscular individuals. If you played high school sports, or carry around a lot of muscle mass, you will be at the higher end of normal. I've been involved in sports and weight lifting my entire life, and I know I carry around a lot more muscle than the average joe. In order for me to get under 25, I would have to lose about 10 pounds and get to a weight of 163. That's not impossible. And I could probably do it. I will work on this and see what happens. But I don't have much wiggle room here. Losing a few pounds isn't going to change my lipid panel either. 

Glucose:

My fasting glucose is way under 100. I'm very happy. No one's fasting glucose should even be close to 100. If your fasting glucose is creeping up and getting into the 90s, you and your doctor need to have a talk about insulin resistance (type 2 diabetes). I hate when physicians ignore fasting glucose numbers that are "high normal" and aren't aggressive about this issue. If this was you, would you want to wait until you are a full fledged diabetic and can't see, can't feel, and are peeing out protein? Get aggressive about this! Especially, if type 2 diabetes runs in their family! The only way you can get type 2 diabetes is if you inherit it! Please start taking Metformin right away!

Vitamin D:

Vitamin D plays a crucial role in nearly every metabolic reaction in our body. It's actually a hormone, not a vitamin. We are finding out more an more about Vitamin D every day. If you want your number, ask your doctor for a 25OH Vitamin D (25 Hydroxy Vitamin D). Not the other two. None of the others matter or are even useful. Vitamin D is important for our bone health, cardiovascular health, helps suppress inflammation, prevents myalgias, joint pain, stiffness, and nearly everything else.

My number was 23. This is low. Normal is considered 30 and up. But you start seeing problems in humans with vitamin D levels less than 40. So we ideally aim for a level of 50-70. So mine is pretty low. Under 10 is considered Vitamin D deficiency, and 10-30 is considered insufficiency. 

If you live north of Atlanta, cover all your skin with clothes (most Muslim women), wear sunblock or have darker skin.... you are deficient. Get it checked and get treated. Our body uses sunlight to convert Vitamin D to it's active form. So yes, I started taking Vitamin D supplements.

TSH:

This tells us about your thyroid function. Mine is 1.74. Perfect! When we treat people with thyroid issues, we like to see their TSH be between 1 and 2. So this is perfect!

Any thoughts?

I would like to hear all of your thoughts and analysis. Would you be as aggressive? In a 34 year old, otherwise healthy, compliant male? Would you start a statin?  Try anything else?

Eating cholesterol does not raise your cholesterol! People need to stop worrying about eating cholesterol! Eat all the eggs and shrimp you want!

What raises your cholesterol is saturated fats! These are fats that are SOLID at room temperature. Butter, margarine, cheese, fat on steak, bacon, chicken skin, pork, goose fat, cream, ice cream, and the fat in milk (even though it looks like liquid, it's actually solid fat particles floating around in liquid).

Eighty-five to ninety percent of your total cholesterol comes from your liver. Our liver makes over 85% of our cholesterol! Only a small percentage comes from food you eat. If you don't eat cholesterol, your liver makes more to make up for the difference. If you eat cholesterol, your liver will make less. So it doesn't matter how much you eat!

What tells your liver to make cholesterol?

SATURATED FAT!

Fats that are solid at room temperature. Avoid those and you will be ok! If you remember that, you will be fine.

We always tell our patients to first try diet and exercise to help improve their cholesterol numbers. So they go around and stop buying foods that say "cholesterol" on the label, or buy "cholesterol free" foods. Bad idea! You liver will just make up the difference.

What we should tell them to do is to avoid foods that have saturated fat in them. Solid at room temperature! Remember that!

Saturated fats are found in high amounts in:

Butter, Coconut, all those butter substitutes, Cheese, Pork, Beef, Chicken skin, Goose fat, veal, sausage, hot dogs, bacon, processed meats, cream, milk and other dairy products, ice cream, etc. You get the picture. SOLID FATS! When you look at that steak and see the marbelling and fat in between the muscle fibers, or the fat on ribs and lamb chops....  IT's SOLID FAT!!!!!

Avoid Solid Fat!

But, there are two liquid fats that contain a lot of saturated fat; coconut oil and palm oil. But my guess is no one really eats those. Especially, not here in the United States. Butter, cheese, cream, bacon, pork, and beef are our main problem.

What about trans fats?

These are liquid fats (like vegetable oil) that are heated in the presence of hydrogen to make them semi-solid. Like all those butter substitutes. These are awful!

Trans fats are even worse for cholesterol levels than saturated fat and cholesterol itself because they raise LDL ("bad") cholesterol AND lower HDL ("good") cholesterol.