"Normal" lab tests????????

[My Flight Surgeon]

Here is a PM question I received. I think the problem is common and the isuues are important to pilots and their careers. I am posting it (anonymously) with permission of the questioner.

DOC:

I went in last week for a regular physical and fasting bloods tests. The Doc's office said everything was fine and try to lose some weight before next year. Here are the results:

Cholesterol

• LDL 114
• HDL 40
• Total 197 Why doesn't HDL + LDL = total

Glucose (nurse said scale is 65-100)

• 84

Tryglycerides (isn't this high? What does it mean)?

• 213

Weight, Height & Age

• 332 lbs 6' 3" Large Frame (played college FB)
• Early 30's

My family has a history of Diabetes, Obesity, Heart Disease and Stroke...

My question to you is how good or bad are these numbers.

Well pardner, the lab numbers look good except the triglycerides. The 213 is too high. This may be an indication of metabolic syndrome, especially with a family history of diabetes. The goal for triglycerides is less than 150. To change this, you need to decrease your carbohydrates, eat whole wheat bread, and increase your exercise to at least 30 minutes of cardio a day. Don’t smoke!!

The total cholesterol is comprised of HDL, LDL and VLDL, that is why HDL + LDL do not equal the total.

Metabolic Syndrome
What is metabolic syndrome?
Metabolic syndrome (also called syndrome X) is a group of risk factors for heart disease. Many people who have type 2 diabetes also have metabolic syndrome.
You have metabolic syndrome if at least 3 of the following are true:

• You are overweight or obese and you carry the weight around your middle. For men, this means a waist that measures greater than 40 inches around. For women, it means a waist that measures greater than 35 inches around.
• You have high blood pressure (130/85 mm Hg or greater).
• You have a high amount of sugar in your blood (a fasting blood sugar of 110 mg/dL or greater).
• You have a high amount of fat in your blood (a triglyceride level of 150 mg/dL or greater).
• You have low HDL cholesterol (the "good" cholesterol). For men, this means an HDL level less than 40 mg/dL. For women, this means an HDL level less than 50 mg/dL.

The more of these risk factors you have, the higher your risk of heart disease. Even if your cholesterol level is normal, you still may be at risk for a heart attack or stroke.
What causes metabolic syndrome?
Metabolic syndrome results from eating a diet that has too many calories and too much saturated fat, and not getting enough physical activity. You can lower your risk of heart disease and diabetes by improving your eating habits, getting more physical activity and losing weight. If you smoke, you should stop smoking.
Can physical activity help reduce my risk?
Yes. Not being active is one of the biggest risk factors for heart disease. "Exercise: A Healthy Habit to Start and Keep" provides useful tips on adding more physical activity to your life.
Can a healthy diet help reduce my risk?
Yes, what you eat can affect your health. "Nutrition: Tips for Improving Your Health" provides information about how to eat a more healthy diet. "Working With Your Doctor to Overcome Overweight and Obesity" offers tips on losing weight and living a healthier lifestyle.


The weight is TOO MUCH for your height. Your Body Mass Index is 41.5 (NORMAL IS <25 and >30 is classified as obese). Here I am, the pot calling the kettle black. I am 6’4” AND 270 # with a BMI of 28.5 – we all eat too much, not the right stuff and don’t exercise enough.

Your family history is not good. I know you can’t change who you chose for parents, but if you religiously change your lifestyle you will increase your longevity and quality of life. Metabolic syndrome frequently leads to diabetes (can be a deal breaker for a pilot if severe enough), heart disease and stroke. My opinion is that we need to have the best quality of life, god health, and be shot by a jealous husband at age 90.

Here is what I would want to see:
HDL of > 40 and preferably near 50
LDL of < 80 – there is not enough evidence for this yet but I push my LDL to the mid 70’s and the aggressive cardiologists are now pushing LDL to the 50’s in patients with diabetes and heart disease. It will be the standard of care in ayear or two.
Total cholesterol of < 160.
Triglycerides of < 150 and preferably < 130.
Exercise at least 30 minutes a day alternating cardio and strength training
Eat a balance diabetic diet at 2000-2200 calories a day, consider a consult with a registered dietician.
Repeat the labs after 6 months

Watch "Super-size Me", it will scare you!

Understand that the nurse is just telling you what the lab slip says about “normals” Normals are derived from plotting the median plus or minus 2 standard devialtions for a large number of people being tested. Since we are becoming a “broader” country, the “normals” will continue to rise over time. This does not necessarily mean that these values are optimal.

A long answer but it looks like you need to change your lifestyle.

[amorris311]

i used to be 332 and im 6'3" as well fb in college has ended early so i cant eat everything in sight now, which really sucks! i feel for ya man.

[jetman]

Are there other kind of units used in the tests? My cholesterol is
4.47 [F]???
LDL 2.49[F] [CALCULATED] MMOL/L
HDL 1.59 [F] MMOL/L
HDL RATIO 2.8[F]
TRIGLYCERIDES 0.86 [F] MMOL/L
Glucose-Fasting 6.0[F] MMOL/L
HS-CRP 0.4[F] mg/L ????????

Dr thanks a lot for post.

[rausda27]

I had some hyperlipidemia about a year ago that was discovered during routine pysical (not aviation medical). I switched to a low carb, no sugar diet and started taking omega 3 fatty acids (aka fish oil) and niacin. The triglycerides are now 80..and I lost 30 pounds, problemo solved! (with the regular exercise my BP has also dropped dramatically.)

The hardest part was the no sugar, but after a few months I got used to it and becasue I felt so much better and could see the results, it was worth the sacrifice.

[My Flight Surgeon]

Jetman-
You must be Canadian, they use mmol/L in Canada and the UK. These values are also used in international medical literature. In the US we use mg/dL. To convert, multiply cholesterol mg/dL by 38.67. To convert glucose, multiply by 88.57.
Your values:
Total cholesterol 4.47 = 173
HDL 1.59 = 61
LDL 2.49 = 96
Triglycerides 0.86 = 76
Glucose 6.0 = 108
These values are all good. I would like the glucose <100 but it is still in the normal range. The lipid values are fantastic.

hs-CRP of 0.4 is great. We want the value to be less than 0.7. Risk for vascular disease rises with an increasing hs-CRP. The values are:
CRP relative risk
<0.7 1.0
0.7-1.1 1.2
1.2-1.9 1.4
2.0-3.8 1.7
3.9-4.9 2.2

[My Flight Surgeon]

In response to rausda27, You are on the mark.
Everyone should watch "Super-Size Me", it is a real eye opener.

[O'Town Pilot]

Originally Posted by My Flight Surgeon

In response to rausda27, You are on the mark.
Everyone should watch "Super-Size Me", it is a real eye opener.

That movie changed my life. I am 17 and watched it in my Health Class....Wow....I wont even look at fast food joints anymore and have become more aware of what is really in food. After the movie, I cut as much of this from my diet as i could.
1-hydrogenated oils.
2-high fructose corn syrup
3-Sat. Fats.
4-Trans fats.
5-bleached/enriched wheat
Hope that will add a few years.

[jetman]

Originally Posted by My Flight Surgeon

Jetman-
You must be Canadian, they use mmol/L in Canada and the UK. These values are also used in international medical literature. In the US we use mg/dL. To convert, multiply cholesterol mg/dL by 38.67. To convert glucose, multiply by 88.57.
Your values:
Total cholesterol 4.47 = 173
HDL 1.59 = 61
LDL 2.49 = 96
Triglycerides 0.86 = 76
Glucose 6.0 = 108
These values are all good. I would like the glucose <100 but it is still in the normal range. The lipid values are fantastic.

hs-CRP of 0.4 is great. We want the value to be less than 0.7. Risk for vascular disease rises with an increasing hs-CRP. The values are:
CRP relative risk
<0.7 1.0
0.7-1.1 1.2
1.2-1.9 1.4
2.0-3.8 1.7
3.9-4.9 2.2

Dr. thanks for all the very valuable info!! For some years now I been taking Lecithin ,Kelp and Omega 3-6-9 daily.Do you think that this suplements may have something to do with low Lipid? Does low Lipid translate into " good cardiovascular health"?
Thanks again

[My Flight Surgeon]

We know the Omega-3 fatty acids are good for lipids.

Lipids are only one of several factors related to heart disease. The others include diabetes (a BIG one), hypertension, smoking, obesity, stress and genetics. There are people with cholesterols of 300 with no heart disease but they are rare. It is best to manage every risk factor for good health.

[I_Money]

Doc - with all this medical information we get these days when should be start to worry - I feel nomal, never really had a medical problem so I feel getting tests done is pointless - is it?

[My Flight Surgeon]

WRONG!

It is somewhat age dependent. You need a lipid profile (the cholesterol tests) done at age 18-20, then every 5 years. Blood pressure should be reviewed avery 2 years. Most of the rest of it is specific depending on your medical and family history. It is better to prevent problems related to high cholesterol and blood pressure than to deal with the consequences (heart attack, stroke, NOT FLYING).

[Old Pete]

Originally Posted by My Flight Surgeon

In response to rausda27, You are on the mark.
Everyone should watch "Super-Size Me", it is a real eye opener.

Dr. Forred,
First I want to thank you for participating in this forum and the information you have shared with us, but I've got to ask if you are kidding about "Super-Size Me". I saw an interview with the guy who made it-not a doctor, no medical or science credentials of any kind-in fact he looked more like a homeless person on drugs. It appeared to me to be nothing more than a publicity stunt. He seemed to want to be the next Michael Moore, with McDonald's substituting for GM.

[My Flight Surgeon]

Could be that was his goal. The movie still was done quite well, he had good medical evaluations and advice, and the data he presents in the end were both amazing and make physiologic sense. The fact is that the percentage of Americans who are either over weight or frankly obese is rising every year. The incidence of diabetes is rising evry year. The incidence of heart disease is NOT going down. Even if the guy is a little odd, he drives home an important point about the American diet, we eat TOO MUCH and it contains way too much sugar and fat.

The other thing that makes one think the guy is on the up and up, we have not heard form him since that project.