(Images sourced from Parade)
By Kaitlin Vogel / May 11, 2021
How healthy are you, really? When it comes to knowing key health numbers, most Americans say that they know their family health history (74%), blood type (58%), waist size (58%), and last blood pressure reading (57%), according to a recent survey from the Cleveland Clinic in partnership with Parade.com and Ipsos.
However, knowledge starts to drop off when it comes to last blood cholesterol level reading (45%), BMI (40%), and last blood sugar reading (38%), where more than half don’t know.
We spoke to several doctors to find out the health facts you need to know, and why.
Fasting Blood Sugar and A1C
Dr. Stacie Stephenson, Certified Nutrition Specialist and CEO of VibrantDoc, breaks down why getting your blood sugar checked is important.
“High blood sugar is all too common in our modern world of constant eating and high-sugar, high-fat junk food, and it puts you at risk of pre-diabetes, metabolic syndrome, or full-blown type 2 diabetes, which comes with many of its own health problems and is also a major risk factor for heart disease,” she says.
You may not know your blood sugar is going too high unless you know your numbers, but every time blood sugar rises well above normal, you risk damaging organs and blood vessels, so it’s important to know if this is happening. You can measure your fasting blood sugar at home with a glucose testing kit, if you don’t mind pricking your finger.
Test first thing in the morning, before breakfast. If you are at risk for diabetes, you may be able to get a prescription for a continuous glucose monitor (CGM), which you stick on your upper arm. This allows you to measure your blood sugar at any time, so you can determine how you react to different foods, and it makes a first-thing-in-the-morning measurement quick and easy. CGMs are becoming more available so you may be able to get one soon without a prescription.
Unlike a fasting blood sugar test, which shows your blood sugar level during a moment in time, an A1C test will tell you your average blood sugar over the past three months. You can purchase an A1C test for home use, but it also includes a finger stick. If you don’t want to test at home, request fasting blood sugar and an A1C test at your next doctor’s appointment, and be sure not to eat anything first (morning appointments make this easiest). If you eat breakfast, your fasting glucose test results won’t be accurate.
If you get abnormal readings on either or both tests, ask your doctor for more detailed testing, like a glucose tolerance test and/or a fasting insulin test, to get a more full and accurate picture of your blood sugar stability. Unfortunately, many people already have type 2 diabetes and don’t know it until they test, but the good news is that with lifestyle changes like a nutrient-dense low-sugar diet and regular exercise, you can quickly get those numbers back down again, in most cases. If you don’t know you are at risk, you may not have the motivation to restore your own blood sugar balance, so get the numbers and take action if they aren’t where they should be.
Most Recent Blood Pressure
Knowing your most recent blood pressure reading is essential, and even more important, in patients with hypertension (chronically elevated blood pressure), is that people know their home blood pressure measurements, Dr. Luke Laffin, MD and preventative cardiologist at Cleveland Clinic, explains that up to 40% of individuals can have a significant difference between measurements taken in a medical setting versus at home.
“We generally treat hypertension based on out-of-office readings and not just based on a clinic measurement,” says Dr. Laffin. “When home blood pressures are significantly lower than in-office blood pressures we call that white coat hypertension, and when the opposite is true (office blood pressures are significantly lower than home blood pressures) we call this masked hypertension.”
Family history (parents, siblings)
Do you know the health status of your immediate family members? If not, ask, if possible, or do some research, Dr. Stephenson states.
“If a parent or sibling has had heart disease, diabetes, cancer, autoimmune disease, mental health issues, or any other chronic condition, you are probably at an elevated risk. Knowing that can be a great motivator to up your health game. Be sure your doctor knows, too, and if you do have inherited risks, ask what extra tests or screenings you could take to protect yourself. Knowledge is power,” says Dr. Stephenson.
Although not a perfect measurement, we have vast amounts of data showing that, in general, individuals with high BMIs have a higher risk of hypertension, diabetes, and the subsequent cardiovascular disease processes such as atrial fibrillation and ischemic heart disease, says Dr. Laffin.
“Family history is important but only knowing that your father had a ‘history of heart disease’ is not sufficient,” Dr. Laffin explains. “Heart disease can be an all-compassing term that can mean anything from a heart attack requiring a stent, an arrhythmia requiring specialized medications, or a stenotic heart valve that needed open-heart surgery. These are very different conditions that often require different tests.”
Inflammation, As Measured by hs-CRP
If you have a family history of heart disease or a close relative has already had a heart attack, you can probably get your doctor to order this high-sensitivity test for inflammation, which is another major risk factor for heart disease (it’s also sometimes called a cardiac CRP), Dr. Stephenson states.
“Even a small amount of inflammation can put your heart at risk, and although inflammation can have symptoms, such as joint pain and swelling, or a general feeling of fatigue or un-wellness, you won’t really know the cause of these general symptoms unless you test and find you really do have elevated inflammation,” says Dr. Stephenson. “Losing weight and reducing sugar and inflammatory fats (like processed oils) are the best ways to bring inflammation back down. If yours is too high, talk to your doctor about re-testing after trying lifestyle interventions. The best hs-CRP number is 0.”
If you have an early family history of heart disease, it might be worthwhile asking your physician to check this level in addition to a conventional blood cholesterol panel, Dr. Laffin states. This level is 90-95% genetically determined, lifestyle interventions do not change it significantly, and current FDA-approved medications are not available to lower it.
“We know that having elevated levels raise your risk of future cardiovascular disease. While we await medications to lower Lipoprotein a (currently being studied in clinical trials), we do our best to aggressively control other cardiovascular risk factors,” Dr. Laffin explains.
Cholesterol: HDL, LDL, and Triglycerides
These measures of the different kinds of fats in your blood will tell you whether you are at a higher risk of heart disease and stroke, and like so many other numbers it’s important to know, elevated levels won’t usually have any symptoms. You can do blood cholesterol tests with at-home kits or ask for a lipid panel from your primary care provider.
Even if your numbers are in the normal range, watch for trends over time (your doctor might not notice), says Dr. Stephenson. If you see your total cholesterol, LDL (“bad”) cholesterol, or triglycerides creeping up, it’s time to take action with lifestyle changes, especially by improving your diet (less sugar and saturated fat, more fiber and lean protein) and exercising more. You also want to raise your HDL (“good”) cholesterol or keep it on the high side, as that is the type that protects you from heart disease.
The solution? A diet rich in healthful plant fats and omega-3 fatty acids from cold-water fatty fish are the best interventions to bring up HDL, Dr. Stephenson explains. If your cholesterol is too high or your HDL is too low, ask your doctor at what point you should be concerned, then take responsibility by continuing to measure once or twice a year to see how your lifestyle changes are influencing those numbers.
How To Be an Advocate for Your Health
Dr. Adam Ramin, MD, urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles outlines the three main factors of being an advocate: seek information, communicate, problem-solve and negotiate.
As soon as a diagnosis is received, it is crucial to seek out factual information about the condition/disease. How does one know what a factual source is? Start with your physician. Ask him or her questions.
“Once I deliver a cancer diagnosis to a patient, for example, one of my most important jobs transitions from provider to listener,” says Dr. Ramin. “Finding a doctor who takes the time to listen to questions and answer them thoroughly is crucial to the treatment journey.”
When someone is told they have a certain condition/disease, it can sometimes feel as though an internal “mute” button is pressed on the brain, mouth, and heart. However, in terms of self-advocacy, this may be one of the biggest and most significant hurdles to overcome when deciding how to move forward.
One way to accomplish this is to organize your thoughts before medical appointments by writing them down. Consider what you know about your diagnosis and aim to obtain any missing information you want to “fill in the blanks” or answer questions that you still need. There can be far fewer questions on day one of a diagnosis than at the next follow-up appointment, so never feel bad for not asking sooner.
At some point after diagnosis, the need to make treatment choices will arise. Armed with the information you’ve sought on your own and questions answered by your doctor or care team, loved ones can also help talk you through decisions. But it is important to remember that this is your body and your life. No one can make treatment decisions for you.
There will be times when the need to have your circumstances considered will require speaking up. Medical care and treatment involve every aspect of daily living, so how it affects each facet of your life will require consideration and possibly accommodation in some areas. These considerations don’t only include health care topics.
As an example, consider what you do for work. For more serious diagnoses, a conversation with your employer about how your workload or hours are handled as you seek care will be crucial—and it may require some negotiation.