Normal, borderline, high cholesterol

WELLNEWS

Victor Dumaguing

Doctors and laboratory personnel, especially medical technologists have strict preparation protocols before doing diagnostic procedures especially when it comes to blood tests; all these for the sake of accuracy and reliability of the results with the ultimate purpose of bringing  back the patient to optimum health.
    Fasting is one item emphasized by the attending physician and at the same time, desired by the clinical lab. In general, fasting for 8-12 hours is routinely followed by almost all laboratory facilities all over the world, with some minor modification depending on the assessment and evaluation of the health status and co-morbidities of the individual patient.  In other words, it is not the proverbial “one  size fits all .”                                                                                                                                                              
With my patients- not that my practice is the standard norm- who most of them take dinner from 630-730pm, the advice is upon waking up, not to take breakfast, no other liquids except water and be at the lab for blood extraction ideally between 630am and not later than 8 am.
    Drinking water is a contentious issue between doctors and a few lab which do not extract blood just because the patient had drunk water before going to the lab. Most endocrinologists Ive  interviewed allow water; and as a teacher of biochemistry, your columnist tells students and patients alike that WATER HAS NO CALORIC LOAD OR VALUE, thus it does NOT in any way affect the actual results whether for FBS( fasting blood sugar, LDL-C, triglycerides) which admittedly require strict fasting preparations Besides, as an added plus factor for both the medtechnologist and the patient, water would make vein fuller leading to a successful one-attempt blood extraction.
    Both American Heart Association and American Stroke Association consider as ‘DESIRABLE” total cholesterol level LESS than 200mg/dl; BORDERLINE HIGH 200-239 mg/dl and HIGH for cholesterol levels 240mg/dl and above. Obviously, those with desirable levels have relatively low risk of heart attack and stroke with the word “relative” to emphasize that “unless there are other risk factors like family history, male gender, and other co-morbidities like diabetes and hypertension. Those with “borderline high” have TWICE the risk of heart attack and stroke. It does not take a genius or a sky-high IQ to realize that a HIGH level can lead to serious health consequences.
    Cholesterol moves through the blood stream to the cells in special carriers called Lipoproteins. LDL-cholesterol is known as the “bad cholesterol>’. Before anything else, the word “density refers to the amount or ratio of proteins/fat content; in the case of LDL-C, protein is just 10-15% with the remaining substance as fats. Some tissues use LDL-C to build cells but too much of it would be deposited together with other substances like platelets to form plaques which narrows, clogs arteries and reduces blood flow, a condition called atherosclerosis. Optimal LDL-C is LESS than 100mg/dl, 100-129mg/dl is near or above normal, 130-159mg/dl borderline high, 160 and above is high. It must be stressed that doctors especially cardiologists are MORE CONCERNED with LDL-C than total cholesterol in regards to the serious clinical complications It brings.
    HDL-C cholesterol is the “good cholesterol, which has more protein content(about 80-85%, thus the “high density’ which help lower the risk of heart attack and stroke. Medical experts believe HDL takes cholesterol away from the arteries and back to .the liver, which will then excrete it through the bile until it is expelled as feces. An HDL of 60mg/dl and above is protective against heart disease. A low HDL (less than 40mg/dl) in men and less than 50mg/dl in women is a major risk factor for heart disease and also stroke.
    TG or TRIGLYCERIDES ARE THE MOST COMMON FATS IN THE BODY, which serves as storage form of fat, and thus as a major source of energy. The body makes them and they also come from food.  As people get older or gain weight, TG and cholesterol levels tend to rise. A high TG combined with a low HDL and high LDL can speed up atherosclerosis thus magnifying the risk of heart attack and stroke. Also it has been found that a very high TG has been one of the probably causes of acute pancreatitis, which is a very serious and may be lethal condition. A normal fasting TG should be LESS than 150mg/dl, borderline high would be 150-199mg/dl, 200- and above is high. Many people with high TG have other conditions or genetic disorders like hereditary or familial dyslipidemia in which both TG and cholesterol are elevated which requires a more aggressive therapeutic management coupled with lifestyle modification in terms of dietary restriction and consistent exercise regimen.
Next Week: Fat Facts