I continue to be flabbergasted by the amount of upside-down health advice that people take as gospel. Once a high-powered marketing department seizes on a flawed or bogus study, you’ll need three generations or more to undo the damage. Just look at the discredited food pyramid and the slop still plopped onto trays at elementary schools or in hospitals.
Take for example the widespread belief that alcohol in small amounts is healthier than no drinks. It turns out that in the original studies, the individuals who consumed no drinks included former drinkers who were too ill to consume more alcohol. Once former drinkers were removed from the category of non-drinkers, the health of the non-drinkers improved dramatically. When the data was adjusted,
“ … the relationship between alcohol and disease was perfectly linear, meaning that alcohol use in any quantity was associated with increased risk of disease when compared to people who don’t drink, and never had.”
Moderate amounts of alcohol provide no hormetic benefits, red wine is a terrible way to find antioxidants, and there’s no relationship between drinking, socializing, and better health. It’s just a bad study that will take a half-century to unwind.
Which brings me to the results from my recent blood test.
In the 1950s, the infamous physiologist Ancel Keys published a study showing a strong correlation between cholesterol and heart disease. In retrospect, we learned that Keys tossed data points that undermined his hypothesis, and he excluded as outliers groups such as Eskimos that would have been fascinating to study for their extremely high cholesterol scores but zero heart disease. In any event, Big Sugar exploited the situation to blame fat for what sugar did, and the sugar industry engaged in straight-up graft for regulatory capture of key government health agencies.
To this day, vast swaths of the general population and medical community believe the cholesterol myth, even though studies show no causation between dietary cholesterol, high LDL cholesterol, and heart disease. Doctors continue to push the relevance of cholesterol scores because 1) we are good at measuring it, and 2) we have drugs that can make substantial changes in the number. Whether cholesterol should be one of the top 10 blood markers we measure, and whether the drug-induced changes actually improve health, is an entirely different question.
One urgent purpose of annual blood labs should be to identify markers of metabolic syndrome. People who think seriously about health issues have connected poor metabolic health to a cluster of terminal health problems including cardiovascular disease, cancer, and Alzheimer’s. Heart surgeons will tell you how they operate all the time on folks with cholesterol scores that fall within normal ranges and whose belts fit fine.
The gold standard for evaluating metabolic health is the amount of insulin your body produces in order to keep you at a certain serum glucose level. For whatever reason, the US health care system doesn’t want you anywhere near this information. A “comprehensive” metabolic panel includes only your fasting glucose score, which is like trying to figure out how far someone has traveled knowing only their MPH. My fasting glucose was 91, but I don’t know how much insulin my body needs to hold that number.
I believe the reason fasting insulin levels are not included in a standard metabolic panel is because there is no medication that can reduce the amount of insulin your body produces. The only thing you can do to increase your insulin sensitivity is to eat less crap (and move more), which doesn’t enrich anyone.
Let’s take a closer look at my lab scores and see if getting jabbed twice (the phlebotomist needed to switch to a smaller needle) had any value at all.
If you want to look at cholesterol, which is all I have, the ratio of triglycerides to HDL is considered a good measure of insulin resistance. The standard lipid panel report shows you all kinds of ratios—but not this one—although you can do the calculation by hand. I doubt 1-in-1,000 laypeople or doctors even know the importance of this crucial fraction. My ratio was 1.0, up somewhat from last year’s 0.7, but the risk factor for metabolic syndrome is anything over 1.8, so no issues there.
There was no HbA1c test ordered by the doctor, a decent marker for diabetes, so no info there.
There was no test of my ferritin levels, a measure of how much iron is stored in the body. Iron overload is a major health problem, which is why periodic blood donation is vital for men and why women, who shed blood monthly for 40 years, live longer than men.
My vitamin D was 99 ng/mL, a blowout good number for protection against respiratory viruses like COVID or influenza, and a credit to my supplementation plus Florida sun.
My doctor also ordered for me an HIV test and a syphilis test, but I can’t say these scores are among the top 500 values important to me today. Free and total testosterone might have been useful … but no.
Frankly, with nothing meaningful to discuss, I have no idea what I’m going to talk about with the doctor at my follow up appointment. I’m going to feel like Colonel Jessup being questioned by Lieutenant Caffey: “What do you want to discuss now, my favorite color?”