Annual Physical - is it worth it ?

2009 the year to get serious about health.
After 65 years you might say "about time."

This is what 'furred up' arteries look like. To much cholesterol and fats in the blood for too long and the arteries start to get damaged. The brownie stuff with red bits in the picture is plaque in or on the artery wall. One day the plaque might break loose and float off to create a blockage. If the blockage is in a small artery in the heart or brain you'll feel and know about it big time.

Luckily for me my arteries seem, thus far, to be OK.

To keep everything looking good I set some health fitness objectives for 2009:

- get an Annual Physical
- run a 10K (6 1/4 miles) on the road in less than an hour
- a couple of strength objectives: 20 push ups with feet up on bench and 8 wide grip pull ups
- find out if I actually have a six-pack.

The results of the physical arrived in the mail this week.

VITAMIN D: After blogging about Vitamin D repeatedly I had mixed feelings with my Vitamin D measurement of 25-Hydroxy at 34.4 ng/mL. The normal range is 32.0 to 100.0. On the other hand it is the end of Winter and I've caught very little sun in the last 5 months (even here in Atlanta, GA).

So maybe it's OK but I'd better do two things. One is to work out exactly how much Vitamin D I get from food. That means reading all the nutrition labels, estimating how much I eat a day and then how much a day. It also means having to rethink not wanting to take a daily Vitamin D supplement. Am I being sensible since all the advice is to take a Vitamin D supplement, at least through the Winter.

Cholesterol and Triglycerides were OK after a little study of what the numbers mean.

Total cholesterol at 179 mg/dl was closer to the upper limit for a good health prognosis of 200 mg/dl than I wanted. However these days total cholesterol is not seen as that important. Far more important is the total for non-HDL cholesterol. I came in at 103 mg/dl on this measure - well inside an upper threshold of 139 mg/dl.

HDL was 69 mg/dl. 40 mg/dl and above is seen as good and above 60 mg/dl is viewed as protective against heart problems. HDL tends to be increased by intense exercise and most of my runs take my heart rate above 165 beats/minute (this is above 90% of heart rate maximum for me). So maybe the running is having a good impact on HDL.

The ratio of Total Cholesterol to HDL [Total Cholesterol/HDL] has started to become an important ratio. For me it calculates as 172/69 = 2.5. For heart health the present view is that you want this ratio to be less than 4.0. Amongst those who have suffered a heart attack, luckily not me, getting this Total Cholesterol/HDL ratio down is important. No one has ever had a second heart attack if they have brought the Total Cholesterol/HDL ratio below 3.0 after the first attack - quite a carrot.

I went through the notes from the presentations at the recent ACSM Health Summit in Atlanta to check everything that Ralph LaForge had to say on cholesterol and triglycerides.

My triglycerides [by the way triglycerides just means three fatty acid molecules linked together by one glycerol molecule] were measured at 93 mg/dl - well within the healthy upper limit of 149 mg/dl.

Our bodies handle triglycerides and cholesterol very differently.

Triglycerides are a form of fat and our bodies burn - oxidize - triglycerides for energy. Fit people burn up triglycerides quickly after a meal but not so in those Metabolic Syndrome or Diabetes for whom triglycerides can stay high for 4 to 7 hours after a meal. While triglycerides are high in the blood particles are being absorbed into the walls of blood vessels and adding to atherosclerotic plaque.

The small cholesterol particles and the intermediate size cholesterol particles are now viewed as the most dangerous. Fit people and unfit people deal with the intermediate size cholesterol particles quite differently. After a meal, the peak in these intermediate size cholesterol particles is about 90 minutes after a meal for fit people but unfit people take a lot longer to start reducing these particles - maybe as long as 4 hours. This longer time in the unfit means a longer time for the particles to cause damage to blood vessels.

At the ACSM meeting, Ralph LaForge also shared that the number of particles is important - not just the total quantity of cholesterol. However at the moment only a limited number of test labs provide cholesterol particle counts such as LipoScience. My tests were carried out by MB LabCorp.

For a long time no one understood why increased fitness, with no reduction in weight, seemed to be protective of health. Why would Diabetes, Heart Health, Metabolic Syndrome all be improved even if body weight is unchanged. It looks as if the answer is in the number of lipoprotein particles in the blood stream. The number of lipoprotein particles is just as important as the actual total quantity of lipoprotein.

Liposcience is using Nuclear Magnetic Resonance to measure the numbers of lipoprotein particles.

All of the cholesterol particles have a protein molecule attached to them. It is these proteins on the surface of the lipoprotein particles which attach to specific receptors in the lining of blood vessels. With increasing understanding of genetics and molecular structure it is now becoming possible to identify genetic differences (maybe defects) which cause different people to react differently. For example, in the case of some forms of hypertriglyceridemia [very high tri-glycerides in the blood], it is specifically the expression of apo CII and apo CIII which is responsible for the problem.

All of this has raised a question for myself - should I add to my Personal Trainer qualifications by taking the exams for Lipid Specialists i.e. helping people with cholesterol and tri-glyceride issue which will lead on to Diabetes, Heart Disease, Metabolic Syndrome. Quite a lot of study would be involved but a definite possibility for 2010.

Alternate Day Fasting

Sounds sad but it's true, just reducing calories (what might be called dieting) and starting to do some exercise is not enough. It has to be a low carb diet teamed with exercise to make a real difference.

The sad reality is that it's very hard to be disciplined all day every day. The old idea that you could 'cheat' on your diet once a week or even for the whole week-end just does not work. For anyone who is considerably overweight and as a result their body is probably very carb sensitive, 'cheating' is a disaster. If this is you then your experience is that even one 'bad' meal can eliminate all the weight loss of a whole week.

It's sad and one wishes the world was different but this is reality. So what to do ?

One option to consider is fasting on three days a week. Usually, fasting is a bad idea as it reduces your body's metabolic rate i.e. you end up burning fewer calories the longer the fast goes on. However if you fast for less than a day, that is from one breakfast time to the next, and on alternate days, your body should not start to protect itself by reducing calorie burn. Lots of varied exercise will keep the calorie burn high.

You can build into three days by partially fasting on one day when you have a small breakfast and then don't eat for the rest of the day. The next day is a 'normal' day which is somewhat calorie restricted i.e. eating carefully.

Then you add on extra fasting days and increase the discipline of fasting days.

To an extent you can make up for the one really 'bad' evening of the week by fasting and exercising the next day.

How much exercise to at least limit the damage ? At least 400 calories of exercise. Best to do this in an exercise sessions of at least 400 calories within 8 hours of the bad meal i.e. get up the next morning early and walk and walk.

Linking alternate day fasting and exercise to a low carb approach is the best way to go. Low carb will inevitably reduce the glycogen in your muscles so hard running or cycling will be difficult but walking or using an elliptical will be OK. On the 'eating' days workout with weights and resistance. The reason for this is to make sure you take in sufficient protein immediately after working out.

Is there any science behind this ? Yes, read this tough paper.