7 Numbers You Should Know About Your Health

 Today I am going to provide a list of 7 biomarkers for you health - numbers you should know.   These are all biomarkers that can be improved through lifestyle interventions - they are numbers that can be normalized and optimized - and in doing so you will reduce your risk for heart disease, diabetes, cancer, Alzeimher's dementia, kidney failure, arthritis and many other conditions.  Optimizing these biomarkers will even decrease your risk of premature death.  I think this should be a pretty good investment of 15 minutes of reading!  (If you want to skip the reading - there is a quick summary at the end of this post).

1. Vitamin D - optimal level 100 - 150 nmol/L (40-60 ng/ml) 
I have blogged on this recently, but the quick summary is that Vitamin D is a vital hormone necessary for healthy bones, as well as being linked to cellular function in nearly all human tissues.  Low levels of Vitamin D are associated with over 100 conditions as well as increased all-cause mortality.
Vitamin D is synthesized in the skin from exposure to sunlight.  It is available in some foods but in general,  food is not considered an adequate source of Vitamin D.  In Canada, supplementation is necessary, at a minimum, between October and March.
​Many factors cause significant variation of Vitamin D levels,  so the best way to know whether you have adequate levels of Vitamin D is to be tested. (this is not an insured service in Canada).

2. Gamma Glutamyl Transferase (GGT) - optimal < 30 U/L
GGT measures a liver enzyme and is commonly described as liver function test most closely associated with the adverse effect of alcohol. GGT is however much more important as it is an indirect measure of the body’s glutathione supply. Glutathione protect cells against the oxidative stress resulting from metabolism. Without this protection the free radicals generated by mitochondria through normal metabolism with oxygen would accumulate, overwhelm and damage the mitochondria and the cell. In normal ageing it has been shown that it is this accumulation of oxidative stress that leads to many of the age-related diseases.
In many ways, glutathione is consider the master antioxidant: working with as part of the enzyme glutathione peroxidase to protect membranes from oxidation, enabling Vitamin E and C in their anti-oxidant capacities as well as working directly.
Glutathione is also a key component of the Phase II metabolism (detoxification) of drugs, hormones and xenobiotics where it works as a component of an enzyme Glutathione s-transferase (GST) that conjugates heavy metals, toxins and other compounds so that they become water soluble and can be excreted in the bile or urine.
Exposure to high levels of toxins that overwhelm glutathione in its Phase II metabolic role will lead to oxidative stress.

3. hsCRP - high sensitivity CRP - optimal < 1.0
Again another topic I have recently blogged about: chronic inflammation.
Chronic inflammation is at the root of 7 of the top 10 causes of death accounting for 80% of all deaths in our society. The most insidious aspect of this type of inflammation is its silent nature that allows for damage to occur without diagnosis.

HsCRP is the gold standard for assessing chronic inflammation - optimizing this number through behavioural change - diet, exercise, stress reduction - decreases the risk for many diseases.

4. Blood Pressure - optimal <115/75 (systolic/diastolic pressures measured in mmHB)
This is the simplest - something that you can do at home, at the local pharmacy and with your doctor. Normal blood pressure is 120/80. Recently there were major headlines in the US, noting a change in the definition of high blood pressure (hypertension), lowering the definition threshold to 130/80 from 140/90. While this change dramatically increases the number of people who will be diagnosed with hypertension - not all will automatically be recommended medications. Those recommendations will depend on a person’s overall risk for cardiovascular disease - anyone with a 10% or greater risk should aim to bring the BP below 130/80.

High blood pressure or hypertension is quantitatively the most important modifiable risk factor for cardiovascular disease (the largest contributor to premature death in our society).

It is also a significant risk factor for both kidney and heart failure.

For every 20 mmHg increase in diastolic blood pressure above 75, the risk of death from heart disease or stroke doubles.

Elevations in blood pressure are caused by dysfunctions within core biological systems

• renin-angiotensin system.
• sympathetic nervous system
• blood vessel constriction and hardening
• kidney fluid and salt balance

Caused by poor behaviours:

• not enough exercise
• excess alcohol
• high dietary sodium
• stress
• Obesity

With genetics alone, accounting for only 2-3% of causes of hypertension

5. Fasting Blood Glucose and or HbA1c: optimal FBS <5.2mmol/L (normal <5.6 mmol/L); optimal HbA1c <5.0%
Maintaining normal blood sugars is one of the most important and tightly regulated functions in your body.

Diabetes mellitus (DM) is the condition when your body cannot maintain normal blood glucose levels. Type I DM is an autoimmune disease where the pancreas stops producing insulin. Type II DM, is characterized by insulin resistance, where the body no longer responds normally to insulin. In order to maintain blood sugars, the pancreas increases production of insulin - leading to elevated insulin levels which in turn trigger inflammatory changes, which in a vicious cycle further worsens insulin resistance. Insulin resistance precedes Type II Diabetes and can remain undetected for years, as glucose levels are maintain as normal until the pancreas begins to fail, which is relatively late in the process.

Diabetes is diagnosed when FBS >7.0 or HbA1c >6.5%

Type II DM is currently at epidemic levels globally having tripled since 2000. Almost 500M people or 1 in 11 have diabetes at an estimated cost of $850M.

The direct complications from diabetes come from damage to blood vessels at two levels:

1. Microvascular
   • Retinal damage (retinopathy) leading to blindness
   • Kidney damage (nephropathy) leading to kidney failure
   • Nerve damage (neuropathy) leading to limb amputation
2. Macrovascular - or cardiovascular disease - resulting in heart disease and stroke.

6. TG/HDL - Triglyceride/HDL ratio - optimal <1.0
Of all the information that can be derived from a lipid panel the TG/HDL ratio provides the best information about risk.

TG/HDL is an excellent marker for insulin resistance and metabolic syndrome

When elevated above 3.5 - this is the simplest test to identify atherogenic dyslipidemia, which is marked by the joint occurrence of elevated TG, low HDL and atherogenic, small, dense, LDL particles. This is highly predictive of cardiovascular disease.

As we have seen above insulin resistance is the precursor to Type II DM and is often silent and undiagnosed, and is also one of the major causes of chronic inflammation.

7. Android:Gynecoid Fat Ratio - optimal <1.0
The major cause of the global diabetes epidemic is the associated obesity epidemic. Over
2B people are overweight with about 600M reaching the definition of obese (BMI >30).

For obese people cardiovascular disease is the leading cause of death and disability, followed by diabetes. Kidney failure and cancer are the other major causes of death.
Obesity, through adipocyte dysfunction leads to a chronic inflammatory state that
predisposes an individual for many diseases. Abdominal or visceral fat contributes
disproportionately to this inflammatory response as compared to peripheral fat.

The best way to measure visceral fat is with a DXA body scan, which provides you with
android:gynecoid fat ratio. The ratio correlates with insulin resistance, showing the clear
link between visceral fat and the pathogenesis of diabetes.

The added benefit of getting a DXA scan is getting understanding your lean muscle mass and bone density. As you age maintaining lean body mass and bone density are both essential for vital longevity avoiding age-related sarcopenia and osteoporosis.

A good alternative (without the extra bone and lean body information) is a waist:hip ratio. The optimal ratio for men in <0.85 and women <0.75.

Abdominal obesity is also a marker for metabolic syndrome - a cluster of conditions that carry risk individually but are collectively carry massive risk:

1. Abdominal obesity
2. High triglycerides
3. Low HDL
4. High Blood Pressure
5. High Fasting Blood sugar​

As you can see, all of the risks for metabolic syndrome have been covered by our 7 numbers.

According to a recent study - almost 1 in 5 Canadians, including 40% of people over 65 have metabolic syndrome .  Unfortunately, many are unaware of it and have placed themselves at massively increased risk for diabetes, heart disease and premature death.

In Summary - 7 Numbers You Should Know

1. ​Vitamin D - optimal level 100 - 150 nmol/L (40-60 ng/ml) ​
2. Gamma Glutamyl Transferase (GGT) - optimal < 30 U/L 
3. ​hsCRP - high sensitivity CRP - optimal < 1.0  
4. Blood Pressure - optimal <115/75 ​
5. ​Fasting Blood Glucose and or HbA1c: optimal FBS <5.2mmol/L (normal <5.6 mmol/L); optimal HbA1c <5.0%
6. ​TG/HDL - Triglyceride/HDL ratio - optimal <1.0
7. Android:Gynecoid Fat Ratio - optimal <1.0

​You can learn your numbers by visiting your family doctor or by contacting us at Wellness Garage.  All of these biomarkers can be normalized or optimized through lifestyle interventions - improvements in diet, exercise, sleep, stress, relationships and purpose.