Week 1: What's Measured Improves

The title is a paraphrase of a famous quote from management consultant Peter Drucker. He used it to show that if you measure the wrong things, yes, what you are measuring may improve, but the goals you are trying to achieve may slip through your fingers if you measure the wrong things.

So today, and every Friday hereafter, I will be making suggestions that I feel will help you become healthier. My first suggestion is that you make an appointment with your doctor for blood work. This will give you a starting point from which you can measure your progress.

What do you measure? This is where it gets a bit controversial. Many doctors do not realize that cholesterol does not matter. This is not some goofy idea that I have developed, this is the consensus view currently. I am not saying that the results of the blood lipid panel I am going to suggest has no value. On the contrarily, it is important. It is just that the measure of total cholesterol is not as valuable as the measure of the various sub categories of cholesterol. In particular it is what is called your LDL and HDL cholesterol that is important. LDL is commonly called "bad"cholesterol. It is not bad, but remember the adage I have already shared, "the dosage is the poison." It is too much that is bad. LDL delivers cholesterol to where the body needs it. Too much LDL carrying cholesterol is an indication that something is wrong. Too much LDL means that the risk of cholesterol being delivered to the wrong place increases. HDL looks for damaged cholesterol and removes it for disposal. So you want LDL low and HDL high.

Note that many typical blood panels do not actually measure LDL. I have always found this puzzling. Instead LDL is guesstimated. Ask your doctor for LDL to be measured, not calculated. When this was done for me my LDL went up to the moderate risk level. The guesstimate had been wrong. You might not be able to get this done. 

The reason cholesterol was used as a benchmark was that the chances are that if your cholesterol was high, so was your LDL. But LDL is a better measure. In the same way there may be a better measure than LDL. Here is where I enter an area where there is no consensus. The blood lipid that many prefer is called ApoB. A similar marker is to measure LDL particle number. Both may be better than LDL as an indication of cardiovascular health. So when you watch a health presentation and hear that your cholesterol level is important you are listening to old, obsolete information. 

An optional test would be to measure particle size. This test tells you how big your LDL particles are. Imagine the effect of a small, hard bowling ball being pushed around your blood stream, occasionally plowing into your artery wall. Now imagine instead it is a soft, large beach ball bounching off the arterial wall. Soft and large is healthier than small and hard. Size does matter. 

You also need to find out what your vitamin D level is. There is a blood test for that. It is estimated that 80% of the population is deficient.

Measuring the insulin level in the blood is another important test. In any event you should measure your fasting blood sugar as well.

I suggest you make an appointment with your doctor before your blood test. He might not be used to measuring some of the things you want to measure. That way you get what you want with no surprises.

Here is what you want. A blood lipid panel that actually measures LDL. You need to know your ApoB and/or particle number. You need to know the amount of vitamin D in your blood. You want to know your fasting blood sugar, and knowing your insulin level would be a nice bonus, although your doctor may not wish to order it unless your fasting blood sugar is high. Most panels measure homocysteine levels as well.

Your doctor should be your friend, not your enemy. No doubt based on his knowledge of your medical history he may want additional tests, a PSA test for men for example. For me it was a uric acid test because of my history of gout. (While I no longer have a constant twinge in my big toe after all my dietary changes, I still have elevated uric acid levels, and ocassionaly pain in my big toe. It is much improved)

I will be talking about the results of your blood tests in week 4, which will allow enough time to get back your results. Even if you are not going along this one year journey with me, the chances are you have not had a health exam for a while. Now is the time.

Remember that what you measure is what you will focus on, so be sure to measure the right things.