Normal ranges of medical tests provide the boundaries that define where health ends and disease begins. Or do they? A growing body of evidence suggests that results in the normal range can provide a false sense of security. When it comes to blood sugar levels, recent research has demonstrated significant pathology occurring in the high normal range.
Normal lab values clearly are essential for defining and diagnosing a variety of familiar illnesses such as hypertension (blood pressure greater than 140/90), obesity (body mass index greater than 30), and diabetes (fasting blood sugar, FBS, greater than 126mg/dL). And yet, you don't go from healthy, with a FBS of 90mg/dL last year, to diabetic, with a FBS of 127mg/dL at this year's checkup.
A growing appreciation of the progression of chronic diseases has created the "pre-patient" category. So for instance, the pre-diabetic has a FBS of 100-125mg/dL, and the pre-hypertensive has a blood pressure of 120-139/80-89. This midway station in the journey to patienthood reflects new understanding of the earlier stages of these diseases.
While this can potentially make everyone pre-something, a scenario that doesn't lend itself to a peaceful mind, it should give us a jump on preventing progression to full-blown disease. And that's a good thing.
Unfortunately, in the typical rushed doctor visit, lab values don't get the attention they need. All too often, the harried physician scans the "abnormal" test result column. If the column is blank, you're good to go, see you next year. Such technique picks up abnormal results but misses trends. And it is the slow trends in many lab values that indicate trouble is brewing. By the time you have an abnormal lab value, you're already a ways down the road.
We must go from a proficiency in diagnosing illness to a proficiency in preventing it.
The interpretation of blood sugar levels is about to undergo a big change. For some time, we have known that Type 2 diabetes (T2D) is associated with decreased cognitive capacity, brain atrophy, dementia and stroke. More recently, the link between these conditions and prediabetes has been made. There is now a growing body of evidence linking blood sugar levels in the high end of normal with significant brain pathology.
Blood sugar in this range appears to cause damage by triggering inflammation and excessive clotting. Brain regions responsible for working memory and verbal fluency are particularly sensitive to these changes.
So what do you do with this information?
One thing this suggests is the importance of preventing big swings in your blood sugar. Throw out all high glycemic index foods. These are the processed carbs, the sugar-laden sodas and snacks that make your blood sugar skyrocket. You could be damaging your brain!
Number two: Be active. The more active, the more sensitive your insulin, the stuff that helps control blood sugar levels. When I say be active, I mean something every day. Walking, dancing, exercise, it doesn't matter what form it takes.
Number three: Work to control stress. Easier said than done, but a necessary focus. Stress increases blood sugar levels and over time can decrease insulin sensitivity. Breathing exercises of as little as 10 minutes per day can have a significant benefit. Physical activity, yoga, tai chi are all great stress reducers. The main thing is you get a kick out of it. If you can't stand doing it, find something else. The idea is to relax a little, not work harder!
Lastly, you are the most important member of your medical team. Ask your physician for a copy of your lab work. Learn about the important lab values and track them each visit. Your doctor should welcome such active participation. We can not expect someone else to be more concerned about our health than we are.
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