Month: December 2019

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Hypercholesterolemia (Elevated or High Cholesterol)

Hypercholesterolemia is the diagnosis of having elevated levels of cholesterol in the blood. It is a type of hyperlipidemia (high levels of lipids in the blood). Cholesterol is measured through blood analysis, and can be affected by diet so much that a fasting blood sample is necessary to gain accurate results. Cholesterol is a naturally occurring substance in the body that is necessary for cell growth. It is when patients have too much cholesterol or problems with cholesterol regulation in the body that high levels can become problematic. While the word lipid is often considered a synonym for fats, fats are actually a type of lipid called triglycerides. The body needs cholesterol, fats, lipids and triglycerides, however when there is an overabundance or improper regulation occurs, patients may experience problems.

Lipid disorders, also called dyslipidemias, are abnormalities of lipoprotein metabolism and include elevations of total cholesterol, Low Density Lipoprotein (LDL) cholesterol, or triglycerides; or deficiencies of HDL (High Density Lipoprotein) cholesterol. These disorders can be acquired or familial (for example, familial hypercholesterolemia). Total cholesterol is a generic overall value, while HDL is a healthy form of cholesterol and LDL is a bad form of cholesterol. LDL can further be analyzed for variations in fluffy sticky cholesterol cells as opposed to smaller and less serious cells. To remember the difference between HDL and LDL, just remember that “H” stands for healthy.

Cholesterol can create blockages of normal blood flow (Atherosclerosis)

Understanding Lab Values:

  • Total blood cholesterol: This includes your HDL, LDL, and 20 percent of your total triglycerides.
  • Triglycerides: This number should be below 150 mg/dL. Triglycerides are a common type of fat. If your triglycerides are high and your LDL is also high or your HDL is low, you’re at risk of developing atherosclerosis.
  • HDL: The higher this number, the better. It should be at least higher than 55 mg/dL for females and 45 mg/dL for males. HDL is “good cholesterol.”
  • LDL: The lower this number, the better. It should be no more than 130 mg/dL if you don’t have heart disease, blood vessel disease, or diabetes. It should be no more than 100 mg/dL if you have any of those conditions or high total cholesterol.
Chart courtesy of Cleveland Clinic, link below

What you can do:

  1. Decrease fat intake: The total fat in your diet should be cut back to no more than 30% of your daily caloric intake. For instance, if you consume 1,800 calories per day, you should get no more than 600 calories from fat. Reduce fatty foods such as meats, dairy (dairy milk & cheeses), egg yolks, and oils like coconut and palm. You can substitute for lower fat options like using cooking oil sprays, margarine, or canola oil. Avoid trans fats. Learn more about Trans Fats here: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/trans-fat
  2. Reduce meat intake: Pork, lamb, and beef are higher in fat than chicken and fish. Choosing leaner cuts such as eye of round and pork tenderloin can help too. Trim fatty portions from meats if you are cooking at home. Choose smaller portions- 3 ounces of meat is plenty. You can choose other foods like beans, and vegetables and protein substitutes.
  3. Increase fiber intake: Fiber can reduce risk of heart disease. Foods high in fiber include nuts, seeds, legumes (peas, lentils, edamame, black beans, and kidney beans), whole grains (barley, oats – oatmeal is a great addition to a cholesterol lowering diet- whole wheat breads and whole wheat pastas), vegetables, and fruits (especially blackberries, grapefruits, apples, bananas, pears, and oranges).
  4. Lower alcohol intake: Too much alcohol can boost triglycerides. Excess alcohol is linked to obesity and weight gain. “Moderate alcohol use” means no more than 2 drinks per day for men and no more than 1 drink per day for women. Avoiding alcohol altogether is even better.
  5. Exercise regularly: A minimum of 2.5 hours of exercise per week is recommended to include running, swimming, walking, weight lifting, yoga, and hiking. Slowly increase your time by starting out with 10-15 minutes and gradually increase your time to ease into a more regular schedule.

References:

https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean

https://www.heart.org/en/health-topics/cholesterol

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Hypertension

Hypertension is a chronic medical condition where the blood pressure in the arteries is elevated above normal ranges. There are two portions of a blood pressure reading: the top number represents the systolic number (the heart is contracting, systole), and the bottom number represents the diastolic number (the heart is relaxed between beats, diastole). Normal ranges for an adult reading is in the range of 100-140mmHG systolic and 60-90mmHG diastolic. High blood pressure is often diagnosed when readings exceed 140/90 over multiple measurements over time.

Hypertension is a diagnosis where a patient has a chronic elevated blood pressure of the arteries, which makes the heart muscle work harder than normal. While blood pressure changes with activity, mood, etc., it is measured by when the heart is contracting (systole) or relaxing between beats (diastolic). While there are various normal accepted blood pressures, and even variable norms for different patients that can change based on age, racial group, and size of patient. It is also generally accepted that high blood pressure is present when a patient continually has a reading of 140/90 mmHg or above. Hypertension can be primary meaning that it is not due to other diagnosis, or secondary meaning that it is a result of some other related diagnosis.

Symptoms of High Blood Pressure:

  • Severe headache.
  • Fatigue or confusion.
  • Vision problems.
  • Chest pain.
  • Difficulty breathing.
  • Irregular heartbeat.
  • Blood in the urine.
  • Pounding in your chest, neck, or ears.

Untreated High Blood Pressure: Hypertension as a diagnosis is serious. Hypertension can lead to other complications such as vision problems, stroke, heart attack (MI), heart failure, peripheral arterial disease (PAD) and is very often the major cause of CKD (chronic kidney disease) and kidney failure.

References:

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

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Diabetes

Diabetes is a condition where there is too much sugar in the body for long periods of time. There are strong genetic factors related to some forms of diabetes, while other forms are attributed to weight gain and lack of exercise. The pancreas makes insulin, which helps the body use consumed sugars.  Diabetes is caused by either the pancreas not producing enough insulin, or the cells of the body are unable to respond to the insulin produced.  There are 4 main types of diabetes:

  1. Type 1 = the body’s failure to produce enough insulin. This was previously known as “insulin-dependent” diabetes mellitus (IDDM), or “juvenile diabetes.”
  2. Type 2 = this starts with “insulin resistance,” where the cells fail to use the insulin produced properly, but can progress to a lack of insulin over time. This was previously known as “non-insulin-dependent” diabetes mellitus (NIDDM), or “adult onset” diabetes.
  3. Gestational Diabetes = when pregnant women without a previous history of diabetes develop high blood sugars during pregnancy requiring close monitoring. Many of these patients may convert back without diabetes after delivery, while others may continue to have diabetes.
  4. Secondary Diabetes = when a patient without previous history of diabetes develops high blood sugars, usually as a result of: (a) an underlying condition, such as Cushing’s syndrome or pancreatitis, (b) a drug or chemical, such as steroidal use, or (c) a surgical procedure, such as a pancreatectomy. A wide range of health problems that damage, injure, interfere with, or destroy the pancreas can cause secondary diabetes. If the underlying cause of secondary diabetes can be successfully treated, insulin production may improve or return to normal. Common causes include:
    • Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas. The main causes of chronic pancreatitis are alcoholism, blocked or narrow pancreatic duct due to some form of trauma or cyst, and heredity.
    • Cushing’s disease is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol spontaneously produced by the adrenals, or by excessive use of cortisol or other similar steroid hormones (i.e., steroids used to treat life threatening diseases such as asthma, rheumatoid arthritis, systemic lupus, inflammatory bowel disease, chronic allergies, etc.).
    • Cystic fibrosis is a genetic disease that causes the incapacitation of the pancreas by fibrosis and can lead to the development of Type 2 Diabetes.
    • Adenocarcinomas are cancers that begin in cells that line the inside of organs. Almost all pancreatic cancers are of this type.
    • Drugs (chemically induced diabetes).
Type 1 vs. Type 2

The importance of insulin is that it enables the body to use consumed sugars as energy. In fact, most diabetic complications arise from the inability to use these sugars. When left roaming in various areas of the body, the excess unused sugars can cause very serious complications. In type two diabetes, which tends to be more common than type one, the patient either does not make enough insulin or is unable to use the insulin the body makes for various reasons. These patients may be placed on an oral medication, an insulin supplement, or a combination to help regulate blood sugar levels.

There are some ethnic groups who are at a higher risk for developing diabetes, which include American Indians, African Americans, Latinos, Asian Americans, and Pacific Islanders. An important factor in controlling diabetes is through diet and exercise. However, even the best-intention patient may find difficulty navigating the ingredient labels of some foods as sugars can come in a variety of types which may be unnoticed by the novice patient. Economically, it is also more difficult for diabetics as their health food lifestyle is typically much more expensive.

While diabetics often check their blood sugars between one to four times a day, the ultimate blood sugar test is the hemoglobin A1C, which is often referred to as A1C. While regular blood sugar readings report current blood sugar levels, the A1C gives a blood sugar average for the past three months. This test is the gold standard used by physicians to monitor the control of the diabetic’s blood sugar. Typically, anyone with an A1C of seven or less is considered to be controlled and those who are over seven will often have changes made to the medications or insulin dosing or both.

Low vs. High Blood Sugar Readings : Slight fluctuations in blood sugar levels are completely normal and also happen on a daily basis in people who do not have diabetes. Between around 60 and 140 milligrams of sugar per deciliter of blood (mg/dL) is considered to be healthy. This is equivalent to blood sugar concentrations between 3.3 and 7.8 mmol/L. “Millimole per liter” (mmol/L) is the international unit for measuring blood sugar. It indicates the concentration of a certain substance per liter.

Checking Blood Sugar Levels : People with type 2 diabetes should take a blood sugar reading at least once a day. Some may need to test as frequently as seven times a day. Doctors recommend that people who need insulin to treat their type 2 diabetes perform three or more blood sugar tests throughout the day, especially if they take multiple daily doses or are using an insulin pump. Most people use a small glucometer machine to check their blood sugars regularly, and it is important to track these readings so that your healthcare providers can get a better idea of how your body is responding to your daily activities to include foods. It is important to keep a food diary, along with a record of what you were doing throughout the day (sitting long periods vs. working out or running, etc.) so that a treatment plan can better be customized to your situation. There are many phone apps that provide easy to use trackers for tracking foods eaten, activity levels and blood sugar readings.

Blood Tests Used

  • Random blood sugar test. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a blood sample showing that your blood sugar level is 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.
  • Fasting blood sugar test. A blood sample is taken after an overnight fast. A reading of less than 100 mg/dL (5.6 mmol/L) is normal. A level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.If your fasting blood sugar is 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
  • Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood sugar levels are tested periodically for the next two hours.A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.

Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Normal levels are below 5.7 percent, and a result between 5.7 and 6.4 percent is considered prediabetes. An A1C level of 6.5 percent or higher on two separate tests means you have diabetes.

A1C levels need to be checked between two and four times a year. Discuss your target A1C goal with your doctor, as it may vary depending on your age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7 percent.

An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, it is important to also monitor your blood pressure and take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. Regular eye and foot exams also are important.

Symptoms of Hyperglycemia: (High Blood Sugar)

Signs of very high blood sugar levels may include the following:

  • Extreme thirst, drinking a lot and then urinating frequently as a result
  • Unintentionally losing a lot of weight within a few weeks
  • Noticeable loss of energy with muscle weakness, tiredness and generally feeling quite unwell
  • Nausea and stomach ache
  • Trouble seeing
  • Poor concentration
  • Frequent infections (cystitis, thrush)
  • Confusion and drowsiness, or even coma

Symptoms of Hypoglycemia: (Low Blood Sugar)

Signs that your blood sugar is too low may include:

  • Racing pulse
  • Cold sweats
  • Pale face
  • Headache
  • Feeling incredibly hungry
  • Shivering, feeling weak in the knees
  • Feeling restless, nervous or anxious
  • Difficulty concentrating, confusion

Diabetes affects many other health conditions and can make a patient more susceptible to getting other new health problems to include most commonly: Neuropathy (damage to the nerves in the extremities), Retinopathy (damage to the retina of the eyes), Chronic Kidney Disease (CKD) (damage to the kidneys), Heart Disease (0ver time sugars can harm blood vessels and arteries), and Erectile Dysfunction (ED) in men (damage to the nerves and vessels supplying blood to the penis).