“This is worrying…” said the Japanese nurse as she scanned my health check results.
“How so?” I replied, trying to sound unconcerned.
She handed me the piece of paper.
Four orange warnings, each with a danger rating of “7” on a scale that maxes out at “9”.
But she was more concerned about the two green ones – according to her, they indicated that I had the kidney function of a man in his 70s.
“Make an appointment to see the urologist,” she told me, “As in right now. Today.”
Just the thing you want to hear on a Monday morning.
Now, I knew there wasn’t much point mentioning intense weight training, creatine monohydrate supplementation, and the effect they can have on blood tests.
I figured the doctor would see the results were just an anomaly, and I’d be given the all clear.
What Am I Doing Here?
So, 48 hours later I’m sitting in the hospital, filling in the questionnaire while I’m waiting to see the doc.
Every other person was probably in their 70s and 80s, and more than a few were in wheelchairs.
I felt like Bill Murray in that elevator scene from Lost In Translation – but for once it was my age that made me stand out, not my foreignness.
Eventually, I’m called in to see the urologist, and he goes through my notes.
“You don’t drink, you don’t smoke, you’re not overweight, you take regular exercise, you have no family history of kidney problems, and you have no symptoms, hmm…”
So I mention creatine monohydrate (a safe, legal supplement pretty much the world over), its effect on blood creatinine levels and the “false positives” it can cause regarding kidney function.
(Thanks to the folks over at examine.com for providing a free, unbiased and trustworthy summary of the current research)
I figure the doc and I will be on the same page.
But as soon as I start asking him questions, you can almost see the shutters come down.
“This could be something serious…” he says quietly, and sends me and my kidneys off for an ultrasound test.
Now, by this time the whole hospital thing is starting to work its voodoo on me.
Those places have a habit of reminding you how complex the body is and how many terrible things can go wrong with it – no wonder med students start becoming paranoid about their health.
Man, I’ve got a killer headache – probably hit the sake too hard last night, then again it could be a subdural hematoma.
After more waiting around with the old guys, the test results come back.
OK, doc – just give it to me straight, I’m a big boy. I can handle it.
He looks at the report, and says “Your kidneys are fine. Look after yourself. Next please.”
WTF? Is that IT?
No explanation of why the test could be so far off the mark, no nothing.
But you know what?
I was so relieved that I just thanked him, walked past the old guys in their wheelchairs, and jogged the 6 miles home.
My kidneys were fine and that was all that mattered.
So that was one bullet dodged – but what about the others?
High Cholesterol & Poor Liver Function
The nurse that originally gave me my results told me to take another blood test in three months, after making a few lifestyle changes.
Lose weight, take some exercise, cut down on alcohol, eat more lean meat, fruits and vegetables.
I told her that I was under 10 % bodyfat, lifted weights 2-3 times per week, was in training for a half marathon, seldom drank alcohol, and ate a diet that was 90 % minimally-processed whole foods.
She frowned, thought for a while, then said “You should eat more tofu.”
I swear that’s what she told me!
Anyhow, here are the numbers with the “7” danger rating (on a scale of “9”, remember).
Total cholesterol = 257
LDL-c cholesterol = 170
AST = 55
ALT = 57
Now, we’re all pretty familiar with cholesterol, and my numbers were nudging you-need-statins-right-now territory.
But how about AST and ALT?
Well, those are commonly regarded as markers of liver function (although that’s not 100 % correct), and mine were almost two times the “normal” limit.
So, I promised to hit the tofu hard and take another blood test a bit further down the track.
Fast Forward Three Months
To be honest, I wasn’t feeling optimistic as I sat waiting for the results of my follow-up blood test.
After all, what had I actually changed in the meantime?
I hadn’t run since completing the half marathon weeks before, I’d actually put on a couple of pounds, and I’d started eating oatmeal for breakfast every morning
But everything else was pretty much identical.
And the tofu thing?
Well, let’s just say that was never really on the cards.
So my jaw almost hit the floor when the doc handed me my test results:
Total cholesterol = 203
LDL-c cholesterol = 130
AST = 55
ALT = 51
My total cholesterol was down a whopping 54 points and my LDL-c was down by 40.
As far as the doctor was concerned, both were now “fine” – in spite of me taking less exercise and putting on weight.
And while I’m sure Quaker Oats would love to take all the credit, I’m far from convinced that it was down to the oatmeal.
In fact, I was totally confused and one question kept bugging me.
How reliable are these tests and what do they actually mean in terms of real-world outcomes?
But the Japanese doctor/patient relationship being what it is, I just smiled, thanked him, and left.
Hey! Aren’t You Forgetting Something?
OK, OK, my AST and ALT results were still way above “normal” but I’d been doing a bit of research in the interim, and had lost a lot of faith in what “normal” was, or even meant.
It’s actually a perfectly normal response to intense exercise, with the researchers concluding that:
Intensive muscular exercise, e.g. weightlifting, should also be considered as a cause of asymptomatic elevations of liver function tests in daily clinical practice
Of course, there’s no guarantee that my elevated AST and ALT levels are down to lifting weights.
But the weird thing is I’d do better in those tests if I stopped doing the resistance training that’s widely acknowledged to provide so many health benefits.
Get healthier (according to those test results) by no longer doing things that make you healthier?
That’s some really messed up logic.
What Does It All Mean?
Here’s something that a friend with a Ph.D. in pharmacology told me.
The same blood sample can be measured three times in the same lab with the exact same equipment and give three different results.
But get this.
Even if the test was 100 % accurate, the reality is folks with low LDL-c can still develop coronary heart disease.
So the test is both inherently unreliable and the meaning of the results themselves is far from cut and dried.
Can you imagine an engineer saying “OK, our calculations could be a way off, but the bridge appears structurally sound. Then again, it could collapse without warning at any moment”?
That’s kind of what it felt like to me.
Then I came across this profanity-riddled gem of a forum post by ER doc, Ph.D. researcher, ex-Marine and strength coach, Jonathon Sullivan:
Does somebody have some really good longitudinal, controlled data in sizable populations that demonstrates a causal relationship between any of these fancy parameters and relevant patient-oriented outcomes (death, MI, hospitalization)?
If so, I would like to see it (seriously). If not, I’m bored, and still of the (non)opinion that Carlos alludes to above. Really, the last time I looked, the literature on this cholesterol/lipid shit is so f**ked up, so full of methodological and statistical f**kery, and so corrupted by drug company money that I honestly do not know what to think. I should note, however, that I kinda stopped giving a shit several years ago and started eating mass quantities of eggs again. Got stronger. A really good study with relevant outcomes might make me give a tiny fraction of a f**k, but I’m not holding my breath.
And all of that is without even considering the complicating variable of how lifestyle (train-hard vs. sit-on-your-ass) impacts the role of diet, cholesterol and lipoproteins in the pathogenesis of vascular disease. Color me completely unconvinced/confused.
And–think about it now–this is my job.
Now, that’s what I call a breath of fresh air – a straight-shooting doctor that’s not afraid to say “We. Just. Don’t. Know.”
Diagnose, Prescribe, Repeat
Don’t get me wrong – I’m grateful to the Japanese health system for giving me a pretty comprehensive annual check, free of charge.
But at times the whole process seemed more like a production line at Honda or Toyota.
Seriously, full automation can’t be that far off – hell, they could even get ASIMO to do it.
Get people in one end, draw blood, take X-rays, measure stuff.
If there’s a number that’s not “normal”, tell folks to:
- Quit smoking
- Cut back on the booze
- Lose some weight
- Take more exercise
And maybe get busy diagnosing something that you can prescribe a drug to correct.
So, what’s the bottom line?
Now, in reality there’s not a whole lot of improvement that I can make in terms of diet, exercise and lifestyle.
So, should I be more focused on doing the best I can to look after myself or on reducing some lab measure that’s of questionable relevance?
Well, here’s Dr Sullivan’s take on that:
More to the point: at the end of the day, I don’t give two f**ks about my plaques, my cholesterol, or any other biological/laboratory measure. I’m into patient-oriented outcomes. If I die at the age of 102 (shot by a jealous husband while pressing bodyweight) and I have cholesterol of a million and plaques the size of Nebraska, which outcome (Age-Quality of Life/Plaque Size) is most important?
I couldn’t agree more.
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