Overall I'm looking to screen for symptoms of metabolic syndrome (1), given that only 12% of Americans are metabolically healthy (2). There is some variance in the diagnostic criteria, and I have my own standards / caveats / adjustments that I've talked about in previous anniversary checkups (see bottom of page).
I'll also include links to the labs I get done (a basic panel if you will), where to get them, and a few others you may want to consider.
Metabolic Syndrome Diagnostic Criteria:
- Large waistline (> 35 inches for women, > 40 inches for men)
- High triglyceride level (> 150 mg/dL)
- Low HDL cholesterol level (< 50 mg/dL for women, < 40 mg/dL for men)
- High Blood Pressure (> 130 / 85 mmHg)
- High fasting blood sugar (> 100 mg/dL)
The 2019 study referenced above adjusted the blood pressure recommendation to 120 / 80 and added an A1c (approximately a 90 day average of your blood sugar) to the fasted blood sugar criteria; < 100 mg/dL and < 5.7% respectively.
Adjustments and Recommendations:
Visceral and Subcutaneous Fat:
- Body Weight: I don't obsess over the scale. At most I weigh myself once / quarter; yes, only about 4 times per year. Unless I have a competition coming up, there isn't a need for this. Body weight can fluctuate a few percent points every DAY, so an annual snapshot is hardly anything to make judgments on, but it's a reference point no less. Many of the things mentioned below are more relevant regardless of the number on the scale.
- Subcutaneous Fat: I use a simple "skin fold" test. There are more accurate methods, but for something you can do yourself with an inexpensive tool and a simple calculator, it's a very useful reference point. Myself, I typically want to stay below 10%, but 15% would be acceptable for (male) athletes.
- Visceral Fat (WHR): This is the fat around your organs opposed to under your skin; think "skinny fat" here. Waist-to-Height-Ratio is a better indicator of visceral fat mass than waist circumference or body mass index (BMI) – the later having been debunked many times prior (3, 4). To calculate this it's literally your waist circumference (in inches) divided by your height (in inches). Typical reference range recommendations are < 0.5 (5, 6, 7).
- Blood Pressure / MAP: You can get a manual or automatic blood pressure cuff at your local drug store for < $50 which is pretty affordable to get a lot of data from. Again, an isolated measurement isn't particularly helpful since a bad day or week can make quite a difference. When I calculate this I look at my annual averages (logged in Cronometer). I also utilize Mean Arterial Pressure (MAP) because it's a single figure to work with rather than juggling both systolic and diastolic pressure. For reference, a blood pressure of 130 / 85 would be a MAP of 100.
- Heart Rate (RHR): Again, a simple fitness tracker can go a long way here. I can look back at a whole year's worth of data from my FitBit and get a glimpse of my average heart rate over they year; though for this summary, a 90-day average is sufficient.
- Cardiovascular Load (CVL): Similarly, this condenses heart rate and MAP to single value (multiply them together). Context of the individual values matters of course, but a low pule and moderate blood pressure isn't the same as "normal blood pressure" and an abnormally high pulse (80 or 90 resting). For reference, a blood pressure of 130 / 85 and a pulse of 70 would yield a CVL of 7,000.
- Breathing (Respiration) Rate: This is easily tracked by fitness trackers, and a good reference point for overall well being. That is, if your mouth-breathing at 18 breaths / minute, I'm pretty sure you're struggling in some of these other areas as well versus slow / deep reps through your nose to the tune of 12 breaths / minute.
- Triglyceride:HDL Ratio: LDL, "bad cholesterol", has been hotly contested. Good thing, TG:HDL ratio has been shown to be a far better indicator of health outcomes. Specifically we're looking for a ratio of 1:1 or less, though "official" recommendations are 2:1 or even 4:1 given the (inaccurate) assumption that TG values of 150 and HDL values of 40 are "healthy."
- HgbA1c / Fasting Blood Glucose: As mentioned above, A1c is essentially a 90-day average of blood sugar. 5.7% is the cut off point from "healthy" to pre-diabetic (6.5% being the barrier for diabetes).
- Fasting Insulin: New this year, this is a test of insulin resistance and the healthy reference range is 3 - 5 (8).
- HS-CRP: Another new addition this year, this is a measure of C-reactive protein and inflammation. Reference ranges here are < 1 mg/dL being acceptable while < 0.3 mg/dL is preferred (9).
- Vitamin D: I've talked a ton about Vitamin D this past year, in no short order due to it's effects on hormone production and immune system function. At any rate, I actually want to test this twice per year; once in the spring when it should be "low(er)" and once in the fall when it would theoretically be at it's peak (at the end of summer). The reference range here is 25 - 80 ng/mL with higher values being preferred (10).
Sleep / Misc.:
- Heart Rate Variability (HRV): This is something I've grown more interested in over the past year. It's a metric of time between heart beats and a good indicator of recovery. There is an individual range, but for my age I'm looking for an average > 60; though the overall number apparently means less than large (25%) drops which would be particularly bad and an indicator of acute stress such as infection.
- Sleep Score: This is another thing a fitness tracker or smart watch can easily track for you – though the formulas each uses are proprietary. You simply need to go back into your phone app and compute the average throughout the year or whatever time frame you'd like. Obviously a longer time span equals more data points and a more accurate representation. I'll be taking a sample from the past 90 days.
Other Lab Considerations:
- Testosterone and SHBG: I don't think these need tested every year, but I wasn't satisfied with the last test I took, and do want to have a reference point in my early 30s so that in my 40s when my doctor says my (low) testosterone is "normal" I can call his bluff.
- CBC: This is more of a snapshot, but I'm curious what my blood electrolyte levels are since urine levels are easier to test, but not as accurate or necessarily relevant. I have some specific issues that I want to look into regarding fluid intake / regulation – obviously thereby effects on sleep and blood pressure.
- Cortisol: The stress hormone... If I were having major issues with sleep or HRV I'd definitely look into this. At the time of writing, my disruptions in those areas are relatively minor, though obviously I'm still fiddling with them.
That was a lot, thanks for sticking with me! Stay tuned for parts 2 and 3 with the results when I get them computed and get my blood work in. Oss!