It struck me this week—with all the attention and debate focused on the President’s annual physical and health—that I’ve been seeing many more patients recently for general checkups. Maybe it’s because it’s the beginning of a new year and a natural time to look for a fresh start. Whatever the reason, there’s definitely a spike (44 million Americans, according to one study!) in patients wanting to “check in,” or requesting a deeper “look under the surface,” in hopes of a better understanding of health risks, issues, and current status.
Have you made the time to get your physical? And, while we’re on the topic, just what really constitutes a comprehensive physical exam? While I know what the typical response to this question is—mammograms, colonoscopies and such—the lack of consensus on how to get and stay healthy is overwhelming for most. Use the following checklist as your guide to getting healthy and understanding your health risks this year.
Diet Red Flags
Food is medicine and that tenet is not likely to change. I always warn patients that we can do a million tests, but if we don’t get the dietary piece right we’ll spend a lot of effort with minimal results. Try this: For the next three days keep a food journal. This is what I have my patients do. No judging or changing, just track what you eat and drink. After the third day, do an audit. How much sugar did you consume? Alcohol? Salt? Processed and refined flours? Bad fat foods and restaurant meals? Aim for these numbers:
- Sugar: 25 grams or less per day (not including whole fruit and natural sugars).
- Alcohol: Less than 4 ounces per day in men, or 3 drinks (4 ounces equals one drink) per week for women.
- Salt: 1500 mg per day maximum
- Restaurant Meals: This includes vending machines, fast food, and convenience stores. Keep it to three times per week or less.
Understanding your food patterns should be the essence of any good physical- food determines the course of our nutritional status, energy, hormone balance, inflammation risks. These are all factors that lead to common symptoms like fatigue, brain fog, anxiety, depression, ADHD or the big diagnosis, like cancer, diabetes, cardiovascular disease and more.
Micronutrient deficiencies can lead to bigger issues later—impacting our mood, hormones, weight, and energy. Each of these micronutrients have important roles in our health, so start tracking the following yearly at least to see where your “normal” may be.
- B12: >500 pg/ml
- Folic acid: 2-20 ng/mL
- Vitamin D: 50-70 ng/ml
- Serum iron: 65-176 µg/dL, men; 50-170 µg/dL, women
- Ferritin: 50-70 ng/ml
- Magnesium: >2.2 mg/do
Continued debate about cholesterol and its role in cardiovascular health leaves many of my patients confused. Cholesterol is still important, but should not be too low or too high. Low cholesterol levels disrupt hormone levels in women, and neurotransmitter levels in all of us—including children. High cholesterol, especially high triglycerides, is a risk factor for poor cardiovascular health and strokes. Sizing your particles can help you understand your risks as well. Small particles are more dangerous and more common in cholesterol type B (LDL B) and a bigger risk factor for atherosclerosis and cardiovascular disease than the larger particles associated with LDL A. Although LDL type and sizing is inherited, you can change your particle size through diet, exercise and improving your digestive health.
Blood pressure screenings are important as well. Chronic high blood pressure can damage your heart and leave you feeling less than your best. Headaches, ringing in the ears, and dizziness are just a few signs of high blood pressure. Low blood pressure is a warning sign as well. I often see low blood pressure with electrolyte imbalances or blood sugar instability, leaving patients frequently fatigued or irritable.
Aim to keep your blood pressure between 120 to 130 (systolic, or the top number) over 80 to 90 (diastolic, or the bottom number).
Your blood sugar should be checked yearly to assess your risk for pre-diabetes and diabetes. You can check a fasting blood sugar or a hemoglobin A1C, which provides a longer reflection of your blood sugar. A fasting blood sugar should be less than 100, while your HGB A1C should be under 5.6.
Inflammation is at the root of many illnesses today, and it still frustrates me that we don’t check these numbers more often. By tracking inflammation markers, we can understand and look for triggers of inflammation before it contributes to a chronic disease. You should know your C reactive protein (CRP), homocysteine, and erythrocyte sedimentation rate levels (ESR). CRP Levels should be below 1 while homocysteine and ESR should be below 10.
- Homocysteine: <10 umol/l
- C-reactive protein (CRP): 1–2 mg/hr
- Erythrocyte sedimentation rate (ESR): <10 mm/hr
For men and women, your hormone levels are important. Know your numbers for testosterone, estrogen, thyroid, insulin and progesterone (depending on gender). Again, tracking these numbers helps to understand your normal, versus what may be normal for someone else.
Here’s what I recommend checking each year along with the ranges you are looking to hit:
- Thyroid-stimulating hormone (TSH): 1-2 U/ml
- Free triiodothyronine (free T3): 3-5 ng/do
- Estradiol: 50-150 pg/ml
- Progesterone: 5-2.0 ng/ml
- Estrone: <150 ng/do
- DHEA: 100–200 ng/ml
- C-peptide: 1–3 ng/ml
- Leptin: 5–15 umol/l
Getting mammograms has been ingrained as one of the preventive measures against breast cancer, but recent guidelines have shifted to recommending mammograms on women 40 to 55 every year, and then every two years in women over 55, unless they have a personal or family history of breast cancer. I believe you should have a baseline mammogram at age 40 and every year thereafter. Breast self-exams are still critical, while thermograms and breast ultrasounds are additional ways to monitor and guard your breast health.
Pap smears, HPV screening, and pelvic exams have been moved to every three years in women. These tests were originally recommended to prevent cervical cancer. I am concerned about this new guideline, and still recommend that my patients have yearly paps and pelvic exams. For women over 65, Pap smears and pelvic exams may stop depending on a patient’s history and previous pap results.
Bone Scan/Osteoporosis Screening
While the conventional osteoporosis screening begins at age 65 with a DEXA or bone mineral density test, I believe it really should start much earlier. There are many additional markers that can help with osteoporosis screening much earlier, including blood and urine markers to assess bone loss. Urine N telopeptides, boron, and strontium are just a few examples. Quantitative ultrasound and X-rays can also play a role in helping to understand osteoporosis risks. (2)
Screening for colon cancer does save lives and a colonoscopy is recommended at age 50. Newer screening tests include Cologuard, an at home stool test along with the in-office fecal occult or hidden blood test.
The world of genetic screening and genetic markers as health predictors is exploding, and understanding your genes can today help better personalize your treatment plan and predict your health patterns. Discuss the options for genetic screening with your doctor to help navigate a truly individualized prevention plan. (3)
In addition to the above, the following should be done yearly.
- Skin Check: Looking for changes in moles, new rashes or discolorations.
- Eye Exam: Assess changes in vision.
- Hearing Test: Especially when there are changes in hearing.
- Dental Exam: Yearly for cavities, infections, changes in enamel. Oral health is now linked to cardiovascular disease, thyroid, and brain health!
All smokers need lung cancer screening including a chest CT until age 80.
Keep this checklist in hand for your annual exam and really understand what prevention means for your body, your chemistry—but most importantly your life. Happy New Year!!!