Blood Work 2.0

So the number one killer of firefighters in the US is still Cardiovascular Disease (CVD)… CVD has been the leading cause of death by a huge margin for quite while and recently the 2010 NIOSH report on Line of Duty Deaths (LODD), a document that thoroughly reviews a few specific LODDs, has two CVD related cases in it; both firefighters died from massive heart attacks one on the treadmill during an annual physical and another in working fire. In the “preventative measures” section of each article it lists “screening for CVD” and “annual physical fitness evaluations” as primary steps for the department to take in an effort to reduce LODD from CVD related causes. So what does CVD screening mean? A good place to start is blood work; not just any panel of tests will do though, for any of the information to be relevant a few parameters must be on place.

Here is what to ask your Doc for and why:

Nuclear Magnetic Resonance (NMR) Lipoprofile

-Total Cholesterol

-LDL Particle Number (LDL P)

-LDL Size




-Lipoprotein Insulin Resistance (LP-IR)

Lipoprotein (a) Lp(a)


C-reactive protein

Total cholesterol:  At this point I’m sure everyone has heard of cholesterol; a measure of the total compilation of blood lipids and proteins that escort fats and cholesterol around the body via the blood. Total cholesterol includes high-density lipoprotein (HDL), Low-density lipoprotein (LDL), and Very low-density lipoprotein (VLDL). Because of the broad range of particles in this measurement “total cholesterol”, as a marker of health, only tells part of the story; as humans, the norm is 120-140mg/dl.

HDL: This is the “good” cholesterol, if you want to assign labels, and it is responsible for “scrubbing” the arteries and transporting unused fats back to the liver for processing. HDL is affected by several factors including genetics and exercise but like all things it is wildly influenced by diet. For HDL you should shoot for a number over 50mg/dl.

LDL: If you ask anyone on the street they will tell you that these are “bad” cholesterol and they cause plaque build up and heart disease, naturally it is more complicated than that. LDL do the opposite of HDL in that they transport fats from the liver out into the body via the blood stream; where it gets sticky is that there are several types of LDL. There are the normal large-puffy LDL (type or pattern A), small-dense LDL (type or pattern B), and the aptly name “intermediate” particles for everything in between. Generally type A LDL is considered innocuous, it is large and puffy and bounces around the arteries with very little chance of becoming stuck. Type B on the other hand is considered atherogenic because it tends to lodge in the arterial walls and is responsible in part for plaque build up. Historically blood levels of LDL have been between 40-70mg/dl however the real emphasis should probably be on particle size not the total number. People who have predominately type A LDL are at much lower risk of CVD than those with predominantly type B LDL. To recap; total should be 40-70mg/dl but the type, A or B, is much more important. To further clarify, cholesterol is carried inside lipoprotein particles; it is helpful to think of cholesterol as a passenger and the lipoprotein particles as a vehicle. It’s not the number of passengers that causes a traffic jam… it’s the number of vehicles! Similarly, it’s not the amount of cholesterol that causes heart disease – it’s the number of lipoprotein particles! Only the NMR test actually counts the number of lipoprotein particles.

The higher the number of lipoprotein particles in your blood, the greater the risk you have for developing Coronary Heart Disease.

Triglycerides: These are a measure of circulating blood fat; contrary to popular belief they are not elevated by a high-fat diet, in fact quite the opposite is true. Elevated triglyceride levels are a clear indication of the bodies intolerance to or inability to effectively metabolize dietary carbohydrate, which when deemed excess by the liver is globbed together in groups of three and released into the blood. B Shift Breakdown: insulin resistance or high carb in take = high triglycerides… Our ancestors had triglycerides in the 50-80mg/dl range and generally anything under 100 is considered safe from a CVD perspective. That being said strength athletes (highly insulin sensitive) and those following a paleoish diet can routinely be in the 30-40 range which is awesome. If you are a drinker this is something to watch out for as alcohol can really jack with your triglyceride levels.

Robb Wolf’s Rule for Boozing: Drink enough to optimize your sex life, not so much that it impacts your blood lipids.

Lipoprotein Insulin Resistance (LP-IR) Score: The LP-IR score is an assessment of insulin resistance, on a scale ranging from 0 (most insulin sensitive) to 100 (most insulin resistant), that combines the results of 6 lipoprotein particle numbers and sizes based on their differential strengths of association with insulin resistance. Using this method it is possible to predict Impaired Glucose Tolerance (IGT) and Diabetes early enough that, in most cases, it can be treated with lifestyle, nutrition, and exercise changes. As I wrote about in Blood Sugar, this is huge for reducing the risk of heart disease.

Lipoprotein (a): High Lp(a) predicts risk of early atherosclerosis independently of other cardiac risk factors, including LDL. In patients with advanced cardiovascular disease, Lp(a)indicates a coagulant risk of plaque thrombosis and accumulates in the vessel wall which increases clotting. Because of its unique ability to predict heart disease in people who would otherwise test “clean” I think it is important to include this test on your first run of lab work.

Glucose: This test is indicating what your fasting blood glucose levels are and is only relevant in context. Meaning that it is very dependent on what you ate for dinner, how much sleep you got, what your stress levels are, etc. etc. Read Blood Sugar

C-reactive protein (CRP): Long story short, this is a marker of systemic inflammation. CRP is a by-product of immune cell activity and indicates a response that could be totally normal or an indicator of health problems. CRP can and should be elevated any time the immune system is battling an infection of any kind. But what happens if your CRP is elevated and you don’t have any obvious infection?  It could mean that your body is fighting a hidden battle in places like your gums and gut lining, CVD is linked very closely with gingivitis. Healthy levels of CRP are below 1.0mg/l.

There are several ways to get your blood work done, one of course is to ask for it during a check up with your Doc another is to send away for a kit online. Whichever you choose be sure that you get it done and if your numbers are not what they should be please look to your diet before you start taking any medication.

5 Responses to Blood Work 2.0

  1. […] It all started off pretty normal, I got my glucometer and started logging my glucose levels as recommended with no real deviation from normal. I had a fasting blood glucose (FBG) of around 85 and my pre-meal number was around 60-70 which is pretty common in the low carb paleo crowd. A standard meal of 6 eggs, 1 cup of Brussels sprouts, .5 sweet potato (1tbs butter). 1 plantain (fried in coconut oil) would get me around 105mg/dl at 1 hour and back down in the 90s at 2 hours, an indication that I am pretty insulin sensitive and everything seems to be in order. One morning toward the end of my experiment, after 4 calls between midnight and 0500, my FBG was 100mg/dl… Whoops! Turns out the sleep depravation threw me off a little so I kept it super low carb < 50grams all day and did an abbreviated strength session to help get my insulin sensitivity back. By dinner my post meal glucose numbers were only slightly above MY normal and I was looking forward to a good nights sleep and a new day. The sleep I got which was awesome but my FBG was still a little elevated at 97mg/dl… I decided to train fasted that morning so I had some coffee and started to get my PT on but was interrupted by a vegetation fire on the other side of the battalion. That early in morning I wasn’t really too worried about the fire and took my time getting changed and hitting the road, about the same speed you would if it was a ringer at your local Kmart. I got about 10 minutes down the road and was cancelled by units at scene so I returned to my workout. I realized though that I had a unique opportunity to get some data on how my body reacts to stress so I took another reading as soon as I got in quarters and, to my dismay, it 123mg/dl… 15-20mg higher than I had been able to get post meal… On a “nothing”, no stress call for which I was already awake… The other thing that I noticed is that my blood sugar stayed elevated much longer in the post stress testing than it did post meal. So even though I have a healthy glucose metabolism it is still thrown way off track by this job; which is a bummer because no matter how clean I eat or fine tuned my strength and conditioning program is I still spend a ton of time with elevated blood sugar (>110) which is a huge risk factor for heart disease. […]

  2. […] For this path it is recommended that you track blood lipids and blood sugar under the direction of your doctor; absent blood work, you can use body […]

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