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How Do Blood Tests Fit Into the Comprehensive Exam?
Cooper Clinic’s in-house lab provides same-day results for the patient to review with their physician.
We began a blog series to define the components of the standard-six comprehensive preventive exam at Cooper Clinic with, ‘What Does a Comprehensive Exam Entail?.’ In this post, we introduced the series and covered the first of six components, Medical Exam & Counseling. Our second component of six is Laboratory Analysis.
Component #2: Laboratory Analysis
Comprehensive lab testing includes cholesterol profile, blood sugar level, complete blood count, homocysteine, urinalysis, high sensitivity C-reactive protein, thyroid stimulating hormone, vitamin D, omega-3 and other important tests. Cooper Clinic’s in-house lab provides same-day results for our physicians to review with the patients. Depending if the patient is new or returning, we examine up to 70 blood tests.
There are a number of risk factors for the development of chronic disease that can only be identified by blood tests. You certainly would not want to find out that you have high cholesterol by having a heart attack!
Cholesterol
A complete cholesterol panel is an important test for prevention. Knowing the numbers in your cholesterol profile (total cholesterol, HDL (good) cholesterol, LDL (bad cholesterol) and triglycerides) helps define your risk for heart disease and stroke.
Almost 32 million adults have significantly high cholesterol levels (≥240 mg/dL). More than one of four adults has high triglyceride levels (risk factor for heart disease and stroke). An HDL cholesterol level <40 mg/dL in adult males and <50 mg/dL in adult females is considered low and is a risk factor for heart disease and stroke; about half of all adults have an HDL cholesterol < 52 mg/dL. What side of 52 mg/dL median level is your HDL? Given that in more than a third of patients, the very first sign of heart disease is death, this is definitely a chronic disease you want to prevent.
Fasting Blood Sugar
A fasting blood sugar measurement and a hemoglobin A1C measurement (which estimates your average blood sugar over the last three months) are important tests for prevention. An estimated 20 million American adults have been diagnosed with diabetes (fasting glucose ≥ 126 mg/dL). Another eight million adults have full blown diabetes, but don’t know it. More than 87 million adults (38 percent of the population) have prediabetes (fasting blood glucose 100-125 mg/dL). If you have prediabetes, you can take active steps in improving lifestyle to significantly lower your risk of developing full blown diabetes. Given that the presence of diabetes can result in vision loss, kidney dysfunction, heart attacks, strokes, poor circulation and amputations, this is definitely a chronic disease you want to prevent.
Kidney disease is another chronic condition that is detected by changes in blood work long before symptoms occur. More than 26 million adults (13 percent of the population) have chronic kidney disease and many do not even know it. Another 20 million are at risk for developing kidney disease because they have risk factors for kidney disease like diabetes or high blood pressure. Chronic kidney disease is a risk factor of heart disease and stroke.
The sooner you know if your kidney blood tests are abnormal, the sooner you can take proactive steps to protect your kidneys from further damage. Given that chronic kidney disease may require treatment with dialysis or kidney transplantation, this is another chronic disease you can prevent.
Vitamin D
Vitamin D is a fat-soluble vitamin that has helps keep calcium and phosphate levels in the blood normal which is important for healthy bones. Although more research is needed in these areas, preliminary studies have demonstrated that vitamin D deficiency is associated with increased risk of death from all causes, cardiovascular events including sudden cardiac death and stroke, diabetes, hypertension and impaired function of the immune and musculoskeletal system.
If you visit clinicaltrials.gov, where all on-going clinical trials are listed, and search vitamin D, you will see that vitamin D deficiency and vitamin D supplementation is being studied in countless conditions including preventing diabetes, improving periodontal (gum disease), reducing hot flashes and improving fatigue! It is clearly the “it” vitamin of this decade.
Vitamin D is made in the skin in the presence of sun exposure. We can also get vitamin D from natural sources like fatty fish (less commonly) and more commonly from fortified foods (milk, breads and cereals). Despite the fact that sun exposure is not hard to come by and that fortified foods are generally available, vitamin D deficiency is shockingly common. A recent national survey of American adults (NHANES survey) identified that 42 percent of adults were vitamin D deficient.
Identifying vitamin D deficiency is simple (with a single blood test) and improving vitamin D levels is easy too once you know you need to do it! Given the myriad of on-going clinical trials involving vitamin D, who knows how many chronic diseases vitamin D levels may influence.
To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the third component within the exam, cardiovascular screening.
Even Runners Need an Annual Physical
Bob Abbott, photo credit: The Dallas Morning News
A well-known Plano, TX runner, Bob Abbott, died last week at the age of 73 due to an aortic aneurysm. His death is a reminder to all of us that even if we are seemingly highly-fit and healthy, a preventive exam is prudent in order to ensure there are no underlying health concerns.
The Centers for Disease Control report that aortic aneurysms were the primary cause of 10,597 deaths in the US in 2009 (and a contributing cause of death in more than 17,215 deaths). About two-thirds of the people who have an aortic aneurysm are men. High blood pressure, high cholesterol, atherosclerosis and smoking all increase risk for aortic aneurysm. People with a history of smoking are 3 to 5 times more likely to develop an abdominal aortic aneurysm.
Sadly, most people who suffer aortic aneurysm don’t have symptoms leading up to the event. And people who do have symptoms may not recognize them for what they are—the symptoms are belly, chest, or back pain and discomfort, and the symptoms are variable—in some people they come and go while in others it’s a constant pain.
Regular exercise, a healthy diet, and blood pressure control offer tons of protective health benefits, but they aren’t a guarantee that we’re invincible and nothing bad is ever going to happen! Physicians at Cooper Clinic regularly identify major (or potentially major) health issues (such as aortic aneurysms) in otherwise healthy individuals as part of an annual preventive medical exam.
Read The Dallas Morning News’ tribute to Bob Abbott here: Remembering Plano’s Bob Abbott.
To learn more about a preventive exam at Cooper Clinic, click here.
Dr. Cooper’s Response to Recent Vitamin Studies
Dr. Cooper continues to provide insight as an inspiring authority in preventive medicine.
In a new editorial in Annals of Internal Medicine (Dec. 16, 2013), physicians warn that “most supplements do not prevent chronic disease or death, their use is not justified and they should be avoided.”
We spoke to our own Kenneth H. Cooper, MD, MPH, on this topic and here are his thoughts:
I’m a strong believer in objective scientific research. In 1984 it was said that exercise did nothing but make you feel good. In the 1970s I began my work to prove that exercise is medicine. Today with our over 600 research articles published on the subject [at The Cooper Institute] we can say for certain that exercise is medicine and has health benefits. On exercise we have bridged the gap between faddism and scientific legitimacy.
I feel that we are in the same place today on the subject of vitamin supplementation as we were 25 to 30 years ago on exercise. It’s my opinion that we should try to prove or disprove the use of vitamin supplementation with objective research.
Recent studies, including those in the Annals of Internal Medicine article are not objective science. The reason is that in nearly all these studies researchers do not measure the blood level of vitamins to determine whether a person needs a vitamin or not. Researchers arbitrarily put study participants on a supplement and compare them to those on a placebo.
In our studies on vitamins B12, D and omega-3 (conducted over the last eight years) we have looked at blood levels and show that they vary tremendously. Some people taking no supplements have a very high level of certain vitamins and some people taking supplements have a very low blood level of vitamins. At Cooper Clinic we treat vitamins like any drug we prescribe. We measure the blood level and recommend vitamin dosages to get blood levels up to satisfactory levels. In my opinion that’s how a vitamin has to be prescribed. In addition, we are studying the long-term benefits of these vitamins in our practice of preventive medicine.
The benefits of vitamins are well documented in scientific literature. For example:
- Vitamin D supplementation reduces fractures from falls in the elderly (as shown in most studies).
- Vitamin D deficiencies can be a factor in osteopenia and osteoporosis and supplementation can be used to treat it.
- Vitamin D deficiency may be related to Multiple Sclerosis and in some clinics, high doses of vitamin D are being used to treat it.
- Vitamin B6 in some cases has been effective in treating carpal tunnel syndrome.
- Omega-3 supplementation has been approved by the FDA to lower blood triglyceride levels.
- Niacin (vitamin B3) is used to lower total cholesterol and to increase HDL (good) cholesterol.
- Folic acid deficiencies in women have been known to result in spinal bifida and neural tube defects in the newborn.
- Vitamin B12 is used as a treatment to correct pernicious anemia and is a factor in cognitive dysfunction in the elderly.
- Folic acid, B6 and B12 have been shown to lower Homocysteine levels, hopefully a beneficial effect on reducing the frequency of heart attacks and stroke.
- Niacin (vitamin B3) has been used to reduce the frequency of some cancers.
I believe that in order to practice responsible medicine we cannot make a broad based statement about vitamins. If every American ate between five to nine servings of fruit and vegetables a day we would not need additional vitamin supplementation. However, because the average American adult eats 3.1 servings of fruits and vegetables and the average teenager gets 1.6 servings, levels of vitamins in the blood can be low and supplementation becomes necessary.
While we can never replace a good diet, I continue to recommend vitamins as insurance for people who don’t follow the recommended daily serving of fruit and vegetables.
To learn more about Dr. Cooper’s work in preventive medicine as the ‘father of aerobics’, click here.
Nuts and Bolts on Nut Butter Nutrition
Not too long ago peanut butter was one of the only choices when it came to nut butters. Now the popularity of almond, cashew and others has grown exponentially. Let’s navigate all the “new” options and break it down so you can choose the best one for you.
There are a number of health benefits nut butters have to offer. They are primarily made of heart healthy fats known to raise healthy (HDL) cholesterol and lower bad (LDL) cholesterol. Nut butters are a good source of vitamin E, many other vitamins and minerals, and fiber. Because they are fats, a little bit goes a long way. Most have about 200 calories per two tablespoons. Scan the ingredient list to make sure it’s short and does not include harmful hydrogenated oils.
Are some nut butters really better than others? Check out the stats to compare the differences. Note these numbers represent averages. Look at the brand labels for specific data on each product.
Nut Butter Nutrition (for two tablespoons):
| Nut | Calories | Total Fat | Saturated Fat | Fiber | Protein |
| Almond | 190 | 16 g | 1.5 g | 4 g | 7 g |
| Cashew | 190 | 15 g | 3 g | 2 g | 5 g |
| Peanut | 190 | 16 g | 2 g | 3 g | 8 g |
| Soy | 200 | 14 g | 2 g | 2 g | 10 g |
| Sunflower | 200 | 16 g | 2 g | 4 g | 3 g |
The Many Ways to Enjoy Nut Butters:
Almond butter: spread on a whole grain waffle; use in recipes for homemade energy bars
Cashew butter: use on sandwiches; substitute for peanut butter in Thai and Indian dishes
Peanut butter: spread on a banana or to dip apples; use in curry paste or in Asian dipping sauces
Soy butter: use as a dip with fresh vegetables or with whole grain crackers
Sunflower butter: smear on whole grain crackers; add vanilla or cinnamon for a flavor kick
Nuts are chock full of nutrition and now with the many options to choose from, you might venture out and try something different. Taste matters, so aside from noting the nutrition stats, you may want to select the ones you enjoy the most.
What is your favorite nut butter?
For more Health Tips and meal preparation inspiration check out the Cooper Aerobics Pinterest page or Recipes section on our website.
Apples for a Healthy Bite
October is National Apple Month! Apples are one of the most popular fruits purchased by American consumers and there are over 700 varieties to be picked! They not only taste great, but they also provide a lot of nutrients. Apples have only 80 calories for a medium-sized fruit. They are rich in soluble fiber, which helps lower bad cholesterol (LDL). They contain good quantities of the antioxidant vitamin C and also beta-carotene and B-complex vitamins. Apples are fiber packed and can be very filling for a power snack before a workout or as a pick-me-up during a mid-day energy slump.
An apple a day really does keep the doctor away! Here are some of the health benefits that make apples so smart to eat. They may:
- Boost weight loss
- Improve brain health and Alzheimer’s disease
- Inhibit growth of cancer cells of the colon, breast and protect against other cancers
- Improve heart health
- Strengthen the immune system
- Increase good bacteria in the gut
Apples are crunchy and satisfying and easy to grab and go. Here are some great ways to pack apples into your routine:
- Lunch box
- Car trips
- Beach/pool trips
- Plane rides
- Picnics
Apples are a ready-to-eat fruit. These tips can help you keep them fresher longer:
- Select apples that are firm to the touch, free of bruises.
- Wash apples under running water and dry with a paper towel.
- If slicing or dicing up an apple, store in a mixture of one part lemon juice and three parts water and either eat within 2 hours or refrigerate.
- Refrigerate apples right away to maintain flavor and slow down ripening. Apples that are stored properly can last 4-6 weeks.
Apples are fun to eat in creative ways:
- Apple slaw
- Apple chips
- Chopped apples as an oatmeal topping
- Baked apples for dessert
- Chopped in tuna salad
- Tossed in a green salad
- Sliced in a turkey sandwich with melted 2% low fat Swiss cheese
- Apples smeared with peanut butter
- Served with a low fat cheese stick for a snack
- Homemade chunky apple sauce
- Low-fat high fiber apple berry muffins or apple walnut bread
What’s your favorite apple?
Top Ten List of Fruits and Fiber
It’s no surprise that eating more fruits and vegetables is the foundation of a healthy eating plan. Yet less than 30 percent of Americans are meeting the goal of at least five servings a day. That may sound like a lot to chew off, but you can make some small, simple changes. Start with even one fruit a day at breakfast or as part of an afternoon snack and go from there. One serving of fruit, which varies in size depending on the specific fruit, has only about 60 calories, zero grams of fat and no sodium. Rich in vitamins, nutrients, fiber, antioxidants and water, ALL types of fruit are healthy carbohydrates that provide our body’s essential fuel. It’s best to go with whole fruits over juices or canned fruit for the fiber benefit.
Why is fiber so important? Here are some great reasons to boost your fiber numbers. Aim for 20-35 grams a day.
Fiber:
-Helps with fullness to manage weight
-Contains cancer-fighting antioxidants
-Aids in digestion
-Lowers blood cholesterol
-Stabilizes blood sugars
Top Ten Fruits and Fiber:
1) Raspberries, 1 cup- 8 grams
2) Blackberries, ¾ cup- 6 grams
3) Boysenberries, ¾ cup- 6 grams
4) Cranberries, fresh, 1 ¼ cups- 5 grams
5) Strawberries, 1 ¼ cups- 4 grams
6) Pear with peel, 1 small or ½ large- 3 grams
7) Orange, 1 medium- 3 grams
8) Clementines- 2 pieces- 3 grams
9) Blueberries, ¾ cup- 3 grams
10) Apple with peel, 1 small (snack size)- 3 grams
Power Up With High Fiber Fruits:
1) Feature a new fruit each week. Experiment by taste testing at the grocery store.
2) Keep it where you see it. Keep a bowl of fruit on your countertop or desk at work. You’re more likely to eat it when it’s right under your nose.
3) Wake up to fruit. Mix diced apples, berries or mashed bananas into your oatmeal.
4) Get creative with salad beyond veggies. Top with blueberries, sliced strawberries or Clementine wedges (or go for all three!).
5) Make your own fruited yogurt. Instead of buying yogurt loaded with sugar, add your own fresh berries to plain fat-free yogurt for fiber and sweetness.
6) Fresh is not the only route. Buy frozen fruit, particularly off season, and stir in fat-free milk for an icy treat.
7) Throw a few Clementines in your work bag or in your kid’s lunch box.
8) Fresh cranberry relish is perfect for a fall side dish, but you don’t have to wait until Thanksgiving to enjoy it! Also you can spread some on you turkey sandwich at lunch.
9) Avoid hunger pangs when you go out to dinner or to a party. Before you go, munch on an apple or pear to curb your appetite. It can be very filling!
10) Don’t skip dessert. Make delicious baked pears or apples in the microwave and sprinkle with some cinnamon and nutmeg for a great quick dessert.
What fruit do you enjoy?
For more information about Cooper Clinic Nutrition Services or to schedule a nutrition consultation, click here or call 972.560.2655.
The Eggciting World of Eggs
At one point you have probably heard that eggs are good for you, and then you later read they’re not. Has anyone told you that brown eggs are more nutritious? Do you ever wonder why sometimes your hard boiled egg has a green ring around it, and is it safe to eat? Read the facts about eggs.
Benefits of Eggs
Eggs are an excellent source of high quality protein. They have the right mix of essential amino acids needed to build tissues, and have 13 essential vitamins and minerals. The egg yolk is the major source of the egg’s vitamins and minerals and is one of the few foods that provides natural vitamin D.
Nutrition Content (1 large egg):
According to the American Egg Board and the Egg Nutrition Center, the cholesterol content in eggs has decreased by 13 percent and the amount of vitamin D has increased, while the calories and protein have stayed the same. While the cholesterol content has lowered, it is still recommended to limit egg yolks to two per week or less if you have elevated cholesterol levels.
- Cholesterol: 185 mg
- Vitamin D: 41 IU
- Calories: 70
- Protein: 6 gm
Frequently Asked Questions:
- Are brown eggs really better for you than white eggs? There is no difference in nutritional content or taste between white and brown eggs. The color of the shell has to do with the color of the hen. White shelled eggs are produced by hens with white feathers and ear lobes, and brown shelled eggs are produced by hens with red/brown feathers and red ear lobes.
- What does it mean if my hard boiled egg has a green ring around it? A green ring on a hard boiled egg means the egg has been overcooked, and is caused by sulfur and iron compounds in the egg reacting on the yolk’s surface. The green color can also be caused by a high amount of iron in the cooking water. The green color is safe to eat.
- Why is the yolk sometimes darker or lighter in color? The color of the yolk varies in shades of yellow depending on the diet of the hen, but does not affect the quality of the egg. If the hen eats plenty of yellow or orange plants, the yolk will be a darker yellow than if she eats white cornmeal, a colorless diet.
- How can I tell if an egg is raw or hard boiled? If you spin the egg and it spins easily, it is hard boiled. If it wobbles, it is raw.
Egg Safety and Storage:
The color of eggs can vary due to many factors. A cloudy egg white is a sign that the egg is very fresh, while a clear egg white is an indication that the egg is aging. A pink or iridescent egg white indicates the egg has spoiled and should not be consumed.
Store eggs in the carton to keep them fresh since the egg shell has thousands of tiny pores over the surface that can absorb flavors and odors. Eggs should be refrigerated because they can age more in one day at room temperature than in one week in the refrigerator. Eggs can be kept refrigerated in their carton for at least 4 to 5 weeks past the pack date (this is the day the eggs were packed, not when they expire).
