THE NUMBERS GAME: WHAT DO THEY MEAN?
People like numbers; they like results too. Tell them their cholesterol has dropped 60 points and they light up. Say their blood pressure is still 170/100 and they’re down in the dumps. But is this overwhelming focus on the numbers justified. Probably not. In all my years of practice I've never seen anyone die from a high cholesterol, high blood sugar, or elevated blood pressure.
What do people with these elevated numbers usually die from?
They die from failed arteries, that close down after years of maltreatment. Yet almost everyone, doctors to patients alike, obsess over a handful of numbers, so much so that the goal becomes correcting the numbers, not stopping or reversing the disease. One drug after another drives the values down, yet the underlying lethal disease is largely ignored. As a result, the risk of suffering death and disability is little changed. For example, even though high blood pressure is associated with three times the risk of dying from a heart attack, treating elevated blood pressure with pills does not reduce the risk of dying from this disease. In fact, too aggressive treatment will increase the risk of dying of heart disease substantially as the diastolic pressure (lower number) is lowered below 85 mm Hg toward a "normal" pressure of 70 mm Hg (See the McDougall Program for a Healthy Heart for details).
These Are Signs Predicting Future Health
You should view these numbers as "signs," waving at you--trying to warn you there is trouble down below. Act by correcting the underlying disease, for example the failing arteries; which means substantial changes in your diet and lifestyle. With these fundamental changes the signs foretelling disaster also will start looking more favorable. The blood pressure, blood sugar, cholesterol, and triglycerides numbers decrease. In this manner your chances of a long healthy life are greatly improved--which after all is all that you are really striving for.
As a "second line" therapy, medications can play an important role. For example, cholesterol lowering medications, like the variety referred to as "statins" (Mevacor, Zocor, etc.) have been shown to reduce the risk of dying from heart disease, and probably strokes. Medications have significant side effects and costs, and are never as effective at restoring health as diet and lifestyle.
How To Treat These Numbers?
Normal blood pressure without medication is 110/70 or less. A rise of 10 mm Hg diastolic (lower number) to 110/80, a number considered by many to be normal, is actually a warning sign that your arteries have twice the risk of closing down compared to a person with a normal pressure. Diet and exercise effectively lower most patient’s blood pressure, but some people more help. Medications should be used to treat patients who maintain a diastolic blood pressure over 100 mmHg for several months despite their best efforts. However, it is dangerous to reduce the level of the diastolic below 85 mmHg because this overtreatment with drugs increases your risk of dying. The reason is a drug-induced decrease in blood flow to the arteries that nourish the heart muscle. Therefore, if you are taking medications you only have the narrow range of 85 to 100 mm Hg diastolic to keep your blood pressure in, otherwise you are being harmed. This tight control is difficult, if not impossible, for most patients. Please understand a pressure below 85 mm Hg diastolic without medication is healthy.
"Normal" cholesterol has been defined by what is usually found in the American population. This value is 210 mg/dl. However, Americans have a 50% chance of dying prematurely from a heart attack or a stroke. "Normal" has been defined by a sick population of people. Therefore, an average American cholesterol level is not for you. When cholesterol increases by 60 mg/dl (say 200 to 260 mg/dl) your risk of dying of heart disease increases 5-fold.
Ideal cholesterol is defined by observing populations of people who do not suffer from heart disease. These would be people living in rural areas of Asia and Africa. Or even some Americans who have very low cholesterol levels, such as the population studied in Framingham, Massachusetts. This ideal level where heart disease is practically unknown is observed to be below 150 mg/dl. Ideally, this level should be achieved by a low-fat, vegetarian diet alone. However, many people (because they have been packing cholesterol away in their tissues for decades) cannot achieve this ideal without the help of medication. (See the McDougall Program for a Healthy Heart for more information).
These are the fats in the blood. High levels are another sign that the blood vessels are in trouble. An ideal value is below 150 mg/dl. However, triglycerides change rapidly; rising, for example, 100 points after eating. The very highest high levels I have seen are over 5000 mg/dl. A low-fat, vegetarian diet that also restricts simple sugars, including fruit and fruit juices, along with moderate exercise lowers these numbers. Studies have not demonstrated lowering triglycerides with medications will prolong life. However, when I see patients with values over 500 mg/dl I will usually prescribe a medication based on my "best guess" that they will gain more future benefit than harm from my medications.
Excess body fat is another sign that you are more likely to suffer from illness or death. Studies have shown weight loss will lower your risks; most likely because long term behavior changes were made. Successful ways to reduce body fat are limited to exercising and/or eating a higher-carbohydrate / lower-fat diet. Both of these being independently good for the body, and especially the heart. Excess body weight has been thought by many people to cause harm by putting an extra strain on the heart. But I believe it is simply another unmistakable sign that the person is eating too many unhealthy foods and not exercising enough.
There are many other signs that your body might be in trouble: elevated blood levels homocysteine level, uric acid, and lipoprotein a. There are also the physical signs such as arcus senilis (gray rings around the cornea), and creases in the ear lobes. And of course, let’s not forget those attention getting symptoms such as chest pain, that bring most people to their senses. Don't ignore these important messages. Instead act by identifying and correcting the underlying causes.