Random testing vs. fasting for cholesterol tests

I got a call this afternoon. It was the nurse at my family doctor's office. She told me my doctor wanted me to have some blood work done and soon. No need to fast, I was told, just get to the lab for some cholesterol tests and others. I went immediately.

In the past, I've puzzled over the fasting instructions that have always been part of having these tests. Would there be any to be gained in having test numbers reflective of cholesterol levels occurring after a meal rather than after 8 to 12 hours of fasting? Once I mistakenly had a little coffee before going to the lab. The lab staff insisted I put the test off for a day. Just how damaging can a few sips of coffee be to one's numbers, I wondered.

Today at the lab, I asked a technician about the change from fasting to random testing. She told me she could see advantages and disadvantages in both. She thought it best not to adhere to either approach in all situations. She herself has cholesterol problems she confessed. In her case, it was genetically caused. For her, she knew it was best to have both fasting and random testing done.

I googled the question and learned:

If nonfasting lipid profiles for cardiovascular risk prediction were used, it would simplify clinical care for patients worldwide. Because only minimal, and clinically unimportant, changes in levels of lipids, lipoproteins, and apolipoproteins have been noted in response to normal food intake in the general population and because nonfasting levels predict cardiovascular events, fasting may not be necessary before determining lipid profiles for predicting cardiovascular risk.

For more on this, read: Fasting and Nonfasting Lipid Levels in the American Heart Association publication Circulation.

Personally, I feel more comfortable having my cardiovascular risks calculated from random tests. First, I am not part of the general populace. I have known cardiovascular problems. The average person doesn't have an ICD hidden in their chest and hardwired to their heart. The average person doesn't have a history of relatively frequent TIAs. The average person doesn't have plaque building up in the carotid artery. How the average person's lipid profile changes, or doesn't, after a meal may not be relevant in my case. I'll leave that to my doctors.

My lipid profile, created from years of blood work done in the morning after a night of fasting, has developed some solid numbers. It will be interesting to see what profile modifications will ensue now that my tests are being based on blood work taken randomly.

Whole Wheat Fusilli with Roasted Red Peppers, Turkey and Goat Cheese

This past weekend was Easter. My wife made a large Easter dinner but she made concessions based on the recent advice I received from my London doctor. As red meat is now just about out, Judy made her stuffing using locally-make low fat turkey sausage. Her potato and leek soup was lighter this year as it contained no heavy cream. Judy took advantage of every opportunity to lighten up on animal fats. The dinner was large but not ridiculously large and we'll work through the leftovers in just a few days.

Today, I uses some of the leftover turkey in a whole wheat fusilli with roasted red peppers, turkey and soft goat cheese concoction. I like the fusilli shape as it offers sauces a surface with good grip. Sauces easily slip free from the twirling fusilli shape.

I served broccoli as the side vegetable. I like the way trimmed broccoli curves along the edge of a pasta bowl. It's too bad I didn't include the broccoli in the picture. It would have added a nice splash of green.

Whole Wheat Fusilli with Roasted Red Peppers, Turkey and Goat Cheese

Serves 2

• 1 Tbsp extra virgin olive oil or canola oil
• 1 small onion, diced
• 1 garlic clove chopped
• 8 oz. of roasted red peppers*
• ¼ cup vegetable broth
• 3-4 oz. roast turkey
• 200g of whole-wheat fusilli
• 3 oz. soft goat cheese
• Fresh ground black pepper to taste
• 1 Tbsp chopped fresh Italian parsley
• 3/4 oz. grated Parmesan cheese 

* My wife bought local, fresh red peppers last fall, blackened them on the barbecue, stripped off the darkened skins and frozen them in freezer bags. If you don't want to roast your own red peppers, jars of roasted red peppers are available at the grocery store. I believe they come packed in both oil and in water.

Directions

Heat oil in heavy, deep skillet over medium heat. Fry onion and garlic until translucent. Add roasted peppers, vegetable broth, roast turkey and freshly ground pepper. Heat through, simmering until sauce thickens.

Cook pasta and drain. Remember to reserve 2 oz. of pasta water. Toss pasta with sauce and half the soft goat cheese. (I actually topped the pasta with the mixture but next time I may remember to toss with the pasta.) Add some pasta water if needed. Serve in pasta bowls with sprinkle of parsley, the remaining goat cheese and a little grated Parmesan.

Enjoy!

And if you're curious as to what, other than turkey, was on my wife's Easter menu, think memories. She made a beautiful bunny cake that simply delighted our two oldest granddaughters. They will always remember the Easter dinner at which grandma Judy served bunny cake. The cake, by the way, was somewhat heart healthy. The recipe called for egg whites only. No yokes.

Computers can be good for kids

Why a black flower, Fiona? It's a drawing, Gug. It can be any colour I want.

I've read articles claiming that young children should not be allowed to use computers. One story said "technology is damaging young children whose brains are not yet fully formed."

Not true, at least not in my experience. My granddaughter, Fiona, will not be five for months but already she knows how to turn on the computer, find her icon and open the paint program. The other day my wife asked, "What is Fiona doing? She is awfully quiet."

I found her sitting at the computer making art. It was clear that the computer in no way is damaging her ability to concentrate. She watches what happens when clicking on this icon or that icon and she learns. She knows more about the paint program than I do.

She loves to experiment with colour and form. The computer is perfect for doing this. If one doesn't like the result created by one colour, erase it and try another. Do you like to experiment with geometric forms? It's easy with a computer but almost impossible for a four-year-old using paint, brush and paper.

I've noticed her work with traditional paints often resembles the stuff she creates on the computer.
Many times there is no big divide between her work on the computer and her work done on paper.

Fiona's mother used a computer at a very young age. Not as young as Fiona, but under ten. I had one of the first Macs and I bought a typing program for the little computer. Her mother would sit in front of the little black and white screen blasting words tumbling down the monitor. To type faster, she learned where to place her hands to best use all her fingers. She was typing more than 60 words per minute while still in grade three or four.

Using computers to do dumb stuff is not a temptation unique to children. Maybe learning to ignore such temptations at an early age is an advantage of early computer use.

Can arterial plaque build-up be halted? Reversed? Maybe.

In keeping with my doctor's orders, I am now eating meat every other day. Red meat will only hit my plate once a month, if that. Fish is about to play a big role in my diet and chicken and turkey will fill in the remaining holes in my menus.

It sounds extreme, at least it did to me but it isn't. According to an article in the Huffington Post, President Bill Clinton is now on on a plant-based diet. He has cut all meat from his diet, except for the occasional fish, as well as dairy. Clinton told CNN that he lives on "beans, legumes, vegetables, fruit."

My doctor, Dr. J. David Spence, made no wild promises to me but he is clearly trying to arrest the build-up of plaque that is taking place in my arteries. He is confident the Mediterranean diet he recommends will be part of the answer. Dr. Spence is not alone in his thinking, there are many in the medical profession who agree with my London, Ontario, doctor. They all believe a plant-based diet can help put the brakes on the insidious growth of arterial plaque.

In the United States, Dr. Dean Ornish and Dr. Caldwell Esselstyn are two doctors gaining fame for the plant-based diets they promote. I believe, Bill Clinton is following Dr. Ornish's dietary advice. Another doctor publicizing a plant-based diet, this one with a bit of a twist, is Dr. Joel Fuhrman.

Dr. Fuhrman has gone so far as to write a cookbook, Eat to  Live, making the claim on the cover that inside are 200 recipes for "reversing disease." My doctor, Dr. Spence, has also written a book, How to Prevent Your Stroke. Dr. Spence makes it clear that although diet plays a major role in fighting stroke, once one is suffering from TIAs (mini-strokes) and has measurable amounts of plaque collecting in the arteries, a change in diet is not the compete answer.

Today doctors have a growing number of weapons in their arsenal for fighting stroke. But stroke research is showing that long before someone at risk sees a doctor, there are actions they could have taken on their own to cut their risk.

• Don't smoke
• Don't drink (to excess)
• Exercise daily
• If overweight, lose it
• Adopt a healthy diet to keep the weight off

I have never smoked. I have one 5 oz. glass of wine with dinner. But until recently, I didn't exercise enough, I was clearly overweight and that was partially because my diet was in need of a major overhaul. Would a better diet have kept my arteries free of plaque? Maybe.

According to a Harvard Medical School publication, "Visceral fat is directly linked with higher total cholesterol and LDL (bad) cholesterol, lower HDL (good) cholesterol . . . " And what would have kept that fat at bay? The Harvard publication says exercise and diet.

Pay attention to portion size, and emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread, refined-grain pasta, and sugary drinks. Replacing saturated fats and trans fats with polyunsaturated fats can also help.

In keeping with my new approach to eating, tonight I prepared curried vegetables on a bed of rice for dinner. The rice was white because, at the moment, all we have in our pantry is Indian basmati rice. As soon as this is gone, we will be switching to brown rice. It has a nice nutty flavour and I will make the switch with no fuss.

Recipe

• I put three teaspoons of extra virgin olive oil in a large, deep frying pan.
• I heated the oil for about 30 seconds and then added two teaspoons of mild curry and swirled the heating mixture around in the bottom of the pan. The next time I make this I will add three teaspoons of mild curry to give this dish a little extra pop.
• When the aroma of the heated curry could be clearly noted, I added two chopped onions and two diced garlic cloves to the oil.
• When the onions began to turn translucent, I added 10 oz. of cauliflowers florets and let the cauliflower absorb lots of the flavour of the curry.
• After a couple of minutes I added a 28 oz. can of diced tomatoes, 18 oz. of salt reduced chicken stock, four peeled, sliced carrots, a sliced zucchini about 8 oz. in size and one  medium sized potato cubed.
• I let the whole concoction simmer for about fifteen minutes.
• I added 8 oz. of sliced green beans, a 14 oz. can of chick peas and a small container of heritage cherry tomatoes which had been halved or quartered.
• I ground a little pepper on top and sprinkled some salt onto the bubbling mix and left all to gently simmer.
• Another fifteen minutes and the curried vegetables were ready to be spooned onto a bed of rice along with a little of the light sauce.

Was it good? Honestly, it needed a little more punch. As I said earlier, next time I'll add a third teaspoon of mild curry. The chicken stock I used was low in both sodium and fat but the next time I make this I will experiment with low salt vegetable stock, and I will keep an eye on the salt I add. Many of us consume too much salt.

So, was it healthy? Yes! It was a good choice for a meatless Monday. Will eating like this stop the build-up of plaque in my arteries from continuing? I can't say for sure but I have my fingers crossed and my spare tire on notice.

Treasures

For my 4-year-old granddaughter the world is a wonderful place filled with treasures. She has a little pink tricycle she calls her scooter. At the back there is a small tray — the trunk. Whenever we go to the park, the short journey is stretched by frequent stops to investigate a treasure.

The crabapple tree in front of my home is the source of many treasures. In the spring, the tree is covered with small, pink flowers attracting dozens of bumblebees bees at any one time. She stops, I hold her high and she picks the pretty, little flowers. Treasures.

The flowers disappear, leaving the ground littered with pink petals, more treasures. Soon little green apples replace the flowers and grown in size and number throughout the summer. By fall the boughs hang low with the weight of the fruit. The tree emits a low, steady hum, the result of hundreds of yellow jackets attracted by the fragrant, juice-filled fruit.

My granddaughter will stop her scooter and I will hold her high in order to pick the biggest, roundest, reddest apples. The ones undamaged by the wasps. She is careful not to bother the buzzing, yellow and black striped insects which appear to understand that we are not a threat. There are enough apples, enough treasures, for all.

Of course, a crabapple tree is not the only treasure to be found. I have two, small, smooth, flat, oval stones discovered by Fiona. They too are treasures and she gave them to me. I treasure them. I will make one into a broach, encircling it with a decorative band of silver. It will be a treasure for all forever.

What I find amazing, startling, even a little sad, is that as we grow older, as we mature, we don't see more treasures in our world but less. Fiona has opened my eyes to the treasures in my world and for this I thank her. I believe I can say, and most would agree, Fiona herself is a little treasure.

The Mediterranean diet is part of the answer

There is a misconception, often spread in the media, that dietary fats are no longer linked to cardiovascular disease. I have heard folks admit to great confusion when it comes to the question of diet as a result of all the conflicting stories boldly featured in the media.

One week it is reported doctors are claiming fat is bad for you and then the very next week, or so it seems, the reports flip, reporting dietary fat is of no consequence. The heart-disease-and-dietary-fat story flip flops in the media as often as a fish out of water.

According to one of my London, Ontario, doctors, J. David Spence, "Patients at risk of cardiovascular disease should limit their intake of cholesterol." Period. For Spence, this is not debatable. The well respected doctor and his co-researchers are certain that "Despite widespread belief to the contrary, it is simply not true that dietary cholesterol is harmless."

Instead of reading newspaper reports, I would suggest reading "Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease." This report can be found in Pulse: The Canadian Journal of Cardiology and found posted online by the U.S. National Library of Medicine.

This report states, "A widespread misconception has been developing among the Canadian public and among physicians. It is increasingly believed that consumption of dietary cholesterol and egg yolks is harmless. There are good reasons for long-standing recommendations that dietary cholesterol should be limited to less than 200 mg/day; a single large egg yolk contains approximately 275 mg of cholesterol (more than a day’s worth of cholesterol)."

The report blames the confusing media stories on "the remarkable effectiveness of the sustained propaganda campaign of the egg producers' lobby. . . . In the past year, two studies funded by egg marketing agencies led to media reports promoting the benefits of eggs." Although Spence et al. agree egg white is a valuable source of high-quality protein, egg yolk, on the other hand, should not be eaten indiscriminately.

If eggs are bad, what about butter? I've had friends say that they once ate margarine for health reasons but have now switched back to butter. They honestly believe the fat in butter is superior to the fat used to produce soft margarine. Despite the media stories, this isn't the case.

One friend loves to say margarine is made from petroleum products, oil sands oil. It's plastic he says and he makes these false claims in front of his young granddaughter. This is a pointless urban legend according to Melissa Wdowik, a nutrition specialist at Colorado State University.

As a man battling arteriosclerosis, I shake my head. People are ignorant about the true position of most doctors when it comes to dietary fat. I lay the blame for this squarely on the media. Take this headline from the Daily Mail in Britain. "At last, the truth: Butter is GOOD for you - and margarine is chemical gunk" The story claims the public has been conned by profit-grabbing manufacturers ignoring decades of scientific evidence in order to peddle their tubs of margarine.

I'd list more links to media stories but I'll let you do the googling. You will be swamped. But approach this search by looking for university supported data rather than media stories. If you do this, you will learn that soft, non-hydrogenated margarine is best -- but like any fat that is being used as spread, it must be used sparingly.

Life is complicated and the media hates a complicated story. No one would dispute the fact that fat is essential in our diets. Medical researchers are concerned with both the total amount of fat in our diets and the type of fat. The recommendation is to avoid trans fats completely. This bans hard margarine from our diets

After eliminating trans fats, one should choose unsaturated fats over saturated ones. This cuts butter from our diets and severely restricts consumption of red meats. According to the American Heart Association, "In general, red meats (beef, pork and lamb) have more cholesterol and saturated (bad) fat than chicken and fish.

I like the attitude of Dr. J. David Spence. I first met Spence while covering a medical story for the local paper. I met Spence again recently when he sat down with my wife and me to discuss the plaque discovered in the arteries leading to my brain.

Dr. Spence laid out a battle plan for us to follow in fighting my increasing stroke risk. I don't want to give anyone the idea that the only weapon in our arsenal is a change in diet. Diet is but one arrow in a large and growing guiver. But, an improved diet, with the accompanying loss of excess weight will play an important role in the coming fight. I quote from Dr. Spence's book: How to Prevent Your Stroke.

"I encourage people to take a positive attitude, thinking of their meatless day every other day not as their punishment day but as their gourmet cooking-class day. You can learn to make chili, pasta, stir-fries, barbecued vegetables, and other dishes without meat, and to make them delicious not with butter and cheese, but with herbs, spices, onions, green peppers, lemon juice, balsamic vinegar, and so on."

The doctor swayed me. My wife and I are going to try the Mediterranean diet made famous by the cooks on the Isle of Crete. Before we head off for Chapters to find a Med-diet cookbook, I'm going to check out the foodie recipes posted by Elena Paravantes on her website "Olive Tomato." But my first foray into Mediterranean cooking will be one of recipes given to me and my wife by Dr. Spence. Stay tuned.

My first attempt at Mediterranean cooking, delicious on a bed of brown rice.

C'est la vie or caught between a rock and a hard place

A risky but bold work of art by Fiona, age 4. One cannot escape risk.

Wednesday my wife and I met with a doctor, an expert in stroke treatment. He is associated with both University Hospital and with the Robarts Research Institute. He laid out the detailed findings from the investigation into the health of my arteries down on the desk. He looked at us for a moment and then told me, "You are trapped between a rock and a hard place."

The tests revealed the arteries in my neck are laden with plaque. My arteries hold three times the amount of plaque as that found in healthy men of my age. This plaque can flake and the small bits can be carried in the blood to the brain. This explains the TIAs, transient ischemic attacks, I have been having. TIAs, also known as "mini-strokes", are taken very seriously by doctors as they can be harbingers of a massive stroke in one's future.

I already take some pretty powerful medications. If all had gone well with these recent tests, I might have had some of my meds cutback. Strong meds often carry risks. Instead, I was given another cholesterol fighting drug which will also boost the benefits gained from the statin I am already taking. These drugs can mess with some important chemicals in the body. To counter this I must add 200mg of another drug taken twice a day. Unfortunately, this drug can increase the bleeding potential resulting from taking the anticoagulant Pradaxa. I take Pradaxa.

My history of heart arrhythmia demands I take an anticoagulant. Arrhythmias increase the risk of blood clots forming in the heart. These can then travel to the brain. An anticoagulant cuts this risk. Unfortunately, because micro bleeding was discovered in my brain, I cannot take the common and inexpensive anticoagulant Coumadin. It would increase my risk of having an uncontrolled cranial bleed.

There is an alternative, the anticoagulant Pradaxa. It will lessen my chance of stroke without increasing my risk of bleeding in the brain. The downside is that Pradaxa is expensive, very expensive, and if I should have a serious bleeding problem, for any reason, the blood thinning achieved by Pradaxa cannot be as quickly reversed as it can with Coumadin.

Yes, I am trapped between a rock and a hard place. But, I am not alone. I am trapped there with my doctors. They have no perfect answers to my health problems. Try this and that may go wrong. Try that and this may go wrong. And either answer is accompanied by the risk of some truly awful side effects, of unwanted consequences.

Our blood clots for good reason. There is no mystery as to why anticoagulants carry risks. All my drugs mess with important functions in my body and messing with those functions is risky. Period. Being a doctor is all about balancing risk. Doctors do a damn amazing job at balancing those risks. I am in awe of the talents, the skills, the knowledge and the bold risk-taking of my doctors.

It was more than a decade ago that I had the mitral valve in my heart repaired robotically. I was the first person in Canada to have such an operation. It was risky but it was clearly worth the risk. My ICD/pacemaker was a risk, some doctors questioned whether I actually needed one. Today my heart is being paced 93 percent of the time. I have had my heart rebooted by my built-in defibrillator at least three times. My doctors and I have taken a lot of risks over the years and so far they have made the right calls.

As of today, I am taking a mixture of ten tables and capsules a day. I chew 'em; I wash 'em down with water; I take 'em with food; I take 'em on an empty stomach. I never did a lot of drugs as a young man growing up in the '60s, but as a senior my world is veering toward Jefferson Airplane country and the land of the white rabbit.

One pill makes you larger,
And one pill makes you small,
And the ones that mother gives you,
Don’t do anything at all (maybe but doubtful).

If I should have a stroke, I know my doctors will wonder what could they have done differently. If I am lucid after the event, I will tell them there is nothing they could have done differently. Nothing. They balanced the risks and we lost.

C'est la vie.