Nonfasting Lipid Level Measures Deemed OK

This was the title of one of the articles in Family Practice News which holds themselves out as "The Leading Independent Newspaper for the Family Physician-Since 1971."

The first paragraph of this story stated "Nonfasting lipid status may be a better marker for impaired lipid metabolism than fasting lipids..." What all this mumbo-jumbo means is that it may be better for us docs to tell our patients not to fast before they give their blood to check their lipid panel.

My patients already know that I tell them not to fast before they give their blood for their routine lipid checks. I've been telling my patients for years that when they fast they are changing their blood chemistry into what it normally isn't. I want to see their blood chemistry as it normally is. I have called fasting "cheating" as it changes the blood chemistry, specifically the triglycerides and blood sugar, and can bring these numbers into the normal range with as little as an 8 hour fast.

By telling patients to fast, we docs will miss those patients who are insulin resistant as their triglycerides (trigs) and blood sugars can become normal with even an 8 hour fast. I have caught many new onset insulin resistant, type 2 diabetics by telling them NOT to fast prior to giving blood for lipid analysis.

For instance, even a trig value of say, 170, will tell me that I have a potential type 2 diabetic in the making. This trig value is certainly high, but it is a trig value which will easily correct itself by as little as an 8 hour fast. So if I would have told my patient to fast, I would have missed this as the trig value would have been normal; and I would not have been able to counsel my patient accordingly.

The same is true with blood sugar readings. By telling my patients not to fast, I catch many a type 2 diabetic extremely early in their disease and I can intervene alot quicker than other practitioners, solely because I told my patient not to fast.

All docs need to tell their patients not to fast before they give blood for routine lipid analysis.

Do I have to say to my colleagues "I told you so." Nah, that would be just plain rude :-)

Dr Jim

(The full article can be found in Family Practice News, Vol. 39, No. 14, p.15.)

Have a great weekend everyone and if you live in the NorthEast---stay dry :-)