Your Health Check Report: Common Concerns and Insights

Q: Your Health Check Report: Common Concerns and Insights

Hello： <br>1. <br>A fasting blood glucose level of 101 is not something to be overly concerned about. <br>The normal reference range is based on the majority of the population, and a single fasting blood glucose measurement can be influenced by the duration of fasting and the foo

Questions about health check-up reports?

Hello Doctor, I am 186 cm tall and weigh 72 kg.
I have a regular exercise routine that includes three aerobic sessions and two strength training sessions per week, with a relatively high intensity.
I also pay attention to my diet.
However, my health check report showed some concerning results, so I have a few questions to ask.
Thank you.
1.
The health check report indicates that my fasting blood glucose level is 101 mg/dL, but I have never had any blood sugar issues in the past.
The check was done at 1:15 PM, and I had been fasting since 10 PM the previous night, which means I fasted for over 12 hours.
I also had urination and bowel movements in the morning.
From my research online, I found that "if fasting exceeds 12 hours, although it is fasting blood, physiological endocrine hormones in the body can affect blood glucose levels and other indicators, making them not reflective of normal physiological conditions." Therefore, I would like to ask if it is possible that the prolonged fasting period, combined with the effects of glucagon and insufficient water intake, could lead to concentrated blood and consequently a higher fasting blood glucose level.
2.
I tend to get anxious, especially during health checks, which causes my heart rate to increase.
This results in blood pressure readings that differ from those taken at home.
I would like to understand if, aside from blood pressure, the anxiety and increased heart rate could also contribute to elevated blood glucose levels due to adrenaline secretion.
3.
The report also shows an ALT level of 50 U/L, while my SGOT and SGPT were normal during my military health check two years ago.
From my online research, I learned that "intense exercise in a short period can indeed cause muscle fatigue and damage, leading to the release of enzymes from the muscles into the bloodstream, which may result in a slight elevation of GPT." On the day of my health check, which was a Friday, I had done two aerobic sessions in the previous four days, running on a treadmill for 36 minutes at a pace of nearly 7 km/h, with increased intensity and speed compared to before, along with two strength training sessions at the same intensity as usual.
I would like to know if my elevated ALT can be attributed to the increased exercise intensity as mentioned online, and whether I should be concerned about liver issues.
Additionally, do you think I need to adjust my exercise routine due to potential overtraining?
4.
This health check also indicated that my total cholesterol is high, while my triglycerides and high-density lipoprotein (HDL) levels are normal.
I have previously been diagnosed with high total cholesterol, which prompted me to start exercising, adjust my diet, and lose weight—overall, I have lost 12 kg.
However, I am unsure why my cholesterol levels have not significantly decreased.
Regarding my dietary adjustments, I currently have oatmeal with hot water for breakfast from Monday to Friday, often accompanied by coffee, fresh milk, or soy milk, and sometimes tea or other beverages.
I manage my sugar intake to be mostly low or sugar-free and monitor my total caloric intake throughout the day.
Do you think the beverages could be contributing to my elevated cholesterol levels, or could it be due to the oily and fried foods from my recent military service? Alternatively, is it possible that there is an underlying genetic issue? I would appreciate your insights.
Thank you.

Aa, 20~29 year old female. Ask Date: 2022/10/23

Dr. Lin Zhebin reply Family Medicine

Hello:
1.
A fasting blood glucose level of 101 is not something to be overly concerned about.
The normal reference range is based on the majority of the population, and a single fasting blood glucose measurement can be influenced by the duration of fasting and the food consumed in the previous meal.
The primary purpose of checking fasting blood glucose is to screen for diabetes, while a more accurate assessment would be the glycated hemoglobin (HbA1c), which reflects your average blood glucose levels over the past three months.
2.
Generally, blood glucose levels should not be significantly affected by stress or anxiety.
3.
The common causes of elevated liver enzymes (GPT/GOT) include hepatitis B, hepatitis C, alcohol consumption, fatty liver, and medications, among others.
It is also possible for elevated levels to result from excessive physical activity leading to a condition similar to rhabdomyolysis, although this typically results in a more pronounced increase in GOT.
The intensity of exercise is subjective; if you do not experience excessive soreness or fatigue after exercising, there may not be a need for adjustment.
4.
If total cholesterol levels are elevated, providing specific values would be more objective.
However, it is mostly related to lifestyle and diet.
Since you are already exercising, you may want to consider dietary adjustments.
Additionally, in cases of elevated total cholesterol, further testing for low-density lipoprotein cholesterol (LDL-C), which is considered "bad" cholesterol and is associated with cardiovascular disease, may be warranted.
5.
In summary, I would recommend that you first consult with a family medicine physician or a gastroenterologist to evaluate and monitor the elevated liver enzyme levels.
Furthermore, regarding blood glucose and total cholesterol, I suggest making dietary adjustments and then following up with a family medicine physician or an endocrinologist for further evaluation or testing in three months.

Reply Date: 2022/10/23

More Info

Understanding your health check report can be a daunting task, especially when you encounter abnormal results. Based on your report, there are several key areas to address: elevated fasting blood glucose, increased ALT levels, and high total cholesterol. Let's break these down and provide insights into what they might mean for your health.

1. Elevated Fasting Blood Glucose: Your fasting blood glucose level of 101 mg/dL is slightly above the normal range (60-100 mg/dL). While you mentioned that you have no prior blood sugar issues, it's important to consider that prolonged fasting can indeed affect blood glucose levels. When fasting for an extended period, your body may release glucose into the bloodstream due to hormonal responses, particularly from glucagon and cortisol. This can lead to a temporary spike in blood sugar levels. Additionally, dehydration can concentrate your blood, potentially leading to higher readings. It’s advisable to monitor your blood sugar regularly and consult with a healthcare provider to determine if further testing is necessary, such as an HbA1c test, which provides a better picture of your average blood glucose levels over the past three months.

2. Impact of Stress on Blood Pressure and Blood Sugar: You noted that you tend to get anxious during health check-ups, which can indeed elevate your heart rate and blood pressure due to the release of adrenaline. This stress response can also influence blood sugar levels. Stress hormones can increase glucose production in the liver, leading to higher blood sugar readings. It’s important to manage stress through relaxation techniques, regular exercise, and possibly mindfulness practices to help mitigate these effects during health assessments.

3. Increased ALT Levels: Your ALT level of 50 U/L is above the normal range (0-40 U/L). Elevated ALT can indicate liver stress or damage, but as you mentioned, intense physical activity can also lead to temporary increases in liver enzymes due to muscle breakdown. If you have recently engaged in more vigorous workouts, this could explain the elevation. However, it’s essential to monitor this over time. If ALT levels remain elevated despite reducing exercise intensity, further evaluation may be warranted to rule out liver conditions such as fatty liver disease or hepatitis.

4. High Total Cholesterol: Your total cholesterol level is elevated at 255 mg/dL, while your triglycerides and HDL (good cholesterol) are within normal ranges. It’s commendable that you have made lifestyle changes, including exercise and dietary adjustments, to manage your cholesterol levels. However, dietary factors can still play a significant role. While oatmeal is a great choice for breakfast, consider evaluating other aspects of your diet, such as the types of fats you consume. Foods high in saturated fats (found in fatty meats, full-fat dairy products, and certain oils) can contribute to higher cholesterol levels. Additionally, beverages like sweetened coffee or tea can add unnecessary sugars and calories, potentially impacting your overall lipid profile. It may be beneficial to consult with a nutritionist to refine your diet further.

In summary, while some of your results are concerning, they may not necessarily indicate severe health issues, especially considering your active lifestyle and dietary awareness. Regular monitoring and follow-up tests are essential to track these values over time. It’s also crucial to maintain open communication with your healthcare provider, who can offer personalized advice based on your overall health and lifestyle. Regular check-ups, ideally every six months to a year, can help catch any potential issues early and allow for timely interventions.

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