A while back I had a patient yell at my staff for telling her she should fast for six hours before her physical.
“If she is like that when she isn’t starving, I certainly don’t want her here when she is!”
Seriously, though, let’s look at this fasting thing more closely…
I hate fasting, personally. Not so much because I am hungry but rather because it forces me to deviate substantially from my routine. I like my routines. And my coffee. Ever smell coffee but know you can’t have it? Makes me turn into a raving lunatic, so I understand where patients are coming from.
So, the questions is, do you HAVE to be fasting for your physical?
You sure don’t.
Gasp! I know right? All this time and NOW we say you don’t have to fast?
Here is the thing. We used to diagnose diabetes based on two fasting blood sugars over 120. The problem was there were actually a number of people who technically probably had diabetes who did not meet that criteria. Now, we can use a thing called the Hemoglobin A1C to diagnose it. This test is a way of estimating your blood sugars over a three month period and it is independent of whether or not you are fasting for the test. If you are not fasting for your physical and your blood sugar is showing elevated? No problem. I slap on a HgA1C and find out the truth.
The other test in question is the cholesterol panel. The main part of that test, the one we are most concerned with, is the LDL (bad cholesterol) that increases your cardiovascular risk (likelihood of having a heart attack or stroke). My feeling was always that if you were fasting, you were sort of cheating anyway because really how much time do we spend fasting? Our bodies live in the non-fasting realm. The advice to fast was never based on actual scientific data. It was a bunch of doctors who sat around in a conference room somewhere and said, “Hell, it is my professional opinion that we should make everyone suffer!” (Cue curmudgeonly fist slam on the table.)
But research earlier this year shows that the predictive value of your LDL number is not affected by whether or not you were fasting for the test.
“Woohoo!” I hear you say?
I have now been pinning down patients for their physicals when they come for their first visit in two years when they have a head cold.
“Look, you and I both know you are not going to come back for your physical in a couple of weeks so let’s just do it now…”
The, “But I haven’t been fasting!” excuse no longer flies, people.
And BONUS, my staff no longer has to harass hangry patients into coughing up copays.
And YOU no longer have to starve!