CHAPTER 17: YOU CANNOT CHANGE WHAT YOU DO NOT MEASURE: PREVENTION STARTS BY KNOWING YOUR IMPORTANT HEALTH NUMBERS
If you can’t measure it, you can’t improve it.
PETER DRUCKER
To end mental illness, it is essential to know if your brain and body are working right and to optimize them if they are not. I have written about this in several of my books because it is critical to know your important health numbers. Check these numbers annually and whenever you feel out of sorts. The important numbers you need to know are organized below according to the BRIGHT MINDS risk factors.
BLOOD FLOW AND VASCULAR FACTORS (CHAPTER 5)
Days a week you exercise: Aim for 5 days a week for 30 minutes or more.
Blood pressure:[750] Good blood pressure is critical for brain health. High blood pressure is associated with lower overall brain function, which means bad decision-making. Recently, the American Heart Association and the American College of Cardiology announced revised guidelines that now mean anyone with blood pressure of 130/80 milligrams of mercury will be diagnosed with Stage 1 hypertension. Previously, a blood pressure of 140/90 was considered hypertension. (The category of “prehypertension” no longer exists.) That means more Americans than ever —half of all men and 38 percent of women, or 103 million people versus 72 million before this change —are now considered to have hypertension.[751] Here are the blood pressure numbers you should know:
- Optimal
- Systolic 90–120
- Diastolic 60–80
- Stage 1 Hypertension
- Systolic 130–139
- Diastolic 80–89
- Stage 2 Hypertension
- Systolic >/= 140
- Diastolic >/= 90
- Hypotension —too low can also be a problem
- Systolic < 90
- Diastolic < 60
Blood lipid panel: Cholesterol and triglycerides (fats) can impact blood delivery to the brain. Cholesterol that is either too high or too low is bad for the brain. Surprisingly, higher cholesterol later in life has been associated with better cognitive performance[752] and a decreased risk of dementia.[753] Normal levels are:
- Total cholesterol (135–200 mg/dL; below 160 has been associated with depression, suicide, homicide, and death from all causes, so 160–200 mg/dL is optimal)
- HDL (>/= 60 mg/dL)
- LDL (<100 mg/dL)
- Triglycerides (<150 mg/dL)
Ask your health-care professional to also test the particle size of your LDL cholesterol because larger particles are less toxic than smaller ones. If you want to find out more about cholesterol, read The Great Cholesterol Myth by Stephen Sinatra and Jonny Bowden.
Complete blood count (CBC): This blood test measures your red and white blood cells. People with a low red blood cell count can feel anxious and tired and have trouble with memory. Enlarged red blood cells can indicate too much alcohol consumption. Too many white blood cells can reveal an infection.
Homocysteine (blood test): High homocysteine levels (>10 micromoles/liter) is linked with atherosclerosis (hardening and narrowing of the arteries) and an increased risk of heart attack, stroke, blood clot formation, and possibly Alzheimer’s disease. Homocysteine levels also reveal whether you are deficient in folate (see page 310).
RETIREMENT AND AGING (CHAPTER 6)
General metabolic panel (blood test): This reveals the health of your liver, kidneys, sodium levels, and more.
Ferritin (blood test): This is a measure of your iron stores. High levels are associated with inflammation (chapter 7) and insulin resistance (chapter 14). Low levels are associated with anemia, restless leg syndrome, ADD/ADHD, and low motivation and energy. A level of 50–100 nanograms/mL is ideal. Women often have lower iron stores than men because of menstruation. Some theorize that this is one of the reasons that women tend to live longer than men. If your level is low, consider taking iron. If it is high, donating blood may help.
![Dr. Amen sitting in a hospital chair, smiling and pointing at the IV in his arm.](images/Illustration-18.1.jpg)
This is me donating blood.
INFLAMMATION AND GUT HEALTH (CHAPTER 7)
C-reactive protein (CRP; blood test): This measures the inflammation level in your body. Inflammation is associated with chronic illnesses such as depression, dementia, and pain syndromes. A healthy CRP range is 0.0–1.0 mg/L.
Omega-3 Index (a drop of blood):[754] This measures the total amount of omega-3 fatty acids EPA and DHA in red blood cells and directly reflects their levels in the brain. The test is a clinically validated biomarker of the health of your brain. Your risk of cognitive decline rises by as much as 77 percent when your Omega-3 Index is low. Aim for a level above 8 percent.
Vitamin B12 (blood test): This is critically important for healthy brain function. A vitamin B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. Symptoms such as fatigue, depression, and poor memory can occur at levels only slightly lower than normal. Vitamin B12 also can be depleted by medications, particularly those that impair stomach and intestinal function, such as proton pump inhibitors for acid reflux. Its deficiency can cause symptoms of mania and psychosis and even masquerade as dementia. A normal range is 211 to 946 picograms per milliliter; optimal is greater than 600.
GENETICS (CHAPTER 8)
Know your genetic risks: Diagram your family tree and take notice of any genetic issues that run in your family.
Consider genetic testing: Genomind (www.genomind.com) and GeneSight (www.genesight.com) are two companies our clinicians use at Amen Clinics.
Folate (blood test): This aids in the production of DNA and other genetic material. It is required for the healthy regulation of genes and is especially important when cells and tissues are growing rapidly, such as in infancy, adolescence, and pregnancy. Folate works together with vitamins B6 and B12 and other nutrients to control blood levels of homocysteine. It is common to have low levels of folate as a result of alcoholism, inflammatory bowel disease (IBD), celiac disease, and certain medications. A normal level is 2 to 20 ng/mL; optimal is thought to be greater than 3 nanograms per milliliter.
HEAD TRAUMA (CHAPTER 9)
Number of past concussions with or without loss of consciousness.
TOXINS (CHAPTER 10)
How many alcoholic beverages you consume each day/week, how many cigarettes you smoke, how often you vape, and how often you use drugs (including marijuana).
There are tests for heavy metals and mold, but you do not need to do them routinely unless you are experiencing symptoms or you know you’ve been exposed to high levels.
MIND STORMS (CHAPTER 11)
QEEG/SPECT tests: There aren’t specific numbers associated with mindstorms, but these tests can be extremely helpful if you suspect a problem.
IMMUNITY/INFECTIONS (CHAPTER 12)
CBC to look at your white blood cell count.
Erythrocyte sedimentation rate (ESR) measures inflammation, which is high in autoimmune disorders.
Antinuclear antibodies (ANA) —antibodies fight infection, but ANAs often attack your body’s tissues. ANAs are often high in autoimmune disorders.
Vitamin D (blood test):[755] Low levels of vitamin D have been associated with obesity, depression, cognitive impairment, heart disease, reduced immunity, cancer, and all causes of mortality. The blood test to get is 25-hydroxyvitamin D level. A normal vitamin D level is 30–100 ng/mL, with the most optimal range being 50 to 100 ng/mL.
NEUROHORMONES (CHAPTER 13)
Thyroid panel (blood test): If your thyroid hormone levels are abnormal, it could explain the cause of anxiety, depression, forgetfulness, weight problems, and lethargy. Hypothyroidism (low) decreases overall brain activity, which can impair your thinking, judgment, and self-control, and it can make it nearly impossible to manage weight effectively. Hyperthyroidism (high) is associated with anxiety, insomnia, and feeling agitated. If you have symptoms, don’t settle for just a TSH test, which measures your thyroid stimulating hormone. TSH levels can be normal even when you have an undiagnosed thyroid problem. Instead, insist that your doctor order all of the following:
- TSH —according to the American Association of Clinical Endocrinologists, anything over 3.0 is abnormal and needs further investigation.
- Free T3 —active thyroid; see the normal ranges for the individual laboratory you use.
- Free T4 —inactive thyroid; see the normal ranges for the individual laboratory you use.
- Thyroid antibodies
- Thyroid peroxidase antibodies (TPO)
- Thyroglobulin antibodies (TG); see the normal ranges for the individual laboratory you use.
- Liver function tests —95 percent of T4 is “activated” in the liver, so having a healthy liver is essential.
- Ferritin level —Ferritin is like the bus that drives active T3 into the cells; ferritin needs to be above 50 for this to occur.
An important note: While thyroid tests can be helpful, your doctor should treat you, not the blood test. I’ve seen too many hypothyroid patients who haven’t been treated because their thyroid numbers were low but “within normal limits.” That’s a little like saying a vitamin D level of 31 is normal (the normal range is 30 to 100). I have never wanted to be at the bottom of any class I was in. How a patient feels and functions (e.g., low energy, constipation, dry hair, dry skin, poor cognition, low body temperature) is more important in assessing thyroid function than using arbitrary normal ranges on blood tests. All of the above tests could be “normal,” and someone could still have a problem.
Cortisol (saliva): This is best done at four intervals throughout the day (to understand your daily cycle): when you first wake up, around lunch time, around dinner time, and just before you go to sleep. Ideally, your cortisol levels are high in the morning (to wake you up) and taper off slowly during the day and evening, allowing you to fall into a restful sleep at night. When cortisol levels are too high, you feel wired. When they are too low, you feel exhausted, spacey, or sluggish.
DHEA-S (blood test): Normal blood levels of DHEA-sulfate can differ by sex and age.
Typical ranges for females:
- Ages 18–19: 145–395 mcg/dL (micrograms per deciliter)
- Ages 20–29: 65–380 mcg/dL
- Ages 30–39: 45–270 mcg/dL
- Ages 40–49: 32–240 mcg/dL
- Ages 50–59: 26–200 mcg/dL
- Ages 60–69: 13–130 mcg/dL
- Ages 70 and older: 17–90 mcg/dL
Typical ranges for males:
- Ages 18–19: 108–441 mcg/dL
- Ages 20–29: 280–640 mcg/dL
- Ages 30–39: 120–520 mcg/dL
- Ages 40–49: 95–530 mcg/dL
- Ages 50–59: 70–310 mcg/dL
- Ages 60–69: 42–290 mcg/dL
- Ages 70 and older: 28–175 mcg/dL
Free and total serum testosterone (blood test): Having an optimal level of testosterone is important for your health and well-being. Too much can cause behavioral problems, such as aggression, but too little is associated with depression, poor memory, and low libido.
Normal levels for adult males:
- Total testosterone: 280–800 nanograms ng/dL —optimal is 500–800 ng/dL
- Free testosterone: 7.2–24 picograms pg/mL —optimal is 12–24 pg/mL
Normal levels for adult females:
- Total testosterone: 6–82 ng/dL —optimal is 40–82 ng/dL
- Free testosterone: 0.0–2.2 pg/mL —optimal is 1.0–2.2 pg/mL
Estrogen and progesterone for women:[756] Depending on the circumstances, these are measured in blood or saliva. Menstruating women are usually tested on day 21 of their cycle, while postmenopausal women can be measured any time. Estrogen is responsible for vaginal lubrication, helps with libido and memory —and so much more. Progesterone calms emotions, contributes to a restful sleep, and acts as a diuretic. See the normal ranges for the individual laboratory you use.
DIABESITY (CHAPTER 14)
Body mass index (BMI):[757] This measurement is the result of comparing weight to height. An optimal BMI is between 18.5 and 25; the overweight range falls between 25 and 30; over 30 indicates obesity, and over 40 indicates morbid obesity. Just Google “BMI Calculator” and fill in your height and weight to determine your BMI. Take this number seriously, because being overweight or obese is associated with having a smaller brain, and when it comes to your brain, size matters! Plus, obesity increases the risk for depression and Alzheimer’s disease. In a new study, 40 percent of all cancers have been linked to excess weight.[758]
Waist-to-Height Ratio (WHtR):[759] This is another way to measure the health of your weight. Some researchers believe this number is even more accurate than BMI because the most dangerous place to carry weight is in the abdomen. Abdominal fat, which is associated with a larger waist, is metabolically active and produces various hormones that can cause harmful health effects, such as elevated blood pressure, high cholesterol and triglyceride levels, and diabetes.
WHtR is calculated by dividing waist size by height. A woman with a 32-inch waist who is 5′10″ (70 inches) would divide 32 by 70 to get a WHtR of 45.7 percent. Generally speaking, it’s healthy to stay under 50 percent —in other words, your waist size in inches should be less than half your height. When measuring your waist size, use a tape measure! Don’t hazard a guess or rely on your pants’ size, which can vary among manufacturers. In my experience, 90 percent of people will underestimate their waist circumference.
Lab tests: Get blood tests for your fasting blood sugar, insulin, and hemoglobin A1c (HbA1c) every year. If they are abnormal, think of it as a health crisis to be taken very seriously.
- Fasting blood sugar
- Normal: 70–105 mg/dL
- Optimal: 70–89 mg/dL
- Prediabetes: 105–125 mg/dL
- Diabetes: 126 mg/dL or higher
- Hemoglobin A1c: This test helps diagnose diabetes and prediabetes by revealing average blood sugar levels over the past few months. Normal results for someone without diabetes are in the range of 4 to 5.6 percent; optimal is under 5.3 percent. Levels of 5.7 to 6.4 percent indicate prediabetes. Higher numbers usually indicate diabetes.
- Fasting insulin: High insulin levels, usually due to a diet high in simple carbs, are associated with many negative health consequences, including fatty liver, abdominal obesity, excessive cravings, elevated blood sugar, acne, polycystic ovarian syndrome (PCOS), hair loss in women in the male pattern (front and sides), increased risk of gout, high blood pressure, and swollen ankles. Normal is 2.6 to 25; optimal is less than 10. High levels are an early marker for diabetes.
SLEEP (CHAPTER 15)
Number of hours you sleep each night.
Number of sleep disruptions: If you suspect you might have sleep apnea, get a sleep test. Symptoms include daytime fatigue, morning headaches, and irritability; untreated sleep apnea triples your risk of depression and dementia.
KNOW YOUR NUMBERS . . . THEN WHAT?
Knowing your important health numbers is the first step. Optimizing them is critical to helping your brain, emotions, and moods work right. If any of them are abnormal, the function of your brain and mental health can be troubled too. Work with your healthcare provider to help get these numbers into the most optimal range possible.
![BRIGHT MINDS Tip icon](images/img_001-BRIGHT-MINDS-tip-icon_SIZED.jpg)
Get in the habit of testing your brain and checking out your important health numbers on an annual basis.