[HN Gopher] Ticker: Don't die of heart disease
___________________________________________________________________
Ticker: Don't die of heart disease
Author : colelyman
Score : 313 points
Date : 2025-11-08 14:59 UTC (8 hours ago)
(HTM) web link (myticker.com)
(TXT) w3m dump (myticker.com)
| qgin wrote:
| I love this sort of documentation-style guide to medical issues.
| Reminds me of https://www.fourmilab.ch/hackdiet/e4/
| camel_gopher wrote:
| Tl;dr be affluent enough to be able to afford great medical care
| and have enough free time for preventative actions
| hshdhdhehd wrote:
| I think the point is it is cheap to prevent. The weird tip is
| doing a different test to the standard one, which costs little
| for typical HNers (but admit every $ counts for many people
| esp. with current inflation, poverty, bad governance) but
| sounds like on par with a dentist doing anything beyond a
| checkup.
| lisbbb wrote:
| A colleague of mine was a vegan, took care of himself, still
| died of pancreatic cancer. It is what it is.
| tonymet wrote:
| Walking and eating sensibly is free. Even a balance oatmeal,
| rice & beans with infrequent meat servings would defend against
| heart disease better than expensive medicine, at less than $1 /
| day.
| pstuart wrote:
| And not smoking or drinking saves you money!
| gdulli wrote:
| Yes, our system is most definitely stacked against the
| poor, but it's important to also remember that we all have
| free will and that some choices fully within our power are
| much better than others.
| tonymet wrote:
| nicotine is likely one of the best appetite-control ,
| cognative-enhancing and anti-anxiety medications ever known
| to man. A large driver of obesity , anxiety and
| psychotropic abuse was smoking cessation.
|
| Giving out nicotine gum , would decimate the drugs
| industry, but likely resolve a lot of our chronic health
| and depression issues.
| giardini wrote:
| tonymet says _> nicotine is likely one of the best
| appetite-control , cognative-enhancing and anti-anxiety
| medications ever known to man.<_
|
| Is this not under-reported? I have known several people
| for whom smoking appears to be truly necessary. One said
| he was prescribed smoking to control his "shakes".
| 64718283661 wrote:
| I've actually considered taking nicotine for these
| reasons. But I don't because it appears you build
| tolerance very quickly.
| tonymet wrote:
| i know a number of people with moderate ADHD who use it
| instead of Adderall.
| yinser wrote:
| Promoting good habits is good but this is health advice from
| an unlicensed commenter to say rice and beans is better than
| taking a statin. Consult your doctor if you're curious what
| to do.
| tonymet wrote:
| It's safer than taking unlicensed tech advice from an
| Internet forum
| lotsofpulp wrote:
| Lentils/legumes are cheap. There is probably no better bang
| for the buck. Yogurt is also cheap.
| tonymet wrote:
| Agree. All the best foods are cheap. It's a myth that
| healthy food is expensive. Most of the produce isle is
| decorative.
| giardini wrote:
| Funny you should use the word "bang". My last experiment
| with lentils years ago began one evening with 3 excellent
| bowls of very tasty lentil soup and ended slowly with 2
| days' worth of "bangs", quickly followed by ostracism by my
| house buddies. So bad!
| lotsofpulp wrote:
| lol, you probably just need time for your gut bacteria to
| adjust. My family makes lentils for at least one meal
| almost every day.
| adi4213 wrote:
| You should try www.betterbrain.com/insurance! It covers this
| set of bloodwork and 92% of covered patients pay $0
| evantbyrne wrote:
| 90 day supply of Atorvastatin costs $10. Running costs a pair
| of shoes.
| camel_gopher wrote:
| You have to be able to get the prescription. HMOs (Kaiser
| specifically) will generally not provide any sort of
| preventative care in this area unless your numbers are very
| high. You can't get access to a cardiologist unless you've
| already had an adverse event.
|
| If you can get time off work and have a PPO, you can get the
| preventative care.
| evantbyrne wrote:
| $10 is the cash price. Your doctor diagnoses, not
| insurance, and you don't need a specialist to get diagnosed
| regardless of what your insurer wants. Even a nurse
| practitioner can prescribe you a statin.
| hshdhdhehd wrote:
| It is a long read and I want to make time for it. Quick search
| check and calc (for calcify etc.) and diet appear alot in the
| article which is not surprising based on other things I have
| watched on the subject.
| lateforwork wrote:
| The title of the article says "don't die of heart disease", but
| given that we all have to die at some point, if you could choose
| what natural cause to die of, wouldn't you pick heart disease? It
| is the best way to die. The worst is stroke. So once you cross a
| certain age, say 60, don't worry about heart disease, worry
| instead about stroke.
| loloquwowndueo wrote:
| Why is heart disease a "good" cause of death?
| lateforwork wrote:
| Less suffering. Stroke on the other hand... you become
| partially disabled, which causes suffering not just for you,
| but also for your loved ones.
| poszlem wrote:
| I think you are confusing "getting a stroke" and "dying
| from stroke". If you get a heart attack and don't die from
| it you might become a burden on your family too.
| Avalaxy wrote:
| Funnily enough, the things you can do to prevent stroke line up
| entirely with the things you can do to avoid heart disease.
| lateforwork wrote:
| The article doesn't mention antioxidants at all, which help
| prevent atherosclerosis.
| masfuerte wrote:
| If you have a massive banger and die immediately that is a
| pretty good way to go.
|
| However, many people suffer from heart failure which, despite
| the name, means partial heart failure. The permanent
| breathlessness gives them a terrible quality of life. They can
| live with this for decades sometimes but it's not much fun.
| jpmattia wrote:
| > _worry instead about stroke._
|
| You say that as if stroke is orthogonal to heart disease. Much
| of what prevents one prevents the other.
| lateforwork wrote:
| Yes but there are habits that are especially important for
| preventing stroke, such as getting 7-9 hours of sleep,
| monitoring and controlling risk factors related to blood
| vessel health that affect the brain uniquely, such as
| preventing irregular heart rhythms (atrial fibrillation),
| anti-inflammatory diet choices focused on brain health, and
| so on.
| DharmaPolice wrote:
| Dementia seems a pretty awful outcome too. I hope my heart
| gives out before my brain.
| lateforwork wrote:
| Alzheimer's too.
| Spooky23 wrote:
| I agree, but both are heart disease and both can be prevented
| in similar ways. My dad and my father in law both died from
| heart disease. My fil was on the surface less healthy. He had
| an extreme high stress job with exposures to environmental
| factors that made it worse, was partially disabled with bad
| knees, etc. i believe he was on blood thinners for almost 20
| years.
|
| He got up to make a sandwich for my mother in law, who was very
| sick, and don't come back. Massive heart attack and aortic
| rupture - he was dead before he hit the ground.
|
| My dad had a lot of stress over his career and his share of
| health issues but found a happy medium and improved his health
| greatly stating about in his late 40s. He was basically
| walk/running 2-5 miles a day for several years after
| retirement. He had a major stroke, recovered somewhat, and then
| ended up almost dying from a kidney stone and resulting
| infection. (He could not communicate pain as part of his
| aphasia.) long story short, he suffered in a lot of ways (pain,
| disability, loss of dignity) for 4 years before finally
| succumbing.
|
| In online discussions, we tend to boil everything down to
| death. Reality is that longer you can put off complications,
| the better you will be when something more severe happens or
| you get sick. As you age, each time something happens, your
| recovery is a little less robust. Go to the doctor, take your
| statins and take care of yourself.
| derbOac wrote:
| Sometimes I think the way this type of thing is framed is
| misleading. There's a list of putative causes of death and
| there's an assumption that they're equally systemically
| impactful, and you can go down the list and just lower the
| probability of each and lower your overall likelihood of death.
|
| That's not totally off, but the thing about cardiovascular
| disease is it affects _everything_ because it 's how your body
| distributes oxygen. Stop distributing oxygen and you die.
|
| That's not to say other organs aren't important, it's just that
| if you replace "cardiovascular" with "oxygen distribution" it
| becomes apparent that almost by necessity it's going to include
| a lot of deaths.
| stavros wrote:
| You assume that you'll die at X years old, and get to pick the
| disease. In reality, you might die of heart disease at 60, or
| cancer at 70, or alzheimer's at 80. Which one do you pick?
| bluGill wrote:
| What I want is a long life of doing what I want. when I must
| die how doesn't matter, but if I can extend my lifespan (well
| span) by not getting a heart attack that is good: more years to
| enjoy life. If I can also extend my life by not getting cancer
| even better. Even if I must die if I can delay that with a good
| life that is what I want.
|
| note that I said good life. There are lots of bedridden people,
| I don't want to be like that. I want to be like the old person
| still doing things in old age.
| rufus_foreman wrote:
| >> given that we all have to die at some point, if you could
| choose what natural cause to die of, wouldn't you pick heart
| disease?
|
| Monty Python, "The Meaning of Life", Part VII.
| tonymet wrote:
| Fabulous information, but lacking information isn't the issue.
| The behavioral changes are obvious and well evangelized : lose
| weight, regular activity (walking), and if necessary, take meds.
| (Yes I know your marathon runner cousin who died suddenly of a
| heart attack, but these are still your best odds)
|
| Telling people what to do rarely fixes anything. People need
| dozens of impressions for those changes to sink in. Friends,
| family, social outings, commercials, movies, songs all promoting
| overindulgence won't be overcome with a helpful pamphlet or
| nagging.
| jasonjmcghee wrote:
| Managing stress shouldn't be overlooked
| tonymet wrote:
| "Stress" is so abused and nebulous that it's impossible to
| define. Nearly every condition is worsened by "stress" but
| there's no way to measure it. And there's no conclusive way
| to manage stress either. Medication, psychotropics, self
| medication, meditation. Nearly all of those are more broadly
| abused and yet stress "worsens".
|
| One person may run an intense soup kitchen 15 hours a day and
| feel little stress, and another can sit at a computer for 9
| hours sending pointless emails and feel tremendous stress.
| Jimmc414 wrote:
| Managing cortisol shouldn't be overlooked
| tonymet wrote:
| "Sleep better, eat better, get less stress, get more
| activity" is about as helpful as saying "don't die".
| tananan wrote:
| Fortunately, as you mention in your last sentence, stress
| is introspectable.
|
| How exactly stress corresponds to biomarkers doesn't matter
| if your desire is to lower it.
|
| The issue is that many of us don't pay attention to how we
| keep our body & mind throughout the day, or do so on a very
| superficial level. So strain on the body can accumulate for
| a long time.
|
| "Stress management" is a lifetime skill. It doesn't come in
| bulletpoints, it's as broad as "living happily".
|
| Edit: That said, this can make the advice "be less
| stressed" a bit vacuous.
|
| But people do get scared when random health issues flare up
| and become more conscious of how they deal with stress in
| life.
|
| So it's not bad to keep reminding people either :)
| tonymet wrote:
| it's bad in the way of "don't think about elephants"
| makes you think about elephants.
|
| "Try not to stress" or "reduce stress" - but how to do
| that? Stress itself is nebulous, and the countermeasures
| are inconclusive.
|
| Think of the last time you were angry or frustrated. Did
| your spouse telling you to "calm down" fix the problem?
| lotsofpulp wrote:
| > The behavioral changes are obvious and well evangelized :
| lose weight, regular activity (walking), and if necessary, take
| meds.
|
| More specifically, it's "change your diet and eat/drink less",
| which is the hardest part. Diet's impact eclipses regular
| activity, and it's consequences build up and compound over
| decades.
| tonymet wrote:
| i agree. Under-eating with baseline activity is better than
| overeating with excessive activity, excluding the extremes.
| Zak wrote:
| This site isn't necessarily meant to have a big sociological
| impact; it provides enough information that someone with
| sufficient motivation, but a lack of resources and expertise
| can take concrete steps to reduce their risk. That seems useful
| to me.
| tonymet wrote:
| in this case "useful" means applying the facts and making
| changes. A detailed map that goes unused is useless. A hand
| drawn map that gets you home is priceless.
|
| People don't need more facts and information - those are in
| surplus. In fact, for most people when they receive too many
| facts, they just glaze over.
|
| The changes needed are trivial
| cogman10 wrote:
| I might just be tired, but this seems highly repetitive. The
| author mentions friends in the field and concierge doctors
| multiple times in as much as I read.
|
| Feels like the whole thing could be shortened to just say "here's
| the tests you run, the drugs you might take, the lifestyle
| changes you should consider".
| naIak wrote:
| Right? It started okay even if a bit too verbose, then there
| was a second introduction. There I lost interest.
| Scubabear68 wrote:
| Somewhat related, one of my thoughts was "what if these
| concierge doctors just keep running tests until they find
| something, anything, to justify their fees"?
| rustman123 wrote:
| It's also demonizing doctors and the healthcare system a bit
| too much for my liking.
|
| I'm located in Europe, so I may have a slightly different view,
| but my doctors clearly care and discuss with me about
| prevention, risks, tradeoffs, ...
|
| They praise the methods of the ,,good" doctors and stamps the
| others as driven by financial gain. Who says the expensive ones
| are any better in this regard? Who says they are more or less
| exaggerating the importance of test results to make you come
| back?
| lotyrin wrote:
| In the US my best doctors produce out of date advice about
| obvious things, have a very distinct gap between "everyday"
| (stuff they actually see) and "incredibly rare" (stuff unique
| enough to be a case study they heard about) in their
| knowledge/understanding and rarely advise things that require
| me to be a proactive and rational person (because they don't
| serve these often), so they'll spend two seconds being like
| "diet and exercise" without a discussion on how that'd work
| or what adjustments I'd actually make (leaving me to do this
| research myself) and then suggest a prescription (because
| even their least proactive patient will probably take a
| pill). They'll wait until things become a disorder before
| addressing them (or discussing with me how to address them).
|
| The worst will basically laugh me out of their office for
| daring to belong to a marginalized identity or failing to
| already have the health knowledge I'm there trying to gain
| from them.
|
| Maybe I have awful luck... but I have very little faith at
| this point. The most effective relationship I had was with a
| hack who was willing to just prescribe whatever I asked him
| for and order whatever tests I asked him for (I think most of
| his patient base were college students seeking amphetamine
| salts).
| bluGill wrote:
| I'm in the us and my doctors have all done the same. Though
| it is obvious most people are not listening to them.
| hackama wrote:
| Very interesting, but do the numerous mentions of taking action
| in your 20s, 30s and 40s mean it's too late for someone in their
| 50s?
|
| Nitpick: he mentions LDL-C but the test results don't mention
| that at all. Only later do I see that is "LDL Cholesterol".
| daveguy wrote:
| No, it is never too late to take action. Even taking action
| after a stent procedure reduces further risk:
|
| https://www.nhs.uk/conditions/coronary-heart-disease/treatme...
| johnrob wrote:
| If you start exercising in your 20s, and never stop, it will be
| so much easier to maintain fitness in 40s 50s etc. The
| challenge is that the benefits are not yet visible in your 20s
| (when you'll probably be healthy and at a proper weight
| regardless). Gotta lay that foundation for older age though!
|
| EDIT - I misread the comment. It's never too late to start,
| just be careful for injuries as that will block your ability to
| exercise.
| HPsquared wrote:
| It's a bit like saving money.
| arjie wrote:
| In general, when science is done, recruitment requirements
| force the experimenters to bucket the participants. One thing
| that often happens is an open bucket, say 35+.
|
| The resulting science is then reported as "When you cross 35,
| your chances of being pregnant immediately drop" or "The brain
| stops developing at 18" and so on.
|
| Almost nothing in the body is really like this, though. You can
| quit smoking later in life and it will help. You can eat better
| later and it will help. You can exercise and it will help. Very
| few things are "the damage is done".
|
| The only constraints are that the later you start the more
| risks you face. E.g. if you first deadlift in your 50s and you
| decide to follow Starting Strength you're going to have
| trouble.
| k__ wrote:
| There doesn't seem to be any mention of hypertension on that
| page.
| Zak wrote:
| If you're going to press ctrl+f and post a critique, I
| recommend including a synonym or two in your search terms.
| jeffbee wrote:
| As much as the HN trend is against AI features in client
| software, this is an excellent use of Gemini-in-Chrome.
| Instead of wracking your brain for English synonyms, you can
| just ask it if the page discusses hypertension, a kind of
| weapons-grade ctrl+f. Mine said
|
| "Yes, the article discusses hypertension, referring to it as
| "high blood pressure.""
| fullStackOasis wrote:
| Actually, there is. You have to search for "pressure". For
| example, "Other Tests: There are some other things that are
| important to know as well. You must know your blood pressure".
| k__ wrote:
| Good point.
|
| I've forgotten that blood pressure is another word for it, as
| all medical papers use hypertension.
|
| Thanks!
| pstuart wrote:
| A key takeaway is: don't be afraid of taking statins if you need
| them. I fell for the "statins are bad" BS for years and have paid
| the price.
| Buttons840 wrote:
| What price have you paid?
| pstuart wrote:
| I now have a cardiologist and just had an MRI to check on the
| state of my aorta, as a recent calcium scan brought up
| concerns.
|
| I've now been on rosuvastatin and ezetimibe for several years
| with zero noticeable negative effects. I'm hoping that this
| with other behavior modification can help stave off further
| damage for a while.
| lisbbb wrote:
| My dad would disagree--he's 84, was on statins for years and
| they did terrible things to his body. I'm sure the drugs kept
| him alive, but the side effects, as he describes them,
| particularly to his legs and kidneys, were pretty severe. He
| only got better when he stopped taking them.
| Buttons840 wrote:
| I believe statins reduce risk by about 30%, so there's a
| roughly 30% chance the statins have done good things for your
| dad.
|
| (I think that's what the stats mean, right? I'm open to
| correction on this. I do believe the statin studies, I'm not
| a science denier. I think what I've said matches the science,
| as far as I understand.)
| pstuart wrote:
| Obviously we all differ in how we respond to medications --
| apparently it's 10% - 15% that have issues with statins.
|
| I think a pragmatic approach would be to try them if
| warranted by testing and be prepared to stop or change them
| if it has issues.
|
| We're learning more and more about the mechanisms of
| cholesterol and there's a variety of medications out there:
| https://www.heart.org/en/health-
| topics/cholesterol/preventio...
|
| And that doesn't address the role that fiber plays in
| managing it (and the virtues of fiber for health in general
| that are coming to light at a rapid clip)
| dawnerd wrote:
| Was this written via LLM? There's a link early on to some ai
| search tool which kinda made me question the validity of
| everything mentioned.
| esseph wrote:
| You should always have questioned the validity, but now you
| feel the need because of LLMs.
| OutOfHere wrote:
| Please strictly cease and desist from accusing material of
| being written by an LLM, whether on this site or on any other
| site. If you want to criticize the material, do so under the
| good faith assumption that it is written by a human.
| dawnerd wrote:
| I think it's absolutely fair to criticize something for
| potentially being generated via an llm or heavily utilized by
| such especially when it comes to medial claims.
|
| Reading it I couldn't help but feel the author relied on ai
| research tools and is now passing that along to everyone
| reading as if it's proven fact. When they link out to an ai
| search engine that's not helpful when trying to cite sources.
| stavros wrote:
| We don't really know the author. For all I know, the LLM is
| more accurate than the specific human, in which case I'd
| _want_ the article to be written by an LLM.
|
| Saying "LLM bad, human good" is both false and
| uninteresting.
| OutOfHere wrote:
| No. It is false criticism. It is like calling one a witch
| in historical times. Anyone gets accused of it without hard
| evidence. For all I know, your comment was AI generated.
| You relied on AI and are now passing that along. It's not
| helpful.
| jeffbee wrote:
| It has many markers of that, including being about ten times
| longer than it needed to have been.
| AaronAPU wrote:
| I was planning to start getting scans ordered for specific risks
| like aneurysm or heart attack but what holds me back is the idea
| the scans will harm me worse than those things.
|
| It is very difficult to have any level of confidence with the
| medical industry so my current approach has been to eat as
| healthy as possible while staying as fit as I can without undue
| extreme stress.
| rogerrogerr wrote:
| As someone who would like to do this but has generally been
| choosing the easy paths - curious what your diet and exercise
| regime looks like.
| AaronAPU wrote:
| Well "fortunately" I'm forced to have a strict diet due to
| some sort of IBS issues. For that, I use the MacroFactor app
| and talk through my daily recipes with ChatGPT, making sure
| to hit the macros and calories targets while also optimizing
| for heart health and IBS. Fat, protein, carbs, fiber. Taking
| AG1 to fill gaps.
|
| For fitness I'm obsessed with biking so I do like 90 minutes
| of endurance/tempo pace 5 days a week and usually a race once
| a week. Zwift is great with a Tacx when weather is bad
| (often).
|
| That isn't a time option for everyone but it is also likely
| well beyond what is necessary for most people.
|
| I also don't drink or smoke or vape which I think is
| important.
|
| Not going to say I'm an expert or an exemplar of health but I
| am really trying everything I know to do at this stage.
| captainkrtek wrote:
| A relevant anecdote. I'm very athletic and skinny, eat well,
| have a resting heart rate in the 40s, but was recently
| prescribed a statin at 30, due to my very high LDL cholesterol
| and lipoprotein A.
|
| My family has a history of cardiovascular disease despite us
| doing what we can w.r.t eating and exercise. I'd encourage you
| to get some tests at least.
|
| My mother similarly was put on statins and is getting a
| cardiovascular work up (calcium scan) because she now has early
| atherosclerosis. She eats super healthy and is a former olympic
| sprinter..
|
| Bonus anecdote: In my free time I do shifts as an EMT with my
| fire dept (911), that is a big wake up call to wanting to be as
| healthy as can be. The number of patients I see who are 50+,
| nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At
| that age I see type 2 diabetes, hypertension, high cholesterol,
| and more.
| AaronAPU wrote:
| They have me on blood pressure meds and do the usual blood
| tests, the tests I considered have been elective and I
| requested them explicitly. Just haven't followed through due
| to aforementioned hesitations. I'm very much aware heart
| issues run in the family and that I have symptoms.
|
| But I would be very happy to do any elective non invasive
| tests. On the fence about going beyond that until/unless the
| Dr. flags it as needed.
| captainkrtek wrote:
| That makes sense! Its easy I think to also go overboard and
| analyze too much, causing stress as you suggest.
| guerby wrote:
| You're probably a "lean mass hyper-responders", a phenotype
| which is actively investigated, initial paper:
|
| Elevated LDL-cholesterol levels among lean mass hyper-
| responders on low-carbohydrate ketogenic diets deserve urgent
| clinical attention and further research
|
| https://pubmed.ncbi.nlm.nih.gov/36351849/
|
| A few other more recent papers:
|
| https://pubmed.ncbi.nlm.nih.gov/35498420/
|
| https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109
|
| Note: I'm not a doctor.
| captainkrtek wrote:
| Interesting, thanks for sharing!
| JoshTriplett wrote:
| > scans will harm me worse than those things
|
| There are two known harms from scans:
|
| - Radiation. This is why people shouldn't get these scans
| several times a year, but 1-2 are very unlikely to move the
| needle. The average radiation from a full chest CT is just
| under the average dose for ~2 years of normal background
| radiation. (I don't know if a CTA uses less than average.)
|
| - Acting on something you would otherwise have ignored, where
| ignoring it might have been the right answer. The main problem
| here is that it's hard to get a medical opinion saying "you
| should ignore this" because of perverse incentives: there's an
| aversion to recommending doing nothing because that could lead
| to a lawsuit, whereas "overtreatment" will not get a doctor
| sued. However, you _can_ make a deliberate decision to do this
| anyway even after getting the scan; seek second and third
| opinions, consider alternatives, weigh risk versus reward, make
| a considered decision.
| lbrito wrote:
| I don't like this kind of content. The author might have a
| personal motivation for it, but for the general public, it's just
| more mental load.
|
| We are all going to die one day.
|
| When I was younger, I would fret over this kind of article.
| Great, one more thing I have to worry about. Now I just mostly
| ignore it. It's impossible otherwise. If I dedicate hours and
| days and months to all the heart best practices, what about when
| the liver, esophagus, kidney, bladder, brain articles come out?
|
| We all know the good practices. Don't be a dumbass. Don't drink
| too much, exercise and so on. Besides that, I'm very much going
| to be reactive, as the article cautions against. I just don't
| have time or mental energy to do otherwise.
| bbor wrote:
| I share your general emotional reaction, but to be fair, heart
| disease is far and away more important than other type of
| disease. More people die of it in the US than die of _all
| cancers combined_ : https://www.cdc.gov/nchs/fastats/leading-
| causes-of-death.htm
| bwfan123 wrote:
| > We all know the good practices. Don't be a dumbass
|
| In theory yes, but in practice we are all dumbasses to some
| extent.
|
| I used to have your attitude until I saw a friend die of a
| heart attack at an early age - and it appeared to me that he
| would have survived if he had an indication. So, now I have
| changed my attitude to one of more data does not hurt.
| FlamingMoe wrote:
| I recently did a comprehensive panel of my own volition with
| Quest Labs and was pleasantly surprised by the entire process. It
| was super easy to schedule, affordable, and their online platform
| is surprisingly sleek.
| potato-peeler wrote:
| The value of the biomarkers are they applicable for all age
| range? What if someone already had a heart attack, then what
| should be the normal values post incident?
| lisbbb wrote:
| Love the chart at the bottom--it really puts on display media
| bias and lack of integrity and using fear to push idiotic
| policies which area really just a way to put everyone in the
| pocket of government and keep them there permanently with zero
| real improvement to public health. Fear get eyeballs. the Covid
| mass hysteria proves that, too.
|
| As far as heart disease goes, yes, it's the big killer and it's
| time people started waking up from the media haze, but to do
| that, you have to admit you were wrong, and for many, that is far
| too tall a hill to climb.
| zamiang_brennan wrote:
| Great post but quite surprised there is no mention of cutting red
| meat. There is a lot of evidence that especially the American
| diet is dangerously high in red meat to the point of elevating
| Heart Disease risk.
| mac-mc wrote:
| IMO, I think that is more of a saturated fat issue, and only a
| subset of the population is like that. Others solve their
| health issues through eating a lot of red meat.
| zoeysmithe wrote:
| Also processed red meats or processed meats in general.
| Processed meats are the ones strongly linked with heart
| disease. At least for those who dont want to go vegetarian.
|
| Processed meats are so bad, they should be eliminated entirely
| from everyone's diet. The World Health Organization has
| classified processed meat as a Group 1 carcinogen. No amount of
| it is considered safe.
|
| Unprocessed read meat is still a problem and WHO advises less
| than 350g a week. Which is 12-18 ounces of cooked meat. 12g is
| about one adult serving of steak. So you really are looking at
| 1.5 servings per week of unprocessed red meat to be safe. At
| most! You probably should try for less or closer to 12g.
|
| And really if you're at a healthy weight, then I'm not sure how
| helpful this is. Obesity is a bigger risk factor. This is a bit
| of the elephant in the room for heart health. Not only should
| we not be eating things associated with heart disease but also
| we need to keep ourselves at a healthy weight.
| fcpk wrote:
| these are extremely outdated recommendations that make no
| sense. most of the basis for those are studies that took
| direct correlation as causality. the problem is a crappy
| lifestyle which incidentally typically includes processed and
| red meats in large quantities in the western world. saturated
| fats are hardly a good indicator of anything when you
| disassociate them from the lifestyle and foods they come with
| for most people. blue zones are now finally coming out as
| simply just the places where records sucked. there are plenty
| of populations with centenarians that had meat rich diets.
|
| yes obesity is bad, as the source enemy of most diseases that
| kill and are not cancer is inflammation. find a diet that
| makes you not obese and have low inflammation, that is vastly
| superior to "Mediterranean diet" or "plant diet" for
| everyone.
| ekianjo wrote:
| Especially the red meat pumped up with hormones...
| throwaway89201 wrote:
| I'm not sure that non-medically indicated CT scans are a great
| idea, as you're at least doubling your yearly dose of radiation
| in the year of the CT scan. Perhaps it's warranted, but the
| article doesn't seem to balance that at all against doing a CT
| scan "every 1-5 years".
| dumbmrblah wrote:
| I agree. As a physician, this is sticking out to me as bad /
| dangerous advice. By getting unneeded regular CT scans, you're
| dramatically increasing your risk of developing cancer. Beyond
| the radiation exposure itself, there is also the very real
| possibility of incidental findings that can lead to further
| testing, invasive biopsies, and unnecessary interventions, all
| of which compound your overall risk. You might solve one
| problem, but you've just guaranteed a much bigger, more
| explosive one down the line.
| bluGill wrote:
| You won't die of heart diesease if you die of cancer first.
| So I guess it sortof checks out, but not what I would choose.
| Esophagus4 wrote:
| Yes - in addition, medical professionals warn against
| "overdiagnosis" from unnecessary screenings.
|
| This can happen when we choose to treat otherwise benign issues
| that would have had few negative consequences for our health or
| longevities. Those treatments can have negative effects that
| are worse than the ailment we're trying to treat.
|
| I know it's a natural tech-guy impulse to quantify everything
| and get access to as much data as you can, but that myopic
| focus can actually lead us to optimize for the wrong thing.
|
| [1]https://pmc.ncbi.nlm.nih.gov/articles/PMC4077659/
|
| [2]https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/
| carbocation wrote:
| Key Takeaway: Get a CT or CTA scan, and if you can afford it go
| for the CTA with Cleerly.
|
| There is a reason that we don't recommend getting imaging for
| everyone, and that reason is uncertainty about the benefit _vs_
| the risks (cost, incidentalomas, radiation, etc, all generally
| minor). Most guidance recommends calcium scoring for people with
| intermediate risk who prefer to avoid taking statins. This is not
| a normative statement that is meant to last the test of time: it
| may well be the case that these tests are valuable for a broader
| population, but the data haven 't really caught up to this
| viewpoint yet.
| safety1st wrote:
| Right.
|
| Hang on a second.
|
| This guy is making a big big claim.
|
| The central point of his article is that he went to a doctor
| who followed the guidelines, tested him and found he wasn't at
| risk for heart disease.
|
| But then he went to another, very expensive concierge doctor,
| who did special extra tests, and discovered that he was likely
| to develop heart disease and have a heart attack.
|
| Therefore he is arguing that THE STANDARD GUIDELINES ARE WRONG
| AND EVEN IF YOU DO EVERYTHING RIGHT AND YOUR DOCTOR CONFIRMS IT
| YOU MAY BE LIKELY TO DIE OF HEART DISEASE ANYWAY, SO ONLY THE
| SPECIAL EXTRA TESTS CAN REVEAL THE TRUTH.
|
| I want a second opinion from a doctor. Is this true? Is this
| for real? Because it smells funny.
| malfist wrote:
| His evidence is also kinda weak. And appeal to authority
| largely about someone who he's paying to tell him he has
| health problems. The incentives aren't aligned.
|
| I also disagree that the 50the percentile is the breakpoint
| between healthy and unhealthy. There's a lot more to deciding
| those ranges beside "well half of the population has better
| numbers"
| kelipso wrote:
| ApoB is a better indicator of heart problems and his ApoB
| was bad, unlike his LDL-C. ApoB is not some imaginary thing
| made up by a quack doctor.
| wrs wrote:
| You may have missed the stat that 30% of the population
| that's the median of will die of heart disease. You don't
| want to be at the median.
| malfist wrote:
| If health science was as simple as health outcomes are
| proportional to one or two measurement percentiles, sure.
| But that's hardly true. Health is a lot more complex than
| that and the disease risk cannot be quantified by a small
| number of parameters
| rgmerk wrote:
| 100% of the population will die of something.
|
| If I die at 90 of a heart attack havjng maintained the
| ability to live independently up until then, I'd take
| that as a massive win compared to my relatives suffering
| through a decade of me with worsening dementia.
| carbocation wrote:
| The claim on an individual level is not objectionable to me.
| The question is that if we extrapolate it out to the
| population and actually take this action for everyone, do we
| make people better off? This is what clinical trials (or at
| least large observational studies) try to achieve. Right now,
| it is not clear.
| sixtyj wrote:
| If there are two contradictory conclusions you should ask for
| the third one, independent on the previous ones.
| Apes wrote:
| The year is 1846, and a doctor has a radical new idea:
| doctors should wash their hands between performing
| autopsies and delivering babies!
|
| You're not sure of whether this is a good idea or not, so
| you ask various physicians, and the consensus is unanimous:
| the very suggestion is offensive, do you think doctors are
| unclean?
|
| A clear conclusion has been achieved.
| sixtyj wrote:
| You're right. My comment doesn't make sense.
| Apes wrote:
| I strongly suspect the truth is both are "right", but they're
| both optimized answers to slightly different problems.
|
| Mainstream medicine is hyper optimized for the most common
| 80% of cases. At a glance it makes sense: optimize for the
| common case. Theres some flaws in this logic though - the
| most common 80% also conveniently overlaps heavily with the
| easiest 80%. If most of the problems in that 80% solve
| themselves, then what actual value is provided by a medical
| system hyper focused on solving non-problems? The real value
| from the medical system isnt telling people "it's probably
| just a flu, let's just give it a few days and see" it's
| providing a diagnosis for a difficult to identify condition.
|
| So if your question is "how do we maximize value and profit
| in aggregate for providing medical care to large groups of
| people", mainstream medicine is maybe a good answer.
|
| But if your question is "how do we provide the best care to
| individual patients" then mainstream medicine has significant
| problems.
| fwip wrote:
| Part of providing good care is not burdening the patient
| with tests or treatments that are very unlikely to yield
| benefit. Put another way, the mission of healthcare is not
| "health at any cost."
| embedding-shape wrote:
| The mission of healthcare in the eyes of those who
| provide it, isn't "health at any cost".
|
| For the people on the other side, "health at any cost" is
| pretty much the goal, usually limited by the "cost" side
| of things, especially in the parts of the world where
| they haven't yet figured out the whole "healthcare for
| the public" thing.
| Aurornis wrote:
| > But then he went to another, very expensive concierge
| doctor, who did special extra tests, and discovered that he
| was likely to develop heart disease and have a heart attack.
|
| It's scarily common in medicine for doctors to start
| specializing in diagnosing certain conditions with non-
| traditional testing, which leads them to abnormally high
| diagnosis rates.
|
| It happens in every hot topic diagnosis:
|
| When sleep apnea was trending, a doctor in my area opened her
| own sleep lab that would diagnose nearly everyone who
| attended with apnea. Patients who were apnea negative at
| standard labs would go there and be diagnosed as having apnea
| every time. Some patients liked this because they became
| convinced they had apnea and frustrated that their
| traditional labs kept coming back negative, so they could go
| here and get a positive diagnosis. Every time.
|
| In the world of Internet Lyme disease there's a belief that a
| lot of people have hidden Lyme infections that don't appear
| on the gold standard lab tests. Several labs have introduced
| "alternate" tests which come back positive for most people.
| You can look up doctors on the internet who will use these
| labs (cash pay, of course) and you're almost guaranteed to
| get a positive result. If you don't get a positive result the
| first time, the advice is to do it again because it might
| come back positive the second time. Anyone who goes to these
| doctors or uses this lab company is basically guaranteed a
| positive result.
|
| MCAS is a hot topic on TikTok where influencers will tell you
| it explains everything wrong with you. You can find a self-
| described MCAS physician (not an actual specialist) in online
| directories who will use non-standard tests on you that
| always come back positive. Actual MCAS specialists won't even
| take your referral from these doctors because they're
| overwhelmed with false cases coming from the few doctors
| capitalizing on a TikTok trend.
|
| The same thing is starting to happen with CVD risks. It's
| trendy to specialize in concierge medicine where the doctor
| will run dozens of obscure biomarkers and then "discover"
| that one of them is high (potentially according to their own
| definition of too high). Now this doctor has _saved your
| life_ in a way that normal doctors failed you, so you
| recommend the doctor to all of your friends and family.
| Instant flywheel for new clients.
|
| I don't know where this author's doctor fits into this, but
| it's good to be skeptical of doctors who claim to be able to
| find conditions that other doctors are unable to see. If the
| only result is someone eating healthier and exercising more
| then the consequences aren't so bad, but some of these cases
| can turn obsessive where the patient starts self-medicating
| in ways that might be net negative because they think they
| need to treat this hard to diagnose condition that only they
| and their chosen doctor understand.
| rasse wrote:
| It's important to note that there's geographic variability in
| guidelines. Also, the article doesn't give enough information
| about the author's other risk factors. For a similar patient
| (based on the initial lab results), treated by a doctor
| adhering to the European guidelines, at least the following
| items would have been considered:
|
| - Lipid lowering drugs
|
| - ApoB testing
|
| - Coronary CT (if the pre-test likelihood of obstructive
| coronary artery disease was estimated to be > 5%)
|
| - Diabetes tests
|
| - Kidney tests
| jbritton wrote:
| A CIMT scan is another option. It uses ultrasound to measure
| carotid artery wall thickness.
| IshKebab wrote:
| That seems like a super dumb reason to me. "We don't look
| because we might misinterpret the results"?? Fix the
| interpretation then!
|
| It's crazy that we haven't optimised MRI scans so that they can
| be routine.
| Buttons840 wrote:
| I am not a statin skeptic--or rather, I don't want to be a statin
| skeptic. I've done the research and it makes sense to me, but I
| still feel some social and psychological pressures to reject
| statins.
|
| When I see that it is widely accepted that ApoB is better to
| measure than LDL-C, but the industry continues to measure LDL-C,
| but not ApoB, I wonder why. It makes me skeptical.
|
| When I see that the purpose of statins is to reduce plaque
| buildup in the arteries, and that we have the ability to measure
| these plaque buildups with scans, but the scans are rarely done,
| I wonder why. Like, we will see a high LDL-C number (which,
| again, we should be looking at ApoB instead), and so we get
| worried about arterial plaque, and we have the ability to
| directly measure arterial plaque, but we don't, and instead just
| prescribe a statin. We're worried about X, and have the ability
| to measure X, but we don't measure X, and instead just prescribe
| a pill based on proxy indicator Y. It makes me skeptical.
|
| In the end statins reduce the chance of heart attack by like 30%
| I think. Not bad, but if you have a heart attack without statins,
| you probably (70%) would have had a heart attack with statins
| too. That's what a 30% risk reduction means, right?
|
| As you can see, I'm worried about cholesterol and statins.
| mac-mc wrote:
| If you fix it without statins through better lifestyle and
| diet, that is the preferrable route.
|
| As to why medicine is like this, it's because it's
| conservative, usually about 17 years behind university
| research[0], and doctors are shackled to guidelines in most
| health systems or risk losing their licenses. It isn't a
| coincidence that the article author had his out-of-pocket
| concierge doctor tell him the more up-to-date stuff.
|
| [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC3241518/
| kryogen1c wrote:
| >doctors are shackled to guidelines
|
| To expand, one of the coverage pillars of malpractice
| insurance (in the US) is the "standard of care". This is
| basically what most doctors and their associations consider
| acceptable, which by definition excludes new, better
| techniques.
|
| This is both a bug and a feature. A move fast and break
| things philosophy would cause more harm than good, but it
| also prevents rapid adoption of incremental improvements.
| mac-mc wrote:
| 17 years is far from rapid or move fast and break things.
| ApoB has been known about for quite a long time, since the
| 90s its effects have been obvious, and showed up in
| research in the 70s-80s!!! It's still not part of standard
| testing!!!
|
| Guidelines also leads to standards of care being random and
| heavily driven by politics & financial reasons disguised as
| medical best practice. South Korea and India are "parallel
| testing" places, which saves time, while the USA & others
| are serial testing places mostly because of their funding
| models.
|
| Talk to any American doctor and they will give you a bunch
| of emotionally wrapped cope about why it's bad because the
| cognitive dissonance sucks and there are liability reasons
| to avoid admitting your wrong. I would argue that in many
| cases, parallel testing is cheaper because $300 of tests is
| cheaper than 4 chained $500 doctor visits. But whatever.
| btilly wrote:
| I have an objection to the "better lifestyle and diet"
| approach.
|
| Sure, it is absolutely true that better lifestyle and diet
| has a huge effect. However it is absolutely certain that the
| vast majority of people who are told to improve their
| lifestyle and diet, won't.
|
| The result is doctors giving advice that they know won't be
| followed. And thereby transferring potential fault from the
| doctor to the patient, with no improvement in actual
| outcomes. "I told the patient to lose weight and maintain
| that with a controlled diet." And yet, most people when told
| to diet, won't. Most people who start a diet won't complete
| it. And most people who lose weight on a diet, have the
| weight back within 5 years. Where each "most" actually is
| "the overwhelming majority". And the likelihood of the advice
| resulting in sustained weight loss probably being somewhere
| around a fraction of a percent.
|
| What, then, is the value of the doctor giving this lecture?
|
| (Disclaimer. I have lost 20 of the pounds I gained during
| COVID, and am making zero progress on the remaining 30. A few
| months ago I successfully started a good exercise routine.
| Given my history, I would expect to only follow it for a few
| years before falling off the wagon. I believe that this poor
| compliance puts me well above average. But do you know what I
| do reliably? Take my prescribed medicine!)
| a1studmuffin wrote:
| Your health is ultimately your own responsibility - it's
| your body. You have free will, and your appetite for risk
| is yours alone. You can choose to ignore expert advice and
| refuse to wear a seatbelt, skip your rehabilitation
| exercises, invest all-in on crypto, or smoke cigarettes.
| None of this responsibility should fall on the expert if
| they communicated the risks clearly.
| kelseyfrog wrote:
| What if you have an intrinsically lower ability to
| perform temporal discounting?
| hshdhdhj4444 wrote:
| Licensing but also insurance.
|
| I think only recently have insurance companies started
| covering APoB testing in your annual exams (or that may just
| be my insurance...).
| collingreen wrote:
| I ALSO want to not be a statin-skeptic but, like you, these
| things look very weird to me. The most prescribed drugs in the
| country and we don't even try to check if they are addressing
| the actual problem?
| nerdponx wrote:
| There is a financial incentive not to look.
| sixtyj wrote:
| https://jamanetwork.com/journals/jamainternalmedicine/fullar...
|
| Meta-analysis conclusion: This literature-based meta-analysis
| did not find evidence for the benefit of statin therapy on all-
| cause mortality in a high-risk primary prevention set-up.
| Aurornis wrote:
| A meta-analysis that only includes 11 studies on statins is
| immediately suspect.
|
| There have been a lot of studies on statins. If a meta-
| analysis comes along and only cherry picks a couple of them,
| something is up.
| ekianjo wrote:
| > There have been a lot of studies on statins
|
| Financed by who?
| AuryGlenz wrote:
| That's fair.
|
| This is totally unsourced now but I did a deep dive quite a
| while ago now and it seemed to me that studies largely
| found that statins after a heart attack helped all cause
| mortality (though not by a ton), but if they were
| prescribed to someone before a heart attack it wasn't
| nearly as clear. Considering how they often make people
| feel it seems like people should be a bit skeptical.
| GeoAtreides wrote:
| Have you read their methodology and understood how they did
| their selection? You could critique their actual
| methodology. Maybe their selection is backed by strong
| arguments, right? And if you think their methodology is
| weak, then please explain why.
|
| Not just throw a two-line comment disparaging the work of
| experienced specialists in the field.
|
| For the curious, here are the author affiliations for this
| study:
|
| Department of Public Health and Primary Care, University of
| Cambridge, Cambridge, England (Drs Ray, Seshasai, and
| Erqou); Department of Cardiology, Addenbrooke's Hospital,
| Cambridge (Dr Ray); Department of Clinical Pharmacology and
| Therapeutics, Imperial College, and National Heart and Lung
| Institute, London, England (Dr Sever); Department of
| Cardiology, Leiden University Medical Center, Leiden, the
| Netherlands (Dr Jukema); and Department of Statistics (Dr
| Ford) and BHF Glasgow Cardiovascular Research Centre,
| Faculty of Medicine (Dr Sattar), University of Glasgow,
| Glasgow, Scotland.
| zargon wrote:
| Concentration of ApoB-carrying lipoproteins in the
| bloodstream as the driver of heart disease is one of the most
| strongly proven facts in medicine. Statins are proven to
| lower LDL (a close-enough substitute for ApoB in most
| situations) by about 30%. I can't look at the study now, but
| most likely it's a situation where patients' cholesterol has
| not been lowered enough by medication to make a meaningful
| difference. If you have an LDL of 160, statins aren't going
| to be sufficient. The issue is doctors/patients not targeting
| a sufficiently low cholesterol level.
| Aurornis wrote:
| > When I see that it is widely accepted that ApoB is better to
| measure than LDL-C, but the industry continues to measure
| LDL-C, but not ApoB, I wonder why. It makes me skeptical.
|
| ApoB is shaping up to be an incremental improvement in
| measurements, but health and fitness influencers have taken the
| marginal improvement and turned it into a hot topic to talk
| about.
|
| This happens with everything in fitness: To remain topical and
| relevant, you always need to be taking about the newest, most
| cutting edge advances. If it's contrarian or it makes you feel
| more informed than your doctor, it's a perfect topic to adopt
| for podcasts and social media content.
|
| ApoB is good, but it's not necessarily the night and day
| difference or some radical medical advancement that obsoletes
| LDL-C. For practical purposes, measuring LDL-C is good enough
| for most people to get a general idea of the direction of their
| CVD risk. The influencers like to talk about edge cases where
| LDL-C is low but then ApoB comes along and reveals a hidden
| risk, but as even this article shows there isn't even consensus
| about where the risk levels are for ApoB right now. A lot of
| the influencers are using alternative thresholds for ApoB that
| come from different sources.
|
| > In the end statins reduce the chance of heart attack by like
| 30% I think. Not bad, but if you have a heart attack without
| statins, you probably (70%) would have had a heart attack with
| statins too. That's what a 30% risk reduction means, right?
|
| 30% reduction in a life threatening issue is _huge_. I don't
| see why you would want to diminish that.
|
| If you were given the choice of two different dangerous roads
| where one road had a 30% lower chance of getting into a life-
| threatening car crash, you would probably think that the choice
| was obvious, not that the two roads were basically the same.
| flenserboy wrote:
| numbers often quoted in favor of statins use relative instead
| of absolute risk. when seen in absolute terms there is little
| case for statins except in some possible particular cases.
| they also do little, if anything, when it comes to life
| extension -- the expected lifespan of a statin user is often
| estimated to be four days longer than that of those who do
| not use them. not only is this essentially statistical noise,
| it discounts the lowered quality-of-life side effects
| experienced by many who have been put on statins.
| Maxion wrote:
| AFAIK statins show better numbers for secondary prevention.
| For primary prevention its a toss up.
| Buttons840 wrote:
| This is all true. If you take a statin and it causes no
| issues, you're... _maybe_ (30%, yay!) better off for it.
|
| If a statin makes you feel miserable, I think any doctor
| would sympathize with a calculated decision to stop them.
| There are many types of statins to try though, so hopefully
| one would work without side effects.
| marcosdumay wrote:
| > There are many types of statins to try though
|
| Most with efficacy determined by the proxy variable of
| LDL-C levels, and with even more questionable results in
| actual lifetime improvement.
|
| I too really wanted not to be that skeptical about
| medicinal research. But if I had high cholesterol and a
| doctor recommended newer statins to me, I don't think I
| would take them.
| endominus wrote:
| >If you were given the choice of two different dangerous
| roads where one road had a 30% lower chance of getting into a
| life-threatening car crash, you would probably think that the
| choice was obvious, not that the two roads were basically the
| same.
|
| You could absolutely think that they were basically the same,
| depending on the base rate. The differece between a one-in-a-
| million and 0.7-in-a-million is 30%, but it wouldn't be
| humanly perceivable. We're all likely faced with situations
| like that regularly. Differing airlines probably have much
| greater variances in their crash statistics, but it just
| doesn't matter in 99.99999% of flights.
| leni536 wrote:
| There is an xkcd for that:
|
| https://xkcd.com/1252/
| lateforwork wrote:
| There are plenty of statin skeptics and for good reasons; see
| prior discussion here:
| https://news.ycombinator.com/item?id=45430939
| m_a_g wrote:
| > and for good reasons
|
| That prior discussion gives no good reasons. The linked
| medium posts are, to be frank, trash.
|
| Statins are well-tolerated drugs with little to no noticeable
| side effects. You might have to try a few. You may need to
| combine ezetimibe to maintain a moderate statin dosage level,
| and that's it. (Like the author of this article)
|
| Source: Leading cardiologists worldwide, and doctors of the
| rich and famous.
| guerby wrote:
| What the BMJ has to say on this very topic of statins:
|
| https://www.bmj.com/campaign/statins-open-data
|
| So no settled science here.
|
| Unless you consider the BMJ a trash journal of course.
| zamadatix wrote:
| I recently went on a statin (atorvastatin) and found I have
| the WILDEST dreams of my life if I don't take them in the
| morning, and my doctor said my liver readings were elevated
| after use but not enough he wants to switch it yet. Which
| alternative statins should I be looking at, or do they have
| even harder side effects to deal with?
| lateforwork wrote:
| > _Statins are well-tolerated drugs with little to no
| noticeable side effects._
|
| Sorry, that's nonsense. It is a dangerous drug with plenty
| of side effects. If it had no side effects it would be sold
| over the counter. The brain needs cholesterol to function.
| If you artificially remove cholesterol this is what
| happens: https://www.health.harvard.edu/cholesterol/new-
| findings-on-s...
| logifail wrote:
| > When I see that the purpose of statins is to reduce plaque
| buildup in the arteries, and that we have the ability to
| measure these plaque buildups with scans, but the scans are
| rarely done, I wonder why.
|
| I'd love to know where to get the right advice on this topic.
|
| I have high LDL-C, had a heart CT in hospital last week, yet
| the hospital's cardiologist phoned me yesterday to _cancel_ a
| scheduled appointment to discuss the results(!), because she
| said I have zero arterial plaques and there 's simply no need
| for us to meet.
|
| I feel really quite lost with this stuff :/
| Buttons840 wrote:
| If it was a calcium scan, it is expected to be zero until mid
| 40s. It doesn't really start to give a signal until then.
|
| A zero is still a zero though, and is associated with low
| risk of heart disease in the near future.
| MPSimmons wrote:
| How old are you? I was told that they're not considered
| diagnostic until somewhat later in life (>50) because the
| plaque may not have calcified yet, which could cause a false
| negative.
| jimmydddd wrote:
| My wife had high cholesterol numbers, so her doctor wanted to
| give her statins. She asked about a scan, he begrudgingly said
| well, I guess you could do that. Her scan showed 0 plaque.
| Buttons840 wrote:
| Plaque won't show as calcium until it has been in your
| arteries for decades and has calcified. It is a delayed
| indicator.
|
| For anyone under 40, it's expected to have zero calcium. Even
| a measure of 1 or 2 when you're below 40 would be a bad sign.
| netfortius wrote:
| I was found to have high cholesterol in my late 20s. At the
| time the doctors (my cardiologist, then a second one brought in
| for advice) determined that the source was hereditary, but the
| effects would be the same. So they put me on statins. It's been
| 40 years now. I changed the statins three times since, when the
| actual one, at a specific time was no longer able to keep the
| values within acceptable limits. Approximately 8-9 years ago (I
| think) I ended up on Rosuvastatin 20mg, which I'm still taking
| every day. I do not maintain any diet (it'd be very hard, as
| I'm a heavy meat eater) and cholesterol levels are still
| staying within acceptable limits. Of course YMMV
| iaaan wrote:
| No heart attacks or strokes? I'm in the same boat (hereditary
| issue), and altering my diet has never had any substantial
| effect on my numbers. I'm not overweight and rarely eat red
| meat, but have had trouble keeping onto a primary care
| physician long term (the people I keep picking seem to move
| between clinics constantly) in order to retain consistent
| access to a statin prescription, but as I continue to age
| I've been getting increasingly anxious that my time is
| coming.
| netfortius wrote:
| So far everything is good. I only had more of a logistic
| issue, once, when moving to France from the US, a few years
| back (retirement) and when my new doctor told me that the
| French do not recommend statins for people at my age and
| overall good shape (active, fit, etc. ), even if the
| numbers are high. I asked her to give me a referral to a
| cardiologist, to whom I mentioned my 35 years of statins in
| the US, and who was of the opinion that after such a long
| time and with no apparent side effects, he would recommend
| continuing on this type of medication. And that was it, so
| I'm now getting the prescription renewals almost
| "automatically", even as my cholesterol is staying within
| limits (under the assumption that it may increase, should I
| stop, especially considering the amazing cuisine and
| products to which I now have access :) )
| liveoneggs wrote:
| Statins also raise your blood sugar and lower your GLP-1,
| increasing your risk of diabetes?
|
| They also tend to be continued well into old age (off label)
| despite increasing fall risk, which is way more dangerous to an
| 80 year old.
| fcpk wrote:
| one better simple indicator than large panels, if you can't get
| access to them or don't have them is simply your
| triglycerides/hdl ratio. aim to be under 2 if using mg/dl and
| under 0.87 if using mmol/L. it's one of the strongest
| correlated indicators of cardiovascular disease. way better
| than any classic cholesterol ratios.
| hshdhdhj4444 wrote:
| > When I see that it is widely accepted that ApoB is better to
| measure than LDL-C, but the industry continues to measure
| LDL-C, but not ApoB, I wonder why. It makes me skeptical
|
| Because this is a recent understanding and healthcare tends to
| be a conservative industry that moves slowly. Sometimes too
| slowly.
|
| And also because LDL remains an excellent measure. The risk
| with LDL isn't false positives. If someone has high LDL they
| likely have an elevated risk of heart disease. The problem with
| LDL testing is that someone with low LDL may still have a high
| risk of heart disease which may be captured in APoB testing.
| hermanzegerman wrote:
| > When I see that it is widely accepted that ApoB is better to
| measure than LDL-C, but the industry continues to measure
| LDL-C, but not ApoB, I wonder why.
|
| That's pretty simple to explain. No conspiracy.
|
| LDL-C is much much cheaper to measure. ApoB costs 36x times as
| much, so Insurance Companies don't like to pay for it
| brandonb wrote:
| > When I see that it is widely accepted that ApoB is better to
| measure than LDL-C, but the industry continues to measure
| LDL-C, but not ApoB, I wonder why. It makes me skeptical.
|
| Part of this is just that insurance coverage lags science.
| We've known that ApoB is more accurate than LDL since the
| 1990's or 2000's, but to be covered by insurance, several more
| steps have to happen.
|
| First, the major professional societies (like the American
| College of Cardiology or National Lipid Associations) have to
| issue formal guidelines.
|
| Then, the USPSTF (US Preventive Services Task Force) needs to
| review all of the evidence. They tend to do reviews only every
| 5 or 10 years. (Countries aside from the US have different
| organizations that perform a similar role.)
|
| If the USPSTF issues an "A" or "B" rating, then insurance
| companies are legally obligated to cover ApoB testing. But that
| also introduces a year or two lag since medical policies are
| revised and apply to the next plan year.
|
| The net effect is that the entire system is 17 years, on
| average, behind research.
| aktuel wrote:
| This is all very interesting, but far too detailed and technical
| for 99% of people. The TLDR should include an easy to understand
| summary without jargon like "VO2" and "a set of HIIT at Zone 4".
| amsterdorn wrote:
| Curious about how accessible these tests are in Europe. Living in
| a country (NL) that doesn't value annual checkups makes me assume
| detailed, preventative blood testing like this is hard, let alone
| possible to get in non-extreme situations.
| dust42 wrote:
| Long story short care about your health. If you don't do already,
| maybe now is a good time to start.
|
| What you put into your body: no processed food, cook yourself,
| lots of variety of veggies and fruits, little meat, little
| alcohol.
|
| What you do with your body: regular exercise, low stress, enough
| sleep.
|
| What you do with your mind: good social environment, good
| relationships.
|
| And an apple a day keeps the doctor away!
| echelon wrote:
| > lots of variety of veggies and fruits, little meat
|
| This is wrong. Our bodies evolved to rend flesh and eat meat.
| They are optimized by millions of years of evolution to process
| and run on meat.
|
| The biochemical pathways of carb-heavy diets put more oxidative
| stress on the body.
| slumpt_ wrote:
| podcast science is a bit low-brow for hn brother
| cd4plus wrote:
| This is wrong. Our bodies evolved to eat a diverse omnivorous
| diet and complex carbs + the antioxidants present in
| vegetables and fruits are anti-oxidative.
| NotGMan wrote:
| This is wrong.
|
| Humans have eaten complex carbs only for the last 10k years
| since agricultural revolution. Before that, outside of a
| small part of Africa, there physically wasn't enough carbs
| available to say that they made any substantial amount of
| our diet.
|
| Most ancenstral carbs were uber high in fiber, and very low
| in glucose (starch) and fructose.
| DennisP wrote:
| I've taken courses in primitive wilderness survival, and
| one of the staple foods was grass seed.
|
| Also lots of roots are edible with cooking, and it looks
| like we've been cooking for about a million years. Then
| there's wild rice, cattails, beans, berries, all sorts of
| stuff.
|
| I agree that most wild plants are high in fiber and low
| in sugar, but there are are a lot of complex carbs to be
| had, if you have fire.
| tgv wrote:
| Vegetables aren't "carb-heavy". And we don't need to recreate
| blindly the circumstances evolution had to adapt us to. E.g.,
| our bodies evolved when the population was much smaller, but
| I don't think you want to argue for mass extinction.
| GeoAtreides wrote:
| >Our bodies evolved to rend flesh and eat meat.
|
| is that why we have flat molars? for eating meat?
|
| (spoilers: no, the flat molars are not for eating meat)
| its-summertime wrote:
| "Long story short" should probably be followed by a short
| version of the long story.
| tgv wrote:
| Not all things labeled "processed foods" are bad, it seems.
| There are enough scientists that say the distinction is often
| hypocritical (example from an article: a factory-made carrot
| cake is labeled UPF, but a home-baked one isn't, even though
| they're practically the same thing). Sugar, fats, and lack of
| fiber make factory-food unhealthy, they say. Others add that we
| can't feed the growing metropolitan areas without it.
| callmeal wrote:
| >a factory-made carrot cake is labeled UPF, but a home-baked
| one isn't, even though they're practically the same thing).
|
| Actually they are not. "Practically" is carrying a lot of
| weight there. The factory baked cake will have a lot more
| extraneous ingredients and usually has a larger quantity of
| sugar and fat. Similar to how restaurant food generally has a
| lot more salt and fat than home cooked food.
| DennisP wrote:
| Yep just a glance at the ingredients shows obvious
| differences. Other issues I've seen studies about include
| contaminants from conveyor belts, and for many snack foods,
| processing into smaller particles, effectively making them
| partially pre-digested.
| macNchz wrote:
| Yes, right off the bat a factory made carrot cake will very
| likely contain dough conditioners, colors, and
| preservatives that no home cook would put in their scratch
| made version.
|
| The direct impact of those extra ingredients alone or in
| combination is not entirely clear at this point, aside from
| building evidence that people whose diets include more of
| that seem to be less healthy.
| 542458 wrote:
| WRT the carrot cake, I will say that while there is only a
| minimal physical difference, there is a practical difference.
| Making a carrot cake at home is a commitment, and most people
| won't frequently go to the trouble except on special
| occasions... But one from the grocery store can be acquired
| casually and without effort, and it's easy to eat a lot more
| of something when it requires no effort.
| kakacik wrote:
| Every time I cook (and thats quite often) I put a bit
| different ingredients that some factory would put in since
| they are the cheapest variant.
|
| Some stuff is BIO, cream or coconut milk are lower fat
| version, or carrots are are without residual pesticides.
| Less salt since we use less salt, and taste buds quickly
| adjust so its still adequately salty, a better mix of herbs
| and spices so taste is.. simply better, more refined. We
| use with much less sugar, the same as for salt above (if
| you eat sweet stuff sparingly then even mildly sweet stuff
| tastes amazingly, just don't go from one extreme to
| another).
| somenameforme wrote:
| Just expanding on a peer post, but industrial made food tends
| to have a large number of preservatives, stabilizers,
| coloring agents, and much more added for commercial reasons.
| An obvious example of this is in something as simple as
| bread. If you've ever made homemade bread. It goes stale in a
| day or two, and it's hard as a rock shortly thereafter.
|
| But that loaf you buy at the store? It'll generally be
| covered in mold before it gets hard, and that's quite the
| achievement since it also tends to be more resistant to mold
| as well! Bread _should_ get hard. This is where a ton of old
| recipes come from. The Ancient Greeks would dip it in wine
| for breakfast, Euroland has bread soup /puddings, and even
| stuff in the US like Thanksgiving stuffings or croutons.
| ekianjo wrote:
| > : a factory-made carrot cake is labeled UPF, but a home-
| baked one isn't, even though they're practically the same
| thing
|
| If you stepped inside a food factory you would see how false
| that statement is
| giardini wrote:
| I dunno! My favorite carrot cake recipe had a full cup of
| vegetable oil in it! I'm not sure that fits into anyone's
| guidelines.
| nothrabannosir wrote:
| You're not wrong but it is not a fair TLDR. TFA has a TLDR
| which says
|
| > If you only read one thing here, make it the "How to not die
| of heart disease" section.
|
| Which itself is still quite long but it emphasizes:
|
| > Every lipidologist I've spoken with has stressed the
| importance of measuring and managing ApoB above all else - it's
| a far better predictor of cardiovascular disease than LDL-C
| (which is what physicians are most familiar with). Every
| standard deviation increase of ApoB raises the risk of
| myocardial infarction by 38%. Yet because guidelines regularly
| lag science, the AHA still recommends LDL-C over ApoB. Test for
| it regularly (ideally twice a year) and work to get it as low
| as possible (longevity doctor Peter Attia recommends 30-40mg
| per deciliter). Many lipidologists will say to focus on this
| above all else.
|
| And:
|
| > I asked several leading lipidologists to stack rank what they
| believe are the most important biomarkers for people to measure
| and manage. [...], and will likely cost anywhere between
| $80-$120 out of pocket.
|
| That's a pretty interesting and relevant part of TFA. Omitting
| that is not a fair "long story short", but rather just
| "different story".
| swat535 wrote:
| Everyone knows the recipe for healthy living, it's the same as
| for similar issues such as personal finance (spend less than
| you earn, save, etc.).
|
| They seem simple on the surface but hard part is execution for
| most people, due to life circumstances and other factors.
| Unhealthy choices persist because society isn't built around
| healthy lifestyles.
|
| So while the comment seems helpful on the surface, it misses
| the forest for the trees.
|
| I think that there needs to be a bigger discussion here,
| regarding why have we engineered a society that inflicts
| suffering and illness on so many?
| guzik wrote:
| > It's not sexy, and as a result an overwhelming majority of the
| population is unaware about how to avoid succumbing to it
|
| When I started building an ECG Holter in my early 20s, I tried to
| get some friends to use it and kept hearing "yeah, but it's not
| exactly sexy to wear that thing." That's when it hit me how
| little people care about prevention until something goes wrong.
| We still have a huge awareness gap to close.
| giardini wrote:
| I asked a heart doctor for a calcium scan. He said I didn't
| need that, but he wanted me to wear a Holter monitor for a few
| days (reasons unknown). I did not.
|
| That was years ago. I have different doctors now but still no
| calcium scan. Time to ask again possibly.
| everdrive wrote:
| What if heart disease saves me from dementia? I'm not just being
| contrarian. I think about this a lot of the time. I'm already 40.
| I'm being healthy now, but whatever damage has already been done
| is baked in. (plus whatever is in my genetics) A quick death at
| 65-70 might be much more preferable to a slow terrible decade-
| long decline.
| JoshTriplett wrote:
| New medical discoveries happen regularly; you might also die
| right before the discovery of a preventative/cure for dementia.
| Living people have options, dead people have none.
|
| Also, given the preferences you expressed in your comment, you
| _especially_ should want to avoid strokes, or the many side
| effects of heart disease, which can make you less healthy for a
| long time.
| MattPalmer1086 wrote:
| Heart disease can be a slow decade long death, where you become
| incapable of physically doing anything. It's not just a heart
| attack out of nowhere and you're dead.
| dehrmann wrote:
| My grandfather always said "there's something to be said for a
| good coronary." He was in his 70's when he said it, and his
| point was that he had a good run, and there's an argument for
| going out while things are still good rather than slowly dying
| over six months in a nursing home (which is what actually
| happened).
| bambax wrote:
| > _Don't Die!_
|
| Why the f* not.
|
| My in-laws are over 95. They refuse to go to an elderly home and
| as a result make everyone miserable, starting with themselves and
| inflicting infinite suffering on their children who each have a
| family of their own, and need to take care of them all of the
| time.
|
| I don't want to do that to my own children. I don't want to not
| die. I don't esp. want to die but I'm not really afraid of it,
| it's just a normal part of life.
|
| Preventing heart disease is probably a good thing, but if one
| prevents every ailment conceivable then how does this work
| eventually?
| CapitalistCartr wrote:
| You're almost certainly going to die by or before 110, anyway.
| (Ir)Regardless of your efforts, or lack thereof, our bodies
| typically give out in the 100-110 year range with _very_ few
| exceptions.
| adrianN wrote:
| If you prevent _every_ ailment you don't become frail and just
| take care of yourself.
| js2 wrote:
| > Sticking to a Mediterranean diet that is light on carbohydrates
| and saturated fats is almost always the safest bet. Almost every
| health diet is some permutation of this.
|
| A permutation that's currently making the rounds in the press
| (even though the original research is from 20 years ago) is the
| "portfolio diet":
|
| https://jamanetwork.com/journals/jama/fullarticle/196970
|
| https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0...
|
| Some press mentions:
|
| https://www.health.harvard.edu/heart-health/the-portfolio-di...
|
| https://www.nytimes.com/2025/11/04/well/eat/health-benefits-...
|
| https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...
| wocram wrote:
| This is a lot of words to say eat a plant-based/vegan diet.
| mac-mc wrote:
| If you dig into research and follow the low-risk experiments that
| people do online to reduce their Lp(a), you can find techniques
| and evidence to do so. It doesn't have to be an impossible-to-fix
| issue.
|
| I like this list of experiments by Greg Muschen:
| https://x.com/gregmushen/status/1924676651268653474
| jeffnv wrote:
| For what it's worth, this article by the doctors at Barbell
| Medicine has been my go to recommendation for what to prioritize
| for health and longevity:
| https://www.barbellmedicine.com/blog/where-should-my-priorit...
| mmaunder wrote:
| Stop drinking. Replace cheese and butter with olive oil in
| copious amounts. Only eat fish meats. Don't smoke or vape. Eat
| salads and other prebiotics. Get some cardio - even walking your
| dog is great. Your brain fog will lift, your skin will clear,
| your mood will improve and your doctor will gasp at how clear
| your carotids are next time they're ultrasounded.
| reidrac wrote:
| There are some points on this post that confuse me.
|
| > In early 2023 during a routine skin check at my dermatologist
| [...]
|
| Are routine skin checks a thing?
|
| > [...] I've spoken with several of the world's leading
| cardiologists and lipidologists [...]
|
| How come?
| dragonwriter wrote:
| > Are routine skin checks a thing?
|
| If you have a dermatologist, I would imagine so.
|
| Is having someone you can describe as "my dermatologist" a
| common thing? Probably not for most people who don't have a
| chronic skin condition of some kind, I would think.
| bluGill wrote:
| they are to me. I'm very light skinned and thus have had
| sigificant sunburn more than once, skin checks have found and
| removed somewhat likely to turn into cancer. Probably useless
| if you are 20, but by 50 they can find and prevent cancer and
| so should become common
| Aurornis wrote:
| Going deep on biomarkers, blood tests, and debates about optimal
| levels is okay for some people who derive motivation from
| obsessing over topics, but I'm starting to notice a trend where
| people obsess about these things for a couple years before
| burning out and moving on to the next topic.
|
| The best thing you can do for yourself is to establish healthy
| diet and lifestyle habits that are sustainable. A lot of people
| who jump from obsession to obsession do a great job at optimizing
| for something for a few years, but when their life changes they
| drop it completely and fall back to forgetting about it.
|
| Fad diets are the original example of this: They work while the
| person is doing it, but they're hard to maintain for years or
| decades. CrossFit and other exercise trends have the same problem
| where some people get extremely excited about fitness for a
| couple years before falling off completely because it's
| unsustainable for them. Some people are able to continue these
| things for decades, but most people do it for a short while and
| then stop.
|
| I'm now seeing the same pattern with biomarker obsessives: They
| go a few years obsessing over charts and trying things for a few
| months at time, but when the interest subsides or they get busy
| with life most of it disappears.
|
| The most successful people over a lifetime are those who
| establish healthy habits that are easy to sustain: Eating well
| enough, reducing bad habits like frequent alcohol or fast food
| consumption, some light physical activity every day, and other
| common sense things.
|
| The most important factor is making it something easy to comply
| with. The $300 biomarker panels are interesting, but most people
| don't want to pay $300 every year or more to get snapshots that
| depend largely on what they did the past week. Some people even
| get into self-deceiving habits where they eat well for a week
| before their blood tests because the blood test itself has become
| the game.
| Flere-Imsaho wrote:
| I learnt a great trick about exercise: find a podcast or audio
| book that you really enjoy listening to. Here's the trick:
| you're only allowed to listen when you're exercising.
|
| Also with food and drink: place friction between the treat and
| yourself. The easiest example is to not have biscuits / alcohol
| in the house.
|
| Bonus tip: alcohol free beer is really good these days.
| portaouflop wrote:
| Alcohol free beer was a game changer for me. Also if I can't
| avoid it alternating alcohol-containing and alcohol-free
| drinks.
|
| For exercise your tip doesn't help me at all. I hate
| audiobooks and podcasts so that would turn me off more from
| exercising. Also I want to concentrate on the exercise and
| not do it halfhearted.
|
| What helped me was to realise how much better I feel after
| exercising - since then i kinda got addicted to it because I
| notice how much worse I feel after not doing it for a couple
| of days.
|
| I agree on the friction. Just not having access to cigarettes
| is the best way for me to not smoke. I just don't buy them
| and bumming one from someone else comes with a degree of
| personal shame for me that makes me avoid them (in almost all
| cases).
|
| I naturally don't like sweet stuff that much - however since
| I moved from EU to America (not US) it's been really hard to
| avoid sugar. Y'all put that stuff into everything it's crazy;
| I gotta watch out like a hawk and go to special stores. In
| Europe it was so much easier, there are always cheap sugar
| free whole foods available in every supermarket.
| Flere-Imsaho wrote:
| It's not just sugar. Emulsifiers affect the gut bacteria in
| a negative way.
|
| I live in the UK and emulsifiers seem to be added to
| everything: sauces, yogurt, bread.
| toast0 wrote:
| If you're exercising for cardio, and you're able to follow
| your book or podcast, you're probably not doing good cardio.
| OTOH, it's not a bad way to do interval training while
| watching sports, go hard when they're yammering, slow down
| when the sports are happening (or, if you're watching soccer,
| you can go hard most of the time and then slow down for the
| replay if anything happens, which is unlikely)
| Flere-Imsaho wrote:
| I lift weights, so there's lots of pauses between the sets!
|
| However I can definitely listen to a podcast when using a
| static bike... As long as your heart rate is 75%0
| autop0ietic wrote:
| You are completely wrong and don't know what you are
| talking about.
|
| You are confusing two different things.
| embedding-shape wrote:
| > If you're exercising for cardio, and you're able to
| follow your book or podcast, you're probably not doing good
| cardio
|
| But on the flip side, even if it isn't ideal, if that tip
| makes at least one person actually do any kind of cardio at
| all, even if it's the worst one on the planet, it's still
| better than nothing.
|
| In fact, I'd probably consider your statement of
| preemptively shooting someone down like that (imagine being
| a 3rd reader of the original comment + your response), is
| massively more harmful to others than parent who at best
| tried to trick someone into doing bad cardio, which again
| would be better than nothing.
| phainopepla2 wrote:
| Maybe our brains work differently, but I have absolutely no
| problem following a podcast while running, and my race
| times indicate that I'm doing good cardio.
|
| I do have a hard time with mind muscle connection during
| weight training if I'm listening to something other than
| music, though.
| reducesuffering wrote:
| > If you're exercising for cardio, and you're able to
| follow your book or podcast, you're probably not doing good
| cardio.
|
| Nonsense. Elite distance runners are doing 80% of their
| miles at essentially a conversational jog with a starkly
| lower HR than the 20% of intense miles. Cardio exercise
| under all levels of intensity is optimal, not just easy or
| just hard.
| giardini wrote:
| Fiere-lmsaho says< _> Bonus tip: alcohol free beer is really
| good these days.<_
|
| Could you recommendation some good alcohol-free beers,
| please?!
| Flere-Imsaho wrote:
| Sure:
|
| [https://luckysaint.co]
|
| [https://brewdog.com/collections/alcohol-free]
|
| [https://www.majestic.co.uk/beer/peroni-0-0-4x330ml-
| bottles-7...]
|
| Note that not all "zero %" beers are actually zero %...
| some have 0.5% alcohol.
| Fire-Dragon-DoL wrote:
| I push hard enough during cardio that I can't really follow a
| podcast properly. On the upside, it's only 30 minutes.
|
| While lifting weight I do that since I rest for 90 seconds in
| between sets, which is actually very boring. I started
| reading books during that time and that has been a big
| improvement.
| kakacik wrote:
| Right on spot. Find a regime for body and mind that you can
| sustain without any significant mental effort, after some time
| lack of good behavior be it sports of healthy food makes one
| uneasy. Bonus points from getting happy from it / making it a
| passion, this helps a lot with coming back after some hiatus
| (ie injury, sickness, long travel etc.).
|
| Personal story - I used to be super sporty, 4x gym training
| during work week - cardio & free weights, climbing over
| evenings after work, hiking/climbing/ski touring over weekends.
| Vacations were mostly more extreme variants of the same. Last
| year broke my both ankles with paragliding, one leg much worse,
| so took me some 8 months to be able to walk straight again,
| with some time in wheelchair, then crutches. All strength &
| stamina gone, flexibility 0, so had to rebuild from scratch and
| I mean deep bottom scratch from which you bounce very slowly,
| not some 1 month stop when things come back quicker. If all
| above weren't my proper passions I would have a hard time
| coming back to being again more active than most(sans that
| paragliding, took the lesson and have 2 small kids). That ankle
| won't ever be same but so far so good, ie managed some serious
| hike&via ferrata mix 2 days ago.
| portaouflop wrote:
| Getting happy from it is 100% the most effective way to
| change habits. Unfortunately it's also very subjective and
| hard to find out what makes you happy...
| intrasight wrote:
| > starting to notice a trend where people obsess about these
| things for a couple years before burning out and moving on to
| the next topic.
|
| Really spot on with one of my besties. He does all the tests.
| He has a concierge doctor. He reads extensively on the topics
| of fitness and nutrition. And yet he doesn't do any of it. It's
| just an intellectual exercise for him. And he has had two heart
| attacks in the last several years. It's so frustrating. I just
| wanna shake him.
| tclancy wrote:
| Warn him before you do. Don't want to scare him.
| hmontazeri wrote:
| Triglyceride-to-HDL Ratio (TG/HDL)
|
| Interpretation: * < 2.0: Insulin sensitive * 2.0-3.9: Moderate
| insulin resistance risk * >= 4.0: High likelihood of insulin
| resistance
|
| Your ratio = 5.0 - Suggests likely insulin resistance.
| kingofmen wrote:
| There's something I deeply don't understand about this.
|
| > I shared these results with a leading lipidologist who
| proclaimed: "Not sure if the lab or the primary care doc said an
| LDL-C of 116 mg/dL was fine but that concentration is the 50th
| percentile population cut point in the MESA study and should
| never ever be considered as normal.
|
| > It's also important to note that, according to a lipidologist
| friend, an ApoB of 96 is at a totally unacceptable 50th
| percentile population cutpoint from Framingham Offspring Study.
|
| So... the exact median value is "totally unacceptable" and
| "should never ever be considered as normal"? I'm open to the
| possibility that the US population is so deeply unhealthy that
| this is true, but then that needs to be argued for or at least
| _mentioned_. Like, you can 't say "you're exactly average in this
| respect" and expect your _and that 's terrible_ to be taken
| seriously without any followup.
|
| Or if I'm misunderstanding what's meant by "50th percentile
| population cut point" then again, I think this jargon should be
| explained, as it's plainly not the usual meaning of "50th
| percentile".
| kqr wrote:
| I had assumed "the MESA study population" was a particularly
| unhealthy bunch in terms of this measurement, meaning the 50th
| percentile puts one in the worst half of an already bad off
| group.
| in_cahoots wrote:
| I don't know the exact details, but I thought the Framingham
| survey was just a cross-section of the population. So getting
| upset about a 50th percentile score makes no sense at a
| population level.
|
| A quick Google says that the Mesa study was actually of
| people without cardiovascular disease at the beginning of the
| study. So again, these conclusions don't make any sense to
| me.
| wrs wrote:
| Of course it makes sense. 30% of this population will die
| of heart disease. You don't want to be at the median of
| that population if you can avoid it. And as a society we
| need to _move_ the median, not just _accept_ it. Which
| means giving people better advice based on better data.
| kingofmen wrote:
| That would make sense, but again, should be mentioned as
| context for why the number is bad. It's not as though we're
| skimping on wordcount here.
| hinkley wrote:
| The other thing these number chasers don't tell you is that
| extremely low LDL numbers are also associated with anger
| management issues. The stuff is used in your body to build
| things. You need some, and probably at least half of the number
| this doc is trying to say is scary. In fact in a different test
| he is advised to talk to his doctor about whether a 29 is safe.
|
| Has the guidance changed that you want LDL less than 2.5x (or
| was it 2x?) your HDLs?
| jorvi wrote:
| The "be an advocate" thing is both true but also incredibly
| selfish and egotistical.
|
| If everyone did that, the whole system would grind to a halt.
| Doctors aren't in a rush because they enjoy so, they are because
| they're already overworked. 1 out of every 25 patients (their
| family) demanding extra attention is possible although still a
| burden. 21 out of every 25 is not possible.
| JKCalhoun wrote:
| My assumption was that we have to be our own advocate because
| the system itself is non-ideal.
|
| My takeaway: if bloodwork were broader, covered more markers,
| there would be one less reason to have to advocate for your own
| health.
|
| I find it odd that you would instead "advocate" for _not_ being
| an advocate for your own health? Are we waiting for a friend to
| say, "Hey, you're looking a little rough."
| jorvi wrote:
| > Are we waiting for a friend to say, "Hey, you're looking a
| little rough."
|
| If you are "looking rough", unless you are in imminent danger
| you should just go to the GP. Your GP is there triage care.
| He'll recommend whether you need something prescribed from
| the pharmacy, a blood test or see a specialist.
|
| If you get refered to a specialist, the hospital will try to
| ascertain if you need a really experienced specialist or if
| you have a relatively simple case that can be handled by one
| with, say, 11 years experience. If he decides the case is too
| complex, he can ask the more experienced specialist to
| preside.
|
| If you short-circuit that and demand to be seen by the most
| experienced specialist, you are robbing a patient that might
| need that experienced hand of extremely valuable care, when
| you could have done with less. Like I said, egotistical.
|
| > My takeaway: if bloodwork were broader, covered more
| markers, there would be one less reason to have to advocate
| for your own health.
|
| Blood work needs lab workers who also have limited time. They
| could indeed do 10 tests but that means more labs and more
| lab workers which increases costs, which are already
| exploding. _Better_ tests would be good.
| gbacon wrote:
| Behaving like docile, compliant cattle benefits only the
| farmer.
| jorvi wrote:
| Perhaps you could feed the cattle with your strawman instead.
| jeffbee wrote:
| Yeah insisting that you are qualified to choose the members of
| the medical staff qualified to do X or Y procedure isn't
| advocating, it's being a prick.
| arjie wrote:
| The primary thing I did was ask a cardiovascular surgeon in my
| network to send the lab requisition form to a lab. This is the
| gate for much of this stuff, even if you pay out of pocket. If
| someone knows a simple "pay and play" testing service that would
| be fantastic.
|
| Most doctors recommend against these and against the full body
| MRI one can get because they believe you'll always find things
| you don't expect and that will make you indulge in interventions
| that have weak support, resulting in deleterious iatrogenic
| effects.
|
| I found that I had no such impulse with the data I had. But a
| friend of mine, supplied with evidence of a little arrhythmia
| went through a battery of tests and experimentation. He was in
| line for getting a cardiac ablation when he finally quit his job
| and stopped having the problem. So I get why they say that.
| There's people like that.
|
| Anyway, if you're curious what you can get for $800 email me and
| I'll post here. I'd do it proactively but I'm traveling so it
| will take a little work.
| rootusrootus wrote:
| I got all the same labs through Function Health. That's the
| standard pay-to-play these days, but there are others.
| arjie wrote:
| Perfect. Looks like everything I'd get from Ulta for $800 but
| for much less. The self serve model is great. Thank you.
| dreamcompiler wrote:
| > To help manage inflammation, there are new medications like
| colchicine that are normally only used in very high-risk
| patients.
|
| Clarification: Colchicine has been used by humans for over 3000
| years. What's new is its use for cardiovascular disorders.
| puttycat wrote:
| I cannot judge the science in most of the article since I'm not a
| medical doctor.
|
| But since I have a PhD in computer science in a relevant
| subdomain, I can certainly judge the part where he recommends the
| following:
|
| > What should you do with your test results? Throw them into
| ChatGPT, of course!
|
| Do _not_ count on anything coming out of ChatGPT for medical
| advice. Period.
| kakacik wrote:
| Yeah its a self-made-help article, if you don't know any better
| this is what you do. It doesn't make it the best choice overall
| though.
|
| It feels like the guy had a... mediocre GP, got scared by skin
| cancer diagnosis and over-corrected to most expensive path
| possible and since stuff was found out we have this article,
| roughly correct but written in a sensationalist (or freaked
| out) style. Some claims are outright false (like GPs not
| knowing heart disease is the biggest killer... really).
|
| Wife is a doctor with overreach between public and private
| healthcare, and those private services also have their own
| motivations which aren't often straightforward help-as-much-as-
| possible, rather milk-as-much-as-possible with tests, scans,
| long term treatments and so on. Especially CT scans pour non-
| trivial amount of radiation on the body that on itself can
| cause cancer down the line.
|
| With public healthcare you at least know primary motivation
| isn't cash flow but helping patients, the issue is rather
| overwhelmed resources with limited time per patient. It always
| depends on individual, as with engineering there are better and
| worse, yet we all somehow expect every single doctor to be 100%
| stellar infallible expert with 150 years of experience across
| all branches of medicine (absolutely impossible for any human
| being). Look around at your work if you are an engineer and
| perceive the spread of quality/seniority of each colleague.
| Same happens in medicine, just stakes are (much) higher.
| AuryGlenz wrote:
| ChatGPT is amazing for interpreting test results. Of course you
| should back it up with a doctor.
|
| Back when 3.5 came out I gave it some information about me when
| I was a teenager on a condition that (multiple) doctors totally
| misdiagnosed. It immediately told me three tests I should have
| done, two of which would have diagnosed it right away. Instead,
| I had to deal with extreme fatigue for over a decade until I
| finally did research on my own and had those same tests done.
|
| As far as test results go, right now we're dealing with our dog
| having increased thirst. She's been on prednisone for a year,
| and that's not an uncommon side effect. We brought her in to
| the vet and they tested her and diagnosed in as stage one
| kidney disease, with no mention of the prednisone. I put those
| results and her details into ChatGPT and it told us it could
| absolutely be the prednisone, and told us we could use an
| inhaler for what we were using the prednisone for - chronic
| bronchitis. Our vet never offered than option. We'll find out
| in a few months if she actually has kidney disease or not, but
| chances are it was just the prednisone.
|
| As a bonus, the vet before this one diagnosed her bronchitis as
| heart failure. They didn't run any tests, scans, etc. Just
| "sorry, your dog is going to die soon." What a fun week that
| was.
|
| ChatGPT is an amazing second opinion tool. Obviously you need
| to ask it neutral, well formed questions.
| wyldfire wrote:
| I was a bit distracted by the capitalization of the word
| "Advocate". Both when used as a noun and a verb. Peculiar.
|
| But a great article with really great suggestions. Too bad
| there's not better medical care by default but good to hear that
| we can take control.
| Waterluvian wrote:
| I'm sensing a potentially significant misallocation of resources.
| My mental model is that there's a _hypothetical_ quantification
| of not just your time and money, but your anxiety, attention
| bandwidth, mental energy, etc.
|
| I think, in some ways, the trick is being able to short circuit
| the entire journey represented by this website in favour of some
| form of, "I'm 40. I should be more mindful of heart disease. I
| should add a 30 min walk to my mornings." And then move on with
| your life.
|
| I think many cultures, but especially American healthcare
| culture, foment a growing background noise of constant anxieties
| and stressors. Life is sufficiently complex but there's always a
| peddler eager to throw you a new ball to juggle (and pay for).
| adammarples wrote:
| I think the article makes a valid point: stop worrying about
| 90% of the other stuff and focus on the thing that will almost
| certainly kill you - heart disease - for which there are easy
| diagnostic and preventative measures. I think they're arguing
| for a better allocation of resources, if anything.
| ericmcer wrote:
| Isn't the global population like 50% obese? What is your
| actual risk of dying from it if you are relatively in shape
| and in your 40s?
| Fire-Dragon-DoL wrote:
| We don't know how to treat obesity 100% though
| xandrius wrote:
| Yep because the system around you wants you to consume to
| obesity.
| rootusrootus wrote:
| It depends. Overall, lowest all-cause death indexed on BMI
| seems to be around 27 plus or minus [0]. Interestingly, for
| all subjects (not just healthy non-smokers), BMI 30-32
| isn't really associated with a dramatic increase in all
| cause mortality.
|
| Obviously life is more complicated than just one measure. I
| figure this is just another data point saying BMI is useful
| for population studies and not great for individual
| diagnosis.
|
| [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10321632/
| AstroBen wrote:
| I think people should be mindful of it since they were 18 -
| it's something that progresses over decades. You can have a lot
| bigger impact making changes when you're young rather than at
| 40
|
| But yeah I agree with your message. Focus on the big impact
| macro level things. Hyper-optimizing it is a waste of energy
| Fire-Dragon-DoL wrote:
| If I'm not wrong, it takes 20 years to revert the damage of
| smoking. I don't think you need to care at 18, but the
| effects will be seen over the course of 20 years
| ericmcer wrote:
| Seriously there is too much shit to worry about to micro manage
| each facet, unless your like a Bryan Johnson billionaire with a
| staff.
|
| Beyond just heart disease & cancer taking you out entirely its:
| my eyesight is going, my hearing, every joint in my body could
| fail, my brain is slowing, etc.
|
| There is just way too much shit to do anything other than be
| like: sleep, exercise, eat better and don't drink too much.
| jokoon wrote:
| yeah, always the usual: eat better and do physical activity
|
| unfortunately, depression cripples my motivation to do physical
| activity
|
| I still do some, but it's never enough
| tschellenbach wrote:
| You can run a full blood panel on your whoop by clicking a button
| and showing up at a quest diagnostics
| m_a_g wrote:
| I'd argue that even the CT scan is unnecessary for a lot of
| people who want to start a preventative regimen to tackle heart
| disease. Especially if you're in your 20s or 30s with no family
| history of heart disease and no absurdly high ApoB results
| combined with really high lp(a).
| righthand wrote:
| Really surprised at the last few paragraphs! Read with caution
| this is not Real medical advice!
|
| This was a good read until they recommended using ChatGPT instead
| of working with your doctor. Also they have some delusion about
| the actual cost of using ChatGPT.
|
| > Pretty incredible. Also free.
|
| Not free at all. Not a good idea to feed a private corporation
| your health data!
| ef2k wrote:
| This reminded me of the other extreme to health consciousness:
| the 109 year old that smoked cigars and ate ice cream every night
| [0].
|
| [0] https://youtu.be/BXyfCGDnuWs?t=332
| darepublic wrote:
| My dad went to doctor who was like his friend as long as I can
| remember. Always received a clean bill of health. Until he
| suddenly got heart disease and a stroke on the operating table.
| His doctor basically said that he had seen this coming. Doctors
| secretary, probably twenty years his junior was a stunner.
| AstroBen wrote:
| > what most primary care physicians will do with patients to help
| them avoid heart disease is not enough. The status quo simply
| does not work
|
| The reason the status quo doesn't work is that people don't
| actually follow the guidelines set
|
| Barely anyone (like 10% last I saw) meets the recommended amounts
| of fruit and vegetable intake or exercise. We're all addicted to
| terrible foods, are sedentary, have high blood pressure and are
| overweight
|
| Before you start micro optimizing everything just fix your diet,
| avoid saturated fat and sodium and get enough moderate intensity
| or better exercise every week
|
| The 95/5 of it is just basic stuff everyone knows and yet barely
| anyone does
| joquarky wrote:
| Unfortunately, the time in our lives when we need to most pay
| attention to these things is when ageism kicks in and yeets us
| completely off of health insurance.
|
| I'm coming up on two years unemployed and feel like an idiot for
| not better preparing for ageism in our industry. I foolishly
| assumed that experience would make up for age.
|
| Don't make the same mistake! Plan to have most of your income
| shrink drastically in your mid-40s.
| tlarkworthy wrote:
| well that inspired me to research getting those tests in Germany.
|
| => heart panel plus
|
| https://en.minu.synlab.ee/heart-panel-plus/
|
| I don't need doctors, I can get ChatGPT to analyse the results.
| embedding-shape wrote:
| The author says this about smoking:
|
| > If you smoke, don't. It's going to kill you.
|
| And then this about alcohol:
|
| > I think it's unreasonable to tell people not to drink alcohol
| if they like it.
|
| Why is it unreasonable to tell people not to drink alcohol, but
| reasonable to tell people to stop smoking? Shouldn't the smoking
| section also get a "at least make sure it's really good tobacco
| that you enjoy and don't smoke too much of it"?
|
| It seems like the personal preferences (don't like smoking, but
| does like alcohol) is getting in the way of their medical-but-
| not-medical advice, instead of being able to apply their
| recommendations equally regardless of what they personally like.
| 6510 wrote:
| If you tell people they cant drink they kill you.
| embedding-shape wrote:
| I've never told anyone to stop drinking alcohol, yet drunk
| people keep killing sober people all the time. So what would
| the difference be?
| mrtksn wrote:
| For alcohol, the default is social drinking which is why you
| don't have widespread alcoholism in most countries where people
| consume plenty of alcohol. For smoking the default is constant
| nicotine top up(the nicotine delivery is instant, lasts seconds
| to minutes and the withdrawal symptoms starts in an hour). Both
| harmful of course but the alcohol has much less harmful
| defaults.
| SalmoShalazar wrote:
| The inconvenient truth that the vast majority of adults refuse
| to acknowledge is that there is no safe level of alcohol. Any
| drink is going to damage you, marginal though it may be.
| Unfortunately the healthiest thing you can do is simply never
| drink alcohol.
| gehsty wrote:
| Eat healthier (less processed foods, more fruit and veg, healthy
| carbs, low sugar and alcohol), exercise regularly and get enough
| sleep. Take a blood pressure measurement every week / month or
| so. Track your weight. React if either start going up. Don't go
| start getting uneasy ct scans.
| programmertote wrote:
| > All of these can be accessed through bloodwork and urinalysis
| and can be done at a local Quest Labs (I'd venture to bet there's
| one within a 10-mile radius of your home), prescribed by your
| doctor, and will likely cost anywhere between $80-$120 out of
| pocket.
|
| A frustrating thing about this suggestion -- if I tell my
| physician (I live in the US) that I want these unusual tests
| prescribed, s/he would scorn at me (as if I'm acting like a know-
| it-all and am questioning his/her wisdom attained through years
| of medicine school and practice).
|
| I truly don't understand about US healthcare is why we allowed
| medical practitioners to put up barriers around medicine (sure,
| ban opioids,chemo drugs and maybe a handful of other toxic-with-
| low-dose meds) and testing by requiring everything doctor's
| prescription?!
|
| For example, my wife had an swollen eyelid (through infection)
| recently. She is an oncologist in training (is a board-certified
| internal medicine doctor). She knows how to treat it -- by
| putting clean, warm cloth over her eyes to allow pores to expand
| and let secretions seep out (to treat the symptom); by adding
| anti-bacterial eye drop like Tobramycin ('mycin' means it's
| Penicillin-variant, which is usually used to treat bacterial
| infection) OR by taking antibacterial medicine like Azithromycin.
| If we were in our home country (in SE Asia), we'd just go to a
| nearby pharmacy and buy either the anti-bacterial eye drop or
| pill, and get it sorted. Since we live in the US (for now), my
| wife has to asked one of her coworkers to prescribe her the
| medicine (she wasn't sure if she can self-prescribe because we
| just moved to CA and don't want her to lose her license). Then
| she took the anti-bacterial pill three times (with the warm cloth
| treatment for symptom), and the infection was treated completely.
|
| I strongly believe that this kind of infection treatment or self-
| prescribed blood tests should be allowed without any doctor
| prescription. Otherwise, it only adds more (unnecessary) patient
| volume to doctors, clinics and hospitals. I remember reading
| someone from India advocating for similar approach on HN or
| Reddit a year or so ago too. In India (just like my SE Asian
| country), they could just go buy medicines over the counter from
| a local pharmacy. No doctor's prescription needed (maybe the law
| is there, but it's not enforce strictly).
| phainopepla2 wrote:
| For the blood tests, at least, you can get them directly from a
| lab with no physician gatekeeping.
| goblin89 wrote:
| It seems to be nearly impossible for me to advocate for myself at
| a place like a hospital.
|
| It might be easier to do this for someone else, but it seems
| narcissistic to assume _I_ of all the patients is so special. If
| there's nobody to advocate _for me_ , clearly I'm not!
|
| Let's say I try it anyway. I tend to be a slow rational thinker
| in real-time situations, especially under pressure. If I try to
| advocate for myself and ask questions, I would need to have time
| to consider the responses (did I even get the information I
| requested, what are the implications) and maybe do some research
| in order to make an informed choice as to whether to proceed or
| not, or whether to ask further questions. However, if I actually
| request time and have people wait for me, I enter a high-pressure
| mode in which I can't think well. The clock is ticking, the
| stakes are high.
|
| Even if it's a simple routine case, I am entrusting myself to
| people who have the power to kill me. If it's anything beyond
| routine, killing or harming me may not even be consequential to
| them (mistakes happen). It is a very particular type of
| situation.
|
| The natural thing for me to believe is that all of these people
| are professionals. If I have reasons to supervise them, it
| automatically implies I believe they are either unprofessional or
| malicious, in which case I really should not be there in the
| first place. The arrangement is that I am not supposed to know
| better than them. If I try to supervise them, that implies I
| think I do. At worst it would be disrespectful or offensive and
| would make them hostile on a personal level (which is always at
| play between humans, regardless of the protocol), at best it
| would make me look like a crackpot not to be taken seriously
| anyway. Besides, if I already assume they make mistakes or are
| unprofessional, their answers can be false anyway.
|
| On the other hand, I am aware that many, many mistakes are made
| in hospitals daily, so I know they are not such infallible
| professionals.
|
| As a result, this makes me very reluctant to go to a hospital or
| a clinic for any reason. It's probably bad.
|
| Anyone has advice for overcoming this? Maybe training to think
| quickly and finding ways out in high-stakes situations like this?
| Tricking yourself into a mode where you feel natural advocating
| for yourself and act in a way that makes people treat you
| seriously without being offensive to them (considering the power
| they have over you)? Learning to not care what people think in a
| healthy way? (Please don't suggest LLMs.)
| Fire-Dragon-DoL wrote:
| That would be useful for me too, similar problem
| deadbabe wrote:
| Unless you're willing to take pills the rest of your life,
| spending a ton of money to study your risk of heart disease is
| always going to lead you to the same conclusion: Don't smoke,
| don't drink, eat healthy and exercise regularly.
| ambicapter wrote:
| > Even while working with incredible infectious disease doctors,
| I still had to fight and constantly remind people what the next
| steps were during our admission.
|
| Can't help but feel this is a factor of the sleep deprivation
| that doctors seem to celebrate.
| bebb wrote:
| Read the article, felt worried.
|
| Came back here and read all the cynical and critical comments,
| felt a lot better.
|
| Thanks guys.
| reducesuffering wrote:
| "This means regular exercise (both strength training, ideally 3x
| per week, and cardio training that helps to improve V02 max like
| Zone 2 training)"
|
| Actually, V02 max is best improved through High Intensity
| Interval Training (HIIT) like doing 400m sprints 8x with a couple
| minutes rest inbetween. V02 max is famous for being one of the
| best predictors of longevity.
|
| Zone 2 training (light jogging) is important in tandem (80% of
| exercise ideally), especially for overall cardiovascular health
| and lowering heart rate.
|
| Best thing I ever did for my health was start running (mostly
| jogging) 4-5 times a week. It's amazing how much your health can
| be improved with 4x 45 minute jogs (just 3 hours/wk). I can
| consume practically any caloric food for needed energy and all my
| health metrics have been substantially linearly increasing since
| I started.
|
| "the stuff that's not good for you: pasta and pizza and bread."
|
| Tell that to the paragons of fitness in marathon running or
| olympic swimming. There are none of them on low carb. The best
| cardio health requires cardio exercise and cardio exercise
| requires carbs as energy. Of course if you're not going to
| exercise and are okay with 50th percentile health, ya carbs will
| hurt you then because youre not using them.
| giardini wrote:
| The discussion seems unduly focused on lipids, whereas I would
| think that _blood pressure_ would be a, if not _the_ , primary
| concern.
|
| Also for those who _do_ take blood pressure medication: _never
| quickly change the dosage_ , and especially _never quit taking_
| it w /o supervision!
|
| I've seen several untimely deaths b/c someone ran out of their BP
| medication and could not get to a pharmacist quickly enough.
| Alternatively the person became irritated with the medication and
| simply stopped taking it.
|
| Maybe part of starting BP medication should be the doctor giving
| you a "safety package" that includes a full month's worth of the
| drug and is to be put on a shelf somewhere where you can get to
| it should your usual prescription run out.
| maxnevermind wrote:
| I was also surprised by that. It is relatively cheap to measure
| as you can just buy BP monitor and do it yourself at home.
| Considering that high BP is very often asymptomatic, I, for
| example, even feel better with high BP, many people walking
| around accumulating damage for years. Not to mention it also
| goes with a baggage of other side-effects like increased
| chances of a stroke and kidney failure. For some reason it hits
| differently when you go eat something salty or drink coffee or
| get all stressed out for now reason and then see increased BP
| with your own eyes. That was what motivated me to stick to a
| better diet, cut caffeine and chill out.
| Beijinger wrote:
| There is an old pharmaceutical product that was available in
| Germany, but can not be obtained anymore. Ouabain /Strophanthin
|
| "Ouabain /wa:'ba:In/[1] or /'wa:beIn, 'wae-/ (from Somali
| waabaayo, "arrow poison" through French ouabaio) also known as
| g-strophanthin, is a plant derived toxic substance that was
| traditionally used as an arrow poison in eastern Africa for both
| hunting and warfare."
|
| It was later found naturally occuring in the human body:
|
| Key Paper: Gottlieb SS, et al. "Elevated concentrations of
| endogenous ouabain in patients with congestive heart failure."
| Circulation. 1992;86(3):846-849. Details: Researchers measured
| plasma EO in 21 patients with severe heart failure (NYHA class
| III-IV), finding mean levels of 1.59 nM--over 3x higher than in
| controls. EO correlated inversely with cardiac index (r = -0.62)
| and positively with mean arterial pressure, but not with atrial
| pressures, suggesting a compensatory role in cardiac output
| regulation rather than simple volume overload.
| tamimio wrote:
| Heart disease is the leading cause for death, but the root cause
| is definitely obesity. There's a an obesity-pandemic that no
| one's talking about it, there should be a national program that
| encourages people getting fit and discourages them from getting
| obese. And by encouraging/discouraging I don't mean some random
| posters posted around, no, things like tax cut for fit people,
| free access to xyz if your bmi is less then abc, cheaper flights
| and insurance if you are fit, and so on.
| dtgriscom wrote:
| > The best time to make the decision to not die of heart disease
| and start taking action is in your 30s and 40s.
|
| And the second best time is now.
| aucisson_masque wrote:
| > I experienced this repeatedly. We were admitted to the hospital
| for over a week when my daughter contracted viral meningitis (the
| scariest experience of my life). Even while working with
| incredible infectious disease doctors, I still had to fight and
| constantly remind people what the next steps were during our
| admission. Nobody is watching over you - it's your job to
| organize things and ensure they're on track. I had to coordinate
| between the infectious disease departments and neurology
| departments and make sure the people doing the lumbar puncture on
| my 9-month-old daughter weren't just residents practicing on my
| child but experts who had conducted the procedure countless times
| before. You must Advocate for yourself and the ones you love.
|
| Don't know why his behavior wasn't noticed more in the comments
| but he's absolutely entitled.
|
| Hospitals and everything have limited resources, by being the
| asshole who request things to go fast for him and only have the
| best of the best to practice on his daughter, he just deprived
| someone else daughter from good care.
|
| This is selfishness, unless the nurses and doctors were napping,
| he shouldn't have that kind of behavior detrimental to everyone
| else. I couldn't read further what he got to say but, coming from
| this man, i don't see how it could be interesting or useful.
|
| I don't have anything to prove it but the whole thing smell
| fishy, when he goes to these 'concierge doctors', of course they
| are going to find things that are not right and were 'missed' by
| his regular doctor. That's literally their business.
|
| if you went there and you were told 'nop, everything is fine.
| Keep doing what you do', you would go back to your GP and forget
| about it. But if he frightens you with bloodwork that show 'not
| optimal' in big red, tells you how wrong your gp is and how you
| should listen to him, you're going to think this guy know so much
| more and deserve my money. It's business.
|
| I trust the national health guidelines: eat healthy, do at least
| 30 min of activity per day and lift weights.
|
| Everything else feel like nuisance, especially coming from folk
| like that.
| mceachen wrote:
| You're conflating advocacy, which indeed he is entitled to,
| with how the hospital is allocating resources and if and how
| they apply competent resources.
|
| Life or death procedures aren't a time for "you get what you
| get and don't have a fit."
| pcl wrote:
| [delayed]
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