Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Inflammation: Medicine's burning question

newyorker.com

Post reply on HN
Print view View original

21–30 of 160 posts

Re: Inflammation: Medicine's burning question

#21

Post by epalmer »

Swizec wrote: post #3
boothead wrote: post #2

It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38, fit and healthy and nothing that suspect in my family history. I found the attitude of my doctor in all this quite surprising. It amounted basically to "You definitely have familial hypercholest…

> almost all of the high quality, science based writing I've read indicates that the mainstream healthcare system's view on cholesterol is wrong. My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways. Their job isn't so much to be right as it is to not be wrong . If that means keeping you subopt…

> My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways

I think it is more a matter of relying on what other doctors are doing and as well what they think their patients will tolerate.

I asked my cardiologist and primary care doctor before going on a well formulated low carb diet. they were both in favor of it but noted that they don't recommend these types of approaches, not because they don't work, but because people don't tend to stick with it.

In 3 months I lost 30 lbs (got a way to go still). My primary said that I have not indication now of prediabetes while I did prior to my diet.

For me I decided to take control of what I can in my health. Keep in mind your MMV.

Re: Inflammation: Medicine's burning question

#22

Post by copperx »

Swizec wrote: post #6
DiabloD3 wrote: post #4

Earlier quoted context omitted.

The problem is, there is no research stating that lowering dietary cholesterol leads to lowered blood levels and the reversal of fatty liver disease. There is research stating that fatty liver disease exists due to long term over-production of cholesterol in the liver, caused by low dietary cholesterol, and increasing dietary cholesterol can lead to the reversal of fatty liver disease; and such research isn't really…

> much of it is around a decade old now Has your doctor done any research/training about cholesterol in the last 10 years? I'm being snarky. But I think it's important to consider the lifecycle of doctor careers. If you go to a liver or cholesterol specialist, then I'm sure they will be up to date with even findings from the last year. But I wouldn't expect a GP to be up to date on what every field within medicine ha…

> The actual job of a computer scientist is writing proofs in Coq

I was with you, but then this analogy went too far.

Re: Inflammation: Medicine's burning question

#23

Post by satx »

statins-for-cholesterol is a hugely profitable business pushed hard for decades by BigPharma, going back to a single faulty "study" in the 1950s, after Eisenhower's heart attack.

My opinion is that statins-for-cholesterol, obsession with cholesterol is as big of a medical scam, a BigPharma misdirection-for-profit, as BigFood's "low-fat" and "whole grain", and gluten scams.

Cholesterol is essential, so much so 90% is produced by the liver without any dietary consumption.

Cholesterol + lipids + calcium sticking to arteries is a reaction to an injury, mostly from systemic, low-grade inflammation. High blood pressure also injures arteries, also causing cholesterol plaque.

Some people with high cholesterol have no CVD, while some people with low cholesterol die from CVD. Maybe cholesterol isn't the problem?

Aspirin's help with CVD was initially thought to be due it blood-thinning effect, getting blood through narrowed arteries, but then its anti-inflammatory effect was more reasonable. btw, statins are also anti-inflammatory (aspirin and similar are cheaper).

Systemic inflammation reduced by aspirin (or statins), less injury to arteries, less plaque.

Systemic, low-grade inflammation also reduces insulin sensitivity, so the body produces more insulin, which is a really nasty hormone. result? adult-onset Type II diabetes.

So "I think" watching inflammatory bio-markers is more important than watching cholesterol, as one could take away from the New Yorker article.

An alkalizing, anti-inflammatory diet is key, complemented by both moderate resistance work and moderate cardio exercise, which also reduce inflammation.

"life-style" of diet and exercise is your best "Heal Thyself" strategy, not BigPharma.

btw, chronic, systemic, low-grade inflammation causes chronic high-levels of cortisone (derived from cholesterol) to reduce the inflammation, and wreaks havoc on the immune system, which of course causes inflammation as a response to injury or foreign matter.

Re: Inflammation: Medicine's burning question

#24

Post by kefka »

boothead wrote: post #2

It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38, fit and healthy and nothing that suspect in my family history. I found the attitude of my doctor in all this quite surprising. It amounted basically to "You definitely have familial hypercholest…

Unfortunately, join the club.

I was diagnosed with type 2 diabetes. My initial fasting glucose was 161 and a1c was 7.1 . Not prediabates, but full on type 2.

So what does the GP say? "Here's some metformin. Oh look, high blood pressure. Here's some statins."

So, what do I do? Certainly not the doctor's advice. He didn't even give me the correct blood-sugar level in which damage is known to be caused (neurons die at 140mg/dL, no ifs ands or buts). Doc said 150mg/dL.

I've posted recently in what I'm doing, but esentially comes down to diet. Turns out that net carbs (or total carbs-fiber) is what causes my body to go haywire. Cutting down to about 10-20g carbs has done well for me.

Since doing only pure diet, 6 days is what it took for my body to start to noticeably fix itself. Now, my blood sugar doesn't go over 120, and my wake-up (fasting) glucose has tested at 100 the last 2 days.

Look up "Eating to the meter". If you can't measure, you can't reliably react and project. It's what I'm doing, and it's working. I have my data to prove it.

Re: Inflammation: Medicine's burning question

#25

Post by boothead »

kefka wrote: post #24
boothead wrote: post #2

It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38, fit and healthy and nothing that suspect in my family history. I found the attitude of my doctor in all this quite surprising. It amounted basically to "You definitely have familial hypercholest…

Unfortunately, join the club. I was diagnosed with type 2 diabetes. My initial fasting glucose was 161 and a1c was 7.1 . Not prediabates, but full on type 2. So what does the GP say? "Here's some metformin. Oh look, high blood pressure. Here's some statins." So, what do I do? Certainly not the doctor's advice. He didn't even give me the correct blood-sugar level in which damage is known to be caused (neurons die at 1…

Thanks for sharing. I've taken a similar approach: cut all crap out of my diet and now in ketosis (according to urine strips). Ultimately this might not be the fix for me, and I might have to add some other interventions (like replacing saturated fat with polyunsaturated fat if I turn out to metabolize SFA poorly) but I'm also convinced that the primary fix must be dietary/lifestyle with some limited support from medication if necessary.

Re: Inflammation: Medicine's burning question

#26

Post by TeMPOraL »

epalmer wrote: post #21
Swizec wrote: post #3

Earlier quoted context omitted.

> almost all of the high quality, science based writing I've read indicates that the mainstream healthcare system's view on cholesterol is wrong. My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways. Their job isn't so much to be right as it is to not be wrong . If that means keeping you subopt…

> My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways I think it is more a matter of relying on what other doctors are doing and as well what they think their patients will tolerate. I asked my cardiologist and primary care doctor before going on a well formulated low carb diet. they were both…

> For me I decided to take control of what I can in my health.

But you did that cooperating with your doctors, which is how it should look. The problem with people taking charge of their own health is usually that they completely reject medical professionals altogether because they "know better". It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?", or "the programming establishment still uses this old Ruby stuff, they don't know JavaScript is the state-of-the art solution!".

Knowing better than your doctor can lead to tragic consequences. Since we're in story-sharing mode: just last week my brother's friends saved the life of a guy who was after surgery that involved installation of stents, but for some reason didn't take the prescribed anticoagulants - he just kept the prescriptions stored in his bag and went happy about his life. He slipped up and admitted to taking no drugs on a checkup in the hospital. According to the doctor who was leading his case, he was hours from dying when they figured out what's going on.

Re: Inflammation: Medicine's burning question

#27

Post by dualogy »

boothead wrote: post #25
kefka wrote: post #24

Earlier quoted context omitted.

Unfortunately, join the club. I was diagnosed with type 2 diabetes. My initial fasting glucose was 161 and a1c was 7.1 . Not prediabates, but full on type 2. So what does the GP say? "Here's some metformin. Oh look, high blood pressure. Here's some statins." So, what do I do? Certainly not the doctor's advice. He didn't even give me the correct blood-sugar level in which damage is known to be caused (neurons die at 1…

Thanks for sharing. I've taken a similar approach: cut all crap out of my diet and now in ketosis (according to urine strips). Ultimately this might not be the fix for me, and I might have to add some other interventions (like replacing saturated fat with polyunsaturated fat if I turn out to metabolize SFA poorly) but I'm also convinced that the primary fix must be dietary/lifestyle with some limited support from med…

> if I turn out to metabolize SFA poorly

Is that a thing? Humans metabolizing Saturated Fats badly? I mean, I know of gall-bladder deterioration after maybe years of very-low-fat eating, but other than that. Would these people also weirdly burn their own body fat (saturated) "badly"? ;)

Re: Inflammation: Medicine's burning question

#28

Post by dualogy »

TeMPOraL wrote: post #26
epalmer wrote: post #21

Earlier quoted context omitted.

> My understanding is that a doctor's first job is to be risk averse. That's why they shy away from bleeding edge research and knowledge, and choose instead to rely on proven ways I think it is more a matter of relying on what other doctors are doing and as well what they think their patients will tolerate. I asked my cardiologist and primary care doctor before going on a well formulated low carb diet. they were both…

> For me I decided to take control of what I can in my health. But you did that cooperating with your doctors, which is how it should look. The problem with people taking charge of their own health is usually that they completely reject medical professionals altogether because they "know better". It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript b…

> It makes exactly as much sense as when a manager decides not to hire a programmer, but instead buys himself a JavaScript book, because "how hard can this programming stuff be anyway?"

Hey, worked out splendidly for Derek Sivers!

Re: Inflammation: Medicine's burning question

#29

Post by JeremyNT »

boothead wrote: post #7
DanBC wrote: post #5

Earlier quoted context omitted.

The NICE evidence, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181/evidence The NICE guidance, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181 Your GP should have used more information than just your non-HDL results; they should have given you a standardised risk assessment call QRISK2. http://www.nhs.uk/news/2014/02February/Pages/NICE-publis…

Thank you for those links! I should have been clearer: what bugged me about my interaction with the GP was that he didn't ask about anything to do with lifestyle/diet. When I went looking on my own - everything I seemed to find from the NHS/Heart UK suggested that cutting saturated fat was essential, leading to my conclusion that this is what the mainstream medical establishment still believes.

As somebody in the same situation (same age, otherwise healthy, high cholesterol, regular exercise) my read is that trying to influence ldl in a meaningful way through diet alone is essentially pointless.

You can knock off a few points, and you can raise HDL a bit, but the likelihood of a dramatic reduction is essentially nil. Going right for the statins kind of makes sense beyond a certain point.

That said, I opted out. My gp showed me the risk in the calculator mentioned above and the difference statins made was not large enough for me to justify it.

Re: Inflammation: Medicine's burning question

#30

Post by carbocation »

Somehow LDL-cholesterol has come up in this thread about inflammation.

The article here offers a highly speculative opinion regarding the role of inflammation across many diseases. The luminaries in cardiology cited in this article ran trials which many of us consider to show that, rather than inflammation being important, any reason to start statins is a good reason.

The genetic data currently supports very little role for inflammation in important diseases like coronary artery disease, whereas there is crystalline evidence supporting the connection between LDL-cholesterol levels and mortality. Interestingly, when genetics are invoked and mere epidemiology is reassessed, there is no clear atheroprotective role of HDL cholesterol.

The treatment of statins is very much like the treatment of vaccines: dismissed in a pseudo-intellectual manner by people who know a lot (just not about the subject at hand).

Post reply on HN