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Inflammation: Medicine's burning question

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Re: Inflammation: Medicine's burning question

#41

Post by coldtea »

boothead wrote: post #35
coldtea wrote: post #31

Earlier quoted context omitted.

On the other hand your GP examined you and has an actual medical degree while you just read some articles on the internet...

Yes, this is a very good point that I try to keep uppermost in my mind. The thing is though that I'm not sure that having a medical degree and several years as a GP actually gives you much more of a grounding in non-drug therapies than someone who can read the original research (or in my case well referenced and balanced synopses of said research by people who's opinion I trust). Which is where my vague sense of disa…

>actually gives you much more of a grounding in non-drug therapies than someone who can read the original research

I don't think one can actually "read the original research" (with the all the prerequisite and pressupossed knowledge that entails) without either having been to medical school and have similar training of his own to such a level.

Having access to said research and being able to read it (in the nominal sense) is not the same as actually being able to "read it" (e.g. understand all that it entails, even things that are not explicitly said).

Even less so for "well referenced and balanced synopses of said research from people one's trust" unless said people are doctors AND have examined you personally. Some well respected pop science journalist's online synopses won't cut it.

In case you doubt your doctor's results, which can of course be not up to par (doctors are fallible too) the prudent thing to do would be to seek counsel with another doctor(s) for a second opinion.

Re: Inflammation: Medicine's burning question

#42

Post by ejstronge »

boothead wrote: post #39
carbocation wrote: post #30

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 r…

I think this is a bit unkind: > dismissed in a pseudo-intellectual manner by people who know a lot (just not about the subject at hand). I'm the one who's potentially sick here, and this (perhaps wrongly) smacks of appeal to authority. What I absolutely don't want to do is disregard medical opinion, but neither am I inclined to abdicate all responsibility for my own health and well being. > The genetic data currently…

>> 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

> I'd be very interested in learning more about this, do you have anything you could recommend?

I'll let the OP chime in if I'm wrong but I believe s/he is referring to the numerous genetic association studies[1] that have implicated LDL biology in coronary artery disease. Look at ref. 2 for a publicly-accessible review. The article details the genes that have been associated with coronary artery disease, none of which appear important for inflammation.

1. https://en.wikipedia.org/wiki/Genome-wide_association_study

2. http://circ.ahajournals.org/content/128/10/1131.full

Re: Inflammation: Medicine's burning question

#43

Post by ejstronge »

boothead wrote: post #15
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…

Having skimmed over, one indication that my GP isn't up to date is that the lipid test is no longer required to be a fasted test, whereas mine was. Interestingly the specialist lipid clinic has also asked for a fasting test.

I'm coming from the US, but the tests that are run by a doctor are often constrained by what the nearby laboratories offer. New, validated tests may be delayed until the relevant laboratories deem them to be cost-effective.

Re: Inflammation: Medicine's burning question

#44

Post by medymed »

carbocation wrote: post #30

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 r…

When the "system" becomes an adversary in one's fight for health, as a result of cost, restricted access to doctors and their time, and when an ocean of credible (and non-credible) information is available relating the mechanistically uncertain world of medication, it is not surprising to see many people feel as if they have looked behind the curtain in a wizard of Oz sense and begin reaching for alternatives. Statins are probably among God's greatest gifts to most people with high LDL as clinical trials show, but many in the HN community might be willing and able to make drastic lifestyle changes that other individuals are incapable of. Many entrepreneurial and data-driven types have the thick headedness to be that 1% of patients for whom lifestyle changes work, or at least we like to think so. In any case, starting a statin (in the case below) and then proving to oneself that one is supreme commander of diet and metabolism may be the optimal route. The issue lies in which pathway to choose for our attempt at supreme commandership--ketogenic, paleo, low trans fat, etc. Once again, the results are unclear in some trials and the mechanisms are as elusive as ever, which is why we reflexively search for explanations in the fey realms of inflammation, microbiome, epigenetics, and so forth. Addendum: Most clinical trials are aimed at helping the general population with a specific condition; it would be interesting to try clinical trials of diets in only highly educated and fairly affluent people who know python (usually not part of the subgroup analysis).

Re: Inflammation: Medicine's burning question

#45

Post by boothead »

coldtea wrote: post #41
boothead wrote: post #35

Earlier quoted context omitted.

Yes, this is a very good point that I try to keep uppermost in my mind. The thing is though that I'm not sure that having a medical degree and several years as a GP actually gives you much more of a grounding in non-drug therapies than someone who can read the original research (or in my case well referenced and balanced synopses of said research by people who's opinion I trust). Which is where my vague sense of disa…

> actually gives you much more of a grounding in non-drug therapies than someone who can read the original research I don't think one can actually "read the original research" (with the all the prerequisite and pressupossed knowledge that entails) without either having been to medical school and have similar training of his own to such a level. Having access to said research and being able to read it (in the nominal…

Yes you're absolutely correct, I'm waiting for a referral to a specialist at the moment.

WRT to my examination though: it didn't go beyond having bloods done. There was no other investigation other than, wow your LDL is really high.

My go to source for understanding this stuff is Peter Attia [1], and a few other independent researchers.

[1] http://eatingacademy.com/nutrition/the-straight-dope-on-chol...

Re: Inflammation: Medicine's burning question

#46

Post by ejstronge »

kefka wrote: post #34
TeMPOraL wrote: post #26

Earlier quoted context omitted.

> 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…

You can count me in on the group that "is not taking the drugs proscribed by the doctor". Type 2 diabetic, and on my way back out of that disease. And I made that informed choice. Statins do not work well with my family history. That was disregarded by doctor. I also said I wanted to try a diet of low/no carbs and testing vigorously in a term called "eating to the meter". Instead proscribed Metformin. Also doc quoted…

I want to comment on the version of your comment that you edited.

You stated that you believe a blood glucose of 140 mg/dl would cause diabetic neuropathy whereas your GP quoted a blood glucose of 150 mg/dl as causative of diabetic neuropathy.

It doesn't seem like things are as starkly different as that. Patients usually develop diabetic neuropathy over many years, so it's not clear that your GP would have 'guaranteed you diabetic neuropathy'.

Re: Inflammation: Medicine's burning question

#47

Post by coldcode »

dspillett wrote: post #16
atomical wrote: post #9

Earlier quoted context omitted.

It comes down to diet. My LDL is 66 and my HDL is 75. I don't eat eggs, meat, or cheese. Basically, nothing that has cholesterol. My numbers will probably be even better this year. I have looked at /r/keto and /r/paleo. Their cholesterol numbers aren't good.

Recent research suggests that cholesterol directly in food isn't a major problem because most of it passes through the digestive system untouched. The problem is actually cholesterol produced by the body using other substances. 80% or more of the cholesterol in your body is produced by your body, no more than 20% of it comes from your diet unless your diet is particularly unbalanced in that manner. The reason cholest…

It's not even all that recent, I took some nutritional biochem classes in the late 70's and the professor said repeatedly that dietary cholesterol was not a big factor in what was in your blood as the molecule was too big to pass through the intestinal wall. What is made by the body (generally from a fatty diet) matters.

Re: Inflammation: Medicine's burning question

#48

Post by rogeryu »

boothead wrote: post #39
carbocation wrote: post #30

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 r…

I think this is a bit unkind: > dismissed in a pseudo-intellectual manner by people who know a lot (just not about the subject at hand). I'm the one who's potentially sick here, and this (perhaps wrongly) smacks of appeal to authority. What I absolutely don't want to do is disregard medical opinion, but neither am I inclined to abdicate all responsibility for my own health and well being. > The genetic data currently…

You might want to read the book Why Zebras don't get Ulcers by Robert Sapolsky. It's about stress, all aspects of it. So it's not about inflammation, although inflammation means stress and in that regard it is covered - you might find it interesting.

Be prepared for lots of chemical terms, but don't let that hold you off - there's enough interesting stuff to read. It has lots of interesting information.

https://en.wikipedia.org/wiki/Why_Zebras_Don't_Get_Ulcers

Re: Inflammation: Medicine's burning question

#49

Post by boothead »

medymed wrote: post #44
carbocation wrote: post #30

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 r…

When the "system" becomes an adversary in one's fight for health, as a result of cost, restricted access to doctors and their time, and when an ocean of credible (and non-credible) information is available relating the mechanistically uncertain world of medication, it is not surprising to see many people feel as if they have looked behind the curtain in a wizard of Oz sense and begin reaching for alternatives. Statin…

I had a long reply to your previous comment written out but you deleted before I could post and it got lost. But I guess what I was saying does boil down to this. I don't have a great deal of faith in the shallow, one size fits all, drug based approach I was offered. I do intend to look at wider options, and you're right that there's a lot of information available. However, I don't intend to do a Steve Jobs. If it looks like I've sustained damage to my arteries already or I can't find an intervention that works then I'll revert to the suggested route.

Re: Inflammation: Medicine's burning question

#50

Post by briHass »

carbocation wrote: post #30

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 r…

>there is crystalline evidence supporting the connection between LDL-cholesterol levels and mortality

The connection is very far from crystalline ([1],[2]) The strong association only seems to appear when considering groups with super high LDL-C levels, likely due to FHC. In any case, the typical approach, statins, has very little positive affect on individuals without pre-existing heart disease ([3],[4])

If vaccines had the same side effects and poor absolute risk reduction that statins have, the anti-vaxers might actually have a point.

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750440/

[2] http://www.crlcorp.com/wp-content/uploads/2013/06/JIMlipidsm...

[3]http://www.thennt.com/nnt/statins-for-heart-disease-preventi...

[4]https://www.sciencebasedmedicine.org/statins-the-cochrane-re...

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