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Avoiding Heart Disease

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Re: Avoiding Heart Disease

#31

Post by danpat »

tansey wrote: post #30

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…

Small backstory and a question for you.

My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc.

As a CS person, I piped up and suggested, tongue in cheek, that the computers were going to take their jobs. This led to a healthy discussion about the human practitioners role in a time when the amount of information they're expected to know is rapidly expanding.

What's your take in the future role of the human in diagnosing and prescribing in a situation like this?

Re: Avoiding Heart Disease

#32

Post by shanev »

It’s great to see other tech people educate themselves about health and help break the stereotypes of the ramen eating, soda drinking nerd. This story reads almost like what happened to my dad last year. He complained of shortness of breath and went to see a cardiologist. He got an angioplasty done, which showed severe calcification of the arteries. The doctor advised him to have a quadruple bypass the very next day. I flew in from San Francisco to be with my dad in the hospital.

After my dad’s surgery, I decided to get more involved in his health. As someone who’s been following a Paleo lifestyle for over 4 years now, I stayed in NJ for 3 months and nursed my dad back to health. I cooked every one his meals for those 3 months. His fasting blood sugar fell from a borderline diabetic value of 121 to a more normal 92. He lost considerable visceral fat around his waist and was looking better than he has in maybe 20 years. All of his blood markers improved.

Good health is both easy and hard. The easy approach is to understand that modern industrialized food is harmful and try to emulate a diet from yesteryear, like Paleo, or your ancestral cultural diet. The flip side of the coin is to dig into science, as you have done, and understand the intriciacies of various blood markers like cholesterol, the difference between small and large particle size, Ha1bc, the various types of short chain fatty acids, figuring out that fat is not a villain, learning the dangerous of low fat foods, etc. I’ve been studying this stuff independently for 4 years, including learning enough biochemistry to get through medical research papers. Everything I have read so far points to a Paleo-type diet being optimal. As an engineer I’m taking the latter approach as I need to prove things to myself before taking it for face value. But for the layman, it’s not really that hard.

Something is wrong in this world when Tom Hanks, with access to the best doctors in the world, announces that he has type 2 diabetes, when I was able to reverse it in my dad in 3 months through diet alone.

I use DirectLabs for my blood work. Crappy site, but very happy with the turnaround time.

Re: Avoiding Heart Disease

#33

Post by claudiusd »

tansey wrote: post #30

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…

I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease?

Now this isn't to say that doctors are bad people who want to make you sick... on the contrary, most of the doctors I know are more passionate about helping people than making money. They are, however, subject to whims of the hospital they work for, which I can almost guarantee is more interested in making a buck than keeping you healthy. This is true of all large companies though, and as Clayton Christensen has taught us, this sort of marginal thinking usually leads to disruptive innovation by a start-up.

Want to disrupt health care? Omada Health is hiring! http://omadahealth.com/jobs

Re: Avoiding Heart Disease

#34

Post by bdesimone »

aaron695 wrote: post #15

> I've been wondering though why didn't I have this level of discussion with my doctor? 1. For starters doctors are good but not super people. The amount of time you can allocate yourself can mean you win via quantity over quality. 2. Tragedy of the commons. Tests that might help you don't necessarily help society. Tying up a machine that helps people with cancer hurts society but might have a benefit to yourself. Wh…

1. Doctors are people like any other. But they've spent years specializing in evidence based medicine. They aren't perfect. No. But they are the best we have.

2. The far bigger problem is doctors order tests that wouldn't change treatment but rather help avoid malpractice.

3. The quote -- every time I read it -- makes me laugh because it's so disingenuous. My wife had a week of dietary training in med school. You know what else she had a week of? Renal. Cardiology. etc. If you think diet and exercise are the only--or even the most effective--means of lowering morbidity for chd (which is what OP is worried about) you'd also be wrong. So I'm not really sure why OP should be looking for a dietary specialist vs a cardiologist.

Re: Avoiding Heart Disease

#35

Post by bdesimone »

claudiusd wrote: post #33
tansey wrote: post #30

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…

I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Now this isn't to say that doctors are bad people who want to make you sick...…

> Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease?

Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really?

You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because you know that the surgical rep will take you out to a nice dinner every time he's in town.

There's a huge population of doctors. Some ethical. Some unethical. But I believe the profession does a pretty admirable job of stamping out immoral behavior when it finds it.

Re: Avoiding Heart Disease

#36

Post by mhurron »

danpat wrote: post #31
tansey wrote: post #30

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…

Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, to…

Doctors offices already have something similar, at least for interactions.

Re: Avoiding Heart Disease

#37

Post by deskglass »

rosser wrote: post #9
eshvk wrote: post #6

Earlier quoted context omitted.

The issue is that doctors give you muddled advice too. I had my blood test done last year and I was told that I should cut down on eating any meat and switch to a plant based diet. He also vaguely told me to do more exercise. Yet, I eat incredibly lean food, albeit high protein mainly because I weight lift. I also run 4.5 miles every other day. He couldn't go into more detail apart from this general warning. I could…

The claim that you can't get sufficient protein for pretty much any level of exercise from a plant-based diet is utterly specious. For example, quinoa is 14% complete protein, and chia is almost 17% — also complete protein — with an Ω3-to-Ω6 ratio of around 3:1, almost exactly the inverse of beef. Source: I'm a vegetarian, and I pay scrupulous attention to this stuff.

You're not going to get much protein from vegetables without a lot of carbs unless you eat protein powder. The two foods you cite are good examples. Quinoa is 71% carb, 14% fat, and 15% protein by calorie. Chia is 36% carbs, 53% fat and 11% protein. If you eat protein powder than it works out fine. (I'm vegan and weightlift).

Re: Avoiding Heart Disease

#38

Post by Amadou »

melling wrote: post #23

Number one leading cause of death: Heart Disease. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate What's scary is that we really don't know much about it. I heard Randell Schwartz (of Perl fame) talk about how the modern carb diet is killing people. He lost 60 pounds by monitoring his carb intake. https://plus.google.com/+RandalLSchwartz/posts/9fYhGYfLNY3

He lost 60 pounds by monitoring his carb intake.

The thing about diets is that everybody has got one that worked for them.

It seems to me that the one thing all of these different diets have in common is that they require the person to monitor what they eat. Whatever the specifics of the diet, the dieter ends up paying more attention to their meals in general and that extra digilgence translates into reduced caloric intake.

I'm not making a judgment on the nutritional value of any particular diet, just the underlying mechanism for why different diets all have somebody claiming that they work.

Even the twinkie diet: http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/

Re: Avoiding Heart Disease

#39

Post by tzm »

danpat wrote: post #31
tansey wrote: post #30

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…

Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, to…

Technically, it's inevitable. Information will be more actionable. http://www-03.ibm.com/innovation/us/watson/watson_in_healthc...

Practically, I think the role of humans will be to create a more human experience and to provide specialized knowledge centers.

Re: Avoiding Heart Disease

#40

Post by graeme »

bdesimone wrote: post #35
claudiusd wrote: post #33

Earlier quoted context omitted.

I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Now this isn't to say that doctors are bad people who want to make you sick...…

> Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really? You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because…

The OP phrased it badly, but the point is sound. Suppose a doctor has a choice of two activities:

1. Read research, unpaid 2. Treat patient, paid

The doctor clearly has an incentive to focus on treating disease. They do read research, but they would surely read even more if they were paid directly to do so.

There's nothing nefarious in this, it happens in any industry. We do more of the things we're paid to do, and less of the things we're not.

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