Live data from Hacker News

Inflammation: Medicine's burning question

newyorker.com

81–90 of 160 posts

Re: Inflammation: Medicine's burning question

#81
post #76

Earlier quoted context omitted.

How is you tryglyceride levels? That should be easy to change with just a diet alone. I believe it is due to consuming excess calories than you really need.

Trigs were fine. Overconsumption is certainly one more thing for me to look at.

Broda Barnes book [1] says, iirc, that high cholesterol levels are basically diagnostic of hypothyroidism. Usually people's superficial thyroid lab #'s look fine (TSH), but their body is not properly activating T4 -> T3.

[1] https://books.google.com/books?id=TJXf2ZqoxUIC

Re: Inflammation: Medicine's burning question

#82
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…

> What disappoints me the most here is now that I feel like it's all on me to determine what my real risk levels are and what's appropriate to treat this.

A convoluted set of circumstances led me to a quick detour in grad school, to sit in on Anatomy at Harvard Med. This included the dissection portion, in which four med students hunch over the cadaver for 3-4 hours at a time. It lead to some of the best medical conversation I've had in my life.

The best topic was summarized as: When you visit a doctor, odds are that he/she has about 15 minutes to an hour to evaluate you before moving onto the next case (often because there are bills to pay.) If you are not an expert on your particular medical history and circumstances, then you are basically screwed, because there is nobody human who can digest all of your medical history and circumstances in the allotted amount of time. It still essentially holds true if you have some serious condition: Consider all of the other patients on the doctor's plate.

That, combined with several other stories and experiences, had a big effect on me: It became obvious that it is worth enormous amounts of time and money to keep fit. When it comes to the med community, the only way to win is not to play.

Re: Inflammation: Medicine's burning question

#83

Earlier quoted context omitted.

Isn't it rather dangerous to give sweeping medical advice to strangers over the internet?

I love the thought that "eat more vegetables" constitutes dangerous advice.

The instructions were more along the lines of "eat nothing but vegetables and ignore your doctor".

Re: Inflammation: Medicine's burning question

#84
post #20
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…

I recently visited my GP and I had a high cholesterol reading. He suggested me to reduce sugars and white flours, get a reading in a month, and depending on that he'll decide whether to prescribe statins. It surprised me that he didn't mention reducing saturated fats or meat consumption. It made me wonder whether refined carbohydrates play a role in high cholesterol. I think I'll have to take a look at the research.

I've collected a lot of research on low-carb diets. In my previous job as a neurology professor, I had access to all of the most medical journals, and was able to save a lot. I have been on a ketogenic diet for 2 years now, and my LDL cholesterol went from 180 to 130, my HDL from 28 to 80, and my triglycerides from 140 to 75. Plus, I lost 70 pounds, no migraines for 2 years, and my anxiety and depression have all but disappeared. 75% of my calories are from fat (50/50 saturated/unsaturated, mostly from red meat, oils including coconut, olive, and avacodo, butter, plus a TON of vegetables). This is pretty typical.

https://drive.google.com/open?id=0BzEPvoDPVTV5SzJlSHV0Y21rZ0...

On page 29, there is a cool paper showing ultrasound cross-sections of blood vessels before and after a low-carb diet, and the resulting dramatic decrease in inflammation.

Re: Inflammation: Medicine's burning question

#85

Earlier quoted context omitted.

> No further questions about what I eat, my stress levels, lifestyle - nothing. A friend has familial hypercholesterolemia - cholesterol levels were around 1000 as a child, on statins since like, age 10. At their request, the doctor dialed back the statin dose and cholesterol levels shot back up within days - even on a vegetarian diet with plenty of exercise. They asked if they could start eating egg yolks again and…

Absolutely, agree with all of that. What I'm moaning about is the absence of desire to explore further. I don't know if I've had high cholesterol for a long time or not or whether it's lifestyle or not, or whether I do actually have a 1 in 500 genetic mutation that means that my liver doesn't process cholesterol correctly or not. I want to look into some of those possibilities a bit more before I take drugs for the r…

The thing is, if you have familial hypercholesterolemia, some forms have life expectancy of 35 without medications. Patients might have severe atherosclerosis at the age of 10. There is a seriously heightened risk of CVD mortality without statins no matter what you eat or how hard you exercise if you really have it. So in that case your doctor is correct: there's nothing you can do but take medication. But what were your lab results for LDL?

Re: Inflammation: Medicine's burning question

#86

Earlier quoted context omitted.

Absolutely, agree with all of that. What I'm moaning about is the absence of desire to explore further. I don't know if I've had high cholesterol for a long time or not or whether it's lifestyle or not, or whether I do actually have a 1 in 500 genetic mutation that means that my liver doesn't process cholesterol correctly or not. I want to look into some of those possibilities a bit more before I take drugs for the r…

The thing is, if you have familial hypercholesterolemia, some forms have life expectancy of 35 without medications. Patients might have severe atherosclerosis at the age of 10. There is a seriously heightened risk of CVD mortality without statins no matter what you eat or how hard you exercise if you really have it. So in that case your doctor is correct: there's nothing you can do but take medication. But what were…

> some forms have life expectancy of 35 without medications

This. You don't have a lot of time to experiment.

My guess is it's best to listen to your doctor and get on statins immediately. Then alter your diet and activity level, and after that try cranking back the statin to see if the lifestyle changes took.

Re: Inflammation: Medicine's burning question

#87

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…

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).

This. It's rather unsettling to see so many well-meaning posters gleefully rejecting prescribed statins. They are playing with their health.

Re: Inflammation: Medicine's burning question

#88
post #55

Earlier quoted context omitted.

Take matters into your own hands and change your diet. Nothing beats a high anti-inflammatory whole-foods plant-based diet. Check the research.

> whole-foods plant-based There should be a lot of veggies, of course, but people seem to think that meat is evil and bad for you. There's a lot of very good reasons to eat lean meats, fish and grass-fed ruminants.

Well, there are plenty of recent studies that suggest that high-protein diets, and ones with a lot of meat in particular, are associated with increases in the rates of several cancers. But to just to play devil's advocate, why eat meat when you don't need to? I've seen some studies suggesting eating fish has health benefits (though there's the problem of pollution in the oceans), but I can't say I have seen anything that would actually recommend red meat, no matter how wholesome the source.

Re: Inflammation: Medicine's burning question

#89
post #50

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…

In controlled, randomized trials and in genetically-driven studies (the two most powerful tools that we have to assess causality), almost all factors that reduce LDL-cholesterol lead to reduced ischemic heart disease and death.

Your commentary about statins being primary useful for secondary prevention (in those who have already had a heart attack) was true until a couple decades ago, but there is now evidence demonstrating that statins reduce primary events (though at a high NNT depending on the population's risk). Naturally, the higher risk the population, the more benefit and lower NNT you will see from any intervention.

A classic genetic study, for example, is that of Hobbs and Cohen looking at PCSK9 variants [1]. People with loss of function mutations in PCSK9 have lower LDL-cholesterol. These people have an even lower risk of ischemic heart disease than you would expect based on the degree of LDL-cholesterol lowering. This is surmised to be due to the lifelong exposure to low LDL-C, though the actual reason is not currently known with certainty.

1 = http://www.nejm.org/doi/full/10.1056/NEJMoa054013

Re: Inflammation: Medicine's burning question

#90

Earlier quoted context omitted.

The thing is, if you have familial hypercholesterolemia, some forms have life expectancy of 35 without medications. Patients might have severe atherosclerosis at the age of 10. There is a seriously heightened risk of CVD mortality without statins no matter what you eat or how hard you exercise if you really have it. So in that case your doctor is correct: there's nothing you can do but take medication. But what were…

> some forms have life expectancy of 35 without medications This. You don't have a lot of time to experiment. My guess is it's best to listen to your doctor and get on statins immediately. Then alter your diet and activity level, and after that try cranking back the statin to see if the lifestyle changes took.

Lifestyle or dietary changes don't work if he has familial hypercholesterolemia. You're not supposed to ever adjust your medication without consulting your MD. It's a good general rule that - when broken - can have fatal consequences in serious diseases such as this.
Post reply on HN