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Inflammation: Medicine's burning question

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Re: Inflammation: Medicine's burning question

#91

Post by carbocation »

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…

In talking about pseudo-intellectual dismissals, I am appealing to the prior news.YC discussions about middlebrow dismissals, which would have been better wording. Sorry about that. How is what I mean different from an appeal to authority? Mostly it has to do with the type of evidence selected by statin "opponents", which tends to be of lower quality.

As for studies that I find instructive, here are a few:

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. [1]

Mendelian randomization demonstrates that genetic scores for LDL cholesterol associate with reduced risk of myocardial infarction (suggesting causality, since cholesterol doesn't reverse-cause a genotype).[2]

IMPROVE-IT showed that a non-statin medication (ezetemibe) added to a statin regimen further reduced the risk of second heart attacks after suffering a first heart attack. This is probably the clearest experimental evidence to date that suggest it's not only statins that reduce cardiovascular risk, but LDL-cholesterol reducing agents more generally that lead to reduced risk of heart attack. [3]

This is a very contemporary summary of genetic and clinical trial data; there is a wealth of older data that I won't get into.

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

2 = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419820/

3 = http://www.nejm.org/doi/full/10.1056/NEJMoa1410489

Re: Inflammation: Medicine's burning question

#92

Post by carbocation »

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…

The interventional studies which have clearly demonstrated an effect of diet on cardiovascular risk are the Lyons Heart Study (for prevention of a second event after a first) and the PREDIMED study (for primary prevention). The broad takeaways are that a Mediterranean diet may reduce risk, and more specifically, supplementing a diet with extra-virgin olive oil and some nuts seems to be beneficial.

The magnitude of the effect of diet (for people without specific monogenic dyslipidemias) is not large, probably in part because most cholesterol in the body is produced by the body.

In many circumstances – especially in the case of familial hypercholesterolemia – diet and exercise will not achieve an acceptable risk reduction. I would conclude by saying that your GP could have engaged with you more effectively to achieve a mutually agreeable outcome. Nevertheless, if you think "cholesterol == unhealthy", this is an acceptable gestalt understanding under the modern Western diet.

Re: Inflammation: Medicine's burning question

#93

Post by LordKano »

jpmattia wrote: post #82
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…

> 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 conv…

I had an issue a few years ago.

I was having frequent acid reflux and 2-3 nights a week, I'd wake up choking on it. This lead to issues with difficulty breathing and shortness of breath.

My doctor treated me with an inhaled steroid for the breathing difficulty and a PPI for the reflux. This helped but it didn't fix the problem. I'd wake up choking once every couple of weeks and this was not acceptable to me.

I started googling for my symptoms and I found someone who had a stomach infection that was causing his reflux, when he treated that infection, the reflux stopped.

I tried to get my doctor to run tests and he wouldn't. I went to a gastroenterologist and began asking him to test me for infections. He stated that the only possible thing that could survive in the acidic environment of my stomach was H. Pylori and since a gastroscopy didn't find any evidence of ulcers, I couldn't possibly have an H. Pylori infection.

I was insistent that I be tested for it... Two days later, I got a call that I did have an H. Pylori infection and the doctor would call in a prescription.

I took a ten day course of antibiotics and a PPI. Almost miraculously, I was cured. No more stomach discomfort. Almost no night time reflux. I wake up choking maybe once in 6-8 months. I am breathing better. I was damaging my lungs for years and it's taking time to recover from that damage but things are constantly improving.

Basically, I would be in much worse health if I hadn't sought out the experiences of other people and if I hadn't pushed back against the advice of my doctors.

Re: Inflammation: Medicine's burning question

#94

Post by brandonmenc »

QSIITurbo wrote: post #90
brandonmenc wrote: post #86

Earlier quoted context omitted.

> 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.

I agree with you - we're just getting our signals crossed.

My unspoken advice was, "under doctor supervision," which I assume everyone understands (I know, a lot people don't.)

You can get a genetic test for FH, but afaik they're rarely performed, although maybe the OP needs one to convince them they really have the condition.

What I suggested was to follow the doctor's advice and, later, under their supervision, adjust statin dosage after lifestyle changes to see if the condition is still present. I'm not a doctor, but I know that my friend's doctor did exactly this - not as a way to convince them they had FH (they were already convinced), but to see if they needed that high of a statin dosage (they did.) That may be what the OP needs to be convinced, while also staying safe.

We both agree that the OP needs to be convinced that they have FH as soon as possible, and should do nothing regarding their treatment without a doctor's approval.

Re: Inflammation: Medicine's burning question

#96

Post by copperx »

jawilson2 wrote: post #84
copperx wrote: post #20

Earlier quoted context omitted.

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…

That's great! I've saved the document.

Seeing now that you were a neurology prof, I have a question.

About 10 years ago I followed a diet similar to the [Slow Carb Diet](https://en.wikipedia.org/wiki/Slow-Carb_Diet) in order to lose fat slowly over a long period of time. One of the unexpected side effects was that I felt extremely clear-headed. I was doing software development at the time and I remember being able to breeze through some thinking tasks. Years later, I was feeling foggy so I used Modafinil and it gave me a similar effect. The low-carb acted as a nootropic on me.

Is there any mechanism that you know about that could make this possible?

Or was it all on my head?

Re: Inflammation: Medicine's burning question

#97

Post by gone35 »

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…

[T]his (perhaps wrongly) smacks of appeal to authority.

Don't dismiss appeals to authority so easily. As it happens, not giving extra weight to experts in proportion to their track record is a provably suboptimal strategy in an adversarial setting (see e.g. [1]). So, in this sense, deferring to trained medical opinion might in fact be the most responsible thing to do.

Note however the bounds in [1] also (indirectly) imply you are better off with a diverse ensemble of expert advice. So if you can afford it, always get a second (or third) reputable medical opinion. And weigh their advice accordingly.

[1] http://www.mit.edu/~9.520/spring08/Classes/online_learning_2...

Re: Inflammation: Medicine's burning question

#98

Post by hackercomplex »

I think there's something to the acid/base thing and I think it's connected to inflammation.

I recommend a vegan diet. Juice celery, and everything else.. drink it soon after juicing don't put in tha fridge. Juice about a half pound of raw cannabis per week if you can (it's not cured so it won't get you high)

and uh.. drink lots of h2o.

Re: Inflammation: Medicine's burning question

#99

Post by shanusmagnus »

jpmattia wrote: post #82
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…

> 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 conv…

Agree 100%. The corollary is that, if you must play, make sure that you yourself are the best expert of your medical history, symptomology, and candidate hypotheses about what may be going on with your health. This is difficult, and perhaps futile, but the sad truth is that due to time issues (and probably information overload) it's your job to a) bootstrap the MD with whatever is relevant about your condition, and b) sanity-check the MD's decisions.

Failure to do either of those things is likely to result in either suboptimal care in the best case, actively misleading care in the worst. I guess the silver lining is that Google + intelligent and motivated person >= most MD diagnoses in my experience.

Re: Inflammation: Medicine's burning question

#100

Post by noir_lord »

tertius wrote: post #71
calebm wrote: post #61

Earlier quoted context omitted.

I've got some friends who do medical research, and from what they say, "translational research" (getting the latest research into the hands of the doctors actually practicing medicine) is a HUGE problem. I have been advised that if I (or a family member) ever gets some medical condition, that if I do a few hours of reading up on the latest research on that condition, chances are that I will be better informed on that…

Probably, but your ability to process the information is severely limited to someone who has be trained on how to do so. And I'm not saying that your doctor has been trained to do so.

My faith in Doctors is pretty much at an all time low.

I kept having bouts of extreme pain with really strange symptoms, Doc's said Reflux but I kept saying it didn't fit the pattern, a dozen AE (ER) visits later and I got a Doc who told me to insist on an MRI.

Turns out I have Syringomyelia, a serious and rare spinal condition which the radiologist spotted by accident as it was on the edge of the scan, he then did a bunch more images and they saw the syrinx.

The next doc I saw I needed an endoscopy and they said the results where abnormal, so I looked into the condition, when I went to see the gastro doc I asked him if the cells where "high" or "low" grade dysplasia and his snarled response "Oh, trying to be a doctor eh", "no, just trying to be an informed patient".

I requested a different gastro doc after that, I read everything I could get my hands on and I'm not stupid, I understand my condition well enough to ask good questions at least.

So yeah, not a massive fan of Docs at the moment.

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