Hacker News Reader

Comment by ralmidani | Hacker News Reader

Putting off an annual checkup with a PCP (I’m 42, and the last PCP I had was a pediatrician). I had long suspected my cholesterol and triglycerides were high due to family history and my excessive love for cheese, and last week that suspicion was confirmed. I’m now more resolute than ever on lifestyle changes (exercise, less red meat, getting most of my calcium from 2% milk).

On the bright side, I also got reassurance that outside the lipid panel, everything else (sugar, kidney and liver function, PSA, etc.) seems normal.

Other than laziness and procrastination, a huge part of me was dreading being told I need a prostate exam and colonoscopy, but fortunately I don’t need either for at least 3 more years.

View on HN

> less red meat

IIUC, they no longer believe that lipid cholesterol levels are directly correlated with intake of dietary cholesterol. See, for example: https://www.hsph.harvard.edu/nutritionsource/what-should-you...

> The biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet—not the amount of cholesterol you eat from food.

> Although it remains important to limit the amount of cholesterol you eat, especially if you have diabetes, for most people dietary cholesterol is not as problematic as once believed.

I would recommend committing to getting a full blood panel (specific to your sex, male or female) at least every 6 months, especially if you are going to be making significant changes to your diet. This was a game-changer for me. I started working with a practice that does health optimization and blood work/labs and has doctors who know how to interpret the results and give recommendations based on them. For me, I had several biomarkers significantly improve by consuming more red meat. I hadn't been trying to avoid red meat consciously, just somehow over the years I started consuming a lot more chicken and turkey and really wasn't having enough beef, etc.

Red meat is a carcinogen according to the WHO.

https://www.iarc.who.int/wp-content/uploads/2018/07/pr240_E....

https://worldanimalfoundation.org/advocate/farm-animals/para....

That's not true. The WHO thinks red meat might be a carcinogen. From the Q&A mentioned in your first link [0]. Also, I would not consider your second link a reliable source. An animal-rights group is not unbiased.

> In the case of red meat, the classification is based on limited evidence from epidemiological studies showing positive associations between eating red meat and developing colorectal cancer as well as strong mechanistic evidence.

> Limited evidence means that a positive association has been observed between exposure to the agent and cancer but that other explanations for the observations (technically termed chance, bias, or confounding) could not be ruled out.

[0] https://www.iarc.who.int/wp-content/uploads/2018/11/Monograp...

My suspicion is that it's the sodium nitrates used in treating certain meats that's causing a lot of the cancer. But this is just speculation on my end.

Are there any randomized controlled trials that show this? (As opposed to no-randomized observational studies)

Did you miss the last few years? The WHO is not to be referenced

How do you go about getting a full blood panel every 6 mo? Doesn’t that come from your primary care doctor? Mine would think I’m insane if I asked for a full blood panel every 6 months at my age with no health issues. But I see the utility in it (trends in the data, anomalies, etc.). So how to do it?

Yeah, you're right. No way in hell I could get my doctor to get a full blood panel every 6 months. Even if I could get him to get me one, he won't order all the stuff I want to see. So I use a boutique, turnkey telemedicine practice (I'm not sure how else to describe it). I order the blood panel and then go over the results with one of their expert patient care coordinators and then speak with one or more of their doctors as needed (all over Zoom). The one I use is Marek Health, but there are others (https://marekhealth.com/)

I think my initial intake was $200-300 to get the full blood panel and have a follow-up with a patient care coordinator as well as an appointment with the doctor (who is incredible). At the time I ordered the blood panel, I wasn't even planning on having a long-term relationship with them, but after seeing some stuff on my blood panel that I wanted to work on and having them come up with a plan, speaking to the docs regularly, I've just gotten so much value out of it. The whole thing made me feel like "wow, this is what healthcare should feel like."

Sadly, it's all out of pocket, but it's the last thing on the list of things I would complain about having to spend money on.

For some people, full bloods every 6 months might be overkill, I guess it just depends on what you have going on (not that I had major issues, but definitely things to address and others to optimize). But without a full panel, you're just flying blind. Sometimes, I get the panel and nothing has moved at all and there's nothing to do. Other times there are things I can easily address and the more panels I have, the more of a personal health profile I have to work with.

What physician is saying no to preventative medicine paid for by the consumer? Why do doctors think we are visiting for their benefit? I would be very interested in the arguments against blood labs. For the doctor, they draw blood and review results, which is something they do every day. For the patient, you draw blood and review results and pay for it, which is something normal people are not greatly inconvenienced by. The money may be the thing, but why would your physician know your budget? If you want a zero risk preventative procedure, the doctor should tell you how much it is, not give financial advice.

What argument would a doctor have against order a wider range of tests? The blood is outside of your body, and the physician is not in the lab running the centrifuge or mixing chemical agents to react.

Every Primary Care doctor visit I've ever had in my life (note: USA) felt like a cross between an assembly line and the DMV. It's all about rushing you through the visit as quickly as possible, spending as little time with the actual expensive doctor as possible, and getting you out the door so that other cu$tomer$ can get crammed through after you. Blood labs? They aint got time for that!

And nowadays, to make matters worse, I have to book an appointment for this delightful experience 2 months in advance for my existing doctor, and five months in advance for a "new patient visit" at a new doctor. Everything around Family Doctors says "go away".

> Every Primary Care doctor visit I've ever had in my life (note: USA) felt like a cross between an assembly line and the DMV.

Note that 'the DMV' is itself a bizarre American experience that a lot of the world doesn't put up with/find a need for.

It took quite a lot of references like this going straight over my head to look into this thing 'everyone [in the USA]' has to do and is familiar with and understand. (If I need a replacement driving licence or to change my address or whatever, I spend two minutes on a web form and it comes in the post. There just isn't 'a DMV' or equivalent office for me to (have to) go to.)

The reasoning I heard from a GP is: the more values you get back, the higher the chance of a false positive. A GP who has blood tested will do so based on your symptoms. Get the lab to do all the possible tests, and chances are at least one of them will be off but since you had no symptoms you’re going to have to test again since it might be a false positive. All this takes a lot of time and creates feelings of insecurity with the patient. So where I’m from, there are no ‘check-ups’ within insured or government funded health care, you strictly react on symptoms. There are only checks for specific forms of cancer and you’re invited for this specifically. Don’t know whether this is the best way, but it’s an explanation for the approach.

> What physician is saying no to preventative medicine paid for by the consumer?

its more common than you think; and many professionals resent the idea that its anything resembling a 'free market' where a 'consumer' (patient) can 'order services' without their provider's approval.

as you might imagine there are reasonable-sounding prima facie arguments for both sides of this discussion.

I have to fight with the doctor every time I want something he doesn't deem necessary.

For the general population, meat and eggs are OK within reasonable amounts of consumption. But those with genetic susceptibility to high cholesterol need to be more careful about their diet than the general population. Same story with diabetes and hypertension.

Edit: FWIW, I’m not planning on abandoning red meat and eggs, but striving for no more than 4 eggs a week and 1, or max 2, servings of red meat. I would rather enjoy beef and lamb for the rest of my life and avoid ever having to eat only egg whites.

Eating less red meat is about lowering your inflammation in your veins - which is a major part of the battle for atherosclerosis. Agreed it's not about your dietary cholesterol. Dairy fat is a big issue for atherosclerosis.

However risk factors are individual so take everyones commentary as educational but apply on what's relevant look at your on individual use case.

It’s not red meat causing the inflammation.

It’s sugar.

Sugar also a culprit - its not a red meat vs sugar thing. However one of the top researchers in cholesterol in the US told me specifically to eat red meat once a year as it has inflammation qualities that are risky for people who have higher risk factors for a cardiac event.

> told me specifically to eat red meat once a year as it has inflammation qualities that are risky

Struggling with that - as in at most once a year?

Yes but that was for people with a high risk cholesterol level - not general public.

However translate that to general parameters as you see fit.

Sure, I understand. I was just parsing it as 'you should eat once a year' (not zero times) - which then didn't seem to tally up with the mentioned risk.

I'd think a small amount every other month or so might be safer - you don't want to look forward to that annual treat and go too crazy!

I see what you are saying. I think the advice was enjoy that one steak dinner a year on a special occasion. Yeah you could also break it up into smaller amounts over the year. I'm largely indifferent to beef but it was a surprising bit of advice from a respected source.

FYI the above is american-focused healthcare language. There are no annual checkups in most other countries outside of certain age or risk groups.

You might however get a health checkup from occupational healthcare sometimes!

Just putting this a note here for non-american readers so they don't get confused.

My family doctor in Canada does an annual check-up (BMI, basic physical, blood and urine) that's covered by provincial healthcare. In addition, those over 50 get a colon cancer check every two years that used to be a full colonoscopy but now it's a new poop sample test.

I'm surprised other countries with free government healthcare don't do that. I would assume it's more economical to detect signs of serious issues early.

Which province? I've never been offered this from my doctor in Ontario, in fact when I requested blood tests it was denied so I had to drive to the US to get my own.

Yes, Ontario. You might need to shop around until you find a family doctor who "believes" in annual checkups. OHIP doesn't seem to object to it (except Vitamin D, which is now out-of-pocket).

> I would assume

So would I (Germany), yet it’s only one blood test every 3 years from the age of 35 on.

You can look into the health benefits of annual checkups, there's a bunch of research showing that it's pretty much useless before say 50-60yo

That's kind of shocking to me. The normal narrative is about how much better the European model is for healthcare, but then you're saying it's missing one of the most fundamental and effective aspects of healthcare (preventative care & early intervention)?

Do you go to the dentist for regular cleaning & exams or only go if you have a toothache?

Annual checkups seem so critical to overall health outcomes- it's far better to catch cancer at stage 1 than stage 4, or to address blood pressure before having a stroke or heart attack rather than after, I'd have thought they'd be strongly prioritized and incentivized my government-controlled healthcare systems.

How many cancers are you going to catch at stage 1 with an annual BMI & bloods check-up?

Yep, I had to Google PCP (I know one acronym PCP, and I was _fairly_ sure that wasn't what the commenter was referring to).

Primary Care Physician for anyone else wondering (equivalent to a GP in England I think)

That being said most people in America don’t get annual checkups unless they have issues either. And there’s also a school of thought that more preventative medicine would be a good thing, so maybe other countries should consider it.

Tangentially, it’s common for your employer’s health insurance provider to provide a discount if get an annual physical.

Edit: (US specific)

Again, this is very USA-specific.

I learned from my father's generation that regular check-ups were vital. My oldest two uncles died from heart issues in their early 60's. The next two and my father have made it to their 70's and show no signs of stopping. There isn't really any difference in lifestyles between the dead and alive ones, other than going to the doctor regularly, and taking whatever medicine they are prescribed. I guess one uncle quit smoking. So that's probably good for him.

for anyone else confused, that's Primary Care Physician, which I take to mean GP/Hausartzt/huisarts.

Thanks for clarifying, and sorry for the confusion - I wish I could edit my comment.

Study: No association between eating eggs and blood lipids, cardiovascular disease, or mortality in 177,000 people in 50 countries.

https://academic.oup.com/ajcn/advance-article-abstract/doi/1...

That's great news that your cholesterol and triglycerides were high and that everything else looks normal! Are there any other tips that you would suggest for making lifestyle changes to help lower cholesterol and triglycerides?

I’m not a Physician or Dietitian, but my dad is a Gastroenterologist and my wife is a Registered Dietitian, so some of their knowledge rubs off on me. And my PCP gave me some tips last week that are still fresh in my mind.

- Exercise can help lower cholesterol slightly. But try to have a reasonable balance between cardio and resistance training. Too much cardio risks having some muscles actually weaken if you maintain a large calorie deficit.

- Diet-wise, you want to go for sustainable weight management, so no extreme or gimmicky diets. Avoid Atkins and Keto (unless a professional tells you you actually need to avoid carbs), extreme fasting, etc.

- 3 moderate meals a day are better than 2 or 1 large feast(s) because they keep your metabolism going for most of the day. Your body can adapt to feast/famine and can go into ketosis, but these are survival mechanisms and harmful, even counterproductive, if you keep your body in these modes for long periods of time (you might even gain weight in feast/famine mode because when you do eat, your body converts as much sugar into fat as it possibly can, in order to prepare reserves for the next “famine”).

- Some fasting is good for spirituality and to teach self-control, but it should not be a permanent state (I plan to fast Mondays and Thursdays as much as possible, leading up to Ramadan in about 50 days). Fasting every single day for the rest of your life is not realistic and probably does more harm than good.

- Eat raw nuts (raw almonds have been observed to lower total cholesterol, lower LDL, and raise the HDL/LDL ratio) as much as you can within your calorie allowance. In general, more plant-based protein and fats, and less animal-based is very helpful (but watch out for high saturated fat from coconuts, and too much soy can mess up men’s hormones). Edit: the soy evidence is not conclusive - see comments below.

- Keep your calorie allowance reasonable and sustainable, and try to eat a good variety of fruits, vegetables, grains, beans, legume, meats, etc. with moderation in everything.

I'm going to ask for a reference on the soy comment. I know there's a lot of fear mongering on soy but I haven't heard of any studies to prove that.

Rest of the advice seems good. Lower fat in diet (specifically dairy fats), increase exercise, higher fiber, lower sugar, more nuts/avocados/salmon.

Treat the disease and not the numbers - so look at all your risk factors for atherosclerosis.

I’m not suggesting avoiding soy altogether, just cautioning against excessive consumption of it. Studies are showing mixed conclusions, but it’s not all fear mongering:

Study showing some effect: https://pubmed.ncbi.nlm.nih.gov/15735098/

Study showing little effect: https://pubmed.ncbi.nlm.nih.gov/11880595/

While the evidence is inconclusive, I wouldn’t take chances if I were trying to have kids. I would imagine getting __all__ of your protein from soy could potentially be harmful, perhaps even in ways other than decreasing testosterone and sperm count.

In general, everything in moderation is best.

> Fasting every single day for the rest of your life is not realistic and probably does more harm than good.

What evidence is there for this statement? What is considered "fasting?" I can't see how a 12-hour feeding window would be problematic. I could understand some people might develop "disordered eating" if their approach is unsustainable, but "more harm than good" isn't true for those that can do it.

One reason for fasting is that it improves insulin sensitivity.

From: https://www.health.harvard.edu/blog/intermittent-fasting-sur...

"Based on this, researchers from the University of Alabama conducted a study with a small group of obese men with prediabetes. They compared a form of intermittent fasting called "early time-restricted feeding," where all meals were fit into an early eight-hour period of the day (7 am to 3 pm), or spread out over 12 hours (between 7 am and 7 pm). Both groups maintained their weight (did not gain or lose) but after five weeks, the eight-hours group had dramatically lower insulin levels and significantly improved insulin sensitivity, as well as significantly lower blood pressure. The best part? The eight-hours group also had significantly decreased appetite. They weren’t starving."

I can’t edit my original comment but I’ll try to add some nuance:

- When I say “fasting” I mean not eating for a good chunk of the day. My Muslim background made me overlook the need to define that clearly.

- I doubt most people can sustain fasting indefinitely, so “disordered eating” and metabolism going out of whack is the most likely outcome.

- If someone has a good reason to fast indefinitely - based on professional advice - then they should go for it. But, like other extreme measures, it’s probably not for the general population.

High cholesterol runs in the family (my grandfather exercises 7 days a week, is thin as a rail, and had a heart attack at 60). I'm 31 and learned that I have high LDL two years ago.

I can only speak to my case, so YMMV. Through a liver blood panel, I learned that I had high bilirubin, SHBG, and GGH - which indicate compromised gallbladder and liver function. One doctor suggested I have my gallbladder removed.

Instead, through research on pubmed and examine.com, I was pointed to TUDCA - a bile salt that helps clear cholesterol and biliary sludge. After two months of supplementation, I've seen a severe reduction in intestinal discomfort - and I suspect a follow-up blood test will show a reduction in my high liver panel and LDL.

If you have abnormally high LDL for your body type and lifestyle, I would encourage you to get a liver panel and look into TUDCA.

Reply on news.ycombinator.com