Avoiding Heart Disease
blog.harjtaggar.com
blog.harjtaggar.com
Doctors are kind of the same way. They see patients who have problems and need them fixed. If you walk into a doctor's office and say your family has a history of heart disease and you're concerned, they'll run a standard diagnostic to see if there is a problem. If there isn't, they'll give you generic advice. Outside of that, they are not really likely to have much insight into how to prevent heart disease in your specific case. Maybe you'll get lucky and the doctor will have recently read a relevant paper.
This seems to me like a problem that you're better off having answered by a medical researcher rather than a physician in the trenches. Researchers are the ones who are taking the long view on outcomes in patients. Keeping with the same analogy, you're probably better off talking to a mechanical engineer at a car company about maximizing the life of your currently healthy transmission.
Also, I generally see this as a problem that will be best addressed by machine learning researchers collaborating with medical researchers. Then again, I'm an ML PhD student working on health applications, so I'm biased. :)
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?
Practically, I think the role of humans will be to create a more human experience and to provide specialized knowledge centers.
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.
<shameless_plug> Want to disrupt health care? Omada Health is hiring! http://omadahealth.com/jobs </shameless_plug>
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.
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.
Suppose a pilot has a choice of two activities:
1. Read FAA safety report, unpaid 2. Fly plane, paid
Doctors, especially at academic institutions, are required not only to be up to date in the latest research, but contribute to it. If a doctor treats a patient in a way not up to par with current practices in research, he will be sued and lose his licensure.
1. Attend CME meeting, often at nice resort locale, usually unpaid, but deductible. Acquire at least 25 hours of such attendance per year.
2. Lose medical license. Pump gas, if you can find a full-service station.
Also, the problem is that such papers don't exist, or at least not in the accuracy or certainty you'd like to have.
It's much easier to gather data from sick people and which treatments worked for them, than gathering decades worth of data from healthy people and correlate causes to which diseases they eventually may have developed.
Doctors most certainly have an incentive to keep their patients from getting sicker. One of the ways we evaluate quality of care is incidence of morbidity. How often does this patient continue to return to the hospital? This is a huge risk to physicians, in the form of a lawsuit.
It isn't like there is any shortage of patients who require care. There are so many ways that hospitals encourage doctors to do bad things to make a buck, but preventing preventative care would not be the first thing I'd target.
[1] http://en.wikipedia.org/wiki/Continuing_medical_education
The folks who go into primary care - i.e. GP's, pediatricians, etc, tend to be more altruistic, and think along the lines of preventative medicine. (They certainly aren't in it for the money...). It's really the subspecialties you hear about some random doc who is pushing tests or surgeries somewhere.
There is a push behind the new "Accountable Care Model" that tries to incentivize better performance on overall health metrics that tries to address this, but too soon to tell how well it works.
Likewise with doctors. I have had 4 doctors in my family (3 still alive), and I've spent many the family meal talking with them about health, longevity, and the mechanical/biology/chemistry behind how your body works and when it works best.
In any case, service life in cars is usually determined by a couple key things: The design of the system, driving conditions, and service. You may feel like you're being blown off when the mechanic says "obey the service intervals and avoid short trips", but that's 99.9% of what you can do to make the car last.
(Special corner cases are widely-understood and well-documented, such as the impact of very high operating temperatures in automatic transmissions during towing)
The conversation with the doctor/nurse should go something like:
You have diabetes. Your body has become insulin resistant because you ate too much sugary/starchy stuff. Eat less of it and you will get better.
That being said, this is a matter of separating the noise from the signal in the population which is quite hard. AFAIK, and I am probably missing a few, but the only real long term modifiers are aspirin, low blood pressure, and high fiber/low cholesterol/low glycemic index foods. Everything else - there isn't enough data to separate noise from signal except for a few specific cases (someone found a gene polymorphism or mutation to something specific, i.e. the risk of blue converse sneakers or something like that)
Ideally, your doctor would be able to tailor your care to your genetics, your lifestyle as well as to your medical history. That is the goal of "personalized medicine". This will likely become more and more common-place over the next decade or two, in particular with respect to the genetic aspect. But for now it remains too expensive and uncertain to be rolled-out by HMOs and national healthcare systems. So you end up with "generic" advice, which is in fact in most cases the best they can do.
If you're healthy (as in, no symptoms) then managing your lifestyle should be your business, not your doctor's, and most advice is obvious anyway (don't eat or drink too much, avoid processed food and all manners of sodas whenever possible, sleep well, exercise).
Regarding lifestyle choices, I also think doctors have seen many people getting sick that seemed to be doing everything right, they're not sure what's best. It's very possible stress is a main contributor to poor health, and just worrying too much about it is bad in itself.
(0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.)
(1) Don't use tobacco or cocaine, and don't drink too much alcohol.
(2) Don't get exposed to radiation or chemotherapy.
(3) Don't have diabetes.
(4) Don't have high blood pressure.
(5) Have low levels of LDL and triglycerides.
(6) Don't eat too much. This is tightly related to #3 and #4, and reasonably related to #5.
(7) Have extremely low levels of LDL and triglycerides throughout your entire life. Having low LDL throughout your entire life reduces your risk of heart disease, even moreso than you would expect based on the LDL value alone. It seems that lifelong exposure to low LDL is more valuable than just late-life exposure to low LDL. [a]
Most of the genetic variants that we can currently interpret when accounting for risk (as opposed to the innumerable ones which we cannot yet interpret) fall into lipoprotein-related pathways. It will be interesting to learn about ones that do not, yet still confer meaningful cardiovascular risk. I don't think that we have a mechanistic explanation yet for the risk conferred by variants in the 9p21 locus, for example. [b]
I'm reasonably certain that your HDL is not particularly important (except as a poor proxy for your socioeconomic status, perhaps).[c] And omega-3 fatty acids have no visible effect when examined in the rigorous way in which we examine any other new drug. [d]
a = http://www.ncbi.nlm.nih.gov/pubmed/20579540
b = http://circgenetics.ahajournals.org/content/6/2/224.long
3, 4, 5 and 7 are hard to modify, either by behavior or with medical intervention.
3 and 4 can often be achieved by succeeding at #6, but certainly this is not true for type I diabetics nor for people with MODY or other non-metabolic-syndrome-type diabetes. Dietary discretion is difficult for almost all of us, it is true.
Grandfather was in decent shape at 40 when pretty much all his arteries clogged. He is now 87 with half a single artery left in his heart. He is not what I would call "living" as much as existing.
On the other side, my mother, grandmother, and great grandmother have intense high blood pressure with no understandable reason.
Well, I figure I may have till I'm 50. Though I hope doing biking marathons would train my heart even a bit to help.
1 = http://www.nhlbi.nih.gov/guidelines/hypertension/speaker2.ht...
Instead, seek out professionals who don't just say everything is OK, but who tell you what specific things to do and tell you why you should do those things backed up by research. A competent MD will not be afraid to refer you to the research that they are using to make their recommendations. A real MD does not say (I'm and expert, trust me) but they are willing to point to the studies and the opinions of other experts. Experts will not all agree but usually, when something really works, there will be a majority who do prescribe that course of action.
FDA published a warning a month or two ago.
By anecdotal information, don't believe the memory problems will necessarily go away...
A representative example: http://en.wikipedia.org/wiki/Scandinavian_Simvastatin_Surviv...
You're gonna do just fine.
b) 15-20 years of being completely and utterly crippled, unable to walk (over a few minutes at a time), eat salt at all, lay down, stand, etc... not sure if this is much of a life.
FYI: if you have clogged arteries, your heart is unable to move the water in your blood, thus if you lay down all that water gathers near the lungs and you can't inhale.
I am not fat, I've always been thin and my cholesterol is bang on perfect, my blood pressure 120/80 or better. Although I've slacked off the gym for about four years I'm pretty active at work.
Anyway out of the blue I am diagnosed with fatty liver: it hurts, I can feel it. Know how people with fatty liver die? Heart attack or stroke, fatty liver significantly increases the chances of either or both.
My grandfather died at age 52 of a heart attack, his daughter my aunt died of a stroke after multiple heart attacks age 70-ish and her brother my uncle also died of a heart attack at age 52 same as his father. Their brother my uncle had a quadruple bypass in his late 50s.
I'm beginning to wonder if people with a family history of heart disease really have NAFLD.
What exactly do you feel and where?
From what I understand most people with NAFLD feel nothing, some people who develop scarring (cirrhosis) and even cancer don't feel anything. The liver is weird, at least it can regenerate from a lot of abuse.
Certainly not trying to diagnose your familial disorder over the Internet, but taking a trip to a good lipid clinic might be something worth considering if you wanted to be aggressive in the pursuit of a diagnosis. (Which, again, might not be what I'm talking about above.)
At work a nurse comes in and we can get tested for high cholesterol, high blood pressure, diabetes. I go and each time even up until my NAFLD my numbers practically perfect.
Maybe I do have some ApoB protein trouble. Although I doubt there is a lipid clinic anywhere in Canada for me to go to.
Thanks anyway.
Thanks.
I'm not so sure this is a wise approach.
I won't say that numbers aren't important, but it's worth noting that in many cases, doctors still don't know what particular measurements actually mean in practical terms because cause versus correlation is so hard to figure out in complex systems like the human body.
As an example: the general consensus has been that "good" cholesterol (HDL) has a protective effect and that those with lower HDL levels are at risk. You can have an LDL of under 150, low triglycerides and your cholesterol ratios can be stellar, but if your absolute HDL number is low, there's a good chance your doctor will talk to you and, at a minimum, recommend ways that you might be able to bring your HDL level up.
One common approach of doing this has been to use niacin, yet a 2011 clinical trial involving the use of niacin in an attempt to increase HDL levels in a high-risk population failed to produce the hoped-for risk reduction despite the fact that the niacin did increase HDL levels[1]. A larger, more recent study had a very similar outcome[2].
One logical possibility is that the HDL level reflects some other underlying factor which controls for risk and doesn't itself have the ability to influence risk. If this is the case, a higher HDL number may confer little to no protection unless it is the product of some other natural process.
[1] http://www.nih.gov/news/health/may2011/nhlbi-26.htm
[2] http://health.usnews.com/health-news/news/articles/2013/03/0...
What seems to be likely regarding cholesterol in general is that it has been greatly over focused on to the detriment of more likely culprits like sugar and refined foods. Of course, the cynic might say you can't take a pill made by Pfizer to lower your sugar and refined foods like you can to lower your cholesterol.
I think this article is very insightful. One very good indicator (although not as good as the details the author got tested) is a person's HDL to triglyceride ratio. High levels of HDL are good, and low triglycerides are good, since its currently thought that higher triglyceride levels are linked to the small, dense LDL particles that work their way into artery walls.
A potential downside is the tendency is to shift from being proactive about your health to diagnosing (or worse -- treating) yourself based on independent research. I get that it's tempting to fire up google scholar, pubmed, uptodate etc to get a better understanding of what's going on -- just don't go the next step and start diagnosing and treating yourself.
See a specialist. See a domain specialist if you can. Get another opinion. Ask questions and air your concerns. If your doctor doesn't adequately answer your questions and concerns, see another doctor. Your greatest asset -- and the one you should be focused on-- is the ability to get multiple opinions from people who have trained for decades on a topic.
It seems like you need to see a new doctor -- not order your own tests.
Source: I'm a vegetarian, and I pay scrupulous attention to this stuff.
From Google, 1 ounce of Chia seeds is 4.7 gms of protein, 138 calories. I would have to eat 31 ounces of Chia seeds to get 150 gms of protein. That is 4030 calories per day. Guess what happens then? I gain weight.
Quinoa provides 3.8 grams of protein per 100kcal of energy [1]. Boneless skinless chicken breast provides 18.8 grams of protein per 100kcal of energy [2].
A weightlifter who wished to consume 100 grams of protein per day would have to eat 2632 kcal of quinoa, vs. 532 kcal of chicken breast.
Just as a quick look to see details as to what would be required. Quinoa is hardly the only source of non-meat protein.
Now, yes that does include a lot of protein shake stuff, that's not that unusual for most weightlifting diets. That's also a vegan diet, so you might be able to add eggs, cheese and milk to that diet and cut back on the powder in the meals if you just wanted to be vegetarian.
The powder is of course to solve the issue you pointed out already.
I'm not vegan, so I've never bothered trying them, but it doesn't seem like it'd be a big problem.
My concern (see my other comment) would be that the diet shown certainly is extremely high calorie, and it looks like it'd be pretty much all nasty shakes to get it down to a more normal level with the same amount of protein.
(EDIT: Note, this would only really be an issue if you do heavy resistance training, as the protein level in that diet is very high for someone who isn't doing weight lifting)
For comparison, I'm a powerlifter. I'm 238lbs currently. My maintenance calorie intake is roughly 2450kcal on average. I aim for about 2800kcal on training days, and equivalently lower on rest days to roughly meet that average. Fitting 220g or so of protein in that is not that hard: I can eat 400g lean chicken and get 100g protein for <900kcal. I can tack on 100g beef jerky and get another 50g protein for less than <300kcal; which leaves it almost hard not to meet the protein target within my calorie goals.
If I were to eat 3387kcal to meet 207g protein, I'd be adding 1-2kg a week.
That's well in excess of the protein synthesis a typical human male body is capable of. In other words: A substantial percentage would be fat. Quite possibly I might end up adding 1.5kg of fat a week on a diet like that, which would get me quite a lot less protein than what I do on my current diet.
For a body builder exercising heavily 2-3 hours a day, on steroids (otherwise lifting heavily for that long every day would just be a total waste of time), that calorie intake might be reasonable. Or for someone who combines the exercise with a highly active job, like say, construction.
It'd be interesting to see that diet brought down to 2400kcal or below with the same protein levels. I suspect it would look a whole lot less pleasant (and that diet looks awful to me in the first place, but I love my meat).
(Now, protein amounts this high are in the "might as well, just in case" level - the possible incremental benefits hinted at in the literature are as far as I know quite marginal - so a lower protein intake would not necessarily be bad, and then it'd quickly become a lot easier to meet it with a reasonable calorie intake)
https://drive.google.com/file/d/0B4anS4KxXuQdUlo3NEtUZ0xROFU...
We're not going to "solve" the problem until we have a ton more data (maybe sensors in everyone along with the understanding of the markers to look for) so we can fit you to an optimal path based on a lot of observed variables. But even then we're just going to be playing percentages off each other, and contrary to the life-extender crowd out there, it may turn out that there is no 110-year optimal path for most of us, at least until we start reengineering the body at a more fundamental level.
You can get enough protein for weight training on a vegetarian diet btw.
Your heart tends to just do it's thing. But if you concentrate on it you might start noticing weirdnesses. These probably aren't your heart, but now you're anxious, so you think about seeing a doctor. But you don't want to waste the doctor's time, so you look around on the Internet to see what it is. And now you're really worried even though you know you don't have any of those things. So you go and see a doctor, and sure enough you don't have anything wrong.
Except now you caught some cold / flu bug from someone in the waiting room.
http://www.condenaststore.com/-sp/Thought-balloon-above-man-...
Of course it's important care about your health and do what you can, but given the large error bars on our knowledge and the randomness of life in general, I think that it's worth thinking about how much time and effort should be spent on it. There is a correct amount of effort, I'm just not sure that monitoring these additional numbers is worth it; it may be adding more noise than signal to the problem of living a fulfilled, healthy, and happy life.
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.
Yes, that is generally true throughout the developed world. On the other hand, heart disease death rates have been declining at all relevant ages across several decades throughout the developed world.[1]
Our understanding of what causes heart disease is very partial indeed. On the other hand, our understanding of how to treat heart disease has increased enormously in my lifetime. My mom, still alive and well at age eighty-one, was a surgical nurse who was described by my late dad as "one of a dozen people in the world who could disassemble and reassemble a heart-lung machine" early in her career. She has seen enormous progress in surgical treatment of heart conditions that used to be sure death sentences, and medical treatment for heart disease has improved greatly too. A CDC report on declining heart disease in the United States[2] suggests what more can be done.
[1] http://www.scientificamerican.com/article.cfm?id=longevity-w...
[2] http://www.cdc.gov/media/releases/2011/p1013_heart_disease.h...
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/
The age old advice of "eat less, move more" ignores the body's natural mechanism for fat regulation, which is primarily the hormone insulin. The higher your blood glucose, the more insulin your body produces, the more fat your body will store, and the less reluctant it will be to release its stored energy.
It's obvious that if you're eating fewer calories, then less energy is available for fat storage -- it's simple thermodynamics -- but basic endocrinology tells us that to lose weight all we need is the negative stimulus of insulin, which is primarily achieved through reducing carbohydrate intake.
These were very sick heart disease patients who were told by their cardiologists they had a year to live, and Dr. Esselstyn (recommended in OPs blog post comments) and Dr. Farvalaro (the guy who invented bypass surgery) cured them all, then took photographic proof with an angioplasty.
Diet is the problem, and a proper diet can fix heart disease.
The researcher Dr Maryanne Demasi[2], herself a research pathologist, has spent three years gathering data, interviewing researchers, scientists and doctors on both sides of the argument, and the show has caused major ripples throughout the medical profession in Australia [3].
The two episodes are on YouTube in full [4] [5] and the transcripts are on the ABC website [6] [7].
For anyone interested in this topic, these shows are HIGHLY recommended.
[2] http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=...
[3] http://www.6minutes.com.au/news/latest-news/expert-takes-aim...
[4] http://www.youtube.com/watch?v=rDVf-00w5gk
[5] http://www.youtube.com/watch?v=wAKaM330xzg
Which one is the naturopath?
However, when you consider that pharmaceutical companies in the US pay doctors (not always directly for prescribing their drugs, but close enough), and also fund most of the research in the US, Australia and probably most other countries, that seems a much stronger candidate for bias than a science researcher who is trying to tell a story on a not-for-profit TV network.
There are plenty of medical "breakthroughs" throughout history that have come from people who were initially branded as heretics/crazies but who eventually were proved correct. Germ theory, antibiotics, anaesthesia etc.
Fact is, eat well and exercise is better advice than checking a bunch of numbers of unproven value for preventing heart disease.
Doctor's don't know how to prevent heart disease, but at least one knows how to reverse heart disease. His advice is a little more extensive: eat well (mostly vegetarian), exercise, meditate, have social support and don't smoke. But it does not involve, in any way, tracking your blood test results. http://en.wikipedia.org/wiki/Dean_Ornish
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.
I would imagine that the client relationship in medicine in similar to other industries. Failure is often not a result of the service you provide, but from the fact that the client doesn't listen to the advice they are paying for.
So this year, I turned 38, off the BP meds more than 3 years now. Then, last month while in China with my family, I had a full blown stroke. Result was lost 2cm of my left brain directly in the region that controls speech and right arm & hand motor skills. Spent 8 days in a Chinese hospital.
For about one week, I talked like a stone cold drunk and my right arm was useless. I thought I might be that way forever. Luckily, after two months, I'm basically fully functionally recovered. Bottom line is the path from a risk indicator like high blood pressure to a stroke or heart attack can be fairly short. Now, at 38 I know I must make some radical change if I'm going to live to 70, no less not be a paralyzed half brain dead invalid.
I'm certainly interested in quantified self tech now. The problem is everyone that needs a doctor to take an intense personal interest in their long term health cannot possibly find a doctor to do so, for any number of reasons. Opportunity is to empower the individual non-medial experts to easily monitor their own health and risk factors over time. Will likely be moving into product development in this space myself.
A good diet is important, and there's enough information out there to determine what a good diet is. I believe weighing yourself daily is real helpful. And regular exercise - a combination or aerobic and anaerobic. There's enough data to indicate that these interventions, combined, are effective in reducing risk.
And, on a less preventive note, truth be told, if someone in their mid 50's is complaining of SOB and has a family history heart disease, most doctors, in the US at least, are going to do more extensive testing.
I'm firmly on the camp that one should measure more - not less - if numbers are fluctuating to reduce worry and stress. Frequent samples, but examining weekly/monthly aggregate trends is the way to go. We just need great tools for visualization.
Dont overanalyze yourself. Since passing out about a year ago because of an infection and not drinking/eating anything that morning i have some serious anxiety issues that affect my life in a bad way. I started to monitor my heart, my blood pressure, my pulse and freaked out whenever something was slightly off. I went to numerous doctors and cardiologists, nobody could find anything of relevance, no risk factors at all. I still worry.
With time it got better but there is a reason we dont usually think about bad things to happen or us or even death, because it affects our psychology in a bad way.
I am not saying do not care for this, but also trust the doctors. The advice of eating healthy, exercising regularly and stop overanalyzing yourself is the right approach and will lower your general risk considerably. Of course go and check your blood once a year but overall there is only so much you can do.
In the end theres many,many risks in life that you cant really pre proactive about because we also dont really know the human body yet. If you get into this you will find hundreds of people suggesting different things, you will learn about all kinds of diseases you shouldnt really worry about in the back of your head because it will bring your quality of life down in the end.
I myself am not very good at what i suggest here, but i wish i was.
The family history profiled here http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-... sounds extremely similar.
Lets say your family eats a certain way when you are young, and your family members die of heart disease. And you continue that pattern into adulthood, eating the same way you were brought up, and you get heart disease.
Is it genetic or is it passed-down environmental?
I think it's the latter.
In North America, both of these doctors have shows on PBS a couple of times a year, in the weekday evenings and they generally run as part of a series of similar shows by other medical doctors.
The two named above have done a significant amount of research into the programs that they suggest, and they publish widely and openly and tell you what research they are looking at and why they recommend certain actions.
Using this data, I've modified my diet and am seeking medical advice to reduce to a normal range. My cholesterol levels are all normal. I eat healthy (a seemingly subjective measure) and exercise regularly. My doctor said I am in perfect health at my recent annual physical.
I'm privileged to be able to afford private blood testing. Apo B data is within everyone's grasp, yet it seems so under-utilized.
I would love to be a customer of a competent company that managed body scans and the process of looking for deltas using humans assisted by software every N years.
Why?
Common medical wisdom now is that doing proactive body scans (usually just the trunk), even just MRI (so no radiation) is bad because it drives the expense and uncertainty of investigating every bump and shadow. And many of the tests will come back inconclusive. I understand that argument but it seems the way to deal with that is to focus not as much on scan #1 but scan deltas.
My anecodtal (IANAD) evidence is that in more than 5 cases of cancer in friends and families, a cancer diagnosis was delayed for many months from onset of symptoms and a few Oncologists have told me that they agree that for most of those cancers, that latency could have been improved if a baseline scan had been available of the organs/bones/nodes in question.
Not every patient would be a good candidate for such a service but the same is true for 23andme.
What. No. If you need to work on a number, why don't you try improving the number of minutes you spend doing cardiovascular exercise per week?
>The advice to "eat well and exercise" didn't seem particularly insightful
...but it actually makes a world of a difference. I think this is the most important advice and people tend to discard it as generic and useless - the truth is that it's very hard. Being active isn't a big deal, but for a week? For a full month? Full year? Full decade? Being consistent in eating well and exercising is challenging.
The doctor won't set goals for yourself, but if need a number, give yourself one and try improving on it constantly. There are tons of tools, apps, websites to help you. I've always been very active since I was a kid and still am now (~500 minutes of sports/week) and I can already see a big difference with my friends who aren't. And I'm not old at all.
If you decide to start exercising cause you have symptoms, it's probably too late.
congrats on the change :)
Also, thanks!
[1] http://online.wsj.com/news/articles/SB1000142405274870340930...
(I have read the base scientific article but can't find the link right now.)
"I use EBT calcium imaging to identify who needs treatment and serial EBT calcium measurements to document adequacy of treatment. I use low dose statin or bile salt sequestrate plus ASA, high dose fish oil derived omega-3 plus frequently add nicotinic acid. In addition I screen for sub clinical insulin resistance, sleep apnea and encourage daily flossing and dental hygiene, regular mild exercise, and lots of fruit and veggies. The calcium score helps motivate compliance and the result is the near elimination of heart attacks and ischemic strokes." http://www.theheart.org/article/1269619.do
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. What you want is different to what your doctor wants.
3. Doctors are not specialists. I read a quote(Unknown how truth) doctors only have 24 hours of dietary training and should not be giving out dietary advice. But given they often see people incapable of helping themselves or going to a specialist they give out advice anyway.
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.
Evidence-based medicine [1] as a norm is actually a surprisingly new thing. Assuming that because someone is a doctor they've "spent years specializing" in it is probably optimistic.
Most here are engineers with a BS/BA. Maybe a MA. And fewer still with a PhD. Not that education is everything, but it's certainly "years specializing."
Compare that to the track of a typical specialist md:
After your undergrad degree you've got.... 4 years in med school. 4-6 years in residency. Plus a 1-3 year fellowship.
Long story short, what's the credible alternative to relying on multiple expert opinions? Are educated (engineers/lawyers/etc) ordering tests based on research they really don't understand on themselves a better? By what evidence?
First of all, if your wife graduated from med school, she should have taken the Hippocratic oath. An oath written by the guy considered the father of western medicine.
You know what he had to say about diet?
“Let food be thy medicine and medicine be thy food”
He also said something along the lines of "if you don't know diet you can't call yourself a doctor" but I can't find the exact quote.
>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.
Actually, you'd be wrong. Consider a clinical study carried out by the inventor of bypass surgery and another doctor, in the best heart hospital in the world considered by US News & World Report.
The study had very sick heart disease patients, who were told they had a year to live by their cardiologists, change their diet. 23 opted in for the study but only 18 chose to continue with the diet after a couple months. Those 18 patients are still alive today 20 years later, and several had an angioplasty done giving photographic proof their plaque buildup had cleared out. The ones who dropped out died shorty after.
The 18 never had a heart attack after they changed their diets, while before they did they had a combined 49 coronary events (that's ~3 heart related emergencies per person average).
It would be so much easier if you could provide some names, or better - the title of the study. I'd like to read it, but can't find it easily. The inventor of the bypass surgery appears to be Michael E. DeBakey, but which of his publications should I read? Thank you.
My #3 point was not that dietary health isn't important. It IS important. It's as important as cardiology, renal, etc in the curriculum. That it's "only" one week is shouldn't be taken (and is repeatedly put forth as, as the OP did) proof of how physicians don't care/ aren't trained in diet.
What does your rant about saying the hippocratic oath have to do with anything? What does that have to do with the amount of emphasis the modern medical education puts on health through diet? Of course food should be your medicine. Natural plants are also the base for some ~70% of our drugs. It's just not the only tool in the toolbox.
Then you accidentally support my earlier point that the average joe is godawful self-treating/diagnosing based on their own research. Thanks.
This statement. In a country with a national health care(like mine) this does not happen. If the doctor thinks you need a test, it gets done.
Supposedly the C677T mutation increases your risk for heart disease. There is also another one, A1298C that is very common but no consensus on how it may effect health. I also matters whether you you have one or two copies of the mutations.
Some recommend supplementing with methylated B vitamins to offset the any negative health effects, but I'm still soaking this in and am not sure what the consensus is it yet.
Personally, given the recent wave of news debunking low-fat/high-carb diets, I'm inclined to take the health research from the past couple of decades with a grain of salt.
I would love for them to be able to monitor their own vital signs more closely (via wearable tech), but even that when done in isolation is not necessarily going to help - for me the real breakthrough will come when we aggregate this data. Imagine being able to use machine learning to detect patterns across groups of people that can help pinpoint specific triggers for disease and illness.
(I haven't tried it out myself yet, but I'm planning to next year - I'm in no way affiliated with them, but definitely seems like a great idea)
I'll vouch for directlabs. I was very happy with their "Comprehensive Wellness Profile". Their website looks slightly sketchy, but their service is fast and cheap.
I got my LASIK done about 8y ago at TRSC (www.lasikthai.com) which means free checkups and touchups for life, too, also down the street. Eye exams are one case where I usually use a hotel car vs. a taxi to get around, as dealing with obnoxious taxi drivers while sort of blind sucks.
"My findings indicate fried foods, powdered egg yolk, excess vegetable oils, partially hydrogenated vegetable oils and cigarette smoke as the greatest culprits in heart disease." http://www.futuremedicine.com/doi/full/10.2217/clp.13.34
Not sure if those are available in India, but my cousin did follow through those tests(in estonia) and has lost 50lbs - now healthier than ever. Has something to do with kinds of blood indicated what kind of diet you suppose to be on, vegeterian, paleo or whatever. my 2c.