I am not a statin skeptic--or rather, I don't want to be a statin skeptic. I've done the research and it makes sense to me, but I still feel some social and psychological pressures to reject statins.
When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.
When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.
In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
As you can see, I'm worried about cholesterol and statins.
If you fix it without statins through better lifestyle and diet, that is the preferrable route.
As to why medicine is like this, it's because it's conservative, usually about 17 years behind university research[0], and doctors are shackled to guidelines in most health systems or risk losing their licenses. It isn't a coincidence that the article author had his out-of-pocket concierge doctor tell him the more up-to-date stuff.
I have an objection to the "better lifestyle and diet" approach.
Sure, it is absolutely true that better lifestyle and diet has a huge effect. However it is absolutely certain that the vast majority of people who are told to improve their lifestyle and diet, won't.
The result is doctors giving advice that they know won't be followed. And thereby transferring potential fault from the doctor to the patient, with no improvement in actual outcomes. "I told the patient to lose weight and maintain that with a controlled diet." And yet, most people when told to diet, won't. Most people who start a diet won't complete it. And most people who lose weight on a diet, have the weight back within 5 years. Where each "most" actually is "the overwhelming majority". And the likelihood of the advice resulting in sustained weight loss probably being somewhere around a fraction of a percent.
What, then, is the value of the doctor giving this lecture?
(Disclaimer. I have lost 20 of the pounds I gained during COVID, and am making zero progress on the remaining 30. A few months ago I successfully started a good exercise routine. Given my history, I would expect to only follow it for a few years before falling off the wagon. I believe that this poor compliance puts me well above average. But do you know what I do reliably? Take my prescribed medicine!)
Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expert advice and refuse to wear a seatbelt, skip your rehabilitation exercises, invest all-in on crypto, or smoke cigarettes. None of this responsibility should fall on the expert if they communicated the risks clearly.
What you're communicating here, perhaps unintentionally, is that what matters is not results, but blame. If the doctor said what to do but the patient didn't do it, all that matters is the patient is to blame.
You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't.
"Who cares if better outcomes are possible, so long as blame is in the right place"? Is that how we want to approach this?
> Sure, it is absolutely true that better lifestyle and diet has a huge effect.
not for me. My cholesterol was hovering in the high 200's, then finally hit 300 and I completely freaked out, radically changed my diet, and lost 22 pounds (from 180 to 158).
What did my high cholesterol do ? It did absolutely nothing. ticked down to like, 280.
So I'm on the statins. my total cholesterol went from high 200's to about 150 in a month and was impacting my liver function. so we reduced the statins to a very low dose (5mg three times a week, crazy low). My total cholesterol hovers around 200 now. My cardiologist tells me that the conventional wisdom of "diet and exercise" is almost entirely disproven to have any meaningful effect on lipids these days (though i havent researched deeply).
> My cardiologist tells me that the conventional wisdom of "diet and exercise" is almost entirely disproven to have any meaningful effect on lipids these days (though i havent researched deeply).
I would be immensely skeptical of this unless he was talking about something much more narrow, like how there's a fraction of people who have really unfortunate genetics and can only improve their blood lipids with medication.
We have mountains of data showing that diet can massively improve lipids, and the combination of diet and exercise are our largest levers for reducing the risk of heart disease for most people. (There are always some fraction of people who can do everything right but have outlier genetics that require medication anyway, just as some people have outlier genetics and can smoke a pack a day their whole lives and reach their 90s.)
I'd check out the Barbell Medicine podcast for anything related to the intersection of lifestyle and health. They're extremely evidence based with a preference for measurable improvements in outcomes over hypothetical mechanisms.
Relevant to this thread are their episodes on testing and screening, hypertension / high blood pressure, cholesterol, fiber, and the new PREVENT heart disease risk calculator.
I'd also check out the episodes on diabetes, Alzheimer's, fatty liver disease, and health priorities.
To expand, one of the coverage pillars of malpractice insurance (in the US) is the "standard of care". This is basically what most doctors and their associations consider acceptable, which by definition excludes new, better techniques.
This is both a bug and a feature. A move fast and break things philosophy would cause more harm than good, but it also prevents rapid adoption of incremental improvements.
17 years is far from rapid or move fast and break things. ApoB has been known about for quite a long time, since the 90s its effects have been obvious, and showed up in research in the 70s-80s!!! It's still not part of standard testing!!!
Guidelines also leads to standards of care being random and heavily driven by politics & financial reasons disguised as medical best practice. South Korea and India are "parallel testing" places, which saves time, while the USA & others are serial testing places mostly because of their funding models.
Talk to any American doctor and they will give you a bunch of emotionally wrapped cope about why it's bad because the cognitive dissonance sucks and there are liability reasons to avoid admitting your wrong. I would argue that in many cases, parallel testing is cheaper because $300 of tests is cheaper than 4 chained $500 doctor visits. But whatever.
There is virtually zero chance that a doctor will lose their medical license for diverging from the from the usual clinical practice guidelines around statins. Check the state medical board disciplinary records.
But if they're employed by a health system and fail to follow company policy then yes, they could be fired.
> When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.
ApoB is shaping up to be an incremental improvement in measurements, but health and fitness influencers have taken the marginal improvement and turned it into a hot topic to talk about.
This happens with everything in fitness: To remain topical and relevant, you always need to be taking about the newest, most cutting edge advances. If it’s contrarian or it makes you feel more informed than your doctor, it’s a perfect topic to adopt for podcasts and social media content.
ApoB is good, but it’s not necessarily the night and day difference or some radical medical advancement that obsoletes LDL-C. For practical purposes, measuring LDL-C is good enough for most people to get a general idea of the direction of their CVD risk. The influencers like to talk about edge cases where LDL-C is low but then ApoB comes along and reveals a hidden risk, but as even this article shows there isn’t even consensus about where the risk levels are for ApoB right now. A lot of the influencers are using alternative thresholds for ApoB that come from different sources.
> In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
30% reduction in a life threatening issue is huge. I don’t see why you would want to diminish that.
If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.
numbers often quoted in favor of statins use relative instead of absolute risk. when seen in absolute terms there is little case for statins except in some possible particular cases. they also do little, if anything, when it comes to life extension — the expected lifespan of a statin user is often estimated to be four days longer than that of those who do not use them. not only is this essentially statistical noise, it discounts the lowered quality-of-life side effects experienced by many who have been put on statins.
This is all true. If you take a statin and it causes no issues, you're... maybe (30%, yay!) better off for it.
If a statin makes you feel miserable, I think any doctor would sympathize with a calculated decision to stop them. There are many types of statins to try though, so hopefully one would work without side effects.
Most with efficacy determined by the proxy variable of LDL-C levels, and with even more questionable results in actual lifetime improvement.
I too really wanted not to be that skeptical about medicinal research. But if I had high cholesterol and a doctor recommended newer statins to me, I don't think I would take them.
>If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.
You could absolutely think that they were basically the same, depending on the base rate. The differece between a one-in-a-million and 0.7-in-a-million is 30%, but it wouldn't be humanly perceivable. We're all likely faced with situations like that regularly. Differing airlines probably have much greater variances in their crash statistics, but it just doesn't matter in 99.99999% of flights.
Meta-analysis conclusion: This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
This is totally unsourced now but I did a deep dive quite a while ago now and it seemed to me that studies largely found that statins after a heart attack helped all cause mortality (though not by a ton), but if they were prescribed to someone before a heart attack it wasn’t nearly as clear. Considering how they often make people feel it seems like people should be a bit skeptical.
Have you read their methodology and understood how they did their selection? You could critique their actual methodology. Maybe their selection is backed by strong arguments, right? And if you think their methodology is weak, then please explain why.
Not just throw a two-line comment disparaging the work of experienced specialists in the field.
For the curious, here are the author affiliations for this study:
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (Drs Ray, Seshasai, and Erqou); Department of Cardiology, Addenbrooke's Hospital, Cambridge (Dr Ray); Department of Clinical Pharmacology and Therapeutics, Imperial College, and National Heart and Lung Institute, London, England (Dr Sever); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (Dr Jukema); and Department of Statistics (Dr Ford) and BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine (Dr Sattar), University of Glasgow, Glasgow, Scotland.
Concentration of ApoB-carrying lipoproteins in the bloodstream as the driver of heart disease is one of the most strongly proven facts in medicine. Statins are proven to lower LDL (a close-enough substitute for ApoB in most situations) by about 30%. I can't look at the study now, but most likely it's a situation where patients' cholesterol has not been lowered enough by medication to make a meaningful difference. If you have an LDL of 160, statins aren't going to be sufficient. The issue is doctors/patients not targeting a sufficiently low cholesterol level.
> When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.
Part of this is just that insurance coverage lags science. We've known that ApoB is more accurate than LDL since the 1990's or 2000's, but to be covered by insurance, several more steps have to happen.
First, the major professional societies (like the American College of Cardiology or National Lipid Associations) have to issue formal guidelines.
Then, the USPSTF (US Preventive Services Task Force) needs to review all of the evidence. They tend to do reviews only every 5 or 10 years. (Countries aside from the US have different organizations that perform a similar role.)
If the USPSTF issues an "A" or "B" rating, then insurance companies are legally obligated to cover ApoB testing. But that also introduces a year or two lag since medical policies are revised and apply to the next plan year.
The net effect is that the entire system is 17 years, on average, behind research.
> When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why.
I'd love to know where to get the right advice on this topic.
I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss the results(!), because she said I have zero arterial plaques and there's simply no need for us to meet.
How old are you? I was told that they're not considered diagnostic until somewhat later in life (>50) because the plaque may not have calcified yet, which could cause a false negative.
> When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical
Because this is a recent understanding and healthcare tends to be a conservative industry that moves slowly. Sometimes too slowly.
And also because LDL remains an excellent measure. The risk with LDL isn’t false positives. If someone has high LDL they likely have an elevated risk of heart disease. The problem with LDL testing is that someone with low LDL may still have a high risk of heart disease which may be captured in APoB testing.
I ALSO want to not be a statin-skeptic but, like you, these things look very weird to me. The most prescribed drugs in the country and we don't even try to check if they are addressing the actual problem?
That prior discussion gives no good reasons. The linked medium posts are, to be frank, trash.
Statins are well-tolerated drugs with little to no noticeable side effects. You might have to try a few. You may need to combine ezetimibe to maintain a moderate statin dosage level, and that's it. (Like the author of this article)
Source: Leading cardiologists worldwide, and doctors of the rich and famous.
I recently went on a statin (atorvastatin) and found I have the WILDEST dreams of my life if I don't take them in the morning, and my doctor said my liver readings were elevated after use but not enough he wants to switch it yet. Which alternative statins should I be looking at, or do they have even harder side effects to deal with?
> Statins are well-tolerated drugs with little to no noticeable side effects.
Sorry, that's nonsense. It is a dangerous drug with plenty of side effects. If it had no side effects it would be sold over the counter. The brain needs cholesterol to function. If you artificially remove cholesterol this is what happens: https://www.health.harvard.edu/cholesterol/new-findings-on-s...
I was found to have high cholesterol in my late 20s. At the time the doctors (my cardiologist, then a second one brought in for advice) determined that the source was hereditary, but the effects would be the same. So they put me on statins. It's been 40 years now. I changed the statins three times since, when the actual one, at a specific time was no longer able to keep the values within acceptable limits. Approximately 8-9 years ago (I think) I ended up on Rosuvastatin 20mg, which I'm still taking every day. I do not maintain any diet (it'd be very hard, as I'm a heavy meat eater) and cholesterol levels are still staying within acceptable limits. Of course YMMV
No heart attacks or strokes? I'm in the same boat (hereditary issue), and altering my diet has never had any substantial effect on my numbers. I'm not overweight and rarely eat red meat, but have had trouble keeping onto a primary care physician long term (the people I keep picking seem to move between clinics constantly) in order to retain consistent access to a statin prescription, but as I continue to age I've been getting increasingly anxious that my time is coming.
So far everything is good. I only had more of a logistic issue, once, when moving to France from the US, a few years back (retirement) and when my new doctor told me that the French do not recommend statins for people at my age and overall good shape (active, fit, etc. ), even if the numbers are high. I asked her to give me a referral to a cardiologist, to whom I mentioned my 35 years of statins in the US, and who was of the opinion that after such a long time and with no apparent side effects, he would recommend continuing on this type of médication. And that was it, so I'm now getting the prescription renewals almost "automatically", even as my cholesterol is staying within limits (under the assumption that it may increase, should I stop, especially considering the amazing cuisine and products to which I now have access :) )
one better simple indicator than large panels, if you can't get access to them or don't have them is simply your triglycerides/hdl ratio. aim to be under 2 if using mg/dl and under 0.87 if using mmol/L. it's one of the strongest correlated indicators of cardiovascular disease. way better than any classic cholesterol ratios.
> When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why.
That's pretty simple to explain. No conspiracy.
LDL-C is much much cheaper to measure. ApoB costs 36x times as much, so Insurance Companies don't like to pay for it
My wife had high cholesterol numbers, so her doctor wanted to give her statins. She asked about a scan, he begrudgingly said well, I guess you could do that. Her scan showed 0 plaque.
I’m sensing a potentially significant misallocation of resources. My mental model is that there’s a hypothetical quantification of not just your time and money, but your anxiety, attention bandwidth, mental energy, etc.
I think, in some ways, the trick is being able to short circuit the entire journey represented by this website in favour of some form of, “I’m 40. I should be more mindful of heart disease. I should add a 30 min walk to my mornings.” And then move on with your life.
I think many cultures, but especially American healthcare culture, foment a growing background noise of constant anxieties and stressors. Life is sufficiently complex but there’s always a peddler eager to throw you a new ball to juggle (and pay for).
I think people should be mindful of it since they were 18 - it's something that progresses over decades. You can have a lot bigger impact making changes when you're young rather than at 40
But yeah I agree with your message. Focus on the big impact macro level things. Hyper-optimizing it is a waste of energy
If I'm not wrong, it takes 20 years to revert the damage of smoking.
I don't think you need to care at 18, but the effects will be seen over the course of 20 years
Lots of the damage done can't be undone when it comes to heart diseaese.
Notably risk goes up with the time spent with bad numbers, so the most leverage you have on affecting your lifetime risk is caring as early as possible.
It's an area under the curve situation. Waiting until you start experiencing symptoms is putting a band-aid on an open wound compared to avoiding injury at all by focusing on high impact habits related to diet and exercise.
Seriously there is too much shit to worry about to micro manage each facet, unless your like a Bryan Johnson billionaire with a staff.
Beyond just heart disease & cancer taking you out entirely its: my eyesight is going, my hearing, every joint in my body could fail, my brain is slowing, etc.
There is just way too much shit to do anything other than be like: sleep, exercise, eat better and don't drink too much.
And even him doesn’t know what’s working and what’s making things worse. He claims to have really good biomarkers but that’s when cherry-picking numbers from studies made in a range of more than two years (!!).
You’ll never see a published set of tests from him. What you’ll see is ads to buy his supplements.
I think the article makes a valid point: stop worrying about 90% of the other stuff and focus on the thing that will almost certainly kill you - heart disease - for which there are easy diagnostic and preventative measures. I think they're arguing for a better allocation of resources, if anything.
It depends. Overall, lowest all-cause death indexed on BMI seems to be around 27 plus or minus [0]. Interestingly, for all subjects (not just healthy non-smokers), BMI 30-32 isn't really associated with a dramatic increase in all cause mortality.
Obviously life is more complicated than just one measure. I figure this is just another data point saying BMI is useful for population studies and not great for individual diagnosis.
Key Takeaway: Get a CT or CTA scan, and if you can afford it go for the CTA with Cleerly.
There is a reason that we don't recommend getting imaging for everyone, and that reason is uncertainty about the benefit vs the risks (cost, incidentalomas, radiation, etc, all generally minor). Most guidance recommends calcium scoring for people with intermediate risk who prefer to avoid taking statins. This is not a normative statement that is meant to last the test of time: it may well be the case that these tests are valuable for a broader population, but the data haven't really caught up to this viewpoint yet.
The central point of his article is that he went to a doctor who followed the guidelines, tested him and found he wasn't at risk for heart disease.
But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack.
Therefore he is arguing that THE STANDARD GUIDELINES ARE WRONG AND EVEN IF YOU DO EVERYTHING RIGHT AND YOUR DOCTOR CONFIRMS IT YOU MAY BE LIKELY TO DIE OF HEART DISEASE ANYWAY, SO ONLY THE SPECIAL EXTRA TESTS CAN REVEAL THE TRUTH.
I want a second opinion from a doctor. Is this true? Is this for real? Because it smells funny.
I strongly suspect the truth is both are "right", but they're both optimized answers to slightly different problems.
Mainstream medicine is hyper optimized for the most common 80% of cases. At a glance it makes sense: optimize for the common case. Theres some flaws in this logic though - the most common 80% also conveniently overlaps heavily with the easiest 80%. If most of the problems in that 80% solve themselves, then what actual value is provided by a medical system hyper focused on solving non-problems? The real value from the medical system isnt telling people "it's probably just a flu, let's just give it a few days and see" it's providing a diagnosis for a difficult to identify condition.
So if your question is "how do we maximize value and profit in aggregate for providing medical care to large groups of people", mainstream medicine is maybe a good answer.
But if your question is "how do we provide the best care to individual patients" then mainstream medicine has significant problems.
Part of providing good care is not burdening the patient with tests or treatments that are very unlikely to yield benefit. Put another way, the mission of healthcare is not "health at any cost."
The mission of healthcare in the eyes of those who provide it, isn't "health at any cost".
For the people on the other side, "health at any cost" is pretty much the goal, usually limited by the "cost" side of things, especially in the parts of the world where they haven't yet figured out the whole "healthcare for the public" thing.
The claim on an individual level is not objectionable to me. The question is that if we extrapolate it out to the population and actually take this action for everyone, do we make people better off? This is what clinical trials (or at least large observational studies) try to achieve. Right now, it is not clear.
His evidence is also kinda weak. And appeal to authority largely about someone who he's paying to tell him he has health problems. The incentives aren't aligned.
I also disagree that the 50the percentile is the breakpoint between healthy and unhealthy. There's a lot more to deciding those ranges beside "well half of the population has better numbers"
If I die at 90 of a heart attack havjng maintained the ability to live independently up until then, I’d take that as a massive win compared to my relatives suffering through a decade of me with worsening dementia.
If health science was as simple as health outcomes are proportional to one or two measurement percentiles, sure. But that's hardly true. Health is a lot more complex than that and the disease risk cannot be quantified by a small number of parameters
It's important to note that there's geographic variability in guidelines. Also, the article doesn't give enough information about the author's other risk factors. For a similar patient (based on the initial lab results), treated by a doctor adhering to the European guidelines, at least the following items would have been considered:
- Lipid lowering drugs
- ApoB testing
- Coronary CT (if the pre-test likelihood of obstructive coronary artery disease was estimated to be > 5%)
> But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack.
It’s scarily common in medicine for doctors to start specializing in diagnosing certain conditions with non-traditional testing, which leads them to abnormally high diagnosis rates.
It happens in every hot topic diagnosis:
When sleep apnea was trending, a doctor in my area opened her own sleep lab that would diagnose nearly everyone who attended with apnea. Patients who were apnea negative at standard labs would go there and be diagnosed as having apnea every time. Some patients liked this because they became convinced they had apnea and frustrated that their traditional labs kept coming back negative, so they could go here and get a positive diagnosis. Every time.
In the world of Internet Lyme disease there’s a belief that a lot of people have hidden Lyme infections that don’t appear on the gold standard lab tests. Several labs have introduced “alternate” tests which come back positive for most people. You can look up doctors on the internet who will use these labs (cash pay, of course) and you’re almost guaranteed to get a positive result. If you don’t get a positive result the first time, the advice is to do it again because it might come back positive the second time. Anyone who goes to these doctors or uses this lab company is basically guaranteed a positive result.
MCAS is a hot topic on TikTok where influencers will tell you it explains everything wrong with you. You can find a self-described MCAS physician (not an actual specialist) in online directories who will use non-standard tests on you that always come back positive. Actual MCAS specialists won’t even take your referral from these doctors because they’re overwhelmed with false cases coming from the few doctors capitalizing on a TikTok trend.
The same thing is starting to happen with CVD risks. It’s trendy to specialize in concierge medicine where the doctor will run dozens of obscure biomarkers and then “discover” that one of them is high (potentially according to their own definition of too high). Now this doctor has saved your life in a way that normal doctors failed you, so you recommend the doctor to all of your friends and family. Instant flywheel for new clients.
I don’t know where this author’s doctor fits into this, but it’s good to be skeptical of doctors who claim to be able to find conditions that other doctors are unable to see. If the only result is someone eating healthier and exercising more then the consequences aren’t so bad, but some of these cases can turn obsessive where the patient starts self-medicating in ways that might be net negative because they think they need to treat this hard to diagnose condition that only they and their chosen doctor understand.
The year is 1846, and a doctor has a radical new idea: doctors should wash their hands between performing autopsies and delivering babies!
You're not sure of whether this is a good idea or not, so you ask various physicians, and the consensus is unanimous: the very suggestion is offensive, do you think doctors are unclean?
There's something I deeply don't understand about this.
> I shared these results with a leading lipidologist who proclaimed: “Not sure if the lab or the primary care doc said an LDL-C of 116 mg/dL was fine but that concentration is the 50th percentile population cut point in the MESA study and should never ever be considered as normal.
> It’s also important to note that, according to a lipidologist friend, an ApoB of 96 is at a totally unacceptable 50th percentile population cutpoint from Framingham Offspring Study.
So... the exact median value is "totally unacceptable" and "should never ever be considered as normal"? I'm open to the possibility that the US population is so deeply unhealthy that this is true, but then that needs to be argued for or at least mentioned. Like, you can't say "you're exactly average in this respect" and expect your and that's terrible to be taken seriously without any followup.
Or if I'm misunderstanding what's meant by "50th percentile population cut point" then again, I think this jargon should be explained, as it's plainly not the usual meaning of "50th percentile".
I had assumed "the MESA study population" was a particularly unhealthy bunch in terms of this measurement, meaning the 50th percentile puts one in the worst half of an already bad off group.
I don't know the exact details, but I thought the Framingham survey was just a cross-section of the population. So getting upset about a 50th percentile score makes no sense at a population level.
A quick Google says that the Mesa study was actually of people without cardiovascular disease at the beginning of the study. So again, these conclusions don't make any sense to me.
Of course it makes sense. 30% of this population will die of heart disease. You don’t want to be at the median of that population if you can avoid it. And as a society we need to move the median, not just accept it. Which means giving people better advice based on better data.
The other thing these number chasers don’t tell you is that extremely low LDL numbers are also associated with anger management issues. The stuff is used in your body to build things. You need some, and probably at least half of the number this doc is trying to say is scary. In fact in a different test he is advised to talk to his doctor about whether a 29 is safe.
Has the guidance changed that you want LDL less than 2.5x (or was it 2x?) your HDLs?
Going deep on biomarkers, blood tests, and debates about optimal levels is okay for some people who derive motivation from obsessing over topics, but I’m starting to notice a trend where people obsess about these things for a couple years before burning out and moving on to the next topic.
The best thing you can do for yourself is to establish healthy diet and lifestyle habits that are sustainable. A lot of people who jump from obsession to obsession do a great job at optimizing for something for a few years, but when their life changes they drop it completely and fall back to forgetting about it.
Fad diets are the original example of this: They work while the person is doing it, but they’re hard to maintain for years or decades. CrossFit and other exercise trends have the same problem where some people get extremely excited about fitness for a couple years before falling off completely because it’s unsustainable for them. Some people are able to continue these things for decades, but most people do it for a short while and then stop.
I’m now seeing the same pattern with biomarker obsessives: They go a few years obsessing over charts and trying things for a few months at time, but when the interest subsides or they get busy with life most of it disappears.
The most successful people over a lifetime are those who establish healthy habits that are easy to sustain: Eating well enough, reducing bad habits like frequent alcohol or fast food consumption, some light physical activity every day, and other common sense things.
The most important factor is making it something easy to comply with. The $300 biomarker panels are interesting, but most people don’t want to pay $300 every year or more to get snapshots that depend largely on what they did the past week. Some people even get into self-deceiving habits where they eat well for a week before their blood tests because the blood test itself has become the game.
> starting to notice a trend where people obsess about these things for a couple years before burning out and moving on to the next topic.
Really spot on with one of my besties. He does all the tests. He has a concierge doctor. He reads extensively on the topics of fitness and nutrition. And yet he doesn't do any of it. It's just an intellectual exercise for him. And he has had two heart attacks in the last several years. It's so frustrating. I just wanna shake him.
I learnt a great trick about exercise: find a podcast or audio book that you really enjoy listening to. Here's the trick: you're only allowed to listen when you're exercising.
Also with food and drink: place friction between the treat and yourself. The easiest example is to not have biscuits / alcohol in the house.
Bonus tip: alcohol free beer is really good these days.
I push hard enough during cardio that I can't really follow a podcast properly.
On the upside, it's only 30 minutes.
While lifting weight I do that since I rest for 90 seconds in between sets, which is actually very boring.
I started reading books during that time and that has been a big improvement.
If you're exercising for cardio, and you're able to follow your book or podcast, you're probably not doing good cardio. OTOH, it's not a bad way to do interval training while watching sports, go hard when they're yammering, slow down when the sports are happening (or, if you're watching soccer, you can go hard most of the time and then slow down for the replay if anything happens, which is unlikely)
The majority of your cardio should be LISS unless you have extreme time constraints, but most people can find 30-60 minutes per day to get the recommended time in. This is an intensity at which you can hold a conversation.
If you have time for TV, you have time for watching it from a treadmill.
> If you're exercising for cardio, and you're able to follow your book or podcast, you're probably not doing good cardio
But on the flip side, even if it isn't ideal, if that tip makes at least one person actually do any kind of cardio at all, even if it's the worst one on the planet, it's still better than nothing.
In fact, I'd probably consider your statement of preemptively shooting someone down like that (imagine being a 3rd reader of the original comment + your response), is massively more harmful to others than parent who at best tried to trick someone into doing bad cardio, which again would be better than nothing.
Maybe our brains work differently, but I have absolutely no problem following a podcast while running, and my race times indicate that I'm doing good cardio.
I do have a hard time with mind muscle connection during weight training if I'm listening to something other than music, though.
> If you're exercising for cardio, and you're able to follow your book or podcast, you're probably not doing good cardio.
Nonsense. Elite distance runners are doing 80% of their miles at essentially a conversational jog with a starkly lower HR than the 20% of intense miles. Cardio exercise under all levels of intensity is optimal, not just easy or just hard.
Alcohol free beer was a game changer for me. Also if I can’t avoid it alternating alcohol-containing and alcohol-free drinks.
For exercise your tip doesn’t help me at all. I hate audiobooks and podcasts so that would turn me off more from exercising. Also I want to concentrate on the exercise and not do it halfhearted.
What helped me was to realise how much better I feel after exercising - since then i kinda got addicted to it because I notice how much worse I feel after not doing it for a couple of days.
I agree on the friction. Just not having access to cigarettes is the best way for me to not smoke. I just don’t buy them and bumming one from someone else comes with a degree of personal shame for me that makes me avoid them (in almost all cases).
I naturally don’t like sweet stuff that much - however since I moved from EU to America (not US) it’s been really hard to avoid sugar.
Y’all put that stuff into everything it’s crazy; I gotta watch out like a hawk and go to special stores. In Europe it was so much easier, there are always cheap sugar free whole foods available in every supermarket.
Right on spot. Find a regime for body and mind that you can sustain without any significant mental effort, after some time lack of good behavior be it sports of healthy food makes one uneasy. Bonus points from getting happy from it / making it a passion, this helps a lot with coming back after some hiatus (ie injury, sickness, long travel etc.).
Personal story - I used to be super sporty, 4x gym training during work week - cardio & free weights, climbing over evenings after work, hiking/climbing/ski touring over weekends. Vacations were mostly more extreme variants of the same. Last year broke my both ankles with paragliding, one leg much worse, so took me some 8 months to be able to walk straight again, with some time in wheelchair, then crutches. All strength & stamina gone, flexibility 0, so had to rebuild from scratch and I mean deep bottom scratch from which you bounce very slowly, not some 1 month stop when things come back quicker. If all above weren't my proper passions I would have a hard time coming back to being again more active than most(sans that paragliding, took the lesson and have 2 small kids). That ankle won't ever be same but so far so good, ie managed some serious hike&via ferrata mix 2 days ago.
Getting happy from it is 100% the most effective way to change habits.
Unfortunately it’s also very subjective and hard to find out what makes you happy…
The discussion seems unduly focused on lipids, whereas I would think that blood pressure would be a, if not the, primary concern.
Also for those who do take blood pressure medication: never quickly change the dosage, and especially never quit taking it w/o supervision!
I've seen several untimely deaths b/c someone ran out of their BP medication and could not get to a pharmacist quickly enough. Alternatively the person became irritated with the medication and simply stopped taking it.
Maybe part of starting BP medication should be the doctor giving you a "safety package" that includes a full month's worth of the drug and is to be put on a shelf somewhere where you can get to it should your usual prescription run out.
I was also surprised by that. It is relatively cheap to measure as you can just buy BP monitor and do it yourself at home. Considering that high BP is very often asymptomatic, I, for example, even feel better with high BP, many people walking around accumulating damage for years. Not to mention it also goes with a baggage of other side-effects like increased chances of a stroke and kidney failure.
For some reason it hits differently when you go eat something salty or drink coffee or get all stressed out for now reason and then see increased BP with your own eyes. That was what motivated me to stick to a better diet, cut caffeine and chill out.
Everyone knows the recipe for healthy living, it's the same as for similar issues such as personal finance (spend less than you earn, save, etc.).
They seem simple on the surface but hard part is execution for most people, due to life circumstances and other factors. Unhealthy choices persist because society isn't built around healthy lifestyles.
So while the comment seems helpful on the surface, it misses the forest for the trees.
I think that there needs to be a bigger discussion here, regarding why have we engineered a society that inflicts suffering and illness on so many?
Not all things labeled "processed foods" are bad, it seems. There are enough scientists that say the distinction is often hypocritical (example from an article: a factory-made carrot cake is labeled UPF, but a home-baked one isn't, even though they're practically the same thing). Sugar, fats, and lack of fiber make factory-food unhealthy, they say. Others add that we can't feed the growing metropolitan areas without it.
WRT the carrot cake, I will say that while there is only a minimal physical difference, there is a practical difference. Making a carrot cake at home is a commitment, and most people won't frequently go to the trouble except on special occasions... But one from the grocery store can be acquired casually and without effort, and it's easy to eat a lot more of something when it requires no effort.
Every time I cook (and thats quite often) I put a bit different ingredients that some factory would put in since they are the cheapest variant.
Some stuff is BIO, cream or coconut milk are lower fat version, or carrots are are without residual pesticides. Less salt since we use less salt, and taste buds quickly adjust so its still adequately salty, a better mix of herbs and spices so taste is.. simply better, more refined. We use with much less sugar, the same as for salt above (if you eat sweet stuff sparingly then even mildly sweet stuff tastes amazingly, just don't go from one extreme to another).
>a factory-made carrot cake is labeled UPF, but a home-baked one isn't, even though they're practically the same thing).
Actually they are not. "Practically" is carrying a lot of weight there. The factory baked cake will have a lot more extraneous ingredients and usually has a larger quantity of sugar and fat. Similar to how restaurant food generally has a lot more salt and fat than home cooked food.
Yes, right off the bat a factory made carrot cake will very likely contain dough conditioners, colors, and preservatives that no home cook would put in their scratch made version.
The direct impact of those extra ingredients alone or in combination is not entirely clear at this point, aside from building evidence that people whose diets include more of that seem to be less healthy.
Yep just a glance at the ingredients shows obvious differences. Other issues I've seen studies about include contaminants from conveyor belts, and for many snack foods, processing into smaller particles, effectively making them partially pre-digested.
Just expanding on a peer post, but industrial made food tends to have a large number of preservatives, stabilizers, coloring agents, and much more added for commercial reasons. An obvious example of this is in something as simple as bread. If you've ever made homemade bread. It goes stale in a day or two, and it's hard as a rock shortly thereafter.
But that loaf you buy at the store? It'll generally be covered in mold before it gets hard, and that's quite the achievement since it also tends to be more resistant to mold as well! Bread should get hard. This is where a ton of old recipes come from. The Ancient Greeks would dip it in wine for breakfast, Euroland has bread soup/puddings, and even stuff in the US like Thanksgiving stuffings or croutons.
You’re not wrong but it is not a fair TLDR. TFA has a TLDR which says
> If you only read one thing here, make it the “How to not die of heart disease” section.
Which itself is still quite long but it emphasizes:
> Every lipidologist I’ve spoken with has stressed the importance of measuring and managing ApoB above all else – it’s a far better predictor of cardiovascular disease than LDL-C (which is what physicians are most familiar with). Every standard deviation increase of ApoB raises the risk of myocardial infarction by 38%. Yet because guidelines regularly lag science, the AHA still recommends LDL-C over ApoB. Test for it regularly (ideally twice a year) and work to get it as low as possible (longevity doctor Peter Attia recommends 30-40mg per deciliter). Many lipidologists will say to focus on this above all else.
And:
> I asked several leading lipidologists to stack rank what they believe are the most important biomarkers for people to measure and manage. […], and will likely cost anywhere between $80-$120 out of pocket.
That’s a pretty interesting and relevant part of TFA. Omitting that is not a fair “long story short”, but rather just “different story”.
Vegetables aren't "carb-heavy". And we don't need to recreate blindly the circumstances evolution had to adapt us to. E.g., our bodies evolved when the population was much smaller, but I don't think you want to argue for mass extinction.
This is wrong. Our bodies evolved to eat a diverse omnivorous diet and complex carbs + the antioxidants present in vegetables and fruits are anti-oxidative.
Humans have eaten complex carbs only for the last 10k years since agricultural revolution. Before that, outside of a small part of Africa, there physically wasn't enough carbs available to say that they made any substantial amount of our diet.
Most ancenstral carbs were uber high in fiber, and very low in glucose (starch) and fructose.
I've taken courses in primitive wilderness survival, and one of the staple foods was grass seed.
Also lots of roots are edible with cooking, and it looks like we've been cooking for about a million years. Then there's wild rice, cattails, beans, berries, all sorts of stuff.
I agree that most wild plants are high in fiber and low in sugar, but there are are a lot of complex carbs to be had, if you have fire.
> Sticking to a Mediterranean diet that is light on carbohydrates and saturated fats is almost always the safest bet. Almost every health diet is some permutation of this.
A permutation that's currently making the rounds in the press (even though the original research is from 20 years ago) is the "portfolio diet":
I might just be tired, but this seems highly repetitive. The author mentions friends in the field and concierge doctors multiple times in as much as I read.
Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".
It’s also demonizing doctors and the healthcare system a bit too much for my liking.
I’m located in Europe, so I may have a slightly different view, but my doctors clearly care and discuss with me about prevention, risks, tradeoffs, …
They praise the methods of the „good“ doctors and stamps the others as driven by financial gain. Who says the expensive ones are any better in this regard? Who says they are more or less exaggerating the importance of test results to make you come back?
In the US my best doctors produce out of date advice about obvious things, have a very distinct gap between "everyday" (stuff they actually see) and "incredibly rare" (stuff unique enough to be a case study they heard about) in their knowledge/understanding and rarely advise things that require me to be a proactive and rational person (because they don't serve these often), so they'll spend two seconds being like "diet and exercise" without a discussion on how that'd work or what adjustments I'd actually make (leaving me to do this research myself) and then suggest a prescription (because even their least proactive patient will probably take a pill). They'll wait until things become a disorder before addressing them (or discussing with me how to address them).
The worst will basically laugh me out of their office for daring to belong to a marginalized identity or failing to already have the health knowledge I'm there trying to gain from them.
Maybe I have awful luck... but I have very little faith at this point. The most effective relationship I had was with a hack who was willing to just prescribe whatever I asked him for and order whatever tests I asked him for (I think most of his patient base were college students seeking amphetamine salts).
Somewhat related, one of my thoughts was “what if these concierge doctors just keep running tests until they find something, anything, to justify their fees”?
> I think it’s unreasonable to tell people not to drink alcohol if they like it.
Why is it unreasonable to tell people not to drink alcohol, but reasonable to tell people to stop smoking? Shouldn't the smoking section also get a "at least make sure it’s really good tobacco that you enjoy and don’t smoke too much of it"?
It seems like the personal preferences (don't like smoking, but does like alcohol) is getting in the way of their medical-but-not-medical advice, instead of being able to apply their recommendations equally regardless of what they personally like.
For alcohol, the default is social drinking which is why you don't have widespread alcoholism in most countries where people consume plenty of alcohol. For smoking the default is constant nicotine top up(the nicotine delivery is instant, lasts seconds to minutes and the withdrawal symptoms starts in an hour). Both harmful of course but the alcohol has much less harmful defaults.
“Alcoholism” is outdated and has been widely replaced by AUD (Alcohol Use Disorder).
I looked at Germany, according to Wikipedia the average consumption of pure ethanol per person per year in Germany as of 2019 was 12.2 liters. This was the 5th highest in the world, and equivalent to 686 standard 5% beers per year.
According to the WHO “moderate drinking” is 1 drink per day for women and 2 drinks per day for men, so the average German is already consuming above WHO guidelines.
It gets worse when you consider that about 1/4 of Germans don’t consume alcohol at all, and another 1/4 barely consume any, suggesting that the “average” isn’t really telling us much and the 70th, 80th, and 90th percentiles have very concerning consumption numbers. I assume most of those people consider themselves “social drinkers” but statistically they cannot be.
The inconvenient truth that the vast majority of adults refuse to acknowledge is that there is no safe level of alcohol. Any drink is going to damage you, marginal though it may be. Unfortunately the healthiest thing you can do is simply never drink alcohol.
I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things.
It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.
Health guidelines take into account when screening/testing is a net harm or benefit for patients in general, and when they move from being a net harm to a net benefit conditional on specific factors like existing diseases, obesity, etc.
Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations.
Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication.
A relevant anecdote. I’m very athletic and skinny, eat well, have a resting heart rate in the 40s, but was recently prescribed a statin at 30, due to my very high LDL cholesterol and lipoprotein A.
My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least.
My mother similarly was put on statins and is getting a cardiovascular work up (calcium scan) because she now has early atherosclerosis. She eats super healthy and is a former olympic sprinter..
Bonus anecdote: In my free time I do shifts as an EMT with my fire dept (911), that is a big wake up call to wanting to be as healthy as can be. The number of patients I see who are 50+, nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At that age I see type 2 diabetes, hypertension, high cholesterol, and more.
You're probably a "lean mass hyper-responders", a phenotype which is actively investigated, initial paper:
Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research
They have me on blood pressure meds and do the usual blood tests, the tests I considered have been elective and I requested them explicitly. Just haven’t followed through due to aforementioned hesitations. I’m very much aware heart issues run in the family and that I have symptoms.
But I would be very happy to do any elective non invasive tests. On the fence about going beyond that until/unless the Dr. flags it as needed.
- Radiation. This is why people shouldn't get these scans several times a year, but 1-2 are very unlikely to move the needle. The average radiation from a full chest CT is just under the average dose for ~2 years of normal background radiation. (I don't know if a CTA uses less than average.)
- Acting on something you would otherwise have ignored, where ignoring it might have been the right answer. The main problem here is that it's hard to get a medical opinion saying "you should ignore this" because of perverse incentives: there's an aversion to recommending doing nothing because that could lead to a lawsuit, whereas "overtreatment" will not get a doctor sued. However, you can make a deliberate decision to do this anyway even after getting the scan; seek second and third opinions, consider alternatives, weigh risk versus reward, make a considered decision.
There are specific recommended minimums in the physical activity guidelines about strength training and endurance training where meeting them is likely to significantly reduce your disease risk and improve your health: https://www.barbellmedicine.com/blog/where-should-my-priorit...
Well “fortunately” I’m forced to have a strict diet due to some sort of IBS issues. For that, I use the MacroFactor app and talk through my daily recipes with ChatGPT, making sure to hit the macros and calories targets while also optimizing for heart health and IBS. Fat, protein, carbs, fiber. Taking AG1 to fill gaps.
For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often).
That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people.
I also don’t drink or smoke or vape which I think is important.
Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.
Fabulous information, but lacking information isn’t the issue. The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds. (Yes I know your marathon runner cousin who died suddenly of a heart attack, but these are still your best odds)
Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.
This site isn't necessarily meant to have a big sociological impact; it provides enough information that someone with sufficient motivation, but a lack of resources and expertise can take concrete steps to reduce their risk. That seems useful to me.
in this case “useful” means applying the facts and making changes. A detailed map that goes unused is useless. A hand drawn map that gets you home is priceless.
People don’t need more facts and information – those are in surplus. In fact, for most people when they receive too many facts, they just glaze over.
“Stress” is so abused and nebulous that it’s impossible to define. Nearly every condition is worsened by “stress” but there’s no way to measure it. And there’s no conclusive way to manage stress either. Medication, psychotropics, self medication, meditation. Nearly all of those are more broadly abused and yet stress “worsens”.
One person may run an intense soup kitchen 15 hours a day and feel little stress, and another can sit at a computer for 9 hours sending pointless emails and feel tremendous stress.
Fortunately, as you mention in your last sentence, stress is introspectable.
How exactly stress corresponds to biomarkers doesn’t matter if your desire is to lower it.
The issue is that many of us don’t pay attention to how we keep our body & mind throughout the day, or do so on a very superficial level. So strain on the body can accumulate for a long time.
“Stress management” is a lifetime skill. It doesn’t come in bulletpoints, it’s as broad as “living happily”.
Edit: That said, this can make the advice “be less stressed” a bit vacuous.
But people do get scared when random health issues flare up and become more conscious of how they deal with stress in life.
So it’s not bad to keep reminding people either :)
> The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds.
More specifically, it’s “change your diet and eat/drink less”, which is the hardest part. Diet’s impact eclipses regular activity, and it’s consequences build up and compound over decades.
I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".
Yes - in addition, medical professionals warn against “overdiagnosis” from unnecessary screenings.
This can happen when we choose to treat otherwise benign issues that would have had few negative consequences for our health or longevities. Those treatments can have negative effects that are worse than the ailment we’re trying to treat.
I know it’s a natural tech-guy impulse to quantify everything and get access to as much data as you can, but that myopic focus can actually lead us to optimize for the wrong thing.
I agree. As a physician, this is sticking out to me as bad / dangerous advice. By getting unneeded regular CT scans, you’re dramatically increasing your risk of developing cancer. Beyond the radiation exposure itself, there is also the very real possibility of incidental findings that can lead to further testing, invasive biopsies, and unnecessary interventions, all of which compound your overall risk. You might solve one problem, but you’ve just guaranteed a much bigger, more explosive one down the line.
> I experienced this repeatedly. We were admitted to the hospital for over a week when my daughter contracted viral meningitis (the scariest experience of my life). Even while working with incredible infectious disease doctors, I still had to fight and constantly remind people what the next steps were during our admission. Nobody is watching over you - it’s your job to organize things and ensure they’re on track. I had to coordinate between the infectious disease departments and neurology departments and make sure the people doing the lumbar puncture on my 9-month-old daughter weren’t just residents practicing on my child but experts who had conducted the procedure countless times before. You must Advocate for yourself and the ones you love.
Don't know why his behavior wasn't noticed more in the comments but he's absolutely entitled.
Hospitals and everything have limited resources, by being the asshole who request things to go fast for him and only have the best of the best to practice on his daughter, he just deprived someone else daughter from good care.
This is selfishness, unless the nurses and doctors were napping, he shouldn't have that kind of behavior detrimental to everyone else. I couldn't read further what he got to say but, coming from this man, i don't see how it could be interesting or useful.
I don't have anything to prove it but the whole thing smell fishy, when he goes to these 'concierge doctors', of course they are going to find things that are not right and were 'missed' by his regular doctor. That's literally their business.
if you went there and you were told 'nop, everything is fine. Keep doing what you do', you would go back to your GP and forget about it. But if he frightens you with bloodwork that show 'not optimal' in big red, tells you how wrong your gp is and how you should listen to him, you're going to think this guy know so much more and deserve my money. It's business.
I trust the national health guidelines: eat healthy, do at least 30 min of activity per day and lift weights.
Everything else feel like nuisance, especially coming from folk like that.
You're conflating advocacy, which indeed he is entitled to, with how the hospital is allocating resources and if and how they apply competent resources.
Life or death procedures aren't a time for "you get what you get and don't have a fit."
Hospitals are full of 'life and death' situation. If everyone were to behave like that, things would stop working or be severely slowed because you can't work correctly when you got that guy breathing on your neck constantly. You lose time answering to load of demands from people getting angrier and angrier because they feel that they don't get the care they need. That makes you angry. Other people are getting less attention, they get angrier.. Etc etc.
I believe you have the right to say it when things are not right, but there is a fine line between that and the behavior he described.
And he wrote that he went to an expensive hospital, this isn't some low tier hospital filled with under qualified, under staffed personals.
I think you really pretty fundamentally missed the point of what he's saying. Perhaps you've never had to confront the full brunt of the bureaucracy of a large-scale medical provider.
If you've got a serious condition, you really do need to have a patient advocate, whether that's yourself or a family member or someone you're paying to fulfill the role or some combination thereof. The medical systems I've encountered for non-trivial care (US HMO, US PPO, Belgium, Norway) just aren't designed for holistic patient care. Each department does their own thing, and it's just luck if there's someone watching over the whole process from the individual patient's standpoint.
Perhaps you took exception to the comment about looking for an expert instead of a newbie (a resident, in the text) working on the author's 9-month-old. One could argue that that's a different issue than the general need for a patient advocate. Fair enough. But if I were watching out for my 9-month-old, I'd definitely want to ask about the track record of each of the doctors in the room. I mean, sure, new trainees need to practice somehow and all, and there's a tragedy of the commons there. But I certainly wouldn't brush someone off as "absolutely entitled" just because he wants the best care he can get for his 9-month-old.
I don't know, maybe it's just me seeing things differently.
I always thought that you got to choose wisely people that you need their expertise, especially in healthcare, but once you picked one hospital you got to commit and let them do their job.
I understand it's not easy when you are in charge of a 9 month old but you got to suffer through that.
If someone was to go so wrong that even an untrained eye could see, it's different.
Maybe I didn't have my fair share of bureaucracy. Maybe my standard are too low.
I sure did have my fair share of mistake when I went to emergencies, undiagnosed broken bones for instance. I never thought a second about requiring 'better' doctors, more competent nurses or more attention. I just accepted that it's thing that happens and nothing is perfect. Went back to the hospital 2 more times and eventually got everything back in order.
I didn’t know who this author was previously (Jared Hecht) but I looked up pictures of him and he definitely does not look like he exercises regularly. He’s skinny (e.g. not overweight) but if I passed by him on the street I would not peg him for someone who exercises seriously.
There is an old pharmaceutical product that was available in Germany, but can not be obtained anymore. Ouabain /Strophanthin
"Ouabain /wɑːˈbɑːɪn/[1] or /ˈwɑːbeɪn, ˈwæ-/ (from Somali waabaayo, "arrow poison" through French ouabaïo) also known as g-strophanthin, is a plant derived toxic substance that was traditionally used as an arrow poison in eastern Africa for both hunting and warfare."
It was later found naturally occuring in the human body:
Key Paper: Gottlieb SS, et al. "Elevated concentrations of endogenous ouabain in patients with congestive heart failure." Circulation. 1992;86(3):846-849.
Details: Researchers measured plasma EO in 21 patients with severe heart failure (NYHA class III-IV), finding mean levels of 1.59 nM—over 3x higher than in controls. EO correlated inversely with cardiac index (r = -0.62) and positively with mean arterial pressure, but not with atrial pressures, suggesting a compensatory role in cardiac output regulation rather than simple volume overload.
Great post but quite surprised there is no mention of cutting red meat. There is a lot of evidence that especially the American diet is dangerously high in red meat to the point of elevating Heart Disease risk.
IMO, I think that is more of a saturated fat issue, and only a subset of the population is like that. Others solve their health issues through eating a lot of red meat.
Yeah it's definitely more about saturated fat from animal sources.
A leaner cut like tenderloin is fine.
Ultimately you just want to keep the calories you get from saturated fats from animal sources to less than 10% of your daily calories. You can still enjoy a nice steak or burger every once in a while, but they shouldn't be a daily staple if health is a priority.
Also processed red meats or processed meats in general. Processed meats are the ones strongly linked with heart disease. At least for those who dont want to go vegetarian.
Processed meats are so bad, they should be eliminated entirely from everyone's diet. The World Health Organization has classified processed meat as a Group 1 carcinogen. No amount of it is considered safe.
Unprocessed read meat is still a problem and WHO advises less than 350g a week. Which is 12–18 ounces of cooked meat. 12g is about one adult serving of steak. So you really are looking at 1.5 servings per week of unprocessed red meat to be safe. At most! You probably should try for less or closer to 12g.
And really if you're at a healthy weight, then I'm not sure how helpful this is. Obesity is a bigger risk factor. This is a bit of the elephant in the room for heart health. Not only should we not be eating things associated with heart disease but also we need to keep ourselves at a healthy weight.
these are extremely outdated recommendations that make no sense. most of the basis for those are studies that took direct correlation as causality. the problem is a crappy lifestyle which incidentally typically includes processed and red meats in large quantities in the western world. saturated fats are hardly a good indicator of anything when you disassociate them from the lifestyle and foods they come with for most people. blue zones are now finally coming out as simply just the places where records sucked. there are plenty of populations with centenarians that had meat rich diets.
yes obesity is bad, as the source enemy of most diseases that kill and are not cancer is inflammation. find a diet that makes you not obese and have low inflammation, that is vastly superior to "Mediterranean diet" or "plant diet" for everyone.
In general, when science is done, recruitment requirements force the experimenters to bucket the participants. One thing that often happens is an open bucket, say 35+.
The resulting science is then reported as “When you cross 35, your chances of being pregnant immediately drop” or “The brain stops developing at 18” and so on.
Almost nothing in the body is really like this, though. You can quit smoking later in life and it will help. You can eat better later and it will help. You can exercise and it will help. Very few things are “the damage is done”.
The only constraints are that the later you start the more risks you face. E.g. if you first deadlift in your 50s and you decide to follow Starting Strength you’re going to have trouble.
If you start exercising in your 20s, and never stop, it will be so much easier to maintain fitness in 40s 50s etc. The challenge is that the benefits are not yet visible in your 20s (when you’ll probably be healthy and at a proper weight regardless). Gotta lay that foundation for older age though!
EDIT - I misread the comment. It’s never too late to start, just be careful for injuries as that will block your ability to exercise.
So your doctor won't agree that you have heart disease but you need to be on a statin but statins are by prescription only... So if you're not going to hire an expensive doctor what can a normal person actually do?
Eat healthier (less processed foods, more fruit and veg, healthy carbs, low sugar and alcohol), exercise regularly and get enough sleep. Take a blood pressure measurement every week / month or so. Track your weight. React if either start going up. Don’t go start getting uneasy ct scans.
> All of these can be accessed through bloodwork and urinalysis and can be done at a local Quest Labs (I’d venture to bet there’s one within a 10-mile radius of your home), prescribed by your doctor, and will likely cost anywhere between $80-$120 out of pocket.
A frustrating thing about this suggestion -- if I tell my physician (I live in the US) that I want these unusual tests prescribed, s/he would scorn at me (as if I'm acting like a know-it-all and am questioning his/her wisdom attained through years of medicine school and practice).
I truly don't understand about US healthcare is why we allowed medical practitioners to put up barriers around medicine (sure, ban opioids,chemo drugs and maybe a handful of other toxic-with-low-dose meds) and testing by requiring everything doctor's prescription?!
For example, my wife had an swollen eyelid (through infection) recently. She is an oncologist in training (is a board-certified internal medicine doctor). She knows how to treat it -- by putting clean, warm cloth over her eyes to allow pores to expand and let secretions seep out (to treat the symptom); by adding anti-bacterial eye drop like Tobramycin ('mycin' means it's Penicillin-variant, which is usually used to treat bacterial infection) OR by taking antibacterial medicine like Azithromycin. If we were in our home country (in SE Asia), we'd just go to a nearby pharmacy and buy either the anti-bacterial eye drop or pill, and get it sorted. Since we live in the US (for now), my wife has to asked one of her coworkers to prescribe her the medicine (she wasn't sure if she can self-prescribe because we just moved to CA and don't want her to lose her license). Then she took the anti-bacterial pill three times (with the warm cloth treatment for symptom), and the infection was treated completely.
I strongly believe that this kind of infection treatment or self-prescribed blood tests should be allowed without any doctor prescription. Otherwise, it only adds more (unnecessary) patient volume to doctors, clinics and hospitals. I remember reading someone from India advocating for similar approach on HN or Reddit a year or so ago too. In India (just like my SE Asian country), they could just go buy medicines over the counter from a local pharmacy. No doctor's prescription needed (maybe the law is there, but it's not enforce strictly).
> what most primary care physicians will do with patients to help them avoid heart disease is not enough. The status quo simply does not work
The reason the status quo doesn't work is that people don't actually follow the guidelines set
Barely anyone (like 10% last I saw) meets the recommended amounts of fruit and vegetable intake or exercise. We're all addicted to terrible foods, are sedentary, have high blood pressure and are overweight
Before you start micro optimizing everything just fix your diet, avoid saturated fat and sodium and get enough moderate intensity or better exercise every week
The 95/5 of it is just basic stuff everyone knows and yet barely anyone does
The primary thing I did was ask a cardiovascular surgeon in my network to send the lab requisition form to a lab. This is the gate for much of this stuff, even if you pay out of pocket. If someone knows a simple “pay and play” testing service that would be fantastic.
Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.
I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.
Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.
ChatGPT is amazing for interpreting test results. Of course you should back it up with a doctor.
Back when 3.5 came out I gave it some information about me when I was a teenager on a condition that (multiple) doctors totally misdiagnosed. It immediately told me three tests I should have done, two of which would have diagnosed it right away. Instead, I had to deal with extreme fatigue for over a decade until I finally did research on my own and had those same tests done.
As far as test results go, right now we’re dealing with our dog having increased thirst. She’s been on prednisone for a year, and that’s not an uncommon side effect. We brought her in to the vet and they tested her and diagnosed in as stage one kidney disease, with no mention of the prednisone. I put those results and her details into ChatGPT and it told us it could absolutely be the prednisone, and told us we could use an inhaler for what we were using the prednisone for - chronic bronchitis. Our vet never offered than option. We’ll find out in a few months if she actually has kidney disease or not, but chances are it was just the prednisone.
As a bonus, the vet before this one diagnosed her bronchitis as heart failure. They didn’t run any tests, scans, etc. Just “sorry, your dog is going to die soon.” What a fun week that was.
ChatGPT is an amazing second opinion tool. Obviously you need to ask it neutral, well formed questions.
Yeah its a self-made-help article, if you don't know any better this is what you do. It doesn't make it the best choice overall though.
It feels like the guy had a... mediocre GP, got scared by skin cancer diagnosis and over-corrected to most expensive path possible and since stuff was found out we have this article, roughly correct but written in a sensationalist (or freaked out) style. Some claims are outright false (like GPs not knowing heart disease is the biggest killer... really).
Wife is a doctor with overreach between public and private healthcare, and those private services also have their own motivations which aren't often straightforward help-as-much-as-possible, rather milk-as-much-as-possible with tests, scans, long term treatments and so on. Especially CT scans pour non-trivial amount of radiation on the body that on itself can cause cancer down the line.
With public healthcare you at least know primary motivation isn't cash flow but helping patients, the issue is rather overwhelmed resources with limited time per patient. It always depends on individual, as with engineering there are better and worse, yet we all somehow expect every single doctor to be 100% stellar infallible expert with 150 years of experience across all branches of medicine (absolutely impossible for any human being). Look around at your work if you are an engineer and perceive the spread of quality/seniority of each colleague. Same happens in medicine, just stakes are (much) higher.
The title of the article says "don't die of heart disease", but given that we all have to die at some point, if you could choose what natural cause to die of, wouldn't you pick heart disease? It is the best way to die. The worst is stroke. So once you cross a certain age, say 60, don't worry about heart disease, worry instead about stroke.
I agree, but both are heart disease and both can be prevented in similar ways. My dad and my father in law both died from heart disease. My fil was on the surface less healthy. He had an extreme high stress job with exposures to environmental factors that made it worse, was partially disabled with bad knees, etc. i believe he was on blood thinners for almost 20 years.
He got up to make a sandwich for my mother in law, who was very sick, and don’t come back. Massive heart attack and aortic rupture - he was dead before he hit the ground.
My dad had a lot of stress over his career and his share of health issues but found a happy medium and improved his health greatly stating about in his late 40s. He was basically walk/running 2-5 miles a day for several years after retirement. He had a major stroke, recovered somewhat, and then ended up almost dying from a kidney stone and resulting infection. (He could not communicate pain as part of his aphasia.) long story short, he suffered in a lot of ways (pain, disability, loss of dignity) for 4 years before finally succumbing.
In online discussions, we tend to boil everything down to death. Reality is that longer you can put off complications, the better you will be when something more severe happens or you get sick. As you age, each time something happens, your recovery is a little less robust. Go to the doctor, take your statins and take care of yourself.
Yes but there are habits that are especially important for preventing stroke, such as getting 7-9 hours of sleep, monitoring and controlling risk factors related to blood vessel health that affect the brain uniquely, such as preventing irregular heart rhythms (atrial fibrillation), anti-inflammatory diet choices focused on brain health, and so on.
If you have a massive banger and die immediately that is a pretty good way to go.
However, many people suffer from heart failure which, despite the name, means partial heart failure. The permanent breathlessness gives them a terrible quality of life. They can live with this for decades sometimes but it's not much fun.
Sometimes I think the way this type of thing is framed is misleading. There's a list of putative causes of death and there's an assumption that they're equally systemically impactful, and you can go down the list and just lower the probability of each and lower your overall likelihood of death.
That's not totally off, but the thing about cardiovascular disease is it affects everything because it's how your body distributes oxygen. Stop distributing oxygen and you die.
That's not to say other organs aren't important, it's just that if you replace "cardiovascular" with "oxygen distribution" it becomes apparent that almost by necessity it's going to include a lot of deaths.
What I want is a long life of doing what I want. when I must die how doesn't matter, but if I can extend my lifespan (well span) by not getting a heart attack that is good: more years to enjoy life. If I can also extend my life by not getting cancer even better. Even if I must die if I can delay that with a good life that is what I want.
note that I said good life. There are lots of bedridden people, I don't want to be like that. I want to be like the old person still doing things in old age.
You assume that you'll die at X years old, and get to pick the disease. In reality, you might die of heart disease at 60, or cancer at 70, or alzheimer's at 80. Which one do you pick?
I think you are confusing "getting a stroke" and "dying from stroke". If you get a heart attack and don't die from it you might become a burden on your family too.
Unfortunately, the time in our lives when we need to most pay attention to these things is when ageism kicks in and yeets us completely off of health insurance.
I'm coming up on two years unemployed and feel like an idiot for not better preparing for ageism in our industry. I foolishly assumed that experience would make up for age.
Don't make the same mistake! Plan to have most of your income shrink drastically in your mid-40s.
> Even while working with incredible infectious disease doctors, I still had to fight and constantly remind people what the next steps were during our admission.
Can't help but feel this is a factor of the sleep deprivation that doctors seem to celebrate.
Curious about how accessible these tests are in Europe. Living in a country (NL) that doesn't value annual checkups makes me assume detailed, preventative blood testing like this is hard, let alone possible to get in non-extreme situations.
My dad went to doctor who was like his friend as long as I can remember. Always received a clean bill of health. Until he suddenly got heart disease and a stroke on the operating table. His doctor basically said that he had seen this coming. Doctors secretary, probably twenty years his junior was a stunner.
If you dig into research and follow the low-risk experiments that people do online to reduce their Lp(a), you can find techniques and evidence to do so. It doesn't have to be an impossible-to-fix issue.
The value of the biomarkers are they applicable for all age range? What if someone already had a heart attack, then what should be the normal values post incident?
> It's not sexy, and as a result an overwhelming majority of the population is unaware about how to avoid succumbing to it
When I started building an ECG Holter in my early 20s, I tried to get some friends to use it and kept hearing "yeah, but it’s not exactly sexy to wear that thing." That’s when it hit me how little people care about prevention until something goes wrong. We still have a huge awareness gap to close.
I asked a heart doctor for a calcium scan. He said I didn't need that, but he wanted me to wear a Holter monitor for a few days (reasons unknown). I did not.
That was years ago. I have different doctors now but still no calcium scan. Time to ask again possibly.
The "be an advocate" thing is both true but also incredibly selfish and egotistical.
If everyone did that, the whole system would grind to a halt. Doctors aren't in a rush because they enjoy so, they are because they're already overworked. 1 out of every 25 patients (their family) demanding extra attention is possible although still a burden. 21 out of every 25 is not possible.
My assumption was that we have to be our own advocate because the system itself is non-ideal.
My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.
I find it odd that you would instead "advocate" for not being an advocate for your own health? Are we waiting for a friend to say, "Hey, you're looking a little rough."
> Are we waiting for a friend to say, "Hey, you're looking a little rough."
If you are "looking rough", unless you are in imminent danger you should just go to the GP. Your GP is there to triage care. He'll recommend whether you need something prescribed from the pharmacy, a blood test or see a specialist.
If you get refered to a specialist, the hospital will try to ascertain if you need a really experienced specialist or if you have a relatively simple case that can be handled by one with, say, 11 years experience. If he decides the case is too complex, he can ask the more experienced specialist to preside.
If you short-circuit that and demand to be seen by the most experienced specialist, you are robbing a patient that might need that experienced hand of extremely valuable care, when you could have done with less. Like I said, egotistical.
> My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.
Blood work needs lab workers who also have limited time. They could indeed do 10 tests but that means more labs and more lab workers which increases costs, which are already exploding. Better tests would be good.
Yeah insisting that you are qualified to choose the members of the medical staff qualified to do X or Y procedure isn't advocating, it's being a prick.
I'd argue that even the CT scan is unnecessary for a lot of people who want to start a preventative regimen to tackle heart disease. Especially if you're in your 20s or 30s with no family history of heart disease and no absurdly high ApoB results combined with really high lp(a).
It seems to be nearly impossible for me to advocate for myself at a place like a hospital.
It might be easier to do this for someone else, but it seems narcissistic to assume I of all the patients is so special. If there’s nobody to advocate for me, clearly I’m not!
Let’s say I try it anyway. I tend to be a slow rational thinker in real-time situations, especially under pressure. If I try to advocate for myself and ask questions, I would need to have time to consider the responses (did I even get the information I requested, what are the implications) and maybe do some research in order to make an informed choice as to whether to proceed or not, or whether to ask further questions. However, if I actually request time and have people wait for me, I enter a high-pressure mode in which I can’t think well. The clock is ticking, the stakes are high.
Even if it’s a simple routine case, I am entrusting myself to people who have the power to kill me. If it’s anything beyond routine, killing or harming me may not even be consequential to them (mistakes happen). It is a very particular type of situation.
The natural thing for me to believe is that all of these people are professionals. If I have reasons to supervise them, it automatically implies I believe they are either unprofessional or malicious, in which case I really should not be there in the first place. The arrangement is that I am not supposed to know better than them. If I try to supervise them, that implies I think I do. At worst it would be disrespectful or offensive and would make them hostile on a personal level (which is always at play between humans, regardless of the protocol), at best it would make me look like a crackpot not to be taken seriously anyway. Besides, if I already assume they make mistakes or are unprofessional, their answers can be false anyway.
On the other hand, I am aware that many, many mistakes are made in hospitals daily, so I know they are not such infallible professionals.
As a result, this makes me very reluctant to go to a hospital or a clinic for any reason. It’s probably bad.
Anyone has advice for overcoming this? Maybe training to think quickly and finding ways out in high-stakes situations like this? Tricking yourself into a mode where you feel natural advocating for yourself and act in a way that makes people treat you seriously without being offensive to them (considering the power they have over you)? Learning to not care what people think in a healthy way? (Please don’t suggest LLMs.)
Please strictly cease and desist from accusing material of being written by an LLM, whether on this site or on any other site. If you want to criticize the material, do so under the good faith assumption that it is written by a human.
Genuinely, why? More people than ever are using LLMs to flood the internet with textual slop far faster than humans who have respect for the craft of writing can generate their own text.
I checked Jared Hecht (the author of this piece’s blog) at jared.xyz and the oldest piece is from March 2023. Why should we give someone who has no evidence of writing anything before the release of ChatGPT the benefit of the doubt that their work is all human written, when all signs point to otherwise?
I think it’s absolutely fair to criticize something for potentially being generated via an llm or heavily utilized by such especially when it comes to medial claims.
Reading it I couldn’t help but feel the author relied on ai research tools and is now passing that along to everyone reading as if it’s proven fact. When they link out to an ai search engine that’s not helpful when trying to cite sources.
We don't really know the author. For all I know, the LLM is more accurate than the specific human, in which case I'd want the article to be written by an LLM.
Saying "LLM bad, human good" is both false and uninteresting.
No. It is false criticism. It is like calling one a witch in historical times. Anyone gets accused of it without hard evidence. For all I know, your comment was AI generated. You relied on AI and are now passing that along. It's not helpful.
I recently did a comprehensive panel of my own volition with Quest Labs and was pleasantly surprised by the entire process. It was super easy to schedule, affordable, and their online platform is surprisingly sleek.
Is having someone you can describe as "my dermatologist" a common thing? Probably not for most people who don't have a chronic skin condition of some kind, I would think.
they are to me. I'm very light skinned and thus have had sigificant sunburn more than once, skin checks have found and removed somewhat likely to turn into cancer. Probably useless if you are 20, but by 50 they can find and prevent cancer and so should become common
It is a long read and I want to make time for it. Quick search check and calc (for calcify etc.) and diet appear alot in the article which is not surprising based on other things I have watched on the subject.
Actually, there is. You have to search for "pressure". For example, "Other Tests: There are some other things that are important to know as well. You must know your blood pressure".
As much as the HN trend is against AI features in client software, this is an excellent use of Gemini-in-Chrome. Instead of wracking your brain for English synonyms, you can just ask it if the page discusses hypertension, a kind of weapons-grade ctrl+f. Mine said
"Yes, the article discusses hypertension, referring to it as "high blood pressure.""
What if heart disease saves me from dementia? I'm not just being contrarian. I think about this a lot of the time. I'm already 40. I'm being healthy now, but whatever damage has already been done is baked in. (plus whatever is in my genetics) A quick death at 65-70 might be much more preferable to a slow terrible decade-long decline.
New medical discoveries happen regularly; you might also die right before the discovery of a preventative/cure for dementia. Living people have options, dead people have none.
Also, given the preferences you expressed in your comment, you especially should want to avoid strokes, or the many side effects of heart disease, which can make you less healthy for a long time.
Heart disease can be a slow decade long death, where you become incapable of physically doing anything. It's not just a heart attack out of nowhere and you're dead.
My grandfather always said "there's something to be said for a good coronary." He was in his 70's when he said it, and his point was that he had a good run, and there's an argument for going out while things are still good rather than slowly dying over six months in a nursing home (which is what actually happened).
Heart disease is the leading cause for death, but the root cause is definitely obesity. There’s a an obesity-pandemic that no one’s talking about it, there should be a national program that encourages people getting fit and discourages them from getting obese. And by encouraging/discouraging I don’t mean some random posters posted around, no, things like tax cut for fit people, free access to xyz if your bmi is less then abc, cheaper flights and insurance if you are fit, and so on.
"This means regular exercise (both strength training, ideally 3x per week, and cardio training that helps to improve V02 max like Zone 2 training)"
Actually, V02 max is best improved through High Intensity Interval Training (HIIT) like doing 400m sprints 8x with a couple minutes rest inbetween. V02 max is famous for being one of the best predictors of longevity.
Zone 2 training (light jogging) is important in tandem (80% of exercise ideally), especially for overall cardiovascular health and lowering heart rate.
Best thing I ever did for my health was start running (mostly jogging) 4-5 times a week. It's amazing how much your health can be improved with 4x 45 minute jogs (just 3 hours/wk). I can consume practically any caloric food for needed energy and all my health metrics have been substantially linearly increasing since I started.
"the stuff that’s not good for you: pasta and pizza and bread."
Tell that to the paragons of fitness in marathon running or olympic swimming. There are none of them on low carb. The best cardio health requires cardio exercise and cardio exercise requires carbs as energy. Of course if you're not going to exercise and are okay with 50th percentile health, ya carbs will hurt you then because youre not using them.
Unless you're willing to take pills the rest of your life, spending a ton of money to study your risk of heart disease is always going to lead you to the same conclusion: Don't smoke, don't drink, eat healthy and exercise regularly.
My dad would disagree--he's 84, was on statins for years and they did terrible things to his body. I'm sure the drugs kept him alive, but the side effects, as he describes them, particularly to his legs and kidneys, were pretty severe. He only got better when he stopped taking them.
I believe statins reduce risk by about 30%, so there's a roughly 30% chance the statins have done good things for your dad.
(I think that's what the stats mean, right? I'm open to correction on this. I do believe the statin studies, I'm not a science denier. I think what I've said matches the science, as far as I understand.)
And that doesn't address the role that fiber plays in managing it (and the virtues of fiber for health in general that are coming to light at a rapid clip)
I now have a cardiologist and just had an MRI to check on the state of my aorta, as a recent calcium scan brought up concerns.
I've now been on rosuvastatin and ezetimibe for several years with zero noticeable negative effects. I'm hoping that this with other behavior modification can help stave off further damage for a while.
Stop drinking. Replace cheese and butter with olive oil in copious amounts. Only eat fish meats. Don’t smoke or vape. Eat salads and other prebiotics. Get some cardio - even walking your dog is great. Your brain fog will lift, your skin will clear, your mood will improve and your doctor will gasp at how clear your carotids are next time they’re ultrasounded.
This is all very interesting, but far too detailed and technical for 99% of people. The TLDR should include an easy to understand summary without jargon like "VO2" and "a set of HIIT at Zone 4".
Really surprised at the last few paragraphs! Read with caution this is not Real medical advice!
This was a good read until they recommended using ChatGPT instead of working with your doctor. Also they have some delusion about the actual cost of using ChatGPT.
> Pretty incredible. Also free.
Not free at all. Not a good idea to feed a private corporation your health data!
Walking and eating sensibly is free. Even a balance oatmeal, rice & beans with infrequent meat servings would defend against heart disease better than expensive medicine, at less than $1 / day.
Promoting good habits is good but this is health advice from an unlicensed commenter to say rice and beans is better than taking a statin. Consult your doctor if you’re curious what to do.
Funny you should use the word "bang". My last experiment with lentils years ago began one evening with 3 excellent bowls of very tasty lentil soup and ended slowly with 2 days' worth of "bangs", quickly followed by ostracism by my house buddies. So bad!
Yes, our system is most definitely stacked against the poor, but it's important to also remember that we all have free will and that some choices fully within our power are much better than others.
nicotine is likely one of the best appetite-control , cognative-enhancing and anti-anxiety medications ever known to man. A large driver of obesity , anxiety and psychotropic abuse was smoking cessation.
Giving out nicotine gum , would decimate the drugs industry, but likely resolve a lot of our chronic health and depression issues.
tonymet says >nicotine is likely one of the best appetite-control , cognative-enhancing and anti-anxiety medications ever known to man.<
Is this not under-reported? I have known several people for whom smoking appears to be truly necessary. One said he was prescribed smoking to control his "shakes".
I think the point is it is cheap to prevent. The weird tip is doing a different test to the standard one, which costs little for typical HNers (but admit every $ counts for many people esp. with current inflation, poverty, bad governance) but sounds like on par with a dentist doing anything beyond a checkup.
You have to be able to get the prescription. HMOs (Kaiser specifically) will generally not provide any sort of preventative care in this area unless your numbers are very high. You can’t get access to a cardiologist unless you’ve already had an adverse event.
If you can get time off work and have a PPO, you can get the preventative care.
$10 is the cash price. Your doctor diagnoses, not insurance, and you don't need a specialist to get diagnosed regardless of what your insurer wants. Even a nurse practitioner can prescribe you a statin.
Love the chart at the bottom--it really puts on display media bias and lack of integrity and using fear to push idiotic policies which area really just a way to put everyone in the pocket of government and keep them there permanently with zero real improvement to public health. Fear get eyeballs. the Covid mass hysteria proves that, too.
As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.
My in-laws are over 95. They refuse to go to an elderly home and as a result make everyone miserable, starting with themselves and inflicting infinite suffering on their children who each have a family of their own, and need to take care of them all of the time.
I don't want to do that to my own children. I don't want to not die. I don't esp. want to die but I'm not really afraid of it, it's just a normal part of life.
Preventing heart disease is probably a good thing, but if one prevents every ailment conceivable then how does this work eventually?
You're almost certainly going to die by or before 110, anyway. (Ir)Regardless of your efforts, or lack thereof, our bodies typically give out in the 100-110 year range with very few exceptions.
I don't like this kind of content. The author might have a personal motivation for it, but for the general public, it's just more mental load.
We are all going to die one day.
When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?
We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.
I share your general emotional reaction, but to be fair, heart disease is far and away more important than other type of disease. More people die of it in the US than die of all cancers combined: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
> We all know the good practices. Don't be a dumbass
In theory yes, but in practice we are all dumbasses to some extent.
I used to have your attitude until I saw a friend die of a heart attack at an early age - and it appeared to me that he would have survived if he had an indication. So, now I have changed my attitude to one of more data does not hurt.
When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.
When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.
In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
As you can see, I'm worried about cholesterol and statins.
As to why medicine is like this, it's because it's conservative, usually about 17 years behind university research[0], and doctors are shackled to guidelines in most health systems or risk losing their licenses. It isn't a coincidence that the article author had his out-of-pocket concierge doctor tell him the more up-to-date stuff.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC3241518/
Sure, it is absolutely true that better lifestyle and diet has a huge effect. However it is absolutely certain that the vast majority of people who are told to improve their lifestyle and diet, won't.
The result is doctors giving advice that they know won't be followed. And thereby transferring potential fault from the doctor to the patient, with no improvement in actual outcomes. "I told the patient to lose weight and maintain that with a controlled diet." And yet, most people when told to diet, won't. Most people who start a diet won't complete it. And most people who lose weight on a diet, have the weight back within 5 years. Where each "most" actually is "the overwhelming majority". And the likelihood of the advice resulting in sustained weight loss probably being somewhere around a fraction of a percent.
What, then, is the value of the doctor giving this lecture?
(Disclaimer. I have lost 20 of the pounds I gained during COVID, and am making zero progress on the remaining 30. A few months ago I successfully started a good exercise routine. Given my history, I would expect to only follow it for a few years before falling off the wagon. I believe that this poor compliance puts me well above average. But do you know what I do reliably? Take my prescribed medicine!)
You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't.
"Who cares if better outcomes are possible, so long as blame is in the right place"? Is that how we want to approach this?
not for me. My cholesterol was hovering in the high 200's, then finally hit 300 and I completely freaked out, radically changed my diet, and lost 22 pounds (from 180 to 158).
What did my high cholesterol do ? It did absolutely nothing. ticked down to like, 280.
So I'm on the statins. my total cholesterol went from high 200's to about 150 in a month and was impacting my liver function. so we reduced the statins to a very low dose (5mg three times a week, crazy low). My total cholesterol hovers around 200 now. My cardiologist tells me that the conventional wisdom of "diet and exercise" is almost entirely disproven to have any meaningful effect on lipids these days (though i havent researched deeply).
I would be immensely skeptical of this unless he was talking about something much more narrow, like how there's a fraction of people who have really unfortunate genetics and can only improve their blood lipids with medication.
We have mountains of data showing that diet can massively improve lipids, and the combination of diet and exercise are our largest levers for reducing the risk of heart disease for most people. (There are always some fraction of people who can do everything right but have outlier genetics that require medication anyway, just as some people have outlier genetics and can smoke a pack a day their whole lives and reach their 90s.)
I'd check out the Barbell Medicine podcast for anything related to the intersection of lifestyle and health. They're extremely evidence based with a preference for measurable improvements in outcomes over hypothetical mechanisms.
Relevant to this thread are their episodes on testing and screening, hypertension / high blood pressure, cholesterol, fiber, and the new PREVENT heart disease risk calculator.
I'd also check out the episodes on diabetes, Alzheimer's, fatty liver disease, and health priorities.
To expand, one of the coverage pillars of malpractice insurance (in the US) is the "standard of care". This is basically what most doctors and their associations consider acceptable, which by definition excludes new, better techniques.
This is both a bug and a feature. A move fast and break things philosophy would cause more harm than good, but it also prevents rapid adoption of incremental improvements.
Guidelines also leads to standards of care being random and heavily driven by politics & financial reasons disguised as medical best practice. South Korea and India are "parallel testing" places, which saves time, while the USA & others are serial testing places mostly because of their funding models.
Talk to any American doctor and they will give you a bunch of emotionally wrapped cope about why it's bad because the cognitive dissonance sucks and there are liability reasons to avoid admitting your wrong. I would argue that in many cases, parallel testing is cheaper because $300 of tests is cheaper than 4 chained $500 doctor visits. But whatever.
But if they're employed by a health system and fail to follow company policy then yes, they could be fired.
I think only recently have insurance companies started covering APoB testing in your annual exams (or that may just be my insurance…).
ApoB is shaping up to be an incremental improvement in measurements, but health and fitness influencers have taken the marginal improvement and turned it into a hot topic to talk about.
This happens with everything in fitness: To remain topical and relevant, you always need to be taking about the newest, most cutting edge advances. If it’s contrarian or it makes you feel more informed than your doctor, it’s a perfect topic to adopt for podcasts and social media content.
ApoB is good, but it’s not necessarily the night and day difference or some radical medical advancement that obsoletes LDL-C. For practical purposes, measuring LDL-C is good enough for most people to get a general idea of the direction of their CVD risk. The influencers like to talk about edge cases where LDL-C is low but then ApoB comes along and reveals a hidden risk, but as even this article shows there isn’t even consensus about where the risk levels are for ApoB right now. A lot of the influencers are using alternative thresholds for ApoB that come from different sources.
> In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
30% reduction in a life threatening issue is huge. I don’t see why you would want to diminish that.
If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.
If a statin makes you feel miserable, I think any doctor would sympathize with a calculated decision to stop them. There are many types of statins to try though, so hopefully one would work without side effects.
Most with efficacy determined by the proxy variable of LDL-C levels, and with even more questionable results in actual lifetime improvement.
I too really wanted not to be that skeptical about medicinal research. But if I had high cholesterol and a doctor recommended newer statins to me, I don't think I would take them.
You could absolutely think that they were basically the same, depending on the base rate. The differece between a one-in-a-million and 0.7-in-a-million is 30%, but it wouldn't be humanly perceivable. We're all likely faced with situations like that regularly. Differing airlines probably have much greater variances in their crash statistics, but it just doesn't matter in 99.99999% of flights.
https://xkcd.com/1252/
Meta-analysis conclusion: This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
There have been a lot of studies on statins. If a meta-analysis comes along and only cherry picks a couple of them, something is up.
This is totally unsourced now but I did a deep dive quite a while ago now and it seemed to me that studies largely found that statins after a heart attack helped all cause mortality (though not by a ton), but if they were prescribed to someone before a heart attack it wasn’t nearly as clear. Considering how they often make people feel it seems like people should be a bit skeptical.
Not just throw a two-line comment disparaging the work of experienced specialists in the field.
For the curious, here are the author affiliations for this study:
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (Drs Ray, Seshasai, and Erqou); Department of Cardiology, Addenbrooke's Hospital, Cambridge (Dr Ray); Department of Clinical Pharmacology and Therapeutics, Imperial College, and National Heart and Lung Institute, London, England (Dr Sever); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (Dr Jukema); and Department of Statistics (Dr Ford) and BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine (Dr Sattar), University of Glasgow, Glasgow, Scotland.
Financed by who?
Part of this is just that insurance coverage lags science. We've known that ApoB is more accurate than LDL since the 1990's or 2000's, but to be covered by insurance, several more steps have to happen.
First, the major professional societies (like the American College of Cardiology or National Lipid Associations) have to issue formal guidelines.
Then, the USPSTF (US Preventive Services Task Force) needs to review all of the evidence. They tend to do reviews only every 5 or 10 years. (Countries aside from the US have different organizations that perform a similar role.)
If the USPSTF issues an "A" or "B" rating, then insurance companies are legally obligated to cover ApoB testing. But that also introduces a year or two lag since medical policies are revised and apply to the next plan year.
The net effect is that the entire system is 17 years, on average, behind research.
I'd love to know where to get the right advice on this topic.
I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss the results(!), because she said I have zero arterial plaques and there's simply no need for us to meet.
I feel really quite lost with this stuff :/
A zero is still a zero though, and is associated with low risk of heart disease in the near future.
Because this is a recent understanding and healthcare tends to be a conservative industry that moves slowly. Sometimes too slowly.
And also because LDL remains an excellent measure. The risk with LDL isn’t false positives. If someone has high LDL they likely have an elevated risk of heart disease. The problem with LDL testing is that someone with low LDL may still have a high risk of heart disease which may be captured in APoB testing.
That prior discussion gives no good reasons. The linked medium posts are, to be frank, trash.
Statins are well-tolerated drugs with little to no noticeable side effects. You might have to try a few. You may need to combine ezetimibe to maintain a moderate statin dosage level, and that's it. (Like the author of this article)
Source: Leading cardiologists worldwide, and doctors of the rich and famous.
https://www.bmj.com/campaign/statins-open-data
So no settled science here.
Unless you consider the BMJ a trash journal of course.
Sorry, that's nonsense. It is a dangerous drug with plenty of side effects. If it had no side effects it would be sold over the counter. The brain needs cholesterol to function. If you artificially remove cholesterol this is what happens: https://www.health.harvard.edu/cholesterol/new-findings-on-s...
They also tend to be continued well into old age (off label) despite increasing fall risk, which is way more dangerous to an 80 year old.
That's pretty simple to explain. No conspiracy.
LDL-C is much much cheaper to measure. ApoB costs 36x times as much, so Insurance Companies don't like to pay for it
For anyone under 40, it's expected to have zero calcium. Even a measure of 1 or 2 when you're below 40 would be a bad sign.
I think, in some ways, the trick is being able to short circuit the entire journey represented by this website in favour of some form of, “I’m 40. I should be more mindful of heart disease. I should add a 30 min walk to my mornings.” And then move on with your life.
I think many cultures, but especially American healthcare culture, foment a growing background noise of constant anxieties and stressors. Life is sufficiently complex but there’s always a peddler eager to throw you a new ball to juggle (and pay for).
But yeah I agree with your message. Focus on the big impact macro level things. Hyper-optimizing it is a waste of energy
Notably risk goes up with the time spent with bad numbers, so the most leverage you have on affecting your lifetime risk is caring as early as possible.
It's an area under the curve situation. Waiting until you start experiencing symptoms is putting a band-aid on an open wound compared to avoiding injury at all by focusing on high impact habits related to diet and exercise.
Focus on adopting the following habits as early as possible: https://www.barbellmedicine.com/blog/where-should-my-priorit...
Beyond just heart disease & cancer taking you out entirely its: my eyesight is going, my hearing, every joint in my body could fail, my brain is slowing, etc.
There is just way too much shit to do anything other than be like: sleep, exercise, eat better and don't drink too much.
You’ll never see a published set of tests from him. What you’ll see is ads to buy his supplements.
https://professional.heart.org/en/guidelines-and-statements/...
Obviously life is more complicated than just one measure. I figure this is just another data point saying BMI is useful for population studies and not great for individual diagnosis.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10321632/
Hang on a second.
This guy is making a big big claim.
The central point of his article is that he went to a doctor who followed the guidelines, tested him and found he wasn't at risk for heart disease.
But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack.
Therefore he is arguing that THE STANDARD GUIDELINES ARE WRONG AND EVEN IF YOU DO EVERYTHING RIGHT AND YOUR DOCTOR CONFIRMS IT YOU MAY BE LIKELY TO DIE OF HEART DISEASE ANYWAY, SO ONLY THE SPECIAL EXTRA TESTS CAN REVEAL THE TRUTH.
I want a second opinion from a doctor. Is this true? Is this for real? Because it smells funny.
Mainstream medicine is hyper optimized for the most common 80% of cases. At a glance it makes sense: optimize for the common case. Theres some flaws in this logic though - the most common 80% also conveniently overlaps heavily with the easiest 80%. If most of the problems in that 80% solve themselves, then what actual value is provided by a medical system hyper focused on solving non-problems? The real value from the medical system isnt telling people "it's probably just a flu, let's just give it a few days and see" it's providing a diagnosis for a difficult to identify condition.
So if your question is "how do we maximize value and profit in aggregate for providing medical care to large groups of people", mainstream medicine is maybe a good answer.
But if your question is "how do we provide the best care to individual patients" then mainstream medicine has significant problems.
For the people on the other side, "health at any cost" is pretty much the goal, usually limited by the "cost" side of things, especially in the parts of the world where they haven't yet figured out the whole "healthcare for the public" thing.
I also disagree that the 50the percentile is the breakpoint between healthy and unhealthy. There's a lot more to deciding those ranges beside "well half of the population has better numbers"
If I die at 90 of a heart attack havjng maintained the ability to live independently up until then, I’d take that as a massive win compared to my relatives suffering through a decade of me with worsening dementia.
- Lipid lowering drugs
- ApoB testing
- Coronary CT (if the pre-test likelihood of obstructive coronary artery disease was estimated to be > 5%)
- Diabetes tests
- Kidney tests
It’s scarily common in medicine for doctors to start specializing in diagnosing certain conditions with non-traditional testing, which leads them to abnormally high diagnosis rates.
It happens in every hot topic diagnosis:
When sleep apnea was trending, a doctor in my area opened her own sleep lab that would diagnose nearly everyone who attended with apnea. Patients who were apnea negative at standard labs would go there and be diagnosed as having apnea every time. Some patients liked this because they became convinced they had apnea and frustrated that their traditional labs kept coming back negative, so they could go here and get a positive diagnosis. Every time.
In the world of Internet Lyme disease there’s a belief that a lot of people have hidden Lyme infections that don’t appear on the gold standard lab tests. Several labs have introduced “alternate” tests which come back positive for most people. You can look up doctors on the internet who will use these labs (cash pay, of course) and you’re almost guaranteed to get a positive result. If you don’t get a positive result the first time, the advice is to do it again because it might come back positive the second time. Anyone who goes to these doctors or uses this lab company is basically guaranteed a positive result.
MCAS is a hot topic on TikTok where influencers will tell you it explains everything wrong with you. You can find a self-described MCAS physician (not an actual specialist) in online directories who will use non-standard tests on you that always come back positive. Actual MCAS specialists won’t even take your referral from these doctors because they’re overwhelmed with false cases coming from the few doctors capitalizing on a TikTok trend.
The same thing is starting to happen with CVD risks. It’s trendy to specialize in concierge medicine where the doctor will run dozens of obscure biomarkers and then “discover” that one of them is high (potentially according to their own definition of too high). Now this doctor has saved your life in a way that normal doctors failed you, so you recommend the doctor to all of your friends and family. Instant flywheel for new clients.
I don’t know where this author’s doctor fits into this, but it’s good to be skeptical of doctors who claim to be able to find conditions that other doctors are unable to see. If the only result is someone eating healthier and exercising more then the consequences aren’t so bad, but some of these cases can turn obsessive where the patient starts self-medicating in ways that might be net negative because they think they need to treat this hard to diagnose condition that only they and their chosen doctor understand.
You're not sure of whether this is a good idea or not, so you ask various physicians, and the consensus is unanimous: the very suggestion is offensive, do you think doctors are unclean?
A clear conclusion has been achieved.
It's crazy that we haven't optimised MRI scans so that they can be routine.
> I shared these results with a leading lipidologist who proclaimed: “Not sure if the lab or the primary care doc said an LDL-C of 116 mg/dL was fine but that concentration is the 50th percentile population cut point in the MESA study and should never ever be considered as normal.
> It’s also important to note that, according to a lipidologist friend, an ApoB of 96 is at a totally unacceptable 50th percentile population cutpoint from Framingham Offspring Study.
So... the exact median value is "totally unacceptable" and "should never ever be considered as normal"? I'm open to the possibility that the US population is so deeply unhealthy that this is true, but then that needs to be argued for or at least mentioned. Like, you can't say "you're exactly average in this respect" and expect your and that's terrible to be taken seriously without any followup.
Or if I'm misunderstanding what's meant by "50th percentile population cut point" then again, I think this jargon should be explained, as it's plainly not the usual meaning of "50th percentile".
A quick Google says that the Mesa study was actually of people without cardiovascular disease at the beginning of the study. So again, these conclusions don't make any sense to me.
Has the guidance changed that you want LDL less than 2.5x (or was it 2x?) your HDLs?
The best thing you can do for yourself is to establish healthy diet and lifestyle habits that are sustainable. A lot of people who jump from obsession to obsession do a great job at optimizing for something for a few years, but when their life changes they drop it completely and fall back to forgetting about it.
Fad diets are the original example of this: They work while the person is doing it, but they’re hard to maintain for years or decades. CrossFit and other exercise trends have the same problem where some people get extremely excited about fitness for a couple years before falling off completely because it’s unsustainable for them. Some people are able to continue these things for decades, but most people do it for a short while and then stop.
I’m now seeing the same pattern with biomarker obsessives: They go a few years obsessing over charts and trying things for a few months at time, but when the interest subsides or they get busy with life most of it disappears.
The most successful people over a lifetime are those who establish healthy habits that are easy to sustain: Eating well enough, reducing bad habits like frequent alcohol or fast food consumption, some light physical activity every day, and other common sense things.
The most important factor is making it something easy to comply with. The $300 biomarker panels are interesting, but most people don’t want to pay $300 every year or more to get snapshots that depend largely on what they did the past week. Some people even get into self-deceiving habits where they eat well for a week before their blood tests because the blood test itself has become the game.
Really spot on with one of my besties. He does all the tests. He has a concierge doctor. He reads extensively on the topics of fitness and nutrition. And yet he doesn't do any of it. It's just an intellectual exercise for him. And he has had two heart attacks in the last several years. It's so frustrating. I just wanna shake him.
Also with food and drink: place friction between the treat and yourself. The easiest example is to not have biscuits / alcohol in the house.
Bonus tip: alcohol free beer is really good these days.
While lifting weight I do that since I rest for 90 seconds in between sets, which is actually very boring. I started reading books during that time and that has been a big improvement.
Could you recommendation some good alcohol-free beers, please?!
[https://luckysaint.co]
[https://brewdog.com/collections/alcohol-free]
[https://www.majestic.co.uk/beer/peroni-0-0-4x330ml-bottles-7...]
Note that not all "zero %" beers are actually zero %... some have 0.5% alcohol.
The majority of your cardio should be LISS unless you have extreme time constraints, but most people can find 30-60 minutes per day to get the recommended time in. This is an intensity at which you can hold a conversation.
If you have time for TV, you have time for watching it from a treadmill.
But on the flip side, even if it isn't ideal, if that tip makes at least one person actually do any kind of cardio at all, even if it's the worst one on the planet, it's still better than nothing.
In fact, I'd probably consider your statement of preemptively shooting someone down like that (imagine being a 3rd reader of the original comment + your response), is massively more harmful to others than parent who at best tried to trick someone into doing bad cardio, which again would be better than nothing.
I do have a hard time with mind muscle connection during weight training if I'm listening to something other than music, though.
You are confusing two different things.
However I can definitely listen to a podcast when using a static bike... As long as your heart rate is 75‰
Nonsense. Elite distance runners are doing 80% of their miles at essentially a conversational jog with a starkly lower HR than the 20% of intense miles. Cardio exercise under all levels of intensity is optimal, not just easy or just hard.
For exercise your tip doesn’t help me at all. I hate audiobooks and podcasts so that would turn me off more from exercising. Also I want to concentrate on the exercise and not do it halfhearted.
What helped me was to realise how much better I feel after exercising - since then i kinda got addicted to it because I notice how much worse I feel after not doing it for a couple of days.
I agree on the friction. Just not having access to cigarettes is the best way for me to not smoke. I just don’t buy them and bumming one from someone else comes with a degree of personal shame for me that makes me avoid them (in almost all cases).
I naturally don’t like sweet stuff that much - however since I moved from EU to America (not US) it’s been really hard to avoid sugar. Y’all put that stuff into everything it’s crazy; I gotta watch out like a hawk and go to special stores. In Europe it was so much easier, there are always cheap sugar free whole foods available in every supermarket.
I live in the UK and emulsifiers seem to be added to everything: sauces, yogurt, bread.
Personal story - I used to be super sporty, 4x gym training during work week - cardio & free weights, climbing over evenings after work, hiking/climbing/ski touring over weekends. Vacations were mostly more extreme variants of the same. Last year broke my both ankles with paragliding, one leg much worse, so took me some 8 months to be able to walk straight again, with some time in wheelchair, then crutches. All strength & stamina gone, flexibility 0, so had to rebuild from scratch and I mean deep bottom scratch from which you bounce very slowly, not some 1 month stop when things come back quicker. If all above weren't my proper passions I would have a hard time coming back to being again more active than most(sans that paragliding, took the lesson and have 2 small kids). That ankle won't ever be same but so far so good, ie managed some serious hike&via ferrata mix 2 days ago.
Also for those who do take blood pressure medication: never quickly change the dosage, and especially never quit taking it w/o supervision!
I've seen several untimely deaths b/c someone ran out of their BP medication and could not get to a pharmacist quickly enough. Alternatively the person became irritated with the medication and simply stopped taking it.
Maybe part of starting BP medication should be the doctor giving you a "safety package" that includes a full month's worth of the drug and is to be put on a shelf somewhere where you can get to it should your usual prescription run out.
It makes zero sense to prioritize one over the other, any more than it makes sense to ignore diet and exercise.
What you put into your body: no processed food, cook yourself, lots of variety of veggies and fruits, little meat, little alcohol.
What you do with your body: regular exercise, low stress, enough sleep.
What you do with your mind: good social environment, good relationships.
And an apple a day keeps the doctor away!
They seem simple on the surface but hard part is execution for most people, due to life circumstances and other factors. Unhealthy choices persist because society isn't built around healthy lifestyles.
So while the comment seems helpful on the surface, it misses the forest for the trees.
I think that there needs to be a bigger discussion here, regarding why have we engineered a society that inflicts suffering and illness on so many?
Some stuff is BIO, cream or coconut milk are lower fat version, or carrots are are without residual pesticides. Less salt since we use less salt, and taste buds quickly adjust so its still adequately salty, a better mix of herbs and spices so taste is.. simply better, more refined. We use with much less sugar, the same as for salt above (if you eat sweet stuff sparingly then even mildly sweet stuff tastes amazingly, just don't go from one extreme to another).
Actually they are not. "Practically" is carrying a lot of weight there. The factory baked cake will have a lot more extraneous ingredients and usually has a larger quantity of sugar and fat. Similar to how restaurant food generally has a lot more salt and fat than home cooked food.
The direct impact of those extra ingredients alone or in combination is not entirely clear at this point, aside from building evidence that people whose diets include more of that seem to be less healthy.
But that loaf you buy at the store? It'll generally be covered in mold before it gets hard, and that's quite the achievement since it also tends to be more resistant to mold as well! Bread should get hard. This is where a ton of old recipes come from. The Ancient Greeks would dip it in wine for breakfast, Euroland has bread soup/puddings, and even stuff in the US like Thanksgiving stuffings or croutons.
If you stepped inside a food factory you would see how false that statement is
> If you only read one thing here, make it the “How to not die of heart disease” section.
Which itself is still quite long but it emphasizes:
> Every lipidologist I’ve spoken with has stressed the importance of measuring and managing ApoB above all else – it’s a far better predictor of cardiovascular disease than LDL-C (which is what physicians are most familiar with). Every standard deviation increase of ApoB raises the risk of myocardial infarction by 38%. Yet because guidelines regularly lag science, the AHA still recommends LDL-C over ApoB. Test for it regularly (ideally twice a year) and work to get it as low as possible (longevity doctor Peter Attia recommends 30-40mg per deciliter). Many lipidologists will say to focus on this above all else.
And:
> I asked several leading lipidologists to stack rank what they believe are the most important biomarkers for people to measure and manage. […], and will likely cost anywhere between $80-$120 out of pocket.
That’s a pretty interesting and relevant part of TFA. Omitting that is not a fair “long story short”, but rather just “different story”.
This is wrong. Our bodies evolved to rend flesh and eat meat. They are optimized by millions of years of evolution to process and run on meat.
The biochemical pathways of carb-heavy diets put more oxidative stress on the body.
is that why we have flat molars? for eating meat?
(spoilers: no, the flat molars are not for eating meat)
Humans have eaten complex carbs only for the last 10k years since agricultural revolution. Before that, outside of a small part of Africa, there physically wasn't enough carbs available to say that they made any substantial amount of our diet.
Most ancenstral carbs were uber high in fiber, and very low in glucose (starch) and fructose.
Also lots of roots are edible with cooking, and it looks like we've been cooking for about a million years. Then there's wild rice, cattails, beans, berries, all sorts of stuff.
I agree that most wild plants are high in fiber and low in sugar, but there are are a lot of complex carbs to be had, if you have fire.
A permutation that's currently making the rounds in the press (even though the original research is from 20 years ago) is the "portfolio diet":
https://jamanetwork.com/journals/jama/fullarticle/196970
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0...
Some press mentions:
https://www.health.harvard.edu/heart-health/the-portfolio-di...
https://www.nytimes.com/2025/11/04/well/eat/health-benefits-...
https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...
Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".
I’m located in Europe, so I may have a slightly different view, but my doctors clearly care and discuss with me about prevention, risks, tradeoffs, …
They praise the methods of the „good“ doctors and stamps the others as driven by financial gain. Who says the expensive ones are any better in this regard? Who says they are more or less exaggerating the importance of test results to make you come back?
The worst will basically laugh me out of their office for daring to belong to a marginalized identity or failing to already have the health knowledge I'm there trying to gain from them.
Maybe I have awful luck... but I have very little faith at this point. The most effective relationship I had was with a hack who was willing to just prescribe whatever I asked him for and order whatever tests I asked him for (I think most of his patient base were college students seeking amphetamine salts).
> If you smoke, don’t. It’s going to kill you.
And then this about alcohol:
> I think it’s unreasonable to tell people not to drink alcohol if they like it.
Why is it unreasonable to tell people not to drink alcohol, but reasonable to tell people to stop smoking? Shouldn't the smoking section also get a "at least make sure it’s really good tobacco that you enjoy and don’t smoke too much of it"?
It seems like the personal preferences (don't like smoking, but does like alcohol) is getting in the way of their medical-but-not-medical advice, instead of being able to apply their recommendations equally regardless of what they personally like.
I looked at Germany, according to Wikipedia the average consumption of pure ethanol per person per year in Germany as of 2019 was 12.2 liters. This was the 5th highest in the world, and equivalent to 686 standard 5% beers per year.
According to the WHO “moderate drinking” is 1 drink per day for women and 2 drinks per day for men, so the average German is already consuming above WHO guidelines.
It gets worse when you consider that about 1/4 of Germans don’t consume alcohol at all, and another 1/4 barely consume any, suggesting that the “average” isn’t really telling us much and the 70th, 80th, and 90th percentiles have very concerning consumption numbers. I assume most of those people consider themselves “social drinkers” but statistically they cannot be.
It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.
Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations.
Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication.
I'd check out the Barbell Medicine podcast episode on the health priorities they recommend patients focus on: https://www.barbellmedicine.com/blog/where-should-my-priorit...
My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least.
My mother similarly was put on statins and is getting a cardiovascular work up (calcium scan) because she now has early atherosclerosis. She eats super healthy and is a former olympic sprinter..
Bonus anecdote: In my free time I do shifts as an EMT with my fire dept (911), that is a big wake up call to wanting to be as healthy as can be. The number of patients I see who are 50+, nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At that age I see type 2 diabetes, hypertension, high cholesterol, and more.
Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research
https://pubmed.ncbi.nlm.nih.gov/36351849/
A few other more recent papers:
https://pubmed.ncbi.nlm.nih.gov/35498420/
https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109
Note: I'm not a doctor.
But I would be very happy to do any elective non invasive tests. On the fence about going beyond that until/unless the Dr. flags it as needed.
There are two known harms from scans:
- Radiation. This is why people shouldn't get these scans several times a year, but 1-2 are very unlikely to move the needle. The average radiation from a full chest CT is just under the average dose for ~2 years of normal background radiation. (I don't know if a CTA uses less than average.)
- Acting on something you would otherwise have ignored, where ignoring it might have been the right answer. The main problem here is that it's hard to get a medical opinion saying "you should ignore this" because of perverse incentives: there's an aversion to recommending doing nothing because that could lead to a lawsuit, whereas "overtreatment" will not get a doctor sued. However, you can make a deliberate decision to do this anyway even after getting the scan; seek second and third opinions, consider alternatives, weigh risk versus reward, make a considered decision.
For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often).
That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people.
I also don’t drink or smoke or vape which I think is important.
Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.
Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.
People don’t need more facts and information – those are in surplus. In fact, for most people when they receive too many facts, they just glaze over.
The changes needed are trivial
One person may run an intense soup kitchen 15 hours a day and feel little stress, and another can sit at a computer for 9 hours sending pointless emails and feel tremendous stress.
How exactly stress corresponds to biomarkers doesn’t matter if your desire is to lower it.
The issue is that many of us don’t pay attention to how we keep our body & mind throughout the day, or do so on a very superficial level. So strain on the body can accumulate for a long time.
“Stress management” is a lifetime skill. It doesn’t come in bulletpoints, it’s as broad as “living happily”.
Edit: That said, this can make the advice “be less stressed” a bit vacuous.
But people do get scared when random health issues flare up and become more conscious of how they deal with stress in life.
So it’s not bad to keep reminding people either :)
“Try not to stress” or “reduce stress” – but how to do that? Stress itself is nebulous, and the countermeasures are inconclusive.
Think of the last time you were angry or frustrated. Did your spouse telling you to “calm down” fix the problem?
More specifically, it’s “change your diet and eat/drink less”, which is the hardest part. Diet’s impact eclipses regular activity, and it’s consequences build up and compound over decades.
This can happen when we choose to treat otherwise benign issues that would have had few negative consequences for our health or longevities. Those treatments can have negative effects that are worse than the ailment we’re trying to treat.
I know it’s a natural tech-guy impulse to quantify everything and get access to as much data as you can, but that myopic focus can actually lead us to optimize for the wrong thing.
[1]https://pmc.ncbi.nlm.nih.gov/articles/PMC4077659/
[2]https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/
Don't know why his behavior wasn't noticed more in the comments but he's absolutely entitled.
Hospitals and everything have limited resources, by being the asshole who request things to go fast for him and only have the best of the best to practice on his daughter, he just deprived someone else daughter from good care.
This is selfishness, unless the nurses and doctors were napping, he shouldn't have that kind of behavior detrimental to everyone else. I couldn't read further what he got to say but, coming from this man, i don't see how it could be interesting or useful.
I don't have anything to prove it but the whole thing smell fishy, when he goes to these 'concierge doctors', of course they are going to find things that are not right and were 'missed' by his regular doctor. That's literally their business.
if you went there and you were told 'nop, everything is fine. Keep doing what you do', you would go back to your GP and forget about it. But if he frightens you with bloodwork that show 'not optimal' in big red, tells you how wrong your gp is and how you should listen to him, you're going to think this guy know so much more and deserve my money. It's business.
I trust the national health guidelines: eat healthy, do at least 30 min of activity per day and lift weights.
Everything else feel like nuisance, especially coming from folk like that.
Life or death procedures aren't a time for "you get what you get and don't have a fit."
I believe you have the right to say it when things are not right, but there is a fine line between that and the behavior he described.
And he wrote that he went to an expensive hospital, this isn't some low tier hospital filled with under qualified, under staffed personals.
If you've got a serious condition, you really do need to have a patient advocate, whether that's yourself or a family member or someone you're paying to fulfill the role or some combination thereof. The medical systems I've encountered for non-trivial care (US HMO, US PPO, Belgium, Norway) just aren't designed for holistic patient care. Each department does their own thing, and it's just luck if there's someone watching over the whole process from the individual patient's standpoint.
Perhaps you took exception to the comment about looking for an expert instead of a newbie (a resident, in the text) working on the author's 9-month-old. One could argue that that's a different issue than the general need for a patient advocate. Fair enough. But if I were watching out for my 9-month-old, I'd definitely want to ask about the track record of each of the doctors in the room. I mean, sure, new trainees need to practice somehow and all, and there's a tragedy of the commons there. But I certainly wouldn't brush someone off as "absolutely entitled" just because he wants the best care he can get for his 9-month-old.
I always thought that you got to choose wisely people that you need their expertise, especially in healthcare, but once you picked one hospital you got to commit and let them do their job.
I understand it's not easy when you are in charge of a 9 month old but you got to suffer through that.
If someone was to go so wrong that even an untrained eye could see, it's different.
Maybe I didn't have my fair share of bureaucracy. Maybe my standard are too low.
I sure did have my fair share of mistake when I went to emergencies, undiagnosed broken bones for instance. I never thought a second about requiring 'better' doctors, more competent nurses or more attention. I just accepted that it's thing that happens and nothing is perfect. Went back to the hospital 2 more times and eventually got everything back in order.
"Ouabain /wɑːˈbɑːɪn/[1] or /ˈwɑːbeɪn, ˈwæ-/ (from Somali waabaayo, "arrow poison" through French ouabaïo) also known as g-strophanthin, is a plant derived toxic substance that was traditionally used as an arrow poison in eastern Africa for both hunting and warfare."
It was later found naturally occuring in the human body:
Key Paper: Gottlieb SS, et al. "Elevated concentrations of endogenous ouabain in patients with congestive heart failure." Circulation. 1992;86(3):846-849. Details: Researchers measured plasma EO in 21 patients with severe heart failure (NYHA class III-IV), finding mean levels of 1.59 nM—over 3x higher than in controls. EO correlated inversely with cardiac index (r = -0.62) and positively with mean arterial pressure, but not with atrial pressures, suggesting a compensatory role in cardiac output regulation rather than simple volume overload.
A leaner cut like tenderloin is fine.
Ultimately you just want to keep the calories you get from saturated fats from animal sources to less than 10% of your daily calories. You can still enjoy a nice steak or burger every once in a while, but they shouldn't be a daily staple if health is a priority.
Processed meats are so bad, they should be eliminated entirely from everyone's diet. The World Health Organization has classified processed meat as a Group 1 carcinogen. No amount of it is considered safe.
Unprocessed read meat is still a problem and WHO advises less than 350g a week. Which is 12–18 ounces of cooked meat. 12g is about one adult serving of steak. So you really are looking at 1.5 servings per week of unprocessed red meat to be safe. At most! You probably should try for less or closer to 12g.
And really if you're at a healthy weight, then I'm not sure how helpful this is. Obesity is a bigger risk factor. This is a bit of the elephant in the room for heart health. Not only should we not be eating things associated with heart disease but also we need to keep ourselves at a healthy weight.
yes obesity is bad, as the source enemy of most diseases that kill and are not cancer is inflammation. find a diet that makes you not obese and have low inflammation, that is vastly superior to "Mediterranean diet" or "plant diet" for everyone.
Nitpick: he mentions LDL-C but the test results don't mention that at all. Only later do I see that is "LDL Cholesterol".
The resulting science is then reported as “When you cross 35, your chances of being pregnant immediately drop” or “The brain stops developing at 18” and so on.
Almost nothing in the body is really like this, though. You can quit smoking later in life and it will help. You can eat better later and it will help. You can exercise and it will help. Very few things are “the damage is done”.
The only constraints are that the later you start the more risks you face. E.g. if you first deadlift in your 50s and you decide to follow Starting Strength you’re going to have trouble.
EDIT - I misread the comment. It’s never too late to start, just be careful for injuries as that will block your ability to exercise.
https://www.nhs.uk/conditions/coronary-heart-disease/treatme...
A frustrating thing about this suggestion -- if I tell my physician (I live in the US) that I want these unusual tests prescribed, s/he would scorn at me (as if I'm acting like a know-it-all and am questioning his/her wisdom attained through years of medicine school and practice).
I truly don't understand about US healthcare is why we allowed medical practitioners to put up barriers around medicine (sure, ban opioids,chemo drugs and maybe a handful of other toxic-with-low-dose meds) and testing by requiring everything doctor's prescription?!
For example, my wife had an swollen eyelid (through infection) recently. She is an oncologist in training (is a board-certified internal medicine doctor). She knows how to treat it -- by putting clean, warm cloth over her eyes to allow pores to expand and let secretions seep out (to treat the symptom); by adding anti-bacterial eye drop like Tobramycin ('mycin' means it's Penicillin-variant, which is usually used to treat bacterial infection) OR by taking antibacterial medicine like Azithromycin. If we were in our home country (in SE Asia), we'd just go to a nearby pharmacy and buy either the anti-bacterial eye drop or pill, and get it sorted. Since we live in the US (for now), my wife has to asked one of her coworkers to prescribe her the medicine (she wasn't sure if she can self-prescribe because we just moved to CA and don't want her to lose her license). Then she took the anti-bacterial pill three times (with the warm cloth treatment for symptom), and the infection was treated completely.
I strongly believe that this kind of infection treatment or self-prescribed blood tests should be allowed without any doctor prescription. Otherwise, it only adds more (unnecessary) patient volume to doctors, clinics and hospitals. I remember reading someone from India advocating for similar approach on HN or Reddit a year or so ago too. In India (just like my SE Asian country), they could just go buy medicines over the counter from a local pharmacy. No doctor's prescription needed (maybe the law is there, but it's not enforce strictly).
The reason the status quo doesn't work is that people don't actually follow the guidelines set
Barely anyone (like 10% last I saw) meets the recommended amounts of fruit and vegetable intake or exercise. We're all addicted to terrible foods, are sedentary, have high blood pressure and are overweight
Before you start micro optimizing everything just fix your diet, avoid saturated fat and sodium and get enough moderate intensity or better exercise every week
The 95/5 of it is just basic stuff everyone knows and yet barely anyone does
Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.
I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.
Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.
But since I have a PhD in computer science in a relevant subdomain, I can certainly judge the part where he recommends the following:
> What should you do with your test results? Throw them into ChatGPT, of course!
Do not count on anything coming out of ChatGPT for medical advice. Period.
Back when 3.5 came out I gave it some information about me when I was a teenager on a condition that (multiple) doctors totally misdiagnosed. It immediately told me three tests I should have done, two of which would have diagnosed it right away. Instead, I had to deal with extreme fatigue for over a decade until I finally did research on my own and had those same tests done.
As far as test results go, right now we’re dealing with our dog having increased thirst. She’s been on prednisone for a year, and that’s not an uncommon side effect. We brought her in to the vet and they tested her and diagnosed in as stage one kidney disease, with no mention of the prednisone. I put those results and her details into ChatGPT and it told us it could absolutely be the prednisone, and told us we could use an inhaler for what we were using the prednisone for - chronic bronchitis. Our vet never offered than option. We’ll find out in a few months if she actually has kidney disease or not, but chances are it was just the prednisone.
As a bonus, the vet before this one diagnosed her bronchitis as heart failure. They didn’t run any tests, scans, etc. Just “sorry, your dog is going to die soon.” What a fun week that was.
ChatGPT is an amazing second opinion tool. Obviously you need to ask it neutral, well formed questions.
It feels like the guy had a... mediocre GP, got scared by skin cancer diagnosis and over-corrected to most expensive path possible and since stuff was found out we have this article, roughly correct but written in a sensationalist (or freaked out) style. Some claims are outright false (like GPs not knowing heart disease is the biggest killer... really).
Wife is a doctor with overreach between public and private healthcare, and those private services also have their own motivations which aren't often straightforward help-as-much-as-possible, rather milk-as-much-as-possible with tests, scans, long term treatments and so on. Especially CT scans pour non-trivial amount of radiation on the body that on itself can cause cancer down the line.
With public healthcare you at least know primary motivation isn't cash flow but helping patients, the issue is rather overwhelmed resources with limited time per patient. It always depends on individual, as with engineering there are better and worse, yet we all somehow expect every single doctor to be 100% stellar infallible expert with 150 years of experience across all branches of medicine (absolutely impossible for any human being). Look around at your work if you are an engineer and perceive the spread of quality/seniority of each colleague. Same happens in medicine, just stakes are (much) higher.
He got up to make a sandwich for my mother in law, who was very sick, and don’t come back. Massive heart attack and aortic rupture - he was dead before he hit the ground.
My dad had a lot of stress over his career and his share of health issues but found a happy medium and improved his health greatly stating about in his late 40s. He was basically walk/running 2-5 miles a day for several years after retirement. He had a major stroke, recovered somewhat, and then ended up almost dying from a kidney stone and resulting infection. (He could not communicate pain as part of his aphasia.) long story short, he suffered in a lot of ways (pain, disability, loss of dignity) for 4 years before finally succumbing.
In online discussions, we tend to boil everything down to death. Reality is that longer you can put off complications, the better you will be when something more severe happens or you get sick. As you age, each time something happens, your recovery is a little less robust. Go to the doctor, take your statins and take care of yourself.
You say that as if stroke is orthogonal to heart disease. Much of what prevents one prevents the other.
However, many people suffer from heart failure which, despite the name, means partial heart failure. The permanent breathlessness gives them a terrible quality of life. They can live with this for decades sometimes but it's not much fun.
That's not totally off, but the thing about cardiovascular disease is it affects everything because it's how your body distributes oxygen. Stop distributing oxygen and you die.
That's not to say other organs aren't important, it's just that if you replace "cardiovascular" with "oxygen distribution" it becomes apparent that almost by necessity it's going to include a lot of deaths.
note that I said good life. There are lots of bedridden people, I don't want to be like that. I want to be like the old person still doing things in old age.
Monty Python, "The Meaning of Life", Part VII.
I'm coming up on two years unemployed and feel like an idiot for not better preparing for ageism in our industry. I foolishly assumed that experience would make up for age.
Don't make the same mistake! Plan to have most of your income shrink drastically in your mid-40s.
Came back here and read all the cynical and critical comments, felt a lot better.
Thanks guys.
And the second best time is now.
Can't help but feel this is a factor of the sleep deprivation that doctors seem to celebrate.
I like this list of experiments by Greg Muschen: https://x.com/gregmushen/status/1924676651268653474
[0] https://youtu.be/BXyfCGDnuWs?t=332
When I started building an ECG Holter in my early 20s, I tried to get some friends to use it and kept hearing "yeah, but it’s not exactly sexy to wear that thing." That’s when it hit me how little people care about prevention until something goes wrong. We still have a huge awareness gap to close.
That was years ago. I have different doctors now but still no calcium scan. Time to ask again possibly.
If everyone did that, the whole system would grind to a halt. Doctors aren't in a rush because they enjoy so, they are because they're already overworked. 1 out of every 25 patients (their family) demanding extra attention is possible although still a burden. 21 out of every 25 is not possible.
My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.
I find it odd that you would instead "advocate" for not being an advocate for your own health? Are we waiting for a friend to say, "Hey, you're looking a little rough."
If you are "looking rough", unless you are in imminent danger you should just go to the GP. Your GP is there to triage care. He'll recommend whether you need something prescribed from the pharmacy, a blood test or see a specialist.
If you get refered to a specialist, the hospital will try to ascertain if you need a really experienced specialist or if you have a relatively simple case that can be handled by one with, say, 11 years experience. If he decides the case is too complex, he can ask the more experienced specialist to preside.
If you short-circuit that and demand to be seen by the most experienced specialist, you are robbing a patient that might need that experienced hand of extremely valuable care, when you could have done with less. Like I said, egotistical.
> My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.
Blood work needs lab workers who also have limited time. They could indeed do 10 tests but that means more labs and more lab workers which increases costs, which are already exploding. Better tests would be good.
It might be easier to do this for someone else, but it seems narcissistic to assume I of all the patients is so special. If there’s nobody to advocate for me, clearly I’m not!
Let’s say I try it anyway. I tend to be a slow rational thinker in real-time situations, especially under pressure. If I try to advocate for myself and ask questions, I would need to have time to consider the responses (did I even get the information I requested, what are the implications) and maybe do some research in order to make an informed choice as to whether to proceed or not, or whether to ask further questions. However, if I actually request time and have people wait for me, I enter a high-pressure mode in which I can’t think well. The clock is ticking, the stakes are high.
Even if it’s a simple routine case, I am entrusting myself to people who have the power to kill me. If it’s anything beyond routine, killing or harming me may not even be consequential to them (mistakes happen). It is a very particular type of situation.
The natural thing for me to believe is that all of these people are professionals. If I have reasons to supervise them, it automatically implies I believe they are either unprofessional or malicious, in which case I really should not be there in the first place. The arrangement is that I am not supposed to know better than them. If I try to supervise them, that implies I think I do. At worst it would be disrespectful or offensive and would make them hostile on a personal level (which is always at play between humans, regardless of the protocol), at best it would make me look like a crackpot not to be taken seriously anyway. Besides, if I already assume they make mistakes or are unprofessional, their answers can be false anyway.
On the other hand, I am aware that many, many mistakes are made in hospitals daily, so I know they are not such infallible professionals.
As a result, this makes me very reluctant to go to a hospital or a clinic for any reason. It’s probably bad.
Anyone has advice for overcoming this? Maybe training to think quickly and finding ways out in high-stakes situations like this? Tricking yourself into a mode where you feel natural advocating for yourself and act in a way that makes people treat you seriously without being offensive to them (considering the power they have over you)? Learning to not care what people think in a healthy way? (Please don’t suggest LLMs.)
I checked Jared Hecht (the author of this piece’s blog) at jared.xyz and the oldest piece is from March 2023. Why should we give someone who has no evidence of writing anything before the release of ChatGPT the benefit of the doubt that their work is all human written, when all signs point to otherwise?
Reading it I couldn’t help but feel the author relied on ai research tools and is now passing that along to everyone reading as if it’s proven fact. When they link out to an ai search engine that’s not helpful when trying to cite sources.
Saying "LLM bad, human good" is both false and uninteresting.
But a great article with really great suggestions. Too bad there's not better medical care by default but good to hear that we can take control.
Clarification: Colchicine has been used by humans for over 3000 years. What's new is its use for cardiovascular disorders.
Interpretation: • < 2.0: Insulin sensitive • 2.0–3.9: Moderate insulin resistance risk • ≥ 4.0: High likelihood of insulin resistance
Your ratio = 5.0 → Suggests likely insulin resistance.
> In early 2023 during a routine skin check at my dermatologist [...]
Are routine skin checks a thing?
> [...] I’ve spoken with several of the world’s leading cardiologists and lipidologists [...]
How come?
If you have a dermatologist, I would imagine so.
Is having someone you can describe as "my dermatologist" a common thing? Probably not for most people who don't have a chronic skin condition of some kind, I would think.
=> heart panel plus
https://en.minu.synlab.ee/heart-panel-plus/
I don't need doctors, I can get ChatGPT to analyse the results.
unfortunately, depression cripples my motivation to do physical activity
I still do some, but it's never enough
I've forgotten that blood pressure is another word for it, as all medical papers use hypertension.
Thanks!
"Yes, the article discusses hypertension, referring to it as "high blood pressure.""
Also, given the preferences you expressed in your comment, you especially should want to avoid strokes, or the many side effects of heart disease, which can make you less healthy for a long time.
Actually, V02 max is best improved through High Intensity Interval Training (HIIT) like doing 400m sprints 8x with a couple minutes rest inbetween. V02 max is famous for being one of the best predictors of longevity.
Zone 2 training (light jogging) is important in tandem (80% of exercise ideally), especially for overall cardiovascular health and lowering heart rate.
Best thing I ever did for my health was start running (mostly jogging) 4-5 times a week. It's amazing how much your health can be improved with 4x 45 minute jogs (just 3 hours/wk). I can consume practically any caloric food for needed energy and all my health metrics have been substantially linearly increasing since I started.
"the stuff that’s not good for you: pasta and pizza and bread."
Tell that to the paragons of fitness in marathon running or olympic swimming. There are none of them on low carb. The best cardio health requires cardio exercise and cardio exercise requires carbs as energy. Of course if you're not going to exercise and are okay with 50th percentile health, ya carbs will hurt you then because youre not using them.
(I think that's what the stats mean, right? I'm open to correction on this. I do believe the statin studies, I'm not a science denier. I think what I've said matches the science, as far as I understand.)
I think a pragmatic approach would be to try them if warranted by testing and be prepared to stop or change them if it has issues.
We're learning more and more about the mechanisms of cholesterol and there's a variety of medications out there: https://www.heart.org/en/health-topics/cholesterol/preventio...
And that doesn't address the role that fiber plays in managing it (and the virtues of fiber for health in general that are coming to light at a rapid clip)
I've now been on rosuvastatin and ezetimibe for several years with zero noticeable negative effects. I'm hoping that this with other behavior modification can help stave off further damage for a while.
This was a good read until they recommended using ChatGPT instead of working with your doctor. Also they have some delusion about the actual cost of using ChatGPT.
> Pretty incredible. Also free.
Not free at all. Not a good idea to feed a private corporation your health data!
Giving out nicotine gum , would decimate the drugs industry, but likely resolve a lot of our chronic health and depression issues.
Is this not under-reported? I have known several people for whom smoking appears to be truly necessary. One said he was prescribed smoking to control his "shakes".
If you can get time off work and have a PPO, you can get the preventative care.
As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.
Why the f* not.
My in-laws are over 95. They refuse to go to an elderly home and as a result make everyone miserable, starting with themselves and inflicting infinite suffering on their children who each have a family of their own, and need to take care of them all of the time.
I don't want to do that to my own children. I don't want to not die. I don't esp. want to die but I'm not really afraid of it, it's just a normal part of life.
Preventing heart disease is probably a good thing, but if one prevents every ailment conceivable then how does this work eventually?
We are all going to die one day.
When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?
We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.
In theory yes, but in practice we are all dumbasses to some extent.
I used to have your attitude until I saw a friend die of a heart attack at an early age - and it appeared to me that he would have survived if he had an indication. So, now I have changed my attitude to one of more data does not hurt.