4 ms·

> What UK Biobank is revealing, scan by scan and layer by layer, is that disease doesn’t arrive out of nowhere. It accumulates quietly, shaped by genes, environ

> What UK Biobank is revealing, scan by scan and layer by layer, is that disease doesn’t arrive out of nowhere. It accumulates quietly, shaped by genes, environment, and habits. I think that is already known for a while. It's called functional reserve, and was a big topic in HIV patients (and then again for SARS-CoV-2). Like people with higher cognitive capabilities will be protected by those a bit longer before onset of HIV-associated neurocognitive disorder (or even dementia). Same for kidneys: They have a functional reserve that you are born with gets used up during life, until it is gone. Acute kidney disease treatment is aimed at preserving whatever little function is left.

readthenotes1 1y ago
A very elderly doctor referred to "cognitive reserve", lamenting hen had more of it when younger.
tsoukase 1y ago
Functional reserve means you are completely well but the start of the disease is coming closer as the former is depleting. Another case is when disease starts subtly and slowly _with_ initial symptoms that are otherwise not debilitating. Eg Alzheimer's starting decades ago by being forgetful. I have no idea which one the post is reffering to.
- findthewords 1y ago
  Thankfully biology has redundancy, so a single cosmic bit flip does not send humans into a BSOD.
  - tsoukase 1y ago
    In biomed sciences we rarely refer to the huge amount of resiliency of living organisms. They are so robust, stable and self healing that it would need a fleet of human made machines to cover the basic difficulties.
tasty_freeze 1y ago
I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk. So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.
- flyinglizard 1y ago
  I previously looked at eGFR numbers and they seem very ballpark-ish and prone to fluctuation, as their name implies. My understanding is that they are used to detect acute cases, rather than to give a real measurement of your kidneys if you’re well.
- coldtea 1y ago
  Maybe you lost weight or changed some aspects of your diet after 50?
- gniv 1y ago
  Your diet is less salty maybe?
- Aurornis 1y ago
  eGFR is an indirect measurement of kidney function. It can be slightly lower in some people with normal kidney function for various reasons. There are additional kidney function tests that would be used for a more complete picture of kidney function if it was suspected that you had a kidney condition. There are more direct GFR tests, minus the ‘e’ prefix which means estimated. However, a better blood test that is more accessible would be Cystatin C. Worth getting one of those as a baseline at some point. In the content of donation, though, it’s not worth risking it. It’s best to play it safe. If you happened to have been inspired by the kidney donation story and blog that circulated in rationalist communities, it’s also worth noting that it was not a great source of information about the relative risks of the procedure, despite being presented as comprehensive and well researched.
manmal 1y ago
It would be interesting what this functional reserve is, right? The microbiome perhaps, or intracellular minerals? Some other thing we haven’t even identified?
- chithanh 1y ago
  In case of kidneys, my understanding is that only a certain subset of glomerular cells are actively filtrating blood at any given point. The other cells form the functional reserve, and start to become active once the other cells age out, or are disrupted due to an event (like poisoning, such as mycotoxin damage from eating moldy food). Once the functional reserve is exhausted however, no new cells can become active and you are left with whatever dwindling GFR you have, until you get a transplant. With the vascular system you have example arterial elasticity which is an important measure of vascular health. When your blood vessels become less elastic it does not immediately cause symptoms, but it increases the risk of heart disease and stroke. This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels.
  - findthewords 1y ago
    >"This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels." And yet in the year 2025 dental care is globally treated as seperate from other healthcare, a strange historical artifact that clings on.
    - bongodongobob 1y ago
      Story from the US: had an awful tooth infection (from a known dead tooth) that I tried to ride out, half my face was swollen up, even my eye looked half shut. Well after a day of this I couldn't take the pain. Called my doctor "we don't pull teeth, you have to call a dentist." So I called a dozen dentist and was told either "we aren't taking new patients" or "we can't get you in for 6 months". I ended up just driving to a dentist and saying "look at my fucking face! Pull this fucking tooth out!" Finally a dentist was able to spare 30 seconds to yank it. Bill was something like $750. The US is a dystopian hellhole.

readthenotes1 1y ago

A very elderly doctor referred to "cognitive reserve", lamenting hen had more of it when younger.

tsoukase 1y ago

Functional reserve means you are completely well but the start of the disease is coming closer as the former is depleting. Another case is when disease starts subtly and slowly _with_ initial symptoms that are otherwise not debilitating. Eg Alzheimer's starting decades ago by being forgetful. I have no idea which one the post is reffering to.

findthewords 1y ago
Thankfully biology has redundancy, so a single cosmic bit flip does not send humans into a BSOD.
- tsoukase 1y ago
  In biomed sciences we rarely refer to the huge amount of resiliency of living organisms. They are so robust, stable and self healing that it would need a fleet of human made machines to cover the basic difficulties.

tasty_freeze 1y ago

I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk. So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.

flyinglizard 1y ago
I previously looked at eGFR numbers and they seem very ballpark-ish and prone to fluctuation, as their name implies. My understanding is that they are used to detect acute cases, rather than to give a real measurement of your kidneys if you’re well.
coldtea 1y ago
Maybe you lost weight or changed some aspects of your diet after 50?
gniv 1y ago
Your diet is less salty maybe?
Aurornis 1y ago
eGFR is an indirect measurement of kidney function. It can be slightly lower in some people with normal kidney function for various reasons. There are additional kidney function tests that would be used for a more complete picture of kidney function if it was suspected that you had a kidney condition. There are more direct GFR tests, minus the ‘e’ prefix which means estimated. However, a better blood test that is more accessible would be Cystatin C. Worth getting one of those as a baseline at some point. In the content of donation, though, it’s not worth risking it. It’s best to play it safe. If you happened to have been inspired by the kidney donation story and blog that circulated in rationalist communities, it’s also worth noting that it was not a great source of information about the relative risks of the procedure, despite being presented as comprehensive and well researched.

manmal 1y ago

It would be interesting what this functional reserve is, right? The microbiome perhaps, or intracellular minerals? Some other thing we haven’t even identified?

chithanh 1y ago
In case of kidneys, my understanding is that only a certain subset of glomerular cells are actively filtrating blood at any given point. The other cells form the functional reserve, and start to become active once the other cells age out, or are disrupted due to an event (like poisoning, such as mycotoxin damage from eating moldy food). Once the functional reserve is exhausted however, no new cells can become active and you are left with whatever dwindling GFR you have, until you get a transplant. With the vascular system you have example arterial elasticity which is an important measure of vascular health. When your blood vessels become less elastic it does not immediately cause symptoms, but it increases the risk of heart disease and stroke. This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels.
- findthewords 1y ago
  >"This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels." And yet in the year 2025 dental care is globally treated as seperate from other healthcare, a strange historical artifact that clings on.
  - bongodongobob 1y ago
    Story from the US: had an awful tooth infection (from a known dead tooth) that I tried to ride out, half my face was swollen up, even my eye looked half shut. Well after a day of this I couldn't take the pain. Called my doctor "we don't pull teeth, you have to call a dentist." So I called a dozen dentist and was told either "we aren't taking new patients" or "we can't get you in for 6 months". I ended up just driving to a dentist and saying "look at my fucking face! Pull this fucking tooth out!" Finally a dentist was able to spare 30 seconds to yank it. Bill was something like $750. The US is a dystopian hellhole.