11 ms·

Avoiding Heart Disease

215 points by kul 13y ago

replicatorblog 13y ago
That's a fascinating story. My company makes biosensors for people to track blood sugar, and our tech has applications to cardiac markers. We've always wanted to sell a kit for home testing, but the market size of willing testers doesn't justify the investment. If a story like yours led some researcher to conduct a study it could lead to a cascade that ultimately puts tools into your hands. Thanks for sharing.
cj 13y ago
> [3] I looked into how I'd get these tests ordered myself and found these options: [...] Directlabs: A dated looking website but offering the option of a la carte tests. Total cost for these three tests: $205 I'll vouch for directlabs. I was very happy with their "Comprehensive Wellness Profile". Their website looks slightly sketchy, but their service is fast and cheap.
bdesimone 13y ago
> Am I missing other major downsides to taking a more proactive approach to managing my own health? Are there other things I should consider looking at to get a complete picture of my health? A potential downside is the tendency is to shift from being proactive about your health to diagnosing (or worse -- treating) yourself based on independent research. I get that it's tempting to fire up google scholar, pubmed, uptodate etc to get a better understanding of what's going on -- just don't go the next step and start diagnosing and treating yourself. See a specialist. See a domain specialist if you can. Get another opinion. Ask questions and air your concerns. If your doctor doesn't adequately answer your questions and concerns, see another doctor. Your greatest asset -- and the one you should be focused on-- is the ability to get multiple opinions from people who have trained for decades on a topic. It seems like you need to see a new doctor -- not order your own tests.
- eshvk 13y ago
  The issue is that doctors give you muddled advice too. I had my blood test done last year and I was told that I should cut down on eating any meat and switch to a plant based diet. He also vaguely told me to do more exercise. Yet, I eat incredibly lean food, albeit high protein mainly because I weight lift. I also run 4.5 miles every other day. He couldn't go into more detail apart from this general warning. I could switch to a more plant, low fat diet. However, would that mean that I would be overall healthy considering that any resistance training would essentially be diminished because I am not getting enough protein in my diet? Should I run more than 15 miles a week and potentially screw my knees. He wasn't sure.
  - rosser 13y ago
    The claim that you can't get sufficient protein for pretty much any level of exercise from a plant-based diet is utterly specious. For example, quinoa is 14% complete protein, and chia is almost 17% — also complete protein — with an Ω3-to-Ω6 ratio of around 3:1, almost exactly the inverse of beef. Source: I'm a vegetarian, and I pay scrupulous attention to this stuff.
    - eshvk 13y ago
      Sure. I am not denying that. It is just inefficient. Let us do some math. I try to hit 150 gms of protein per day while also staying within my calorie limit. I can do that right now while staying under a 1800 calorie limit. From Google, 1 ounce of Chia seeds is 4.7 gms of protein, 138 calories. I would have to eat 31 ounces of Chia seeds to get 150 gms of protein. That is 4030 calories per day. Guess what happens then? I gain weight.
    - gabemart 13y ago
      > Quinoa is 14% complete protein, and chia is almost 17% Quinoa provides 3.8 grams of protein per 100kcal of energy [1]. Boneless skinless chicken breast provides 18.8 grams of protein per 100kcal of energy [2]. A weightlifter who wished to consume 100 grams of protein per day would have to eat 2632 kcal of quinoa, vs. 532 kcal of chicken breast. [1] http://ndb.nal.usda.gov/ndb/foods/show/6383 http://ndb.nal.usda.gov/ndb/foods/show/6383 [2] http://ndb.nal.usda.gov/ndb/foods/show/1018 http://ndb.nal.usda.gov/ndb/foods/show/1018
- DanBC 13y ago
  There's also a risk of becoming hyper-aware of stuff that just doesn't matter. Your heart tends to just do it's thing. But if you concentrate on it you might start noticing weirdnesses. These probably aren't your heart, but now you're anxious, so you think about seeing a doctor. But you don't want to waste the doctor's time, so you look around on the Internet to see what it is. And now you're really worried even though you know you don't have any of those things. So you go and see a doctor, and sure enough you don't have anything wrong. Except now you caught some cold / flu bug from someone in the waiting room.
  - sliverstorm 13y ago
    This happened to me with cars & funny noises. I noticed a noise in my first car that, two years later, turned into a spun bearing & rod knock. Ever since I pay super close attention to every noise my vehicles make! Problem is, vehicles make a lot of noises, even when they are operating correctly. Drives me crazy
perlpimp 13y ago
Tim Ferris has an excellent write up on 4 hour body. Part of it is to do extensive bloodwork & other tests that go far beyond what most doctors do - with them you can get a clearer picture. Talking to doctor with those in hand might give a clearer picture to you and your doctor. Not sure if those are available in India, but my cousin did follow through those tests(in estonia) and has lost 50lbs - now healthier than ever. Has something to do with kinds of blood indicated what kind of diet you suppose to be on, vegeterian, paleo or whatever. my 2c.
WizzleKake 13y ago
> Generic advice to eat well and exercise is not as effective as having a specific number you're trying to improve on e.g. lowering your ApoB count. What. No. If you need to work on a number, why don't you try improving the number of minutes you spend doing cardiovascular exercise per week?
- euphemize 13y ago
  Was thinking the same. Also >The advice to "eat well and exercise" didn't seem particularly insightful ...but it actually makes a world of a difference. I think this is the most important advice and people tend to discard it as generic and useless - the truth is that it's very hard. Being active isn't a big deal, but for a week? For a full month? Full year? Full decade? Being consistent in eating well and exercising is challenging. The doctor won't set goals for yourself, but if need a number, give yourself one and try improving on it constantly. There are tons of tools, apps, websites to help you. I've always been very active since I was a kid and still am now (~500 minutes of sports/week) and I can already see a big difference with my friends who aren't. And I'm not old at all. If you decide to start exercising cause you have symptoms, it's probably too late.
  - eshvk 13y ago
    The problem is that most people don't know what "eating well" and "exercising" really means. I will take myself as an example. When I graduated from grad. school in December of 2011, I was 270 lbs which at 5'10" is fucking fat. I had some idea that I needed to eat less. I remember going to a nutritionist and a doctor back in school. She gave me some vague ideas that were taken from the pyramid scale about how I should be having 3 full meals a day and should incorporate "some exercise" every day. It took me two years to understand that no diet actually works as well as a life style change. It took me that long to understand everything from macros, to body fat percentage and to be able to accurately predict my weekly weight based on my intake. This was all stuff that I had to learn on my own. For example, common wisdom is to exercise more, jog say 30 minutes a week. Last week, I ran 4.5 miles at 8 minutes a mile. My heart rate monitor told me I burnt 200 calories. That is one tablespoon of peanut butter. There are loads of people who spend 3 hours in the gym and then go "re-energize" with a frappucino which completely destroys the time in the gym. This shit is not easy to understand and comprehend. However, yes it is doable. I lost about 110 lbs over the past two years and have consistently kept it off but I know this will be a struggle forever to reshape myself. However, when I look back into notes I made, I realize how hard the process really is.
njonsson 13y ago
I had an elevated Lp(a) level and was able to reduce it dramatically by taking niacin, under the supervision of my cardiologist. YMMV?
dirtyaura 13y ago
"Numbers are constantly fluctuating, monitor them too frequently and you'll get stressed. This is actually a direct quote from my doctor. In my opinion it's still not a reason to ignore the numbers." I'm firmly on the camp that one should measure more - not less - if numbers are fluctuating to reduce worry and stress. Frequent samples, but examining weekly/monthly aggregate trends is the way to go. We just need great tools for visualization.
gambiting 13y ago
"and it's hard to see the insurance companies being willing to foot the bill for tests that aren't deemed necessary" This statement. In a country with a national health care(like mine) this does not happen. If the doctor thinks you need a test, it gets done.
JPKab 13y ago
My father is in the hospital about to have a quadruple bypass. He has been a vegan for 15 years and is on his 2nd heart attack. The "animal fats cause heart disease" stuff has brainwashed him into thinking that his carb rich vegan diet is good for him. It's not (which isn't to say that if he did a GOOD vegan diet he wouldn't be much healthier). I think this article is very insightful. One very good indicator (although not as good as the details the author got tested) is a person's HDL to triglyceride ratio. High levels of HDL are good, and low triglycerides are good, since its currently thought that higher triglyceride levels are linked to the small, dense LDL particles that work their way into artery walls.
aaron695 13y ago
> I've been wondering though why didn't I have this level of discussion with my doctor? 1. For starters doctors are good but not super people. The amount of time you can allocate yourself can mean you win via quantity over quality. 2. Tragedy of the commons. Tests that might help you don't necessarily help society. Tying up a machine that helps people with cancer hurts society but might have a benefit to yourself. What you want is different to what your doctor wants. 3. Doctors are not specialists. I read a quote(Unknown how truth) doctors only have 24 hours of dietary training and should not be giving out dietary advice. But given they often see people incapable of helping themselves or going to a specialist they give out advice anyway.
- bdesimone 13y ago
  1. Doctors are people like any other. But they've spent years specializing in evidence based medicine. They aren't perfect. No. But they are the best we have. 2. The far bigger problem is doctors order tests that wouldn't change treatment but rather help avoid malpractice. 3. The quote -- every time I read it -- makes me laugh because it's so disingenuous. My wife had a week of dietary training in med school. You know what else she had a week of? Renal. Cardiology. etc. If you think diet and exercise are the only--or even the most effective--means of lowering morbidity for chd (which is what OP is worried about) you'd also be wrong. So I'm not really sure why OP should be looking for a dietary specialist vs a cardiologist.
  - dragonwriter 13y ago
    > Doctors are people like any other. But they've spent years specializing in evidence based medicine. Evidence-based medicine [1] as a norm is actually a surprisingly new thing. Assuming that because someone is a doctor they've "spent years specializing" in it is probably optimistic. [1] http://en.wikipedia.org/wiki/Evidence-based_medicine http://en.wikipedia.org/wiki/Evidence-based_medicine
    - bdesimone 13y ago
      EB as a term is new, the specialization is not. Most here are engineers with a BS/BA. Maybe a MA. And fewer still with a PhD. Not that education is everything, but it's certainly "years specializing." Compare that to the track of a typical specialist md: After your undergrad degree you've got.... 4 years in med school. 4-6 years in residency. Plus a 1-3 year fellowship. Long story short, what's the credible alternative to relying on multiple expert opinions? Are educated (engineers/lawyers/etc) ordering tests based on research they really don't understand on themselves a better? By what evidence?
7Figures2Commas 13y ago
> Generic advice to eat well and exercise is not as effective as having a specific number you're trying to improve on e.g. lowering your ApoB count. I'm not so sure this is a wise approach. I won't say that numbers aren't important, but it's worth noting that in many cases, doctors still don't know what particular measurements actually mean in practical terms because cause versus correlation is so hard to figure out in complex systems like the human body. As an example: the general consensus has been that "good" cholesterol (HDL) has a protective effect and that those with lower HDL levels are at risk. You can have an LDL of under 150, low triglycerides and your cholesterol ratios can be stellar, but if your absolute HDL number is low, there's a good chance your doctor will talk to you and, at a minimum, recommend ways that you might be able to bring your HDL level up. One common approach of doing this has been to use niacin, yet a 2011 clinical trial involving the use of niacin in an attempt to increase HDL levels in a high-risk population failed to produce the hoped-for risk reduction despite the fact that the niacin did increase HDL levels[1]. A larger, more recent study had a very similar outcome[2]. One logical possibility is that the HDL level reflects some other underlying factor which controls for risk and doesn't itself have the ability to influence risk. If this is the case, a higher HDL number may confer little to no protection unless it is the product of some other natural process. [1] http://www.nih.gov/news/health/may2011/nhlbi-26.htm http://www.nih.gov/news/health/may2011/nhlbi-26.htm [2] http://health.usnews.com/health-news/news/articles/2013/03/09/niacin-wont-help-may-harm-heart-patients-study http://health.usnews.com/health-news/news/articles/2013/03/0...
- scotch_drinker 13y ago
  I think the OP is referring to the fact it's much easier to focus and improve on specific items than it is to follow some nebulous generic advice. "Lose weight" is much less effective than "Exercise 30 minutes per day and eat 2200 calories per day". What seems to be likely regarding cholesterol in general is that it has been greatly over focused on to the detriment of more likely culprits like sugar and refined foods. Of course, the cynic might say you can't take a pill made by Pfizer to lower your sugar and refined foods like you can to lower your cholesterol.
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7402 13y ago
This New Yorker cartoon shows in humor the limits of attempting to optimize your health. http://www.condenaststore.com/-sp/Thought-balloon-above-man-reads-Less-Cholesterol-Regular-Checkups-No-Nic-New-Yorker-Cartoon-Prints_i8575250_.htm http://www.condenaststore.com/-sp/Thought-balloon-above-man-... Of course it's important care about your health and do what you can, but given the large error bars on our knowledge and the randomness of life in general, I think that it's worth thinking about how much time and effort should be spent on it. There is a correct amount of effort, I'm just not sure that monitoring these additional numbers is worth it; it may be adding more noise than signal to the problem of living a fulfilled, healthy, and happy life.
phormula 13y ago
One thing I have recently become aware of, after my doctor ordered a test, is checking for mutations in the MTHFR gene. It's an enzyme which deals with how we process folate into its active form and is important in many pathways Supposedly the C677T mutation increases your risk for heart disease. There is also another one, A1298C that is very common but no consensus on how it may effect health. I also matters whether you you have one or two copies of the mutations. Some recommend supplementing with methylated B vitamins to offset the any negative health effects, but I'm still soaking this in and am not sure what the consensus is it yet.
- tunesmith 13y ago
  My sister and best friend have both recently researched this. Apparently the MTHFR gene mutation is very common, like 30% of us or something.
melling 13y ago
Number one leading cause of death: Heart Disease. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate What's scary is that we really don't know much about it. I heard Randell Schwartz (of Perl fame) talk about how the modern carb diet is killing people. He lost 60 pounds by monitoring his carb intake. https://plus.google.com/+RandalLSchwartz/posts/9fYhGYfLNY3 https://plus.google.com/+RandalLSchwartz/posts/9fYhGYfLNY3
- tokenadult 13y ago
  Number one leading cause of death: Heart Disease. Yes, that is generally true throughout the developed world. On the other hand, heart disease death rates have been declining at all relevant ages across several decades throughout the developed world.[1] Our understanding of what causes heart disease is very partial indeed. On the other hand, our understanding of how to treat heart disease has increased enormously in my lifetime. My mom, still alive and well at age eighty-one, was a surgical nurse who was described by my late dad as "one of a dozen people in the world who could disassemble and reassemble a heart-lung machine" early in her career. She has seen enormous progress in surgical treatment of heart conditions that used to be sure death sentences, and medical treatment for heart disease has improved greatly too. A CDC report on declining heart disease in the United States[2] suggests what more can be done. [1] http://www.scientificamerican.com/article.cfm?id=longevity-why-we-die-global-life-expectancy http://www.scientificamerican.com/article.cfm?id=longevity-w... [2] http://www.cdc.gov/media/releases/2011/p1013_heart_disease.html http://www.cdc.gov/media/releases/2011/p1013_heart_disease.h...
- Amadou 13y ago
  He lost 60 pounds by monitoring his carb intake. The thing about diets is that everybody has got one that worked for them. It seems to me that the one thing all of these different diets have in common is that they require the person to monitor what they eat. Whatever the specifics of the diet, the dieter ends up paying more attention to their meals in general and that extra digilgence translates into reduced caloric intake. I'm not making a judgment on the nutritional value of any particular diet, just the underlying mechanism for why different diets all have somebody claiming that they work. Even the twinkie diet: http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/ http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/
a8da6b0c91d 13y ago
Fred Kummerow seems like a credible authority on the subject of heart disease: "My findings indicate fried foods, powdered egg yolk, excess vegetable oils, partially hydrogenated vegetable oils and cigarette smoke as the greatest culprits in heart disease." http://www.futuremedicine.com/doi/full/10.2217/clp.13.34 http://www.futuremedicine.com/doi/full/10.2217/clp.13.34
- robertcuci 13y ago
  Is powdered egg yolk a commonly eaten food or a common ingredient in processed foods?
whyleyc 13y ago
Interesting writeup - I've been thinking a lot about this recently, as a member of my family is dealing with an ongoing illness which is poorly understood. I would love for them to be able to monitor their own vital signs more closely (via wearable tech), but even that when done in isolation is not necessarily going to help - for me the real breakthrough will come when we aggregate this data. Imagine being able to use machine learning to detect patterns across groups of people that can help pinpoint specific triggers for disease and illness.
albertsun 13y ago
It's possible that genetic factors count for more than everything else for certain people. The family history profiled here http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-heart-killer-in-the-dna-binding-a-family.html http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-... sounds extremely similar.
- Noxchi 13y ago
  I have a theory that rather than heart disease being genetic, it is environmental that is passed down through family. Lets say your family eats a certain way when you are young, and your family members die of heart disease. And you continue that pattern into adulthood, eating the same way you were brought up, and you get heart disease. Is it genetic or is it passed-down environmental? I think it's the latter.
aedocw 13y ago
For those interested in getting a much more comprehensive look at their blood, along with a consultation from a doctor to help you better understand the connections, check out http://www.wellnessfx.com/ http://www.wellnessfx.com/ (I haven't tried it out myself yet, but I'm planning to next year - I'm in no way affiliated with them, but definitely seems like a great idea)
tansey 13y ago
I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as long as possible, they will give me some generic intuitive advice, but they have no real insight because they are not in the business of maximizing the lifetime of healthy cars. Doctors are kind of the same way. They see patients who have problems and need them fixed. If you walk into a doctor's office and say your family has a history of heart disease and you're concerned, they'll run a standard diagnostic to see if there is a problem. If there isn't, they'll give you generic advice. Outside of that, they are not really likely to have much insight into how to prevent heart disease in your specific case. Maybe you'll get lucky and the doctor will have recently read a relevant paper. This seems to me like a problem that you're better off having answered by a medical researcher rather than a physician in the trenches. Researchers are the ones who are taking the long view on outcomes in patients. Keeping with the same analogy, you're probably better off talking to a mechanical engineer at a car company about maximizing the life of your currently healthy transmission. Also, I generally see this as a problem that will be best addressed by machine learning researchers collaborating with medical researchers. Then again, I'm an ML PhD student working on health applications, so I'm biased. :)
- danpat 13y ago
  Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, tongue in cheek, that the computers were going to take their jobs. This led to a healthy discussion about the human practitioners role in a time when the amount of information they're expected to know is rapidly expanding. What's your take in the future role of the human in diagnosing and prescribing in a situation like this?
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shanev 13y ago
It’s great to see other tech people educate themselves about health and help break the stereotypes of the ramen eating, soda drinking nerd. This story reads almost like what happened to my dad last year. He complained of shortness of breath and went to see a cardiologist. He got an angioplasty done, which showed severe calcification of the arteries. The doctor advised him to have a quadruple bypass the very next day. I flew in from San Francisco to be with my dad in the hospital. After my dad’s surgery, I decided to get more involved in his health. As someone who’s been following a Paleo lifestyle for over 4 years now, I stayed in NJ for 3 months and nursed my dad back to health. I cooked every one his meals for those 3 months. His fasting blood sugar fell from a borderline diabetic value of 121 to a more normal 92. He lost considerable visceral fat around his waist and was looking better than he has in maybe 20 years. All of his blood markers improved. Good health is both easy and hard. The easy approach is to understand that modern industrialized food is harmful and try to emulate a diet from yesteryear, like Paleo, or your ancestral cultural diet. The flip side of the coin is to dig into science, as you have done, and understand the intriciacies of various blood markers like cholesterol, the difference between small and large particle size, Ha1bc, the various types of short chain fatty acids, figuring out that fat is not a villain, learning the dangerous of low fat foods, etc. I’ve been studying this stuff independently for 4 years, including learning enough biochemistry to get through medical research papers. Everything I have read so far points to a Paleo-type diet being optimal. As an engineer I’m taking the latter approach as I need to prove things to myself before taking it for face value. But for the layman, it’s not really that hard. Something is wrong in this world when Tom Hanks, with access to the best doctors in the world, announces that he has type 2 diabetes, when I was able to reverse it in my dad in 3 months through diet alone. I use DirectLabs for my blood work. Crappy site, but very happy with the turnaround time.
- tdfx 13y ago
  > Something is wrong in this world when Tom Hanks, with access to the best doctors in the world, announces that he has type 2 diabetes I would imagine that the client relationship in medicine in similar to other industries. Failure is often not a result of the service you provide, but from the fact that the client doesn't listen to the advice they are paying for.
LizVerano 13y ago
This make sense.
dr_ 13y ago
His doctor is correct. Even the lab work obtained - ApoB and CRP - was just a picture in a moment in time. You are not going to be checking these levels on a daily basis, or monthly, at least not until there's an easier way to measure things without having to get stuck with a needle all the time. Stress is considered a risk factor, but how do you plan on measuring stress? And maybe not with respect to heart disease specifically, but today a study was released suggesting loneliness was as much a health risk as drinking and smoking 15 cigs a day - but how does one measure the extent of loneliness? A good diet is important, and there's enough information out there to determine what a good diet is. I believe weighing yourself daily is real helpful. And regular exercise - a combination or aerobic and anaerobic. There's enough data to indicate that these interventions, combined, are effective in reducing risk. And, on a less preventive note, truth be told, if someone in their mid 50's is complaining of SOB and has a family history heart disease, most doctors, in the US at least, are going to do more extensive testing.
warmfuzzykitten 13y ago
And now he's a hypochondriac. Fact is, eat well and exercise is better advice than checking a bunch of numbers of unproven value for preventing heart disease. Doctor's don't know how to prevent heart disease, but at least one knows how to reverse heart disease. His advice is a little more extensive: eat well (mostly vegetarian), exercise, meditate, have social support and don't smoke. But it does not involve, in any way, tracking your blood test results. http://en.wikipedia.org/wiki/Dean_Ornish http://en.wikipedia.org/wiki/Dean_Ornish
seancoleman 13y ago
I can really empathize with Harj. I have a paternal history of high cholesterol, my grandfather recently having bypass surgery. Using WellnessFX I discovered that I have an extremely high Apo B level, nearly twice the upper limit of the low-risk range. Thinking my first test was an anomaly, I was retested over the course of several months with consistent results of less than 3% variation. Using this data, I've modified my diet and am seeking medical advice to reduce to a normal range. My cholesterol levels are all normal. I eat healthy (a seemingly subjective measure) and exercise regularly. My doctor said I am in perfect health at my recent annual physical. I'm privileged to be able to afford private blood testing. Apo B data is within everyone's grasp, yet it seems so under-utilized.
carbocation 13y ago
How to avoid heart disease: (0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.) (1) Don't use tobacco or cocaine, and don't drink too much alcohol. (2) Don't get exposed to radiation or chemotherapy. (3) Don't have diabetes. (4) Don't have high blood pressure. (5) Have low levels of LDL and triglycerides. (6) Don't eat too much. This is tightly related to #3 and #4, and reasonably related to #5. (7) Have extremely low levels of LDL and triglycerides throughout your entire life. Having low LDL throughout your entire life reduces your risk of heart disease, even moreso than you would expect based on the LDL value alone. It seems that lifelong exposure to low LDL is more valuable than just late-life exposure to low LDL. [a] Most of the genetic variants that we can currently interpret when accounting for risk (as opposed to the innumerable ones which we cannot yet interpret) fall into lipoprotein-related pathways. It will be interesting to learn about ones that do not, yet still confer meaningful cardiovascular risk. I don't think that we have a mechanistic explanation yet for the risk conferred by variants in the 9p21 locus, for example. [b] I'm reasonably certain that your HDL is not particularly important (except as a poor proxy for your socioeconomic status, perhaps).[c] And omega-3 fatty acids have no visible effect when examined in the rigorous way in which we examine any other new drug. [d] a = http://www.ncbi.nlm.nih.gov/pubmed/20579540 http://www.ncbi.nlm.nih.gov/pubmed/20579540 b = http://circgenetics.ahajournals.org/content/6/2/224.long http://circgenetics.ahajournals.org/content/6/2/224.long c = http://www.ncbi.nlm.nih.gov/pubmed/22607825 http://www.ncbi.nlm.nih.gov/pubmed/22607825 d = http://www.nejm.org/doi/full/10.1056/NEJMoa1205409 http://www.nejm.org/doi/full/10.1056/NEJMoa1205409
- pcrh 13y ago
  Most of those amount to "be lucky", which isn't very helpful advice.
  - carbocation 13y ago
    1, 3, 4, 5, 6, and 7 are all modifiable.
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mmuelly 13y ago
Avoid heart disease - die of cancer! Honestly, I would take the massive coronary event any day over the slow, miserable death that cancer involves.
- voltagex_ 13y ago
  Why does it have to be one or the other?
oceanic 13y ago
Catalyst, an excellent science program on the ABC [1], Australia's national broadcaster, has just had a two-part episode called "The Heart of the Matter", about the science (or lack of it) behind the cholesterol theory. The researcher Dr Maryanne Demasi[2], herself a research pathologist, has spent three years gathering data, interviewing researchers, scientists and doctors on both sides of the argument, and the show has caused major ripples throughout the medical profession in Australia [3]. The two episodes are on YouTube in full [4] [5] and the transcripts are on the ABC website [6] [7]. For anyone interested in this topic, these shows are HIGHLY recommended. [1] http://www.abc.net.au http://www.abc.net.au [2] http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=catalyst http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=... [3] http://www.6minutes.com.au/news/latest-news/expert-takes-aim-at-saturated-fat-myth http://www.6minutes.com.au/news/latest-news/expert-takes-aim... [4] http://www.youtube.com/watch?v=rDVf-00w5gk http://www.youtube.com/watch?v=rDVf-00w5gk [5] http://www.youtube.com/watch?v=wAKaM330xzg http://www.youtube.com/watch?v=wAKaM330xzg [6] http://www.abc.net.au/catalyst/stories/3876219.htm http://www.abc.net.au/catalyst/stories/3876219.htm [7] http://www.abc.net.au/catalyst/stories/3881441.htm http://www.abc.net.au/catalyst/stories/3881441.htm
- simplexion 13y ago
  Don't bother with the first episode. It is full of nonsense, including a naturopath as an "expert". The second episode regarding statins is far more evidence-based.
  - oceanic 13y ago
    I think the stuff about the effects of high sugar and high carbohydrate diets in the first episode is pretty solid. Which one is the naturopath?
    - simplexion 13y ago
      The "Nutritionist"
- voltagex_ 13y ago
tessierashpool 13y ago
I have heart disease. if I hadn't followed the advice of Dr. Joel Fuhrman (drfuhrman.com) I'd already be dead. I don't have time to get into it here, but conventional cardiology is essentially malpractice in my opinion. if you have heart disease, or you know someone who does, please check out Dr. Fuhrman's work.
simplexion 13y ago
"Eat food. Not too much. Mostly plants." ~Michael Pollan
smewpy 13y ago
When I was 28 years old, found I had high blood pressure. Over next 7 years I took BP meds but also lost weight and worked out. Doctors ran tests but never found a root cause - it was just high for no assignable reason and I was told to take meds. At 34 years old, was in best shape of my life, except still taking BP meds. That year, I stopped taking the meds, but monitored BP every few months. It was borderline high but not crazy. So this year, I turned 38, off the BP meds more than 3 years now. Then, last month while in China with my family, I had a full blown stroke. Result was lost 2cm of my left brain directly in the region that controls speech and right arm & hand motor skills. Spent 8 days in a Chinese hospital. For about one week, I talked like a stone cold drunk and my right arm was useless. I thought I might be that way forever. Luckily, after two months, I'm basically fully functionally recovered. Bottom line is the path from a risk indicator like high blood pressure to a stroke or heart attack can be fairly short. Now, at 38 I know I must make some radical change if I'm going to live to 70, no less not be a paralyzed half brain dead invalid. I'm certainly interested in quantified self tech now. The problem is everyone that needs a doctor to take an intense personal interest in their long term health cannot possibly find a doctor to do so, for any number of reasons. Opportunity is to empower the individual non-medial experts to easily monitor their own health and risk factors over time. Will likely be moving into product development in this space myself.
avifreedman 13y ago
Planning to manage one's own health is probably best. I would love to be a customer of a competent company that managed body scans and the process of looking for deltas using humans assisted by software every N years. Why? Common medical wisdom now is that doing proactive body scans (usually just the trunk), even just MRI (so no radiation) is bad because it drives the expense and uncertainty of investigating every bump and shadow. And many of the tests will come back inconclusive. I understand that argument but it seems the way to deal with that is to focus not as much on scan #1 but scan deltas. My anecodtal (IANAD) evidence is that in more than 5 cases of cancer in friends and families, a cancer diagnosis was delayed for many months from onset of symptoms and a few Oncologists have told me that they agree that for most of those cancers, that latency could have been improved if a baseline scan had been available of the organs/bones/nodes in question. Not every patient would be a good candidate for such a service but the same is true for 23andme.
mtdewcmu 13y ago
My feeling is that the state of scientific knowledge is pretty weak on how to prevent a heart attack that's still 20 years away. Doctors should not overstate what is known scientifically, otherwise they are probably telling you things that are not true.
aantix 13y ago
I read this treat protocol from a dr. on a heart forum : "I use EBT calcium imaging to identify who needs treatment and serial EBT calcium measurements to document adequacy of treatment. I use low dose statin or bile salt sequestrate plus ASA, high dose fish oil derived omega-3 plus frequently add nicotinic acid. In addition I screen for sub clinical insulin resistance, sleep apnea and encourage daily flossing and dental hygiene, regular mild exercise, and lots of fruit and veggies. The calcium score helps motivate compliance and the result is the near elimination of heart attacks and ischemic strokes." http://www.theheart.org/article/1269619.do http://www.theheart.org/article/1269619.do
wonnage 13y ago
I worked for WellnessFX (mentioned in the article) in the past and definitely recommend their service. The stuff they test for is not a part of standard (e.g yearly physical) blood work and you'd have to convince your doctor to give you the tests (intimidating, expensive). Granted, this is because the larger medical establishment either doesn't think they're necessary, or has yet to come to a consensus on their interpretation. Personally, given the recent wave of news debunking low-fat/high-carb diets, I'm inclined to take the health research from the past couple of decades with a grain of salt.
- nanodeath 13y ago
  WellnessFX looks interesting. What are some of the other competitors in this space; do you know offhand?
memracom 13y ago
Joel Fuhrman http://www.drfuhrman.com/ http://www.drfuhrman.com/ is one of a number of medical doctors who promote a coordinated attack on the causes of bad health like heart disease, rather than relying on reducing one or two indicators. Neal Barnard is another such doctor http://www.nealbarnard.org/ http://www.nealbarnard.org/ In North America, both of these doctors have shows on PBS a couple of times a year, in the weekday evenings and they generally run as part of a series of similar shows by other medical doctors. The two named above have done a significant amount of research into the programs that they suggest, and they publish widely and openly and tell you what research they are looking at and why they recommend certain actions.
kayoone 13y ago
I am pretty late to this but i wanted to raise an important point. Dont overanalyze yourself. Since passing out about a year ago because of an infection and not drinking/eating anything that morning i have some serious anxiety issues that affect my life in a bad way. I started to monitor my heart, my blood pressure, my pulse and freaked out whenever something was slightly off. I went to numerous doctors and cardiologists, nobody could find anything of relevance, no risk factors at all. I still worry. With time it got better but there is a reason we dont usually think about bad things to happen or us or even death, because it affects our psychology in a bad way. I am not saying do not care for this, but also trust the doctors. The advice of eating healthy, exercising regularly and stop overanalyzing yourself is the right approach and will lower your general risk considerably. Of course go and check your blood once a year but overall there is only so much you can do. In the end theres many,many risks in life that you cant really pre proactive about because we also dont really know the human body yet. If you get into this you will find hundreds of people suggesting different things, you will learn about all kinds of diseases you shouldnt really worry about in the back of your head because it will bring your quality of life down in the end. I myself am not very good at what i suggest here, but i wish i was.
rdl 13y ago
Why not come to Thailand and drop a few hundred dollars on comprehensive imaging studies, like I'm doing this week?
- computer 13y ago
  Do you have a link with more information on how to go about getting this done?
  - rdl 13y ago
    http://www.bumrungrad.com/ http://www.bumrungrad.com/ is the place I use. It's a bit more than $200 for MR, etc., but I'm doing the exec screening w/ stress test and ultrasound (http://www.bumrungrad.com/en/health-check-up-bangkok-thailand http://www.bumrungrad.com/en/health-check-up-bangkok-thailan...) and x-ray, and may do MR and would potentially get a CT (obviously avoid CT if you don't need it due to the radiation dose, but with modern equipment I'm personally not super worried). I got my LASIK done about 8y ago at TRSC (www.lasikthai.com) which means free checkups and touchups for life, too, also down the street. Eye exams are one case where I usually use a hotel car vs. a taxi to get around, as dealing with obnoxious taxi drivers while sort of blind sucks.
pitchups 13y ago
Surprised that there is just one mention in this entire thread of Dr. Esselstyn[1] and Dr. Dean Ornish[2] - two doctors who deserve more attention in any discussion on the topic of preventing heart disease. They have published research and studies showing that it is possible to prevent and actually reverse heart disease - even in advanced cases of artery blockage - by strict diet and lifestyle changes. President Clinton has adopted their recommended diet after his coronary bypass surgery. Highly recommend reading their research studies and books on the subject. [1] http://en.wikipedia.org/wiki/Caldwell_Esselstyn http://en.wikipedia.org/wiki/Caldwell_Esselstyn [2] http://en.wikipedia.org/wiki/Dean_Ornish http://en.wikipedia.org/wiki/Dean_Ornish
yurhirt 13y ago
It seems to me, as a curious non-medic, that at the root of heart disease is a state of persistent arousal, which is similar to stress -- high blood pressure, high blood sugars and fats, tachycardia, low immune, high inflammation, poor digestion, etc. All arguably useful if you are hunting prey or raiding the next village. But bad for the body in the long run. So I think we ought to ask why in this day and age do we seem to find this biological state desirable -- for example, does it paradoxically enable us, while still alive, to be more productive?
jdnier 13y ago
The simplicity of "switch to a whole foods, plant-based diet and you simply won't die from heart disease" has eased my similar anxieties. http://www.heartattackproof.com/ http://www.heartattackproof.com/ See also the related documentary, http://www.forksoverknives.com/ http://www.forksoverknives.com/.
- skittles 13y ago
  Then watch the Fat Head documentary and be confused once again.

215 points by kul 13y ago

That's a fascinating story. My company makes biosensors for people to track blood sugar, and our tech has applications to cardiac markers. We've always wanted to sell a kit for home testing, but the market size of willing testers doesn't justify the investment. If a story like yours led some researcher to conduct a study it could lead to a cascade that ultimately puts tools into your hands. Thanks for sharing.

cj 13y ago

> [3] I looked into how I'd get these tests ordered myself and found these options: [...] Directlabs: A dated looking website but offering the option of a la carte tests. Total cost for these three tests: $205 I'll vouch for directlabs. I was very happy with their "Comprehensive Wellness Profile". Their website looks slightly sketchy, but their service is fast and cheap.

bdesimone 13y ago

> Am I missing other major downsides to taking a more proactive approach to managing my own health? Are there other things I should consider looking at to get a complete picture of my health? A potential downside is the tendency is to shift from being proactive about your health to diagnosing (or worse -- treating) yourself based on independent research. I get that it's tempting to fire up google scholar, pubmed, uptodate etc to get a better understanding of what's going on -- just don't go the next step and start diagnosing and treating yourself. See a specialist. See a domain specialist if you can. Get another opinion. Ask questions and air your concerns. If your doctor doesn't adequately answer your questions and concerns, see another doctor. Your greatest asset -- and the one you should be focused on-- is the ability to get multiple opinions from people who have trained for decades on a topic. It seems like you need to see a new doctor -- not order your own tests.

eshvk 13y ago
The issue is that doctors give you muddled advice too. I had my blood test done last year and I was told that I should cut down on eating any meat and switch to a plant based diet. He also vaguely told me to do more exercise. Yet, I eat incredibly lean food, albeit high protein mainly because I weight lift. I also run 4.5 miles every other day. He couldn't go into more detail apart from this general warning. I could switch to a more plant, low fat diet. However, would that mean that I would be overall healthy considering that any resistance training would essentially be diminished because I am not getting enough protein in my diet? Should I run more than 15 miles a week and potentially screw my knees. He wasn't sure.
- rosser 13y ago
  The claim that you can't get sufficient protein for pretty much any level of exercise from a plant-based diet is utterly specious. For example, quinoa is 14% complete protein, and chia is almost 17% — also complete protein — with an Ω3-to-Ω6 ratio of around 3:1, almost exactly the inverse of beef. Source: I'm a vegetarian, and I pay scrupulous attention to this stuff.
  - eshvk 13y ago
    Sure. I am not denying that. It is just inefficient. Let us do some math. I try to hit 150 gms of protein per day while also staying within my calorie limit. I can do that right now while staying under a 1800 calorie limit. From Google, 1 ounce of Chia seeds is 4.7 gms of protein, 138 calories. I would have to eat 31 ounces of Chia seeds to get 150 gms of protein. That is 4030 calories per day. Guess what happens then? I gain weight.
  - gabemart 13y ago
    > Quinoa is 14% complete protein, and chia is almost 17% Quinoa provides 3.8 grams of protein per 100kcal of energy [1]. Boneless skinless chicken breast provides 18.8 grams of protein per 100kcal of energy [2]. A weightlifter who wished to consume 100 grams of protein per day would have to eat 2632 kcal of quinoa, vs. 532 kcal of chicken breast. [1] http://ndb.nal.usda.gov/ndb/foods/show/6383 http://ndb.nal.usda.gov/ndb/foods/show/6383 [2] http://ndb.nal.usda.gov/ndb/foods/show/1018 http://ndb.nal.usda.gov/ndb/foods/show/1018
DanBC 13y ago
There's also a risk of becoming hyper-aware of stuff that just doesn't matter. Your heart tends to just do it's thing. But if you concentrate on it you might start noticing weirdnesses. These probably aren't your heart, but now you're anxious, so you think about seeing a doctor. But you don't want to waste the doctor's time, so you look around on the Internet to see what it is. And now you're really worried even though you know you don't have any of those things. So you go and see a doctor, and sure enough you don't have anything wrong. Except now you caught some cold / flu bug from someone in the waiting room.
- sliverstorm 13y ago
  This happened to me with cars & funny noises. I noticed a noise in my first car that, two years later, turned into a spun bearing & rod knock. Ever since I pay super close attention to every noise my vehicles make! Problem is, vehicles make a lot of noises, even when they are operating correctly. Drives me crazy

perlpimp 13y ago

Tim Ferris has an excellent write up on 4 hour body. Part of it is to do extensive bloodwork & other tests that go far beyond what most doctors do - with them you can get a clearer picture. Talking to doctor with those in hand might give a clearer picture to you and your doctor. Not sure if those are available in India, but my cousin did follow through those tests(in estonia) and has lost 50lbs - now healthier than ever. Has something to do with kinds of blood indicated what kind of diet you suppose to be on, vegeterian, paleo or whatever. my 2c.

WizzleKake 13y ago

> Generic advice to eat well and exercise is not as effective as having a specific number you're trying to improve on e.g. lowering your ApoB count. What. No. If you need to work on a number, why don't you try improving the number of minutes you spend doing cardiovascular exercise per week?

euphemize 13y ago
Was thinking the same. Also >The advice to "eat well and exercise" didn't seem particularly insightful ...but it actually makes a world of a difference. I think this is the most important advice and people tend to discard it as generic and useless - the truth is that it's very hard. Being active isn't a big deal, but for a week? For a full month? Full year? Full decade? Being consistent in eating well and exercising is challenging. The doctor won't set goals for yourself, but if need a number, give yourself one and try improving on it constantly. There are tons of tools, apps, websites to help you. I've always been very active since I was a kid and still am now (~500 minutes of sports/week) and I can already see a big difference with my friends who aren't. And I'm not old at all. If you decide to start exercising cause you have symptoms, it's probably too late.
- eshvk 13y ago
  The problem is that most people don't know what "eating well" and "exercising" really means. I will take myself as an example. When I graduated from grad. school in December of 2011, I was 270 lbs which at 5'10" is fucking fat. I had some idea that I needed to eat less. I remember going to a nutritionist and a doctor back in school. She gave me some vague ideas that were taken from the pyramid scale about how I should be having 3 full meals a day and should incorporate "some exercise" every day. It took me two years to understand that no diet actually works as well as a life style change. It took me that long to understand everything from macros, to body fat percentage and to be able to accurately predict my weekly weight based on my intake. This was all stuff that I had to learn on my own. For example, common wisdom is to exercise more, jog say 30 minutes a week. Last week, I ran 4.5 miles at 8 minutes a mile. My heart rate monitor told me I burnt 200 calories. That is one tablespoon of peanut butter. There are loads of people who spend 3 hours in the gym and then go "re-energize" with a frappucino which completely destroys the time in the gym. This shit is not easy to understand and comprehend. However, yes it is doable. I lost about 110 lbs over the past two years and have consistently kept it off but I know this will be a struggle forever to reshape myself. However, when I look back into notes I made, I realize how hard the process really is.

njonsson 13y ago

I had an elevated Lp(a) level and was able to reduce it dramatically by taking niacin, under the supervision of my cardiologist. YMMV?

dirtyaura 13y ago

"Numbers are constantly fluctuating, monitor them too frequently and you'll get stressed. This is actually a direct quote from my doctor. In my opinion it's still not a reason to ignore the numbers." I'm firmly on the camp that one should measure more - not less - if numbers are fluctuating to reduce worry and stress. Frequent samples, but examining weekly/monthly aggregate trends is the way to go. We just need great tools for visualization.

gambiting 13y ago

"and it's hard to see the insurance companies being willing to foot the bill for tests that aren't deemed necessary" This statement. In a country with a national health care(like mine) this does not happen. If the doctor thinks you need a test, it gets done.

JPKab 13y ago

My father is in the hospital about to have a quadruple bypass. He has been a vegan for 15 years and is on his 2nd heart attack. The "animal fats cause heart disease" stuff has brainwashed him into thinking that his carb rich vegan diet is good for him. It's not (which isn't to say that if he did a GOOD vegan diet he wouldn't be much healthier). I think this article is very insightful. One very good indicator (although not as good as the details the author got tested) is a person's HDL to triglyceride ratio. High levels of HDL are good, and low triglycerides are good, since its currently thought that higher triglyceride levels are linked to the small, dense LDL particles that work their way into artery walls.

aaron695 13y ago

> I've been wondering though why didn't I have this level of discussion with my doctor? 1. For starters doctors are good but not super people. The amount of time you can allocate yourself can mean you win via quantity over quality. 2. Tragedy of the commons. Tests that might help you don't necessarily help society. Tying up a machine that helps people with cancer hurts society but might have a benefit to yourself. What you want is different to what your doctor wants. 3. Doctors are not specialists. I read a quote(Unknown how truth) doctors only have 24 hours of dietary training and should not be giving out dietary advice. But given they often see people incapable of helping themselves or going to a specialist they give out advice anyway.

bdesimone 13y ago
1. Doctors are people like any other. But they've spent years specializing in evidence based medicine. They aren't perfect. No. But they are the best we have. 2. The far bigger problem is doctors order tests that wouldn't change treatment but rather help avoid malpractice. 3. The quote -- every time I read it -- makes me laugh because it's so disingenuous. My wife had a week of dietary training in med school. You know what else she had a week of? Renal. Cardiology. etc. If you think diet and exercise are the only--or even the most effective--means of lowering morbidity for chd (which is what OP is worried about) you'd also be wrong. So I'm not really sure why OP should be looking for a dietary specialist vs a cardiologist.
- dragonwriter 13y ago
  > Doctors are people like any other. But they've spent years specializing in evidence based medicine. Evidence-based medicine [1] as a norm is actually a surprisingly new thing. Assuming that because someone is a doctor they've "spent years specializing" in it is probably optimistic. [1] http://en.wikipedia.org/wiki/Evidence-based_medicine http://en.wikipedia.org/wiki/Evidence-based_medicine
  - bdesimone 13y ago
    EB as a term is new, the specialization is not. Most here are engineers with a BS/BA. Maybe a MA. And fewer still with a PhD. Not that education is everything, but it's certainly "years specializing." Compare that to the track of a typical specialist md: After your undergrad degree you've got.... 4 years in med school. 4-6 years in residency. Plus a 1-3 year fellowship. Long story short, what's the credible alternative to relying on multiple expert opinions? Are educated (engineers/lawyers/etc) ordering tests based on research they really don't understand on themselves a better? By what evidence?

7Figures2Commas 13y ago

> Generic advice to eat well and exercise is not as effective as having a specific number you're trying to improve on e.g. lowering your ApoB count. I'm not so sure this is a wise approach. I won't say that numbers aren't important, but it's worth noting that in many cases, doctors still don't know what particular measurements actually mean in practical terms because cause versus correlation is so hard to figure out in complex systems like the human body. As an example: the general consensus has been that "good" cholesterol (HDL) has a protective effect and that those with lower HDL levels are at risk. You can have an LDL of under 150, low triglycerides and your cholesterol ratios can be stellar, but if your absolute HDL number is low, there's a good chance your doctor will talk to you and, at a minimum, recommend ways that you might be able to bring your HDL level up. One common approach of doing this has been to use niacin, yet a 2011 clinical trial involving the use of niacin in an attempt to increase HDL levels in a high-risk population failed to produce the hoped-for risk reduction despite the fact that the niacin did increase HDL levels[1]. A larger, more recent study had a very similar outcome[2]. One logical possibility is that the HDL level reflects some other underlying factor which controls for risk and doesn't itself have the ability to influence risk. If this is the case, a higher HDL number may confer little to no protection unless it is the product of some other natural process. [1] http://www.nih.gov/news/health/may2011/nhlbi-26.htm http://www.nih.gov/news/health/may2011/nhlbi-26.htm [2] http://health.usnews.com/health-news/news/articles/2013/03/09/niacin-wont-help-may-harm-heart-patients-study http://health.usnews.com/health-news/news/articles/2013/03/0...

scotch_drinker 13y ago
I think the OP is referring to the fact it's much easier to focus and improve on specific items than it is to follow some nebulous generic advice. "Lose weight" is much less effective than "Exercise 30 minutes per day and eat 2200 calories per day". What seems to be likely regarding cholesterol in general is that it has been greatly over focused on to the detriment of more likely culprits like sugar and refined foods. Of course, the cynic might say you can't take a pill made by Pfizer to lower your sugar and refined foods like you can to lower your cholesterol.
- 13y ago

7402 13y ago

This New Yorker cartoon shows in humor the limits of attempting to optimize your health. http://www.condenaststore.com/-sp/Thought-balloon-above-man-reads-Less-Cholesterol-Regular-Checkups-No-Nic-New-Yorker-Cartoon-Prints_i8575250_.htm http://www.condenaststore.com/-sp/Thought-balloon-above-man-... Of course it's important care about your health and do what you can, but given the large error bars on our knowledge and the randomness of life in general, I think that it's worth thinking about how much time and effort should be spent on it. There is a correct amount of effort, I'm just not sure that monitoring these additional numbers is worth it; it may be adding more noise than signal to the problem of living a fulfilled, healthy, and happy life.

phormula 13y ago

One thing I have recently become aware of, after my doctor ordered a test, is checking for mutations in the MTHFR gene. It's an enzyme which deals with how we process folate into its active form and is important in many pathways Supposedly the C677T mutation increases your risk for heart disease. There is also another one, A1298C that is very common but no consensus on how it may effect health. I also matters whether you you have one or two copies of the mutations. Some recommend supplementing with methylated B vitamins to offset the any negative health effects, but I'm still soaking this in and am not sure what the consensus is it yet.

tunesmith 13y ago
My sister and best friend have both recently researched this. Apparently the MTHFR gene mutation is very common, like 30% of us or something.

melling 13y ago

Number one leading cause of death: Heart Disease. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate What's scary is that we really don't know much about it. I heard Randell Schwartz (of Perl fame) talk about how the modern carb diet is killing people. He lost 60 pounds by monitoring his carb intake. https://plus.google.com/+RandalLSchwartz/posts/9fYhGYfLNY3 https://plus.google.com/+RandalLSchwartz/posts/9fYhGYfLNY3

tokenadult 13y ago
Number one leading cause of death: Heart Disease. Yes, that is generally true throughout the developed world. On the other hand, heart disease death rates have been declining at all relevant ages across several decades throughout the developed world.[1] Our understanding of what causes heart disease is very partial indeed. On the other hand, our understanding of how to treat heart disease has increased enormously in my lifetime. My mom, still alive and well at age eighty-one, was a surgical nurse who was described by my late dad as "one of a dozen people in the world who could disassemble and reassemble a heart-lung machine" early in her career. She has seen enormous progress in surgical treatment of heart conditions that used to be sure death sentences, and medical treatment for heart disease has improved greatly too. A CDC report on declining heart disease in the United States[2] suggests what more can be done. [1] http://www.scientificamerican.com/article.cfm?id=longevity-why-we-die-global-life-expectancy http://www.scientificamerican.com/article.cfm?id=longevity-w... [2] http://www.cdc.gov/media/releases/2011/p1013_heart_disease.html http://www.cdc.gov/media/releases/2011/p1013_heart_disease.h...
Amadou 13y ago
He lost 60 pounds by monitoring his carb intake. The thing about diets is that everybody has got one that worked for them. It seems to me that the one thing all of these different diets have in common is that they require the person to monitor what they eat. Whatever the specifics of the diet, the dieter ends up paying more attention to their meals in general and that extra digilgence translates into reduced caloric intake. I'm not making a judgment on the nutritional value of any particular diet, just the underlying mechanism for why different diets all have somebody claiming that they work. Even the twinkie diet: http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/ http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/

a8da6b0c91d 13y ago

Fred Kummerow seems like a credible authority on the subject of heart disease: "My findings indicate fried foods, powdered egg yolk, excess vegetable oils, partially hydrogenated vegetable oils and cigarette smoke as the greatest culprits in heart disease." http://www.futuremedicine.com/doi/full/10.2217/clp.13.34 http://www.futuremedicine.com/doi/full/10.2217/clp.13.34

robertcuci 13y ago
Is powdered egg yolk a commonly eaten food or a common ingredient in processed foods?

whyleyc 13y ago

Interesting writeup - I've been thinking a lot about this recently, as a member of my family is dealing with an ongoing illness which is poorly understood. I would love for them to be able to monitor their own vital signs more closely (via wearable tech), but even that when done in isolation is not necessarily going to help - for me the real breakthrough will come when we aggregate this data. Imagine being able to use machine learning to detect patterns across groups of people that can help pinpoint specific triggers for disease and illness.

albertsun 13y ago

It's possible that genetic factors count for more than everything else for certain people. The family history profiled here http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-heart-killer-in-the-dna-binding-a-family.html http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-... sounds extremely similar.

Noxchi 13y ago
I have a theory that rather than heart disease being genetic, it is environmental that is passed down through family. Lets say your family eats a certain way when you are young, and your family members die of heart disease. And you continue that pattern into adulthood, eating the same way you were brought up, and you get heart disease. Is it genetic or is it passed-down environmental? I think it's the latter.

aedocw 13y ago

For those interested in getting a much more comprehensive look at their blood, along with a consultation from a doctor to help you better understand the connections, check out http://www.wellnessfx.com/ http://www.wellnessfx.com/ (I haven't tried it out myself yet, but I'm planning to next year - I'm in no way affiliated with them, but definitely seems like a great idea)

tansey 13y ago

I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as long as possible, they will give me some generic intuitive advice, but they have no real insight because they are not in the business of maximizing the lifetime of healthy cars. Doctors are kind of the same way. They see patients who have problems and need them fixed. If you walk into a doctor's office and say your family has a history of heart disease and you're concerned, they'll run a standard diagnostic to see if there is a problem. If there isn't, they'll give you generic advice. Outside of that, they are not really likely to have much insight into how to prevent heart disease in your specific case. Maybe you'll get lucky and the doctor will have recently read a relevant paper. This seems to me like a problem that you're better off having answered by a medical researcher rather than a physician in the trenches. Researchers are the ones who are taking the long view on outcomes in patients. Keeping with the same analogy, you're probably better off talking to a mechanical engineer at a car company about maximizing the life of your currently healthy transmission. Also, I generally see this as a problem that will be best addressed by machine learning researchers collaborating with medical researchers. Then again, I'm an ML PhD student working on health applications, so I'm biased. :)

danpat 13y ago
Small backstory and a question for you. My fiancée is a psychiatric nurse practitioner. Recently, we were having dinner with a few of her colleagues, and they were complaining about the overwhelming number of new medications coming to market, and how they could never remember all the interactions, what to use for what, which ones were new, which had been retired, etc, etc. As a CS person, I piped up and suggested, tongue in cheek, that the computers were going to take their jobs. This led to a healthy discussion about the human practitioners role in a time when the amount of information they're expected to know is rapidly expanding. What's your take in the future role of the human in diagnosing and prescribing in a situation like this?
- 13y ago

shanev 13y ago

It’s great to see other tech people educate themselves about health and help break the stereotypes of the ramen eating, soda drinking nerd. This story reads almost like what happened to my dad last year. He complained of shortness of breath and went to see a cardiologist. He got an angioplasty done, which showed severe calcification of the arteries. The doctor advised him to have a quadruple bypass the very next day. I flew in from San Francisco to be with my dad in the hospital. After my dad’s surgery, I decided to get more involved in his health. As someone who’s been following a Paleo lifestyle for over 4 years now, I stayed in NJ for 3 months and nursed my dad back to health. I cooked every one his meals for those 3 months. His fasting blood sugar fell from a borderline diabetic value of 121 to a more normal 92. He lost considerable visceral fat around his waist and was looking better than he has in maybe 20 years. All of his blood markers improved. Good health is both easy and hard. The easy approach is to understand that modern industrialized food is harmful and try to emulate a diet from yesteryear, like Paleo, or your ancestral cultural diet. The flip side of the coin is to dig into science, as you have done, and understand the intriciacies of various blood markers like cholesterol, the difference between small and large particle size, Ha1bc, the various types of short chain fatty acids, figuring out that fat is not a villain, learning the dangerous of low fat foods, etc. I’ve been studying this stuff independently for 4 years, including learning enough biochemistry to get through medical research papers. Everything I have read so far points to a Paleo-type diet being optimal. As an engineer I’m taking the latter approach as I need to prove things to myself before taking it for face value. But for the layman, it’s not really that hard. Something is wrong in this world when Tom Hanks, with access to the best doctors in the world, announces that he has type 2 diabetes, when I was able to reverse it in my dad in 3 months through diet alone. I use DirectLabs for my blood work. Crappy site, but very happy with the turnaround time.

tdfx 13y ago
> Something is wrong in this world when Tom Hanks, with access to the best doctors in the world, announces that he has type 2 diabetes I would imagine that the client relationship in medicine in similar to other industries. Failure is often not a result of the service you provide, but from the fact that the client doesn't listen to the advice they are paying for.

LizVerano 13y ago

This make sense.

dr_ 13y ago

His doctor is correct. Even the lab work obtained - ApoB and CRP - was just a picture in a moment in time. You are not going to be checking these levels on a daily basis, or monthly, at least not until there's an easier way to measure things without having to get stuck with a needle all the time. Stress is considered a risk factor, but how do you plan on measuring stress? And maybe not with respect to heart disease specifically, but today a study was released suggesting loneliness was as much a health risk as drinking and smoking 15 cigs a day - but how does one measure the extent of loneliness? A good diet is important, and there's enough information out there to determine what a good diet is. I believe weighing yourself daily is real helpful. And regular exercise - a combination or aerobic and anaerobic. There's enough data to indicate that these interventions, combined, are effective in reducing risk. And, on a less preventive note, truth be told, if someone in their mid 50's is complaining of SOB and has a family history heart disease, most doctors, in the US at least, are going to do more extensive testing.

warmfuzzykitten 13y ago

And now he's a hypochondriac. Fact is, eat well and exercise is better advice than checking a bunch of numbers of unproven value for preventing heart disease. Doctor's don't know how to prevent heart disease, but at least one knows how to reverse heart disease. His advice is a little more extensive: eat well (mostly vegetarian), exercise, meditate, have social support and don't smoke. But it does not involve, in any way, tracking your blood test results. http://en.wikipedia.org/wiki/Dean_Ornish http://en.wikipedia.org/wiki/Dean_Ornish

seancoleman 13y ago

I can really empathize with Harj. I have a paternal history of high cholesterol, my grandfather recently having bypass surgery. Using WellnessFX I discovered that I have an extremely high Apo B level, nearly twice the upper limit of the low-risk range. Thinking my first test was an anomaly, I was retested over the course of several months with consistent results of less than 3% variation. Using this data, I've modified my diet and am seeking medical advice to reduce to a normal range. My cholesterol levels are all normal. I eat healthy (a seemingly subjective measure) and exercise regularly. My doctor said I am in perfect health at my recent annual physical. I'm privileged to be able to afford private blood testing. Apo B data is within everyone's grasp, yet it seems so under-utilized.

carbocation 13y ago

How to avoid heart disease: (0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.) (1) Don't use tobacco or cocaine, and don't drink too much alcohol. (2) Don't get exposed to radiation or chemotherapy. (3) Don't have diabetes. (4) Don't have high blood pressure. (5) Have low levels of LDL and triglycerides. (6) Don't eat too much. This is tightly related to #3 and #4, and reasonably related to #5. (7) Have extremely low levels of LDL and triglycerides throughout your entire life. Having low LDL throughout your entire life reduces your risk of heart disease, even moreso than you would expect based on the LDL value alone. It seems that lifelong exposure to low LDL is more valuable than just late-life exposure to low LDL. [a] Most of the genetic variants that we can currently interpret when accounting for risk (as opposed to the innumerable ones which we cannot yet interpret) fall into lipoprotein-related pathways. It will be interesting to learn about ones that do not, yet still confer meaningful cardiovascular risk. I don't think that we have a mechanistic explanation yet for the risk conferred by variants in the 9p21 locus, for example. [b] I'm reasonably certain that your HDL is not particularly important (except as a poor proxy for your socioeconomic status, perhaps).[c] And omega-3 fatty acids have no visible effect when examined in the rigorous way in which we examine any other new drug. [d] a = http://www.ncbi.nlm.nih.gov/pubmed/20579540 http://www.ncbi.nlm.nih.gov/pubmed/20579540 b = http://circgenetics.ahajournals.org/content/6/2/224.long http://circgenetics.ahajournals.org/content/6/2/224.long c = http://www.ncbi.nlm.nih.gov/pubmed/22607825 http://www.ncbi.nlm.nih.gov/pubmed/22607825 d = http://www.nejm.org/doi/full/10.1056/NEJMoa1205409 http://www.nejm.org/doi/full/10.1056/NEJMoa1205409

pcrh 13y ago
Most of those amount to "be lucky", which isn't very helpful advice.
- carbocation 13y ago
  1, 3, 4, 5, 6, and 7 are all modifiable.
  - 13y ago

mmuelly 13y ago

Avoid heart disease - die of cancer! Honestly, I would take the massive coronary event any day over the slow, miserable death that cancer involves.

voltagex_ 13y ago
Why does it have to be one or the other?

oceanic 13y ago

Catalyst, an excellent science program on the ABC [1], Australia's national broadcaster, has just had a two-part episode called "The Heart of the Matter", about the science (or lack of it) behind the cholesterol theory. The researcher Dr Maryanne Demasi[2], herself a research pathologist, has spent three years gathering data, interviewing researchers, scientists and doctors on both sides of the argument, and the show has caused major ripples throughout the medical profession in Australia [3]. The two episodes are on YouTube in full [4] [5] and the transcripts are on the ABC website [6] [7]. For anyone interested in this topic, these shows are HIGHLY recommended. [1] http://www.abc.net.au http://www.abc.net.au [2] http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=catalyst http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=... [3] http://www.6minutes.com.au/news/latest-news/expert-takes-aim-at-saturated-fat-myth http://www.6minutes.com.au/news/latest-news/expert-takes-aim... [4] http://www.youtube.com/watch?v=rDVf-00w5gk http://www.youtube.com/watch?v=rDVf-00w5gk [5] http://www.youtube.com/watch?v=wAKaM330xzg http://www.youtube.com/watch?v=wAKaM330xzg [6] http://www.abc.net.au/catalyst/stories/3876219.htm http://www.abc.net.au/catalyst/stories/3876219.htm [7] http://www.abc.net.au/catalyst/stories/3881441.htm http://www.abc.net.au/catalyst/stories/3881441.htm

simplexion 13y ago
Don't bother with the first episode. It is full of nonsense, including a naturopath as an "expert". The second episode regarding statins is far more evidence-based.
- oceanic 13y ago
  I think the stuff about the effects of high sugar and high carbohydrate diets in the first episode is pretty solid. Which one is the naturopath?
  - simplexion 13y ago
    The "Nutritionist"
voltagex_ 13y ago

tessierashpool 13y ago

I have heart disease. if I hadn't followed the advice of Dr. Joel Fuhrman (drfuhrman.com) I'd already be dead. I don't have time to get into it here, but conventional cardiology is essentially malpractice in my opinion. if you have heart disease, or you know someone who does, please check out Dr. Fuhrman's work.

simplexion 13y ago

"Eat food. Not too much. Mostly plants." ~Michael Pollan

smewpy 13y ago

When I was 28 years old, found I had high blood pressure. Over next 7 years I took BP meds but also lost weight and worked out. Doctors ran tests but never found a root cause - it was just high for no assignable reason and I was told to take meds. At 34 years old, was in best shape of my life, except still taking BP meds. That year, I stopped taking the meds, but monitored BP every few months. It was borderline high but not crazy. So this year, I turned 38, off the BP meds more than 3 years now. Then, last month while in China with my family, I had a full blown stroke. Result was lost 2cm of my left brain directly in the region that controls speech and right arm & hand motor skills. Spent 8 days in a Chinese hospital. For about one week, I talked like a stone cold drunk and my right arm was useless. I thought I might be that way forever. Luckily, after two months, I'm basically fully functionally recovered. Bottom line is the path from a risk indicator like high blood pressure to a stroke or heart attack can be fairly short. Now, at 38 I know I must make some radical change if I'm going to live to 70, no less not be a paralyzed half brain dead invalid. I'm certainly interested in quantified self tech now. The problem is everyone that needs a doctor to take an intense personal interest in their long term health cannot possibly find a doctor to do so, for any number of reasons. Opportunity is to empower the individual non-medial experts to easily monitor their own health and risk factors over time. Will likely be moving into product development in this space myself.

avifreedman 13y ago

Planning to manage one's own health is probably best. I would love to be a customer of a competent company that managed body scans and the process of looking for deltas using humans assisted by software every N years. Why? Common medical wisdom now is that doing proactive body scans (usually just the trunk), even just MRI (so no radiation) is bad because it drives the expense and uncertainty of investigating every bump and shadow. And many of the tests will come back inconclusive. I understand that argument but it seems the way to deal with that is to focus not as much on scan #1 but scan deltas. My anecodtal (IANAD) evidence is that in more than 5 cases of cancer in friends and families, a cancer diagnosis was delayed for many months from onset of symptoms and a few Oncologists have told me that they agree that for most of those cancers, that latency could have been improved if a baseline scan had been available of the organs/bones/nodes in question. Not every patient would be a good candidate for such a service but the same is true for 23andme.

mtdewcmu 13y ago

My feeling is that the state of scientific knowledge is pretty weak on how to prevent a heart attack that's still 20 years away. Doctors should not overstate what is known scientifically, otherwise they are probably telling you things that are not true.

aantix 13y ago

I read this treat protocol from a dr. on a heart forum : "I use EBT calcium imaging to identify who needs treatment and serial EBT calcium measurements to document adequacy of treatment. I use low dose statin or bile salt sequestrate plus ASA, high dose fish oil derived omega-3 plus frequently add nicotinic acid. In addition I screen for sub clinical insulin resistance, sleep apnea and encourage daily flossing and dental hygiene, regular mild exercise, and lots of fruit and veggies. The calcium score helps motivate compliance and the result is the near elimination of heart attacks and ischemic strokes." http://www.theheart.org/article/1269619.do http://www.theheart.org/article/1269619.do

wonnage 13y ago

I worked for WellnessFX (mentioned in the article) in the past and definitely recommend their service. The stuff they test for is not a part of standard (e.g yearly physical) blood work and you'd have to convince your doctor to give you the tests (intimidating, expensive). Granted, this is because the larger medical establishment either doesn't think they're necessary, or has yet to come to a consensus on their interpretation. Personally, given the recent wave of news debunking low-fat/high-carb diets, I'm inclined to take the health research from the past couple of decades with a grain of salt.

nanodeath 13y ago
WellnessFX looks interesting. What are some of the other competitors in this space; do you know offhand?

memracom 13y ago

Joel Fuhrman http://www.drfuhrman.com/ http://www.drfuhrman.com/ is one of a number of medical doctors who promote a coordinated attack on the causes of bad health like heart disease, rather than relying on reducing one or two indicators. Neal Barnard is another such doctor http://www.nealbarnard.org/ http://www.nealbarnard.org/ In North America, both of these doctors have shows on PBS a couple of times a year, in the weekday evenings and they generally run as part of a series of similar shows by other medical doctors. The two named above have done a significant amount of research into the programs that they suggest, and they publish widely and openly and tell you what research they are looking at and why they recommend certain actions.

kayoone 13y ago

I am pretty late to this but i wanted to raise an important point. Dont overanalyze yourself. Since passing out about a year ago because of an infection and not drinking/eating anything that morning i have some serious anxiety issues that affect my life in a bad way. I started to monitor my heart, my blood pressure, my pulse and freaked out whenever something was slightly off. I went to numerous doctors and cardiologists, nobody could find anything of relevance, no risk factors at all. I still worry. With time it got better but there is a reason we dont usually think about bad things to happen or us or even death, because it affects our psychology in a bad way. I am not saying do not care for this, but also trust the doctors. The advice of eating healthy, exercising regularly and stop overanalyzing yourself is the right approach and will lower your general risk considerably. Of course go and check your blood once a year but overall there is only so much you can do. In the end theres many,many risks in life that you cant really pre proactive about because we also dont really know the human body yet. If you get into this you will find hundreds of people suggesting different things, you will learn about all kinds of diseases you shouldnt really worry about in the back of your head because it will bring your quality of life down in the end. I myself am not very good at what i suggest here, but i wish i was.

rdl 13y ago

Why not come to Thailand and drop a few hundred dollars on comprehensive imaging studies, like I'm doing this week?

computer 13y ago
Do you have a link with more information on how to go about getting this done?
- rdl 13y ago
  http://www.bumrungrad.com/ http://www.bumrungrad.com/ is the place I use. It's a bit more than $200 for MR, etc., but I'm doing the exec screening w/ stress test and ultrasound (http://www.bumrungrad.com/en/health-check-up-bangkok-thailand http://www.bumrungrad.com/en/health-check-up-bangkok-thailan...) and x-ray, and may do MR and would potentially get a CT (obviously avoid CT if you don't need it due to the radiation dose, but with modern equipment I'm personally not super worried). I got my LASIK done about 8y ago at TRSC (www.lasikthai.com) which means free checkups and touchups for life, too, also down the street. Eye exams are one case where I usually use a hotel car vs. a taxi to get around, as dealing with obnoxious taxi drivers while sort of blind sucks.

pitchups 13y ago

Surprised that there is just one mention in this entire thread of Dr. Esselstyn[1] and Dr. Dean Ornish[2] - two doctors who deserve more attention in any discussion on the topic of preventing heart disease. They have published research and studies showing that it is possible to prevent and actually reverse heart disease - even in advanced cases of artery blockage - by strict diet and lifestyle changes. President Clinton has adopted their recommended diet after his coronary bypass surgery. Highly recommend reading their research studies and books on the subject. [1] http://en.wikipedia.org/wiki/Caldwell_Esselstyn http://en.wikipedia.org/wiki/Caldwell_Esselstyn [2] http://en.wikipedia.org/wiki/Dean_Ornish http://en.wikipedia.org/wiki/Dean_Ornish

yurhirt 13y ago

It seems to me, as a curious non-medic, that at the root of heart disease is a state of persistent arousal, which is similar to stress -- high blood pressure, high blood sugars and fats, tachycardia, low immune, high inflammation, poor digestion, etc. All arguably useful if you are hunting prey or raiding the next village. But bad for the body in the long run. So I think we ought to ask why in this day and age do we seem to find this biological state desirable -- for example, does it paradoxically enable us, while still alive, to be more productive?

jdnier 13y ago

The simplicity of "switch to a whole foods, plant-based diet and you simply won't die from heart disease" has eased my similar anxieties. http://www.heartattackproof.com/ http://www.heartattackproof.com/ See also the related documentary, http://www.forksoverknives.com/ http://www.forksoverknives.com/.

skittles 13y ago
Then watch the Fat Head documentary and be confused once again.