
Inflammation: Medicine's burning question - matco11
http://www.newyorker.com/magazine/2015/11/30/inflamed
======
boothead
It's great to read things like this... I wish my GP would do the same.

I recently had a really high cholesterol reading (both total cholesterol and
LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38,
fit and healthy and nothing that suspect in my family history. I found the
attitude of my doctor in all this quite surprising. It amounted basically to
"You definitely have familial hypercholesterolemia. There is no other possible
option here other than statins". No further questions about what I eat, my
stress levels, lifestyle - nothing.

What disappoints me the most here is now that I feel like it's all on me to
determine what my real risk levels are and what's appropriate to treat this. I
don't subscribe to the mainstream NHS view still heavily pushed that eating
saturated fat -> high cholesterol == unhealthy as I think it's a lot more
complicated (as this article shows). I don't like being is this situation as
I'm as susceptible to human bias as the next person, and I'm not a doctor,
however almost all of the high quality, science based writing I've read
indicates that the mainstream healthcare system's view on cholesterol is
wrong.

~~~
coldtea
On the other hand your GP examined you and has an actual medical degree while
you just read some articles on the internet...

~~~
calebm
I've got some friends who do medical research, and from what they say,
"translational research" (getting the latest research into the hands of the
doctors actually practicing medicine) is a HUGE problem.

I have been advised that if I (or a family member) ever gets some medical
condition, that if I do a few hours of reading up on the latest research on
that condition, chances are that I will be better informed on that condition
than my GP.

~~~
tertius
Probably, but your ability to process the information is severely limited to
someone who has be trained on how to do so. And I'm not saying that your
doctor has been trained to do so.

~~~
noir_lord
My faith in Doctors is pretty much at an all time low.

I kept having bouts of extreme pain with really strange symptoms, Doc's said
Reflux but I kept saying it didn't fit the pattern, a dozen AE (ER) visits
later and I got a Doc who told me to _insist_ on an MRI.

Turns out I have Syringomyelia, a serious and rare spinal condition which the
radiologist spotted by accident as it was on the edge of the scan, he then did
a bunch more images and they saw the syrinx.

The next doc I saw I needed an endoscopy and they said the results where
abnormal, so I looked into the condition, when I went to see the gastro doc I
asked him if the cells where "high" or "low" grade dysplasia and his snarled
response "Oh, trying to be a doctor eh", "no, just trying to be an informed
patient".

I requested a different gastro doc after that, I read everything I could get
my hands on and I'm not stupid, I understand my condition well enough to ask
good questions at least.

So yeah, not a massive fan of Docs at the moment.

~~~
tertius
I can relate to this.

I feel that the chasm between the lay person and the MD has widened
tremendously in our lifetimes (I'm in my 30s).

This also, unfortunately has made the average patient be almost completely
uninformed. They demand medication to cure their, self-inflicted, ills, or try
to diagnose through Web MD.

I for one will educate my children and will continue to educate myself to not
require an MD on every occasion.

But I know that I'm not an MD and I was not trained to diagnose. I'm glad you
found doctors who could give you a correct diagnosis that you can lean on to
help you through your own search for the truth. I feel this is the best
solution at the end of the day, for patients and doctors to be partners.

* My dad is an MD and my wife is a biological scientist which really puts me at an advantage.

------
carbocation
Somehow LDL-cholesterol has come up in this thread about inflammation.

The article here offers a highly speculative opinion regarding the role of
inflammation across many diseases. The luminaries in cardiology cited in this
article ran trials which many of us consider to show that, rather than
inflammation being important, any reason to start statins is a good reason.

The genetic data currently supports very little role for inflammation in
important diseases like coronary artery disease, whereas there is crystalline
evidence supporting the connection between LDL-cholesterol levels and
mortality. Interestingly, when genetics are invoked and mere epidemiology is
reassessed, there is no clear atheroprotective role of HDL cholesterol.

The treatment of statins is very much like the treatment of vaccines:
dismissed in a pseudo-intellectual manner by people who know a lot (just not
about the subject at hand).

~~~
boothead
I think this is a bit unkind:

> dismissed in a pseudo-intellectual manner by people who know a lot (just not
> about the subject at hand).

I'm the one who's potentially sick here, and this (perhaps wrongly) smacks of
appeal to authority. What I absolutely don't want to do is disregard medical
opinion, but neither am I inclined to abdicate all responsibility for my own
health and well being.

> The genetic data currently supports very little role for inflammation in
> important diseases like coronary artery disease, whereas there is
> crystalline evidence supporting the connection between LDL-cholesterol
> levels and mortality

I'd be very interested in learning more about this, do you have anything you
could recommend? I'm fully aware that the majority of what I read on the
internet is likely to be along the lines of "don't sweat it, eat natural and
you'll be fine" and I'd very much appreciate some exposure to the opposite
point of view too.

~~~
gone35
_[T]his (perhaps wrongly) smacks of appeal to authority._

Don't dismiss appeals to authority so easily. As it happens, _not_ giving
extra weight to experts in proportion to their track record is a provably
suboptimal strategy in an adversarial setting (see _e.g._ [1]). So, in this
sense, deferring to trained medical opinion might in fact be the most
responsible thing to do.

Note however the bounds in [1] also (indirectly) imply you are better off with
a diverse _ensemble_ of expert advice. So if you can afford it, always get a
second (or third) reputable medical opinion. And weigh their advice
accordingly.

[1]
[http://www.mit.edu/~9.520/spring08/Classes/online_learning_2...](http://www.mit.edu/~9.520/spring08/Classes/online_learning_2008.pdf)

~~~
carbocation
This is correct. I reference one of the Mendelian randomization studies in my
comment [1].

1 =
[https://news.ycombinator.com/item?id=10739687](https://news.ycombinator.com/item?id=10739687)

------
snowwrestler
Inflammation will probably turn out to be some combination of a fad and a real
phenomenon that is simply a symptomatic mask for a host of different
underlying issues. For example an allergy to dairy and a GI infection are
different conditions but both present with inflammation.

And by the way, we don't really know why allergies develop at all. The best
treatments simply tire them out, or suppress the symptoms. The immune system
in general is poorly understood, so perhaps it's not surprising that people
have trouble thinking past "inflammation" in general.

The idea that the human body has some pervasive fault or malfunction that can
be addressed by adherence to an ascetic diet is not really new. One can find
similar accounts going back hundreds of years in Western medicine, and even
farther back in religions. For some reason, our minds seem to incline that
way.

And it's true to some extent: obesity makes almost any disease worse, and
obesity can be avoided or reduced by an ascetic diet. That is true for almost
every human being, which is the highest standard that medical advice can meet.

Unfortunately, most diet advice does not meet that standard. By which I mean,
it's easy to find counterexamples to most diet advice. A diet might tell you
to avoid dairy, but there are millions of people who consume dairy and yet are
perfectly healthy. A diet might tell you to take fish oil, but there are
millions of people who never do, yet are perfectly healthy. A diet might tell
you to avoid gluten, yet there are millions of perfectly healthy people who
eat gluten every day. And again--I'm not talking about real allergies here,
I'm talking about general diet advice.

The future seems pretty clear to me. We know that each person's genetic code
is unique. We know that each person's genetic code is expressed in unique ways
due to epigenetics and other factors. We know that each person has a unique
collection of gut bacteria, skin bacteria, and other hangers-on.

Ultimately, if we want to create more perfect health, we will need to learn
how to collect each person's unique information, tie it reliably to health
outcomes, and then introduce highly personalized therapies based on that
information.

The demand on information technology will be _enormous_. This will be a growth
industry for humanity for at least the next century, I bet.

------
satx
Inflammation can fan the flames of depression

"In the health area of psychology at Rice, we're very focused on the
intersection of health behavior, psychology and medicine," said Christopher
Fagundes, an assistant professor of psychology and co-author of the paper.
"One thing that we're particularly interested in is how stress affects the
immune system, which in turn affects diseases and mental health outcomes, the
focus of this paper."

The authors found that in addition to being linked to numerous physical health
issues, including cancer and diabetes, systemic inflammation is linked to
mental health issues such as depression.

Among patients suffering from clinical depression, concentrations of two
inflammatory markers, CRP and IL-6, were elevated by up to 50 percent.

Fagundes said chronic inflammation is most common in individuals who have
experienced stress in their lives, including lower socio-economic status or
those who experienced abuse or neglect as children.

Other contributing factors are a high-fat diet and high body mass index.

[http://www.sciencedaily.com/releases/2015/12/151218110253.ht...](http://www.sciencedaily.com/releases/2015/12/151218110253.htm)

------
satx
statins-for-cholesterol is a hugely profitable business pushed hard for
decades by BigPharma, going back to a single faulty "study" in the 1950s,
after Eisenhower's heart attack.

My opinion is that statins-for-cholesterol, obsession with cholesterol is as
big of a medical scam, a BigPharma misdirection-for-profit, as BigFood's "low-
fat" and "whole grain", and gluten scams.

Cholesterol is essential, so much so 90% is produced by the liver without any
dietary consumption.

Cholesterol + lipids + calcium sticking to arteries is a reaction to an
injury, mostly from systemic, low-grade inflammation. High blood pressure also
injures arteries, also causing cholesterol plaque.

Some people with high cholesterol have no CVD, while some people with low
cholesterol die from CVD. Maybe cholesterol isn't the problem?

Aspirin's help with CVD was initially thought to be due it blood-thinning
effect, getting blood through narrowed arteries, but then its anti-
inflammatory effect was more reasonable. btw, statins are also anti-
inflammatory (aspirin and similar are cheaper).

Systemic inflammation reduced by aspirin (or statins), less injury to
arteries, less plaque.

Systemic, low-grade inflammation also reduces insulin sensitivity, so the body
produces more insulin, which is a really nasty hormone. result? adult-onset
Type II diabetes.

So "I think" watching inflammatory bio-markers is more important than watching
cholesterol, as one could take away from the New Yorker article.

An alkalizing, anti-inflammatory diet is key, complemented by both moderate
resistance work and moderate cardio exercise, which also reduce inflammation.

"life-style" of diet and exercise is your best "Heal Thyself" strategy, not
BigPharma.

btw, chronic, systemic, low-grade inflammation causes chronic high-levels of
cortisone (derived from cholesterol) to reduce the inflammation, and wreaks
havoc on the immune system, which of course causes inflammation as a response
to injury or foreign matter.

~~~
beagle3
> An alkalizing, anti-inflammatory diet is key

Can anyone cite a peer reviewed study / documentation of "alkalizing" diets?
I've attempted to trace this idea back to anything scientific, and always
eventually came up with "well, someone I trust once told me ...".

~~~
satx
[https://en.wikipedia.org/wiki/Acid%E2%80%93base_homeostasis](https://en.wikipedia.org/wiki/Acid%E2%80%93base_homeostasis)

one of the nasty results of a acid diet (sugar, mammal/fowl products, etc) is
that the body will buffer the serum pH on the low side to stay within the
body's healthy pH range by robbing calcium from bones and teeth.

~~~
beagle3
Thanks, but that's not what I'm after - let me rephrase my question.

Acid/Base homeostasis is obviously important, and the body works hard to
maintain it, no question about it. However, there is a claim (e.g. the one you
made) that an "alkalizing diet" is healthier in some way than a "common" diet
-- and I'm looking for a reference for that.

I have found references saying that ingesting sodium bicarb (the ultimate
alkalizing agent) was shown to help with very controlled amounts and strenuous
exercise, and was otherwise either useless or harmful. I have found many
claims, but not one properly supported by an experiment, that an "alkalizing
diet" (which often includes acids like lemon juice or apple cider vinegar in
those descriptions with some hand waving) is good for you.

So, my question is: I am trying to understand the origin of the "alkalizing
diet" argument, and see whether it is science, pseudo-science or myth; can you
help me with that?

------
PaulHoule
I am not really sure that inflammation is a single entity. Today is is
fashionable to claim everything has something to do with inflammation, but I
remember the time a medical mixup caused me to get a high-sensitivity CRP test
after I had just smacked a quadricep muscle enough that I was off my feet and
on painkillers for a week and my CRP reading was as low as it can be.

------
hackercomplex
I think there's something to the acid/base thing and I think it's connected to
inflammation.

I recommend a vegan diet. Juice celery, and everything else.. drink it soon
after juicing don't put in tha fridge. Juice about a half pound of raw
cannabis per week if you can (it's not cured so it won't get you high)

and uh.. drink lots of h2o.

