
Avoiding Heart Disease - kul
http://blog.harjtaggar.com/my-heart
======
tansey
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. :)

~~~
claudiusd
I love your analogy, but I think you drew the wrong conclusion. Doctors don't
have an incentive to prevent you from getting sicker any more than your
mechanic has an incentive for keeping your car out of the shop. Why would your
doctor read the latest research on preventing disease when he can make a tidy
profit from treating your disease?

Now this isn't to say that doctors are bad people who want to make you sick...
on the contrary, most of the doctors I know are more passionate about helping
people than making money. They are, however, subject to whims of the hospital
they work for, which I can almost guarantee is more interested in making a
buck than keeping you healthy. This is true of all large companies though, and
as Clayton Christensen has taught us, this sort of marginal thinking usually
leads to disruptive innovation by a start-up.

<shameless_plug> Want to disrupt health care? Omada Health is hiring!
[http://omadahealth.com/jobs](http://omadahealth.com/jobs) </shameless_plug>

~~~
bdesimone
> Why would your doctor read the latest research on preventing disease when he
> can make a tidy profit from treating your disease?

Woah woah woah there. Are you really saying doctors don't read the latest
research so that they can make a greater profit? Really?

You could have at least picked a more realistic example of misaligned
incentives in medicine... e.g. using a more expensive drill bit during a
surgery because you know that the surgical rep will take you out to a nice
dinner every time he's in town.

There's a huge population of doctors. Some ethical. Some unethical. But I
believe the profession does a pretty admirable job of stamping out immoral
behavior when it finds it.

~~~
graeme
The OP phrased it badly, but the point is sound. Suppose a doctor has a choice
of two activities:

1\. Read research, unpaid 2\. Treat patient, paid

The doctor clearly has an incentive to focus on treating disease. They do read
research, but they would surely read even more if they were paid directly to
do so.

There's nothing nefarious in this, it happens in any industry. We do more of
the things we're paid to do, and less of the things we're not.

~~~
bdesimone
It's sound if you assume both aren't part of the job description. Change the
occupation in the poorly constructed analogy and we have...

Suppose a pilot has a choice of two activities:

1\. Read FAA safety report, unpaid 2\. Fly plane, paid

Doctors, especially at academic institutions, are required not only to be up
to date in the latest research, but contribute to it. If a doctor treats a
patient in a way not up to par with current practices in research, he will be
sued and lose his licensure.

------
carbocation
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)

~~~
Justsignedup
Well, I'm fucked.

Grandfather was in decent shape at 40 when pretty much all his arteries
clogged. He is now 87 with half a single artery left in his heart. He is not
what I would call "living" as much as existing.

On the other side, my mother, grandmother, and great grandmother have intense
high blood pressure with no understandable reason.

Well, I figure I may have till I'm 50. Though I hope doing biking marathons
would train my heart even a bit to help.

~~~
pw
Get on a statin even if your LDL levels are within the normal range. They're
very safe (safer than aspirin, arguably) and effective.

~~~
memracom
Do not follow quack recommendations like this. pw is not a medical doctor and
is not licenced to practice medecine. That makes pw a quack.

Instead, seek out professionals who don't just say everything is OK, but who
tell you what specific things to do and tell you why you should do those
things backed up by research. A competent MD will not be afraid to refer you
to the research that they are using to make their recommendations. A real MD
does not say (I'm and expert, trust me) but they are willing to point to the
studies and the opinions of other experts. Experts will not all agree but
usually, when something really works, there will be a majority who do
prescribe that course of action.

~~~
monstar
Do not follow quack recommendations like this. memracon is not a medical
doctor and is not licenced to practice medecine. That makes memracom a quack.

~~~
jerf
Sorry, no, that does not logically follow. You do not need to be a
professional to recommend that you use professional advice. It would only be
hypocritical if memracon had subsequently made specific recommendations.

------
7Figures2Commas
> 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/2013/03/0...](http://health.usnews.com/health-
news/news/articles/2013/03/09/niacin-wont-help-may-harm-heart-patients-study)

~~~
scotch_drinker
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.

~~~
alphaoverlord
I think the parent comment's argument is that improvement on specific items
isn't well correlated with "better health". Even interventions aimed at
specific metrics have shown to have no or negative consequences. For example,
niacin in the AIM-HIGH trial.

------
JPKab
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.

------
bdesimone
> 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
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
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.

~~~
gabemart
> 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)

~~~
mhurron
[http://breakingmuscle.com/nutrition/how-to-build-muscle-
mass...](http://breakingmuscle.com/nutrition/how-to-build-muscle-mass-on-a-
plant-based-diet)

Just as a quick look to see details as to what would be required. Quinoa is
hardly the only source of non-meat protein.

Now, yes that does include a lot of protein shake stuff, that's not that
unusual for most weightlifting diets. That's also a vegan diet, so you might
be able to add eggs, cheese and milk to that diet and cut back on the powder
in the meals if you just wanted to be vegetarian.

The powder is of course to solve the issue you pointed out already.

~~~
eshvk
Most of the protein shake stuff would not solve the issue for a vegan diet.
Most of the protein shake stuff is made from Whey or Casein or egg whites
which IIRC are not vegan. There is pea protein or hemp protein but my quick
googling tells me is high carb and low protein and can easily throw you off
your calorie limits.

~~~
vidarh
Both pea protein and soy protein products with comparable protein to kcal
ratios are available from the company I buy my protein from.

I'm not vegan, so I've never bothered trying them, but it doesn't seem like
it'd be a big problem.

My concern (see my other comment) would be that the diet shown certainly is
extremely high calorie, and it looks like it'd be pretty much all nasty shakes
to get it down to a more normal level with the same amount of protein.

(EDIT: Note, this would only really be an issue if you do heavy resistance
training, as the protein level in that diet is very high for someone who isn't
doing weight lifting)

------
7402
This New Yorker cartoon shows in humor the limits of attempting to optimize
your health.

[http://www.condenaststore.com/-sp/Thought-balloon-above-
man-...](http://www.condenaststore.com/-sp/Thought-balloon-above-man-reads-
Less-Cholesterol-Regular-Checkups-No-Nic-New-Yorker-Cartoon-
Prints_i8575250_.htm)

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.

------
melling
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)

~~~
Amadou
_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/)

~~~
bollockitis
Anyone can lose weight simply reducing calories, but that weight loss isn't
permanent or sustainable, and it may not be healthy. If you run the numbers,
the Twinkie Diet guy was actually eating fewer carbs than the average American
simply because of calorie restriction, and his low protein intake would almost
certainly result in the loss of muscle mass.

The age old advice of "eat less, move more" ignores the body's natural
mechanism for fat regulation, which is primarily the hormone insulin. The
higher your blood glucose, the more insulin your body produces, the more fat
your body will store, and the less reluctant it will be to release its stored
energy.

It's obvious that if you're eating fewer calories, then less energy is
available for fat storage -- it's simple thermodynamics -- but basic
endocrinology tells us that to lose weight all we need is the negative
stimulus of insulin, which is primarily achieved through reducing carbohydrate
intake.

------
oceanic
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=...](http://www.abc.net.au/catalyst/team/maryannedemasi.htm?site=catalyst)

[3] [http://www.6minutes.com.au/news/latest-news/expert-takes-
aim...](http://www.6minutes.com.au/news/latest-news/expert-takes-aim-at-
saturated-fat-myth)

[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
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
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
The "Nutritionist"

------
warmfuzzykitten
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)

------
shanev
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
> 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.

~~~
shanev
Most doctors don't have a clue about proper nutrition and promote the Standard
American Diet, which is a recipe for diabetes and heart disease.

------
smewpy
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.

------
dr_
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.

------
dirtyaura
"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.

------
kayoone
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.

------
albertsun
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-...](http://www.nytimes.com/2013/05/13/health/seeking-clues-to-a-heart-
killer-in-the-dna-binding-a-family.html) sounds extremely similar.

~~~
Noxchi
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.

------
tessierashpool
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.

------
memracom
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.

------
seancoleman
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.

------
replicatorblog
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.

------
avifreedman
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.

------
pitchups
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)

------
WizzleKake
> _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
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
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.

~~~
euphemize
yep. there are tons of factors to take into account (genetic, economical,
etc.), but doing this right often means changing lifestyle altogether.

congrats on the change :)

~~~
eshvk
> (genetic, Oh sure. I can't control genetics but I can definitely try to work
> hard to control what is within my hands. E.g. I am of Indian cultural
> heritage. Both my parents are first generation and the cuisine is incredibly
> high fat, high carb and low protein. This simply sets the stage for obesity
> very easily (yes, ironical in a country of crippling poverty and
> starvation). That coupled with sedentary lifestyles has shown (at least in
> studies) that Indian Americans are [1] more prone to heart diseases than
> other sectors. This means unlearning the habits of an entire childhood and
> learning how to eat more carefully. It is not easy and it is definitely not
> simply a matter of "eating more healthy" and "exercising more".

Also, thanks!

[1]
[http://online.wsj.com/news/articles/SB1000142405274870340930...](http://online.wsj.com/news/articles/SB10001424052748703409304576167003904805530)

(I have read the base scientific article but can't find the link right now.)

------
aantix
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)

------
aaron695
> 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
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.

~~~
Noxchi
#3 is totally wrong.

First of all, if your wife graduated from med school, she should have taken
the Hippocratic oath. An oath written by the guy considered the father of
western medicine.

You know what he had to say about diet?

“Let food be thy medicine and medicine be thy food”

He also said something along the lines of "if you don't know diet you can't
call yourself a doctor" but I can't find the exact quote.

>If you think diet and exercise are the only--or even the most effective--
means of lowering morbidity for chd (which is what OP is worried about) you'd
also be wrong.

Actually, you'd be wrong. Consider a clinical study carried out by the
inventor of bypass surgery and another doctor, in the best heart hospital in
the world considered by US News & World Report.

The study had very sick heart disease patients, who were told they had a year
to live by their cardiologists, change their diet. 23 opted in for the study
but only 18 chose to continue with the diet after a couple months. Those 18
patients are still alive today 20 years later, and several had an angioplasty
done giving photographic proof their plaque buildup had cleared out. The ones
who dropped out died shorty after.

The 18 never had a heart attack after they changed their diets, while before
they did they had a combined 49 coronary events (that's ~3 heart related
emergencies per person average).

~~~
Evgeny
_Actually, you 'd be wrong. Consider a clinical study carried out by the
inventor of bypass surgery and another doctor, in the best heart hospital in
the world considered by US News & World Report._

It would be so much easier if you could provide some names, or better - the
title of the study. I'd like to read it, but can't find it easily. The
inventor of the bypass surgery appears to be Michael E. DeBakey, but which of
his publications should I read? Thank you.

------
gambiting
"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.

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

------
wonnage
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
WellnessFX looks interesting. What are some of the other competitors in this
space; do you know offhand?

------
yurhirt
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?

------
whyleyc
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.

------
aedocw
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)

------
jdnier
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
Then watch the Fat Head documentary and be confused once again.

------
mmuelly
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_
Why does it have to be one or the other?

------
cj
_> [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.

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

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

~~~
computer
Do you have a link with more information on how to go about getting this done?

~~~
rdl
[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-thailan...](http://www.bumrungrad.com/en/health-check-up-bangkok-
thailand)) 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.

------
mtdewcmu
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.

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

------
a8da6b0c91d
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
Is powdered egg yolk a commonly eaten food or a common ingredient in processed
foods?

------
LizVerano
This make sense.

------
perlpimp
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.

