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More Millennials Are Having Strokes (scientificamerican.com)
200 points by indogooner on July 2, 2017 | hide | past | web | favorite | 183 comments

Iron deficiency anemia (IDA) has been associated with strokes in young people. IDA doesn't necessarily have pronounced symptoms and a diagnosis with a blood sample is simple and cheap. It is often considered a "female disorder" but it's only slightly more common in females than males.

tldr: Have your blood checked.

[1] https://www.hindawi.com/journals/crinm/2012/487080/

EDIT: As most follow up comments seem to center around diet as a cause, I wanted to point out that there are several other causes.

Various deficiencies are definitely a problem in my friend population, where many of them are vegans.

The vegan diet is a diet of deficiencies, and since none of them are particularly careful about what they eat, I worry that it is making them all worse off. Iron and B12 may be the most obvious, but also D3, calcium, zing, animal based nutrients like creatine, and I'm sure others.

Unfortunately, this becomes a touchy subject with them very quickly, and most of them believe "being vegan is healthier," but are uninterested in engaging with or supporting this claim.

> The vegan diet is a diet of deficiencies, and since none of them are particularly careful about what they eat

First off, B12 is important, but most vegan milk-substitute things have 25% or 50% of the US RDA of B12 per serving. Not all - a lot of almond milk isn't supplemented with B12 (to which i grumble). They're often also iron-supplemented. Here, for example, is the nutrition label for Silk Organic Unsweetened Soy Milk:


Note the vitamin D and calcium in there as well. The FDA is generally clever about the requirements they put on things -- the potential for such deficiencies is well-known, and so is addressed at a few places.

Creatine isn't a necessary nutrient - our kidneys and livers synthesize it.

Finally, I, at least get a lot of "zing" in my diet by being creative about what we cook. (Sorry, couldn't resist) Zinc, however, you should pay attention to, but eating a diversity of beans and nuts (and tofu) covers it quite well.

Seriously, though: It's not hard to have the bases covered. If you're really concerned and not just concern-trolling, sit down with your friends and a copy of Cron-o-Meter, which is one of the most comprehensive meal nutrition profilers around. It's what I used when figuring out the overall layout for our family's meals, and it did lead me to a few cheats -- like favoring molasses as a sweetener, throwing flaxseed in place of part of the flour in a bunch of recipes, etc., to make sure we were hitting all the targets. Useful software.

Beans, nuts and tofu may be 'good' vegetable sources of zinc but they're still awful compared with meat. You'd have to eat 2.5 cups of baked beans every single day to maintain recommended daily intake.

(Not concern-trolling, just a vegetarian who was disgruntled to discover how easy it is to become zinc deficient, after specifically asking a GP if I needed to take any supplements, and was told no. I take a 25mg daily supplement now.)

Source: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

I'm not vegan, but the counterargument I've heard is that an unbalanced omnivore diet can also lead to deficiencies/nutrition problems, and that actually the average vegan diet is more balanced overall than the average omnivore diet, so it's unfair to single out vegans when eating a healthy and varied diet is a challenge for everyone.

In other words, you should probably be just as worried about your non-vegan friends who eat too much meat, not enough leafy greens, not enough vitamins, etc.

How can a vegan diet be more balanced? It lacks diversity which as far as I understand is the primary foundation for good healthy diet. Many different things in not too much quantity.

Strictly speaking vegan is obviously a more limited subset of omnivore. But in a practical sense, it would surprise me if vegans didn't have more variety in their diet.

I was vegetarian for almost a decade, basically my 20s, and what became clear immediately was that I had to figure out different stuff to eat. Default food wouldn't work anymore, so I have to branch out a lot and find foods that I would've never thought about before. I think my experience is relatively common.

That having been said, it IS easier to have a deficient diet, if you're not paying attention. "Carbitarian" is what some people call veg-ns who just hork down pasta, bread, and whatever other unhealthy nonfood is technically animal-free.

So I think it's possible that veg-ns have a more diverse diet on average, and that they also are statistically more likely to have deficiencies (something like a bimodal distribution).

Obviously, these are empirical questions.

I think you mean to say that veganism is a subset of vegetarianism? Omnivores by definition eat animal products.

I'm typically vegetarian to suit my own wacky body chemistry and slow metabolism (tldr; lowered/normalized my blood pressure, cholesterol, lost weight etc by diet changes and exercise) and would like to underline the point you're making about finding dietary substitutes. Protein consumption was the hardest thing for me to adjust back into nominal ranges. It's pretty easy to overconsume carbs (carbitarianism) on the way to getting the 50-100g of protein needed for a typical semi-active to active day.

Has your slow metabolism been confirmed by lab tests? Many people seem to think they have a slow metabolism but very few actually do.

I suppose I don't fit the scientific definition of a slow metabolism. I clock in at around 1800 calories per day, which is within a nominal range. That said, I cannot eat the way the rest of those around me can without gaining huge amounts of weight. I've lost 100lbs and it took a lot of time to figure out that I just can't eat the same as my friends do and maintain a healthy weight.

Most likely you're overestimating how much your friends actually eat. Unless you're monitoring them 24/7 then you don't really know for sure.

I suppose it's possible for vegans/vegetarians to eat better/more balanced than many omnivores, purely because they're much more likely to be taking an active interest in nutrition.

The folks who eat frozen pizza every night probably aren't the most balanced eaters.

But in the context of this article, the point was simply that if you eat more or less anything you will get most of the different general food types you need (salad, protein, fibers, carbs) and thus you will most likely get what you need.

Vegans trying to find substitutes for some of those general food types doesn't mean they end up being more diverse just that they have to look at more alternatives but the body doesn't really care if you eat iceberg and romain and baby spinach it cares that you eat fibers and protein and minerals.

I am not an expert it just seems to me that by not excluding things from your diet like meat you are getting a for much less (eating meat gives you not just protein but ex. iron)

Things that other protein substitutes doesn't necessarily give you.

For example milk (calcium) prevents iron absorption, so you might say a person eats meats hence his diet is balanced and rich in iron but he will suffer from iron defiency if too much milk is consumed. Also there is no natural source of B12 in commercial farm meat and fish since they are not grass fed and not ocean plankton fed. But the feed they get does have B12 exactly like a proper vegan diet where the person takes pills .

> For example milk (calcium) prevents iron absorption, so you might say a person eats meats hence his diet is balanced and rich in iron but he will suffer from iron efficiency if too much milk is consumed

Calcium can inhibit iron absorption, but not to this degree. A typical healthy individual will still be able to absorb iron from dairy products, because dairy products themselves contain iron. Where it becomes a problem is for people who are already anemic.

Remember that the body doesn't need very much iron in the first place, since it's capable of recycling it. It only needs to replace the small amount that's lost in this cycle. And furthermore, the body's absorption of iron is already pretty inefficient, so the effects of naturally-occurring calcium in dairy aren't this extreme.

> How can a vegan diet be more balanced? It lacks diversity which as far as I understand is the primary foundation for good healthy diet.

How does it lack diversity? There's far, far more non-animal foodstuffs in the world than types of meat/fish... Also, most traditional and 'varied' diets contain far more vegetable matter than meat anyway.

Yes, and all those non-animal foodstuffs are available also to normal people, in addition to additional foodstuffs which come from animals. Vegan diet is less diverse by definition, as they merely limit themselves, they do not eat anything non-vegans can't. Simple maths.

You're confusing there space of possibilities with the space of what's actually consumed. An omnivore's diet is not more diverse if they only eat pepperoni pizza.

I'm not vegan, but isn't it possible to live healthy, as a vegan?

Very much so. Notice that none of the "vegans are unhealthy" claims are substantiated by any evidence.

The problems I seen is when vegans try to duplicate some food they used to each with some unhealthy combination of ingredients. There is a vegan pastry shop nearby which is quite popular and their substitute for the butter frosting didn't seem exactly healthy (a mixtures of various oils and thickeners.)

I'm absolutely willing to agree that vegan frosting is also bad for you, but I don't think anyone is saying "all vegan food is healthy". Hell, Oreo cookies are vegan, and they're terrible for you. Same goes for arsenic.

Yes, but you need vitamin supplements.

Western diet without meat is bland and typically lacking. In substantially vegetarian countries like India, the diversity of vegetarian food is far more than anything in Western diet.

What omnivores can consume is different from what they do consume.

Saying it's 'less diverse' isn't the same as saying it 'lacks diversity'...

is it?

He mentioned that they're not very careful about what they eat. Regardless of the diet, you have to pay attention to what you're consuming, otherwise you're going to have problems.

It's actually pretty rare to eat too much meat. Meat is expensive, despite subsidies. Unless you deliberately go out of your way to eat lots of meat, you won't be eating that much.

Furthermore, the combination of meats, vitamin D-added milk, and enriched cereals, the latter two courtesy of the FDA who have centuries of history fighting malnutrition, and who for example introduced hominy grits to the South to combat pellagra, tends to hit everybody's basic nutrition requirements with the exceptions of dietary fiber, vitamin C, and potassium. While good health is still dependent on eating a variety of vegetables, it's important to give the US food system its due -- it produced pretty good results before the modern Age of Excessive Sweeteners.

> the FDA who have centuries of history fighting malnutrition

Founded in 1906.

Well, 1.11 centuries. It's plural!

Perhaps that is true for a vegan diet where you only eat standard American food, but a whole foods plant-based diet has been shown time after time to lower risks for all sorts of diseases, from heart disease to cancer to parkingsons and MS.

Iron and calcium are in plants, D is in fact added to milk, and can be added to a plant based diet via a pill as well if you don't synthesize enough. You are an animal; your body creates enough creatine (creatine production is in fact downregulated when you consume meat). B12 can also be added via a pill, and it is already added to many foods like cereal.

When you look deeper into the facts, you will see that the Standard American Diet faces far more deficiencies, the most obvious being fiber.

Eating a diet largely based on plants but with meat every now and then has all the benefits of a purely plant based diet but without the problems

Please name one problem with a vegan diet that's solved by meat. Meat is a carcinogen, it's highly correlated with a variety of diseases, and the "vitamin supplements" doesn't hold water seeing as how animals killed for meat have to be given vitamin supplements anyway.

Eating meat is a fantastic last resort if you don't have enough food and your only other option is malnutrition/starvation, but it's terrible for you as anything other than a stopgap until you can eat some plants/fungi.

The aforementioned malnutrition of vegans. And no you do not need to feed properly managed livestock vitamin supplements.

Eating meat is fantastic because it contains a lot of macro and micro nutrients. With a vegan diet it is extremely hard to impossible to get all micronutrients.

2/3 of people trying to become vegetarian start eating meat again. Meat reduction simply is more viable.

Of course eating too much of this powerful food is bad for you. But also sunlight causes a variety of diseases and we don't try to live without sunlight. Obesity and cardiovascular diseases are not really an issue if you have a reduced intake of meat. Red and processed meats increase the risks of colorectal cancer with relative increases that seem really high, but with tiny absolute increases as colorectal cancer is extremely uncommon.

> Eating meat is a fantastic last resort if you don't have enough food and your only other option is malnutrition/starvation, but it's terrible for you as anything other than a stopgap until you can eat some plants/fungi.

Eating meat seems like a viable strategy for many other species, not sure why it isn't a viable one for humans as well, especially given that we seem to be highly evolved as hunters (I mean, we are, by a long shot, the most successful predator in recent evolutionary history).

Which meat eating animals live into their hundreds?

Several species of Pacific rockfish.



Carcinogen? Source?

The WHO is a fairly reputable source.[0]

[0] http://www.who.int/features/qa/cancer-red-meat/en/


After allowing for measurement error, a 3% increase in the consumption of energy intake from animal protein was associated with a 15% higher risk (95% confidence interval [CI]: 3-30%; p(trend) = 0.01) and a 2% increase in energy from plant protein intake was associated with a 23% lower risk (95% CI: 36-7%, p(trend) = 0.006).

Do you have direct links to peer-reviewed sources, not search results for videos? Also I am always skeptical of websites where all the content is produced by one doctor and phrases like "From the physician behind the trusted website NutritionFacts.org, How Not to Die reveals the groundbreaking scientific evidence behind the only diet that can prevent and reverse many of the causes of premature death and disability" are found on it. Most practicing physicians are much more careful with their wording.

His videos summarize peer reviewed sources. Everything is evidence based.

I've been thinking of doing vegetarian + ocasional liver. But I'm not super comfortable with upping my legume intake to replace meat.

Be careful with liver if you're a woman who is pregnant / thinking of becoming pregnant - it's super high in retinol which can cause problems.

This is true, but the bioavailability of non-heme iron is 14-18% of heme iron https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

It makes sense to just eat a balanced diet.

Also zinc and copper is found in animal sources. The only non-animal source for vitamin D is UV exposed mushrooms.

Or alternatively you can just go outside for a bit.

You could sunbathe naked in Vancouver for six months a year and not get enough vitamin D.

I had a look, and while that's an exaggeration it's certainly hard to get enough of it in winter. In summer in Calgary it's 600IU per min while in winter it takes 2 hours 42 minutes to get that much. http://purenorth.ca/vitamin-d-your-health/how-much-do-i-need...

That calculator is assuming "midday sun", which doesn't last for very long. (Also, I've been told that 1500 IU/day is what I should aim for.)

That's a lot more than the likes of the Mayo clinic recommend but presumably there is a reason for that. Even if there wasn't, nearly 3 hours outside per day in winter is not that attractive sounding.

My understanding is that 600 IU/day is a "we have lots of evidence that getting less than this is bad" whereas 1500 IU/day is "we know this is completely safe, and there's some evidence that it's better than 600 IU/day". Rather like vitamin C, there's some debate about how much is optimal, but you need to take truly astounding amounts in order to cause adverse effects.

Just wear enough protection, especially if you are in austrailia. Skin cancer is also on the rise.

What is the "standard american diet"? Are you talking junk food which is certainly a bad diet? Or are you talking about the food plate/pyramid which is definitely a good diet?

> The food plate/pyramid which is definitely a good diet?

Just an FYI: no diets have been conclusively shown to definitely be good. The science simply has never been done. The two competing diet regimes (high carb, low fat and low carb, high fat), are recommended by their supporters based on proxies for their theoretical long term benefit, not based on their measured long term benefit.

This is surprising to me, as in India a large part of the population is vegetarian. We don't seem to be susceptible to the same problems.

The move away from Milk products & Eggs seems to open a huge nutrient gap that the vegan population hasn't adequately identified how to fill.

Some vegetarians in developing countries do not have a B12 problem (which also causes anemia) because their food and water are more dirty, and there (B12) bacteria producing. For those vegans at least, their best bet is to accidentally eat enough food contaminated with bacteria or feces to consume decent quantities of B12.

Source: The Dietitian's Guide to Vegetarian Diets, 3rd edition, 2011. See page 192.


This comment was both disgusting and enlightening. Wow, who would have thought some people derive nutritional value from feces-laden water?!

I feel like I have come across similar concepts. There is a theory for instance that developing countries get fewer auto-immune diseases because they are exposed to more germs.

It either destroys your civilization or causes it to thrive. ;- )

3rd edition, page 192... good call, buddy. otherwise, you would have been downvoted to death.

Actually, there are higher incident of B12 deficiency in Indian vegetarians as found by a study done in late 90s (sorry I don't have specific reference).

Indians dont have a practice of regular/ preventive doctor visits, annual checkup and diagnostic testing. They only go to doctor when there are significant medical issues. So these issues are not found until they morph into bigger problems.

I have a quite a few younger cousins who died in their 30's. Not a single one ever was tested for cholesterol despite poor eating habits and obesity.

Recently I noticed a few startups in India focusing on diagnostic testing. But their user base seems to still be elderly than young people.

There is little evidence that annual checkups actually produce better health outcomes for people without serious chronic medical conditions.

India also has an established traditional eating pattern which is supportive of health and good nutrition. For example, cumin seeds are extremely high in iron, and make their way into lots of Indian cuisine. The mineral content of seeds generally isn't very bioavailable, but the extensive wet grinding and precooking of spices followed by cooking with starch and acid is a nearly ideal (and quite impressive) technique to convert locked-up metal phytates to bioavailable citrates and lactates. That prehistoric Indians were able to figure this out suggests that it brought significant benefits.

> This is surprising to me, as in India a large part of the population is vegetarian. We don't seem to be susceptible to the same problems.

In India, vegetarians typically do eat dairy products (although not eggs). Dairy doesn't contain a ton of iron and cobalamin (vitamin B12), but it's a non-negligible amount, and it's possible that that alone accounts for the difference. Remember that vegetarians in India also eat a ton of lentils, which are a great source of iron when consumed in large quantities.

(While it's hard to ingest the full daily recommended amount of each from dairy products alone, an otherwise-healthy individual can make do with a lot less than the recommended levels without developing anemia).

Also Indian food is often cooked with Ghee which is clarified butter.

Ghee has plenty of fatty acids and vitamins and the vegetarian food you usually get in India is soaked in it.

Indian food is also very heavy in spices many of which contain iron, zinc and many other minierals.

Can't you get enough iron from vegetables such as broccoli?

Women lose iron during menstruation and feel anemic sometimes.

Vegan is a lot more restrictive than vegetarian though- I know many Indians who are vegetarians, but I don't think any of them are vegans.

I'd assume Jains have to be.

Jains can have milk. They cannot have things that grow underground

Partially correct. [Source : I'm part of the Jain community]

There's sects that enforce not eating underground veg (potato/onion/ginger/etc) at anytime. Others avoid eating these only during 4 months of monsoon. Others maintain no restrictions.

One of the the core tenets is non-violence, and the Jain ideology provides levels of life, from animals, to trees, to wind and fire. Violence to sensory animals is seen as abhorrent, whereas violence to plants is unavoidable. Underground plants seem to have a higher level of life as many animals are part of their ecosystem. (One hypothesis I have is that these rules actually came about due to the seasonality of these vegetables during the inception of the ideology -- we no longer are similarly restricted in our farming.)

Lapsed members such as myself form a large part of the community -- hence the above claim is only partially true.

On a sidenote, more and more science fiction I've been reading seem to have elements (like Gaia) that provide a higher level of respect to vegetation than non-life, which has provided for some stimulating ideas.

Indians eat a fuck ton of dairy and eggs. Vegetarian diets aren't a problem -- human cultures have not eaten meat since basically forever. However, vegan diets are a modern thing. No civilization has ever adopted a completely vegan diet.

How do people with Lactose intolerance get their nutrients then?

Probably meat

> The vegan diet is a diet of deficiencies

This is, unfortunately for you, completely fabricated. I'd recommend at least checking Google Scholar before making silly claims on HN.

If you'd like to make a claim, cite your source. If you'd like to circlejerk the "vegan is bad, meat is good" fiction, downvote instead.

Eh, op is right and wrong. You certainly can get everything you need and be very healthy as a vegan, but... if you eat about what a normal person eats except without the meat and cheese? you are, as they say, gonna have a bad time.

As a child, I insisted on being a vegitarian - as long as my parents cooked for me (and were careful to see to it that I had a balanced diet, compete proteins, lots of nutritional yeast, etc... They had spent time as vegetarians themselves, so knew how to do that.) I was quite healthy.

After I moved out? I did very poorly, because I wasn't willing or able to put in the effort to see to it that I had balanced nutrition.

That's the thing; as a meat eater? There are a lot of ways for me to get complete nutrition (and yes, it comes with a lot of other things that I don't need, but at least I get what I do need.) - so even someone who puts minimal effort into eating a balanced diet is not going to suffer from deficiencies very often, if they eat meat in the traditional manner. (Quite the opposite, really.) If you put the same effort in but avoid all meat and animal products? at least in the place and time where I live? You are probably going to make yourself sick.

In a culture where most people eat meat, you need to put in a lot more effort and research in order to avoid deficiencies as a vegetarian.

You could argue that this is a truism and that the same could be said for a meat-eater in a culture that just ate vegetables. Most cultures have evolved a traditional set of foods that won't leave you with severe deficiencies of anything, and so if you cut out certain classes of food from that tradition, you need to pay more attention to what you are consuming in order to see to it that you get enough of the nutrients you need.

I'm not sure Rural and Vegan intersect much. Doubtful this Is the source issue.

I'd wager a sedentary lifestyle and stimulants are a major culprit.

Most, really? Have you spoken to "most" vegans?

That's not how statistical inference works.

Don't forget Vitamin K2.

The reason more females have it is because of blood loss from periods (Iron is needed to make up Red-blood cells).

I had IDA for over a year. My doctor tried to fix/ mask it with iron supplements, turns out was a coeliac. Which explains why I was constantly felt lethargic/ hung-over.

Pro tip: Don't trust everything your doctor says (new Dr suspected it and ordered tests straight away).

I will second this, many doctors are willfully ignorant and can't even conceive of the notion that a doctor is capable of being uninformed or wrong.

I've been having some unexplained medical issues lately and asked for some specialized blood tests and was refused (this being Canada, you go to the doctor with your hat in your hand, begging that they actually take your problems seriously, and if they don't want to help you, you're out of luck.)

> blood loss from periods

...is a whopping 10-35 mL per period—hardly enough to cause a nutrient deficiency.

"In women of reproductive age, periods are the most common cause of iron deficiency anaemia."


The flip side is hemochromotosis, women doesn't necessarily become symptomic while pre menopausal. The blood loss masks/treats it until menopause.

What do you ask for to have your blood checked?

Would whatever tests they do as part of a routine blood tests in a physical include it or is it something separate you'd have to ask for?

First off, for the record, routine physicals/wellness exams are not evidence based.

That being said, theres nothing about routine physicals/wellness exams that are standard. Every doctor/clinician has a different idea of what a routine physical is and many (most?) ignore official guidelines. I've had routine physicals from many different doctors (I've moved a lot) and ever single one of them do something different. One didn't actually touch me other than blood pressure (which was done by a medical assistant) but ordered a ton of "routine" blood work and talked to me a real lot. One listened to my heart, lungs, looked at my eyes, nose, throat, and felt every single one of my organs (that she could) but didn't order any blood work at all. Some call to see me every year some don't call until a few years later. Then there's this nonsense - https://sciencebasedmedicine.org/32293/

So absolutely nobody knows what your doctor orders, you'll have to ask them. (Which you should do anyways).

Routine screening of individuals without symptoms or other indications can also harm, so caution is warranted: https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

"I would like to be screened for anemia" is what you would say to your doctor.

Where I live there is a standard blood test, which consists of at least 11 different values. It's a routine thing which is done at at your yearly check-up, but also to check for infections, for example. It is probably similar to a complete blood count (CBC)[1].

I'm not an expert, but from what I understand iron deficiency anemia (IDA) would show in several of these standard blood test values. Not only would Hemoglobin levels be low but also the size of red blood cells be influenced. For a more specific diagnosis of IDA you could ask for ferritin levels, which are not part of the CBC.

[1] https://en.wikipedia.org/wiki/Complete_blood_count

The key words would be to ask for an "iron panel". In most US states you can also order one yourself without a doctor's visit, but without much option of having insurance cover it.

Excess heme iron from consuming meat is also associated with heart attacks. So too much iron isn't good either.


I _really_ doubt it's an iron deficiency considering how much iron is spammed into every particle of fortified grain within the US, and how much grain the average person consumes overall. If anything, I'd guess that it's too much iron.


Curious, I remember a study a few years ago suggesting a lot of makes in western countries had excessive iron as a result of eating lots of meat and not bleeding.

Cooking in an iron skillet is an easy way to supplement your diet with iron.


tiny warning: if you take iron supplement, you'll shit black (or a very dark shade of gray). Do not panic.

Same is true for Pepto Bismol.

Someone I knew took some extra strength Pepto Bismol to treat an upset stomach and diarrhea. Her stool ended up turning black, which I advised is a sign of intestinal bleeding.

She went to the emergency room and learned that bismuth, the active ingredient in Pepto Bismol, can temporarily turn stool black. [0]

[0] https://www.pepto-bismol.com/en-us/faq/black-stool-black-ton...

Possible reasons: Diet (any non-red meat eating diet for nutrient deficiencies, or too much meat due to reliance on fast food), drug/stimulant use (YOLO culture?), More sedentary lifestyle (Desk jobs, social media for 'entertainment'), Lack of resources to take time off from work (too many hours + high rents = no time/money to do have non-home hobbies)

The interesting statistic was the urban regions were less pronounced than the suburbs, which may indicate something either cultural or economic that may drive this change.

Either way, it's unfortunate. We're living in the best possible time in history, and many millennials are being impacted by something which - in some cases - may be completely avoidable.

> drug/stimulant use (YOLO culture?) [...] The interesting statistic was the urban regions were less pronounced than the suburbs, which may indicate something either cultural or economic that may drive this change.

"Energy drinks" (Red Bull, Monster, Rockstar et. al.) blew up in the late '90s/early 2000s or so. As far as I remember, early marketing for these was heavily targeted at "extreme sports" fans and practitioners of their less-extreme variants (e.g. skateboarding). I wonder if that targeting might have something to do with the urban/suburban split.

What does not consuming red-meat have to do with anything? Consumption of red meat is at an all time high and is growing every year.

> Consumption of red meat is at an all time high and is growing every year.

I was curious to see if this was actually the case, but the data doesn't really seem to support this claim. Meat consumption overall appears to have remained relatively stable over the past few years, but it's mostly been an increase in poultry intake that's made up for a simultaneous decline in red meat consumption.





According to another comment here, iron deficiency is a common cause of strokes in younger people. Diets low in red meat often lead to iron deficiency. (Of course, this can be addressed with a supplement, but not everyone who avoids red meat also takes iron supplements.)


Excess iron in men also elevates cancer incidence, so I don't think one should take an iron supplement if there's no need. A blood test is necessary. If you look closely at the men and women's multivitamins that are sold in stores, you'll see that there is no iron on the men's multivits.

Excess iron can be reduced by donating blood.

Also important: cast iron cookware introduces a non-insignificant amount of iron into cooked food, which can be detrimental (or beneficial) depending on the subject.

High iron also correlates to an increased risk of heart disease, liver disease, diabetes, and more. http://www.webmd.com/men/features/too-much-iron-in-your-bloo... That's one reason why I donate blood regularly. They check my iron levels, then bleed off a bunch I don't need.

A couple potential causes:

Increasing incidence of morbid obesity, HTN, type II diabetes, which are risk factors for strokes.

Increased incidence of IV drug abuse, which sometimes leads to endocarditis, leading to septic emboli (I see this very often).

Yes. We need to stop subsidizing and normalizing obesity.

Honestly, I think the opioid epidemic is really what is driving this more. Unfortunately the article doesn't bring it up.

Though I do agree with you in general that we need a fundamental cultural change or we are going to see the average life expectancy.

Every morbidly obese child you see has s good chance of not living past 50-60, and their adulthood is going to be marked by early disability.

In fairness the article actually does bring up the drug angle twice, but in passing.

>in our data we saw this [youthful stroke] increase independently of that,” says Brett Kissela, professor and chair of the Department of Neurology and Rehabilitation Medicine at the University of Cincinnati, who headed the 2012 work. It is likely drug use among the younger adult population also plays a role, he says

>Ralph Sacco, president of the American Academy of Neurology, notes that “data has been scant” about strokes among younger people. “There has been mounting evidence from different studies suggesting that even though the incidence and mortality of stroke is on the decline, the rates may not be dropping quite as much—and even [may be] increasing—among younger populations,” Sacco says. “The reasons for these trends are not entirely clear but there are concerns about obesity, diabetes and physical inactivity having a greater impact in younger stroke victims.” Drug use may be another factor, he adds.

Thanks, I did miss those references. I do wish they had mentioned IV drug abuse specifically because that is far and away the largest factor. I would wager stimulants like meth and cocaine as as second, followed by vasculitis caused by levamisole laced cocaine (used to be really common when I trained).

Sleep deprivation is known to cause strokes, take a look at how many millennials are expected to put in 80-100 hours for a 40 hour check , extreme high competition overtime just to hold onto their seat.

OK, ready to get out of my bubble. How true is this? The only people I know that work more than 40 hours a week still work less than 60. This is in "office", food, and service jobs.

I know people that would work 80 hour weeks. They were engineers in the gaming industry and a couple crunch weeks were not uncommon.

But that's a really specific situation for a short period of time.

I starting working in games in the early 2000s. The first game I worked on (Black & White) had me working 16-20 hour days, 6-7 days a week for 9 months. It destroyed my health and turned me into an agoraphobic for at least a year, with related conditions lasting much longer. I've seen people have to check into mental health institutions after shipping games.

At one place I worked, there was a "crack board", where they would have sweepstakes on who was going to come apart at the seams and lose it. Who knew mental health issues could be so fun? "lol".

Needless to say I no longer work in games, it has done damage to my body and psyche for very little return..

Ridiculous. Time for a union. The game industry is fun, but it is not worth your health, especially just to line someone else's pocket.

I think it lines your own pockets too.

Do employers ever get sued for having an abusive work culture?

Never seen it happen. I even had a car crash due to the pressure of insane hours.

Companies just love "externalised cost". Screw the lives of the employees, environment, etc. Society is pretty broken.

Having a culture of ridiculous work hours is not a crime.

And as long as thousands of developers handle/enjoy the game industry environment, there's no compelling reason to change.

> Having a culture of ridiculous work hours is not a crime.

But it should be, per labor law. At a minimum, its wage theft.


Sorry to hear about what you went through. Any tips about how you recovered, or what you would have done differently?

The gaming industry is notorious.

I worked in an environment where people around me were putting in upwards of 80 hrs. I was closer to 60 hrs because I had 2+ hrs of commute time each day. Still, I had to put in time at home during crunches. We probably had about five months of 40 hr weeks spread throughout the year between launches, yet many people still went well over even then.

It's not universal, but I don't think it's uncommon.

Yeah I routinely exceed 60 during peak season. 80 if I'm working weekends too. And that's focused work with lots of context shifts. So yeah after peak season I'm on the edge of burn-out.

I'd imagine I'm not doing myself any favours there health wise.

Then why are you doing it? Serious question. Is the pay so far above average that it's justified to sacrifice your health, or is the job market too tight to get a less cruel job?

>Then why are you doing it?

Planning on getting out before the next cycle of crazy hours.

But to answer the question - various reasons. It facilitated a relocation to Europe. Rapid career progression to managerial level. Control over what projects I want to do. Multiple rounds of overseas assignments. Minimal supervision. Exposure to new things in a notoriously secretive industry. Pay is decent too, but that's not really a motivation for charging hard.

>is the job market too tight to get a less cruel job

No I can walk into a job with equal pay and far less stress tomorrow. It would kill progression & personal development though. I figure I can always coast later if need be.

By the time you get to coast stress may well have taken its toll physically and mentally.

Enjoy your health while you have it, it's far more enjoyable than a few more coins in the bank.

I know a lot of grad students who had lives like that.

Yeah that's pretty common in grad school, but it varies a lot by advisor, goals, etc.

It's not that uncommon to work 12 hours per day 7 days a week in touristic places.

Any data to back this up? I'm a millennial and know plenty other millennials and they usually put 35-40h per week as is standard in Europe.

20h for me in germany :-P

This. The whole culture of working overtime and weekends as a "norm" is horribly unhealthy. Weekends were invented for a reason, i.e. to not work. I spend most of my weekends biking, hiking, socializing, working on personal projects, and generally trying to be healthy, both physically and mentally.

I say this as a cardiac arrest survivor. I would be terrified to be stuck in an office for 7 days a week. It's just not right for the body or mind.

That, combined with MDMA or Adderall, is more likely to lead to epilepsy. Strokes have a stronger connection to diet and weight.

Drugs in the amphetamine class do not cause epilepsy as far as I know. I would be very interested in a source, if you have one.

Likewise. I'm interested in nootropics, but have two relatives with different types of epilepsy.

He probably meant Parkinson's.

There are several numeracy issues with the story.

The first is strokes are incredibly rare. Going from 5-ish to 10-ish per 10K hospitalizations. "When I was that age" I was never hospitalized once, so you need to factor in how many times that group is hospitalized. I would theorize its extremely rare leading to perhaps better diagnosis or something rather than actual medical effects. Also its worth contemplating that "when I was that age" a kid who stroked out on coke was considered a coke related death not a stroke related death. A classic example when I was that age was the story of "Len Bias" a basketball player who celebrated being drafted by the Celtics by snorting coke until he died. There was quite a circular firing squad of blame but attitudes in that era were unified that coke killed, not strokes, despite the medical definition and all that.

The next numeracy issue is there's about 84 million in the group and unlike previous generations its not white majority and there are considerable differences in race and ancestry and socioeconomic group. Basically that group can't be usefully compared to historical groups because its literally a different people. You wouldn't compare Bolivia with Nigeria and claim the comparison means anything when there's no relationship between the separate and unrelated groups of people. Its entirely possible that (now older) middle class professional Scotts-Irish have a different stroke profile than formerly Mexican peasant villagers. Apples to Oranges means nothing. That group is a different nation merely coincidentally happening to inhabit the same plot of land. Like comparing the medical issues of the pre-Crusades residents of Jerusalem to Crusades ere residents. Or pre- and post- Holocaust ghettos in eastern europe. Its a different people, the comparison means nothing.

The next numeracy issue is there's 84M in the group, as of May 15 2015 Time magazine (per google) claims only 53M are in the workforce. As of 2013 Gallup poll indicated only 43% of the group have a full time job, and 43% of 83M is 36M. So there's a lot of handwaving involved, but when only 36M out of 84M are working full time, overwork is probably not statistically possible to double the instance of strokes. That would imply strokes are something like six times more likely among full time workers. Basically the socioeconomic group is extremely poor and disenfranchised and no percentage of ivy grad programmers dying at their desks at video game companies is numerically high enough to double the entire groups stroke rate. There are not enough SV programmers such that if they all died of strokes it would boost the numbers. Whats killing kids can't be work because the employment stats are so incredibly dire, permanent long term economic decline and all that.

From what I understand, strokes are caused by the same thing heart attacks are - atherosclerotic plaques, and APs are caused by high blood cholesterol - APs are literally constituted of cholesterol/foam cells. Has the consensus changed?

Depends on the type of stroke. There are occlusive strokes, which are due to blockage by plaques, and there are hemorrhagic strokes, which are due to vessel failure and bleeding.

Anecdata: My dad died of a hemorrhagic stroke. My mom of an occlusive stroke. No plaques in my dad. A very few in my mom. It's complicated.

While that may be the most common cause, there are many causes of strokes including, in some cases, birth defects that have nothing to do with lifestyle or genetics (as far as we know). See: AVM.

I was under the impression that those correlations are clear but the causalities are still very much up for debate.

There are two major kinds of stroke, ischemic and hemorrhagic.

More commonly from dissections of the internal or external carotid or vertebral arteries, which for some bizarre reasons happens less as you age.

Don't take this the wrong way but your statement is incorrect. I don't have time to type out all the various subsets of strokes but Wikipedia is a good initial source. Dissections are fairly uncommon. Far more common are emboli strokes from afib, small vessel atherosclerosis, for example.

Interestingly, dissections as you mention cause ischemic strokes by (generally speaking) flicking off clots that mess things up downstream that form within a pouch made by the dissection (low blood flow + body trying to patch things up = pro-coagulation). Note in this case there is a tear in the artery wall but the wall remains (ie, no blood exits the artery).

This is different than an aneurysm, when the arterial wall bursts and you have bleeding within the brain. That is termed a hemorrhagic stroke.

Source: hospitalist physician for 7 years who has cared for 100s of strokes at a hospital that specializes in neurology.

my wife had a stroke at age 30. 4 strokes actually, 2 bleeds and 2 clots. accidental overdose on stims.

What do you mean by stims? Like adderall?

I'm sorry to hear that. What were the stims that caused that?

2 months ago:

"Researchers Find Gut Bacteria Can Trigger Brain Lesions That Lead to Strokes ; Another connection between the gut and the brain."


HN: https://news.ycombinator.com/item?id=14315355

I couldn't find the separation by kind of stroke (arterial/veinous, ischemic/hemorrhagic).

I enjoyed reading this, and was surprised to learn it was written two decades ago in (1998). I wonder what we've learned since?

Almost doubled in some areas since 2003. That's huge.


It’s “click bait”, and what a sad, sad view to have on addiction. I hope it never affects you or anyone you care about.

Stress of being slaves to a bank for the rest of their lives when wages and jobs in those areas are shrinking, and while they watch the planet being trashed.

My longshot theory: Molly.

I've watched brilliant brains literally get ruined by the overuse of that garbage. I would bet anything that it's more dangerous than any of its users want to admit.

Do you know what a stroke is?

This may only be a case study, but these doctors indicate an association between MDMA use and strokes.


Available data imply a strong association between MDMA abuse and cerebral infraction.

Yes, do you?

Funny how the downvotes and attacks come when you discuss the possibility of drug-induced brain damage in Millennials to a website full of.... drug-defending Millennials!

I think molly is stupid, and would never try it. BUT molly-induced brain damage is usually hyponatremia, or a subtler form of damage to the serotonin system. not stroke.

The absence of proof is not the proof of absence. Also, did I not mention "longshot theory"?

I stand by what I said and will double down in fact. Too many people melting their brains with that crap and there are almost definitely unforseen consequences of doing so.

It's mostly obesity. If we allowed for obesity as a reason to deny health coverage, then health innsurance would be affordable.

And since it costs nothing to lose weight, it seems fair.

> since it costs nothing to lose weight, it seems fair.

This is only a half truth. Starving yourself is free, but losing weight while still eating a variety of foods (most people can't stomach 24/7 lentils) on extreme financial (including preparation equipment) and time constraints (prep time, time to get ingredients) is nontrivial. Look at the nutritional content of the cheapest and most readily available food you can find (fast food, walmart-brand sausages, etc etc etc). It's typically full of fat and sugars. Higher-quality readily available foods are typically more expensive and harder to come by in poorer areas. Higher-qiality food you prepare yourself is an option, but learning how to do as such is nontrivial and the time investment to prepare these foods can be a major challenge for some.

It's not that hard with proper planning (I did it, I lost 70lbs).

Takes 20 minutes for oven to eat up and 12 for pizza to cook.

In 32 minutes you can cook a healthy cheap meal with variety.

I ate porridge for breakfast, cottage cheese and salad for lunch and and chicken/veg, fish/veg for evening meal.

No one's responsible for anything anymore. What you're saying essentially amounts to poverty preventing people from shedding a disease of affluence.

If we allowed for bad opinions as a reason to deny health coverage, then health insurance would be affordable.

And since it costs nothing to post better, it seems fair.

No need to go full denial. Insurance is priced according to risk. If I've got a record of accidents and traffic violations then my car insurance costs more. If I'm 100 lbs overweight and hypertensive then life insurance costs more. Medical insurance can be priced the same way, creating incentives to maintain a healthy weight and diet.

The problem with your theory is that driving is optional and not something we engage in 24/7. Being alive is a continuous thing and we don't understand all the myriad things that contribute to stuff like weight gain.

I was seriously overweight for a time. It did not get better until I was diagnosed with a genetic disorder and began getting proper treatment for that. Until I had a proper diagnosis, my body just did not seem to work the way everyone told me bodies worked.

I ate healthy. I exercised regularly. I was well educated and well read. Yet my problems seemed to defy solutions for a lot of years, until I finally got the right diagnosis.

Most people who are overweight wish they could solve it. They often don't know how, even after taking all the usual advice.

New research into things like gut biome is beginning to cast light on such phenomena, but this is hardly a solved problem, contrary to what many people seem to think.

Insurance is priced according to risk, yes. However, most insurance is priced against fairly good odds that they will not pay to an individual. Which ultimately points to health care being a relatively stupid place to trust to an insurance market.

I don't necessarily disagree, but I think you start getting into challenging grey area with pre-existing conditions. Is being overweight a consumer responsibility but an auto-immune disease isn't? How do you effectively draw a line between disease or health risks someone should be responsible for versus not.

Well ideally you have insurance before the "pre existing" condition exists (or is discovered).

However in general I think pre-existing conditions need to be handled by something other than "insurance" and the trick is to do it in a way that doesn't incentivize people from foregoing insurance until they get sick.

Hey, if your family has a history of cancer, they should also charge you more right? It's only fair.

Even assuming that this was true... the logic doesn't even make sense. If you have fewer people in an insurance pool, than the costs of it are higher. Pretty much by definition.

You can almost get away with this if you purport that the actual costs of the pool would go down. However, all it takes is one person having a surprise expense to demolish any small pool's planning.

Seriously, think on this at a level. Try to go in with just 5 friends to cover your costs for health. Works right up to the first time one of you visits the doctor. Which is to say it doesn't work.

> "Even assuming that this was true... the logic doesn't even make sense. If you have fewer people in an insurance pool, than the costs of it are higher. Pretty much by definition."

What? That doesn't make any sense and it's surely not by definition.

If you have a set of people, and you create a subset with the healthiest people of the subset (so, what you are doing by removing the obese), of course that the costs per person will be lower for the subset than for the all set.

That isn't how insurance works. To do an insurance pool, you have to have a lot of people, knowing that you won't be paying out to most of them. Otherwise, it is not insurance, but some sort of group savings/pay as you go.

That is, the main variable that gets you to lower rates, is higher participation. Anything else doesn't come close.

You have to let it sink in that you can not have a small subset "save up" enough to pay for "their share." It just doesn't work without having large groups lose out and be completely unable to cover the costs in their group. Instead, this would be akin to group gambling where eventually one loser will bankrupt the entire pool.

Now, there is a related concept that you need to diversify your risk pool such that you don't fall prey to the same risk on everyone. This is what hit some major flood insurance providers after Katrina. I could see similar arguments for not wanting to insure a bunch of folks from the same locale. (Oddly, insurance doesn't typically branch out beyond locales...)

There is a concept of trying to get the higher risk pool to pay more through some rough proxies (typically age, for car insurance) to pay higher premiums. Again, though, most young drivers do not have accidents. Nor do the insurance companies typically actually need such high premiums to cover costs. As evidenced by their fairly mediocre savings plans they offer folks for not having an accident.

All of this, though, really just points out that calling this an "insurance" for health is just silly and is ultimately the wrong model.

> "That isn't how insurance works. To do an insurance pool, you have to have a lot of people, knowing that you won't be paying out to most of them. Otherwise, it is not insurance, but some sort of group savings/pay as you go."

Seriously, not only this is clearly not how it works, but it actually makes zero economic sense, it doesn't work like that at all.

Insurance companies have people there calculating the expected costs with the different groups and - whenever legal - they DO DISCRIMINATE amongst them. Why do you think woman pay less for life insurance than men? Or why do woman pay less than men for car insurance? According to your rational that shouldn't be the case, you should just put them all together and everyone would pay less.

Let's just reduce this at absurdum for you to get it.

You have a group of 100 people. 50 completely healthy according to a medical check-up, 50 with HIV needing constant medication: Now, where do you think the health insurance premium would be lower for the 50 healthy ones:

1 - If we charged all the 100 people the same?

2 - If we divided the group and charged the 50 people with HIV differently than the 50 healthy people?

Answer this question and immediately you will understand why what you are claiming is wrong.

You are missing my main point here. In large because I did a poor job making it, so I can't even remotely be upset. :)

Insurance works by getting people to pay in to it that will not get paid out of it. Pretty much by definition. This is why we pay insurance for cars, instead of just avoiding cars. Same for title insurance. Same for life insurance. The vast majority of people that pay into these schemes do not get paid out of them.

Now, the only way you can use a pool of "healthy" people to get low costs, is to have a pool of healthy people that are not using medical procedures. You can do this by discriminating out people that need procedures, but realize this also means you discriminate out people as soon as they start to need these procedures.

Car insurance kind of works here. Many will take on "higher risk" kids for insurance. But as soon as those kids make a claim, they will refuse to re-insure them. Same with houses. Make a claim, find that you have a chance of needing to get new insurance policy.

So, for your little hypothetical. My point is take the 50 that are healthy, and have them pay lower rates. And then, as soon as one of them hits a high cost procedure, find that you don't have enough to cover it. (Just one cancer patient will blow out a pool of 50 people in a heartbeat.)

Could it work to keep costs down? Yes, but only in a way in which would not benefit you. As soon as you needed what those costs were supposed to cover, you would be kicked out of the pool.

This is like the poor sods that think they can do a health savings plan. Only if you are very wealthy, and still only if you never actually get into an accident or need it.

You assume some factor results in obesity, which the causes strokes. There is no evidence for this.

More likely, a common combination of factors causes both obesity and strokes.

> it costs nothing to lose weight

Citation needed.

Don't buy so much food.

I completely disagree with losing weight "costing nothing". A good diet is usually more expensive than a bad diet. Preparation also requires more time, which is money. Education on what you have to eat, how to cook it, etc. is money too. Exercise requires free time, which is money too. Hence why poor people have higher levels of obesity.

I agree completely, but most people could go 80% of the way just by eating 20% smaller portions of the same food they eat right now.

Does it cost more to cook smaller portions? I think even worst case scenario is it costs the same, e.g. you cook the same amount and throw 20% away (or it goes bad).

What would help is if people stopped treating weight loss as some insurmountable problem.

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