Saturday, October 8, 2011

Cholesterol and CVD Risk in a Nutshell

This is a brief summary of my current understanding about how to interpret cholesterol values as they appear on the blood chemistry panels that's done during regular medical check ups. (I deliberately don't list specific ranges, as this is about the essentials of what I think is a correct perspective.)

  • Elevated total cholesterol in the absence of inflammation (and associated oxidative stress) is unlikely to contribute to heart disease. (Though an extreme elevation or depression in cholesterol may indicate other problems in your body.)

  • Elevated cholesterol (especially high LDL relative to HDL) in the presence of inflammation is likely a risk factor. This is because this scenario involves LDL cholesterol carriers becoming oxidized and stuck inside the lining of blood vessels causing artherosclerosis as well as processes leading up to acutely threatening events such as infarctions.

  • The likelihood of cholesterol becoming target of harmful oxidation is higher in people who have blood sugar dysregulation (suggested by elevated triglycerides) such as the obese or (pre)-diabetic, because these malfunctions contribute to the formation of "small dense" highly oxidizable LDL as well as inflammation.

In other words, the more inflamed and/or diabetic your are (risk increases dramatically if you eat a typical Western diet) the more an elevation in cholesterol is likely to be a concern in regard to heart disease. In this situation, statin drugs may lower your risk somewhat, but possibly with side effects that will ultimately kill you from causes other than heart disease.

In people who do not fit the above disease- or dietary profile, cholesterol is likely of no particular concern unless it is heavily elevated or depressed. (Extremes in both directions may indicate chronic infection, genetic weaknesses related to cholesterol metabolism, or thyroid dysfunction.)

The apparently most relevant marker that suggests heart disease risk as it relates to inflammation is hsCRP ("High Sensitivity C Reactive Protein"). hsCRP tends to be well below 1.0 mg/L in healthy individuals with no acute infections.

This is not medical advice, and, as a health consultant, I don't diagnose or treat disease, but if your doctor isn't equipped with the knowledge to even discuss these points, he or she has no business trying to "treat" your cholesterol values as such.

(*Technically, what's listed on blood panels isn't actually cholesterol, but cholesterol carrier proteins, but, oh well, once we have declared war on a natural substance, who needs such distinctions...)

Thanks to Chris Masterjohn for contributing through lectures and writings to my understanding. (Any errors are mine and this is not an attempt at paraphrasing Chris.)

Thursday, October 6, 2011

Thank you, Steve Jobs.

Steve, I cannot thank you enough. You inventions fueled my interest in computers from when I was 12. You provided me with tools for work and fun that I have enjoyed using every day for hours and hours. You have been living proof that success and unwavering commitment to one's ideals are not just compatible, but that valid ideals, pursued relentlessly, are the drivers of lasting business- and personal success. You have been an inspiration when I have taken my own steps into the unknown, showing that failure is nothing to fear, but something to learn from.

Monday, October 3, 2011

The Wizard of Oz (Part I)

OK, it is perhaps getting a bit old to criticize mainstream health advice. I mean, if you are reading this, you probably already suspect that cable television is the go-to place for learning at least 15 different ways to waste muscle-, bone- and brain mass by eating tofu and whole grains while running on a treadmill.

On the other hand, when I receive such a hilariously stupid promotional message as I did this morning, I can't resist the temptation to publicly register my mocking response.

The particular message was about Dr. Oz's (aka the Wizard of Oz's) health “tips” in Men's Fitness Magazine.

My snide remarks are inserted after each quoted section:

“Hi there-

Thought you may have interest in Dr. Oz's tips for living life to its absolute fullest. Help your man live to 100 with Oz’s advice! In the September issue of MF, he’s prescribing a mix of competition, training, nutrition, and preventative medicine that will keep your man tuned for the rest of his life!”

That is a decent intro, indicating that the advice is directed towards women who are then supposed to harass their men into taking some prescribed actions. (As we all know, health has nothing to do with internal motivation.)

“Annoyed that your guy isn’t taking care of himself? Wish you could help him get in the best shape of his life? Or maybe you just want to help him get back on track?”

So "your guy" is a fixer-upper in the health department?

There are three options:

1) Your guy knows he is out of shape, but doesn't care.
2) Your guy doesn't know (or evades) that he is out of shape, and doesn't care.
3) Your guy knows he is out of shape and does care.

For #1 my suggestion is that you acknowledge that you two have incompatible values regarding health and fitness. Loath it as you wish, but don't pester him with "Wizard of Oz"-info. If he truly is a man he will not tolerate it. (If he does tolerate it, he is not an alpha-male, and you must therefore leave him for a tattooed gangster/crossfitter [See, this is holistic health coaching at its best!])

For #2, my advice is to dump him. A brain-in-a-vat would be OK, but who wants to live with a brain-in-a-tub-of-lard?

If it is #3, then your guy has already tried every single health platitude spouted by Dr Oz's, resulting in even more stubborn love handles (the carb addiction fat site) and/or on his legs/chest (the estrogenic fat sites). Get him away from Dr Oz before he acquires an insulin/estrogen related cancer.

“For guys in their 20s

Twentysomethings’ testosterone levels are high, so they have a big desire to be sexually intimate and a need to build muscle mass. Place more emphasis on muscle-building activities. They should be working out every other day, building up their core, arms, and legs. The one activity they should definitely be doing is pull-ups. You know you’re fit if you can lift your own body weight at least 10 times—that’s the bare minimum.”
Doesn't this sound like a description of pubescent chimpanzee?

Anyway, I am past 40, yet the gist of the above actually fits me quite well, but with the difference that my "need" to build muscle is both driven by testosterone-induced vanity and my belief that muscle mass is one of the most important determinants of health and longevity.

“Guys in their 30s

Once your guy hits his 30s, he can start to move away from muscle-building activities a little bit and focus more on fitness. Young guys are more able to move around, but thirtysomethings are a little stiffer and start putting on more weight. So now they have to worry about not burning as many calories.”

On my 30th birthday, I barely knew what a second mortgage is, yet here Dr Oz proposes that one's 30s should be the time to scale back on that testosterone-driven muscle building craze and prepare for retirement (buying a mobility scoter?). The 30s is when guys just happen to become a little "stiff" and chubby (aka the "registered dietitian"-look), right?

Anyway, as far as I can tell, I begun to age backwards by my late 30s when I ditched the USDA/ADA/Oz diet and begun to pay attention to what people with superior health and fitness were actually doing.

“Guys in their 40s

By the time your guy is in his 40s, it all becomes about your body’s pliancy. Once he loses the ability to stay flexible and balanced, he starts to develop frailty—and frailty is what really hurts us when we get older. So I would spend more time doing yoga or balance activities, like doing exercises with your eyes closed. To improve your balance, do this simple test. Stand up straight with your arms folded across your chest, close your eyes, and raise one foot, bending the knee at a 45-degree angle. Set a goal of balancing for 15 seconds.”

Balance exercises are probably a good idea, but one's 40s?!! :) Not that frail 40 year olds (or 20 year olds, or 10 year olds) don't exist today, but the fact that this particular "schedule" of degenerative aging is tossed around as normal and uncontroversial is a glaring admission of the intellectual- and practical failure of the government-pharmaceutical-medical establishment that the majority of people have chosen to endorse and listen to. Enough said.

“Guys in their 50s

The big epiphany—and this is going to blow your mind—is that the fitness level of someone who is 17 years of age is no different from someone who is 65 years of age. So your man has to be able to stay physically active throughout his life. Guys past the age of 50 should focus more on endurance activities as they get older—things like biking, running, the elliptical if he has weak knees, and swimming.”

So, suddenly after twenty years of progressive stiffness, frailty and obesity the typical 50 year old can suddenly enjoy fitness like a typical 17 year old. I can't follow the logic, but, oh well.

More “endurance activity”? I'm reminded of the middle aged, metabolically deranged men who suddenly realize: "I'm obese, I'm diabetic, I desperately need to do something! I need to train for a Marathon!".

This is one reason that gyms have CPR equipment.

We know the archetype from fitness centers everywhere: A sweaty, red-faced, and panting, 50-something with an enormous wheat-belly suddenly clasping his chest in terror.

Meanwhile, on the TV screen attached to the unfortunate's treadmill we see the face of a recently polypectomized Dr Oz doing his best to obfuscate the message of an actually quite fit 50-something: Gary Taubes.

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