Newly lost faith in health care

[dan33]

As to farming, when input costs exceed the price you are paid for the product you produce you let the land lie fallow.

I understand that but what is causing the low prices? Is it the processed food market? Or the propaganda that animal products are bad for you?

 

[Speaks]

Is it dirty lobbying if it is addictive/ unhealthy? There is no argument that carbohydrates both processed and unprocessed are addictive. The Federal government has not had a pro-population agenda since teddy Roosevelt. We have been lied to about everything since Roosevelt said we have a right to know what is in our food and medicine and it's probably not healthy to keep a side of beef on the floor laying in a pool of blood and fat.

On the topic of not being able to produce more animal products, why are we subsidizing farmers to not use land? In addition, nearly the whole central ny dairy industry has been wiped out as a result of the milk and butter are bad for you campaign. There are a lot of places up there that have been farmed for over 100 years that are sitting vacant.

And efficency wise if that was the case, they should have looked to input vs output. I can get a lot farther on steak and eggs vs a bag of granola and spaghetti.

By not dirty I meant that I was not implying bribes. I think its a lot of studies funded by food companies showing their products are healthier than natural, what they would call "educating the congressman" and of course the standard campaign contributions. Its still corrupt but a more sophisticated version of it that is generally tolerated.

I dont disagree with you on any of the rest.

 

[ztc92]

Yes and no to the last sentence.

Yes in that the population like us (Lean Mass Hyper Responders) is less than 5%. Way way way less than 5%. Very low to near zero carb lean athletes effectively didn’t exist 30 years ago, and are still rare today. I had an LDL cholesterol of 592, enough to give doctors heart attacks. They’d never heard of such a thing, and were completely shocked and horrified.

But the implications, they are far reaching. For decades, the operating assumption has been that THE big causative indicator for heart disease is cholesterol (first total, then LDL, then particle size, APo B, etc …). And with that eating fat, particularly animal fats (especially red meat and saturated fats) is the driver of LDL cholesterol. That assumption has radically changed our eating habits since the 1950s.
Don’t eat animal products, but load up on starchy carbohydrates and industrial seed oils, because they will lower cholesterol.
Well hooray it worked, cholesterol is lower. Most of America adopted a radical intervention with the best of intentions, what could possible go wrong?

How’s that working out? Has the population’s health improved?

Most people who go to a very low carbohydrate diet aren’t going to see massive increases in LDL cholesterol. But as they pull harder on any of these 3 levers by getting leaner, exercise more, and further lower carbohydrate, then LDL will rise.

The LMHR phenomenon appears that energy transfer system effect. Higher energy demand from fat, and less fat storage available from the body, then higher requirements for LDL cholesterol. That definitely matches my experience to a T. And I’ve tested that pretty thoroughly on myself. I get really high LDL when I’m ripped, working hard and eating 3 lbs of steak and not much else. And I dropped LDL 450 pts by getting fat, lazy and loading up on bread and fruit juice (which tanked my HDL, quadrupled my Triglycerides, and was the worst experience of my life), all to convince the army I was “healthy” enough to deploy. The irony.

You show me a guy with crazy high LDL, but also high HDL and low Triglycerides, and I’ll show you a lean athlete eating very few carbohydrates.

So why does this all matter? If LDL is the bad guy, the CAUSE of heart disease, then shouldn’t the ideal test of that assumption be the Lean Mass Hyper Reaponders? Shouldn’t an otherwise healthy population, but with massively high LDL be rapidly developing atherosclerosis?

It’s almost as though we don’t know what we think we know, and maybe it’s time to reevaluate our assumptions.

This is a great summary and definitely a group of patients I’m not familiar with (and haven’t personally treated). However with my interests in sports medicine I may encounter patients that fit this profile in the future and this is a really nice primer on things to consider.

Just to make sure I’m understanding, are you suggesting that the body compensates for the low-carb diet in these elite athletes by making more LDL to serve as fuel for a largely ketogenic diet?

If yes, are there any discussions of this from Peter Attia? I follow him and his work closely for personal interest and recall he had often been zero or low-carb while training at a high level. Perhaps Peter Attia fits the LMHR profile?

As an anecdote, my grandfather lived to 90 but had some health issues along the way. He was always lean and muscular to the day he died. His diet most of his working life (logging, farming) was to eat a dozen eggs, pound of bacon, 6 pieces of toast and pint of milk ever morning. He would work outside all day and then have a dinner that was essentially meat and potatoes, often with ice cream for dessert. As he got older, his blood work suggested extremely high cholesterol (I don’t know specific metrics). Not surprisingly, doctors often tried to get him to take statins and eat more plants to lower his cholesterol. The more he did this (and the lower his cholesterol) the worse he felt. At around 70 he had a heart attack and struggled to recover for over a year despite following all the recommendations. He eventually said the hell with it and stopped taking his statin, went back to the diet of his youth and within a few months he was back to his former self, even better than before his heart attack.

I do believe statins have a place and for some patients, can truly be life saving. That said, I also have a healthy level of skepticism that we may not fully understand who the best candidates are, especially to people who appear to be healthy other than their cholesterol (especially high LDL).

Look forward to reading more about this in due time!

 

[yfarm]

I understand that but what is causing the low prices? Is it the processed food market? Or the propaganda that animal products are bad for you?

Consolidation in agribusiness, competition from lower cost producers outside the US. Have a cousin that feeds out grade a choice angus on the farm where my grandfather spent his entire life feeding herefords. There used to be independent cattle buyers, now one buyer, works for Cargill, take it or leave it price. “You are giving me McDonalds price for high grade meat” . Corn, soy beans, pick your crop its the same story.Everyone in the chain is making a living except the guy with all the risk. Will just see further consolidation until the producers are large enough to dictate prices, just like healthcare.

 

[Speaks]

This is a great summary and definitely a group of patients I’m not familiar with (and haven’t personally treated). However with my interests in sports medicine I may encounter patients that fit this profile in the future and this is a really nice primer on things to consider.

Just to make sure I’m understanding, are you suggesting that the body compensates for the low-carb diet in these elite athletes by making more LDL to serve as fuel for a largely ketogenic diet?

If yes, are there any discussions of this from Peter Attia? I follow him and his work closely for personal interest and recall he had often been zero or low-carb while training at a high level. Perhaps Peter Attia fits the LMHR profile?

As an anecdote, my grandfather lived to 90 but had some health issues along the way. He was always lean and muscular to the day he died. His diet most of his working life (logging, farming) was to eat a dozen eggs, pound of bacon, 6 pieces of toast and pint of milk ever morning. He would work outside all day and then have a dinner that was essentially meat and potatoes, often with ice cream for dessert. As he got older, his blood work suggested extremely high cholesterol (I don’t know specific metrics). Not surprisingly, doctors often tried to get him to take statins and eat more plants to lower his cholesterol. The more he did this (and the lower his cholesterol) the worse he felt. At around 70 he had a heart attack and struggled to recover for over a year despite following all the recommendations. He eventually said the hell with it and stopped taking his statin, went back to the diet of his youth and within a few months he was back to his former self, even better than before his heart attack.

I do believe statins have a place and for some patients, can truly be life saving. That said, I also have a healthy level of skepticism that we may not fully understand who the best candidates are, especially to people who appear to be healthy other than their cholesterol (especially high LDL).

Look forward to reading more about this in due time!

He has talked a little about both LMHR and also a genetic variation that has basically no LDL at all. He is very much in the camp though that ApoB is causal of ASCVD and should be stamped down to the lowest possible level often with the help of PSCK9 inhibitors and statins. At least what I have heard while he is very critical of looking at LDL vs ApoB he is quite dismissive of the idea that LMHR is safe with those lipid levels or some of the alternative views on lipids generally within the community of low carb fans. And I dont mean dismissive as a criticism necessarily though I am also not so sure I agree with him on this point. I think there is not a significant body of evidence yet and he has a fairly high threshold for proof.

 

[Pharmseller]

Bonus, that trapline is also a good place to pick up a "female (or male) companion for hire"- depending on standards of course (these are the more budget-friendly variety).

There’s a reason that area is called Felony Flats.



P

 

[Deadfall]

Gary Brecka formerly worked as an actuary in the life insurance industry. He left that job and built a business around coaching for optimal health. His website is theultimatehuman.com. Yes, there are products he endorses or sells, but you can choose to buy them or not. There is a ton of free advice and guidance and it’s worth following if greater wellness is of interest to you.

Didn't know that. Just seen what he did with dana white. Lots of others since. Has made a difference in my life as well

 

[ddowning]

Consolidation in agribusiness, competition from lower cost producers outside the US. Have a cousin that feeds out grade a choice angus on the farm where my grandfather spent his entire life feeding herefords. There used to be independent cattle buyers, now one buyer, works for Cargill, take it or leave it price. “You are giving me McDonalds price for high grade meat” . Corn, soy beans, pick your crop its the same story.Everyone in the chain is making a living except the guy with all the risk. Will just see further consolidation until the producers are large enough to dictate prices, just like healthcare.

My dad is gone now, but he constantly harped on this. He said the death of the small farmer was the death of America and the American dream. It was sure as hell the death of his American dream. He never had the money or backing to farm big and the family farm from his youth was basically lost when my grandfather took some large risks that didn't work out. At that point he stopped trying to grow and just made a living with what he had. Since farming is now only profitable if you are comparatively large compared to the 60s and 70s, the old equipment and small amount of land was not enough to get my old man started and my mom and grandfather talked him out of it due to the "risk."

I have not farmed except as a hobby, but it appears this country is in great need of the formation of a large cooperative or some serious anti-trust/monopoly regulation. All of the industries that I can see below surface level are quickly being bought up by the big players. They are not only buying their suppliers to vertically integrate, but they are buying their competition. What was 20 or 30 successful small companies 25 years ago is now all held by one holding company. Multiple building material companies and optics/archery/hunting companies are this way. How many brands does Monsanto control now? I believe vertical integration can be a good thing as it increases efficiency and cuts out the fat from the people who produce nothing, but are just middle men. Buying the competition on the other hand is a vehicle for greed. Once a few companies own it all they can fix the price and suck the wealth out of the economy. I think we are in for a world of hurt if things don't change. Most of the economy in this country is now built on middleman mark-up. The actual producers are making very little and the middleman is taking home most of the money. It is the same in construction. I have some opinions on why that is, but I won't further muck up the thread with those.

 

[ddowning]

As to farming, when input costs exceed the price you are paid for the product you produce you let the land lie fallow.

A few years ago, I wanted to buy as much land to hunt as I could possibly afford. I started looking into the economics of farming in Iowa. It seems like, to the extent they can predict and control it, most of the profit from farming is sucked up by the companies selling the inputs. Inputs go up and down and leave the farmer with just enough of a tiny dangling carrot to keep going. After some research, it became obvious to me that farming was not going to pay for me to own more land. I did not have a way to utilize a family member's equipment, so would need to share crop, lease, or invest in equipment. The pay off was never good enough to break even. I decided I was better off to try to make more money doing what I already know how to do, and use that money to buy land. Most of the time, the cash rent would pay for half the interest on the loan to buy the land and that was it. For people that could make a larger lump sum payment it is likely a bit different, but there doesn't seem to be much profit there. A lot of neighbors that own all of their land and equipment outright already had trouble turning any profit this past year on corn. This country (really it seems like the world) is pretty broken by the system (global economy/central banking).

If the big money keeps up like this there will likely be a food shortage with massive problems for humanity. Why would you pay big money to farm food for everyone else? It is the Atlas Shrugged scenario manifesting itself.

 

[JDBAK]

You would have to follow them more than a year to make the conclusions you are making.

What conclusions do you think I'm making?

I'm not concluding that the LMHR phenotype is the ideal mode of being, or necessarily that it's even safe. I don't know. We're in totally uncharted territory, way beyond the borders of our knowledge or common modern experience. Yes, some large populations have basically eaten this way since forever (particularly in places like my home Alaska), and probably were LMHR, but there's virtually no data in modern people to examine.

However, a common man can observe that, by all accounts, the LMHR types appear to be thriving, despite LDL levels vastly beyond what conventional medicine considers dangerous. This is largely in middle aged people, who by virtue of age alone should be showing significant heart disease. Just to be considered for the LMHR study, participants have to have been on low carb/ketogenic diets with elevated LDL for years.....at a minimum this is all a serious challenge to the conventional wisdom of the diet heart hypothesis that we've all been stuck living under for most of our lives.

Modern medicine has made an incredibly bold claim and stuck with it for decades. It's become dogma, and has radically affected what we eat. The diet heart hypothesis entails a belief that ancient foods, the foods that constituted the vast bulk of the available calories in many areas of the non-agricultural world for most of human history....somehow those foods are the major cause of heart disease.

Huh. Well, maybe. That is a bold claim. What evidence is there for that? There ought to be some tests about that. I'm no longer willing to just default accept whatever "The Science Tm" says, especially when it goes so heavily against plain common sense and observations in my daily life. Nor the historical and anthropological evidence of Alaskans (or Sami, or plains Indians, or Massai, etc) or early explorers. The burden of proof for such a claim lies on YOU modern medicine.

In short, it's not easy to declare what is true and complete and ideal in a complex system like the human body...but it's not all that hard to poke holes. It's doesn't take much to demonstrate that what we think we know is insufficient and probably isn't true. My frustration is that most of our medical system seems uninterested or incapable of considering contrary evidence. It is unfortunately quite possible to have better health outcomes by letting common sense and common observation be your guide, rather than to do submit to whatever your doctor tells you if he just relies on the AMA, AHA, ADA, USDA, FDA, etc. to do his thinking for him.

I'm not claiming that we should all have LDLs of 300-700. I don't know what the ramifications of that is. I suspect there's probably downsides that I don't know of. But I do know that there are more and more people like me that, rather inconveniently, and totally contrary to the predictions of "Modern Medicine Tm", keep on not dying of heart disease. Shocker.

My conclusion in all this? Something is wrong about this story we've told for 60 years. Also, our medical institutions are still made up of people, and are just as likely to engage in dogmatic, delusional group think as the rest of us mortals.

Heart disease is a /long-term disease.

Fine and yes, heart disease is a long term disease, and this study only lasted one year. But of note, the average age was 55, and average length of time on an ketogenic diet with high LDL cholesterol was 5 years. And of the 100 participants....zero would be considered high risk from their baseline plaque or plaque progression. To be considered for the study you already had to have been on it for 2 years minimum (maybe 3? can't remember) before the study began. If the diet heart hypothesis was true, shouldn't there be something like a dose dependent response to spectacularly high cholesterol? We're not talking about people with just elevated levels of LDL, these people are several standard deviations away from what's been considered dangerous.
Where is the signal?

I would also mention that you can have high HDL and low Triglycerides eating a shit pile of carbohydrates, they are not mutually exclusive. Those 2 factors are more indicative of exercise and metabolic condition than anything. For example, my HDL is 80+, Triglycerides sub 50 and I eat 300-400 carbs a day.

True and I don't dispute that. For me, what carbohydrates I eat seem to matter. Also for me and many others, it's much easier to eat carbohydrates to excess and go on a blood sugar roller coaster. But that's not everybody, and that's fine.

Side note, it was interesting to me that in my quest to pass a test crash my LDL numbers in the Army, by nearly completely switching from a fat based metabolism to carbohydrate based, I only gained like 12-15lbs of fat in 5 weeks. I ate carbohydrates excessively, but very low fat. Yes I got fat, lost muscle, got sick all the time, skin problems, multiple rolling cold sores outbreaks, massive blood sugar and energy level/mood problems. But I didn't really get all that fat. I highly suspect that had I added more fat with the carbohydrates I would have gotten fatter more quickly. Interesting.

All this to say, I think many diets can work. IMO, being a reasonable bodyweight, lean, muscular and exercising hard are the most important, really terrible genetics withstanding, for long term health.

Concur. I forget the tribe, but there was a tropical indigenous people I read of that consumed something like 85% or more carbohydrates, with no imported food. Like several indigenous populations uncorrupted by modern food-like substances, they seemed to live long healthy lives absent modern chronic diseases. Likewise there have been several extremely low carb populations that seemed to do equally well. Usually more muscular however. Anyway, there's more than one way to live well.

 

[JDBAK]

He has talked a little about both LMHR and also a genetic variation that has basically no LDL at all. He is very much in the camp though that ApoB is causal of ASCVD and should be stamped down to the lowest possible level often with the help of PSCK9 inhibitors and statins. At least what I have heard while he is very critical of looking at LDL vs ApoB he is quite dismissive of the idea that LMHR is safe with those lipid levels or some of the alternative views on lipids generally within the community of low carb fans. And I dont mean dismissive as a criticism necessarily though I am also not so sure I agree with him on this point. I think there is not a significant body of evidence yet and he has a fairly high threshold for proof.

Attia is an interesting case to me. I like him, have listened to a fair bit of his content. But, he seems pretty arrogant in some ways. He seems to refuse to be willing to seriously consider that maybe some of his assumptions are suspect, as evidenced by all these actual flesh and blood LMHR types that keep on inconveniently not developing heart disease.

It's kinda like the joke about the skeptical expert that argues "OK the FINE!. So what if it works in practice? Does it work in theory?!"

 

[Speaks]

Attia is an interesting case to me. I like him, have listened to a fair bit of his content. But, he seems pretty arrogant in some ways. He seems to refuse to be willing to seriously consider that maybe some of his assumptions are suspect, as evidenced by all these actual flesh and blood LMHR types that keep on inconveniently not developing heart disease.

It's kinda like the joke about the skeptical expert that argues "OK the FINE!. So what if it works in practice? Does it work in theory?!"

Yea I like Attia but he gets really stuck on some things in a way that does not always seem to track. In this case given the years of pumping himself full of every cholesterol lowering medicine on the market it might cause some level of cognitive dissonance to consider the possibility that the basis for this was incorrect.

 

[songster]

our health care system is awful. takes months to get an appointment and then they spend 10 minutes with you before they rush you out. no time to get to know a patient. we're just a number

 

[JDBAK]

This is a great summary and definitely a group of patients I’m not familiar with (and haven’t personally treated). However with my interests in sports medicine I may encounter patients that fit this profile in the future and this is a really nice primer on things to consider.

Just to make sure I’m understanding, are you suggesting that the body compensates for the low-carb diet in these elite athletes by making more LDL to serve as fuel for a largely ketogenic diet?

Yes. It's not seen so much in the general population going ketogenic that has excess body fat and lower energy demands, but it appears that once a person becomes sufficiently lean, dependent on fat for energy (consuming few carbohydrates) and with high energy demands, then the need for LDL goes up. Check out Dave Feldman's lipid energy model hypothesis on

Cholesterol Code

Reverse Engineering the Mystery

cholesterolcode.com

I suspect there's a genetic component in there as well, as there are lean athletes like Shawn Baker on carnivorous diets that have high, but not stupendously high LDL. I was like 10 standard deviations high LDL at one point as a carnivore. I've heard of a 70 something year old with an LDLc of 700, who'd been eating that way for who knows how many years.

Also, as a fat adapted person fasts the LDL tends to rise.

Conversely, one of the short term hacks to lower LDL is to gorge on fat for about 3 days. Dave has run that experiment on himself several times and posted the result. I think he dropped his LDL like 40% or something (100+ points?) doing this.

If yes, are there any discussions of this from Peter Attia? I follow him and his work closely for personal interest and recall he had often been zero or low-carb while training at a high level. Perhaps Peter Attia fits the LMHR profile?

The time I've heard him really wrestle with the topic was with Dave Feldman a few years ago. It as very frustrating to listen to. I don't think Attia was capable of considering Feldman's evidence or point of view at the time. I like Attia and think he's done some great work. But I found him quite arrogant, and have much more respect for Dave Feldman and his pursuit of science.

As an anecdote, my grandfather lived to 90 but had some health issues along the way. He was always lean and muscular to the day he died. His diet most of his working life (logging, farming) was to eat a dozen eggs, pound of bacon, 6 pieces of toast and pint of milk ever morning. He would work outside all day and then have a dinner that was essentially meat and potatoes, often with ice cream for dessert. As he got older, his blood work suggested extremely high cholesterol (I don’t know specific metrics). Not surprisingly, doctors often tried to get him to take statins and eat more plants to lower his cholesterol. The more he did this (and the lower his cholesterol) the worse he felt. At around 70 he had a heart attack and struggled to recover for over a year despite following all the recommendations. He eventually said the hell with it and stopped taking his statin, went back to the diet of his youth and within a few months he was back to his former self, even better than before his heart attack.

I do believe statins have a place and for some patients, can truly be life saving. That said, I also have a healthy level of skepticism that we may not fully understand who the best candidates are, especially to people who appear to be healthy other than their cholesterol (especially high LDL).

I'm agnostic about statins, but it baffles me that we take one snapshot in time lipid test, look at one number in isolation, and then prescribe statins forever. No thanks.

Look forward to reading more about this in due time!

 

[timekiller13]

My cousin is a perfect example of why doctors don’t waste their time and just prescribe whatever people want.

She’s 60-70lbs overweight. Has high BP, borderline diabetic. She asked the doctor for something to help her lose weight. The doctor gave her an exercise regimen and a diet regimen to follow.

My cousin said “I’ll just find a doctor who will prescribe me Wegovy.”

 

[Pharmseller]

Our culture believes healthcare should be free and our lifestyles should be without consequences.

No ownership.




P

 

[wh0cansay]

There is no reliable research linking LDL to cardiovascular disease. End of story.

Statins are a death sentence.

 

[HFBPA889]

I have high LDL cholesterol…I have refused statin drugs. LDL cholesterol DOES NOT cause atherosclerosis or heart disease. There is a great heart surgeon named Dr. Philip Ovadia who has great knowledge and information you should look at…along with many other doctors not beholden to the medical establishment. Do your own research…you need to take control of your health…the doctors come out of indoctrination camps (college) and follow protocols established by their pay masters (big pharma).

 

[Pharmseller]

Please.

Show some respect.

Capitalize the B and P.

It’s Big Pharma, peasants.





P

 

[yfarm]

I have high LDL cholesterol…I have refused statin drugs. LDL cholesterol DOES NOT cause atherosclerosis or heart disease. There is a great heart surgeon named Dr. Philip Ovadia who has great knowledge and information you should look at…along with many other doctors not beholden to the medical establishment. Do your own research…you need to take control of your health…the doctors come out of indoctrination camps (college) and follow protocols established by their pay masters (big pharma).

You have the players mixed up here a little.
The most coercive player is medicare through their payment system the goal of which is to pay as little as possible for as much as they can wring out of you as a provider.
Medicare establishes care guidelines and mandates compliance through their “Quality” system, if you dont do what they say you get docked. No appeal.
Those guidelines are developed by the bureaucrats with advice from advisory panels made up of experts in the field but the bureaucrats are not bound to follow the advice of the panel. There may be reps from pharma on the panel. Obviously pharma has avenues to influence those guidelines.
If you think that any lowly medical student or resident physician has any time to be indoctrinated by pharma you are sadly mistaken, they are just trying to survive working 80-100 hrs a week and avoid being in the line of fire by an attending on rounds. They are happy that a pharm rep may show up and buy lunch for a conference some noon but thats about the extent of pharmas influence on an in training physician.
Want to blame someone for most of the problems in health care today, look at the feds both the senators and reps as well as the bureaucrats at HHS.