Newly lost faith in health care

[ztc92]

If someone in their 30s has HTN he isn’t “broke”. He is eating a terrible diet and not getting any exercise. Just the facts man. A doctor isn’t going to be able to fix that. So what’s the point of going yearly for a check up to have the doc tell you you’re essentially overweight, eat like crap, and don’t get enough exercise seeing as you already know that? I mean come on people know what they’re eating and doing.

The much better course of action is to take care of yourself, eat well, get plenty of sleep and exercise. That will go a lot further in living a long happy life than a yearly check up from some general practiomer who writes Lisonopril scripts all day long.

I don’t want to be confrontational, but in the interest of promoting good health, I feel I need to point out this is not always the case. I agree with you that high blood pressure at a young age is definitely a concern, but there are other possible causes that do NOT relate to lifestyle.

One fairly common example would be renal artery stenosis. In some people, the artery that supplies blood to the kidney is narrowed and this leads to reduced blood flow to the kidney. That kidney senses the low blood flow as a problem and sends signals via hormones to increase the blood pressure and therefore increase the blood flow to the kidney.

This is just one of multiple examples I could provide where no amount of exercise or improved diet will impact the blood pressure.

That said, I also fully agree a healthy lifestyle is essential and try to discuss diet, exercise, sleep and substance use with all my patients for this reason.

If I can get one message across to you all, it’s that even if you live the healthiest lifestyle possible, there are still factors out of your control that can greatly impact your health. If these factors are stacked against you, a well-trained physician, armed with good screening/diagnostic tests and potentially using treatments including pharmaceuticals, procedures or surgeries can have a MASSIVE impact on your health. Get your yearly check-up, if done well it may greatly impact your life.

 

[MThuntrrr]

The super great majority of doctors receive little to no nutritional training. So good luck. Be an advocate for yourself.

A few starters... no or very little sugar, no pre-made food, fast food, good fats only from nuts, Avocado, and fish. More fiber. Very little or no alcohol. Avoid high processed food. And....exercise atleast a few times a week.

The foods you should be eating should be made, not unwrapped. That's the basics.

Some cholesterol issues are related, but they great majority is related to diet and lifestyle.

There are many natural things you can take from the health food store. Do your

False. I’m an MD and nutrition was a significant piece of the curriculum. During medical school, I heard the same rhetoric about MD’s not learning much about nutrition. I considered myself a nutrition/health nut prior to medical school, and I assure you my understanding was vastly deeper after medical school.

 

[Pharmseller]

False. I’m an MD and nutrition was a significant piece of the curriculum. During medical school, I heard the same rhetoric about MD’s not learning much about nutrition. I considered myself a nutrition/health nut prior to medical school, and I assure you my understanding was vastly deeper after medical school.

Not saying he’s right but I think it’s irresponsible to say he’s wrong.

He’s painting with a broad brush but you’re countering with your specific curriculum.

Nutrition was a significant piece of your curriculum. Absent more information you cannot project your experience across multiple curricula.

Therefore you can only say his statement is false in your experience.

He might be right about the great majority. You’re just not part of that majority.

Not splitting hairs.





P

 

[Marble]

False. I’m an MD and nutrition was a significant piece of the curriculum. During medical school, I heard the same rhetoric about MD’s not learning much about nutrition. I considered myself a nutrition/health nut prior to medical school, and I assure you my understanding was vastly deeper after medical school.

With all due respect...No...it is true. I didn't say all of them, just most. This is from Dr and nurses who have told me that. This is why there are dietitians and naturopath docs.

You guys have your talents and are highly trained and intelligent, and you have saved my life two times. But the majority do not even discuss diet options with any seriousness. And they should. There are a lot of diseases that have several factors with your diet bring one of the main biggest contributors.

Sent from my SM-S918U using Tapatalk

 

[timekiller13]

If someone in their 30s has HTN he isn’t “broke”. He is eating a terrible diet and not getting any exercise. Just the facts man. A doctor isn’t going to be able to fix that. So what’s the point of going yearly for a check up to have the doc tell you you’re essentially overweight, eat like crap, and don’t get enough exercise seeing as you already know that? I mean come on people know what they’re eating and doing.

The much better course of action is to take care of yourself, eat well, get plenty of sleep and exercise. That will go a lot further in living a long happy life than a yearly check up from some general practiomer who writes Lisonopril scripts all day long.

I’ve had HTN since I was 18. I was a 2 sport athlete in highschool.

I still have HTN at 40. I’m 5’11” weigh 170lbs. I run 35-40 miles a week, lift 3x week. I’ve ran several marathons, have done a few triathlons. I never eat fast food. My main diet is boiled eggs, chicken, fish, deer meat, lots of fruit. Very little caffeine (2 cups coffee daily), no sodas, no nicotine, minimal alcohol.

Tried to stop taking my BP meds last year. 3 days off of it my BP was 190/110. I’ve had a bunch of tests done. Genetics is the answer.

I went to one of those functional medicine doctors, hoping to get off the lisinopril. He could get me off of it, if I bought $200 worth of supplements a month . Fix my one pill a day issue by wanting me to take 3 or 4 supplements. No thanks.

 

[Predator_SD]

You can't exercise away genetics. Many issues can be addressed before they cause significant problems. Avoiding the doc because you're "healthy" isn't going to accomplish that. And yes there are people that do all the right things and still have hypertension in their 30's.

Some sure, absolutely. But the overwhelming majority are out of shape and eat like crap. Just look around you it’s an American epedemic. Just watch how many people are crammed in the fast food drive thrus at lunch and dinner times. It’s a real problem that’s only getting worse.

You can’t “doctor” away these horrible lifestyle choices. Genetics is rarely the cause of HTN, just a fact.

 

[Predator_SD]

I’ve had HTN since I was 18. I was a 2 sport athlete in highschool.

I still have HTN at 40. I’m 5’11” weigh 170lbs. I run 35-40 miles a week, lift 3x week. I’ve ran several marathons, have done a few triathlons. I never eat fast food. My main diet is boiled eggs, chicken, fish, deer meat, lots of fruit. Very little caffeine (2 cups coffee daily), no sodas, no nicotine, minimal alcohol.

Tried to stop taking my BP meds last year. 3 days off of it my BP was 190/110. I’ve had a bunch of tests done. Genetics is the answer.

I went to one of those functional medicine doctors, hoping to get off the lisinopril. He could get me off of it, if I bought $200 worth of supplements a month . Fix my one pill a day issue by wanting me to take 3 or 4 supplements. No thanks.

Sorry to hear you fall in the minority that aren’t causing htn and a myriad of other conditions because they live off fast food and soda and get zero exercise.

I was speaking of the masses, made a generalization on the state of American diet and wellness which is in horrible shape. And the culture of “there’s a pill for that” as opposed to actually working on improving fitness and diet. I could have been more clear or elaborated a bit.

 

[timekiller13]

Sorry to hear you fall in the minority that aren’t causing htn and a myriad of other conditions because they live off fast food and soda and get zero exercise.

I was speaking of the masses, made a generalization on the state of American diet and wellness which is in horrible shape. And the culture of “there’s a pill for that” as opposed to actually working on improving fitness and diet. I could have been more clear or elaborated a bit.

Oh there is no doubt that lifestyle is the main issue for most people.

I’ve worked in healthcare for over a decade, from emergency medicine, occupational health, inpatient nursing and education. People prefer the easy way out. It’s human nature. Either work hard and take months to see results, or take a pill and “fix” your issue with little change on the end users lifestyle.

Look at GLP-1s. I’ve seen so many people get on that to lose weight. It works. But so does modifying your diet and exercising. But that requires commitment and dedication. And it takes time. People want instant gratification. And quite honestly, doctors are too busy or just too burned out to dedicate huge amounts of time trying to educate people and get them to change their lifestyle.

Burnout is a real issue in healthcare. I’ve seen some great emergency medicine providers basically just give up and go through the motions, because they have nearly ruined themselves trying to do the right thing. Hell, I was there as a nurse. Nearly walked away from healthcare completely a few years ago. Felt like I was doing nothing more than slapping bandaids on people and fighting a battle that I could never win.

Government regulations and reimbursement standards have taking the critical thinking aspect away from healthcare. Everyone is so “task oriented” now that they don’t think about the reasons for that task, they just complete the task and move on to the next one.

I’ve got a cohort of new grad RNs I am training and I’m trying to make them understand the “why” behind things. I don’t want people to just do their job, I want them to understand the reason they are doing or not doing something.

It’s a struggle. But I’m hoping I can make a little difference.

 

[Speaks]

I don’t want to be confrontational, but in the interest of promoting good health, I feel I need to point out this is not always the case. I agree with you that high blood pressure at a young age is definitely a concern, but there are other possible causes that do NOT relate to lifestyle.

One fairly common example would be renal artery stenosis. In some people, the artery that supplies blood to the kidney is narrowed and this leads to reduced blood flow to the kidney. That kidney senses the low blood flow as a problem and sends signals via hormones to increase the blood pressure and therefore increase the blood flow to the kidney.

This is just one of multiple examples I could provide where no amount of exercise or improved diet will impact the blood pressure.

That said, I also fully agree a healthy lifestyle is essential and try to discuss diet, exercise, sleep and substance use with all my patients for this reason.

If I can get one message across to you all, it’s that even if you live the healthiest lifestyle possible, there are still factors out of your control that can greatly impact your health. If these factors are stacked against you, a well-trained physician, armed with good screening/diagnostic tests and potentially using treatments including pharmaceuticals, procedures or surgeries can have a MASSIVE impact on your health. Get your yearly check-up, if done well it may greatly impact your life.

Super good point. I am a bit of a health nut, and while I think some screening stuff designed as minimum population level testing / advise is kind of wasted on those willing to put in some effort everyone should be getting bloodwork and screening annually. You could have artery stenosis, you could be a cholesterol hyper responder, you might have high LPa, all kinds of stuff you might never catch and would not be obvious without testing which could be a time bomb without knowing about it and may require different protocols than a healthy normal person.

 

[Idaboy]

I’ve had HTN since I was 18. I was a 2 sport athlete in highschool.

I still have HTN at 40. I’m 5’11” weigh 170lbs. I run 35-40 miles a week, lift 3x week. I’ve ran several marathons, have done a few triathlons. I never eat fast food. My main diet is boiled eggs, chicken, fish, deer meat, lots of fruit. Very little caffeine (2 cups coffee daily), no sodas, no nicotine, minimal alcohol.

Tried to stop taking my BP meds last year. 3 days off of it my BP was 190/110. I’ve had a bunch of tests done. Genetics is the answer.

I went to one of those functional medicine doctors, hoping to get off the lisinopril. He could get me off of it, if I bought $200 worth of supplements a month . Fix my one pill a day issue by wanting me to take 3 or 4 supplements. No thanks.

Uff, that's a bummer, genetics definitely impact.....I have a close friend with similar story, sorry to hear.
I am sure you had in depth work up, but primary care can miss some things. For severe high blood pressure it's sometimes worth seeing kidney doc (nephrologist), as they are blood pressure experts and get in the weeds of odd cases of high bp. (A cardiologist can also be helpful, but it can be hit or miss with them working up other causes vs adding medication.). If you have any risks or features of sleep apnea gets that checked out, wasn't a magic bullet but will raise BP is sleep apnea not treated

 

[S.Clancy]

Other casual observations:

1. "Health nut" in my experience has a high probability of just meaning "nut"...
2. Blood pressure meds are some, if not the, safest and most effective medications in existence. If my BP was genetically high (190/110, holy cripes) I'd be gobbling the BP meds.
3. Genetics are the end all. My grandmother smoked for over 40 year and lived to 85, basically completely healthy until the last couple months.

 

[omicron1792]

Not saying he’s right but I think it’s irresponsible to say he’s wrong.

He’s painting with a broad brush but you’re countering with your specific curriculum.

Nutrition was a significant piece of your curriculum. Absent more information you cannot project your experience across multiple curricula.

Therefore you can only say his statement is false in your experience.

He might be right about the great majority. You’re just not part of that majority.

Not splitting hairs.

Other casual observations:

1. "Health nut" in my experience has a high probability of just meaning "nut"...
2. Blood pressure meds are some, if not the, safest and most effective medications in existence. If my BP was genetically high (190/110, holy cripes) I'd be gobbling the BP meds.
3. Genetics are the end all. My grandmother smoked for over 40 year and lived to 85, basically completely healthy until the last couple months.

Truth. You can make minor adjustments to health overcoming genetics. But only minor imo. We play the cards we are dealt.

 

[Idaboy]

Some sure, absolutely. But the overwhelming majority are out of shape and eat like crap. Just look around you it’s an American epedemic. Just watch how many people are crammed in the fast food drive thrus at lunch and dinner times. It’s a real problem that’s only getting worse.

You can’t “doctor” away these horrible lifestyle choices. Genetics is rarely the cause of HTN, just a fact.

Ummm, not sure that is correct. "Genetics is rarely the cause of HTN, just a fact".
Do have a resource you could reference to that statement? Yes, we know lifestyle, weight and medical conditions contribute, but please share your reference on "rarely the cause". Not pickin a fight, but there is data from fairly large, population based studies that have demonstrated family history/familial impact as risk factor for high blood pressure ( eg Framingham studies, and interestingly twin studies as well just to name a few), but maybe your aware of others that discount prior studies

 

[omicron1792]

Ummm, not sure that is correct. "Genetics is rarely the cause of HTN, just a fact".
Do have a resource you could reference to that statement? Yes, we know lifestyle, weight and medical conditions contribute, but please share your reference on "rarely the cause". Not pickin a fight, but there is data from fairly large, population based studies that have demonstrated family history/familial impact as risk factor for high blood pressure ( eg Framingham studies, and interestingly twin studies as well just to name a few), but maybe your aware of others that discount prior studies

You’re absolutely correct. Certain ethnic groups have much higher rates of certain diseases.

Check out Floyd mayweather dad. You could see all his abs and he weighs 140lbs and had terrible trouble with hypertension and cardiovascular disease. He lived and trained as a boxer.

 

[TandKHunting]

As someone on statins....I have had high cholesterol ratings since getting out of the Marines. No matter how many miles I ran a day, how clean my diet was...my numbers were always borderline high and got worse as I aged into my mid 30's. My family has a history of high cholesterol with my uncle dying of either a heart attack or pulmonary embolism at 54 years old. He was warned at 40 years old that he needed to take Lipitor and he refused. That obviously didn't end well.

Sometimes the solution is not as simple as diet and exercise. My wife is a nurse. She has seen healthy 25 year olds with strokes, heart attacks, cancer, and the list goes on. That's why it's important to fill out your family health history accurately, get annual draws, and do genetic testing if necessary. As my wife would say....you have to be an advocate for yourself.

You gotta do what's best for you, but if diet and exercise doesn't lower your numbers or you are still borderline high...I wouldn't resist medications. If taking one small pill a day extends your life by 10, 15, or 20 years it is most certainly worth it.

 

[JoeDirt]

As someone on statins....I have had high cholesterol ratings since getting out of the Marines. No matter how many miles I ran a day, how clean my diet was...my numbers were always borderline high and got worse as I aged into my mid 30's. My family has a history of high cholesterol with my uncle dying of either a heart attack or pulmonary embolism at 54 years old. He was warned at 40 years old that he needed to take Lipitor and he refused. That obviously didn't end well.

Sometimes the solution is not as simple as diet and exercise. My wife is a nurse. She has seen healthy 25 year olds with strokes, heart attacks, cancer, and the list goes on. That's why it's important to fill out your family health history accurately, get annual draws, and do genetic testing if necessary. As my wife would say....you have to be an advocate for yourself.

You gotta do what's best for you, but if diet and exercise doesn't lower your numbers or you are still borderline high...I wouldn't resist medications. If taking one small pill a day extends your life by 10, 15, or 20 years it is most certainly worth it.

Statins are the biggest healthcare scam, I would suggest you look into a atrial scan and do an elimination low crab high protein diet. Triglycerides are what you should be looking at not high cholesterol. It is well known now that high cholesterol is GOOD! Its a hormone your body needs its sent out to do repairs. By taking statins you're hurting this natural process.

Plenty of information out there on people who have extremely high cholesterol on a carnivore diet nearing a decade with no arterial cholesterol buildup.

Genetics do play a role but are not as important as eating right and exercise. People who broadly say "Genetics" are using it more of an excuse for high numbers however they're not the cause, bad genetics do not help but they take more of the blame because most people just want to take a pill.

Also "eating right" is a term tossed out there. Genetic do play some role in what type of food is tolerated.

 

[TandKHunting]

Statins are the biggest healthcare scam, I would suggest you look into a atrial scan and do an elimination low crab high protein diet. Triglycerides are what you should be looking at not high cholesterol. It is well known now that high cholesterol is GOOD! Its a hormone your body needs its sent out to do repairs. By taking statins you're hurting this natural process.

Plenty of information out there on people who have extremely high cholesterol on a carnivore diet nearing a decade with no arterial cholesterol buildup.

Genetics do play a role but are not as important as eating right and exercise. People who broadly say "Genetics" are using it more of an excuse for high numbers however they're not the cause, bad genetics do not help but they take more of the blame because most people just want to take a pill.

Also "eating right" is a term tossed out there. Genetic do play some role in what type of food is tolerated.

 

[Predator_SD]

Ummm, not sure that is correct. "Genetics is rarely the cause of HTN, just a fact".
Do have a resource you could reference to that statement? Yes, we know lifestyle, weight and medical conditions contribute, but please share your reference on "rarely the cause". Not pickin a fight, but there is data from fairly large, population based studies that have demonstrated family history/familial impact as risk factor for high blood pressure ( eg Framingham studies, and interestingly twin studies as well just to name a few), but maybe your aware of others that discount prior studies

Two second search brother. If you want to truly take a deep dive and look at endless amounts of research simply google it.

If you’re trying to actually argue that the increasing prevelence of HTN, DM, etc is not being caused by diet and lifestyle than you’re likely very much a part of the culture i’m talking about. Denial, not my fault, and “there’s a pill for that”.

It’s getting WORSE than it was for our parents and grandparents before us. That is not because of genetics it’s because of our increasingly sedentary lifestyles coupled with our increasingly processed garbage diets. Don’t lie to yourself man. It’s not genetics for the vast majority of pill poppers out there.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4624264/

https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.124.22753

How much exercise do we need to do?

Small amounts of exercise protect against early death, heart disease and cancer, according to new research.

evidence.nihr.ac.uk

Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery - PMC

Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity ...

pmc.ncbi.nlm.nih.gov

High-Salt Diet and Hypertension: Focus on the Renin-Angiotensin System - PMC

A high-salt diet is one of the major risk factors in the development and maintenance of hypertension. Numerous experimental and observational studies have confirmed the association of sodium intake with blood pressure levels. The effects of a ...

pmc.ncbi.nlm.nih.gov

I mean, the studies are endless but you don’t need them. Just go outside and walk up and down the street for an hour. Count how many people have are overweight and out of shape vs those who aren’t.

Insight into differences in dietary sodium adherence between men and women with heart failure - PMC

Men with heart failure are reported to be less adherent to low sodium diets than women. One potential reason may be that men consume more food and consequently more sodium than women. To compare dietary sodium intake, urine sodium excretion, and ...

pmc.ncbi.nlm.nih.gov

 

[Pharmseller]

View attachment 870086

But just think of all the money you’ll save!

Just say no to Big Pharma!




P

 

[Idaboy]

Two second search brother. If you want to truly take a deep dive and look at endless amounts of research simply google it.

If you’re trying to actually argue that the increasing prevelence of HTN, DM, etc is not being caused by diet and lifestyle than you’re likely very much a part of the culture i’m talking about. Denial, not my fault, and “there’s a pill for that”.

It’s getting WORSE than it was for our parents and grandparents before us. That is not because of genetics it’s because of our increasingly sedentary lifestyles coupled with our increasingly processed garbage diets. Don’t lie to yourself man. It’s not genetics for the vast majority of pill poppers out there.

View attachment 870106

https://pmc.ncbi.nlm.nih.gov/articles/PMC4624264/

https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.124.22753

How much exercise do we need to do?

Small amounts of exercise protect against early death, heart disease and cancer, according to new research.

evidence.nihr.ac.uk

Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery - PMC

Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity ...

pmc.ncbi.nlm.nih.gov

High-Salt Diet and Hypertension: Focus on the Renin-Angiotensin System - PMC

A high-salt diet is one of the major risk factors in the development and maintenance of hypertension. Numerous experimental and observational studies have confirmed the association of sodium intake with blood pressure levels. The effects of a ...

pmc.ncbi.nlm.nih.gov

I mean, the studies are endless but you don’t need them. Just go outside and walk up and down the street for an hour. Count how many people have are overweight and out of shape vs those who aren’t.

View attachment 870116

Insight into differences in dietary sodium adherence between men and women with heart failure - PMC

Men with heart failure are reported to be less adherent to low sodium diets than women. One potential reason may be that men consume more food and consequently more sodium than women. To compare dietary sodium intake, urine sodium excretion, and ...

pmc.ncbi.nlm.nih.gov

I did not discount diet, lifestyle, are major contributors to hypertension, and obviously are modifiable. I am not disagreeing with you or science about that, and probably the most important, since we can impact them.

You stated that "Genetics is rarely the cause of HTN, just a fact.", and I disagree with you on that. My point being that maybe a better statement is 'high blood pressure risks are clearly linked to diet, exercise and lifestyle. In addition to those risks, family history contributes to risk factors as well'
I NEVER SAID, that I disagreed that these with your view on these factors. But to say that genetic are "rarely" the cause, is not my read of the medical literature.
Thanks for the Google search, those all make complete sense. But even the Google search you posted cited genetic factors. I don't think that saying genetic factors are " rarely contributing" to high blood pressure is simply not accurate.