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1 & 2 ok, but i don't think intense exercise is good for your health long term.Goals: (reality marked with a *)
- avoid caloric excess*
- adequate fiber intake
- intense exercise 2-3x/wk*
.
1 & 2 ok, but i don't think intense exercise is good for your health long term.Goals: (reality marked with a *)
- avoid caloric excess*
- adequate fiber intake
- intense exercise 2-3x/wk*
.
I wasn't aware that they had found the fountain of Youth.Ignoring the body of evidence that low testosterone is detrimental to the aging male, and then failing to address it properly is the only stupid thing.
I wasn't aware that they had found the fountain of Youth.
Student in my 20's here. Somewhat in uncharted waters but I am curious as to what will happen and willing to experiment on myself.
Metformin 500 mg qd
Pravastatin 20 mg qd
Fish oil
Multivite
You will dieStudent in my 20's here. Somewhat in uncharted waters but I am curious as to what will happen and willing to experiment on myself.
Metformin 500 mg qd
Pravastatin 20 mg qd
Fish oil
Multivite
If you are going to use Rx meds for preventive care what you need is some more data (labs) and a progressive physician. Don't treat yourself.
I'm clearly not one to shy away from pharmaceuticals for health optimization, but statins are a drug class that I would hesitate to take unless you have very very high cholesterol levels. That drug class is not benign and the data on cholesterol levels and MI's is somewhat weak. It's true that data on statin use seems to be beneficial in avoiding CV events but you should look into wether this may be due to the fact that statins have anti inflammatory effects, and may be irrespective of cholesterol levels. Realize, too, that statin use has been historically pushed very very hard by Big Pharma and the NNT is around 110 last I checked. There are generations of cardiologists who may still worship at the statin altar, but what is the science really saying these days. Again, look at your risk factors and pay attention to the SE profile of statins. Not harmless.
For Metformin, the people who will benefit most are people with some level of insulin resistance. How do you tolerate carbs? Do you tend to gain quite a bit of weight after eating a high carb diet (low fat)? What are your fasting blood glucose levels?? If you consistently are in the mid-high 90's and FOR SURE over 100, then you have insulin resistance to some extent. It's a spectrum. Check fasting insulin levels for indications of some level of hyperinsulinemia, a sure sign of insulin resistance, and also check A1C. The lower the better.
If you find that you have insulin resistance (and it tends to increase with age), then consider metformin, but have this discussion with your Dr. Many are aware and are treating prediabetes. Studies on actual weight loss seem equivocal. But, if you restrict carbs (you must do that if you are insulin resistant, there is no choice) and take metformin, you can very well lose weight with exercise.
If you catch insulin resistance quickly before you become hyperinsulinemic, then DM-II is a CHOICE (with the knowledge that we have today). But, again, the natural history of this "disease" is normoglycemia for a long time (5 or 10 years?) before hyperglycemia. By the time you are consistently warranting of a DM-II (FBG>126 on multiple occassions) you will have been hyperinsulinemic for years. And by virtue of that, you will have had a very hard time losing excess weight. By that time, also, you will have greatly taxed your B cells potentially to the point of no return (Insulin dependency), and at THAT point it will be very hard to reverse course.
So, you need to understand the disease, and your genetic propensity, and catch things early. Don't f.ck around with HTN or DM. We all see the effects of those two comorbidities. Put pride aside and do what you need to do. Not all meds are bad. ACEI's and ARBs have a very favorable SE profile. Not all do, however.
You will die
I get what you're saying about statins. Not sure if I'll ever find a progressive doc willing to write the Rx and monitor me with labs save for a close friend, family friend, etc. I don't blame them either - too much liability. Should probably a least get a baseline CMP to check my liver enzymes. Purposefully went for prava due to lowest rates of enzyme elevation, myopathy, etc. No hepatic metab.
I liked what I read about the "cumulative damage hypothesis" regarding plaque formation, and how early intervention stems its development better. I know, I know, it doesn't translate to clinical outcomes, etc.
As for metformin - any actual data indicating risk to user or unfavorable side effect profile in an otherwise healthy, non-obese nondiabetic? Especially at such a low dose? I have found nothing to say that it is of significant risk (save for some reports of B12 deficiency, correctable with supplementation).
Hah. Indeed.
That's a tough one. It depends on the herniation and the surrounding structures as you are aware. Some people improve with time and others don't. I beAnybody have experience with disc disease? Found out I have an L5-S1 herniation a few months back and haven't found relief despite TFESI and heavy PT.
Yeah, I was hoping it would get better with time and PT and that doesn't seem to have happened. Unfortunately, the data seems to indicate that operating within the first 6-12 months of symptoms is beneficial but after that outcomes go downhill. So not a lot of time to make up my mind.That's a tough one. It depends on the herniation and the surrounding structures as you are aware. Some people improve with time and others don't. I be
I've PT is the best solution but it isn't a guarantee either. Chances are, this will flair up from time to time.
Time to operate is when you have radiculopathy. Don't wait for a deficit or muscle wasting. I'm not sure a microdiscectomy is beneficial if these symptoms are not present.
If the TFESI didn't work you could try the standard ESI. I will go back and forth btw the two depending on results. But I'm not someone that subscribes to steroid injection care strictly. I believe they are temporizing measures only.
Yeah, I was hoping it would get better with time and PT and that doesn't seem to have happened. Unfortunately, the data seems to indicate that operating within the first 6-12 months of symptoms is beneficial but after that outcomes go downhill. So not a lot of time to make up my mind.
Tough finding time off as a resident as well.
Couldn't agree more.Diet, exercise, and avoiding medications/supplements will cure or adequately treat 90% of the health problems in the US. We have become so absurdly dependent on taking pills (including supplements) to prevent or treat disease, often with significant side effects or unrecognized side effects. Diet means more than eating a "low fat" meal, which means a meal packed with carbohydrates, particularly HFCS made from enzymatic cleavage of corn to fructose. HFCS is present in 40-60% of all of our foods and the liver is the only organ that can metabolize HFCS (compared to most organs and cells that can metabolize sucrose). Excess HFCS is metabolized to fat. Our society has become obese due to low fat foods packed with HFCS. Simple solution- stop eating foods with HFCS and substitute foods with more fat (more satiating requiring less volume of food) or protein. Low amounts of complex carbohydrates are preferred. We really don't need pills for every malady- just eat reasonably, exercise every other day, and avoid pills. Vitamin D is the only vitamin that is deficient in our diet but is sometimes present in fortified foods.
Diet, exercise, and avoiding medications/supplements will cure or adequately treat 90% of the health problems in the US. We have become so absurdly dependent on taking pills (including supplements) to prevent or treat disease, often with significant side effects or unrecognized side effects. Diet means more than eating a "low fat" meal, which means a meal packed with carbohydrates, particularly HFCS made from enzymatic cleavage of corn to fructose. HFCS is present in 40-60% of all of our foods and the liver is the only organ that can metabolize HFCS (compared to most organs and cells that can metabolize sucrose). Excess HFCS is metabolized to fat. Our society has become obese due to low fat foods packed with HFCS. Simple solution- stop eating foods with HFCS and substitute foods with more fat (more satiating requiring less volume of food) or protein. Low amounts of complex carbohydrates are preferred. We really don't need pills for every malady- just eat reasonably, exercise every other day, and avoid pills. Vitamin D is the only vitamin that is deficient in our diet but is sometimes present in fortified foods.
1 & 2 ok, but i don't think intense exercise is good for your health long term.
MS1 here...been keto for a couple years. Have you noticed any significant increase in interest in low carb higher fat diets amongst your colleagues? Read a lot of nutrition literature and books and the whole high carb low fat mantra doesn't make any sense to me. Yet, that's the only thing my school teaches in every nutrition lecture.been on keto and down to 200
80% of physique is diet.
70% genetic, 20% diet, 10% exercise
Couldn't agree more.
As for those on the T bandwagon... Can you please forward some prospective studies over? The whole movement sounds awfully similar to HRT in women...ie: it's low, let's replace it. The initial studies seemed great. We all know how that ended up...
Eh I wouldn't go as far as 70% genetic though I do believe it plays a role. The fact that I have witnessed obese people from obese families become absolutely lean, muscular and athletic and then continue to maintain it demonstrates to me that genetics isn't as large as some would like to think it is.
In my personal opinion I think people mistake poor habits for genetics in that kids who have obese parents are more likely to be obese. But I believe it's because they grow up in a house that may not put a large emphasis on personal health including proper diet and daily exercise.
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I grew up in such a household. My diet consisted primarily of McDonald's, KFC, Burger King Wendy's and Arby's. Never drank anything but regular soda and milkshakes. My diet couldn't have been worse. Still I entered college at 5'8" 118#. Didn't break 130# til I hit my 30s. Granted I ran a bit but that was largely because it came naturally and was easy for me. So I think genetics plays a larger role than you think. I was the proverbial skinny guy with a hollow leg who could eat a ton and never put on weight. However, as I've gotten older I can't do that anymore. Maybe my telomeres are shortening.
just think of the billions of dollars that would be saved in treating hypertension and its associated complications and metabolic syndrome by simply eating more responsibly......
You cannot store more energy that what you bring into the system, simple physics.Correct. It will take a change in thinking. People think that eating any fat will cause massive obesity when in fact it is sugars, but especially HFCS that is the main culprit. It was take a sea change in the recommendations about diet.
Anybody have experience with disc disease? Found out I have an L5-S1 herniation a few months back and haven't found relief despite TFESI and heavy PT.
Well, sugars spike your insulin load which causes you to shunt into fat. A ketogenic diet markedly reduces insulin throughout the day and I'm fact, you could eat more calories and still lose weight than you could on a low fat diet.You cannot store more energy that what you bring into the system, simple physics.
HFCS or fatty foods, although probably detrimental to overall health, are irrelevant regarding obesity.
The main culprit is size of food servings: if you compare to Europe your serving size are probably twice as large thus 2x more calories.
Couldn't agree more.
As for those on the T bandwagon... Can you please forward some prospective studies over? The whole movement sounds awfully similar to HRT in women...ie: it's low, let's replace it. The initial studies seemed great. We all know how that ended up...
You cannot store more energy that what you bring into the system, simple physics.
HFCS or fatty foods, although probably detrimental to overall health, are irrelevant regarding obesity.
The main culprit is size of food servings: if you compare to Europe your serving size are probably twice as large thus 2x more calories.
And herein lies the EXACT reason for why we face an obesity and diabetes epidemic......
A misunderstanding of the VERY DIFFERENT metabolic pathways that different macronutrients undergo. Fat has very little impact on insulin levels. Carbohydrates, especially the sugars, have an immense impact on insulin secretion. Failing to understand this simple biochemical/metabolic difference is, literally, why we are seeing what we see in our society today.
If you have high levels of circulating insulin, either from a high carb diet, or from diabetes/pre-diabetes, you will have a very difficult time losing fat, because of the action of the hormone insulin and it's role in fat STORAGE. It is an anabolic hormone. The moe of it, the more fat you will have, even if you may be skinny fat with a high degree of visceral fat.......
If you are very insulin sensitive, this concept will be harder for you to understand without going back to the biochemistry texts.......
There are plenty of analogies which illustrate this metabolic concept but it's critical to understand HOW the body processes, metabolically, different macronutrients.
Like this review? 'Forever Young'†-Testosterone replacement therapy: a blockbuster drug despite flabby evidence and broken promises. - PubMed - NCBIDo your own research. I'm not here to hand hold you or sell you anything.
Like this review? 'Forever Young'†-Testosterone replacement therapy: a blockbuster drug despite flabby evidence and broken promises. - PubMed - NCBI
My point is that there is a lot of talk about TRT and I've seen very little to no evidence for it. Feel free to show me otherwise. The majority of pubmed recently on testosterone replacement is similar articles to the above.
I do agree 100% with your diet advice above though.
Female HRT is not a complete story. The WHI gave it a bad rap but what got lost in the noise is that there are legitimate benefits. The study showed a decreased risk of colon cancer and hip fracture. In addition, estrogen supplementation alone was not associated with increased breast cancer risk.
In addition, the timing of starting HRT is an important point that doesnt get a lot of press. There's a difference in response when you give HRT to a woman who is 7 years post menopausal versus a woman who is peri menopausal.
Not saying HRT is the fountain of youth but there is a lot we don't know and it can't be thought of as black and white when there is so many variables.
Eh I wouldn't go as far as 70% genetic though I do believe it plays a role. The fact that I have witnessed obese people from obese families become absolutely lean, muscular and athletic and then continue to maintain it demonstrates to me that genetics isn't as large as some would like to think it is.
In my personal opinion I think people mistake poor habits for genetics in that kids who have obese parents are more likely to be obese. But I believe it's because they grow up in a house that may not put a large emphasis on personal health including proper diet and daily exercise.
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PLEASE do not get a surgery for non radiculopathic low back pain. DO NOT get provocative discography either, as that is simply a gateway to surgery. Do not get an artificial disc, as they r fraught with problems and complications. In this day and age, hard to find surgeons that will even offer surgery for non radiating low back pain, but they r still out there. Very unlikely it will help, definitely might very well make things worse. Especially a fusion! Especially at your age! U will be getting repeat fusions periodically down the road as the levels above and below the fusion degenerate due to increased biomechanical load.
That post from Noyac about early surgery is horrible advice. Most quality spine surgeons won't even jump right in and operate even if u present with acute foot drop!
I would see a good quality pain doc. Post on the pain form to get recommendations in your area. The point is to determine if the pain is truly discogenic. The fact that u have a bludging disc on MRI means nothing, pretty much everyone over 30 does. There are many other reasons for non radiating low back pain, with reasonable treatments available.
If it truly is discogenic....There is no great solution for discogenic pain. If it is isolated to a single disc, the only two real options on the table in 2017 are biacuplasty and the mesoblast phase one intradiscal stem cell trial currently going on at many academic centers. Both have reasonable preliminary data but are definitely experimental. I would not have either personally.
If I were u I would just continue to learn to live with it, do the home exercises from PT regularly, try a fitted back brace not to be worn more than 60 minutes daily, TENS unit, some topicals, control your weight, regular aerobic exercise, Tylenol, etc.
As mentioned above, disc pain tends to burn itself out. One of the current theories is actually that it is an infectious issue, and there is some nice data from a trial with IV abx for discogenic pain!
Good luck, sorry u r dealing with this as a resident.
I see...minsunderstood your earlier post.Thanks for the recommendations. I definitely wouldn't be worried if it wasn't radiculopathic. My exam findings are consistent with an L5-S1 radiculopathy. Actually an almost textbook presentation.
I'd love to see that data about IV abx. I'm trying everything to avoid surgery. Waiting on that inversion table to arrive thanks to the earlier posts lol