The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
-
Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
-
Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
-
Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
-
Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
No email address required.
Notes -
I believe her LDL is around 135.
Assuming they actually prolong life. My understanding is that "statin clinical trials have shown marginally significant benefits on mortality" at best over 5 years, and there's no good evidence they reduce long-term morality. That's why I came here to ask the question, I'm curious if there's newer or better evidence to support their effectiveness. If they don't work, then we're just risking side-effects for no gain.
I get that nutrition is hard to study, but do you really have no opinions about this topic as a doctor? Shouldn't lifestyle changes be the first line of treatment for this sort of thing? If you had to recommend the optimal diet to a patient with high cholesterol, what would it be?
I ask this because my mother is something of a health nut and will follow credible diet and lifestyle advice religiously. When her doctor told her to cut out red meat, butter, and eggs, she completely eliminated these things from her diet. If a doctor told her eating nothing but unseasoned boiled potatoes was the key to lower cholesterol, she'd eat nothing but unseasoned boiled potatoes. On the other hand, her doctor has not told her to avoid things like processed sugars or margarine, so she still eats plenty of that stuff.
So I'm interested in trying to set her up with the best evidence-based diet and lifestyle interventions possible. Since she is going to religiously follow some sort of diet program regardless, it may as well be the best possible program.
She is not at all overweight, goes on long hikes/jogs daily, skis, bikes, and is otherwise very physically active for a 70 year old.
I haven't seen any studies recently that have made me update significantly. I do agree that the benefits from statins are marginal, which is why I pointed out that they're so cheap that it's not too much of a fuss to take them. For primary prevention, it's minimal, it's somewhat better for secondary prevention where an adverse cardiovascular event has already occurred.
The risks, however, are also rather small. So we have a class of drugs that doesn't do very much good, doesn't do very much harm, but on the margin seem slightly positive and don't cost much. I wouldn't go out of my way to recommend them, but I have no issue with prescribing them either.
Please keep in mind that I'm a psychiatry trainee haha. While dietary advice isn't out of my core practice, especially with diseases like bulemia or when some drugs cause weight gain, I genuinely think that overly obsessing over dietary intake beyond basic, Common Sense™ knowledge is of minimal utility.
If someone did ask me for dietary advice (and everything is from a do as I say, not as I do stance, don't look at what I eat), then I'd suggest making sure they're eating leafy greens, and avoiding large quantities of deep fried or smoked meats. I'm not going to tell them how many eggs to eat, or what brand of milk to drink. Even for the advice against highly processed meat, the carcinogenic risk is also tiny in absolute terms, so I wouldn't belabor the point.
I do this not because I enjoy being ignorant, but because nutritional science makes no sense. As long as your diet avoids any obvious nutritional deficits and you're getting vitamins and minerals, while keeping to a healthy weight I'd be fine with it.
More specific advice would be tailored towards people with particular diseases like diabetes, and for those with cholesterol issues, I'd stress weight loss more than any particular category of food.
(Mild exception, I think the evidence for ice cream being good for you is interesting, and unless you eat a bucket a day having more won't hurt)
She's doing better than me! I'd tell her to keep on keeping on really. While GLP-1As have some surprising benefits, with interesting evidence emerging of all kinds of surprising yet positive impacts, including reduction in Alzheimer's risks, I would at least recommend looking into them, though of course you'd need a doctor willing to prescribe them. But if she's otherwise doing well and her existing diet isn't grossly unhealthy, I'd say to not fix what isn't broken.
More options
Context Copy link
More options
Context Copy link