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Old 11-20-13, 05:41 PM   #126
Sixty Fiver
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I spoke with my doctor today about statins... he said he will only prescribe them for people with hyperlipidemia and other contributing risk factors for heart disease.

He is not one to push pills as a solution... he jokes that simply getting off the couch can do wonders for many people.

I won the BP lottery today... the nurse was really surprised at the 99/70 with a "just sat down" pulse of 55 and said that was like a teenager.

My doctor explained the cycling thing to her.
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Old 11-20-13, 08:28 PM   #127
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I spoke with my doctor today about statins... he said he will only prescribe them for people with hyperlipidemia and other contributing risk factors for heart disease.

He is not one to push pills as a solution... he jokes that simply getting off the couch can do wonders for many people.

I won the BP lottery today... the nurse was really surprised at the 99/70 with a "just sat down" pulse of 55 and said that was like a teenager.

My doctor explained the cycling thing to her.
Congrats!

... But I'll call you and raise you one:

I saw my cardiologist today - and my systolic was 98! (and he cut my BP med in half...)

But, even better, the subject of the new standards was never even mentioned. BUT, what we did talk about was the lifestyle (diet and exercise) changes that I have made -- and because of that, he thinks it is possible he may be able to D/C the 10mg of Crestor that I am taking!
... I guess the process of answering that questions starts next week when he wants me to get a lipid panel...

Please wish me luck on this one, as I REALLY would like to get off of statins because I have experienced 3 different side affects from them. But I won't do it without his say-so -- not only because I respect his opinion but, with a strong family history of heart disease as well as my own history of high blood pressure and high cholesterol, I would hesitate to do it on my own (even though I know more about it than probably 90% of the PCP's out there)
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Old 11-21-13, 01:31 AM   #128
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Machka
Rowan wrote-"Fortunately, my medical record doesn't follow me around like a bad smell unless I allow it to for one reason or another. Doctor-atient confidentiality means a lot in Australia."
My guess is he -rowan-feels fortunate the record DOESN'T follow him- because this cardiologist more or less wrote "I don't want to see him because he wasn't interested in my suggested treatment" a negative sort of comment-I think- perhaps "code" to other MDs "this patient is difficult"
which is why rowan feels fortunate it doesn't follow him.

It is hard to say just what "he sees no need to pursue my course" actually means??
Polite way of saying- "please don't come back" ??
Nope ... not at all.

Rowan was declared healthy (and in control of his own health) by the Specialist who wrote that statement. However, should something come up, the Specialist would have no qualms about seeing Rowan again. The Specialist did not write: "I don't want to see him because he wasn't interested in my suggested treatment" or any similarly negative.

And the fact that medical records don't follow us around here in Australia is a separate comment from the comment the Specialist made. The word "however" in his second paragraph indicates a change of direction in the discussion.

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Old 11-21-13, 02:09 AM   #129
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Congrats!

... But I'll call you and raise you one:

I saw my cardiologist today - and my systolic was 98! (and he cut my BP med in half...)

But, even better, the subject of the new standards was never even mentioned. BUT, what we did talk about was the lifestyle (diet and exercise) changes that I have made -- and because of that, he thinks it is possible he may be able to D/C the 10mg of Crestor that I am taking!
... I guess the process of answering that questions starts next week when he wants me to get a lipid panel...

Please wish me luck on this one, as I REALLY would like to get off of statins because I have experienced 3 different side affects from them. But I won't do it without his say-so -- not only because I respect his opinion but, with a strong family history of heart disease as well as my own history of high blood pressure and high cholesterol, I would hesitate to do it on my own (even though I know more about it than probably 90% of the PCP's out there)
My BP and resting pulse have always been low... when I smoked my BP got up to 110/80 and think part of that was also stress related. I still had a resting pulse that was below 55 and could drop most of my cycling buddies and enjoy a smoke while I waiting for them to catch up.

I figured that since I may have won the gene lottery in some respects and because I want to chase my wife when I am 100 and be a burden to my grandchildren that I should ditch that habit and don't miss it... I might spark up my pipe once in a blue moon.

My cholesterol numbers have always been enviable and my doctor wishes everyone was as healthy in that respect... people in my family live a hella long time and heart attacks are almost unheard of.

My father died of a heart attack in his early sixties but he was a very heavy smoker and abused alcohol for almost his entire life. His brothers and sisters (my aunts and uncles) are all well into their late 70's and 80's now and enjoying great health save for joint issues... they have all had hip replacements. None of them smoked or quit many decades ago (before I was born) and they were not drinkers either.

My mom developed type 2 diabetes in her sixties and kicked that to the curb by adopting a healthier diet... she was always very active physically and despite being a light smoker and occasional drinker lived to 83 and succumbed to pancreatic issues. The doctor said her cardio and respiratory functions were that of someone half her age.

I just need a new back... mine is goobered and it limits the amount of activity I can do.

By adopting a lower carb diet I have reversed some unpleasant weight gain and managed to stay pretty lean despite a reduced activity that can also be sporadic.
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Old 11-21-13, 04:09 AM   #130
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Interesting article talking about statins within the Australian medical system.

Cholesterol-lowering statins explained ...
http://www.abc.net.au/health/library...01/3881358.htm

"The guidelines say

•regardless of a person's absolute risk level, treatment should begin with lifestyle interventions.

•people at high risk (those with >15% risk of a cardiovascular event within five years) are recommended to be treated simultaneously with lifestyle interventions and with therapies aimed at reducing both blood pressure and blood cholesterol. This is generally regardless of the level of their blood pressure or blood cholesterol.

•people at moderate risk (those with 10-15% risk of a cardiovascular event within 5 years) should be given the opportunity to reduce their risk by following lifestyle advice, with drug therapy only considered if their risk has not reduced in three to six months or if they have specific additional factors."



The article goes into a lot more detail than that, including talking about the side-effects of statins.
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Old 11-21-13, 05:55 AM   #131
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Nope ... not at all.

Rowan was declared healthy (and in control of his own health) by the Specialist who wrote that statement. However, should something come up, the Specialist would have no qualms about seeing Rowan again. The Specialist did not write: "I don't want to see him because he wasn't interested in my suggested treatment" or any similarly negative.

And the fact that medical records don't follow us around here in Australia is a separate comment from the comment the Specialist made. The word "however" in his second paragraph indicates a change of direction in the discussion.
Maybe so-I just was not sure what "he sees no need to pursue my course(and that is in writing)" means.
So you figure pursue means "debate/or disagree with" as in Dr saw no need to disagree with my plan
-not as I took it Dr saw no need to "follow" my case
Seems reasonable.
The "in writing" made me take a more negative slant-
Usually-in USA- extra writing is done to CMA in some way.
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Old 11-21-13, 06:03 AM   #132
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Maybe so-I just was not sure what "he sees no need to pursue my course(and that is in writing)" means.
So you figure pursue means "debate/or disagree with" as in Dr saw no need to disagree with my plan
-not as I took it Dr saw no need to "follow" my case
Seems reasonable.
The "in writing" made me take a more negative slant-
Usually-in USA- extra writing is done to CMA in some way.
I'm not just "figuring" or "guessing" what Rowan and his Specialist meant ... I know what they meant.

And there was a very positive reason it was done in writing.
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Old 11-21-13, 06:06 AM   #133
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Ahhhhhhhh
I was a bit slow! It is early here new orleans-6am-only 1 cup of coffee so far.
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Old 11-21-13, 09:59 AM   #134
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... "The guidelines say

•regardless of a person's absolute risk level, treatment should begin with lifestyle interventions.
...

•people at moderate risk (those with 10-15% risk of a cardiovascular event within 5 years) should be given the opportunity to reduce their risk by following lifestyle advice, with drug therapy only considered if their risk has not reduced in three to six months or if they have specific additional factors."

... .
And, actually, the American guidelines have said, and still say, pretty much the same. Unfortunately, most physicians simply ignore that part of the guidelines -- or give it a half hearted, token effort -- because they work under the assumption that nobody will make the effort to make the necessary life style changes...

Often, they will give the patient the chance to make the changes, but no real support (which the evidence shows is a critical factor)...

I am thankful that I am going to the Preventive cardiology department -- as well as the wellness clinic -- of the Cleveland clinic because there I have been getting excellent support for my lifestyle changes...

Yesterday, I saw the cardiologist, nutritionist and exercise physiologist.
... Because of my lifestyle changes, (stress reduction, nutrition and exercise) the cardiologist is starting the process to get me OFF of the statins that I have been taking since 1996. (I'll have my lipids checked next week -- if they are low enough, I think we will give it a try without them.)
.... Wish me luck! (I've dealt with several different side affects from those darn things and I would love to be shed of them)
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Old 11-21-13, 10:54 AM   #135
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I sure wish i could get off statins, my family history of high cholesterol and triglycerides has caught up to me. I don't smoke, weigh 150, cycle constantly, eat healthy , enjoy alcohol but not excessively. I started taking a fish oil pill with my Lipitor and went off alcohol for a month and my numbers were substantially lower, I sure wish I could say it was the no booze and fish oil. My doctor says no matter what I do my triglycerides will still be high if not for the Lipitor. What do you guys think. Thanks Jim
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Old 11-21-13, 11:05 AM   #136
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I sure wish i could get off statins, my family history of high cholesterol and triglycerides has caught up to me. I don't smoke, weigh 150, cycle constantly, eat healthy , enjoy alcohol but not excessively. I started taking a fish oil pill with my Lipitor and went off alcohol for a month and my numbers were substantially lower, I sure wish I could say it was the no booze and fish oil. My doctor says no matter what I do my triglycerides will still be high if not for the Lipitor. What do you guys think. Thanks Jim
You may have to change your lifestyle a little... I am betting that if you are cycling constantly that you have a carb heavy diet and this can raise your triglycerides.

One thing to do is to look at your carb intake... lots of "healthy" diets are too high in carbs and cyclists tend to be carb junkies.

That Mediterranean diet is for real... it is loaded with Omega 3's and does not have the Omega 6's that western foods are loaded with.
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Old 11-21-13, 11:27 AM   #137
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Latest "good food" news- eat nuts-any nuts and peanuts count (and real peanut butter counts)-drops various risks by significant amounts
TV said drops mortality by 20%- but not literally-the time frame wasn't mentioned.

Wish my BP was lower than 138/78- )on lisinopril HCTZ-) easily 15 pt higher if I took nothing. Could be worse of course.
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Old 11-21-13, 02:26 PM   #138
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I sure wish i could get off statins, my family history of high cholesterol and triglycerides has caught up to me. I don't smoke, weigh 150, cycle constantly, eat healthy , enjoy alcohol but not excessively. I started taking a fish oil pill with my Lipitor and went off alcohol for a month and my numbers were substantially lower, I sure wish I could say it was the no booze and fish oil. My doctor says no matter what I do my triglycerides will still be high if not for the Lipitor. What do you guys think. Thanks Jim
I agree with 65'r. My understanding is that Triglycerides have more to do with lifestyle than genes. And, if that is the case, then I would wonder why he would tell you that they will "always be high"...
... We're trained to never question a physician (they are gods you know!). But asking questions should always be an option -- particularly if it will impact YOUR health and well being...

(Just a thought: he might have said that because he does not have a magic pill to bring them down -- but that doesn't mean that you can't!)
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Old 11-21-13, 03:29 PM   #139
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I sure wish i could get off statins, my family history of high cholesterol and triglycerides has caught up to me. I don't smoke, weigh 150, cycle constantly, eat healthy , enjoy alcohol but not excessively. I started taking a fish oil pill with my Lipitor and went off alcohol for a month and my numbers were substantially lower, I sure wish I could say it was the no booze and fish oil. My doctor says no matter what I do my triglycerides will still be high if not for the Lipitor. What do you guys think. Thanks Jim
I bet you can drop the triglycerides to less than 100 if you cut your carbs to <100g/day. Triglycerides are connected to carbs. If you get ride of them, the trig's drop as will your A1c. It starts with _eliminating_ grains and embracing fats (coconut oil, avocado, nuts, olive oil, grass-fed butter and meats, oily fish and full fat dairy are all good to go). Carbonfiberboy may point out that your cycling performance could suffer. He's correct. You'll get off drugs, though. It's up to you.
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Old 11-21-13, 05:17 PM   #140
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Less than 100g of carbs a day dam I will be one cranky guy. But I think you guys are onto something carbs are my weak point, with cycling I think I can throw anything down and not worry about it. Maybe it's time to find a new Doc
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Old 11-21-13, 07:16 PM   #141
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Less than 100g of carbs a day dam I will be one cranky guy. But I think you guys are onto something carbs are my weak point, with cycling I think I can throw anything down and not worry about it. Maybe it's time to find a new Doc
I just had a discussion on a related topic with a nutritionist yesterday. Her advice was that each meal should be balanced to include three parts: protein, vege's, carb...
... And that is also the standard diet pushed to diabetics....

So, if it works for a diabetic, it should work for you.

As for ditching the physician. Obviously that is up to you. But, you might want to have a talk with him first. Unfortunately, physicians get almost zero training in nutrition -- so whatever he knows about it, he got on his own. Basically, I am suggesting that if you have otherwise been happy with him, you may want to keep him. EVERY physician will have his weak points.
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Old 11-21-13, 07:51 PM   #142
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I bet you can drop the triglycerides to less than 100 if you cut your carbs to <100g/day. Triglycerides are connected to carbs. If you get ride of them, the trig's drop as will your A1c. It starts with _eliminating_ grains and embracing fats (coconut oil, avocado, nuts, olive oil, grass-fed butter and meats, oily fish and full fat dairy are all good to go). Carbonfiberboy may point out that your cycling performance could suffer. He's correct. You'll get off drugs, though. It's up to you.
My trigs are 34 and I eat lots of carbs, but I try to make them good carbs.
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Old 11-21-13, 10:19 PM   #143
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My trigs are 34 and I eat lots of carbs, but I try to make them good carbs.
You are one of the lucky ones that are carb tolerant, then. You must have chosen your parents well!
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Old 11-21-13, 10:23 PM   #144
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Less than 100g of carbs a day dam I will be one cranky guy. But I think you guys are onto something carbs are my weak point, with cycling I think I can throw anything down and not worry about it. Maybe it's time to find a new Doc
The upside is that you'll get to eat more fat. When a food company makes something 'fat-free' it tastes like crap. They then add sugar (HFCS) and salt until they can sell it. The 'original' version with the fat was more healthy and generally better tasting. Once you get used to it, it's no big deal.

The real bonus is that you get off the drugs.
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Old 11-21-13, 10:44 PM   #145
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I bet you can drop the triglycerides to less than 100 if you cut your carbs to <100g/day. Triglycerides are connected to carbs. If you get ride of them, the trig's drop as will your A1c. It starts with _eliminating_ grains and embracing fats (coconut oil, avocado, nuts, olive oil, grass-fed butter and meats, oily fish and full fat dairy are all good to go). Carbonfiberboy may point out that your cycling performance could suffer. He's correct. You'll get off drugs, though. It's up to you.
I went to my doc for my annual physical today. This was a good opportunity to explore these diet/statin/blood chemistry issues with him. He's a very sharp guy who pays attention to everything. He was very familiar with the issues being discussed here.

He ran my numbers on his phone app for the latest statin guidelines. I came up 12%. He said, yeah, that's an observed correlation between my numbers and outcomes in a dated study. However, that has really nothing to do with me, partly because correlation is not causation, partly because my exact combination of numbers isn't contained in the study, and partly because there are particular things associated with me personally which were not explored in the study. But mostly because of the causation issue. There are no studies that show that a person with my profile, given a statin, will live longer than a person of my profile without the statin. None. Now, a person who presents with coronary artery disease (CHD) . . . That's a whole 'nuther matter. There are many studies that show that people with CHD will live longer with a statin than without. Not to say that there aren't ways to alter one's numbers without a statin, but in the case of CHD the statin studies are definite.

That's because when one does a diet/outcome study, it's very difficult for the researcher to prove causation, simply because it's all too complicated. Diets may need to be tailored to an individual metabolism. Different dietary items have different effects on different people. Observational studies have no way to prove what was eaten. Interventional studies frequently don't include many foods which might have a profound effect on the result, regardless of macro category. But statins are much simpler: either take it or not.

Here's a nice paper that outlines some of the problems and explains some of what is known about contoversial topics of diet:
http://www.ravnskov.nu/A%20hypothesi...20response.pdf

As some posters have pointed out above, it is well-known that eating a high carbohydrate meal will raise LDL levels immediately after the meal. These drop off quickly. However, continually eating high carb meals will slowly raise continuous LDL concentrations, due to a slower elimination of these LDLs by the liver. However, it is not known that this actually increases the risk of CHD. In fact, it turns out that eating a high carb meal also increases the activity of fat-burning activity in skeletal muscle, lipoprotein lipase (LPL) activity. So that's something to consider: maybe it's supposed to work that way. As I've pointed out before: eat the carbs you're going to burn. I burn at least 500 cal./hour, riding or lifting weights.

As far as the whole eat-more-fat-to-avoid-heart-disease thing goes, there's simply no evidence. AFAIK there are only two long term studies which show that diet can reduce heart disease in people with CHD. Both these studies show that a vegetarian very low fat diet can reverse heart disease.

They are Ornish's study:
http://www.ncbi.nlm.nih.gov/pubmed/9...?dopt=Abstract
and Esselstyn's study:
http://www.heartattackproof.com/reversal01.htm

Here is a well referenced summation about what is known about diet and its contribution to or its prevention of CHD.
http://www.nutritionmd.org/health_ca...nutrition.html

Everyone agrees: the largest contributor to a tendency for CHD is abdominal fat. That's a really easy fix, actually saves money, and fixes many health issues, not just heart disease. Doesn't really matter too much how you do it: the effect is so great that effects of method are lost in the noise. Just do it.

BTW, in looking more closely at my diet, I discovered that my whey protein was contributing ~100mg cholesterol/day. Found an equivalent one with an order of magnitude lower cholesterol content. Read your label.

CFB: BP 108/70 today.
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Old 11-22-13, 01:07 AM   #146
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Abdominal fat is connected to higher triglycerides and these are connected to higher carb intake and is an indicator for metabolic syndrome, diabetes, and heart disease.

If you want to lower your triglycerides look at your carb intake.

Those triglycerides are also an indicator for inflammation which is believed by a great many people to contribute more to heart attack risk than cholesterol numbers.

Again, look at your carb intake.

Eating meals that are high in carbohydrates cause insulin spikes and blood sugar crashes (the bonk)... our bodies don't like this.

I never bonk.
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Old 11-22-13, 04:48 AM   #147
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I never bonk.
That's what I like most about a high fat/lower carb diet. A long and steady supply of energy. No need to refuel very often.
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Old 11-22-13, 05:16 AM   #148
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Just to clarify ...

There are two types of carbs: simple and complex. (Or perhaps in more modern terms high-GI vs. low-GI)

Everything I've read has said that complex carbs (i.e. veggies, whole grains) are OK, but that those of us with high triglycerides should reduce or eliminate the simple carbs (i.e. sugar, certain fruits).


Personally, I feel much better if I eat a complex carb diet and significantly reduce the amount of meat I consume. For 6 years, when I was at my peak fitness level, I ate meat once or twice a month. The rest of my meals were complex carb ... and cheese. I was slender, fit, and feeling good. My blood tests were also well within normal ranges.
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Old 11-22-13, 07:53 AM   #149
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Carbon',

Thanks for that. The paper you sited is a good one. Just some thoughts on it:
-- Ravnskov tells us: "even if many studies were supportive, one single study that falsifies it and which is based on verifiable observations should suffice for its rejection.

I would strongly disagree. While that statement MAY be true in some circumstances, those exceptions cannot be used to justify his sweeping generality. For example: While many studies have confirmed that higher LDL and lower HDL contributes to heart disease, a few recent studies have added medications that either lower dietary cholesterol or raise HDL cholesterol to those who already had favorable lipid profiles (through the use of statins). And, since they saw no change from those additional meds, some have said that refutes the entire lipid hypothesis. I would disagree. It merely points out that going from good to really good does not have a significant affect -- but it says nothing about going from bad to good.

Also, the paper repeatidly bemoans the 'fact' that you cannot prove the value of a truly healthy diet because people will not stick to it. I disagree with that. It is a self-fulfilling prediction where the physician says something like: "Well, you can try improving your cholesterol with life style changes, but most people are not able to do it..." He has guaranteed failure in two ways: 1) discouraging the patient from trying and, 2) Lack of support for those changes.

In addition, the paper also bemoans the 'fact' that they cannot get accurate measurements on diet because of the deficiencies of self-reporting... I think that USED to be true. Today, with smart phone apps, it is quick, easy and convenient to record every morsel that passes your lips when it happens... I think the research community needs to catch up to the technology that is already in wide use today and do some good studies on the effects of diet on health and well being...

And finally, the paper did correctly point out (as Esselstyn and Campbell have): too many studies only study dietary changes that take the person from really bad to bad -- and then say: "See it doesn't work". Those are studies of invalid hypothesis -- so they cannot be used to generalize and extrapolate...

BTW, last week I went to a talk by Dr Esselstyn. The talk was good and, at 80, he looked very good and was very sharp mentally. (He even broached the topic of cycling where he said with a sheepish little grin: "Cycling is good -- as long as you stay on the bike!") In addition, he told us that he is doing another, more extensive study of the "Whole food, plant based diet" he advocates and the results, when published early next year, will be strongly supportive of his diet.

And, finally: Congrats on the BP! Those are good numbers!
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Old 11-25-13, 02:59 AM   #150
Rowan
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Here is an explanation of my heart situation:

http://www.bikeforums.net/showthread...t-attack-isn-t
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