Member
One of the chief problems with lifestyle changes for lipids (or anything, for that matter) is that people won't do it, and if they do it, it's generally not drastic enough to make a difference. Assuming that you are making sufficiently drastic changes, you'll probably get more benefit than most, but it's still just not going to be enough if you are a patient with established disease. It depends on what level of risk you're comfortable with, and you can mitigate the risk to very low levels, actually. But not with lifestyle alone.
Member
Well, two days ago, I warmed up on the treadmill for about 20 min.
Did empty bar squats, press, and rack pulls.
Did worked my way up to 135 on squats, bench, and DL.
Felt great during and after!
Not bad for 9 days out.
Feel great! Gonna keep slowly increasing now.
Thanks for the info and sharkng experiences everyone!
Member
So, I had replied earlier in this thread. Like ERdocDD, restarted the program. Squat at 135, bench 100 and dead at 185. Big step down from what I would have been doing but nice to get under the bar again.
Member
I'm talking about familial hypercholesterolemia, wich I've found to be on every 250 - 500 person, according to my "researches" in internet. When LDL is about 200 and higher. Now, when you say, "Your lipids will change some with lifestyle changes - maybe, but not to a therapeutic extent", what do you mean? If a 55 y.o fat guy is making his blood test, showing he's HDL 55, LDL 155, TR 150, and most of his diet is McDonalds, pizzas and that sort of thing, with normal glucose, BP under 140, and his parents are 75 - 80 with no serious heart problems, will you put him on statins on the spot? Appropriate diet can lower his LDL to 100 - 120, and lowering his weight + making some good sports(let's say the linear progression) will raise his HDL to 60. Does he still need the pills?Originally Posted by Pluripotent
Well, that's exactly the trouble with diets - people generally won't stick to that kind of regime for long enough.One of the chief problems with lifestyle changes for lipids (or anything, for that matter) is that people won't do it, and if they do it,..
As far as I know, after having an MI, even if the LDL was, let's say, 80, they'll put him on statins. Anyway, when it's a case with a known heart disease, that's already another story...but it's still just not going to be enough if you are a patient with established disease.
(I'm not a doctor, and all my knowledge is from what I find in the web.)
Member
At some point, I'm going to put together the relevant articles and studies for this argument, but I don't have them at hand right now. Lipids respond less to lifestyle modifications than other risk factors, such as blood pressure and insulin resistance (the exception being the triglyceride portion of the lipid panel, which is mostly diet related).
As you note at the bottom of your post, we are talking about two different scenarios here. First, the person with high lipids and no evidence of vascular disease. The question about what to do with these people is very much in debate right now and is controversial. So I don't think I'm going to be able to solve that problem, also it's going to be a decision that each patient will make differently. I'd say, however, that if it's truly FH, then you need to be treated or you will have problems. These people have early and often catastrophic vascular disease affecting any organ that has a blood supply -- or all of them -- and it's more common than what is reported, because most docs don't even look for it.
The second question is what to do with the person with established vascular disease who has elevated lipids. I think that's a bit more straightforward, although there is very little agreement on how aggressive you need to treat such patients. Or, to say it better, there is no disagreement among lipidologists, but there is a lot of misunderstanding accompanied by terrible guidelines resulting in virtually no one being treated properly (just adding a statin and hoping for the best is a bad strategy, but this is what's done virtually 100% of the time). Whether these people have had a vascular event or not (stroke, MI, PVD, etc), it is currently possible to reduce their risk of having an event (first or subsequent) to a very low, almost negligible risk, and the fact that this is almost completely mismanaged is a testament to how messed up medicine is. We have the knowledge and the technology to virtually prevent catastrophic vascular events in almost all high risk patients and we're not doing it. But diet and exercise will not be enough to help these people. In your example, you hypothesize someone lowering their cholesterol from over 200 to 100-120 (probably not going to happen with diet and exercise alone, but OK, we'll go with that). It's just not enough. Just google "cholesterol risk curve" and you will very quickly see what I'm talking about.
Member
I had a STEMI in Feb 2014, as I’ve detailed earlier in this thread. I take a 20 mg statin every day. I don’t like having to take it, I think fatigue is a side effect (thankfully the only one). I am, however, after a lot of reading, resigned to taking it for the rest of my life. As a 61 year old white male, I am in the target group where it’s most effective. I work out an hour a day, either cardio or weights, and as much as possible am careful with my diet and booze consumption. I realize lifestyle alone is not enough with my situation and history, so as much as I hate taking it, the 81mg aspirin and 20 mg statin are part of breakfast.
I’m fit, healthy, retired and still active as a firefighter. I’m doing all I can to delay ‘the big one’ that likley waits for me. It’s an uncertain way to live, but whatcha gonna do eh?
Member
Inspiring comebacks in this thread.
I suppose each an every setback just ends up making you stronger in some way, shape or form and I'm convinced that the stronger you are at the beginning of the trial the better your chances of coming out the other side.
Kudos to you all.
Pete
✓ Member
Pluripotent- Years ago, a friend of mine who is an ER nurse told me that hearts of people who are obese are larger and she described them as “floppy.” And she said that when people lose weight that the heart muscle does not revert back to a smaller size. As she described it, a lot of the damage is done. I find this somewhat hard to believe because it’s a muscle, right? Can you tell me if this is true? And if so, then would the same be true for some of these athletes?
My grandfather had his first major heart attack in his early 50’s. And he had two more but lived into his late 80s. And I have a brother who is obese and lives to eat. So, I feel like it’s just a matter of time. It’s terrifies me.
Member
A heart can be large for a lot of reasons, many of them pathological, but not all. An athlete will have a larger heart because it works harder, and it's only "larger" because of what we're comparing it to. We use "average" as synonymous with "normal" without really thinking about it. But if you start with a sick, relatively weak population, then "average" is sick and weak.
An obese person will work his heart harder, and unlike the athlete, it will become pathological eventually, but there are several forms of heart failure. "Floppy" might imply dilated cardiomyopathy, which is a possibility, and is irreversible. There are many reasons for developing that, obesity could be a contributing factor, but not all obese people get that. So,
✓ Member
Thank you for the explanation. I've always wondered about the floppy descriptor. I recall asking, but she didn't provide an answer. I'm surprised to see the number of people in this thread who have had heart attacks at what I would consider to be a young age. I guess you never know. My grandmother always thought she would outlive my grandfather, but she died three years earlier. Anyhow, thank you!
Posting Permissions
