Lets talk about our own health for a second...

[dhb]

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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.

 

[dhb]

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.

 

[GA8314]

I wasn't aware that they had found the fountain of Youth.

No such claim made. In fact, it's NOT some magic elixir. Benefits are very gradual for the most part. Some take 6 months to realize. Others sooner.

How long does testosterone take to show effects?

 

[Norepi]

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

 

[GA8314]

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

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.

 

[dhb]

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 die

 

[Norepi]

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.

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).

You will die

Hah. Indeed.

 

[GA8314]

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.

Yes, I agree that cumulative damage is important. Also CV disease is multifactorial. Our decisions are only as good as our data/information.

It's hard to say how 500 mg Metformin is going to hurt you. Some people struggle with GI SE's but usually it's tolerated especially at such a low dose. First check fasting BG. Also, how do you respond to carbs? Regardless, 500 mg Metformin is very safe IMO.

 

[invitro]

Agree with GA3814, he is a smart dude.

Check your fbg. Ideally it should be less than 85. Metformin can be useful in that regard. I don't have terrible insulin resistance at this point but I find it really helps it avoiding bloat and weight gain if taken prior to a cheat meal.

There is a lot of interest in the drug as an anti-aging med and for bodybuilding purposes due to its ability to shunt glucose (more) selectively to muscle glycogen than fat. It's upregulation of AMP-K may be anti-neoplastic.

When Sevo asked the question about health I was assuming he was looking for ways to achieve a healthy, muscular and aesthetic physique. You don't have to use test or GH or metformin to live to 100. But if you do I feel there is a greater than normal chance you will look good and have greater mobility in your old age.

What's the point of living to 100 if you look and feel like s**t for 30 years prior?

Amirite?

It's up to the individual in the end of course. The best part of this forum is hearing a lot of different viewpoints from experienced anesthesiologists and motivated residents and fellows. You just have to choose what information will help achieve your ultimate goals best.

 

[Ronin786]

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.

 

[Noyac]

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.

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.

 

[Scotty_G]

There is a drug that nobody has mentioned that theoretically has no side-effects and has a broad application. It's called naltrexone, specifically Low-dose naltrexone. It traditionally is used off-label for autoimmune conditions and diseases. While there are no large based studies, limited cases/groups have been looked at with somewhat positive results. The theory behind it is twofold: anti-inflam effects on the body and stimulation of the body's endogenous endorphins. (upregulation because of the constant blockade provided by this drug) You take a very low dose and it has to be compounded. Besides have emergency surgery with recent usage lol the s/e are nill.

 

[GA8314]

I personally believe that "sugar" is toxic and addictive. Here's a medication for weight loss with a combined Naltrexone/Wellbutrin....

#1 Prescribed Weight Loss Medication | CONTRAVE (naltrexone HCl/bupropion HCl)

I stay away from "added sugar" as much as possible. In addition to holding off on most carbs (I cheat like everyone but really shouldn't and feel great when I don't), a no brainer is to avoid sugar and of course high fructose corn syrup (actually only about 55% fructose and 45% sucrose). The effects on insulin, and thus the swings in BG, add to cravings, but it looks like it also effects the brain, neurotransmitters and endorphins........ High fat, moderate protein, low carb diets do not seem to do that....

Ever see kids and how they act towards candy??? Like little addicts. Sugar should have warning labels....

Check out this guy. Pediatric endocrinologist....

 

[Scotty_G]

Yes naltrexone is coupled into that weight-loss drug but that is relatively "new". More importantly the people who used low dose naltrexone do not take 8mg which is what is in this stupid combo weight-loss pill. The typically LDN dosage is 4.5mg once a day at night. I can't promise that naltrexone can work for everyone but in a subset of people it does. It's also cheap 🙂

 

[Ronin786]

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.

 

[Man o War]

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.

Have you tried an inversion table? One of the nurses I worked with did 5 minutes in the morning and 5 minutes at night and avoided surgery.

 

[Scotty_G]

Inversion table is good. My mother uses one daily and it does seem to help.

 

[MacMil]

Just had lumbar decompression surgery 6 weeks ago. Have a terrible back from my time as a combat Corpsman (medic). Multiple levels of herniation, DGD, stenosis, you name it and I have it. Had terrible persistent radicular pain and numbness despite multiple attempts of ESI's and PT. This surgery has been so good for me so far, and each week is getting better. I agree with the above, if you have any radiculopathy at all do not wait. As a reference this has been going on since 2010. They did not expect me to have such dramatic results so quickly, or at all for that matter. Glad I finally decided to move forward with the procedure.

 

[Aether2000]

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.

 

[dhb]

 

[facted]

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.

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...

 

[GA8314]

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.

I agree on the carb issue. But, if you have HTN and diet and lifestyle don't do the trick, then you need to address it with the anti-HTN med which is best suited to you and having the least SE's. If you have insulin resistance, then allowing A1C's to approach even the 6% or above is simply asking for trouble. The slow, steady, glycosylation of vascular endothelium will be a problem for you.

Look at the damage that uncontrolled HTN and DM causes so many patients.

As for TRT, that depends. How do you feel? What are your levels? Can you increase it simply by losing fat, and thus lessening aromatization? For sure worth a try. As for TRT, I will say that many many guys function differently at very different levels. Some guys may function very well at TT 500 (assuming mid range freeT). Others may not as well. It's extremely variable. And, no, it's not a magic elixir. You could take very high levels and not even notice a difference other than negative SE's. Again, more is NOT always better. But, high normal is likely to be the sweet spot for most men.

If you are over 40 and experiencing symptoms, and have corrected for any modifiable factors which could be exacerbating those symptoms, then TRT may be for you since over the next 10, 15, 20 years, you are only going to go lower. Sure, there are outliers.....

Unfortunately, many otherwise modifiable risk factors in our profession, are not really modifiable. Stress, and sleep disturbances being two of them which can be MAJOR contributors. So, what will one choose to do? Suffer, or be proactive? I'm in the proactive camp.

If anyone has further questions on this sensitive topic, feel free to PM me.

 

[GA8314]

1 & 2 ok, but i don't think intense exercise is good for your health long term.

Intense, long distance, cardio has led to dysrhythmias and cardiomyopathy, but we are talking guys that run 12 miles per day. What's the cut off?? Not sure, but data is suggesting that extreme distance running has it's drawbacks.

80% of physique is diet. Some cardio (low impact) is definitely good IMO. Weight training and maintaining good muscle mass (not extreme which requires drugs for most) and bone density is very beneficial.

That being said, if you are spending 4 hours in the gym as a professional bodybuilder, with persistent increases in afterload, you're probably going to see some LVH over time. Most are not doing this, however.

Moderation. Also, keep the weight lower so as not to overstrain the joints or cause injury. These are important as we get older....

 

[bobjonesbob]

been on keto and down to 200

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.

 

[deleted162650]

80% of physique is diet.

70% genetic, 20% diet, 10% exercise

 

[MacMil]

70% genetic, 20% diet, 10% exercise

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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[anonperson]

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...

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.

 

[deleted87051]

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.

 

[MacMil]

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.

Exactly, but for every story like yours there is one more with the exact opposite results. The fact remains that with enough effort, dedication and consistency an obese person can get fit. And likewise I've seen plenty of people who were fit their whole life separate from the military and become fat slobs. Based on my experience genetics plays a role in how fast or slow you can change your body. Genetics does not "doom" you to be a certain way though which is the point in trying to make. Anyone who has been in the gym long enough has heard the "my genes won't let me lose weight" when in reality it's heir inability to control their diet.


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[Aether2000]

It is really very simple for most people: Increase weight of 55 lbs is associated with a RR of 5.2 of developing hypertension Increase weight of 10-22 lbs is associated with a RR of 1.7 Weight loss is associated with significant resolution of hypertension and metabolic syndrome as reported in multiple studies on bariatric surgery. Glucose levels also normalize in many with weight loss, to the point some insulin dependent diabetics may no longer need any insulin at all. Of course there are outliers, but much of what was touted as "genetically unmodifiable" actually are modifiable. With 1/3 of the American population either significantly overweight and another 1/3 obese, 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......

 

[facted]

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......

And that is how? Our country has been telling us eat lots of sugars and avoids fats like the plague for decades now. Many, many people follow that and from an epidemological basis it's been a DISASTER. I personally think the evidence is building for a low carb, higher fat diet for a while now. Until our public health recs change though, it won't make too much of a difference.

 

[Aether2000]

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.

 

[dhb]

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.

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.

 

[Timeoutofmind]

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.

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.

 

[Aether2000]

Actually it does matter what source calories are used with respect to obesity. Princeton University - A sweet problem: Princeton researchers find that high-fructose corn syrup prompts considerably more weight gain

 

[facted]

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.

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.

Furthermore, a high fat diet is more filling, and in some studies, causes many to eat less simply due to satiety.

 

[GA8314]

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...

Do your own research. I'm not here to hand hold you or sell you anything.

 

[GA8314]

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.

 

[teacher2md]

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.

I think you're both right, you're just making different points.

The physical reality is that you can't store more energy than what you consume, period. You could eat an diet of 90%HFCS, but if you're expending more calories than you take in, you'll still lose weight.

However, the composition of weight loss would be very poor (losing muscle more than fat)and your insulin surges in response to that diet would be terrible and likely set you up for diabetes.

 

[facted]

Do 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.

 

[GA8314]

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.

I think TRT has been much maligned by the media and sensationalism associated with anabolic steroids. There is a plethora of research showing safety and efficacy of properly administered TRT.

 

[Aether2000]

Obesity from high sugar intake (particularly hfcs) may be in part due to reduced satiation with foods containing hfcs. Therefore sizes of food are indeed larger resulting inmore caloric intake. But a high sweets diet also causes more steep increases and decreases in the the slope of the sugar curve therefore leading to increased tiredness and less physical activity. However there still is a difference between sugar and high fructose corn syrup in terms of obesity even when all of these factors are controlled and the rat studies.

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[GA8314]

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.

Not to mention it was PremPro. So, a synthetic estrogen with synthetic progesterone.

For TRT, it's bioidentical. The only difference is the T molecule is attached to an ester. The ester link get's cleaved, however, and it's the identical molecule that is endogenous to your body which binds the receptor. Again, we are not talking about supraphysiologic levels for sustained periods of time (though you can find surprisingly high doses studied for up to 20 weeks with few adverse effects), but rather bringing symptomatically low levels to a more robust, but normal range.

 

[deleted162650]

I've decided to go with the Mitch Hedburg diet plan:

 

[GA8314]

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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Agreed. Unless you are talking athleticism or the ability to put on muscle. Those things have a high genetic component, as I think we'd all agree. But, for simply staying or becoming lean, I believe much of it comes down to diet.

 

[Ronin786]

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.

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

 

[Timeoutofmind]

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

I see...minsunderstood your earlier post.

Have u had three ESIs?

Tried gabapentin? Start with a very low dose just qHS.

Radiculopathic pain often but not always gets better with time.

 

[sevoflurane]

I am with you guys that are saying to give it some time. I have had radiculopathy in the past after sport injuries.
After the acute phase and some PT, my symptoms have resolved. Core strengthening really helps.
Our particular field has a tendency to keep us in the sitting position for long periods of time. Correct posture and a will to actively stand during the day will help prevent discogenic/spine symptoms. Our bodies are just not intended to be sitting in a chair 8 hours a day.

I hope I never have to go under for any sort of back issues.

Just my 2 cents