I don't even know. But exercise is the god-tier reigning champion of all things health. You can count on it pretty reliably to show up as a positive effect source in any health study.
I walk my kids to school every morning. And I walk to pick them up. It's a 10 minute walk to get them, so that's about 40 minutes of walking each day. I could drive and get there in 2 minutes then wait in a line. It would probably cut the time in half, but walking is better for the environment (noise, pollution, safety, wear and tear), me, and my relationship with the kids (we, y'know, talk while we walk).
There's people that live even closer that drive their kids to school. One of them lives literally 19 houses down the street from it.
I also have a rule where if I can go somewhere within 20 minutes on a bike, I'm taking my bike. Most places I go fall under this rule, and I live in what most would call a suburban hellscape.
My wife used to drive to work. Driving took longer than walking. But she still drove.
I think it's less about easy vs hard and more about the culture around driving in the US.
That's great - for me the problem is weather. Where I live it's hot, >80s Fahrenheit, >28 celsius, for 4 months a year. So unless I want to always be sweaty, I can't really walk more then 10 minutes at a time.
I tried biking to work for a while - 13 miles. During summer/fall, it was pretty nice, I'd go early in the morning, shower at the gym, and then bike home. 2 workouts a day when the weather was fair.
The sweaty part, you'll get less sweaty as you get more in shape, both exerting less and retaining heat less efficiently due to lower BMI. But - you'll probably never not be sweaty if the distance is anything significant like, say, 13 miles.
Let's talk about colder climates. I was a consultant for a few years, and got to travel all over. I recall visiting Calgary in the winter, and some maniac dev manager biked to work every day, rain, snow or shine. 6 miles he said (helpfully translating units for me).
In the US a large number of people have moved to suburbs in the south. On a bad year our lows are in the 90F range. Add in asphalt architecture and in the sun temps are commonly 125F+
To get a statin you have to go to the doctor, get a blood test, get a prescription for the statin, and start taking it, get blood retested, adjust dose (possibly), etc. Then you have to go to the pharmacy, pay for it and take it every single day.
To exercise you literally have to walk for 30 minutes. That's it.
Walking for 30 minutes/day when you previously walked 0 minutes/day will have a dramatically larger mortality reduction than taking a statin.
For the record adding a statin reduced my (genetically very high) cholesterol by over 50%, and I will almost certainly take it for the rest of my life. Diet and exercise changes led me to lose over 80lbs, required 0 doctor visits, cost $0, and has completely changed my life and my likely health trajectory.
So yes take statins, but no statins aren't 'easy' unless you are very well integrated into a health care system and actively having checkups where your cholesterol levels are being checked and reviewed, which is only true of a very low % of people in the US, even those with gold plated healthcare coverage.
> Walking for 30 minutes/day when you previously walked 0 minutes/day will have a dramatically larger mortality reduction than taking a statin.
It might for all-cause mortality, but it is unlikely to reduce ASCVD mortality more than a statin, or statin + ezetimibe would. Even if your high LDL isn't genetic, once you've done the damage to your arteries, it is basically going to stay there, and treatment targets for preventing further damage at that point (or some regression, if you get really aggressive with combo therapy and get down below 50) aren't often possible with lifestyle changes alone.
Sure, but the primary point of the discussion for the article we're all discussing is around ASCVD, so switching to all-cause mortality is kind of moving the goalposts.
People at risk for ASCVD should also realistically just be doing both. It shouldn't be an either/or.
My response was pointing out you weren't actually responding to me, you were making some other point. My point was fully on topic within the context of the sub-thread.
All of this is fine, having your response take the shape of a rebuttal was silly.
I mean, I literally agreed with you on the all-cause mortality as the very first thing I said. I would not call that a rebuttal. I was just attempting to refocus the discussion back on where the context had been before you suddenly changed it.
Let's trace the context:
The very first comment is talking about lowering inflammation in relation to this article. This is within the context of ASCVD
The next comment is saying to exercise. This is in answer to someone asking about inflammation in context of ASCVD.
The next comment is saying this is harder than taking a pill. Still in context of ASCVD.
Then you comment saying it's not that hard in comparison to getting a statin. Which, again, is treating for ASCVD.
The next comment is talking specifically about how walking will not be enough to impact your cholesterol. Again, ASCVD.
Then you switch the goalposts to talking about all-cause mortality when the entire rest of the conversation has been about ASCVD.
Then I reply saying yeah sure exercise impacts a whole lot more causes of mortality but again reiterate that suggesting it as a solution in a conversation about ASCVD does not make much sense. The people in this situation are worried about ASCVD in specific - their remedial actions should focus on ASCVD. Your commentary also further restricts things by talking about if you previously weren't exercising at all, but plenty of people that DO exercise regularly and walk 30 minutes a day are still at risk for ASCVD because exercise does very little to reduce cholesterol without additional lifestyle modifications around diet, and even then, it is unlikely to get you to modern treatment targets.
Who is the person here who went against all the prior context? Not me.
----
But if you're going to say I'm rebutting your points, I suppose I might as well actually do that.
First, we can just talk about lifestyle changes in general - we know they don't work for most people. Not in the sense that if someone adheres to them they don't function, but that most people don't adhere to them. People aren't awesome about adhering to medications either, but they're a lot better than they are about overhauling their diet and exercise regimen. Countless studies here, very obvious evidence when looking at drugs like GLP-1s and the impact they're having on weight loss vs. lifestyle changes, etc. I can dig up studies here if you really want, but I do feel like this should be pretty self-evident.
Next, let's look at your strange claim about how statins are only easy for a low % of people in the US, despite the fact that over 1/3rd of the adults in the US take statins. Atorvastatin is literally the most prescribed drug in America.
> After 2013, the number of individuals who used statins increased 149% from 37 million in 2012–2013 period to 92 million users in 2018–2019.
92m statin users in the US as of 2019, almost exclusively used in adults. 260ish million adults in the US as of 2022. If a third of all adults are using them, it can't be that hard, either.
How many adult Americans get the CDC recommended 150 minutes a week of moderate aerobic activity, less than the 210 you are saying is easier than statins? 46%. I suspect that number drops if you increase the amount of aerobic activity by more than a third, but there's not data on that specific number of 30 minutes a day that I can find. And the CDC, for all cause mortality, says you really should add in some resistance training as well, which brings the number down to 23%. And the sort of people doing this regularly also tend to be people that are more health conscious, have better diets, etc., too, which means they were already less likely to need statins. For people that don't live that lifestyle, they've not lived it for a reason - and changing to someone that does live that lifestyle is a significant shift.
I'm not saying exercising is that hard - I hit 5 hours a week most weeks, and more some weeks. I also spent a decade or so with an LDL sitting in the 70-110 range, which we know means I was depositing plaque, despite that being in range to just barely out of range on most lab reports. So I take a combo therapy to get mine down to <40 to hopefully get some regression and to stabilize what won't regress. Anecdotally, I can tell you what's easier between the two for me to do - taking the pills. They show up on my doorstep, I spend 5 minutes each Sunday putting them in pill organizers, and 30 seconds each morning taking them. Bloodwork related to the ASCVD stuff? Once a year. Insurance covers it all, but even if it didn't, I can get a 90 day supply of 20mg Rosuvastatin for $8 and ezetimibe for $9 from CostPlus and similar prices from goodrx, and a lipid panel from jasonhealth is $10 (though I think they have a draw fee which is probably $25ish). But this stuff is all generic and so cheap you don't need great insurance to cover it - none of this requires a preauth. You're really unlikely to be fighting your insurance on any of this even with a pretty mediocre plan.
So your entire argument that a lifestyle change of walking for 30 minutes a day every day is significantly easier (or even not-so-significantly) vs. a couple of hours a year of doctors visits and labwork and then popping one or two pills daily is just pretty fundamentally flawed - it doesn't match the numbers even in the absolute and even less when you consider the success rate of lifestyle changes. The picture you paint of the ability to get on a statin as difficult even among those with "gold plated insurance" doesn't make sense. The only thing that does is that yes, going from no exercise to regular exercise will lower all-cause mortality. But the whole conversation had been about ASCVD until that point, and even the rest of your comments in both cases were discussing statins, which are again, almost entirely focused on ASCVD.
If someone goes from not exercising at all to walking 30 minutes a day, it will make a definite dent in blood pressure. Changing diet will add another dent. Walking for 90 minutes a day will make a bigger dent than 30. The degree of the changes reflects the degree of the results.
Why would they be platonists? Diogenes was the Greek philosopher who shunned material things and famously lived in a barrel. Seems like that would be the ancient Grecian philosopher that might inspire some form of voluntary homelessness.
There's a (apparently un-substantiated[0]) claim that Plato was buff; "Plato" was apparently a nickname and meant "broad" in Classical Greek, referring to his wrestlers physique.
[0] I heard this claim a long time ago, but according to Wikipedia (https://en.wikipedia.org/wiki/Plato#Life) it's apocryphal. The Talk page has a decent argument for it not being the case.
Ah fair, I meant in that they're homeless so they must live in their heads/in ideas which are more real to them (hence Plato), so they're shredded from always being active and outside.
Avoid allergenic foods, Highly processed foods. Get plenty of sleep. Manage stress. Avoid toxins like alcohol or smoking. Avoid chemical irritants including perfumes, dyes, fragrances in detergent or soap, ….
Not sure why this is downvoted, this is correct on all points. I've been on a journey to lower chronic inflammation and you would not believe how hard it is to find stuff that doesn't have "fragrance" or other mysterious potentially-inflammation-causing substances.
Honestly that used to be a common midday break for me at work.
2 slices of bread per sandwich with ham and/or cheese inbetween the 2
I never gained weight and always ate a lot tho and as i got older i've become more active.
> People at highest risk are those who work in environments where they’re continuously exposed to fragrances, such the cleaning industry, cosmetics industry or agriculture industry. You also may be at slightly higher risk if you are continuously exposed to fragrance through personal overuse.
I saw an interesting video that mentioned a study.
Even though 10K steps a day is considered an arbitrary amount, this study found that level of activity counteracted inflammation.
>And avoiding putting stuff in your body that makes your immune system react like air pollution, microplastics,
Good luck avoiding either of those. For the first one, if you live in a heavily industrialized or urban area and can't just leave for X reasons, should you perhaps breathe less?
As for microplastics, from all I've read about them, they're now in nearly everything and many modern humans who haven't spent their lives living and eating/drinking entirely off the land in the deep remote country are unavoidably saturated with them to the point where (need to find the source again) the average modern adult human in the developed world has something like a teaspoon worth of microplastic inside their body. They've become essentially impossible to avoid if you eat or consume any modern food item.
I have never understood how one supposed to reduce stress. For me, stress is a signal that there is some threat in my environment. Such threats are often outside of my control. How is one supposed to reduce something that he or she has little control over?
Well, not with that attitude. Surely you've seen people on life that you felt overly stressed themselves. It's not just a natural bodily reaction, how you react to the reaction. Some people can spiral out of control with stress, amplifying it. Other people can relax and not let it get to them.
Try meditation? Not the religious stuff, just breathing exercises and trying to clear your mind
> Some people can spiral out of control with stress, amplifying it. Other people can relax and not let it get to them.
That is what I have never been able to figure out. At face value, I believe some people are just 'built' more resilient that others, but that is purely conjecture.
I've tried meditation, but it never really provided any relief. Sure, in the moment, it might reduce stress or a bit, but at least for me, the relief isn't really persistent. If I mediate for 10 minutes, then I get 10 minutes of relief and then after 30 minutes, I am back to where I was before meditating. Same with any other methods I have attempted. How do you reduce stress? How effective are your methods?
Yes, there is that risk. On the other hand there is the risk of stroke, which I am more scared of, which is why I take aspirin. What is the impact of NSAID Gastritis? How bad is it and can you recover from it?
If you have been prescribed the Aspirin then it’s important to continue or discuss with your Physician. But as I mentioned in another comment, there are gastro protective Aspirin pills available.
The impact has been significant. Small servings of non-irritating food for months. I’m told the stomach lining does heal given time, and my symptoms are better now than a few months ago. The post I originally replied to sounded like a recommendation to take Aspirin speculatively as a preventative, which is exactly the mistake I made. Gastro resistant tablets might have helped, but the general advice is to be very careful with NSAIDs on the stomach (although I still use topical Ibuprofen gel when needed).
I was taking a lot of Ibuprofen due to frequent illnesses while simultaneously needing to be healthy. I started to get terrible heartburn that caused me to hunch over at times. Tried dietary changes. Finally, I happened to read that this and ulcers is a side effect of NSAIDs. Switched to acetaminophen, and was generally more judicious about taking fever meds, and I haven’t had heartburn in months now.
The conventional wisdom is that low dose aspirin prevents heart attacks by lowering the tendency for blood to clot. I've long had a theory that it was the anti-inflammatory effect that had the greatest benefit.
Potentially inhibiting IL-6 or reducing Lp(a). We'll get an early glimpse from some robust Phase 3's next year. These have been in the works for several years with tens of thousands of patients enrolled - it'll be an exciting set of readouts.
Novo Nordisk purchased Corvidia Therapeutics in 2020 [1] for their IL-6 antibody and will read out the first of three Phase 3's in 2026 [2]. Their programs, however, are focused on individuals with higher risk factors like chronic kidney disease (2026 topline), a couple kinds of heart failure (2027), and a prior myocardial infarction (heart attack; 2027). These trials notably are on top of "standard of care" existing therapies, so they're looking for additional benefit beyond what is commonly sought, like LDL reduction (highlighted in other comments).
Novartis recently announced an intended acquisition of Tourmaline Bio for their IL-6 antibody [3]. So attention to the biological target is heating up.
Another target mentioned in the comments is Lp(a). Genetic studies suggest a heightened risk of cardiovascular disease. Therapeutics aimed at reducing Lp(a) levels are being explored separate from IL-6 for a similar end goal of avoiding cardiovascular events (i.e. heart attacks, death).
Novartis will read out a Phase 3 of an Lp(a) reducing therapeutic in the first half of 2026 [4]. Amgen will likely read out theirs likely sometime thereafter [5]. These have been a long time coming: Amgen in-licensed their asset from Arrowhead in 2016 [6], Novartis in-licensed their asset from Ionis/Akcea in 2017 [7].
If any of these work, there's a chance that they'd be explored in patients with less pronounced risk than the original studies in these Phase 3's. Amgen has already announced an intent to explore their Lp(a) drug in a Phase 3 with participants with elevated Lp(a) at "high risk" for a first cardiovascular event in 2H25/1H26.
I'm not a doctor, but I am passionate about this stuff in my own life.
tl;dr: Exercise, sleep, and diet. Plus a zillion different supplements and medicines as adjuncts to a healthy lifestyle.
First, consider what inflammation is. It's fundamentally an immune response designed to attack unhealthy tissue and to facilitate repair of healthy tissue - the effects of inflammation are largely driven by cytokines like TNF-alpha (which is responsible for killing unhealthy cells and recruiting immune cells), IL-1 (which recruits immune cells), and IL-6 (which drives cRP production - the biomarker that you usually look for to gauge systemic inflammation). The production of these is mediated by nuclear factor kappa B (NF-kB).
Other major factors are things like reactive oxygen species (or "free radicals"), which can oxidize all sorts of things in the body and cause damage (which is good when the thing being damaged is a pathogen or damaged cell, bad when it's healthy tissue). Damaged tissue provokes immune responses.
So, if you want to "reduce inflammation", you want to:
1. Reduce stimuli or downregulate processes which are causing the production of inflammatory cytokines
2. Upregulate the production of anti-inflammatory cytokines
3. Ensure sufficient antioxidant capacity to deal with ROS production and oxidative stress
If you've got a chronic illness or autoimmune disorder, you're dealing with inflammation just because your "make immune defenses" signals are stuck on. But you can also have chronic inflammation through too much fat (adipose tissue is an endocrine organ!), environmental or diet factors, or just behaviors which result in an imbalance between pro- and anti-inflammatory responses in the body (for example: smoking induces consistent tissue damage, which drives immune responses).
Exercise upregulates production of anti-inflammatory cytokines and improves mitochondrial efficiency, which results in less ROS production during cellular respiration. Sugar surges cause elevated ROS production, and chronically-elevated blood glucose results in insulin resistance, which promotes inflammatory cytokine production. Lipopolysaccharides from gut bacteria in the bloodstream stimulate immune responses. Insufficient sleep upregulates NF-kB directly, but also contributes to dysfunction of other systems which can upregulate NF-kB.
If you're sleeping plenty, eating well, and exercising, and you don't have a chronic health condition, your inflammation levels are probably pretty good. But you can generally further reduce them with supplementation of things like:
* Omega-3 fatty acids (which compete with omega-6 fatty acids - "seed oils", which produce inflammatory prostaglandins) - this is why your doctor wants you to take fish oil
* Turmeric, resveratrol, and green tea extracts (which contain compounds which inhibit NF-kB and are ROS scavengers),
* Vitamin D (which inhibits cytokine production and supports your natural antioxidant systems)
* NAC, which replenishes glutathione (the primary driver of the body's antioxidant systems)
There are medications, of course, like your regular old aspirin and ibuprofen, which reduce prostoglandin production (which is one upstream of NF-kB), corticosteroids (which block NF-kB), as well as more exotic entries such as GLP-1 peptides (which, among other things, improve insulin sensitivty and reduce adipose tissue, which results in reduced systemic inflammation) or BPC-157 peptides (which acutely inhibit NF-kB, upregulate antioxidant enzymes, and help regulate nitrous oxide, which is how they can help heal NSAID-induced leisons).
This is by no means comprehensive - there are plenty more mechanisms and interventions to explore - but it should be a pretty good clue as to why "diet and exercise" are standard health advice. You don't want to turn off your inflammation responses - they're responsible for taking out pathogens, killing tumors and maintaining a healthy body - but you don't want them chronically upregulated, either.
It’s too hard to sit longer than 1h, its shape is just 10 light years away from what your body feels like a natural or comfortable sitting position. Its lumbar support and back shape in general is terrible in every possible way.
It feels like people who make it never actually use it.
I’m just about a week later in my kidney donation than the author.
My husband was diagnosed with chronic kidney disease in late
2022 and it rapidly progressed to end-stage renal failure at the end of 2023. He’s been on dialysis since February.
It took quite a bit of semi-political hurdles to get him on the UNOS transplant list; once that happened, several people had volunteered to go thru the process to be a donor on his behalf.
I was the only one cleared; it turns out I was a match, but a better one could be found, so I went ahead and donated to an anonymous recipient. A few days after my donation, a match was found for him, and he receives his new kidney in a few weeks. That will make all this worth it for me.
My pain was much less than the author’s; it never got 9over a 3. I used one Oxy pill, and the rest of the time, Tylenol controls it. Still sore around the main laparoscopic site (1-2) still uncomfortable and can’t sleep on my left side 2 weeks out.
Definitely feeling the fatigue I was told to expect as my body adjusts to one kidney. I was told to plan for 6 weeks out of work, and I think I’m going to need most of that to rebuild stamina. I’ve been trying to walk as much as I can, weather and fatigue permitting, and I’ve had helpers to deal with the weight restrictions I’m under.
The weight restriction is so annoying, especially as I've been trying to get into better shape/exercise more. I'm glad your donation went well & hope that your husband's surgery goes just as well.
I imagine taking 6 weeks off of work would be the hardest part of this for many people, unless they can get fully-paid medical leave. Presumably most people with decent middle-class jobs do get that.
> Preorders at $349 start today for beta units, and Elemind expects to start general sales later this year. The company will offer customers an optional membership at $7 to $13 monthly that will allow cloud storage of sleep data and access to new apps as they are released.
Ever known anyone in end-stage renal failure? Not a lot that could be that really bad; waiting to get on the UNOS transplant list, while doing daily dialysis…
These tools have the advantage of not being multi-taskers and can manage version for all your tools. You wouldn’t need pyenv and npm and rvm and…
We’ve even started committing the .mise.toml files for projects to our repos. That way, since we work on multiple projects that may need multiple versions of the same tool, it’s handled and documented.
Doctor of osteopathy (DO). My first doctor as an adult was a DO and treated things like sinus infections with medication, but when I picked up a ladder and something popped in my back, he adjusted my spine and put it back into place and almost instantly it stopped hurting.
I worked with MDs for years and they said DO was considered a legit medical specialty, just non identical curriculum. Chiropractics was more a specialized physical therapy practice, also useful, if expectations are sensible.
I had a primary care provider who was a DO and she was a wizard, but sadly moved out of state.
