Medical school and ATS, page 2

reply to post by VneZonyDostupa

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Fat and Cholesterol aren't sticking to the arteries because there's simply "too much" in the blood. Especially fat.

Edit: Except for extreme cases such as Familial Hypercholesterolemia, even more so when homozygous rather than hetero.

Sure, too much can increase blood pressure. But hypertriglyceridemia isn't being caused by fatty foods. And dietary cholesterol rarely affects serum cholesterol levels.

reply to post by DevolutionEvolvd

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The point is...it has less to do with how much fat and cholesterol we eat, and more to do with the effects of the foods we eat on LDL particle size, number and LDL receptor activity (i.e., Insulin suppreses LDL receptor activity...which explains, accordingly, why insulin resistant people are at higher risk for the development of atherosclerosis)

reply to post by Unvarnished

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You're *very* close (in fact, if you were on my service, I would probably give it to you because I didn't stress one bit enough). The "trick" in the question was that the man is having bowel problems with occult blood. This means he likely he has some sort of lesion, possibly cancer. One red flag for bowel cancer is a strep bovis (group D strep) bacteremia and valve vegetation. Your next step would be colonoscopy.

But, like I said...your answers were very good and would certainly not be inappropriate, especially given how poorly worded the first bit of my question was. Strong work, medical student =)

Originally posted by DevolutionEvolvd
reply to post by VneZonyDostupa

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Fat and Cholesterol aren't sticking to the arteries because there's simply "too much" in the blood. Especially fat.

Technically, they are. The more of these compounds there are floating in your blood, the more likely they are to encounter that microtear in your arterial wall before it is properly healed.

But hypertriglyceridemia isn't being caused by fatty foods.

True, it's mostly genetic, but a low-fat diet (or anti-cholesterol drug regimen) certainly helps prevent some of the nastier sequelae.

And dietary cholesterol rarely affects serum cholesterol levels.

Not true. There is a very strong and very well-researched link between increased dietary cholesterol intake and increased serum cholesterol levels. Of course, there are *many* factors involved in controlling your serum cholesterol, but to say diet "rarely affects" the serum level is ignoring a mountain of evidence to the contrary.

Here is a twin study (used to control for genetic variation) that demonstrates diet is an environmental factor in altering lipid levels.

Another study shows that a moderately-controlled diet can reduce cholesterol by up to an average of 5.3% in just 6 months, and more tightly-controlled diets even more.

Originally posted by DevolutionEvolvd
reply to post by DevolutionEvolvd

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which explains, accordingly, why insulin resistant people are at higher risk for the development of atherosclerosis)

Technically, you're only seeing part of the story on this one. The current thinking is that the insulin resistance is only dangerous if the person is uncontrolled (ie has high blood sugar). High blood sugar can damage arterial walls due to the osmotic effect leading to high blood pressure (more glucose osmoles in the blood causes fluid to flow from the surrounding tissues and into the vessels, leading to more pressure).

reply to post by VneZonyDostupa

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Did the question you ask me pertain to the USMLE step 3? Because the main bugs we covered were Strep Viridans for left sided and Staph A. for right sided (especially IV users), I just learned a new fact on ATS =D

reply to post by Unvarnished

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Yeah, it's really more of a Step 2/3 question, so I guess that was a bit unfair, haha. I do remember it being mentioned in my second year pathology class, but I also loved infectious diseases (hence my current field), so I tended to really hone in on that stuff. Plus, our pathology professor had a research project in ID, so he expanded a bit on that field.

reply to post by VneZonyDostupa

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Insulin resistance alone causes hypertension. Well, it's not really insulin resistance, but rather hyperinsulinemia through the retention of sodium and insulin's affects of intracellular magnesium.

reply to post by VneZonyDostupa

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I'm certainly not denying that diet affects blood lipids (VLDL, LDL, HDL and TC) directly. I will, however, argue that dietary cholesterol has little effect on serum cholesterol on most individuals. And total cholesterol, unless in extreme cases such as FHC, isn't really a good predictor of heart disease, or really MI and death from cardiac events. And lets not forget the problems associated with low cholesterol (lately, there have been some alarming studies).

As far as low-fat diets, haha, most of the data doesn't support them for the prevention of heart disease. In fact, it's quite the opposite, considering the amount of carbohydrate consumed to compensate for calories lost through fat. And, as you say, high carb intake has some very damaging effects, including reactive oxygen species produces by glycation and AGE's.

The consensus is beginning to shift again...away from fat, and saturated fat, as being the main dietary constituent of heart disease and towards carbohydrate, mainly high-glycemic carbs. But this isn't new information. Most of the data supports this...it's just difficult to persuade researchers and scientists when they simply accept what's "known" or deny what goes against what's "known". Anyway...

I really don't have the time right now, as i'm at work, to grab the sources...

reply to post by VneZonyDostupa

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That is exactly what I am really interested in, Internal Medicine, ID! I am an international student so we're mostly limited to family med/IM. How is the field? It seems interesting, I loved medical microbiology.

reply to post by DevolutionEvolvd

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I'm going to reserve comment on most of your statements until you find your sources. You're making a lot of claims about the reasons cholesterol rises or falls, but I also know you're one of the few people here who attempts to support your claims with valid research, so I'll wait and see.

reply to post by Unvarnished

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Personally, I think the field is wonderful. I work as a hospitalist, but also have the specialized ID training, so HIV and "complicated infection" patients tend to fall to my service. It's always interesting, for sure =)

reply to post by VneZonyDostupa

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Oh okay great, that is one of the fields I am looking into, does ID allow for a lot of traveling as well? How are the hours?

reply to post by Unvarnished

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Hours are sort of what you make of it. I work as a hospitalist/consultant, depending on the day or the week and which hospital I'm at. So, some days are long, others aren't. I usually do 14 on, 14 off, which means I work for two weeks straight at about 80-90 hours per week and then have two weeks off to relax, travel, or whatever I want to do.

reply to post by VneZonyDostupa

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Oh okay that's good, because I realized by now that I want to do a specialty where the work is not as demanding so I can spend time with my family as well. I mean, I only have 80 or so years to live on this planet lol.

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