An unprecedented window into how diseases take hold years before symptoms appear

I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk.

So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.

It would be interesting what this functional reserve is, right? The microbiome perhaps, or intracellular minerals? Some other thing we haven’t even identified?

Functional reserve means you are completely well but the start of the disease is coming closer as the former is depleting.

Another case is when disease starts subtly and slowly _with_ initial symptoms that are otherwise not debilitating. Eg Alzheimer's starting decades ago by being forgetful.

I have no idea which one the post is reffering to.

A very elderly doctor referred to "cognitive reserve", lamenting hen had more of it when younger.

This holds true for many things. It’s easier to stay in shape and maintain a healthy weight than it is to recover from getting out of shape or overweight. The longer someone spends out of shape or overweight, the harder it becomes to escape the cycle. There’s no better time to start than now.

As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.

It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing

Only if you have an excellent health insurance plan. Otherwise, preventive treatment costs you money, while curative treatment is paid for you.

Sounds like a misguided incentive ...

This is a well known phenomenon in medicine. It is always carefully considered when making public health decisions regarding e.g. screening programs and intervention best practices.

For example, a PSA test is useful to detect cancer of the prostate, if a male patient has urination problems. But doing general screening for high PSA values in middle aged men is not considered a good idea, because there are too many false positives and it would likely lead to many unnecessary invasive interventions.

> I wonder if, in parts, the effects of the so called "mild covid" and "long covid" […] are nothing but psychological. There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.

Uncertainty does not imply psychological. It’s like saying ”our users report a lot of different bugs that we can’t reproduce, they must be all imagined”, except the body is OOMs more complex than even the most carelessly developed enterprise application. There is uncertainty in every part of medicine, all the time. That’s why it takes time and is difficult (often too difficult) to root cause everything that happens.

If you have a novel pathogen with neurological effects (see olfactory impacts - people literally losing their sense of smell), it would be my first guess of mysterious symptoms rather than.. checks notes the war in Ukraine? Honestly I’m not sure how to connect your first sentence to the next.

The Gaza conflict has been running since before 1948 at various levels of intensity, and the Ukraine conflict since 2012.

It's possible that social media is making people ill, but long COVID is very real and very different.

There is growing evidence that long covid is actually CIRS (toxic mold usually from living in water damaged buildings) triggered by covid. Only 25% of people have the genes for CIRS, but then it takes exposure and a immune shock to get your systems out of whack (lyme, covid, etc.) The vast array of symptoms come from the mycotoxins becoming present in every part of your body and affecting all your systems, especially your gut biome.

Source: I have it and am on the long road to recovery. Before I moved out of my house this spring, I could have days with several migraine level headaches and where my vision was so messed up I could barely see 10 feet. I don't have bad days like that anymore since I moved to my sisters. (I have lots of other symptoms too, this is just a sample.)

As someone who has seen multiple people close to me, including my wife, struggle with long covid, I can tell you the answer is simply no. Anecdotal, yes, but this shouldn't be an argument.

We are several years in now. These statements are actually pretty hurtful for people who have been through a lot. It's like saying you could beat cancer if you only wanted to, or if you didn't think all those negatives thoughts, you wouldn't be so ill now.

Not only is it suggesting that this misery is in some way 'your own fault', but it also implies that it isn't real, or serious, at least not in the same way other diseases are.

And yes, psychological problems are real too, indeed. But it is not the same. The origin narrative around a disease does in fact matter for people trying to cope with it, and how others see you, for insurance, for politics and medical care. Please be more respectful about it.

I would reframe this and ask whether psychiatrists should be spending a lot more time understanding the patient’s immune system history and other factors. Brain fogs and other symptoms are understood by many patients to be modulated by other health processes, and physical fitness is considered a treatment by some practitioners, yet psychiatry is recovering from a legacy of medical dogma in which the brain and the immune system are completely separate, due to the idea of the blood-brain barrier. I would recommend to look more comprehensively at patients’ clinically relevant information, which I believe would produce deeper, systems-level understanding and treatments in more than enough cases to be worthwhile.

The "between-the-ears" brigade is at it again. Just asking questions.

For most people Ukraine and Gaza are just very remote worries, unless of course they're related to people there or close to the conflicts.

AI might be real stressor for those losing their job, or bad for those using it as a virtual love interest or therapist, but it's mostly a remote worry for most too.

Of the three, only the covid flu could have real mild/long effects. But if you want to seek other psychological factors, iflation, the job market, the loneliness epidemic, and other such things are much more likely ones...

>>There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.

Just because it is a "cloud of uncertainty" to you does not mean it is to people actually studying the phenomenon.

Multiple studies are already identifying scores of biomarkers correlated with Long COVID, e.g., "Identified from 28 studies and representing six biological classifications, 113 biomarkers were significantly associated with long COVID"[0]. The same type of phenomenon happened with Chronic Fatigue Syndrome, now identified as "Myalgic encephalomyelitis" where patients were long disregarded as simply having psychological problems, and the same with many auto-immune disorders. These can all be discovered with a sub-30second DDG search.

Yes, the democracies of the world are under assault from right-wing or authoritarian movements and this is dramatically increasing uncertainty, worry, and indeed harm for everyone. But before you start dismissing disease processes as caused by social psychologies and causing more harm to those already suffering, perhaps search for more concrete causes first.

[0] https://pubmed.ncbi.nlm.nih.gov/36744129/