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  • Writer's pictureNick Allen

How we’re diagnosing disease too late

“Alzheimer’s disease starts in the brain more than 20 years before the first symptom… It’s a disease of younger and middle-aged people” - Richard Isaacson

Neurologist Richard Isaacson’s words don’t just apply to Alzheimer’s disease. The majority of today’s leading killers are diseases that start from a young age, yet they’re only diagnosed in later decades when it’s too late to avoid serious consequences. In this post we’ll discuss two of the leading killers to compare what we’re doing currently to what we should be doing.

There’s no better place to start than cardiovascular disease (CVD), widely considered a disease of old age. While it’s true that your risk of a heart attack or stroke increases as you age, the determination of when you’ll suffer from one of these events (or if you’ll be able to avoid them entirely) is dependent on risk factors that start accumulating from the day you’re born.

Even medical professionals choose to ignore this fact, as the main decision-making tool for whether or not to treat CVD is a 10-year risk calculator. This basically means that if you’re not likely to have a heart attack in the next 10 years, you’re not likely to find a doctor willing to take action. This is despite the fact that your risk of having a heart attack in 15 or 20 years could be quite high.

Another key demonstration of this principle is seen with metabolic health, particularly in the development of diabetes. Diagnosis is currently defined by two simple criteria: a fasting blood sugar level of ≥ 126 mg/dL or a hemoglobin A1c of ≥ 6.5%. The problem is that these are lagging indicators of metabolic dysfunction that started years prior. You can still make an impact at this point, but you’re generally not altering the disease process — just doing what you can to limit the consequences.

We have tools that allow us to pick up on the first signs of metabolic dysfunction, but they’re rarely utilized. An oral glucose tolerance test (OGTT), if done properly with frequent glucose and insulin measurements, can detect when you start requiring more insulin to get glucose into your cells. This is the canary in the coal mine, the first warning sign that diabetes is on the horizon. It may be years later when you finally see a rise in A1C or fasting glucose. The years that separate these events represent a critical window where making appropriate changes can lead to the complete reversal of insulin resistance, and avoidance of a life-changing diabetes diagnosis.

The failure to implement these tactics isn’t entirely attributable to a lack of knowledge. While there is a need to further emphasize prevention in medical education, the reality is that action follows money and currently there’s no money to be found in early-stage disease prevention. Until this changes, you’ll be hard-pressed to find a doctor that even takes you seriously for thinking about your health years in advance.


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