Tests Predict Disease Years Before Symptoms: But Do You Really Want To Know? And Can Doctors Do Anything About It?

Modern medicine is getting into the soothsayer business.  Various technologies now make it possible to foresee the health future of an individual and predict with some certainty which maladies may befall a person years before symptoms or signs become apparent.

In an imaginary scenario, sixty-two year old John Smith goes to a new comprehensive diagnostic center called ORACLE OF HEALTH and undergoes a battery of blood, vision, genetic and dexterity tests that are predictive for diseases such as macular degeneration, glaucoma, Alzheimer’s disease, cancer, diabetes, even death itself.

But who is going to tell our fictional subject John Smith that he will lose some of his sight, have to start taking insulin or anti-diabetic drugs and will have cancer diagnosed within the next 5 years, and deliver the bad news all in the same day?  He might be so dismayed as to add another prognostication to the list – mental depression.  Or worse yet, attempted suicide.

Here is a partial list of the some of the tests that can predict disease years before it occurs.

  • A blood test can predict kidney disease 5 years before damage begins. [United Press International Nov 6, 2015]
  • A telomere length blood test (telomeres being the end caps of our chromosomes) is said to predict a future case of cancer 13 years before it develops.  [Telegraph May 1, 2015]  A drawback is that multiple tests would need to be performed over a period of time to measure whether the shortening of one’s telomeres is due to normal aging or is accelerated and indicative of future cancer. [EBiomedicine June 2015] However, investigators have determined telomere length is not much better at predicting mortality than a coin toss.  [Science Daily April 6, 2016]
  • Researchers found that testing for 5 amino acids (leucine, isoleucine, valine, tyrosine and phenylalanine) in the blood is highly predictive for the onset of diabetes at some time in the future.  [WebMD March 20, 2011]
  • Yet another blood test can predict the onset of Alzheimer’s disease with 100% accuracy a decade before symptoms occur.  However, this test is only applicable to those individuals who have a dominant genetic predisposition (ApoE4 gene) for the disease.  [Alzheimer Europe Aug 26, 2015]
    A simpler memory test may be predictive for Alzheimer’s disease 18 years prior to its diagnosis.  Those who fail the test are 10 times more likely to develop memory loss. [Science Alert June 29, 2015]
  • Instillation of a fluorescent dye into the arm can, upon eye examination, help eye doctors detect changes in the optic nerve at the back of the eyes that predicts glaucoma a decade before side vision is lost. [Daily Mail Sept 7, 2015]
  • There are 34 genes that are associated with risk for macular degeneration, a blinding eye disease that usually occurs in the latter years of life.  But genetic tests for macular degeneration are said to promise more than they can deliver. [Medscape Sept 16, 2014]
  • A dark adaptation test (the time it takes to refill visual chemicals in the back of the eyes after bleaching by bright light) in excess of 6.5 minutes predicts future macular degeneration by 4 years before visual decline. [Clinical & Epidemiologic Research March 2014]  An abnormally long period of adaptation to the dark is better than 90% accurate and specific for future macular degeneration. [Investigative Ophthalmology Visual Science 2014; Maculogix]
  • An online test available under the name DEATH CLOCK allows participants to submit personal health data that is predictive of how many more years they have to live.  I took the test and it predicted I would live another 12 years (4227 days, 23 hours, 38 minutes and 49 seconds to be precise). [Death Clock]
  • A marker of inflammation (interleukin-6) in the blood is now said to be a reliable marker of whether a person will survive the next five years.  [Daily Mail Nov 29, 2016; Canadian Medical Assn. Journal Nov 28, 2016]
  • A simple test of balance and strength as tested by the ability to sit on the floor and rise from that position without using hand support is a fairly reliable at determining survival. [Fox8; European Journal Preventive Cardiology Dec 13, 2012]

What now?

So once we are foretold of maladies to come, what are we to do?  Unless there is good news attached to the prognostication it just may serve to provoke needless anxiety.

Putting a patient on notice a disease is in progress is one thing, instructing them how to put a halt to it another.  There are no proven treatments for common conditions like macular degeneration, kidney disease, fatty liver or cancer.  Furthermore, bringing down risk numbers like cholesterol, blood pressure and blood sugar may not reduce mortality.

Beyond the obvious, what?

The obvious comes to mind.  Cease smoking tobacco, limit alcohol and cut sugars and carbohydrates out of the diet.  But people with poor health habits are probably the least likely to undergo prognostic tests.

Taking the health-minded and putting them through a battery of tests to predict future health problems when they don’t smoke, over-consume alcohol and already eat a good diet may result in telling patients what they already practice.

Doctors loathe prevention.  Doctors have been taught to treat disease as it occurs, not treat non-disease.  Modern medicine embraces a “detect and collect” mentality.  The new paradigm would now be a “collect before it even becomes a disease.”  Is there even an insurance billing code for pre-disease medications?

Can it be presumed that modern medicines, which were approved to treat diseases, with all their accompanying side effects, are appropriate for healthy people?

Take a baby aspirin?  Maybe not

Maybe skip all the predictive tests and just place everyone on low-dose aspirin, let’s say at age 50?

A baby aspirin is often thought of as a preventive measure against heart attacks.  But a baby aspirin (81 mg) is ineffective and a larger dose (160 mg) is required.  A full size aspirin pill is 325 mg.  Aspirin tablets of any dose can induce bleeding ulcer or brain hemorrhage, which represents disease substitution. [American Journal Medicine 2010]

There is no benefit in taking a statin cholesterol-lowering drug if your risk for a heart attack or stroke is less than 20% over the next 10 years.  [British Medical Journal Oct 22, 2013]

Take an anti-diabetic drug?  Maybe not

The anti-diabetic drug metformin has been proposed as a cancer preventive agent.  [Annals Translational Medicine June 2014]

Chronic use of metformin can induce gas, diarrhea, stomach cramps, abdominal swelling, indigestion, and incomplete or infrequent bowel movements. Another metformin-induced problem is late onset diarrhea.  Metformin also induces a vitamin B12 deficiency that can turn into peripheral nerve problems in the feet and hands.  Metformin can also induce a thiamin (vitamin B1) deficiency that could theoretically result in heart failure (wet beriberi).

A review of nine studies where metformin was used among overweight individuals who did not have diabetes was not convincing. [American Family Medicine Sept 2005]

Furthermore, it’s actually illegal to promote metformin to prevent cancer or even promote it for healthy individuals.

Take a Polypill?  Maybe not.

Some experts propose a Polypill (combination low-dose aspirin, statin cholesterol-lowering drug and 3 blood pressure pills) to delay or avert heart attacks and strokes.  But the Polypill idea, first suggested in 2003, has been an idea that physicians haven’t embraced.  And it is fraught with the prospect of over-medicalizing the adult population and subjecting them to drug side effects when they are healthy.

For example, about 10% of subjects taking the Polypill will develop a chronic cough from taking one of the blood pressure medications (lisinopril). [Journal Royal Society Medicine Dec 1, 2009]

In a large study (1813 subjects) the combination of any two of three medicines (statin, aspirin, blood pressure drug) was ineffective.  All three were required to reduce the risk for a heart attack or stroke, which increases the risk for side effects. [American Heart Journal Aug 2013]

Another strategy is to determine who will benefit most from a Polypill.  Subjects with a coronary artery calcium score (calcification) of zero at age 50 will derive no benefit from the Polypill regardless of whether they have high cholesterol, diabetes, high blood pressure or are obese.  A 50-year old individual with a calcium arterial score of 100+ will derive the best benefit.  [American Journal Cardiology Aug 15, 2014] A coronary artery calcium score of zero confers a 15-year “warranty” during which mortality from coronary artery disease remains under 1%.

But that means exposing an entire population of adults to radiation from CAT-SCANs and repeat CAT-SCANs to determine arterial calcification.  One study of 9715 adults without chest pain showed 4864 had a calcium score of zero (50%).  [MedScape July 20, 2015] (Isn’t this evidence that calcium rather than cholesterol is the real culprit behind arterial disease?)

Another problem with the Polypill is compliance.  Will the masses take it?  One study shows only 45.5% will.  [Journal American College Cardiology Nov 18, 2014]

An anonymous blogger posted this about the Polypill: “Make it mandatory, with a penalty for failing to comply.  Oh, and make it free.”  America is headed towards fascist medicine.

Diet is primary

The futility of prescribing medicines to prevent disease is borne out with the realization an apple a day is equivalent in heart attack risk reduction to taking a statin cholesterol-lowering drug.  [British Medical Journal 2013]  Doctors won’t get patients coming back to their offices for checkups and re-prescriptions by writing scripts for apples.

What to do (best guess)

I can offer my best guess what adults should do.  (I do have a commercial interest in this idea.)

Skip all the prognostic tests while healthy and take a resveratrol pill.   Resveratrol does all what an aspirin or statin drug does and is over 50 times more effective than metformin, and in contrast to Rx medications, in modest dose is not associated with significant side effects or inducement of nutrient deficiencies.

In fact, resveratrol inhibits clumping of blood platelets in arteries even among patients with aspirin resistance. [Journal Cardiovascular Pharmacology Aug 2006]  Just like aspirin, resveratrol prevents an abnormal number of chromosomes (tetraploidy) that is thought to be a precursor for cancer. [Proceedings National Academy Sciences Feb 25, 2014]

Like B vitamins, resveratrol inhibits homocysteine, an undesirable blood protein associated with brain and cardiovascular disease. [Clinical Chemistry Laboratory Medicine 2005]

A companion to resveratrol would be quercetin, which inhibits inflammation and blood clotting like aspirin but is a far superior antioxidant. [Acta pharmacologica Sinica 1993]

The combination of resveratrol + quercetin even inhibits the re-closure of coronary arteries following the placement of a stent. [Journal Nutrition Aug 2012]

Not only do resveratrol and quercetin inhibit inflammation and formation of blood clots, they facilitate the disposal of cholesterol from the liver and amyloid plaque from the brain, have germicidal properties against viruses, bacteria and fungi, serve as a natural antidepressant by virtue of their ability to inhibit homocysteine and monoamine oxidase, are 50-200 times more effective than metformin and also favorably influence hundreds of genes involved in aging and trigger an internal gene switch that activates internal enzymatic antioxidants (glutathione, catalase, SOD) that protect critical organs (heart, brain, eyes) against threats posed by lack of oxygen, a phenomenon called preconditioning. [Medicine 2016; Diabetes Aug 2006; Free Radical Biology Medicine Oct 2016]

Afraid to give up your trusted statin drug?  Combine it with resveratrol to amp up protection for your heart. [Journal Molecular Cardiology March 2007]

Resveratrol: safety beyond compare

Resveratrol is safer than aspirin, ibuprofen, acetaminophen, the three common anti-inflammatory pain relievers.  Resveratrol is far safer than a statin drug.  While resveratrol is not totally free from (reversible) side effects, there are no reports of hospitalizations due to resveratrol consumption, even over-consumption, whereas aspirin, statins and metformin all have been reported to produce side effects that required hospitalization.  [Journal American Medical Assn. June 6, 2012; Journal American Medical Assn. Dec 1, 2004; European Review Medicine Pharmacological Science Feb 2013]

An estimated 42 million Americans take troublesome statin drugs.  [American Counsel on Science & Health Dec 4, 2015] Over 4 out of 10 statin drug users are forced to cease taking them due to side effects.  [New England Journal Medicine June 24, 2015]  More than 50 million Americans inappropriately take as aspirin for prevention of a heart attack. [Journal American College Cardiology Jan 2015]  Aspirin kills 400% more American than the flu (20,000 estimated deaths per year).

While modest-dose resveratrol is considered safe (up to 350 mg), excessively high doses (1000+ mg) may be problematic.  While overdose is a potential problem for aspirin, statins and resveratrol, one brand of resveratrol {Longevinex®) has been demonstrated to be safe and completely non-toxic even when given in mega-doses.  Mega-dose resveratrol (2800 mg human equivalent dose in humans) damaged heart muscle in animals whereas the same dose of Longevinex® did not damage the heart. [Experimental Clinical Cardiology 2010]

Americans are playing with fire while overlooking resveratrol.  — © Bill Sardi, ResveratrolNews.com

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