In my previous From The News post, I mentioned that the definition of “high” blood pressure will soon be lowered from 140/90 to 130/80. (The systolic, or top number, is when your heart is contracting. The diastolic, or lower number, is when your heart is between beats.) I also said I believe the redefinition is likely driven by a desire to sell more drugs.
A couple of you commented that the drugs might be necessary. Okay, maybe that’s true for some people. I’ve never had high blood pressure, so I’ve had the luxury of not being personally concerned with the subject. Nonetheless, I thought I’d dig through my database of articles and studies to explain why I’m not convinced that most people diagnosed with “high” blood pressure need drugs.
The best way to treat a health problem is to treat the root cause, not the downstream effect. So what causes high blood pressure? Many of the so-called experts still insist the problem is sodium. (They’re generally the same so-called experts who insist saturated fat causes heart disease.)
Dr. Frank Sucks … er, Sacks – the same researcher who wrote the American Heart Association’s we were right all along about saturated fat! presidential advisory report – has been a long-time champion of low-salt diets. He believes he proved lowering salt will save our hearts with his famous DASH trial. Here’s what his Harvard profile says about it:
These multi-center National Heart Lung and Blood Institute trials found major beneficial additive effects of low salt and a dietary pattern rich in fruits and vegetables on blood pressure.
Actually, that’s not what the DASH trial showed at all. You have to read the study carefully (and I have) to get the true picture, but here’s the brief summary: Sacks put people on either a standard American diet that included plenty of sugar and other junk, or on a low-fat DASH diet that included no sugar and no junk. Then he had them consume versions of those two diets that were high in salt, medium in salt, or very low in salt.
In order to claim he’d proved restricting salt is beneficial, Sucks had to compare the blood-pressure differences between people on the high-salt/junk diet and people on the low-salt/DASH diet. That’s akin to comparing people on a high-salt/high-whiskey diet to people on a low-salt/high-water diet, then declaring that restricting salt prevents liver damage.
Within each diet group – junk food vs. DASH – restricting salt by a whopping 75% only produced a blood-pressure drop of about three points. Whoopee.
Other researchers have found similar results (and unlike Dr. Sucks, reported them honestly). Here are some quotes from a 1998 meta-analysis titled Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride:
In 58 trials of hypertensive persons, the effect of reduced sodium intake on systolic blood pressure was 3.9 mm Hg, and on diastolic blood pressure was 1.9 mm. In 56 trials of normotensive persons, the effect of reduced sodium intake on systolic blood pressure was 1.2 mm Hg.
Once again, restricting sodium produced a teeny drop of a few points.
These results do not support a general recommendation to reduce sodium intake.
Gee, do ya think?
Here are some quotes from a 2008 E Science News article:
Contrary to long-held assumptions, high-salt diets may not increase the risk of death, according to investigators from the Albert Einstein College of Medicine of Yeshiva University.
They reached their conclusion after examining dietary intake among a nationally representative sample of adults in the U.S. The Einstein researchers actually observed a significantly increased risk of death from cardiovascular disease (CVD) associated with lower sodium diets.
“Our findings suggest that for the general adult population, higher sodium is very unlikely to be independently associated with higher risk of death from CVD or all other causes of death,” says Dr. Hillel W. Cohen, lead author of the study and associate professor of epidemiology and population health at Einstein.
And here are some quotes from a Food Navigator article about a Cochrane review of sodium-restriction studies:
The authors, led by Professor Rod Taylor from Peninsula College of Medicine and Dentistry in the UK, found no strong evidence to support the idea that salt reduction reduces cardiovascular disease or all-cause mortality in people with normal or raised blood pressure.
People with normal or raised blood pressure at baseline showed no strong evidence of benefit from salt intake restriction. Salt restriction did, however, increase the risk of death from all causes in those with congestive heart failure, reported the authors.
I found that article amusing because it provided a perfect example of The Anointed in action. The researchers concluded that given the results, we need to conduct more research before governments jump in to set lower targets for salt intake.
But as we know, The Anointed don’t believe they should be bothered with providing evidence before instituting a Grand Plan. So here’s how a spokesperson for a U.K. organization calling itself the Consensus Action on Salt and Health replied to the Cochrane review:
Campaign director Katharine Jenner told FoodNavigator that it is “very disappointing” to see the message from the review indicates that salt reduction may not be beneficial.
“This is a completely inappropriate conclusion, given the strong evidence and the overwhelming public health consensus that salt raises blood pressure which leads to cardiovascular disease,” said Jenner.
Whenever you hear The Anointed insist that by gosh, there’s a consensus and therefore the debate is over, you know they’re peddling junk science they don’t want examined.
Jenner told FoodNavigator that “there is no sense in waiting for further trials before progressing with an international salt reduction programme, which will immediately save many thousands of lives.”
Of course not. Because when The Anointed devise a Grand Plan, it must always be implemented RIGHT NOW or people will die … and it will be your fault for insisting on evidence before proceeding.
Salt restriction is the standard dietary advice, but it doesn’t do much. So after concluding that your low-salt diet just isn’t working for some reason, your doctor will reach for the prescription pad. The drugs do lower blood pressure. But do they save lives?
That’s where it gets a bit murky. In Doctoring Data, Dr. Malcolm Kendrick stated that there’s no convincing clinical evidence that blood-pressure medications reduce mortality for most people with “high” blood pressure.
Here are some quotes from an article on the Whitaker Wellness Institute website:
Another hypertension myth is that it is a silent killer that sets us up for strokes and heart attacks and knocks about five years off life expectancy. Although this is true for patients who have very high blood pressure and/or existing cardiovascular disease, diabetes, or kidney disease, the picture is considerably different for mild hypertension, which is defined under current guidelines as 140-159/90-99.
Scientific data published in top medical journals over the past few years makes it clear that mild hypertension does not confer these risks. For example, reevaluation of data from the renowned Framingham Heart Study shows that deaths related to hypertension barely budge until systolic blood pressure reaches 175 and mortality rates climb significantly only above 185. In other words, malignant hypertension is a killer. Uncomplicated mild hypertension is not.
Sixty percent of hypertensive Americans fall into the mild category. Nevertheless, more than half of them are treated with medications. And that’s the real tragedy.
There is no convincing scientific evidence that treating basically healthy patients with mild hypertension provides any benefits. In a groundbreaking recent study, researchers reviewed all the clinical trials in the medical literature comparing drug treatment of mild hypertension with placebo or no treatment. They found no differences in heart attacks, strokes, and deaths between treated and untreated individuals. But they did find that the drugs caused a lot of misery.
Maybe the drugs provide life-extending benefits for people with very high blood pressure. For people merely in the “high” range of 140 to 159, I’m not convinced. It seems the drugs merely treat a symptom.
As I said earlier, the best option is to treat the root cause. Several studies have hinted at the root cause, or at least one of them. Here are some quotes from a 2010 WebMD article:
A new study shows that a low-carbohydrate diet was equally good as the weight loss drug orlistat (the active ingredient in Alli and Xenical) at helping overweight and obese people lose weight, but people who followed the low-carb diet also experienced a healthy drop in their blood pressure levels.
“I expected the weight loss to be considerable with both therapies but we were surprised to see blood pressure improve so much more with the low-carbohydrate diet than with orlistat,” researcher William S. Yancy, Jr., MD, an associate professor of medicine at Duke University Medical Center, says in a news release. “If people have high blood pressure and a weight problem, a low-carbohydrate diet might be a better option than a weight loss medication.”
In the study, published in the Archives of Internal Medicine, 146 obese or overweight adults were randomly divided into two groups. Many of the participants also had chronic health problems, such as high blood pressure or diabetes.
The first group was advised to follow a low-carbohydrate, ketogenic diet consisting of less than 20 grams of carbohydrates per day, and the second group received the weight loss drug orlistat three times a day, plus counseling in following a low-fat diet (less than 30% of daily calories from fat) at group meetings over 48 weeks.
The results showed weight loss was similar in the two groups. The low-carb diet group lost an average of 9.5% of their body weight and the orlistat group lost an average of 8.5%. Both weight loss methods were also not significantly different at improving cholesterol and glucose levels.
But when researchers looked at changes in blood pressure, they found nearly half of those who followed the low-carbohydrate group had their blood pressure medication decreased or discontinued during the study, compared to only 21% of those in the orlistat group.
Plenty of doctors who prescribe low-carb diets have said the same thing: many of their patients end up ditching the blood-pressure medication. In fact, if the patients combine a low-carb diet with the medication, they can actually become dizzy from low blood pressure.
A study published waaaay back in 1985 suggests why a low-carb diet can lower blood pressure:
Both systolic and diastolic blood pressure were found to be significantly related to fasting serum insulin level even when age, weight, and serum glucose level were controlled. The relation between serum insulin and blood pressure was more pronounced in those women with a family history of hypertension. These data indicate that insulin may play a major role in the regulation of blood pressure in obesity and that the previously accepted relation of weight to blood pressure may depend on blood levels of insulin.
So there you go. High blood pressure, like so many other aspects of metabolic syndrome, is apparently driven by chronically high insulin. It’s the high insulin that needs fixing, not the symptoms it produces.
The Whitaker Wellness article provides some practical advice as well:
We would all be better served by shifting the focus to safe, natural, proven therapies that not only lower blood pressure but, unlike antihypertensive drugs, also improve multiple aspects of health.
Regular aerobic and resistance exercise, which reduces systolic blood pressure as effectively as many medications, rejuvenates every system in your body. Losing as little as 10 pounds or 5 percent of your total weight provides significant all-around benefits. Relaxation techniques, meditation, yoga, acupuncture, and neurofeedback reduce stress’s adverse effects on blood pressure, health, and quality of life.
Cutting out high-glycemic sugars and starches lowers blood sugar, lipids, insulin resistance, and other aspects of metabolic syndrome as well as helping to lower blood pressure. Beets, leafy greens, and other nitrate-rich foods boost synthesis of nitric oxide (NO), which dilates and protects the arteries.
Magnesium has powerful effects on blood pressure because it relaxes and reduces pressure on the arteries; that 75-80 percent of Americans fail to get the RDA of magnesium is a likely contributor to our high rates of hypertension. Coenzyme Q10 has positive effects on blood pressure and the entire cardiovascular system.
Cut the refined carbs, eat some leafy greens, get some exercise, and supplement your diet with magnesium and CoQ10. Sounds a lot better than taking medications if you ask me.
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