March 2004

Vol. 3     No. 3  

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Favorite Five

My Favorite Five Articles Found in Recent Medical Journals

Hypertension Caused by Blood Flow Restriction

Retinal arteriolar diameter and risk for hypertension by Tien Yibn Wong in the February 2004 issue of the Annals of Internal Medicine found people with narrowing of their small arteries in the retina of their eyes have a greater risk of high blood pressure.  The size of the arteries was determined by taking photographs of the back of the eye (the retina).  The risk of developing hypertension over the next 10 years was about 60% higher in those with the most narrowing compared to the least narrowing.

Narrowing and constriction of the small arteries thoughout the body causes elevation of blood pressure by increasing the resistance to the flow of blood.  The body must compensate for this restriction and resistance by raising the blood pressure in order to deliver adequate oxygen and nutrients to the tissues.

Approximately 50 million people in the US have hypertension – and as many as 42% of people aged 35 to 64 years in Western countries have elevated blood pressure (it is so common it is almost “normal”).  Universally, doctors treat the elevated blood pressure as if it were a disease, yet the increase in pressure is actually a response to impairment of blood flow from restricted blood vessels. The restrictions are caused by years of consuming unhealthy foods.

Rather than correct the poor circulation, the accepted response, as taught by the pharmaceutical industries, is to lower the blood pressure by weakening the heart (beta blockers), weakening the arteries (calcium channel blockers), depleting fluids (diuretics), and/or counteracting hormones (ACE inhibitors).   In other words, doctors are counteracting the body’s own efforts to adjust to the poor circulation.  This is why the results of the efforts are so disappointing – for example, treating high blood pressure with the best of intentions does almost nothing to reduce the risk of death from heart disease and all too little to reduce the risk of stroke.

The proper response from your doctor should be to improve your circulation.  This would be accomplished by a healthier diet (a plant-based diet), and the elimination of artery-constricting alcohol and coffee.   Most of our patients (98%) are off all their medications for treating hypertension with an excellent, or at least, an acceptable blood pressure, within 4 days of following a healthy diet and taking a little daily exercise.

Wong TY.  Retinal arteriolar diameter and risk for hypertension.  Ann Intern Med. 2004 Feb 17;140(4):248-55.

Take Your BP at Home – Get Off Medications

Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial by Jan Staessen in the February 25, 2004 issue of the Journal of the American Medical Association reported that making decisions on whether to treat hypertension based on home readings rather than readings obtained in a doctor’s office resulted in less aggressive treatment, at lower costs, with no difference in well-being, and no damage to the heart.1  Plus, checking BP at home led to twice as many people discontinuing their medications.

Many people are treated with blood pressure medications because they become frightened when they visit their doctor and they never get a second chance to be unburdened from daily medications.  This can be remedied when you take control by monitoring your BP at home.  If you use an automated device (purchased in a drugstore or medical supply store or by the Internet) you also remove “observer bias.”  Advantages for home blood pressure monitoring are: identification of people with “white coat syndrome,” and avoiding the false readings from this syndrome; a greater number of blood pressure readings, and daily encouragement to follow a healthy diet and exercise program from these self-taken readings.

Your goal should be to get off blood pressure medications (actually all medications) by becoming a healthier person through diet and exercise.  However, measurements obtained in your doctor’s office may be a serious barrier to that end.  Not only may you get higher readings, but you may also have to deal with your doctor’s ego.  I have seen too many doctors offended by even the suggestion that a patient reduce or stop his medications – after all it was the doctor’s well-educated opinion that recommended the medication in the first place – how could this decision be questioned?

Most of my patients are able to stop all of their BP medications within a few days of beginning a healthier diet – and part of this decision is made from measurements made under comfortable conditions.  If you would like to learn more about my approach, then please see my August 2002 Newsletter article, “Take Blood Pressure at Home - Get Off Your Medications.”

The most recent guidelines for treating hypertension with medications are from the British Hypertension Society (2004) and they state, “Initiate antihypertensive drug therapy if sustained systolic blood pressure (top number) of 160 mm Hg or greater or sustained diastolic blood pressure of 100 mm Hg or greater.”2  Most people I see have been started on medications for pressures lower than these, after one or two readings in the doctor’s office, and with no evidence that their blood pressure elevation was sustained (such as for months).  By understanding all the facts behind this medical issue you can make better decisions and get the benefits.

1)  Staessen JA .  Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial.  JAMA. 2004 Feb 25;291(8):955-64.

2)  British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary.  BMJ. 2004 Mar 13;328(7440):634-40.

Free access to this article at:  http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7440/634

Natural Hormone Supplements of Questionable Value

Red clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial by Charlotte Atkinson  in the February 2004 issue of Breast Cancer Research found a dietary “phytoestrogen supplement” (26 mg biochanin A, 16 mg formononetin, 1 mg genistein and 0.5 mg daidzein) taken daily for 1 year did not worsen or improve mammographic breast density in women aged 49–65 years.1 Furthermore, there were no effects of the isoflavone supplement on reproductive hormones, like estrogen (estradiol), FSH or LH in postmenopausal women, or on hot flashes or other menopausal symptoms.

Conventional estrogen replacement therapies (HRT) increase the density of the breasts and a low-fat diet has been shown to decrease (improve) breast density.2  Greater density of the breast tissue is related to greater risk of developing breast cancer (because estrogen increases breast tissue and promotes breast cancer).  There are many claims that the way to improve the health of women is for them to take supplements that mimic the effects of estrogen.  Many of these are derived from plants, like soybeans and clover.  The results from these studies are mixed.  (See my August 2002 newsletter article, “Phytochemicals and Phytoestrogens” for more information.)  The only safe and effective approach women can take is to follow a healthy plant-based diet (and exercise). (See the McDougall Program for Women book for details.)

1)  Atkinson  C. Red clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial [ISRCTN42940165]. Breast Cancer Res 2004, 6:R170-R179.

2)  Boyd NF.  Effects at two years of a low-fat, high-carbohydrate diet on radiologic features of the breast: results from a randomized trial. Canadian Diet and Breast Cancer Prevention Study Group.  J Natl Cancer Inst. 1997 Apr 2;89(7):488-96.

Even “Good” Dairy Fat is Bad

Effect of conjugated linoleic acid on body composition and plasma lipids in humans: an overview of the literature by Antonius Terpstra in the March 2004 issue of the American Journal of Clinical Nutrition reported that so called “good fat” from dairy products, conjugated linoleic acid (CLA), is of little or no benefit in humans.  “Thus, the results of the studies in humans indicate that the effect of CLA on body fat is considerably less than that anticipated from mice studies and that CLA has no major effect on plasma lipids.”

The dairy industry now runs a national advertising campaign trying to convince the public that eating dairy products will help them lose weight – and one of the arguments used for this nonsense has been that this kind of fat from cow’s milk (and meat) causes weight loss.  This review of the human studies shows little benefit.  Contrary to the hopes of the dairy sellers, CLA does not lower cholesterol or reduce the risk of heart disease.  Besides CLA there are loads of other saturated fats in dairy products that promote both heart disease and obesity.  Yet the dairy industry is advertising otherwise.  (See my May 2003 newsletter article, “Marketing Milk and Disease.”)

Only because people love to hear good news about their bad habits can the dairy industry succeed in convincing some gullible people that food (cow’s milk) designed to grow a 60-pound calf into a 600-pound cow could be “the long-anticipated weight loss miracle for the 21st century.”

Terpstra AH.  Effect of conjugated linoleic acid on body composition and plasma lipids in humans: an overview of the literature.  Am J Clin Nutr. 2004 Mar;79(3):352-61.

Tai Chi Improves Overall Health

The effect of Tai Chi on health outcomes in patients with chronic conditions – a systematic review by Chenchen Wang in the March 8, 2004 issue of the Archives of Internal Medicine reported physiological and psychosocial benefits from this traditional Chinese martial arts practice.  Tai Chi was found to be safe and effective, promoting balance control, flexibility, and cardiovascular fitness. A total of 743 articles were reviewed in order to come to these conclusions.

Tai Chi combines deep breathing and relaxation with slow, graceful, gentle movements. Proponents claim it enhances good health, memory, concentration, balance, strength, and flexibility.  Plus, mental benefits are experienced for anxiety and depression, and for deterioration seen with aging.  This form of exercise is recommended for patients who have undergone heart surgery, as well as for those suffering from heart attacks, heart failure, hypertension, arthritis and multiple sclerosis.

Tai Chi instruction in your community can be found by referring to your local phone directory or by checking with your neighborhood health club.

Wang C.  The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review.  Arch Intern Med. 2004 Mar 8;164(5):493-501

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