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Advice vs. Education
Natural Blood Pressure Control
Lifestyle and Blood Pressure
Supplements for Hypertension
Ask Dr. J: Irritable Bowel Syndrome
References
In The Health News
Diet and Disease
Recipe of the Month: Marinated Raw Kale
Dear Friends,
At my 10th medical school reunion, in 1980, I was surprised
that one of my classmates said that he had been following
my holistic medicine career (now often called “complementary,
alternative, and integrative medicine). He noted that he also
would tell patients to eat better, exercise more, and relax,
and that “it used to be called common sense, and now
it’s called holistic health.”
The difficulty with this is that just telling people to follow
better habits does little to help them. The new government
eating guidelines have the same problem—advice without
funded education campaigns. Most people already know that
better habits would be beneficial but have no clue as to how
to implement changes. (I always give specific, complete written
guidelines to patients, educating and encouraging them at
the same time.)
In addition to recommending fruits and vegetables, the guide
says to avoid “refined grains.” What they should
say is that people should avoid “white bread”
(as well as white rice). (Perhaps they do not want to use
that phrase because of the powerful agricultural business
interests that flood the market with white flour products.)
They also hedge their comments by encouraging only half of
grain consumption to be whole grains.
Although one food manufacturer is now touting that all their
cereals contain “whole grains,” they neglect to
point out that their products also contain large amounts of
sugar, hydrogenated oils with “trans fats,” artificial
flavors, colors, and preservatives. For many people the confusion
is only compounded by conflicting statements from many supposed
health authorities, many of whom are also selling products
for their special diets. I remember seeing an ad for “chocolate
mousse” from Weight Watchers, with the caption “Another
Friend,” as though people could solve their problems
of loneliness and depression through food rewards.
The government would do far more good if they spoke in plain
language, and gave real health advice (eat vegetables; whole
grains, such as whole wheat, brown rice, oatmeal, and millet,
instead of white bread, donuts, and cake; beans (lentils,
pinto beans, kidney beans, soy products); fresh fruits instead
of sugary snacks; nuts and seeds; low-fat organic dairy; and
wild fish, such as salmon and sardines). It would also help
if they actually made an effort to enhance nutrition education
in schools, where vulnerable kids might get some messages
that counter all of their exposure to fast food ads.
Incorporating healthy messages in our education system is
not difficult, and it would go a long way toward solving the
increasingly early development of obesity and chronic degenerative
disease. It would also help if leaders set good examples,
instead of proudly showing disdain for broccoli, or having
photo-ops with edible but highly refined, unhealthy junk.
Maintaining normal blood pressure is essential to long-term
health. Although it is common for blood pressure to go up
as people age, it is not inevitable and it is not healthy.
The pressure of the blood in the arteries is dependent on
many physiological processes and biochemistry. It is affected
by stress, nutrition, hormones, exercise, drugs, and the function
of the kidneys, brain, blood vessels, and heart.
When the heart beats, the pressure in the arterial system
rises (systolic pressure) and during relaxation, just before
the next beat, the pressure is lowest (diastolic pressure).
Normal numbers are 100 to 120 (millimeters of mercury) for
systolic and 60 to 80 for diastolic (120/80 or 100/60 for
examples). Although some specific disorders can cause high
blood pressure, it is most commonly unrelated to such conditions
and called “essential” or “primary hypertension.”
This is most often related to lifestyle, including diet, stress,
exercise, smoking, and weight.
In the long run, chronically elevated blood pressure causes
problems for the heart and arteries, including congestive
heart failure, heart attacks, and strokes, as well as other
health problems, including eye and kidney disease. Even slight,
persistent increases in blood pressure can lead to serious
problems over time.
It is very common for elevated blood pressure to cause no
symptoms until damage has been done to the cardiovascular
system. It is therefore important to have regular blood pressure
checkups. This is something you can do at home with automated
blood pressure machines that are relatively inexpensive and
reasonably accurate. However, because blood pressure can vary
quite a bit from moment to moment, it is good to check it
often and regularly. Sometimes blood pressure goes up from
the stress that some people feel by being in the doctor’s
office (“white coat syndrome”), so consider doing
it at home also.
For primary hypertension that is mild to moderate, the first
approach to treatment should always be lifestyle changes and
dietary supplements. Unfortunately, treatment often starts
with medications and vague advice about eating better and
getting some exercise without the attitude that these will
really work.
The typical drugs for hypertension include diuretics, beta-
or alpha-blockers, ACE inhibitors, enzyme blockers, and calcium
channel blockers, which are designed to reduce blood volume,
relax the heart muscle, or open up the blood vessels. However,
these all have significant side effects, such as low potassium
and magnesium in the blood, suppression of the heart muscle
leading to congestive heart failure, rapid heart rate, fatigue,
shortness of breath, low blood pressure, dizziness, fainting,
and sexual dysfunction.
Lifestyle changes have a powerful effect on blood pressure.
Regular aerobic exercise, weight loss, and a diet high in
fresh, vitamin C-rich vegetables and fruits have all been
shown to lower blood pressure, and often they can bring it
down to completely normal, eliminating any need for medication.
In a study of 102 subjects, training three times a week for
10 weeks, led to an average 13 point drop in systolic pressure
and a 6.3 average drop in diastolic pressure. Other studies
have shown that exercise improves the function of cells lining
the arteries (endothelium). These cells produce nitric oxide,
a substance that relaxes the arteries to open up blood flow
and reduce pressure.
Intense exercise may lead to increased oxidative stress on
the artery walls, but this can be prevented by antioxidants
(vitamin C; flavonoids) in food or supplements. Long term
exercise, even if only twice a week, leads to much greater
reductions in blood pressure, from 184/107 to 130/87. Daily
exercise is likely to be even better. (This may seem like
a lot, but remember that most animals exercise every time
they eat.)
Visualization, breathing exercises, yoga, meditation, or
other mind-body training, are also known to reduce blood pressure
in hypertensive patients. Diet plays one of the most important
roles in blood pressure control. Strictly limiting salt intake
is almost always helpful, although many people will find it
difficult to be strict enough to make a difference. Non-meat
eaters have lower blood pressure than people who eat meat,
partly because of the high levels of potassium, magnesium,
and antioxidants in fruits and vegetables. Sugar, caffeine,
and alcohol consumption also contribute to hypertension.
Numerous supplements are helpful in treating high blood pressure
and are an important part of a comprehensive program. Magnesium
(500-1000 mg), coenzyme Q10 (200-600 mg), garlic (1000 mg),
vitamin C (2000-6000 mg), vitamin E (400-800 IU), and fish
oil, are all associated with better blood pressure control.
Evidence also suggests benefits from hawthorn (500 mg), arginine
(2000-8000 mg), and taurine (2000-4000 mg).
New evidence shows that linolenic acid (a vegetarian source
of omega-3 oils, from flaxseeds and walnuts, for examples)
helps to prevent hypertension. A study of 4594 participants
showed 33 percent less hypertension in subjects with the highest
intake of linolenic acid compared to those with the lowest
intake.
Another report shows that high intake of folic acid, which
reduces heart risks by lowering homocysteine, also lowers
the risk of developing hypertension. A study of over 150,000
women shows total folic acid intake over 1000 mcg from food
and supplements cuts the risk in half for younger women, and
by 20 percent in older women. High-dose supplements were necessary;
food levels alone did not reduce risk. In young diabetics,
supplements of 5 mg of folate improves endothelial function
and arterial blood flow. Folate is extremely safe in these
doses.
Q. My daughter has irritable bowel syndrome.
What do you recommend for her that might help?
—HR, Canada, via Internet
Irritable bowel syndrome refers to diarrhea, gas, bloating,
abdominal discomfort, and intermittent constipation, without
intestinal bleeding or inflammation. It may be precipitated
by food sensitivities, poor dietary choices (particularly
sugary foods), intestinal overgrowth of yeast (Candida), and
high stress.
It often helps to eliminate common food sensitivities, often
including wheat (or other gluten-containing grains: rye, spelt,
kamut, and barley) and dairy products, but it may be precipitated
by almost any commonly consumed food. The symptoms are almost
the same as lactose intolerance, requiring the elimination
of milk from the diet. Yeast overgrowth is usually related
to excessive sugar intake, frequent antibiotic therapy, or
hormone treatments, such as prednisone.
In addition to avoiding processed foods, artificial ingredients,
caffeine, and soft drinks it helps to make sure the diet contains
adequate fiber. Aside from the dietary changes, dietary supplements
may well be beneficial. I have often found that L-glutamine
is helpful because it supports the health of the intestinal
lining cells and reduces watery diarrhea. The typical dose
is 2000 to 8000 mg daily.
Supplements that help relax the bowel are also useful, including
gamma-linolenic acid (GLA from borage or evening primrose
oils) and magnesium (high doses of magnesium can cause diarrhea).
The usual dose of GLA is 200-500 mg). In treating intestinal
yeast overgrowth, it helps to use acidophilus (the friendly
bowel bacteria), deodorized garlic (500-1000 mg), and grapefruit
seed extract (GSE), which helps to kill yeast. The usual adult
dose of GSE is 200 to 400 mg. Some combination of these therapies
should help her.
Dietary Guidelines for Americans 2005,
www.health.gov/dietaryguidelines/dga2005/document
Ketelhut RG, et al., Regular exercise as
an effective approach in antihypertensive therapy. Med Sci
Sports Exerc. 2004 Jan;36(1):4-8.
Higashi Y, Yoshizumi M, Exercise and endothelial
function: ... Pharmacol Ther. 2004 Apr;102(1):87-96.
Tsai JC, The beneficial effect of regular
endurance exercise training on blood pressure... Clin Exp
Hypertens. 2004 Apr;26(3):255-65.
Murugesan R, et al., Effect of selected
yogic practices on... hypertension. Indian J Physiol Pharmacol
2000 Apr;44(2):207-10.
Psaltopoulou T, et al., Olive oil, the
Mediterranean diet, and arterial blood pressure.... Am J Clin
Nutr. 2004 Oct;80(4):1012-8.
Alonso A, et al., Fruit and vegetable consumption
is inversely associated with blood pressure... Br J Nutr.
2004 Aug;92(2):311-9.
Appleby PN, et al., Hypertension and blood
pressure among meat eaters, fish eaters, vegetarians and vegans...
Public Health Nutr. 2002 Oct;5(5):645-54.
May JM, Qu ZC, Nitric oxide-induced oxidant
stress in endothelial cells: amelioration by ascorbic acid.
Arch Biochem Biophys. 2004 Sep 1;429(1):106-13.
Burke BE, et al., ...coenzyme Q10 in isolated
systolic hypertension. South Med J. 2001 Nov;94(11):1112-7.
Touyz RM, Role of magnesium in the pathogenesis
of hypertension. Mol Aspects Med 2003 Feb 6;24(1-3):107-36.
Djousse L, et al., Dietary Linolenic Acid
Is Associated With a Lower Prevalence of Hypertension in the
NHLBI Family Heart Study. Hypertension. 2005 Jan 17; [Epub
ahead of print]
Forman JP, et al, Folate intake and the
risk of incident hypertension among US women. JAMA. 2005 Jan
19;293(3):320-9.
Pena AS, Folic acid improves endothelial
function in children and adolescents with type 1 diabetes.
J Pediatr. 2004 Apr;144(4):500-4.
Lim DS, et al., Effect of oral L-arginine
on oxidant stress, endothelial dysfunction, and systemic arterial
pressure in young cardiac transplant recipients. Am J Cardiol.
2004 Sep 15;94(6):828-31.
a. Drug side effects are getting increasing press lately
with the heart risks from NSAIDs and the revelation that Prozac
is associated with suicidal and violent behaviors. Regular
use of ibuprofen (such as Advil and Motrin) for three months
or more has recently been shown to increase damage to the
small intestinal lining. In a study of 41 arthritis patients,
small bowel injury was seen in 71 percent of the NSAID users,
compared to only 10 percent of the controls, who took acetaminophen
(Tylenol) or nothing. (Graham DY, et al., Visible small-intestinal
mucosal injury in chronic NSAID users. Clin Gastroenterol
Hepatol. 2005 Jan;3(1):55-9.)
b. A combination of herbs, including chamomile and peppermint,
is as effective as medications in controlling the symptoms
of acid reflux disease (heartburn) without side effect, reducing
the symptoms by almost 80 percent compared to placebo. (Melzer
J, et al., Meta-analysis: phytotherapy of functional dyspepsia...
Aliment Pharmacol Ther. 2004 Dec;20(11-12):1279-87.) Another
study shows that chamomile tea (5 cups a day) may help protect
against colds and menstrual cramps. (Holmes E, A Metabonomic
Strategy for the Detection of the Metabolic Effects of Chamomile.
J Agric Food Chem 2005 Jan 26;53 (2), 191 -196.)
Olive oil appears to be protective against development of
breast cancer. While olives also contain other nutrients,
oleic acid, the monounsaturated fat in olives may contribute
to the protective effect. A new study shows that oleic acid
blocks the activity of the Her-2/neu oncogene, the most common
gene associated with breast cancer, and it appears to accelerate
programmed cancer cell death (apoptosis). (Menendez JA, et
al., Oleic acid, the main monounsaturated fatty acid of olive
oil, suppresses Her-2/neu (erbB-2) expression... Ann Oncol.
2005 Jan 10; [Epub ahead of print]
Many people do not like kale, a cabbage-family vegetable
that is nutritionally rich, but this recipe that a friend
sent me is very tasty, and may make you into a kale devotee
as it did me. Remove the stems from 2 pounds of kale and finely
chop the leaves after a thorough cleaning. Mince one onion,
one red bell pepper, and a half cup (or more) of cilantro.
Juice one large lemon, and mix with 2 to 3 Tbsp of tamari
soy sauce (for salt restricted diets, leave this out and add
some more lemon and freshly ground pepper). Combine all the
ingredients and let the mixture sit for several hours or overnight.
You can also add some garlic for variety, or experiment with
some other favorite herbs. This can be served as a side dish
or as a snack by itself, or you can insert some into whole
wheat pita pocket bread with slices of tomato, shredded carrot,
or avocado for a tasty sandwich.
drjanson@drjanson.com
Year-round phone: 386-409-7747
180 Massachusetts Ave.,
Arlington, MA 02474
225 North Causeway, New Smyrna Beach, FL 32169
3 Overlook Dr., Suite 3, Amherst, NH 03131
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