Men's "Health" Or Not

In an article about high blood pressure (HBP), Men's Health shows the value of health journalism by listing a bunch of techniques which:
1. Most folks do anyway
2. Folks with metabolic syndrome, which is the largest cause of HBP, can't or won't want to do
3. May not actually help that much; they may just be things that folks that are healthy do, and folks that have metabolic syndrome don't do, meaning they will be correlates with HPB, not causative agents

What the article could have said, but didn't, is that carb restriction cures metabolic syndrome and HPB in about 80% of the population.

So, salt restriction, 2 drinks a day, and exercise may be counted on to lower HPB by a few points, if at all.  If that's your treatment you'll get on or stay on meds.  Or, you can stop sugaring yourself to death and get off of meds and eat as much salt as you like, if you are one of the 80%.

Luckily for "Men's Health" there's no such thing as medical malpractice journalism.

http://www.menshealth.com/mhlists/lower-blood-pressure/ticker-tracker-home-edition.php

Elevated Visceral Fat: "Nobody Wants That"

The language that follows is the language of observational/epidemiological studies:

"among obese adults, visceral fat was associated with more than a twofold increased risk of developing incident diabetes (odds ratio 2.42, 95% CI 1.59 to 3.68).  In addition, developing either condition was also associated with markers of insulin resistance including elevated fructosamine levels (OR 1.95, 95% CI 1.43 to 2.67) and elevated fasting blood glucose (OR 1.88, 95% CI 1.38 to 2.56).

But there were no associations with general markers of obesity, including body mass index (BMI) or total body fat."

In other words, "these are interesting correlations."

Not that I would disagree with their conclusions:

"Our study may have implications for understanding differences between metabolically healthy and pathologic obesity."

This is interesting because not everyone that's fat is insulin resistant, and those who are develop illness as much higher rates than those who are not.

This is also interesting:

"In participants without diabetes at baseline, a number of factors were significantly and independently associated with incident diabetes in obese adults:

• Elevated visceral fat: OR 2.42, 95% CI 1.59 to 3.68 (P<0 .001=".001" li="li">
• Elevated systolic blood pressure: OR 1.26, 95% CI 1.07 to 1.48 (P=0.006)
• Elevated fructosamine levels: OR 1.95, 95% CI 1.43 to 2.67 (P<0 .001=".001" li="li">
• Elevated fasting blood glucose: OR 1.88, 95% CI 1.38 to 2.56 (P<0 .001=".001" li="li">
• Weight gain from baseline: OR 1.06, 95% CI 1.02 to 1.10 (P=0.002)
• Family history of diabetes: OR 2.32, 95% CI 1.25 to 4.29 (P=0.008)

"There were no associations for BMI, total body fat, or abdominal subcutaneous fat, they reported." 

Many of the same factors correlated with the development of insulin resistant in those not obese when the study began.

http://www.diabetesincontrol.com/index.phpoption=com_content&view=article&id=13578&cacatid=1&Itemid=17

All in all, this fits a well recognized pattern of illness - high fructosamine levels/high fructose intake, visceral fat, high blood pressure, elevated fasting glucose, weight gain, and family history of diabetes.  

Lucky for us, most of these symptoms are treatable through carb restriction - I recommend starting out at 25-50g/day to stop these symptoms, and after weight/fat/symptom normalization, many will be able to eat more carbs but maintain their wellness.  Eat meat, eggs, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Mercola On Fructose

What is the link between fructose and blood pressure? Fructose in your diet raises your blood pressure in three key ways:

1. When your liver breaks down fructose, uric acid is produced as a byproduct. Uric acid also drives up your blood pressure by inhibiting nitric oxide in your blood vessels. Nitric oxide helps your blood vessels maintain their elasticity. When you consume large amounts of fructose, increasing uric acid levels drive up your blood pressure. If your uric acid levels are chronically elevated, you have an increased risk for hypertension, kidney disease, metabolic syndrome and diabetes. Large amounts of fructose also place a great strain on your liver, which is responsible for most of the metabolic burden.
2. As metabolic physician and nutrition expert Dr. Ron Rosedale has explained, insulin stores magnesium. If your insulin receptors are blunted and your cells grow resistant to insulin, you can't store magnesium, so it passes out of your body through urination. Magnesium relaxes muscles; so, when your magnesium level is low, your blood vessels will constrict rather than relax, which further raises your blood pressure.
3. Insulin causes your body to retain sodium, which in turn causes fluid retention. Fluid retention results in elevated blood pressure and can ultimately lead to congestive heart failure.

I strongly advise keeping your TOTAL fructose consumption below 25 grams per day, or as low as 15 grams if you have high blood pressure, are overweight, or diabetic.

The fructose in whole fruits is generally healthy, unless you consume large amounts, and/or in the form of fruit juices or dried fruits. Still, if you have any of the health issues just mentioned and you're consuming large amounts of fruit, you would be wise to restrict your fruit intake to under 15 grams of fructose per day as well until your condition has normalized.

http://articles.mercola.com/sites/articles/archive/2012/09/23/broccoli-health-benefits.aspx?e_cid=20120923_SNL_Art_1

As always with Dr. Mercola's posts, you have to take the good with the bad.  This article starts out by hyping the benefits of broccoli consumption, but the citations indicate the research is mostly epidemiological, which means little to me.  Not that I would disagree with four servings of broccoli per week, but I doubt this would offer the mythical benefit for most of us in terms of improving blood pressure.  

However, I like the model he's proposing above with regards to how we are such a sick, diabetic, hypertensive culture.  And with this issue, we don't have to rely on goofy science to know if it helps.  With carb restriction generally and fructose specifically, most of us will see blood pressure normalization.

I found that after carb restriction, potassium supplementation further normalized my BP, and recently met someone who's doctor recommended potassium for that purpose also, which I thought was good news.

The big takeaway - all these symptoms (high blood pressure, dis-lipidemia, visceral fat, gout, insulin resistance/diabetes) are not discrete illnesses, but representative of excess consumption of carbs in general and sugars (which almost always are about 50% fructose) specifically.

Inexcusable

Here's an interesting statement, in which correlation and causality are confounded:
A condition like high blood pressure is sneaky. You don’t feel it, and it generally doesn’t cause any outward signs or symptoms. Yet it silently damages blood vessels, the heart, kidneys, and other organs.

So let's think for a moment about causality - if folks with hypertension also are more likely to have blood vessel damage, does that mean it is caused by the high blood pressure?  Obviously, not.  There could be a third factor that's causing both.


So the authors move on:
High blood pressure — also known as hypertension — isn’t a disease. It is a sign that something is wrong in the body. In some people with hypertension, the culprit is a narrowing of the arteries supplying the kidneys (renal artery stenosis), or an overactive thyroid gland (hyperthyroidism) or adrenal glands (aldosteronism). When these are treated, blood pressure drops back to normal. More often, though, doctors find no underlying cause for high blood pressure. This condition is called essential hypertension.

So, in this analysis from the smart folks writing this magazine for Harvard, the fact that 80% of those with hypertension can reduce their BP back to normal by restricting carbs isn't even worth mentioning.  That is inexcusable.  It is not a secret, it's a treatment that requires no medication, and has as side effects the following:  proven superior results (by interventions studies up to one year) for weight loss, lipid profile improvement, reduction of gout, and reduction of NAFLD.  In short, there's absolutely no drawback to this treatment.   


Back to the causality v. correlation issue:
High blood pressure contributes to the development of stroke, heart attack, heart failure, and kidney disease. In the United States, it directly accounts for about 60,000 deaths a year and contributes to another 300,000.

This is statistical gymnastics - neat tricks but only as accurate as the assumptions of those doing the calculations.  The fundamental question - is high blood pressure a cause of or a correlate with the other diseases of civilization? - has not been answered to my knowledge aside from the fact that it seems to be a correlate.  The evidence of that is that the best intervention for controlling HBP is also the best intervention for treating the other correlates of HBP, which are also correlates of metabolic syndrome, all of which get worse when folks are sick enough to be diagnosed as "diabetic."  IOW - did those folks suffer from the HBP or did they suffer from the underlying problem - lack of glycemic control - for which HBP is only one of several correlates?

Interesting study, but hopefully, upon review, you will see the baked in correlation v. causality issue here:
These researchers looked at the 1,007 men and women admitted to the hospital over a 10-month period for any potentially heart-related problem. These ranged from chest pain and fainting to heart attack, heart failure, atrial fibrillation, and pericarditis. In this group, 69% had been diagnosed with high blood pressure before being admitted to the hospital. Each person was followed for one year. At the end of that time, 17% of those with high blood pressure had died, compared with 9% of those with normal blood pressure. Rehospitalization for a cardiac problem followed the same pattern: 31% of those with high blood pressure, and 18% of those without (American Journal of Cardiology, published online, Aug. 24, 2011).

But, the smart folks writing this magazine want you to know there's hope:

But there is actually good news about high blood pressure: there is a lot a person can to do help keep it in check, and even prevent it from occurring in the first place.

How? The National Heart, Lung, and Blood Institute; the Centers for Disease Control and Prevention; and the American Heart Association offer these recommendations:

• Achieve and maintain a healthy weight for your height.
• Exercise regularly.
• Eat a diet that is rich in fruits, vegetables, and whole grains.
• Limit sodium intake to under 2,300 milligrams a day (one teaspoon of salt), and get plenty of potassium (at least 4,700 mg per day) from fruits and vegetables.
• Drink alcohol in moderation, if at all.
• Reduce stress.
• Monitor your blood pressure regularly, and work with your doctor to keep it in a healthy range.

(sarcasm alert!)...and when all that doesn't work, keep on popping those pills.  It frankly wouldn't take all those big dollar, big brain, high credentialed organizations to give you this kind of nearly pointless, assinine advice.  I could have done that for a lot less than they have been paid over the years. (This ends the sarcasm alert)

In a follow up post, I'll throw out a bit of speculation about the "lies, damned lies, and statistics" aspect of the high blood pressure concern.