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Category Archives: High Blood Pressure
Trainer Sean Preuss has a new post on the issue. Well worth a read. For example:
The nine studies analyzed included 341 people between the ages of 20 and 72 years old. The studies ranged from six to 26 weeks long. The average blood pressure reduction was 3.2/3.5 mmHg.
Those reductions have value but are not life-altering. However, these studies were mostly performed with healthy people with desired blood pressure numbers. In general, people with less room to improve will do just that: improve to a smaller degree. Men and women with hypertension are likely to see greater improvements.
The American Heart Association has published guidelines aiming to reduce premature death and illness caused by cardiovascular diseases such as heart attacks, high blood pressure, and strokes.
The guidelines focus on seven factors critical to cardiovascular health:
- blood sugar
- blood pressure
- physical activity
- total cholesterol
- body mass index (BMI)
- ideal diet
Using data from the Atherosclerosis Risk In Communities study (almost two decades’ follow-up), researchers found that those who maintained goals for six or seven of the American Heart Association critical factors had a 51% lower risk of cancer compared with those meeting no goals.
For detailed information about the specific goals, click here.
As you might expect, I was curious about what the American Heart Association considered a heart-healthy diet. I quote the AHA summary:
The recommendation for the definition of the dietary goals and metric, therefore, is as follows: “In the context of a diet that is appropriate in energy balance, pursuing an overall dietary pattern that is consistent with a DASH [Dietary Approaches to Stop Hypertension]-type eating plan, including but not limited to:
- Fruits and vegetables: ≥ 4.5 cups per day
- Fish: ≥ two 3.5-oz servings per week (preferably oily fish)
- Fiber-rich whole grains (≥ 1.1 g of fiber per 10 g of carbohydrate): ≥ three 1-oz-equivalent servings per day
- Sodium: < 1500 mg per day
- Sugar-sweetened beverages: ≤ 450 kcal (36 oz) per week
Intake goals are expressed for a 2000-kcal diet and should be scaled accordingly for other levels of caloric intake. For example, ≤ 450 calories per week represents only up to one quarter of discretionary calories (as recommended) coming from any types of sugar intake for a 2000-kcal diet.
Diet recommendations are more complicated than that; read the full report for details. Only 5% of study participants ate the “ideal diet.” The Mediterranean diet easily meets four out of five of those diet goals; you’d have to be extremely careful to reach the sodium goal on most any diet.
Cardiovascular diseases and cancer are among the top causes of death in Western societies. Adhering to the guidelines above may kill two birds with one stone.
The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t. The result? Mediterranean dieters enjoyed longer lifespans and less heart disease, cancer, strokes, diabetes, and dementia.
Over the last 15 years, researchers have been clarifying exactly how and why this might be the case. A study from Finland is a typical example.
The traditional Mediterranean diet provides an abundance of fresh fruit, including berries. Berries are a rich source of vitamin C and polyphenols, substances with the potential to affect metabolic and disease processes in our bodies.
The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks. Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.
What does platelet function have to do with anything? Platelets are critical components of blood clots. Blood clots can stop life-threatening bleeding, but also contribute to life-threatening strokes and heart attacks. Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes. That’s why millions of people take daily aspirin, the best known platelet inhibitor.
Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes. Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function. These changes would tend to reduce the occurence and severity of cardiovascular disease.
So berries don’t just taste good, they’re good for us. If price is a concern, focus on the berries that are in season or use frozen berries.
Steve Parker, M.D.
The enduring popularity of the Mediterranean diet is attributable to three things:
For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.
The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption.He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too.Dietary saturated fat does tend to raise cholesterol levels.
Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around.See References below for the most recent studies.
Relatively strong evidence supports the Mediterranean diet’s association with:
■ increased lifespan
■ lower rates of cardiovascular disease such as heart attacks and strokes
■ lower rates of cancer (prostate, breast, uterus, colon)
■ lower rates of dementia
■ lower incidence of type 2 diabetes
Weaker supporting evidence links the Mediterranean diet with:
■ slowed progression of dementia
■ prevention of cutaneous melanoma
■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars
■ less risk of developing obesity
■ better blood pressure control in the elderly
■ improved weight loss and weight control in type 2 diabetics
■ improved control of asthma
■reduced risk of developing diabetes after a heart attack
■ reduced risk of mild cognitive impairment
■prolonged life of Alzheimer disease patients
■ lower rates and severity of chronic obstructive pulmonary disease
■ lower risk of gastric (stomach) cancer
■ less risk of macular degeneration
■ less Parkinsons disease
■ increased chance of pregnancy in women undergoing fertility treatment
■reduced prevalence of metabolic syndrome (when supplemented with nuts)
■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant
Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes?Association, of course, is not causation.
The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individualsin an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death.Make sure they stay on the assigned test diet.Then you’d have an answer for that population and those two diets.Then you have to compare the winning diet to yet other diets.And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.
Now you begin to see why scientists tend to rely on observationalrather than interventional diet studies.
I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases.At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all prevalent.And you couldn’t pick three programs with more differences!So I had my work cut out for me.
After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population.People with particular medical problems or ethnicities may do better on another diet. People with diabetes or prediabetes are probably better off with a carbohydrate-restricted diet, such as the Low-Carb Mediterranean Diet.
Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones.The Mediterranean diet qualifies as plant-based.
Sofi, Francesco, et al. Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. American Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010. doi: 10.3945/ajcn.2010.29673
Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209
Feart, Catherine, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Journal of the American Medical Association, 302 (2009): 638-648.
Scarmeas, Nikolaos, et al. Physical activity, diet, and risk of Alzheimer Disease. Journal of the American Medical Association, 302 (2009): 627-637.
Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.
Fung, Teresa, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119 (2009): 1,093-1,100.
Mente, Andrew, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine, 169 (2009): 659-669.
Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.
Mozaffarian, Dariush, et al. Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors. Lancet, 370 (2007) 667-675.
Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.
Martinez-Gonzalez, M.A., et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).
Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.
The risk of heart and vascular disease is more closely linked to distribution of excess fat than with degree of obesity as measured by overall weight or body mass index. Waist-hip ratio (WHR) is a measure of abdominal or central obesity, the type of fat distribution associated with coronary artery disease. A high ratio indicates the android body habitus. To determine your waist-hip ratio:
- While standing, relax your stomach—don’t pull it in. Measure around your waist mid-way between the bottom of the rib cage and the top of your pelvis bone. Usually this is at the level of your belly button, or an inch higher. Don’t go above the rib cage. Keep themeasuring tape horizontal to the ground and don’t compress your skin.
- Then measure around your hips at the widest part of your buttocks. Keep the tape horizontal to the ground and don’t compress your skin.
- Divide the waist by the hip measurement.The result is your waist-hip ratio.
For example, if your waist is 44 inches (112 cm) and hips are 48 inches (122 cm): 44 divided by 48 is 0.92, which is your waist-hip ratio.
Scientists haven’t yet determined the ideal WHR, but it is probably around 0.85 or less for women, and 0.95 or less for men. Ratios above 1.0 are clearly associated with risk of cardiovascular disease such as heart attacks. The higher the ratio, the higher the risk. Compared with body mass index, WHR is a much stronger predictor of coronary artery disease. Several of the other obesity-related illnesses are also correlated with WHR, but the relationship between WHR and cardiovascular disease is particularly strong.