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.
