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February 2005

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

Advice vs. Education

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.

Natural Blood Pressure Control

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 and Blood Pressure

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.

Supplements for 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.

Ask Dr. J: Irritable Bowel Syndrome

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.

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References

Dietary Guidelines

Dietary Guidelines for Americans 2005, www.health.gov/dietaryguidelines/dga2005/document

Hypertension

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.

In The Health News

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.)

Diet and Disease

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]

Recipe of the Month: Marinated Raw Kale

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.

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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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