Tag Archive for: hypertension

Fasting: Another Piece of the Puzzle

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Fasting is gaining popularity. Actually, periods of complete abstinence from food within a 24-hour cycle is what really seems to be gaining in popularity, but this study doesn’t address intermittent fasting. It examines fasting for a specific period of time before a dietary change—in this case, to the DASH diet. We don’t know if the results would be the same if someone were switching to a ketogenic diet or a paleolithic diet. These are the major results of the study we began examining on Tuesday.

The Results

  • The five-day fast prior to beginning the DASH diet appeared to have positive effects on blood pressure. There was an average drop of eight points in systolic BP and a reduction in the use of medication to lower blood pressure.
  • Subjects adhering to the DASH diet lost weight as well. However, it was not the reduction in weight loss that caused the drop in systolic blood pressure based on their analysis.
  • The immunome, a portion of the total proteome I talked about a few weeks ago, improved. While the exact mechanism is not known, the positive changes in immune proteins appeared to have a positive effect on lowering blood pressure.
  • Researchers also discovered genetic differences between those who responded to the fast and the subsequent DASH diet by lowering their blood pressure and those who did not. The key seems to be in the bacteria that produce short-chain fatty acids. Fasting was identified as a way to increase the bacteria producing those SCFAs.

What Does It Mean?

What are we to conclude? With only 71 total subjects, there’s not a lot of data to generalize to entire populations, but here’s what I think is important.

First, fasting does have a role to play in the health of our microbiome; it also has role to play in our immune function. It’s not completely clear why these changes can occur, but research shows that they do. It may be that eliminating food for a period of time helps the naturally occurring bacteria to function better.

Second, it doesn’t seem to have anything to do with intermittent fasting. It very well may be that complete abstinence from food could get you similar benefits if you were to withhold food for 18 or 20 hours a day and only eat in a very small block of time. But until fasting for a specific amount of days is compared with hourly intermittent fasting, we just don’t have the best answers yet.

The Bottom Line

Fasting, however you define it, appears to have some beneficial effects. If you find a way that fits into your lifestyle, there doesn’t seem to be any reason that you shouldn’t do it unless you have a metabolic disorder and must eat. For example, if you have problems with your blood sugar or take meds that must be accompanied by food, fasting may not be for you.

Here’s my plan: now and then, I’m going to try a reduction to 500 to 800 hundred calories per day for one to three days. That seems to be supported by the most science. It also appears to benefit immune function the most.

Anticipating questions from those doing a ketogenic or paleolithic diet, is the diet after the fast important? Maybe if you select the right foods, such as going vegan during those fasting days, you may get the positive changes in your microbiome. What would happen if you then went on a ketogenic or paleo diet after that? We just don’t know whether the changes would last. This study provided a few pieces of the puzzle, but there’s much we still need to know.

What are you prepared to do today?

        Dr. Chet

Reference: Nat Comm (2021)12:1970. https://doi.org/10.1038/s41467-021-22097-0

How Fasting Affects the Microbiome

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How did you do? I asked you to reduce your caloric intake to fewer than 1,200 calories and keep it vegan if you can. Paula and I did okay, but not completely vegan.

Before I describe the study, you need to know that wasn’t the actual fasting part of the study—that was the fasting preparation phase. The actual fast was 300 to 350 calories per day of vegetable juice and vegetable broths. If you’ve ever done a detox just drinking tea and broths, that’s very similar.

There were multiple parts of the study, but we’ll focus on just two. The purpose of the two portions of the study was to examine changes in the microbiome and immunome as well as blood pressure after 12 weeks on the Dietary Approach to Stop Hypertension (DASH) diet. Before the dietary changes were begun, researchers randomly assigned 71 subjects to either the fasting-plus-DASH diet or just the DASH diet alone. All the subjects had diagnosed hypertension as well as metabolic syndrome.

This was one of the most complicated analyses I’ve ever seen because there were so many genes examined related to the bacterial composition of the gut as well as the immune system. The first question is simply this: were there changes in the microbiome after the initial fast? Yes, but the changes were reversed once normal eating resumed.

I’ll cover the post-DASH diet changes in Saturday’s Memo. Until then, unless you have metabolic issues or must eat at specific times of the day with medications, give the fast, the real fast as described above, a try for just one day.

What are you prepared to do today?

        Dr. Chet

Reference: Nat Comm (2021)12:1970. https://doi.org/10.1038/s41467-021-22097-0

What Is ACE?

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Angiotensin-converting enzyme—ACE—is the enzyme that converts angiotensin I into angiotensin II (ANG2). You’re probably thinking, “Well, that clears it up!” Here’s the problem: under the right conditions, ANG2 causes vasoconstriction and sodium and water retention, and the result can be hypertension because the overwhelmed kidneys can’t get rid of sodium or fluids.

However, it gets more complicated. There are two ANG2 receptors, A1 and A2, but A1 creates the problems related to blood pressure. It also contributes to pulmonary hypertension and pulmonary fibrosis under the right conditions. The problem is that we don’t know exactly what those conditions are.

What we are finding out is this: the lung contains A1 and A2 receptors, and it just so happens that the COVID-19 virus can use those receptors to allow the virus entry into cells. Once there, the viruses can multiply and may contribute to the extreme immune response of the lower lungs.

For people who are being treated for hypertension and are taking an ACE inhibitor, it would seem prudent to take your medication on schedule. If you take a medication whose name ends in “pril”—that’s your ACE inhibitor. We don’t know for sure that it will help and there’s a lot of research to go, but we will find out. Until then take your BP medications and do all those other things you’re supposed to do to lower BP.

What about the rest of us? Is there something we can do? Maybe and I’ll cover that on Saturday.

Reminder: my audio High Blood Pressure: Getting It Down is half price this week, CD or MP3. Learn more about what you can do to control your blood pressure.

What are you prepared to do today?

        Dr. Chet

References:
1. DOI: 10.1101/2020.02.24.20027268.
2. doi: https://doi.org/10.1101/2020.01.26.919985.

High Blood Pressure and COVID-19

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If you have hypertension, commonly called high blood pressure, and you’re taking a medication called an ACE inhibitor (angiotensin-converting enzyme inhibitor), make sure you take it regularly. It may—and I repeat, may—provide some protection against the COVID-19 virus. I’ll spend the rest of the week explaining why, but I want you to have that information first because you have no idea what you’ll be exposed to between now and Saturday.

What prompted this urgency? I read a Research Letter in JAMA Network that reported the comorbidities of people who died in 21 hospitals in Wuhan, China, between January 21 and 30, 2020; comorbidities are the simultaneous presence of two chronic diseases or conditions. The first indicator of morbidity (death) was age and try as we may, we can’t change that. The top modifiable morbidity was hypertension; half the people who died had high blood pressure. The second was diabetes.

Near the end of the short paper, the authors noted that hypertension is not a typical risk factor for sepsis, the uncontrolled immune-system response seen in the most serious cases of COVID-19. They commented that prior research had demonstrated that ACE receptors were discovered in the lungs; perhaps ACE inhibitors could be used as a potential treatment for the COVID-19 infection. More research is needed. I’ll examine this issue the rest of the week.

Insiders, remember there’s a Conference Call tomorrow night. I’ll explain this research and address some of the outlandish claims being made by so-called experts about cures for COVID-19 as well. If you’re not an Insider, go to the Store at drchet.com to check out how you can become one now.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. doi:10.1001/jamanetworkopen.2020.5619

Not So Smartphones

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Many variables that were included in the smartphone study weren’t reported, and there’s a good reason for that: they were non-significant. I don’t mean not statistically significant—I mean not significant in the real world either. In fact, I don’t think I’ve ever seen a study with so many variables that were non-significant.

The one that surprised me the most was that simple tracking of blood pressure or the use of the artificial intelligence (AI) application did not change the percentage of people who took their BP medications regularly. Neither approach shifted the scale one little bit. I would have expected that at least some people would have started taking their meds regularly, but they didn’t in either group. In next Tuesday’s Memo, I’m going to give you a good reason to take your meds based on a recent COVID-19 study.

Many of the variables were from questionnaires, and as I often remind you, self-reporting is always suspect. But it raised a few questions about the reported results.

Questions

The first question I had was related to the statistical analysis they ran. Instead of looking for differences within groups, they ran comparisons only between groups. I’m not saying that any differences were profound, but it did appear that there were some that were interesting.

For example, the control group demonstrated no differences in servings of processed meats per week, but the app group decreased servings by about one-half portion. The servings of sugar-sweetened beverages decreased by about a half-portion per week as well, while there were no changes in the control group. That would seem to be a benefit and if a statistical analysis were run, it might have been statistically significant—take a win wherever you can get it. You shouldn’t overstate the findings, but it does support the idea that reminders about a healthier diet might be effective.

I don’t understand why the researchers used an application that was being beta-tested for use in the study. If the number of subjects was limited, and AI requires a lot more data points to really “learn” enough to decide what the subjects need to know and how best to present it to them, it seems the study was destined to fail before it began. If they had called it a pilot study to gain insight to propose a major clinical trial, that would be more logical because that’s what pilot studies are for: to decide whether larger studies are warranted. They came to the same conclusion, but focused on what they didn’t show instead of what they did.

The Bottom Line

The use of smartphones, tablets, and laptops together with applications designed to monitor health are growing in use. Paula recently had a consultation with a specialist and her first telemed physical. I think there’s a place for these types of electronic services, especially during this unusual time. But no matter how many subjects are used to train AI, I think it will always stop short of what they hope applications will do, because there’s no app that will get people to do what they don’t want to do. No logic. No mini-goal setting. No reasoning.

I always thought that education was the key. It isn’t. Even with my education, I have trouble doing the things that I know I should do for my health. The willingness to change has to come from within. Until people have that, no program, person, or application will help them achieve their health goals. It’s wrapped up in the third word in my tagline: what are YOU prepared to do today? It is and always be your choice.

Because we’ve talked about blood pressure all week and more is coming next week, this seems like an obvious time to offer you my High Blood Pressure download at half price; only a few CDs are left, also half price, and when they’re gone, they’re gone. Members and Insiders who log in first will get their discounts as well.

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/39OmUCc.
2. JAMA Open. doi:10.1001/jamanetworkopen.2020.0255.

Limitations of the Smartphone BP App

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In the examination of a smartphone application to help lower blood pressure, the results were a little surprising. Take a look at the graphic representation above of the study, including the results. More and more journals are going to that type of graphic summary. They’re great summaries, but they don’t always tell the entire story.

A quick review on blood pressure: systolic is the upper number and indicates the pressure when your heart is beating; diastolic is the lower number and indicates the pressure when your heart is resting. The ideal BP range is 110/70 to 120/80.

In this case, as you could see on the graphic, there was a difference of only 3 mmHg in systolic BP between those using the AI-generated coaching application and those who didn’t use that app. One of the discussion points was that the number of subjects was not great enough to be able to discern the significance of less than a 5 mmHg difference in BP. Achieving statistical significance is pretty much irrelevant in the real world if the difference between the approaches was so small. Yes, in a population of 50 million, a 1 mmHg drop in systolic BP may save some lives, but who do you really want tracking your BP: an artificial presence or your physician?

What really caught my attention was that both approaches worked. The overall decrease in the AI group was 8.3 mmHg versus 6.8 mmHg in the control group. There were decreases in diastolic BP as well. Whether it was the automated BP reporting alone or not, it appeared that just paying attention got results. But that’s not all I got out of the study. I’ll let you know more on Saturday. By the way, how you coming along with your new habit?

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/39OmUCc.
2. JAMA Open. doi:10.1001/jamanetworkopen.2020.0255.

Get Health Support via Your Smartphone

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Paula has an appointment with her primary care doctor this morning, and she’ll be right here on the sofa when it happens. Telemedicine is now a part of everyday life, but your phone can be an asset to your health even beyond speaking to your doctor.

For example, hypertension is still a significant problem in the U.S., and it’s directly related to heart disease, stroke, and kidney disease. The typical treatments are medications, diet, and exercise. The problem is that too many people don’t follow through consistently enough to help themselves. Before I go any further, here’s a hypothetical: Imagine an application for your smartphone that would record your blood pressure and help you with diet and exercise recommendations and tracking; would that help you and others lower mild hypertension?

That’s what a group of physicians and public health officials in the Chicago area wondered. In the Smart Hypertension Control Study, they scanned more than 2,700 electronic medical records to find just over 300 people with mild hypertension to take part in a study comparing two different approaches to managing hypertension. Both the experimental group and the control groups used home blood pressure monitoring (HBPM) that could be reported automatically after it was taken with a Bluetooth connection to a smartphone. The experimental group used a smartphone app—a hypertension personal control program (HPCP).

The application used artificial intelligence to provide reminders and feedback along with diet and exercise information. The primary outcome was a difference in BP between the groups; I’ll tell you more about the results on Thursday. Until then, pick one single habit, such as taking your temperature or washing your hands, and through Saturday see how regularly you do that.

Hypertension is bad any time, but with a virus that seems to kill people with preexisting conditions, this is a great time to improve your habits.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Open.doi:10.1001/jamanetworkopen.2020.0255.

It’s All in the Dash

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In this Memo, we’re going to pretend the survey’s treatment options for high blood pressure are real. The choices were a pill, a cup of tea, exercise, and an injection once a month. If they were real, which one might be the best option for you? To me, it all comes down to The Dash.

You’ve probably heard about The Dash before. It’s a story about a person’s life such as yours. On your gravestone, there’s a dash between the day you were born and the day you died; your life is in the dash. How does this relate to the treatments offered in the survey, even though hypothetical?

What treatment option will give you the best potential quality of life? Not just adding a month, year, or even five years; what will those years be like? Will you just be alive or will you be really living?

It’s a no-brainer. Whether real or imaginary, the treatment that offers you the best chance to really live during those five years is exercise. A cup of tea may provide some good phytonutrients. A pill or an injection may affect an organ or a system to keep your blood pressure under control. But regular exercise will actually treat the systems involved in hypertension: the heart, blood vessels, muscles, nerves, and even hormone levels. Exercise is not a salve to make you feel better. It’s going to have profound effects and give you the best chance at a good quality of life during those extra five years.

I know the study was just a pilot survey and no treatment can guarantee you that you’ll live longer. But what I said about exercise is real. It gives you the best chance at having a better quality of life, not just during a potential extra five years, but all the years before then as well. What do you want your dash to be like? It just depends on the answer to one real question:

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

The Survey’s Most Surprising Results

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Before I get into what I found surprising, I want to point out that this was a survey about hypothetical treatment options. It was just a preliminary or pilot project just to see how people would answer; the head researcher said as much. The other factor was that subjects were 45 and younger. If an older population were asked the same questions, the results could be different. Or maybe not.

What surprised me was that even when asked about something as simple as drinking a cup of tea every day, less than 100% of the people said they would do it for an extra five years of life. The 7% who said they wouldn’t do anything stuns me. It’s a survey! You could misrepresent your answers—go ahead and lie!—who would know? Maybe it’s a function of the under-45 population surveyed; maybe they hadn’t yet started to be concerned about their limited lifespans.

What’s amazing is that most subjects already had high blood pressure according to the report. They knew the treatments were hypothetical, and yet some still couldn’t be bothered to try to add five more years of life. If they care that little about a hypothetical treatment, how are they approaching actual treatment?

On Saturday, I’ll focus on those who said they would do something to live five years longer and which option might be the best—assuming they were real. It all comes down to The Dash.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

What Would You Pay for More Time?

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What price would you pay if you could gain an extra month of life? How about a year? How about five years? I think the longer you get, the more incentive to pay a higher price. It seems a large group of subjects agree with me according to a study reported this past weekend at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018.

Researchers surveyed over 1,300 people to determine what price they would be willing to pay for a longer life if they were diagnosed with high blood pressure. Subjects could choose from a daily pill, a daily cup of tea, regular exercise, or a monthly injection. The kind of treatment didn’t matter; the more additional time they got, the more willing the respondents were to consider the treatment.

Which was most appealing? The pill and the cup of tea. The least appealing? The injection. All treatments exceeded 93% if they would give a person an extra five years.

How about you? If you’re diagnosed with hypertension, what would you be willing to do for an extra month, year, or five years? While you think on it, Thursday’s Memo will be about something I found surprising in the study.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH