Posts Tagged ‘high blood pressure’

Do Omega-3s Lower Blood Pressure?

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues, Supplements and Health

The Good News About Fish Oil

Author: Dr. Stephen Chaney

High Blood PressureHigh blood pressure or hypertension is a major problem in this country. Over 60% of Americans have high blood pressure. Only 47% of those with hypertension are adequately controlled. 20% of them don’t even know that they have high blood pressure.

In this case, ignorance is definitely not bliss. That’s because high blood pressure significantly increases the risk of stroke, heart attacks and congestive heart failure.

The causes of high blood pressure are many. Genetics, obesity, lack of exercise, sodium, alcohol, saturated fats and too few fresh fruits and vegetables all play a role. Age also plays a role. As we age, our blood vessels become less flexible and our blood pressure rises by about 0.6 mm Hg per year.

Medications can help, but many of them have significant side effects and often aren’t fully effective in controlling blood pressure. That’s why natural approaches are so important.

Because there are so many causes of hypertension, natural approaches for lowering your blood pressure are not simple. Natural approaches start with weight loss, restricting sodium intake, increasing physical activity, moderating alcohol intake and something called the DASH diet. In short, there is not just one simple change that you can make that will totally eliminate hypertension. It requires a complete lifestyle change.

That’s why the latest study on the effect of omega-3s on blood pressure is so exciting. If the headlines are true, adding omega-3s to your diet may be one of the most effective things you can do to lower your blood pressure naturally. So let’s examine the study to see if the headlines are accurate.

How Was The Study Designed?

This study (Miller et al, American Journal of Hypertension, doi:10.1093/ajh/hpu024) was a very large, well designed study. It is a meta-analysis of 70 randomized, placebo controlled clinical studies. Key characteristics of these studies were:

  • The mean study duration was 69 days. That means these beneficial effects occur relatively quickly.
  • The mean EPA + DHA dose was 3.8 g/day (range = 0.2 – 15 g/day). A wide range of doses was included.
  • The EPA & DHA came from all sources (seafood, EPA+DHA fortified foods, fish oil, algal oil, and purified ethyl esters. The source did not affect the outcome.
  • Olive oil was the most commonly used placebo, with omega-6 vegetable oils being used as placebos in a few studies. The choice of placebo did not affect the outcome.
  • None of the people in these studies were taking blood pressure lowering medications. That means these studies were specifically designed to see whether omega-3s lowered blood pressure, not whether they had any additional benefit for people already taking medications. This is important because if you only focus on groups who are already taking multiple medications, you tend to obscure the beneficial effects of omega-3s (see my recent Health Tip “Is Fish Oil Really Snake Oil?”)

Do Omega-3s lower Blood Pressure?

Fish OilThe authors of the study reported that:

  • Compared to placebo, EPA+DHA reduced systolic blood pressure (that’s the upper reading) by 1.52 mm Hg and diastolic blood pressure (that’s the lower reading) by 0.99 mm Hg.
  • When they looked at those participants who already had high blood pressure, the numbers were even more impressive – a 4.51 mm Hg decrease in systolic blood pressure and a 3.05 mm Hg decrease in diastolic blood pressure. That’s important because for each 2 mm Hg reduction in blood pressure there is a 6% decrease in stroke mortality, a 4% decrease in heart disease mortality, and a 3% decrease in total mortality.

More to the point, the authors of the study concluded that “A decrease of 4.51 mm Hg in systolic blood pressure among those with high blood pressure could help an individual avoid having to take medication to control blood pressure levels”.

  • When they looked at the study participants who had normal blood pressure the numbers were still significant – a 1.25 mm Hg decrease in systolic blood pressure and a 0.62 decrease in diastolic blood pressure. The authors pointed out that this could prevent, or at least delay, the age-related progression towards hypertension.
  • The effect of omega-3s on systolic blood pressure (4.51 mm Hg decrease) was comparable to the most successful lifestyle interventions – 3-10 mm Hg decrease for 10 pound weight loss, 4-9 mm Hg decrease for increased physical activity, 2-8 mm Hg decrease for sodium restriction, and 2-4 mm Hg for decreased alcohol consumption.
  • A dose of at least 1 gm/day of EPA+DHA was required for a significant decrease in systolic blood pressure, and a dose of over 2 gm/day was required for a significant decrease in both systolic and diastolic blood pressure

While this is a single study, it is consistent with a number of previous studies in this area. Based on the existing body of literature I would recommend omega-3s as part of a holistic approach for keeping your blood pressure under control.

The Bottom Line:

1)     A recent meta-analysis of 70 published clinical studies (AJH, doi: 10.1093/ajh/hpu024) has shown fairly convincingly that omega-3 fatty acids are effective at lowering blood pressure. Moreover, this study is consistent with a number of previous studies. The evidence appears to be strong enough for omega-3s to be considered as part of a holistic approach to keeping your blood pressure under control.

2)     If you already have high blood pressure, you should know that omega-3s caused blood pressure to decrease by 4.51 mm Hg in people like you. The authors of the study concluded that this decrease in blood pressure is large enough that some people may be able to avoid blood pressure medicines entirely. For others addition of omega-3s to their diet will likely allow their physicians to reduce the dose of medications required to keep their blood pressure under control – thus minimizing the side effects of the medications.

3)     If you already have slightly elevated blood pressure that has not yet progressed to clinical hypertension, you should know that omega-3s also give a modest decrease in blood pressure in people like you. The authors of the study concluded that this decrease was enough to prevent or delay the age-related onset of hypertension.

4)     The effect of omega-3s on reducing blood pressure is equivalent to the most successful lifestyle changes (weight loss, increased physical activity, sodium restriction and alcohol moderation). That doesn’t mean that you should pop fish oil pills and forget the other lifestyle changes. The idea is to combine as many of those lifestyle changes as possible so that you may never have to worry about high blood pressure again.

5)     You need at least 1 gm/day of EPA+DHA to reduce systolic blood pressure and more than 2 gm/day to reduce both systolic and diastolic blood pressure.

6)     Contrary to the hype you may have been reading elsewhere, the source of EPA+DHA didn’t matter. The only caveat is that many people really struggle with trying to get 1-2 gm/day of EPA+DHA from fish. It’s a bit too much of a good thing.

7)     Don’t think of hypertension as a “Do it yourself” project. Hypertension is a silent killer. It’s one of those diseases where the first symptom is often sudden death – or, even worse, a life that is no longer worth living. Work with your physician. Let them help you find the right balance between lifestyle changes (including omega-3s) and medications to keep your blood pressure under control.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is There Really Such A Thing A Positive Stress?

Written by Dr. Steve Chaney on . Posted in Fitness and Health, Issues, Stress Management

Stress Can Be Your Friend

Author: Dr. Pierre DuBois

Motorbike racing on the track.Do you consider yourself an optimist or a pessimist? When the going gets tough, the optimists among you can take heart—new research that has found that viewing stress positively can be of benefit to both the mind and body.

When the brain perceives stress (either physical or psychological), it reacts by releasing cortisol, adrenaline and norepinephrine to prepare the body for a “fight or flight” response. Fortunately for us, this response is not triggered in most people today as frequently as it once was or for the same kinds of reasons.

After all, relatively few of us are in life-threatening situations on a regular basis. Today’s “modern” stresses are more likely to be caused by wrestling with the IRS, trying to escape a traffic jam or competing with a coworker for a promotion.

It is interesting to note that stress, in itself, is not necessarily a negative thing. It is how we perceive it that makes it either good or bad for us. This is a hopeful discovery, as most people have only limited control over how much stress they experience. The everyday stresses of modern life are difficult to escape. But if we can train our minds to view them as a challenge rather than a threat, it could actually help to bring about better health.

Scientists from a handful of universities, including Yale University and Columbia University, examined the effects of stress on 300 investment bankers who had just emerged from a round of layoffs (I know it’s difficult to feel bad for the stress of investment bankers, but stay with me here). In the study, published in the Journal of Personality and Social Psychology, scientists divided the participants into two groups, and tried to alter the perception of half of them to view stress as debilitating and the other half to view it as an enhancement.

The first half of the participants were shown videos of people succumbing to stress. The other half were shown videos of people meeting challenges, such as sports figures accomplishing a difficult goal. The results showed that those who had a more optimistic view of stress had fewer health problems, including headaches and muscle pain, and performed better at work than the pessimistic group. In addition, levels of cortisol (the stress hormone) were lower in those who viewed stress as potentially enhancing.

There is actually a term for positive stress, called eustress, which was coined by endocrinologist Hans Selye in the 1970s. It has been proven that stress in moderation improves cognitive performance and improves memory.

Good stress involves the kind of challenges where we feel that we are in control and are accomplishing something. It boosts the immune system and can improve heart function. So eliminating all stress from our lives is probably not a good idea.

The stress to watch out for is the chronic, long-term emotional stress, which causes stress hormones to remain at persistently high levels, leading to many chronic ailments such as heart disease, high blood pressure and depression.

However, viewing certain stressors as challenges rather than threats can be a positive thing and can help ensure that you have a healthy, satisfying and exciting life.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Skipping Breakfast Increase Heart Disease Risk?

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues, Uncategorized

Should You Eat Breakfast Every Day?

Author: Dr. Stephen Chaney

Mature Man - Heart AttackDoes skipping breakfast actually increase your risk of heart attacks? You’ve probably heard the saying “Eat breakfast like a king, lunch like a prince, and dinner like a pauper”.

You’ve probably also heard that skipping breakfast is associated with increased risk of things like:

 

  • obesity
  • high blood pressure
  • and diabetes

If you believe those associations are true, the latest study showing an association between skipping breakfast and heart disease risk just makes sense. After all, obesity, high blood pressure and diabetes all increase the risk of heart disease.

But, how good is the evidence skipping breakfast actually increases the risk of any of those things?

The evidence for the link between skipping breakfast and heart disease risk:

Let’s start with the current study linking breakfast skipping with heart disease (Cahill et al, Circulation, 128: 337-343, 2013) because its study design is similar to the studies linking breakfast skipping to obesity, high blood pressure and diabetes. This study surveyed the eating habits of 27,000 men (45+ years old) enrolled in the Health Professionals Follow-Up Study in 1992 and followed those men for 16 years.

The results were pretty dramatic. After correcting for other factors that might influence heart disease risk, the men who skipped breakfast were 27% more likely to develop heart disease over the next 16 years than the men who ate breakfast on a daily basis.

As impressive as the association between breakfast and heart disease was, there was an even more impressive association that never made it into the headlines.

There was no association between skipping breakfast and eating late in the evening. However, those men who ate late in the evening were 53% more like to develop heart disease than men who did not.

The pros and cons of the study:

The pros:

1)     The strength of this study is that it is large (27,000 participants), long (16 years) and well designed. The results were statistically very significant.

The cons:

1)     This study only shows associations. It does not prove cause and effect. Having said that, it would be really, really hard to design a placebo controlled study for breakfast versus no breakfast. So cause and effect is almost impossible to prove for this type of comparison.

2)     The study did not ask what kind of breakfast the participants were eating. We don’t know whether the breakfasts were a Danish and coffee, an Egg McMuffin and hash browns  or a high protein smoothie with perhaps some fruit or oatmeal– and, believe me, there is a difference among those three breakfasts!

The Bottom Line:

1)     Eating breakfast is probably a good thing. Yes, the evidence that skipping breakfast increases heart disease risk is circumstantial, but it is also substantial. This is a large, well designed study.

2)     Not all breakfasts are equal. You probably already knew that! I recommend a breakfast with fruit, nuts, whole grains in moderation and lean protein sources.

3)     While this particular study only included men, previous studies suggest that the potential health risks of skipping breakfast are equally strong for women.

4)     Finally, while skipping breakfast grabbed all the headlines, the data suggest that eating late at night is an even stronger predictor of heart disease risk.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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