[Ed note: if you’re new to Doc Gumshoe, this is our break from investment chatter: He’s our favorite medical writer and he shares his contrarian and thoughtful commentaries with us every now and again. Any opinions and assertions are his own.]
It all starts with an unassailable truth: the healthier you are to start with, the better your odds of fighting off a whole range of illnesses, from Addison’s Disease to Zollinger-Ellison syndrome. The essentials of staying healthy are not deeply mysterious, and if I listed them here, you would likely emit a groan and move on to something more interesting. But another truth, unfortunately also unassailable, is that for most of history, the emphasis in mainstream medicine has been not on keeping people healthy, but on treating sickness. People go to the doctor, not when they want advice on how to stay healthy, but when they are sick. The first medical question the doctor wants an answer to is, “what’s your principal complaint?” If you don’t have a principal complaint, why are you here?
Yes, there have always been wise doctors who stressed staying healthy, and recently health maintenance has been increasingly emphasized by all manner of medical bodies – government, academic, professional organizations, and voluntary groups. Take high blood pressure – hypertension – as an example.
The JNC7 Catechism
The Joint National Committee on Prevention, Detection, Evaluation, and treatment of High Blood Pressure (widely known as the JNC) has, in its past several treatment recommendations, emphasized “Life Style Modifications” as the treatment for persons having what they now term “prehypertension.” Here’s how they classified blood pressure in their latest recommendations:
[The Seventh Report of the Joint National Committee on Prevention, Detection Evaluation, and Treatment of High Blookd Pressure. JAMA 2003;289:256-71]
And here’s how they say prehypertension needs to be treated:
“Prehypertension is not a disease category. Rather, it is a designation chosen to identify individuals at high risk of developing hypertension, so that both patients and clinicians are alerted to this risk and encouraged to intervene and prevent or delay the disease from developing. Individuals who are prehypertensive are not candidates for drug therapy based on their level of BP and should be firmly and unambiguously advised to practice lifestyle modification in order to reduce their risk of developing hypertension in the future (see Lifestyle Modifications).”
This is what they say about Lifestyle Modifications:
“Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hypertension. … BP is also benefited by an adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is a diet rich in fruits, vegetables, and lowfat dairy products with a reduced content of dietary cholesterol as well as saturated and total fat. … Dietary sodium should be reduced to no more than 100 mmol per day (2.4 g of sodium). Everyone who is able should engage in regular aerobic physical activity such as brisk walking at least 30 minutes per day most days of the week. Alcohol intake should be limited to no more than 1 oz (30 mL) of ethanol, the equivalent of two drinks per day in most men, and no more than 0.5 oz of ethanol (one drink) per day in women and lighter weight persons. … For overall cardiovascular risk reduction, patients should be strongly counseled to quit smoking.”
What Happens in the So-Called “Real World”
So here’s what happens, at least quite a lot of the time: our patient walks into the doctor’s office, and his blood pressure is 135 over 85. (I made our patient a man, because men are more likely to have high blood pressure than women.) The doctor tells him, without a whole lot of conviction, that he has “prehypertension,” and that he needs to do some lifestyle modification. (I should note here that the concept of “prehypertension” has not had a lot of take-up in the clinical community; most docs have a reasonably good notion of which of their patients are at higher risk for developing established hypertension and which ones can continue in the “prehypertension” range without progressing to the real thing.)
Our patient already knows what’s coming: more exercise, less yummy food, less booze, no smoking. He knows he should follow that plan, and he hopes he’ll have the strength of character to, by gosh, just do it! And maybe, at first, he sort of does follow it. But the problem is, he feels absolutely fine. He has no symptoms, and therefore no regular incentive to stay with the program.
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Okay, a year or two later he’s back at the doctor’s, and now his BP is 150 over 95, and the doc tells him that he now definitely does have hypertension. The doc asks him, perhaps more out of duty than really wanting to know, whether he has stuck with his lifestyle modification plan. Maybe he weasels, maybe he fesses up. The doc knows, however, that the chances are that our guy has not stuck with the plan. So now the doc tells our patient that he has got to get on that plan and stick with it, and he’s going to prescribe an antihypertensive drug to go along with it.
Now he’s facing the prospect of being on an antihypertensive drug for the rest of his life. Or maybe two, or even three different antihypertensive drugs.
The Alternative Treatment “Solution”
Then, this pops into his in-box:
“SECRET REVEALED: Lower Your Blood Pressure
“How to Lower Blood Pressure Naurally Once & For All!”
“Top-Secret Ingredient From the Deep Sea Found to
Naturally Lower Blood Pressure
& Cholesterol Without Expensive Prescriptions!”
Skipping down a bit, there’s this …
“Big Pharma and conventional regimens will have you confused, over-medicated, and frustrated because you aren’t treating the major triggers of elevated blood pressure.
Not only do you lose time and money, you end up losing faith that there are answers.
Here’s the secret: you lower your blood pressure by reversing the major triggers of elevated blood pressure at the cellular level … and by inhibiting the #1 Blood Pressure Enzyme.”
Of course, there’s a link to a video, which starts off with this banner headline:
“Deep Sea Secret Scientifically Proven
to Fight Real Cause of High Blood Pressure
Watch Below for Revealing New Evidence”
Then follows a little line warning you that the 25% savings expires tomorrow. No matter when you click on the link, the 25% savings always expires tomorrow.
The video continues:
“I want you to forget every depressing thing you’ve ever heard or believed about getting older…
Think living to 120 in great health & a good mind is impossible?
There’s an astonishing new breakthrough from the deep sea that’s changing the very “facts of aging” … it has the ability to restore nearly every part of your body to a younger, stronger, and more rejuvenated state… making you virtually immune to the diseases of “old age!”
Our Bottom Line Scientific Facts Will Show You How Studies Reveal The Secret To:
- Lower bad oxidized LDL cholesterol by over 29 points!
- Improve blood flow by over 50% and revive damaged arteries!
- Cut your odds of dementia by almost half!
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- Boost brain energy levels by a staggering 71%!
Here’s One Thing I Need You To Do Before We Go Any Further… Turn off the TV– your Cell Phone, close down your email and… LOCK the door & Pay Attention to Every Word on This Page.
Okay. The video goes on and on, and eventually – eventually! – it reveals what the ingredients are in this amazing miraculous cure:
The first is …
“Seanol™: An extremely rare seaweed extract (from Ecklonia Cava) proven 100 times more powerful than any land-based antioxidant.
Over 15 years of research and nearly $40 million worth of clinical studies back it up.
It’s the only FDA-approved Ecklonia Cava marine-algae extract in existence.
Not Only is Seanol More Potent… It Stays In your body 12 Hours, compared to Land Based Antioxidants that work on for 30 minutes…”
The second is …
“Super Ingredient #2:
A deep-sea omega-3 discovery that blows away every fish oil in existence!
It delivers an unheard of 85% more DHA omega-3s to your heart, brain, joints, and eyes!
Scientists have discovered that the type of omega-3 it contains is the true miracle worker.
Not only is this the worlds most powerful Omega…
But you can get more than 8X the benefits of a Fish Oil without the burps and after taste…People LOVE This Benefit…
With This SUPER-OMEGA, you can say goodbye to your fish oil and…
- Heart trouble
- Poor memory
- Vision Problems
- Dry or itchy skin
- Joint pain
- Lack of endurance
- Poor circulation
- Mood swings or depression”
… and the third is …Vitamin D3!
“For The 1st Time Ever, These 2 MARINE SUPER NUTRIENTS Have Been Combined For YOU!
It’s never been done before, but we’re bringing you the first age-busting formula that combines Seanol and Calamarine.
It’s called Marine-D3.
Because it also includes a superior form of vitamin D…
To Give You Even MORE Intense Rejuvenation & Repairing POWER!
Research shows that this life-saving vitamin plays a key role in preventing nearly every major disease, from depression to heart disease.
But a whopping 75% of Americans simply don’t get enough!
Your cells are literally starving to death without it!
With Marine-D3, turning back the clock is no longer some futuristic dream – it’s a longevity breakthrough you can benefit from NOW!
Its Extreme Rejuvenating Power Comes From Joining Three Healing Powerhouses!
Each of these nutrients is tremendously effective on their own, but when combined for the first time ever in Marine- D3, the synergy of all three delivers unprecedented anti- aging and disease-fighting benefits!
Together, they attack aging from every conceivable angle and restore health in nearly every system in your body!”
Well, we can easily see why our patient would be sorely tempted by these blandishments – live to 120 in good health, why not? And the ingredients in this remedy all sound on the up-and-up – an antioxidant, a source of Omega 3, and Vitamin D3. These couldn’t be bad, and who knows, they might even help with his hypertension.
For the moment, I won’t go into the reservations that have been raised about the effectiveness of antioxidant supplements. I will do no more than suggest that those evil free radicals that they’re supposed to counteract may indeed have some necessary function, and that perhaps we shouldn’t be in a hurry to extirpate then utterly. (There will be more about that in a future commentary.) But here’s the issue:
Will Supplements That Contribute to Health Actually Cure an Illness?
We’re in agreement that the better a person’s baseline health, the better his or her chances are of warding off all manner of illness and disease. But once that disease raises its ugly head, will taking steps that contribute to overall health do much to reverse the course of the disease?
Let’s go back to high blood pressure as an illustrative case. The pathophysiology (medicalese for the processes that lead to the illness) of hypertension is complex, and I’m sure you don’t have the patience for a digest of Braunwald’s 2000 page Heart Disease text. But let me present a simple example of a common cause of high blood pressure, and try to explain how it plays out.
Suppose a person eats a really salty meal. Here’s what happens: first, the concentration of salt in his (yes, it’s a guy again!) blood stream rises. As the blood passes through the kidneys, a precise regulatory process takes place. The sodium concentration in the blood needs to be kept at a constant level, so if it gets too high, the blood needs to be diluted by adding water – i.e., our patient gets very thirsty, drinks water, and the total fluid in his blood stream increases. But the total capacity of his circulatory doesn’t increase, so what happens is that the blood is under greater pressure – i.e., hypertension. Now, this hypertension could be temporary. The kidneys will then pass the excess liquid from the blood into the bladder, and into the toilet it goes, restoring our patient’s BP back to where it was before he scarfed down all those salty snacks.
During that interval, while he was having an episode of hypertension, warning signals were being sent from his circulatory system to his brain. Most large arteries have nerves which sense the pressure within the artery; these are called baroreceptors. The way they work is that when pressure increases in the artery, it stretches to accommodate the pressure, and the nerves stretch, and they send signals to the brain stem saying, “Do Something!” The brain then sends signals that reduce heart rate and relax arterial muscle tone, lowering blood pressure.
These baroreceptors work very well indeed, but for a short time only. When there are rapid changes in blood pressure, the signals go off quickly, at really short intervals. However, their function is short-term modulation of blood pressure. After as short a time as a couple of days, if blood pressure remains elevated, the baroreceptors stop sending these alarm signals, and accept the increased BP as the ”new normal.” This phenomenon is sometimes called “resetting the barostats.”
What that means is that if our patient regularly overloads on salt, his body essentially has no way of sensing that he has high blood pressure. His kidneys will do what they need to do to keep his sodium level at an okay concentration, but as far as blood pressure regulation, his brain now accepts that 150 over 95 is normal. It’s getting no alarm signals from the baroreceptors.
Other Mechanisms of Hypertension
I don’t want to leave you with the impression that every time you eat potato chips, you’re risking a lifetime of drug treatment for high blood pressure. Some people are more salt-sensitive in this regard than others; that seems to be particularly the case in people who are genetically programmed to retain salt, perhaps because their ancestors lived in parts of the world where salt was scarce. Another common mechanism is the renin-angiotensin system (RAS). Renin is an enzyme produced by the adrenal glands, adjacent to the kidneys. Renin eventually becomes a substance called angiotensin, which promotes constriction of the arteries, increasing BP, and boosts the heart’s pumping action, also raising BP. Some individuals are more renin-sensitive than others and therefore more prone to hypertension.
There are many effective and (by and large) quite safe drugs to treat hypertension. I’m not going to try to evaluate the different classes at this point, but if you would like to hear my personal views, please post a comment to that effect and I could devote a piece to those issues.
However, the bottom line here is that once hypertension is established, changing the lifestyle factors that led to hypertension isn’t going to do much to make it go away. Disease processes are in place, and these need to be attacked directly.
But What About Those Healthful Supplements?
Okay, that particular combination consisted of three ingredients, all of which actually do have some healthful credentials.
First, antioxidants. There is some evidence suggesting a connection between oxidative stress and factors that increase blood pressure, and at least one study reported that some hypertensive patients that took a supplement, pycnogenol, based on pine bark, were able to reduce the dosage of their antihypertensive drug by about 30% without their BP rising significantly. But so far data about this association is scant, and antioxidants vary all over the map, so on this front my guess is that treatment for hypertension with antioxidants of any kind is a shot in the dark. And data on the antioxidant in the “Marine D3” preparation, ecklonia cava, is slim.
Second, Omega 3 supplements. These do have a beneficial effect on lipid balance. They tend to raise HDL cholesterol (the good kind), lower triglycerides, and have a small effect on LDL cholesterol (the bad). People with elevated cholesterol frequently also have high blood pressure, but the two conditions need to be treated separately – fixing one doesn’t fix the other, so I don’t see Omega 3’s as an effective high blood pressure remedy.
Third, Vitamin D. Here the story is more interesting. There is strong evidence that persons with low levels of a hormone (calcifediol) which is metabolized in the liver from Vitamin D3, have increased cardiovascular mortality and increased prevalence of hypertension. The suggested mechanism is that Vitamin D3 may inhibit the RAS, through which heart rate and arterial pressure are increased. So you would think that taking supplemental Vitamin D3 might actually lower blood pressure. However, so far, evidence that it actually works as a treatment for hypertension is absent.
My bottom line: these supplements might well help to maintain health, but they’re highly unlikely to control established high blood pressure. Staying healthy and treating disease are two separate projects, and each one has to be addressed individually. This is not only true for hypertension, but for most other diseases, despite the rosy pictures painted by the merchants of alternative treatments.
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Let me remind you – “Doc Gumshoe” is not a physician. I’ve been a medical writer for 30 years or so, and, while I stick up for my capacity to understand the medical evidence as well as anybody else, I don’t give specific medical advice. Physicians treat human patients; I deal in scientific (I hope!) information. I am exceedingly grateful for any kind of feedback and can try to address specific questions. And if there are general topics that you would like to hear more about, please let me know!
Michael Jorrin (aka Doc Gumshoe)