RE: Re: Blood pressure and sodium

[Guest guest]

>>Certainly the rice diet as originally construed did manage to control

very severe hypertension, and I'm sure that very low sodium diets will

lower BP. But I don't think the diets you're talking about are this

type of super-low sodium diet.

I am.

>>Apart from the very low sodium diets (which are not used clinically in

my experience, due to difficulty in adherence),

I always am disturbed when people say this. Yes, adhering to a healthier diet

takes discipline, but then again, what in life that is of value doesnt?

And, MDs and clinicians always like to not recommend such a stirct discipline

saying compliance is low. Well, so is compliance to BP medication due to the

many side effects, including sexual ones. But, they dont stop prescribing and

recommending them. So, being they both have a low complaince rate, lets push

the healthier verison.

>> the change in BP due to modest reductions in sodium (to about 1500 mg/day, is

much lower.

You have to factor in the fact that whenever you put people on a study, their BP

goes down.

I would not make an across the board statement like this. Some go up. Of

course, all good studies are the difference " between " the experimental group

and the control group and not just the experimental " pre " vs " post " As fas as

I know the Goldhammer study used a control group as did McDougall. though I

might be wrong.

>>{{So in normotensives, only 2 mm systolic and 1 mm Hg diastolic.}}

This is not relevant to CR-ON. We are an intrepid lot, so to extrapolate

average numbers from a meta analysis on the general population with modest

dietary changes, to CR-ON, which is (or would be) the subgroup that would be

the most adherent with the most discipline, is not relevant. We are doing this

not for the overal generic benefit, but to get the most out of it that we can.

On the AHA old Step II diet, they only acheived small improvements in blood

lipids. Same with the ADA diet in diabetics. But, the Portfolio trial, th

DPPT, our studies and many others etc, so that much more dramatic results can be

achieved with more intensive changes. Moderate changes produce moderate

results. And unfortunatelty, this is why many dont recommend dietary changes

and why most give up. They put the effort in, work hard, make moderate changes,

and for all their effort they see little or no results. So why do it? But, if

they were encouraged and educated and supported in making more dramatric

changes, they would experience more dramatic results. And, what is more

motivating than dramatic results?

As was recently published, CR-ON produced dramatic changes in the heart. The

study was published in the January 17, 2006 issue of the Journal of the American

College of Cardiology.

We just published a new one also ... " The researchers measured blood levels of

cholesterol, insulin and markers of inflammation both before and after the

study. At the start of the study, 48 percent of the men had metabolic syndrome,

while at the end just 19 percent still did. Forty-two percent had diabetes at

the start of the study, but only 23 percent did at the end. The average LDL, or

" bad, " cholesterol reading went down 25 percent. Results of the study appear in

the Jan. 10 online issue of the Journal of Applied Physiology. "

The data you cite is important if I was discussing this with a group of public

health professionals about making public health policies, or trying to implement

a community intervention, but i dont see the relevance to this group, the

intrepid travelers.

>>I didn't know what the Pritikin diet recommended, so I looked on their

website. They say you can eat up to 1.5 g/day sodium.

Our recommendations are the same as the IOM and as I posted earlier in this

discussion, it is based on age. The range is " no more than " 1200 - 1500

dependant on age and health. At the center, we keep it under 1200 for

everyone.

>> 1.5 mg/day is a modest sodium intake, and not really a low sodium intake.

I agree. My own intake is around 500 mgs a day, and thats without adding any

salt or using anything with added sodium. My BP in a family that has high BP,

is 90/95 over 60/65. At one point, is was well over 130/85

>>This is far above what the original rice diet used. Which rice diet

are you talking about? The original Kempner rice diet had only 15-25

g/day of protein, and ONLY 100-150 mg/day of sodium, one-tenth the

sodium of what the Pritikin, DASH, and other diets recommend.

I know he reported that, but it is hard to achieve a diet that is under 500 mgs

a day as that is what occurs in about 1200 calories of naturally ocurring plant

foods. And he included tomatoes, celery, etc, plant foods that were higher in

natural sodium. My own guess is that it was around 500 mgs in reality.

>>Even patients who really

need such a diet - those with congestive heart failure, kidney

disease, etc. almost never follow such diets. Otherwise our

pharmaceutical company stocks would have a lot less value.

Again, nor do they take their medicine, or follow any other advice ie, lose

weight, exercise, relax.

>>But maybe the CR crowd is an intrepid lot.

Welcome aboard to our " long strange trip " and hopefully the emphasis will be on

" long "

PS you may find the following interesting, written my a collegue of mine.

http://www.foodandhealth.com/cpecourses/salt_new.php

<http://www.foodandhealth.com/cpecourses/salt_new.php>

Regards

jeff

[Guest guest]

>>Certainly the rice diet as originally construed did manage to control

very severe hypertension, and I'm sure that very low sodium diets will

lower BP. But I don't think the diets you're talking about are this

type of super-low sodium diet.

I am.

>>Apart from the very low sodium diets (which are not used clinically in

my experience, due to difficulty in adherence),

I always am disturbed when people say this. Yes, adhering to a healthier diet

takes discipline, but then again, what in life that is of value doesnt?

And, MDs and clinicians always like to not recommend such a stirct discipline

saying compliance is low. Well, so is compliance to BP medication due to the

many side effects, including sexual ones. But, they dont stop prescribing and

recommending them. So, being they both have a low complaince rate, lets push

the healthier verison.

>> the change in BP due to modest reductions in sodium (to about 1500 mg/day, is

much lower.

You have to factor in the fact that whenever you put people on a study, their BP

goes down.

I would not make an across the board statement like this. Some go up. Of

course, all good studies are the difference " between " the experimental group

and the control group and not just the experimental " pre " vs " post " As fas as

I know the Goldhammer study used a control group as did McDougall. though I

might be wrong.

>>{{So in normotensives, only 2 mm systolic and 1 mm Hg diastolic.}}

This is not relevant to CR-ON. We are an intrepid lot, so to extrapolate

average numbers from a meta analysis on the general population with modest

dietary changes, to CR-ON, which is (or would be) the subgroup that would be

the most adherent with the most discipline, is not relevant. We are doing this

not for the overal generic benefit, but to get the most out of it that we can.

On the AHA old Step II diet, they only acheived small improvements in blood

lipids. Same with the ADA diet in diabetics. But, the Portfolio trial, th

DPPT, our studies and many others etc, so that much more dramatic results can be

achieved with more intensive changes. Moderate changes produce moderate

results. And unfortunatelty, this is why many dont recommend dietary changes

and why most give up. They put the effort in, work hard, make moderate changes,

and for all their effort they see little or no results. So why do it? But, if

they were encouraged and educated and supported in making more dramatric

changes, they would experience more dramatic results. And, what is more

motivating than dramatic results?

As was recently published, CR-ON produced dramatic changes in the heart. The

study was published in the January 17, 2006 issue of the Journal of the American

College of Cardiology.

We just published a new one also ... " The researchers measured blood levels of

cholesterol, insulin and markers of inflammation both before and after the

study. At the start of the study, 48 percent of the men had metabolic syndrome,

while at the end just 19 percent still did. Forty-two percent had diabetes at

the start of the study, but only 23 percent did at the end. The average LDL, or

" bad, " cholesterol reading went down 25 percent. Results of the study appear in

the Jan. 10 online issue of the Journal of Applied Physiology. "

The data you cite is important if I was discussing this with a group of public

health professionals about making public health policies, or trying to implement

a community intervention, but i dont see the relevance to this group, the

intrepid travelers.

>>I didn't know what the Pritikin diet recommended, so I looked on their

website. They say you can eat up to 1.5 g/day sodium.

Our recommendations are the same as the IOM and as I posted earlier in this

discussion, it is based on age. The range is " no more than " 1200 - 1500

dependant on age and health. At the center, we keep it under 1200 for

everyone.

>> 1.5 mg/day is a modest sodium intake, and not really a low sodium intake.

I agree. My own intake is around 500 mgs a day, and thats without adding any

salt or using anything with added sodium. My BP in a family that has high BP,

is 90/95 over 60/65. At one point, is was well over 130/85

>>This is far above what the original rice diet used. Which rice diet

are you talking about? The original Kempner rice diet had only 15-25

g/day of protein, and ONLY 100-150 mg/day of sodium, one-tenth the

sodium of what the Pritikin, DASH, and other diets recommend.

I know he reported that, but it is hard to achieve a diet that is under 500 mgs

a day as that is what occurs in about 1200 calories of naturally ocurring plant

foods. And he included tomatoes, celery, etc, plant foods that were higher in

natural sodium. My own guess is that it was around 500 mgs in reality.

>>Even patients who really

need such a diet - those with congestive heart failure, kidney

disease, etc. almost never follow such diets. Otherwise our

pharmaceutical company stocks would have a lot less value.

Again, nor do they take their medicine, or follow any other advice ie, lose

weight, exercise, relax.

>>But maybe the CR crowd is an intrepid lot.

Welcome aboard to our " long strange trip " and hopefully the emphasis will be on

" long "

PS you may find the following interesting, written my a collegue of mine.

http://www.foodandhealth.com/cpecourses/salt_new.php

<http://www.foodandhealth.com/cpecourses/salt_new.php>

Regards

jeff

[Guest guest]

I must agree with you, since there are undocumented problems with a low sodium diet.

1500 mgs is what I did for 5 yrs - now I do 3000, I've had HTN since 1986, and I don't care about the studies, because everyone is diff, and the studies just don't fit me.

No one will ever cure essential HTN with a diet, until they find out what causes it, and I believe the risk factor is age.

Regards.

[ ] Re: Blood pressure and sodium

> PS You also have to consider that with the studies we do, and theone McDougall did and the ones the Rice Diet did, that not only werethose drops in SBP seen, there was also the reduction in orelimination of, HTN medicine during the study. So, the originalnumbers were while on HTN meds and the final numbers were withoutthem. So the actual drops were much more.> > We get around 80% of our patients off their HTN meds in 14-21 days.The rice diet has similar stats.> > Jeff>------------------------Well, Jeff, I stand corrected in terms of very low sodium diets. Certainly the rice diet as originally construed did manage to controlvery severe hypertension, and I'm sure that very low sodium diets willlower BP. But I don't think the diets you're talking about are thistype of super-low sodium diet.Apart from the very low sodium diets (which are not used clinically inmy experience, due to difficulty in adherence), the change in BP dueto modest reductions in sodium (to about 1500 mg/day, is much lower. You have to factor in the fact that whenever you put people on astudy, their BP goes down. So I was referring to the drop in systolicBP compared to placebo. For example, when you do such a study, the systolic BP may go down, bysay an average of 13 mm Hg, with a typical study, but it may well dropby an average of 8 mm Hg in the placebo control group, so the actualfall in BP due to the actual change in diet, is much less.Here is what a structured analysis of a great number of studies inthis area shows: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=15266549 & query_hl=45 & itool=pubmed_DocSumCochrane Database Syst Rev. 2004;(3):CD004937.Effect of longer-term modest salt reduction on blood pressure.He FJ, MacGregor GA.You can click on the link to read the whole abstract, but-{{Now read this part carefully:}}In individuals with elevated blood pressure the median reduction in24-h urinary sodium excretion was 78 mmol (4.6 g/day of salt), themean reduction in systolic blood pressure was -4.97 mmHg (95%CI:-5.76to -4.18), and the mean reduction in diastolic blood pressure was-2.74 mmHg (95% CI:-3.22 to -2.26). {{So 5 mm Hg systolic and 2.7 mm Hg diastolic - very similar to what Isaid.}} In individuals with normal blood pressure the median reduction in 24-hurinary sodium excretion was 74 mmol (4.4 g/day of salt), the meanreduction in systolic blood pressure was -2.03 mmHg (95% CI: -2.56 to-1.50) mmHg, and the mean reduction in diastolic blood pressure was-0.99 mmHg (-1.40 to -0.57). {{So in normotensives, only 2 mm systolic and 1 mm Hg diastolic.}}----------------------------This is peripheral to the discussion about vitamin D and bloodpressure. I of course believe we should be following a dietary sodiumintake, ideally, in the 1-2 g/day range, and I agree that as you getolder, or if you are African American (or maybe Hispanic, also), orhave kidney disease, you should be closer to 1 g/day than 2 g/day. I didn't know what the Pritikin diet recommended, so I looked on theirwebsite. They say you can eat up to 1.5 g/day sodium. This is my ownrecommendation as well (well, 1.5-2.0, but leaning towards the lowerend), so again, I think any disagreements between us are less thanthey appear, unless you are advocating going lower than what thePritikin website recommends. 1.5 mg/day is a modest sodium intake,and not really a low sodium intake.This is far above what the original rice diet used. Which rice dietare you talking about? The original Kempner rice diet had only 15-25g/day of protein, and ONLY 100-150 mg/day of sodium, one-tenth thesodium of what the Pritikin, DASH, and other diets recommend. Bloodpressure reductions with this diet were huge, I agree, but no one usesthis.For a ref, see:http://www.ajcn.org/cgi/reprint/4/3/254.pdfI presume you're talking about the Rice Diet program run out of Dukeand championed by ti?If so, I could find only one article by ti using this diet:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=11152083 & query_hl=50 & itool=pubmed_docsumHere is what they say about change in blood pressure:"systolic and diastolic blood pressure decreased by 4.3 mmHg (p <0.01) and 2.4 mmHg (p < 0.05), respectively. "I guess my own approach to all of this has been to avoid very radicaldiets; I've tried to follow a very low sodium diet, and i've actuallyliked it - but I have found it to be too hard to follow in the contextof family and socializing and practicality. Even patients who reallyneed such a diet - those with congestive heart failure, kidneydisease, etc. almost never follow such diets. Otherwise ourpharmaceutical company stocks would have a lot less value.But maybe the CR crowd is an intrepid lot. Has anyone surveyed therange of sodium intakes that people follow? It would be interestingto find this out.

[Guest guest]

I must agree with you, since there are undocumented problems with a low sodium diet.

1500 mgs is what I did for 5 yrs - now I do 3000, I've had HTN since 1986, and I don't care about the studies, because everyone is diff, and the studies just don't fit me.

No one will ever cure essential HTN with a diet, until they find out what causes it, and I believe the risk factor is age.

Regards.

[ ] Re: Blood pressure and sodium

> PS You also have to consider that with the studies we do, and theone McDougall did and the ones the Rice Diet did, that not only werethose drops in SBP seen, there was also the reduction in orelimination of, HTN medicine during the study. So, the originalnumbers were while on HTN meds and the final numbers were withoutthem. So the actual drops were much more.> > We get around 80% of our patients off their HTN meds in 14-21 days.The rice diet has similar stats.> > Jeff>------------------------Well, Jeff, I stand corrected in terms of very low sodium diets. Certainly the rice diet as originally construed did manage to controlvery severe hypertension, and I'm sure that very low sodium diets willlower BP. But I don't think the diets you're talking about are thistype of super-low sodium diet.Apart from the very low sodium diets (which are not used clinically inmy experience, due to difficulty in adherence), the change in BP dueto modest reductions in sodium (to about 1500 mg/day, is much lower. You have to factor in the fact that whenever you put people on astudy, their BP goes down. So I was referring to the drop in systolicBP compared to placebo. For example, when you do such a study, the systolic BP may go down, bysay an average of 13 mm Hg, with a typical study, but it may well dropby an average of 8 mm Hg in the placebo control group, so the actualfall in BP due to the actual change in diet, is much less.Here is what a structured analysis of a great number of studies inthis area shows: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=15266549 & query_hl=45 & itool=pubmed_DocSumCochrane Database Syst Rev. 2004;(3):CD004937.Effect of longer-term modest salt reduction on blood pressure.He FJ, MacGregor GA.You can click on the link to read the whole abstract, but-{{Now read this part carefully:}}In individuals with elevated blood pressure the median reduction in24-h urinary sodium excretion was 78 mmol (4.6 g/day of salt), themean reduction in systolic blood pressure was -4.97 mmHg (95%CI:-5.76to -4.18), and the mean reduction in diastolic blood pressure was-2.74 mmHg (95% CI:-3.22 to -2.26). {{So 5 mm Hg systolic and 2.7 mm Hg diastolic - very similar to what Isaid.}} In individuals with normal blood pressure the median reduction in 24-hurinary sodium excretion was 74 mmol (4.4 g/day of salt), the meanreduction in systolic blood pressure was -2.03 mmHg (95% CI: -2.56 to-1.50) mmHg, and the mean reduction in diastolic blood pressure was-0.99 mmHg (-1.40 to -0.57). {{So in normotensives, only 2 mm systolic and 1 mm Hg diastolic.}}----------------------------This is peripheral to the discussion about vitamin D and bloodpressure. I of course believe we should be following a dietary sodiumintake, ideally, in the 1-2 g/day range, and I agree that as you getolder, or if you are African American (or maybe Hispanic, also), orhave kidney disease, you should be closer to 1 g/day than 2 g/day. I didn't know what the Pritikin diet recommended, so I looked on theirwebsite. They say you can eat up to 1.5 g/day sodium. This is my ownrecommendation as well (well, 1.5-2.0, but leaning towards the lowerend), so again, I think any disagreements between us are less thanthey appear, unless you are advocating going lower than what thePritikin website recommends. 1.5 mg/day is a modest sodium intake,and not really a low sodium intake.This is far above what the original rice diet used. Which rice dietare you talking about? The original Kempner rice diet had only 15-25g/day of protein, and ONLY 100-150 mg/day of sodium, one-tenth thesodium of what the Pritikin, DASH, and other diets recommend. Bloodpressure reductions with this diet were huge, I agree, but no one usesthis.For a ref, see:http://www.ajcn.org/cgi/reprint/4/3/254.pdfI presume you're talking about the Rice Diet program run out of Dukeand championed by ti?If so, I could find only one article by ti using this diet:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=11152083 & query_hl=50 & itool=pubmed_docsumHere is what they say about change in blood pressure:"systolic and diastolic blood pressure decreased by 4.3 mmHg (p <0.01) and 2.4 mmHg (p < 0.05), respectively. "I guess my own approach to all of this has been to avoid very radicaldiets; I've tried to follow a very low sodium diet, and i've actuallyliked it - but I have found it to be too hard to follow in the contextof family and socializing and practicality. Even patients who reallyneed such a diet - those with congestive heart failure, kidneydisease, etc. almost never follow such diets. Otherwise ourpharmaceutical company stocks would have a lot less value.But maybe the CR crowd is an intrepid lot. Has anyone surveyed therange of sodium intakes that people follow? It would be interestingto find this out.