Re: Re: DASH question

[Guest guest]

In a message dated 4/30/06 3:10:11 PM, frand.2@... writes:

From what I have read about the DASH diet, it was based on a study of

about 500 adults and I bet not too many of them had

hyperaldosteronism. 

Aldo does not cause HTN without excess salt in the diet. Also it does not cause fibrosis of the heart and blood vessels and the kidney unless there is salt in the diet.

We don't know what caused their hypertension. 

If it was from eating a high amount of sodium, I am sure it did lower

their BP but I don't believe that will work for everyone.  That is

why I don't intend to try it although I try to eat as little sodium

as possible since I can't tolerate it. I know Dr. Grim promotes the

diet but I don't think it will help us.  I have read that a low salt

diet raises the aldosterone level so it seems to me that if

aldosterone is our problem, the DASH diet won't help. 

It is already high in PA.

I, for one, do

not trust these studies.  There is lots of $$$ to be made on diet

books.  I did look at the DASH diet and it is very similar to the

Hilton Head Metabolism Diet. 

Well the book does cost $7 and you tax $ paid for the study. It is up to you to assess the evidence. But withour reading the book you really dont understand the science.

I tried that several years before I

developed an aldosterone problem. 

You have likely had an aldo problem as long as your BP has been above 120/80.

I stayed on it for a couple of

months or more and did lose a lot of weight but don't remember that

it lowered my BP.  At that time it was well-controlled with meds and

the dose was never lowered after I went on the diet and lost weight. 

Every time I slipped the least little bit, I gained several pounds

back right away then lost it when I went back on the diet.  It was

low salt, low fat, no refined sugar and high potassium.

The DASH has been tested the Hilton diet has not that I can find.

 

I think that a lot of studies are engineered to reach a certain

result.  If those people ate a high of salt diet, then the DASH diet

probably did lower their BP.  Years ago, I worked with a girl who

liked a lot of salt.  While we were at lunch one day, we all were

horrified to see her put 20 shakes or more of salt on spaghetti.  I

never add any, it already has more than enough.  She said that she

just loves salt.  A few weeks after that, she found out that she had

very high blood pressure and she was in her early 20s.  Take the

Subway commercials for example.  I saw that guy on 60 Minutes or

Dateline and he said that before he started eating at Subway, he was

eating 10,000 calories a day.  No wonder he lost weight eating at

Subway, but I'll bet it never worked for many other people. 

I have found that diuretics raise my bp, too.  It seems that anything

that takes sodium out of my body raises my bp.  I tried Lasix a

couple of times and both times, my systolic pressure went up about 20

points within an hour of taking it. 

Lasix is a piss-poor BP control agent. Unless it is taken bid. Sure does make your K low tho.

 

Fran

>

> Today will be my 12th day on the DASH diet and I've

> averaged about 1800 mg sodium per day.  My BP has

> consistently run 6-10 points higher since the day

> after I started the diet.  I've made no other

> lifestyle changes and my meds are the same.  Is there

> a reason for this?  According to the book you should

> see a significant drop in BP by two weeks.

>

> Thanks,

> a

You may not be DASH sensitive or may have salt sneaking in some where. The only way to tell is have your Dr. collect a 24 hr urine to check the Na in it.

You many also need to reduce your salt more than 1800 mg. esp if you have PA. Look at Ricediet.com for the lowest of the low.

>

[Guest guest]

Then I don't understand why my BP was never lower than

190/90 for the 4 days last year when I was bedridden

in the hospital, NPO and getting a D5W IV.

> Aldo does not cause HTN without excess salt in the

> diet.

[Guest guest]

Good point about the differences between people. The only way to know

for sure what works best for you is to run a short test. Say, two

weeks at 2500MG sodium, then two weeks at 1500MG sodium. Then

measuring BP 4 x day and K and Na blood levels weekly. The aldo-renin

test would be good too, if it worries you, but you have to make sure it

isn't some other factor rising aldo. Licorice - especially the real

glycyrrhiza glabra root in tea infusions - can raise it. Other

endogenous imbalances or stresses can too. The basic diet used for the

DSH trials isn't as much of an issue - it is sensible in its balancing

of types of carbs, oils and sugars. But the total amount of sodium

consumed daily does affect BP downward - in varying degrees - in

groups studied in all work I can find, much of it replicating the first

trials. Rising aldosterone is something I have never seen. Is there a

study with proper controls to be certain that ONLY lowering salt raised

aldo levels?

The DASH book has very modest sales history, along with its various

derivatives. The licensing, apparently was not done with the predatory

vigor big publishers apply. So, mammon is no motive there. The fact

that its original trials - and later replications - studied much wider

and more randomized groups than any of the other, big-money diets so

far, added to its modest financial performance impressed many pharmo

researchers.

a's comment about her BP going up 6-10 points since starting the

diet makes me think " how does she know there is positively no other

factor causing her BP to rise at the same time she started the diet? "

Unless experimenters know there is no other variable or causal factor,

it could be many things. Otherwise, we commit two logical fallacies :

(1) Questionable cause - A and B regularly occur together. Therefore A

is the cause of B. This fallacy requires that there is not, in fact,

a common factor or factors that actually cause both A and B.

(2) Post hoc ergo propter hoc - sometimes confused with questionable

cause, this fallacy refers to when B follows A in time. Just because

B happened after A does not mean A caused B.

But I want to know about anything new. Especially about rising

aldosterone. As a PA pt for whom the lowering daily total dietary

sodium lowered my dose of aldo-blocker drugs by almost 3/4, I want to

know if it is rising aldo! My BP remains controlled, even if I don't

follow the DASH diet - just with the low total sodium each day. And if

it is, so long as my BP stays safe, and my LVH continues to shrink, why

should I care?

Aldosterone isn't our problem - it is high BP. That's what we know

causes stroke and cardiomyopathy, eyesight, sleep and other system

problems. What we DON'T know is if there something new about PA pts

with rising aldo, but controlled BP! Aldo continues to rise slowly

after most pts get their BP controlled medically, the UCSF

Endocrinology Dept reports.

Thanks,

Dave

On Apr 30, 2006, at 1:09 PM, pagirl1946 wrote:

>> From what I have read about the DASH diet, it was based on a study of

> about 500 adults and I bet not too many of them had

> hyperaldosteronism. We don't know what caused their hypertension.

> If it was from eating a high amount of sodium, I am sure it did lower

> their BP but I don't believe that will work for everyone. That is

> why I don't intend to try it although I try to eat as little sodium

> as possible since I can't tolerate it. I know Dr. Grim promotes the

> diet but I don't think it will help us. I have read that a low salt

> diet raises the aldosterone level so it seems to me that if

> aldosterone is our problem, the DASH diet won't help. I, for one, do

> not trust these studies. There is lots of $$$ to be made on diet

> books. I did look at the DASH diet and it is very similar to the

> Hilton Head Metabolism Diet. I tried that several years before I

> developed an aldosterone problem. I stayed on it for a couple of

> months or more and did lose a lot of weight but don't remember that

> it lowered my BP. At that time it was well-controlled with meds and

> the dose was never lowered after I went on the diet and lost weight.

> Every time I slipped the least little bit, I gained several pounds

> back right away then lost it when I went back on the diet. It was

> low salt, low fat, no refined sugar and high potassium.

>

> I think that a lot of studies are engineered to reach a certain

> result. If those people ate a high of salt diet, then the DASH diet

> probably did lower their BP. Years ago, I worked with a girl who

> liked a lot of salt. While we were at lunch one day, we all were

> horrified to see her put 20 shakes or more of salt on spaghetti. I

> never add any, it already has more than enough. She said that she

> just loves salt. A few weeks after that, she found out that she had

> very high blood pressure and she was in her early 20s. Take the

> Subway commercials for example. I saw that guy on 60 Minutes or

> Dateline and he said that before he started eating at Subway, he was

> eating 10,000 calories a day. No wonder he lost weight eating at

> Subway, but I'll bet it never worked for many other people.

>

> I have found that diuretics raise my bp, too. It seems that anything

> that takes sodium out of my body raises my bp. I tried Lasix a

> couple of times and both times, my systolic pressure went up about 20

> points within an hour of taking it.

>

> Fran

>

>

>>

>> Today will be my 12th day on the DASH diet and I've

>> averaged about 1800 mg sodium per day. My BP has

>> consistently run 6-10 points higher since the day

>> after I started the diet. I've made no other

>> lifestyle changes and my meds are the same. Is there

>> a reason for this? According to the book you should

>> see a significant drop in BP by two weeks.

>>

>> Thanks,

>> a

>>

>

>

[Guest guest]

If that BP is higher than w/o the hospital and the D5W-IV there must be

a cause. Some detective work. Are you absolutely certain of all

ingredients in the IV? How? Any other serum-intake (meds, water

supply, etc) or stressors?

Dave

On Apr 30, 2006, at 2:34 PM, a Hall wrote:

> Then I don't understand why my BP was never lower than

> 190/90 for the 4 days last year when I was bedridden

> in the hospital, NPO and getting a D5W IV.

>

>

>> Aldo does not cause HTN without excess salt in the

>> diet.

>

>

[Guest guest]

In a message dated 4/30/06 11:25:03 PM, dave@... writes:

> Then I don't understand why my BP was never lower than

> 190/90 for the 4 days last year when I was bedridden

> in the hospital, NPO and getting a D5W IV.

It may take 2 weeks to flush out the excess Na. What were you in the hosptial for? It is a very stressful situation so not a good place to assess BP. Did it go down at night.

If they were using automated devices you may have had faulty readings. If the staff was doing it they may not have been doing it correctly. Do you have any records of all BPs taken and we can see if some may have even been dry labing the BPs which we do know happens. ie they just wirte down what the last shift got.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

In a message dated 4/30/06 11:07:16 PM, dave@... writes:

Good point about the differences between people.  The only way to know

for sure what works best for you is to run a short test.  Say, two

weeks at 2500MG sodium, then two weeks at 1500MG sodium.  Then

measuring BP 4 x day and K and Na blood levels weekly.  The aldo-renin

test would be good too, if it worries you, but you have to make sure it

isn't some other factor rising aldo.  Licorice - especially the real

glycyrrhiza glabra root in tea infusions - can raise it. 

Licorice raises BP but lowers aldo and renin and K.

Other

endogenous imbalances or stresses can too.  The basic diet used for the

DSH trials isn't as much of an issue - it is sensible in its balancing

of types of carbs, oils and sugars.   But the total amount of sodium

consumed daily does affect BP downward - in varying degrees -  in

groups studied in all work I can find, much of it replicating the first

trials.  Rising aldosterone is something I have never seen.  Is there a

study with proper controls to be certain that ONLY lowering salt raised

aldo levels?

If the RAAS is working normally low sodium diet (which is really a normal human sodium diet) will increase renin and aldosterone.

The DASH book has very modest sales history, along with its various

derivatives.  The licensing, apparently was not done with the predatory

vigor big publishers apply.  So, mammon is no motive there.  The fact

that its original trials - and later replications -  studied much wider

and more randomized groups than any of the other, big-money diets so

far, added to its modest financial performance impressed many pharmo

researchers.

a's comment about her BP going up 6-10 points since starting the

diet makes me think "how does she know there is positively no other

factor causing her BP to rise at the same time she started the diet?" 

Unless experimenters know there is no other variable or causal factor,

it could be many things.   Otherwise, we commit two logical fallacies :

(1) Questionable cause - A and B regularly occur together. Therefore A

is the cause of B.   This fallacy requires that there is not, in fact,

a common factor or factors that actually cause both A and B.

(2) Post hoc ergo propter hoc - sometimes confused with questionable

cause, this fallacy refers to when B follows A in time.   Just because

B happened after A does not mean A caused B.

But I want to know about anything new.  Especially about rising

aldosterone.  As a PA pt for whom the lowering daily total dietary

sodium lowered my dose of aldo-blocker drugs by almost 3/4, I want to

know if it is rising aldo!    My BP remains controlled, even if I don't

follow the DASH diet - just with the low total sodium each day.  And if

it is, so long as my BP stays safe, and my LVH continues to shrink, why

should I care?

Once again aldo MUST have excess sodium in the diet to cause problems. So even if aldo goes up with low sodium it is not causing the aldo damage. You must have salt and aldo to get damage.

PUBMED DOCA-Salt HTN for more info.

Aldosterone isn't our problem - it is high BP.   That's what we know

causes stroke and cardiomyopathy, eyesight, sleep and other system

problems.  What we DON'T know is if there something new about PA pts

with rising aldo, but controlled BP!    Aldo continues to rise slowly

after most pts get their BP controlled medically, the UCSF

Endocrinology Dept reports.

Thanks,

Dave

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

In a message dated 4/30/06 4:35:53 PM, shahall@... writes:

Then I don't understand why my BP was never lower than

190/90 for the 4 days last year when I was bedridden

in the hospital, NPO and getting a D5W IV.

Rather make that PUBMED Kempner Rice diet.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

In a message dated 4/30/06 4:35:53 PM, shahall@... writes:

Then I don't understand why my BP was never lower than

190/90 for the 4 days last year when I was bedridden

in the hospital, NPO and getting a D5W IV.

Indeed in some it may take 4-6 weeks for BP to normalize of low sodium. Google Kempner rice diet.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

Well in the old days it was rice diet or die if you had malignant high blood pressure.

A number chose to die.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

In a message dated 5/1/06 3:50:19 PM, shahall@... writes:

Never mind, I'd forgotten that I was only on 50 mg

spiro bid then, vs. 100 mg bid now.

a

Thatll do it.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

Never mind, I'd forgotten that I was only on 50 mg

spiro bid then, vs. 100 mg bid now.

a

> Then I don't understand why my BP was never

> lower than 190/90 for the 4 days last year when I

> was bedridden in the hospital, NPO and getting a

> D5W IV.

[Guest guest]

I'll choose a little higher dose of spiro, if

necessary

a

> Well in the old days it was rice diet or die if you

> had malignant high blood

> pressure.

>

> A number chose to die.

[Guest guest]

On May 1, 2006, at 7:36 AM, lowerbp2@... wrote:

>

> In a message dated 4/30/06 11:07:16 PM, dave@... writes:

>

>

>> Good point about the differences between people.  The only way to know

>> for sure what works best for you is to run a short test.  Say, two

>> weeks at 2500MG sodium, then two weeks at 1500MG sodium.  Then

>> measuring BP 4 x day and K and Na blood levels weekly.  The

>> aldo-renin

>> test would be good too, if it worries you, but you have to make sure

>> it

>> isn't some other factor rising aldo.  Licorice - especially the real

>> glycyrrhiza glabra root in tea infusions - can raise it. 

>

> Licorice raises BP but lowers aldo and renin and K.

according to Zment's " Evidence Based Herbal Medicine " licorice taken as

asthma palliative infusions raises aldo, having no measured effect upon

renin or K, from 2 large sample Japanese studies. The amounts were

unseemly large (1-2 grams per day). Of course he points out that the

Japanese diet is very rich in sodium from Shoyu alone. That book is a

kind of " damning with faint evidence " all the herbs in some ways. But

its point that just because something is a plant means it is safer is

well taken - and illustrated many times.

Dave

[Guest guest]

In a message dated 5/2/06 1:31:33 AM, dave@... writes:

according to Zment's "Evidence Based Herbal Medicine" licorice taken as

asthma palliative infusions raises aldo, having no measured effect upon

renin or K, from 2 large sample Japanese studies.   The amounts were

unseemly large (1-2 grams per day).  Of course he points out that the

Japanese diet is very rich in sodium from Shoyu alone.  That book is a

kind of "damning with faint evidence" all the herbs in some ways.  But

its point that just because something is a plant means it is safer is

well taken - and illustrated many times.

Dave

Guess he needs to read the literature on what he writes about. See if you can track down the article he wrote and when. L blocks 17 OH thus letting cortisol get to MC receptor in the renal tubule, this increases the sythesis of ENac th Sodium channel. Na leaks into cells and is pumped back into the blood. This increases volume, and BP which suppress renin. As renin is suppressed so is AI and AII and therefore aldo goes to zero.

This has been know for 30+ years except the 17OH blocking is only about 10 years old.

Suggest you pubmed licorice and hypertension.

Maybe the stuff he talks about does not contain licorice?

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

In a message dated 5/2/06 1:31:33 AM, dave@... writes:

according to Zment's "Evidence Based Herbal Medicine" licorice taken as

asthma palliative infusions raises aldo, having no measured effect upon

renin or K, from 2 large sample Japanese studies.   The amounts were

unseemly large (1-2 grams per day).  Of course he points out that the

Japanese diet is very rich in sodium from Shoyu alone.  That book is a

kind of "damning with faint evidence" all the herbs in some ways.  But

its point that just because something is a plant means it is safer is

well taken - and illustrated many times.

Dave

Can you get me the reference he cites. I would like to look at it.

May your pressure be low!

CE Grim, BS(Chem/Math), MS(Biochem), MD.

Board Certified in Internal Medicine, Geriatrics and Hypertension

Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

Specializing in Difficult to Manage High Blood Pressure

Clinical Professor of Medicine, Medical College of Wisconsin

[Guest guest]

Yes, lent my book to the pulmonary dept at Wash Hosp. I'll phone her

and get it.

Dave

On May 2, 2006, at 7:39 AM, lowerbp2@... wrote:

>

> In a message dated 5/2/06 1:31:33 AM, dave@... writes:

>

>

>> according to Zment's " Evidence Based Herbal Medicine " licorice taken

>> as

>> asthma palliative infusions raises aldo, having no measured effect

>> upon

>> renin or K, from 2 large sample Japanese studies.   The amounts were

>> unseemly large (1-2 grams per day).  Of course he points out that the

>> Japanese diet is very rich in sodium from Shoyu alone.  That book is

>> a

>> kind of " damning with faint evidence " all the herbs in some ways. 

>> But

>> its point that just because something is a plant means it is safer is

>> well taken - and illustrated many times.

>>

>> Dave

>

>

> Can you get me the reference he cites. I would like to look at it.

>

>

>

> May your pressure be low!

>

> CE Grim, BS(Chem/Math), MS(Biochem), MD.

> Board Certified in Internal Medicine, Geriatrics and Hypertension

> Former Epidemiologic Intelligence Services Officer (Lt. Comdr.), CDC

> Specializing in Difficult to Manage High Blood Pressure

> Clinical Professor of Medicine, Medical College of Wisconsin

>