How Low Should You Go?

The Sprint Study: How Low Should Your Blood Pressure Be?

Sept 14, 2015

Reference: New York Times , NIH National Heart and Blood Institute Sept 2015

This is really a big deal.   I’m very relieved to hear at because it was just two years ago that a huge meta-analysis said it was no big deal to treat high blood pressure until it was 160/95.   Now we have exactly the opposite and to a remarkable degree.

This is the Sprint Study. In it, 9,300 adults from about 100 medical centers across America and Puerto Rico with high blood pressure were recruited to two arms. One group was treated to a systolic (the upper number) pressure of 140. The other was pushed down to 120 or lower.   The study was meant to be concluded in 2017 but was released this week because the preliminary findings were so robust that the authors felt it to be unethical to continue and not release their findings.   The extra effort of pushing blood pressure down to 120 or lower resulted in a 30% additional decrease in “bad things” like stroke and heart attack, and death about 25% less.   We have had about a 70% drop in stroke since the 1970s when we started to treat high blood pressure, so this should be in addition to that. This is a pretty simple study with a pretty dramatic finding, and just about every expert in the field agrees with the importance of it, and the need to implement this into clinical practice.

What’s my read on it.   Well, I can’t help but agree with it.   It makes sense. But I have a very different take on it. First of all, basic human physiology. As folks get older in indigenous societies around the world, their blood pressure drops. In America, it’s like a rite of passage that our blood pressure rises and by age 70 some 70% of us have high blood pressure.   That means it’s our environment that is askew here in America. And just what is it in America that is doing it to us? And what is high blood pressure?

Second answer first.   High blood pressure isn’t just your pressure gauge being higher. It is actually better called “Endothelial dysfunction” – which basically means the lining of your blood vessels is out of whack, and can’t relax. That results in high blood pressure. It can’t relax because of a shortage of nitric oxide, brought on by inflammation and toxins. The most notable toxin is sugar and fructose, that pushes you towards making more uric acid. Uric acid soaks of nitric oxide and with that, your blood pressure rises.   American’s eat 10% of their total calories in the form of fructose alone. (Not everyone agrees with this analysis.) Another toxin is lead.  Another is trans fats (though they are fading.).   But the biggest problem may be your waistline. Fat is inflammatory. Fat tissue is not just passive calorie storage, it is the source of potent inflammation. And that goes everywhere in your body, and annoys your blood vessels. And that contributes to high blood pressure.   Finally, carbohydrates are the final “toxin”.   They cause insulin to be secreted. Insulin tells your kidneys to hang on to salt. It’s that simple. You have shown it yourself when you go on a diet for three days and don’t eat any carbs. You lose 8 pounds.   Seven of those pounds were from the salt water you hung on to. High blood pressure is a disease of too much salt water stuffed into too small a space. The pressure has to go up. In the last 2000 years, and last 100 in particular, we have developed more and more foods that are more “glycemic” and hence, more insulin inducing.

WWW. What will work for me. This study is slightly insane. It’s advocating for treating high blood pressure more aggressively.   In the world of treatment, that is correct. But there is a better world. Prevention. And that starts with weight loss.   Prove it for yourself. Lose 10 pounds and watch your blood pressure drop. Lose 20, and watch it plummet.   The choice is ours.   Do we have the will to change our environment, and lose weight, eat less sugar, less carbohydrates, less trans fats, or would we rather take a pill. This is a huge study. It confirms that changing our environment is crucial. And if you can’t, well, then. Here are three pills.

 

Pop Quiz

  1. If we pay attention to this study, we should take pills until our blood pressure is below 120 instead of below 140.   (One extra pill a day on average) T or F

True

  1. This study was meant to be concluded in 2017 but was such a remarkable result, the authors felt compelled to release it earlier.   T or F

That’s exactly what happened.   Very significant

  1. Our environment has changed in the last 200 years by the addition of more fruits and vegetables. T or F

Well, actually probably true, because we can get vegetables year around now which we couldn’t before, but what has happened is that we really eating much less vegetables and fruits, and instead are eating a lot more sugar and refined flour products.

  1. We have not gained much weight recently in America.   T or F

Are you kidding, we are getting fatter by about 1 pound per person per year.

  1. Losing weight lowers our insulin, and helps our kidneys stop holding onto salt.   T or F

Bingo, making weight loss more important than an extra pill.

5 thoughts on “How Low Should You Go?

  1. Lissa

    Your explanation of high blood pressure is correct, but only part of the answer.
    Blood pressure regulation is extremely complicated, involving numerous systems of the body, and a number of interactive regulatory mechanisms involving both the central and peripheral nervous systems, the kidneys, the adrenal gland, as well as the circulatory systems.

    While I agree that it is likely that the SAD – standard american diet, is part of the problem, your explanation is not supported by research – it is a theory. And, once again, diet is only part of the equation. What about physical activity? What about stress levels? What about sleep?

    Reply
    1. Dr John Whitcomb Post author

      Thanks for the comment Lissa. I love feedback. And I agree with you. To put nuance and subtly into a one pager and still stake out a clear position is an art I’mn not always good at. I think fructose, Nitric acid, uric acid…..salt and lack of potassium, magnesium….are play many roles. But it’s fun to connecture and the SAD is certainly a problem.

      Reply
  2. Judith Gianareles

    Does the fructose that is mentioned in your article sourced from fresh fruits and vegetables? Can you explain further???

    Reply
    1. Dr John Whitcomb Post author

      Yes, Judith. Fruit is typically about 6 % fructose. More than two pieces of fruit a day and your LDLs will start to rise. So fruit, on general principles, is good mostly for getting fat. I don’t care where fructose comes from. It’s concentration that matters, and the use of it with fiber. You can make fructose artificially if you want, by converting it from glucose with enzymes, or extracting it from sugar.

      Reply
      1. Judith Gianareles

        Good afternoon: Thanks for answering my question about fructose. I pulled this excerpt from the MNT knowledge center blog (linked from your blog). Written by Hannah Nichols. Now I’m slightly confused. I use fruit with raw vegetables in a smoothie every day. Bad, good???
        “However, ingestion of sugars – including fructose – in their naturally occurring biological contexts (i.e. as whole fruits) is not harmful and is likely beneficial. “

        Reply

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