Some objectivity on all the diet rubbish

The more I’ve learned, the more horrified I’ve become. Science is being misused for marketing and political purposes. Evidence is being distorted and bias has inundated media, research, government policies and clinical guidelines. Unsound information proliferates in professional and advocacy organizations, academic institutions and journals; and even professionals aren’t reaching beyond beliefs to critically examine studies and recognize credible information. So much valuable and critically important information, and the very best science — well documented in careful, objective, evidence-based research — is never reported and never published. Fear sells and unfounded scares, exaggerations and “what-ifs?” are being used to terrify people about their foods, bodies and health.

Diet from our ancestors

Introduction to the Paleolithic Diet is Ben Balzer's page. He is a family physician in Australia. Probably the clearest introduction on the web.

Dieting - increases your CVD risk - bloody hell.

Dr. Reubin Andres of the National Institute on Aging admitted that weight loss can improve blood sugar levels, blood pressure and cholesterol in the short term. “The only problem is that when you look at mortality rates,” he said, “they don’t look good. Fat people who are subject to weight loss have a higher mortality rate than those who remain fat.”

Statistics are like a girls bikini - they show a lot but hide the vital parts. Truth is an illusive ideal. Sloganeering the easy option!

Where is the epidemic?

The emperor's new crisis!

In fact, Blair and colleagues are renowned for decades of research showing weight is not a significant predictor of mortality, it's fitness........

statin or diet

MN: And people who have had a heart attack?

JA: Statins are definitely helpful for people who have already had a heart attack. Still, the Lyon Diet Heart Study shows how much more effective a healthy diet is in reducing the risk of heart attack for these folks. The participants were randomly assigned to receive counseling about a Mediterranean-style diet (see end of article) or a standard post-heart attack diet. Those who went on the Mediterranean-style diet developed 72% less heart disease than those in the control group. There was also a 56% lower death rate and 61% less cancer than the people in the control group. Simply eating a Mediterranean-style diet is nearly three times more effective at preventing recurrent heart disease and death in post-heart attack patients than is taking a statin. Even more surprising, those on the Mediterranean-style diet did not have lower cholesterol than those eating the standard post-heart attack diet. So when your doctor tells you to get your cholesterol down…keep that in mind.

Google overdosedamerica or centre for medical consumer

Dash Diet - what to expect.

How can you assist a motivated patient?
Patients can obtain information about the DASH diets at this website: www.nhlbi.nih.gov/health/public/heart/hbp/dash Collecting 24-hour urine for potassium and sodium establishes where the patient is at baseline; subjects eating an average North American diet excrete approximately 40 mmol of potassium per day and 150 mmol of sodium per day. The potassium target for the DASH diet is a 24-hour urinary potassium of 80 mmol. The sodium target for a low-sodium diet is a 24-hour urinary sodium of 50-100 mmol. These tests cost $1.49 each in BC.

hypertension

Mild Hypertension - An approach to using evidence in the decision making process

The key pooled outcomes from these 5 trials reveal the following: Would you take the pill?
1. Total mortality, RR 0.95 [0.71 - 1.11] - no real difference between taking or not aking.
2. Total serious adverse events were not reported in any of the trials.
3. Total cardiovascular events (fatal and non-fatal strokes plus fatal and non-fatal coronary heart disease) were reduced from 4.0% to 3.2%, RR 0.81 [0.71 - 0.92], ARR 0.8%,
Number Needed to Treat is 125 people for 5 years for one person to benefit.
4. Withdrawals due to adverse events, RR 4.8 [4.2 - 5.6], ARI 9%, NNH 11 for 5 years.

You now feel you are in a position to explain the benefits and harms to your patient.

Treatment of Hypertension

Aiming for a target diastolic BP of lower than 90 mm Hg provides no therapeutic advantage for most hypertensive patients.

The two groups with lower bp might be expected to have fewer cardiovascular events but this was not seen

ALLHAT STUDY

• Total mortality, coronary heart disease and end-stage renal disease are similar for first-line thiazides (diuretic), CCBs (Calcium channel blockers) and ACEIs (Angiotensin-Converting Enzyme).

• Heart failure is increased with first-line CCBs as compared to thiazides or ACEIs.

• Stroke is reduced with first-line thiazides as compared to ACEIs.

• BP control and tolerability are better with first-line thiazides as compared to ACEIs.

• Cost is substantially less for thiazides as compared to beta-blockers, ACEIs, CCBs, alpha blockers, and angiotensin receptor blockers.

Drugs of Choice in the Treatment of Hypertension

After review of the long term hypertension studies, including the epidemiologic and randomized placebo controlled drug trials, certain clinically important facts stand out:

• Risk of cardiovascular events correlates better with systolic than diastolic blood pressure.(1)

• Risk correlates better with blood pressures taken outside the doctor's office than with office blood pressures.(2)

• Blood pressure consistently decreases with placebo treatment (10/8 mm Hg).(3)

• The average additional blood pressure fall in the active treatment group is modest (11/6 mm Hg).(3), (4)

• The average blood pressure fall with treatment in trials using low doses of just one drug (7-9.5/46.5mm Hg) (5), (6) is similar to that obtained from an overview of trials using high doses of multiple drugs (11/6 mm Hg).(3), (4)

These facts suggest the following ways to assist in managing your patients with hypertension:

• Put more emphasis on systolic and home blood pressures when making treatment decisions.

• Appreciate that some of the blood pressure lowering effect seen in the office is due to the placebo effect. In other words, no matter what you are prescribing, it is likely to appear efficacious.

• Realize that pushing the dose seldom improves the antihypertensive effect. Likewise, the dose can frequently be lowered in patients receiving high doses of antihypertensive drugs without changing the antihypertensive effect.

Can blood pressure be lowered by a change in diet? Evidence from the DASH trials

Substantial BP lowering can be achieved by a reduced dietary sodium intake, the DASH diet, or a combination of the two. This approach is applicable to those patients consuming an average North American diet who are motivated to make a change.

Atenolol

If you on this maybe you'd be better off on something else

High cholesterol GOOD!!!!

The Benefits of High Cholesterol

A study of elderly French women living in a nursing home showed that those with the highest cholesterol levels lived the longest (The Lancet, 4/22/89). The death rate was more than five times higher for women with very low cholesterol. Several other studies have shown similar results. Ironically, Dr. Ravnskov noted that in his practice it was usually the elderly women who were most worried about their cholesterol levels.

Cholesterol and risk of stroke

Yet data from Japan directly contradicts Ebrahim et al's conclusions. From 1958 to 1995 fat consumption increased from 5% to 20% of the total daily energy consumption, and cholesterol concentrations rose from 3.9 mmol/l to 5.0 mmol/l.² During this period the rate of stroke (combined) fell from 1344/100 000/year to 205/100 000/year in those aged 60-69. This is a 6.5-fold reduction in the rate of stroke.³ (There was also a decrease in death rate from coronary heart disease.)

Cholesterol

HOW WE CAME TO BELIEVE THAT THE LOW-FAT DIET IS GOOD AND CHOLESTEROL IS BAD

By Maryann Napoli
(February 2003)

Despite decades of effort and many thousands of people randomized [into clinical trials], there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality.

British Medical Journal, March 31, 2001

Blood pressure - diet suplements

Take a peek here

Look for DASH eating plan here

and here

Cochrane abstract reviews salt, potassium, magnesium, diet etc

For Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Aspirin is therefore not recommended in patients with elevated blood pressure who have not had a prior stroke or heart attack. See here