Hypertension: Is It Time to Replace Drugs with Nutrition? (2014)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
"Dr. Houston also cautioned that the role of supplements in hypertension has not yet been tested in clinical outcomes trials in the manner that conventional drugs have been assessed. So while there is an apparent role for supplements in treating hypertension, their ability to improve cardiovascular outcomes remains to be proven."
"Many natural compounds in food, as well as certain nutraceutical supplements, vitamins, antioxidants, or minerals, can mimic drugs, functioning in a similar fashion to a specific class of antihypertensive medications. However, they may be less potent and take longer to work than the antihypertensive drug."
And beyond supplements, diet/fitness changes are massively more difficult to implement than taking a medication.
There's no inherent reason to prefer more "natural" solutions to medical issues. It just sounds good. Put up clinical trials to give your hypothesis real standing.
Part oft he problem with clinical trials of nutrition is that they do not stratify for genetics. Take Riboflavin for example. For a long time there were studies saying it worked and then studies saying it did not. But when they looked at MTHFR variants in people the result became more consistent that for these people with the minor allele Riboflavin worked.
https://www.sciencedirect.com/science/article/abs/pii/S01675...
https://jmhg.springeropen.com/articles/10.1186/s43042-022-00...
https://www.sciencedirect.com/science/article/abs/pii/S03009...
So in this case, if someone was deficient in Riboflavin, supplementing Riboflavin is much more preferable since the deficiency is the root cause of the hypertension and correcting the deficiency might resolve a variety of issues, not just the hypertension.
Yes there is:
1) Treatment just treats the issue, unlike a healthy lifestyle which helps people avoid them in the first place.
2) Good health has various benefits beyond just fixing one particular health problem.
But the role of medicine is to treat the diseased and maybe offer some guidance along the way. Being healthy is up to the individual and maybe public health campaigns.
1. Supplements/"Natural compounds"
2. Diet/lifestyle changes
We should absolutely not replace pharmaceuticals with supplements/"Natural compounds" without clinical data showing it works.
And for diet/lifestyle changes, that's really hard to implement. People just aren't good at changing their lifestyles. So while overall we should be promoting more healthy lifestyles, it should not replace pharmaceuticals when trying to treat a specific issue.
I've been on ADD medication (time-released amphetamines) for more of my life than not and I'm pretty chemically dependent on it at this point, which I resent and wish I could change about myself, but as of right now it is simply not feasible to do so, because withdrawal is horrible, and I have a job to do, bills to pay, and a family on the way. every three months I check in with my psychiatrist to get three more months of prescriptions, and to have a quick chat about my mental health and how I'm doing. this past month I told her I was experiencing some anxiety at work around completing projects, which is something I've had issues with for years, but I told her that I noticed I was getting significantly better at dealing with it, to the point of surprising myself somewhat. she told me that was great... but that if I ever wanted to try any anxiety medications, keep in mind I could ask her, because, for example, drug $X and $Y would probably work well for me. I told her thanks but no thanks I feel like I'm doing great without that, and it made me realize, once again, how crazy the pill-pushing nature of modern medicine is, especially psychiatry. it would have been very easy for me to say "sure why not" and add another medication whose effects can't be 100% predicted to my daily intake, affecting my mind and body in ways that may or may not be desirable, possibly in the short term, possibly in the long term.
with previous psychiatrists, especially as a youth, I was put on a variety of different anti-depression medications, because nobody could understand my depression, but in hindsight it wasn't any sort of "clinical depression" (maybe not the right term?) where I was depressed inexplicably and randomly, my depression was pretty obviously caused by my environment at home and school. a gym coach would have been infinitely more useful than any of the medications I took for depression during this time. but no, the Scientifically-Reached Medical Conclusion was, take more pills, try different ones until you find one that works for you, this is the Only Possible Solution To Your Problems.
shit's fucked
There's certainly no money for pharmaceuticals!
This can also be viewed from the opposite end:
> The fact that certain "drugs" mimic the pharmacodynamics of existing natural substances is nothing new.
Actually I find it more appropriate to say that the man-made substance mimics nature.
People have been using natural remedies for thousands of years.
Oetzi the Iceman carried a piece of Fomes Fomentarius 5,000 years ago, a fungus that apparently was used as a diuretic in Indic folk medicine:
https://botit.botany.wisc.edu/toms_fungi/dec2001.html
I have no reason to believe that it did not work.
Patent-free availability and lower cost can be reasons. (assuming they work)
If you discover that, say, eating cocktail onions cures cancer, you're allowed to patent that. Cocktail onions as such wouldn't be patentable, but using them to cure cancer would be.
In the sense that a person with cancer could be sued for eating unlicensed cocktail onions?
Why not address a potential root cause?
Because it's hard and people are unreliable when it comes to diet/lifestyle changes.
No reason not to address it, and I'd be surprised if most doctors don't bring up their desire for the patient to have a healthier lifestyle. But it's not realistic to have it replace pharmaceuticals as a general stance.
Especially not the natural approaches which are merely anecdotally "proven" for thousands of years.
Certainly all modern drug companies have come so much further in only the last few decades when they have never been so modern. And benevolent too, in a way only they can do. The human brain is so much different now. I love it every time they come up with a miracle pill where you take one and you are cured for life. My first job out of university was at a pharmaceutical manufacturer. It couldn't have been more eye-opening after you see the amazing things going on back there!
Instead of natural approaches, sometimes all you really need are the much more potent and rapidly effective pharmaceuticals which are completely non-toxic and have no possible side effects whatsoever.
Oh wait . . .
Nobody argues against drugs to treat hypertension, but there is little awareness that diet can have a massive effect. Proper diet, of course, should be the preferred path if at all possible.
Sadly, our society has normalized a vicious circle of the very detrimental Western Diet, leading to the need for pharmacological interventions when the cardiovascular feces hits the fan as people get older.
That, to me, is the point of this article.
Trust me, when they find out why you re hypertensive, nutrition, supplements, and lifestyle changes can easily treat hypertension.
Natural supplements can't be patented, so how could they treat disease? /s
My plan is to avoid this stuff until I'm old with a healthy lifestyle, but you can't just tell other people to do that.
Peter Attia and Rick Johnson
> Dr. Houston also cautioned that the role of supplements in hypertension has not yet been tested in clinical outcomes trials in the manner that conventional drugs have been assessed.
It will be time after those studies have materialized and superiority to drugs is proven.
It’s also well known that most people won’t stick to the type of diet needed. So it still leads to the fact that drugs are the most effective treatment. It’s not like Big Pharma is getting rich off of water pills that went generic years ago and even without insurance are relatively cheap .
Metabolically (or biologically) it turns out what we do at Virta already lowers blood pressure (i.e. hypertension) substantially. Reversing insulin resistance (i.e. T2 diabetes) reverses number of other metabolic irregularities. Evidence well published: https://www.virtahealth.com/research
[that said, there are some other niche reasons for high blood pressure too, which we don't address today, but most "hypertension" is driven by the same drivers as insulin resistance]
But I'd still recommend more broccoli for everyone.
https://pubmed.ncbi.nlm.nih.gov/22051430/
I do not care if a supplement works for "most people", I only care if it works for me.
I don't know if that's enough for everyone, but the other major factors are also evident: excess weight, lack of exercise, chronic high blood sugar, etc.
I'm on drugs for hypertension and they cost me less than 10 euros a month and that's if I go buy them at the pharmacy, if my doctor makes me a prescription they are free for me and I'm sure the government pay them a lot less than a private citizen.
They also fall into the category of generic drugs, most of the time they are manufactured in my country by Italian companies.
A 30-day supply of Lipitor - I think, the most-prescribed drug in America? - is something like $150–200. Our cost was something like a dollar and we'd sell it for something like ten.
I'm on lercanidipine and ramipril, a month worth of pills cost 2.50 euros for the former and 3.80 euros for the latter.
both are manufactured in Italy.
Diet and exercise can help, but they take time (serious time for some people) and are expensive. As part of dealing with blood pressure, I switched to cooking my own meals (the salt and cholesterol levels in all restaraunt or ready-to-go meals, not just fast food, are horrifying) but that's a significant time investment and generally just as or more expensive than fast food. I can afford to do that, but someone working two minimum wage jobs just to pay the rent likely can't. Similarly, it's possible for some people with the luxury of working from home and enough income to afford a space with exercise equipment to hop on an exercise bike for one of their many pointless 30 minute meetings each day, but someone who has to live outside the city and commute a few hours in will have much more trouble with that.
Drugs work and work fast. My BP was in the 150/100 range and meds brought it down to 115/80 within a week or two. I've been dropping weight and with any luck in the future could go off the meds if I'm able to hold at a lower level, but that requires constant maintenance. They're a great option for many people.
In the article, you will find that Dr. Houston does recommend these lifestyle changes and reduction of medications to the extent possible. That extent is entirely. Not that you will achieve it, but it is something you could do, if you so chose.
Diet and excersize are not expensive and largely can reduce expenses. Walking a few miles a day is adequate. No equipment nor subscription is necessary.
Investigate "five ingredient dinner" or "five minute meals" if time is really pressing. Alternatively, engage with family during the preparation of a meal, get them to join and contribute. This can give kids a valuable life skill and help cut down on screen time and sedentary home life
I can go to the store, buy a few dollars of rice, beans, tomatoes, and so on, cook dinner and clean it up, but this is hours of my day every day and the tomatoes and any leafy greens will start going bad rapidly. Alternatively, on my way home from work I can stop by Wendy's, get the four for four combo and get a thousand calories in two minutes for four dollars plus tax. It is more expensive in dollars and dramatically more expensive in time to eat healthy. For people working hourly jobs to survive, people with children who value the ability to spend their few non-working hours a day with them, and so many other cases, there is a very real cost.
There is a very vocal segment on the internet, traditionally of upper middle class (or upper class) folks born into wealth that say "why can't everyone just restrain themselves and be healthy" in the same tone of voice as one might say "why wouldn't they just ask their personal trainer for tips" or "what can a banana cost, ten dollars?". They're out of touch with the reality of a huge chunk of society.
Further you have framed my position as one of luxury, but this is just a stereotypical additude of people that aren't willing to do the necessary things.
Are you arguing for your family or just some theoretical family? I suggested "5 minute meals", which are really meals you can make in five minutes or thereabouts. Search for one. There are few apartments I've seen in years that don't have dishwashers and I would know, I grew up without. Dishes don't take hours unless you never do them and have a massive pile to wash. Washing a plate and fork takes minutes. Do that when you finish eating instead if placing them aside in a pile.
Spending time with family or kids is what you make it. Teach your kids to cook and they will have that skill for life. It's called active engagement. Cooking is not a chore, it's a fulfilling activity where you can become an expert and make things others enjoy.
Walking is free. You just have to get up and walk. The healthiest and longest lived people on earth eat simple diets and walk 2-3 miles per day. Often to the store. Read about the Japanese or Sicilians.
I just saw bananas on the shelf for 19 cents a piece. I bought one.
* Lots of people aren't prepared to make the level of change required and so medication can be a better option; and
* Medication will probably reduce risk a lot faster than lifestyle adjustment if things are already dire.
fix I'm not so sure, but help, that is true.
I have hypertension myself, it's been in my family for generations, it's a moderate hypertension, but no kind of diet could lower it.
Drugs did in a very short amount of time and they are both cheap and had no consequences whatsoever.
Not really although it can certainly help. There is evidence that there is a profound change (infection of some sort) in the Kidney and at some point that causes a run away inflammatory response that leads to Hypertension, it is an autoimmune condition that is extremely difficult to manage or get rid of. They believe it may be responsible for a great deal of Essential hypertension in adults today.