17 ms·

The curious case of high blood pressure around the world

91 points by known 9y ago

esaym 9y ago
>"diets that include too much salt" Hasn't that been debunked I thought I read? I certainly hope so. I had the pleasure of visiting with my Grandma's sister who was down for the holidays with us. She did not eat much of our cooking as she stated that her doctor had her on a "low sodium diet". She said she couldn't eat alot of things she liked, but it wasn't so bad as there was no restriction on sugar intake so she "gets to eat all the sweets" she wants. And that was demonstrated several times at the dessert table and by the several bags of candy she brought with her from back home. I was quite dumbfounded.
- pkaye 9y ago
  What I've read is that only about 20% of the population has salt induced hypertension. Regarding low salt diet which I am on due to kidney disease, our tastes actually adapt the lower salt contents if you do it long enough however you still need enough to bring out the flavor in many things. My solution is to pick things that have other stronger tastes like sweet, sour, spicy, etc.
  - ianai 9y ago
    Vinegar or lemon juice also help perk flavors up.
    - OtterCoder 9y ago
      Don't forget lime juice!
  - mc32 9y ago
    Also low salt can result in muscle cramps. https://www.webmd.com/fitness-exercise/heat-cramps#1 https://www.webmd.com/fitness-exercise/heat-cramps#1
- emmelaich 9y ago
  Debunked is too strong a word. It has undergone revision.
- jdnier 9y ago
  Recent studies have, in fact, shown that dietary salt has a significant effect on blood pressure for many people, and on endothelial function for everyone. https://nutritionfacts.org/video/sodium-and-arterial-function-a-salting-our-endothelium/ https://nutritionfacts.org/video/sodium-and-arterial-functio...
  - leggomylibro 9y ago
    "My doctor" (scare quotes included free of charge) says that it's only really important for people who are hypersensitive to sodium. I didn't ask if there was a test for that, though. So you know, take it with a - I'm so sorry I can't help it - grain of salt.
  - JamesBarney 9y ago
    I read the transcript, and this describes a temporary affect. There are better studies on the long term effect that say the effect of salt is very low on long term health outcomes.
- declan 9y ago
  If you have normal blood pressure (normotensive population), then a high-salt diet has no association with cardiovascular events and death: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30467-6/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... /"Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets."/ Eating too little salt can result in increased risk of cardiovascular events and death: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558770/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558770/ /"we cannot extrapolate that lowering sodium consumption would reduce cardiovascular risk or premature death. In fact, randomized controlled trial evidence suggests just the opposite: that lower sodium intake may lead to worsened cardiovascular disease and earlier death."/ Low salt == higher risk of a heart attack resulting in death: https://www.ncbi.nlm.nih.gov/pubmed/21540421 https://www.ncbi.nlm.nih.gov/pubmed/21540421 /"Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion... Lower sodium excretion was associated with higher CVD mortality."/ Salt intake is not associated with blood pressure, although body mass index and age are: https://academic.oup.com/ajh/article/28/3/362/2743418/Relationship-Between-Nutrition-and-Blood-Pressure https://academic.oup.com/ajh/article/28/3/362/2743418/Relati... /"Considering their squared partial correlation coefficient, age and BMI were the most important parameters relating to SBP [systolic blood pressure] level. Salt intake was not associated with SBP in either sex after multiple adjustments." If you do have high blood pressure, supplement with potassium: https://www.ncbi.nlm.nih.gov/pubmed/26039623 https://www.ncbi.nlm.nih.gov/pubmed/26039623 /"Potassium supplementation is associated with reduction of blood pressure"// Salt intake is not linked to heart problems for adults 71 to 80 years old: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091399 http://jamanetwork.com/journals/jamainternalmedicine/fullart... /"we observed that sodium intake estimated by FFQ [food frequency questionnaire] was not associated with mortality or risk for CVD [cardiovascular disease] and HF [heart failure] in a cohort of adults 71 to 80 years old. These findings extended to sex-based and race-based subgroups and in participants with and without hypertension at baseline."/
- YeGoblynQueenne 9y ago
  >> Hasn't that been debunked I thought I read? I certainly hope so. I have heard of no such "debunking". With all due respect, but you should really try to do a bit of research and backup such assertions, when they can start rumours that could affect peoples' health. "I thought I read" is not nearly enough to claim some health guideline is now "debunked". Btw, sugar intake is definitely not known to raise blood pressure, at least until it leads to other problems like diabetes, which can ruin your kidneys and then cause raised blood pressure. Your grandma's sister was probably misinterpreting her doctor's advice, most likely along the lines that "sugar isn't bad for blood pressure" to mean that she can have all the sugar that she likes. That your grandma's sister had a very unreasonable reaction to the unfortunate restrictions imposed on her diet, does not have anything to do with whether salt raises blood pressure, of course.
  - lobster_johnson 9y ago
    It is not that new, and it's been widely covered. https://www.sciencedaily.com/releases/2017/04/170425124909.htm https://www.sciencedaily.com/releases/2017/04/170425124909.h... https://academic.oup.com/ajh/article/28/3/362/2743418 https://academic.oup.com/ajh/article/28/3/362/2743418
    - YeGoblynQueenne 9y ago
      Yes, there are a few studies like the ones you quote that contradict the received wisdom about the relation of salt and blood pressure, but they are still very few (compared to the studies that show the opposite) and very new, to be anywhere near "debunking" anything. On top of that, current recommendations (from the WHO, US CDC and others) are to limit salt intake to between 3-5mg daily (for healthy adults) and while those recommendations stand, dismissing them as "bunkum" is irresponsible. In general, a handful of studies is never enough to challenge long-standing assumptions, in science. It takes a lot more work and a lot more time. Until then, spreading rumours that the assumptions have been "debunked" risks being harmful. For an example: a friend of mine is convinced, after reading some article in the popular press, that it is not salt that raises blood pressure, but the additives put into it, so she insists on cooking meals for her hypertensive partner with sea salt, that doesn't have additives (so, according to her, it doesn't raise blood pressure). Her partner is on anti-hypertensive medicine, has had a bypass and should really be keeping his salt intake under control. His health is in danger because of someone's haste to report an isolated study as a paradigm shift.
reasonattlm 9y ago
This piece is a great example of entirely the wrong way to think about this issue. The procession of mechanisms is as follows, starting with layer 1: - calcification - cross-linking - vascular smooth muscle dysfunction Which gives you layer 2: - vascular stiffness Which then, entirely and all by itself ( http://dx.doi.org/10.1371/journal.pcbi.1003634 http://dx.doi.org/10.1371/journal.pcbi.1003634 ), causes layer 3 by messing with the feedback mechanisms for blood pressure control: - hypertension, raised blood pressure Which then causes layer 4: - microvascular damage, such as stroke, kidney issues - major vascular damage and sudden death when combined with atherosclerosis - cardiac hypertrophy, which is a maladjustment to hypertension Calcification may be secondary to cellular senescence and other inflammatory mechanisms. Persistent cross-linking may be made worse by dietary sugars, or may not - the better studied forms of sugary by-product are not all that relevant to persistent cross-linking that stiffens tissue. You can read up on glucosepane to learn more about that. The vascular smooth muscle dysfunction is probably caused by a combination of inflammatory mechanisms and everything else that changes with age and poor health, such as metabolic syndrome. So if thinking about fixing hypertension, you want to be watching people building cross-link breakers, such as the Spiegel team at Yale, funded by the SENS Research Foundation, or people clearing out senescent cells, such as the current brace of senolytic therapy companies, one of which was seed funded by the SENS Research Foundation. Watching the groups looking into smooth muscle may or may not go anywhere; it is very hard to say at this stage whether there is any one target that might help enough for the usual pharmaceutical development approach to work well enough to care about in the near term.
- qume 9y ago
  You seem to have a good handle on this subject. Im curious about your opinion on whole food plant based diets for inhibiting this progression through these layers you describe.
- agumonkey 9y ago
  Great comment, from explanation to potential solutions. Thanks a ton
- YeGoblynQueenne 9y ago
  The procession of mechanisms is as follows, starting with layer 1: - calcification - cross-linking - vascular smooth muscle dysfunction Could you please throw some links behind that? I've never heard of cross-linking before and I'd never made the connection with calcification and high blood pressure, but it sounds interesting to look into.
grwthckrmstr 9y ago
My dad got diagnosed with high blood pressure when he was 30. For the past 26 years, our family has maintained a low-salt, low-oil diet. There is regular exercise and walking. Low consumption of alcohol and also junk/saturated fatty food, meditation and breathing exercises. I'm damn proud of my dad and the way he's maintained his blood pressure problem throughout his life. As a by product, the entire family is health conscious. Props to my mom for making sure we always eat well and healthy. It wouldn't be possible without her constant effort. As a result of growing up in this household, I'm extremely sensitive to salty, oily,and junk food. In the sense that, it doesn't cause a reaction or anything, but I can TASTE the HIGH amount of salt and oils in All the food that's served around me, and I see people gobbling it up without even realising. Lifestyle diseases.
- beagle3 9y ago
  The lifestyle diseases are apparently not related to oils, and for 80% of the population, salt either (someone posted links earlier). The culprit appears to be the combination of carbs and fat; there are cultures who have lived on mostly carbs which are healthy, and some who have lived on mostly fat that are; but the combination is lethal. Also, salt is often demonized unfairly (though in your case, it might be right - sodium sensitivity is mostly genetic). Too little sodium is more dangerous than too much for most people. Keto flu is a flu-like condition often accompanied by rash that is a result of dropping carbs without increasing sodium+potassium+magnesium intake, with salt likely playing the largest part. I am now increasing my salt intake gradually, after having essentially no salt for the last 40 years (grew up in a salty household but didn’t like the taste). It is hard but I am sleeping better, having less muscle cramps, and losing more weight than with the same diet before increasing salt. YMMV.
  - watwut 9y ago
    Salt does not cause the disease, but regulating salt is how you regulate high blood pressure when you have it (which his dad has). Yep, muscle cramps are side effect. People with high pressure measure it often, so they eventually get idea on what works.
  - 9y ago
robg 9y ago
Amazing to me that the most basic biological system for survival - stress - is no where mentioned. And we've known for 40 years that relaxation techniques are as effective at treating hypertension as prescription medications.
- tremendulo 9y ago
  It's a weakness of empiricism that scientists remain reluctant to consider the role of (unmeasurable) psychological states, such as pleasure or stress, in the context of a (measurable) physiological response, such as raised blood pressure. My guess is that, together with stress, it is visceral pleasures (arising from our relationship to food, sex, drugs, alcohol, or other substances/habits) that are responsible for high blood pressure. Eating food with salt is just one of the ways it can be made more tasty, and thus more pleasurable, since salt heightens the response of our taste buds.
  - naasking 9y ago
    Because it's difficult to objectively measure stress and pleasure between people.
    - jschwartzi 9y ago
      So we continue to look for our keys under the streetlight rather than in the bushes where we dropped them.
      - naasking 9y ago
        Except we don't actually know where the keys were dropped, so might as well start under the streetlight.
        tremendulo 9y ago
        Science starts with problems, not observations. If excessive pleasure is unhealthy or bad, why do people seek it? We can use folk psychology as starting point, e.g. consumption of Ben and Jerry's in response to relationship difficulties.
Tharkun 9y ago
So I recently found out I'm one of those many people with high blood pressure. This knowledge has been stressing me out (I don't want to die yet). I'm reasonably active as far as software engineers go: 10k+ steps daily and exercise 2-3 times/week. My BMI is 28, which is in the overweight category, but I carry a fair amount of muscle along with my flab. My diet is the hardest part to control. I live alone and spend a lot of time at the office, so I often eat takeout Chinese and other convenience food. My point is that a lot of us HN-y folks probably lead comparable lifestyles. The kind that we may think aren't too unhealthy, but for at least some of us, that assumption is wrong. Please keep an eye on your blood pressure and your waistline. I wish I had started paying attention to this much sooner. Now I'm not sure whether I can still reverse the outcome.
- kiliantics 9y ago
  Could be the Chinese food? Most takeout or food that you don't cook yourself is high in sodium, which raises your blood pressure. If you cook for yourself with non-processed ingredients and without over-seasoning - and stay well-hydrated - then maybe you'd be fine. As someone that moved to the USA and started eating out a lot, I quickly realised my sodium intake shot up drastically and that I should cook for myself more to be healthy
- kayoone 9y ago
  I have been diagnosed with borderline high bp (around 140/90, sometimes a bit lower, sometimes higher) 5 years ago and tried everything to reverse it, as the Doctor did not want to put me on meds so early. Lost 10kg (BMI 23.5), 60km of cycling a week, 2x exercise a week, reasonably good diet, no smoking, little alcohol. From all those measures my BP did not improve a lot, the systolic is nowadays mostly okay, but i seem to have a problem with the diastolic bp which is often in the 90-95 range. Right now i am undergoing more checks again and will probably resort to meds now, which i wanted to avoid (which otherwise healthy, fit 35 year old wants to start taking bp meds) but it seems like i can't and i don't want to damage myself more than i already have. Until now, no real cause has been found, it could even be some nervous disorder because of high stress times i had in the past, but nobody knows. I also have no family history of high bp, so it still puzzles me and freaks me out to the point i got an underlying anxiety. If losing weight etc. does not help much, also get your kidneys and thyroid checked. I have some kidney checks coming up and it freaks me out... The good thing is that it made me a lot more conscious of what i eat, drink and do, i just wish i would have monitored it earlier because i don't even know when it started.
galfarragem 9y ago
Age factor must be also relevant: A friend of my father has the same lifestyle and food habits today at 60's as during his 40's and 50's. He always had normal blood pressure until recently.
anon1253 9y ago
I've had high blood pressure since 24. I've had every possible diagnostic test, tried medication (no avail). I'm not overweight and do walk about 50 minutes a day, eat as healthy as can be expected. And still it averages around 170/90. I gave up on it. If global disaster doesn't kill me first, it'll probably be a heart attack around 50. There are worse ways to go. Seriously, even lifestyle changes for the relatively healthy only seem to make a 10 mmHg difference, so eh. Whatever.
- vfc1 9y ago
  High blood pressure is a largely diet-related western only disease. It's not normal that it rises with age either, just something we got used to it. If you want to cure your blood pressure, watch this video till the end - https://nutritionfacts.org/video/how-not-to-die-from-high-blood-pressure/ https://nutritionfacts.org/video/how-not-to-die-from-high-bl... Then if you want the details, have a look at this playlist - https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exRO1DoEP0BAzdy https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exR...
- owebmaster 9y ago
  Try intermittent fasting and/or keto diet. My pressure changed from 140/90 to 120/70 only with the diet. Needless to say that literally all aspects of my life improved with this change. Come to the Church of Intermittent Fasting®.
- chiefalchemist 9y ago
  What does the data say about the risks to someone like you (i.e., otherwise healthy, healthy lifestyle, etc.)? Certainly if you didn't take care of yourself the risk would increase. But, perhaps, high BP isn't as risky if it's the only risk you have.
- abraham_s 9y ago
  Have you ruled out sleep apnea?
chiefalchemist 9y ago
I think it's fair and necessary to ask: Are the (negative) effects of high blood pressure the same for all genders across all gene pools? Also, what is the breakdown of high blood pressure being a disease? Vs being a symptom (of another disease)? We need deeper data.
nickjj 9y ago
White coat syndrome cannot be ignored too. This is where your BP can increase by a lot just by being in a doctor's exam room. I went in for a checkup a few years ago and they took my BP and it was like 140/93 with an 87 heartbeat (I was 32 and in decent shape), so my doctor was like, hey I don't want to put you on any medication but your BP looks a little high, let's chart your BP at home for the next 2 months and see how it goes. So I grabbed a BP machine and about 3 times a week I took my BP, alternating arms and doing it at various times in the day. I could see that my BP was a little high for weeks, but by the end of the 2 months I had a 2 week stretch where it was about 120/80 steady. I took the same BP machine I bought and took it to the follow up exam and it was 138/87. That's a pretty big spike. Now I take it myself twice a month or so (just for good measure) and it's usually 120/80ish with a resting heart beat of 58-62. My dentist likes to take your BP before doing any type of work and it was 135/88 before a cleaning too. I don't know about you, but I generally don't like getting my BP taken. It causes some anxiety. I wouldn't immediately discount high BP to white coat syndrome, but you should ask your doctor if you can track your BP at home if you're on the cusp of high BP.
- vwcx 9y ago
  Can you recommend a particular BP machine? I have $100 in an FSA I need to spend in the next 16 hours and I've had a similar experience to you with white coat syndrome.
  - nickjj 9y ago
    My doctor recommended this one https://www.amazon.com/gp/product/B000NY6JXA https://www.amazon.com/gp/product/B000NY6JXA (it's $42). Keep in mind, that I'm not a doctor and I don't know if this one will work for you. I would definitely ask your doctor. Maybe run this one by him/her for a confirmation.
- YeGoblynQueenne 9y ago
  I've read a couple of studies [1] [2] [3], relating specifically to home BP monitoring for kidney patients. The studies seemed to indicate that home BP monitoring ("ambulatory BP monitoring", ABPM) is more accurate than office, or dialysis unit, monitoring. I think one part of this may be because ABMP allows for more frequent measurements to be taken throughout the day and under similar circumstances each time. There may also be a factor of allowing yourself to relax a bit before taking your BP. Guidelines for BP measurement instruct you to sit still for a few minutes, before taking your BP, which is something that is often not convenient to do in a doctor's office (for instance, if your BP is taken the moment you walk in etc). ___________ [1] Ambulatory blood pressure in chronic kidney disease; https://www.ncbi.nlm.nih.gov/pubmed/23595357 https://www.ncbi.nlm.nih.gov/pubmed/23595357 "ABPM has been shown to be a better tool for predicting CV risk, CKD progression, end stage renal disease (ESRD) or death than office-based pressures." [2] Home blood pressure monitoring in CKD; https://www.ncbi.nlm.nih.gov/pubmed/24529535 https://www.ncbi.nlm.nih.gov/pubmed/24529535 "Home BP monitoring provides more data than conventional clinic or dialysis-unit BP measurements and is relatively easy to accomplish, is cost-effective, and has been shown to have an increasing role in the management of BP in the CKD population." [3] "The complex relationship between CKD and ambulatory blood pressure patterns."; https://www.ncbi.nlm.nih.gov/pubmed/25704346 https://www.ncbi.nlm.nih.gov/pubmed/25704346 "ABPM has been shown to be superior to clinical BP measurement for correlating with end-organ damage and prognosis in CKD."
rskar 9y ago
I wonder if the world-wide trend on high blood pressure is aligned with that of vitamin D?: - https://naldc.nal.usda.gov/download/17956/PDF https://naldc.nal.usda.gov/download/17956/PDF - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/ - http://www.journals.uchicago.edu/doi/full/10.1086/691683 http://www.journals.uchicago.edu/doi/full/10.1086/691683 - http://ajcn.nutrition.org/content/87/4/1080S.full http://ajcn.nutrition.org/content/87/4/1080S.full - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/

91 points by known 9y ago

>"diets that include too much salt" Hasn't that been debunked I thought I read? I certainly hope so. I had the pleasure of visiting with my Grandma's sister who was down for the holidays with us. She did not eat much of our cooking as she stated that her doctor had her on a "low sodium diet". She said she couldn't eat alot of things she liked, but it wasn't so bad as there was no restriction on sugar intake so she "gets to eat all the sweets" she wants. And that was demonstrated several times at the dessert table and by the several bags of candy she brought with her from back home. I was quite dumbfounded.

pkaye 9y ago
What I've read is that only about 20% of the population has salt induced hypertension. Regarding low salt diet which I am on due to kidney disease, our tastes actually adapt the lower salt contents if you do it long enough however you still need enough to bring out the flavor in many things. My solution is to pick things that have other stronger tastes like sweet, sour, spicy, etc.
- ianai 9y ago
  Vinegar or lemon juice also help perk flavors up.
  - OtterCoder 9y ago
    Don't forget lime juice!
- mc32 9y ago
  Also low salt can result in muscle cramps. https://www.webmd.com/fitness-exercise/heat-cramps#1 https://www.webmd.com/fitness-exercise/heat-cramps#1
emmelaich 9y ago
Debunked is too strong a word. It has undergone revision.
jdnier 9y ago
Recent studies have, in fact, shown that dietary salt has a significant effect on blood pressure for many people, and on endothelial function for everyone. https://nutritionfacts.org/video/sodium-and-arterial-function-a-salting-our-endothelium/ https://nutritionfacts.org/video/sodium-and-arterial-functio...
- leggomylibro 9y ago
  "My doctor" (scare quotes included free of charge) says that it's only really important for people who are hypersensitive to sodium. I didn't ask if there was a test for that, though. So you know, take it with a - I'm so sorry I can't help it - grain of salt.
- JamesBarney 9y ago
  I read the transcript, and this describes a temporary affect. There are better studies on the long term effect that say the effect of salt is very low on long term health outcomes.
declan 9y ago
If you have normal blood pressure (normotensive population), then a high-salt diet has no association with cardiovascular events and death: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30467-6/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... /"Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets."/ Eating too little salt can result in increased risk of cardiovascular events and death: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558770/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558770/ /"we cannot extrapolate that lowering sodium consumption would reduce cardiovascular risk or premature death. In fact, randomized controlled trial evidence suggests just the opposite: that lower sodium intake may lead to worsened cardiovascular disease and earlier death."/ Low salt == higher risk of a heart attack resulting in death: https://www.ncbi.nlm.nih.gov/pubmed/21540421 https://www.ncbi.nlm.nih.gov/pubmed/21540421 /"Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion... Lower sodium excretion was associated with higher CVD mortality."/ Salt intake is not associated with blood pressure, although body mass index and age are: https://academic.oup.com/ajh/article/28/3/362/2743418/Relationship-Between-Nutrition-and-Blood-Pressure https://academic.oup.com/ajh/article/28/3/362/2743418/Relati... /"Considering their squared partial correlation coefficient, age and BMI were the most important parameters relating to SBP [systolic blood pressure] level. Salt intake was not associated with SBP in either sex after multiple adjustments." If you do have high blood pressure, supplement with potassium: https://www.ncbi.nlm.nih.gov/pubmed/26039623 https://www.ncbi.nlm.nih.gov/pubmed/26039623 /"Potassium supplementation is associated with reduction of blood pressure"// Salt intake is not linked to heart problems for adults 71 to 80 years old: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091399 http://jamanetwork.com/journals/jamainternalmedicine/fullart... /"we observed that sodium intake estimated by FFQ [food frequency questionnaire] was not associated with mortality or risk for CVD [cardiovascular disease] and HF [heart failure] in a cohort of adults 71 to 80 years old. These findings extended to sex-based and race-based subgroups and in participants with and without hypertension at baseline."/
YeGoblynQueenne 9y ago
>> Hasn't that been debunked I thought I read? I certainly hope so. I have heard of no such "debunking". With all due respect, but you should really try to do a bit of research and backup such assertions, when they can start rumours that could affect peoples' health. "I thought I read" is not nearly enough to claim some health guideline is now "debunked". Btw, sugar intake is definitely not known to raise blood pressure, at least until it leads to other problems like diabetes, which can ruin your kidneys and then cause raised blood pressure. Your grandma's sister was probably misinterpreting her doctor's advice, most likely along the lines that "sugar isn't bad for blood pressure" to mean that she can have all the sugar that she likes. That your grandma's sister had a very unreasonable reaction to the unfortunate restrictions imposed on her diet, does not have anything to do with whether salt raises blood pressure, of course.
- lobster_johnson 9y ago
  It is not that new, and it's been widely covered. https://www.sciencedaily.com/releases/2017/04/170425124909.htm https://www.sciencedaily.com/releases/2017/04/170425124909.h... https://academic.oup.com/ajh/article/28/3/362/2743418 https://academic.oup.com/ajh/article/28/3/362/2743418
  - YeGoblynQueenne 9y ago
    Yes, there are a few studies like the ones you quote that contradict the received wisdom about the relation of salt and blood pressure, but they are still very few (compared to the studies that show the opposite) and very new, to be anywhere near "debunking" anything. On top of that, current recommendations (from the WHO, US CDC and others) are to limit salt intake to between 3-5mg daily (for healthy adults) and while those recommendations stand, dismissing them as "bunkum" is irresponsible. In general, a handful of studies is never enough to challenge long-standing assumptions, in science. It takes a lot more work and a lot more time. Until then, spreading rumours that the assumptions have been "debunked" risks being harmful. For an example: a friend of mine is convinced, after reading some article in the popular press, that it is not salt that raises blood pressure, but the additives put into it, so she insists on cooking meals for her hypertensive partner with sea salt, that doesn't have additives (so, according to her, it doesn't raise blood pressure). Her partner is on anti-hypertensive medicine, has had a bypass and should really be keeping his salt intake under control. His health is in danger because of someone's haste to report an isolated study as a paradigm shift.

reasonattlm 9y ago

This piece is a great example of entirely the wrong way to think about this issue. The procession of mechanisms is as follows, starting with layer 1: - calcification - cross-linking - vascular smooth muscle dysfunction Which gives you layer 2: - vascular stiffness Which then, entirely and all by itself ( http://dx.doi.org/10.1371/journal.pcbi.1003634 http://dx.doi.org/10.1371/journal.pcbi.1003634 ), causes layer 3 by messing with the feedback mechanisms for blood pressure control: - hypertension, raised blood pressure Which then causes layer 4: - microvascular damage, such as stroke, kidney issues - major vascular damage and sudden death when combined with atherosclerosis - cardiac hypertrophy, which is a maladjustment to hypertension Calcification may be secondary to cellular senescence and other inflammatory mechanisms. Persistent cross-linking may be made worse by dietary sugars, or may not - the better studied forms of sugary by-product are not all that relevant to persistent cross-linking that stiffens tissue. You can read up on glucosepane to learn more about that. The vascular smooth muscle dysfunction is probably caused by a combination of inflammatory mechanisms and everything else that changes with age and poor health, such as metabolic syndrome. So if thinking about fixing hypertension, you want to be watching people building cross-link breakers, such as the Spiegel team at Yale, funded by the SENS Research Foundation, or people clearing out senescent cells, such as the current brace of senolytic therapy companies, one of which was seed funded by the SENS Research Foundation. Watching the groups looking into smooth muscle may or may not go anywhere; it is very hard to say at this stage whether there is any one target that might help enough for the usual pharmaceutical development approach to work well enough to care about in the near term.

qume 9y ago
You seem to have a good handle on this subject. Im curious about your opinion on whole food plant based diets for inhibiting this progression through these layers you describe.
agumonkey 9y ago
Great comment, from explanation to potential solutions. Thanks a ton
YeGoblynQueenne 9y ago
The procession of mechanisms is as follows, starting with layer 1: - calcification - cross-linking - vascular smooth muscle dysfunction Could you please throw some links behind that? I've never heard of cross-linking before and I'd never made the connection with calcification and high blood pressure, but it sounds interesting to look into.

grwthckrmstr 9y ago

My dad got diagnosed with high blood pressure when he was 30. For the past 26 years, our family has maintained a low-salt, low-oil diet. There is regular exercise and walking. Low consumption of alcohol and also junk/saturated fatty food, meditation and breathing exercises. I'm damn proud of my dad and the way he's maintained his blood pressure problem throughout his life. As a by product, the entire family is health conscious. Props to my mom for making sure we always eat well and healthy. It wouldn't be possible without her constant effort. As a result of growing up in this household, I'm extremely sensitive to salty, oily,and junk food. In the sense that, it doesn't cause a reaction or anything, but I can TASTE the HIGH amount of salt and oils in All the food that's served around me, and I see people gobbling it up without even realising. Lifestyle diseases.

beagle3 9y ago
The lifestyle diseases are apparently not related to oils, and for 80% of the population, salt either (someone posted links earlier). The culprit appears to be the combination of carbs and fat; there are cultures who have lived on mostly carbs which are healthy, and some who have lived on mostly fat that are; but the combination is lethal. Also, salt is often demonized unfairly (though in your case, it might be right - sodium sensitivity is mostly genetic). Too little sodium is more dangerous than too much for most people. Keto flu is a flu-like condition often accompanied by rash that is a result of dropping carbs without increasing sodium+potassium+magnesium intake, with salt likely playing the largest part. I am now increasing my salt intake gradually, after having essentially no salt for the last 40 years (grew up in a salty household but didn’t like the taste). It is hard but I am sleeping better, having less muscle cramps, and losing more weight than with the same diet before increasing salt. YMMV.
- watwut 9y ago
  Salt does not cause the disease, but regulating salt is how you regulate high blood pressure when you have it (which his dad has). Yep, muscle cramps are side effect. People with high pressure measure it often, so they eventually get idea on what works.
- 9y ago

robg 9y ago

Amazing to me that the most basic biological system for survival - stress - is no where mentioned. And we've known for 40 years that relaxation techniques are as effective at treating hypertension as prescription medications.

tremendulo 9y ago
It's a weakness of empiricism that scientists remain reluctant to consider the role of (unmeasurable) psychological states, such as pleasure or stress, in the context of a (measurable) physiological response, such as raised blood pressure. My guess is that, together with stress, it is visceral pleasures (arising from our relationship to food, sex, drugs, alcohol, or other substances/habits) that are responsible for high blood pressure. Eating food with salt is just one of the ways it can be made more tasty, and thus more pleasurable, since salt heightens the response of our taste buds.
- naasking 9y ago
  Because it's difficult to objectively measure stress and pleasure between people.
  - jschwartzi 9y ago
    So we continue to look for our keys under the streetlight rather than in the bushes where we dropped them.
    - naasking 9y ago
      Except we don't actually know where the keys were dropped, so might as well start under the streetlight.
      - tremendulo 9y ago
        Science starts with problems, not observations. If excessive pleasure is unhealthy or bad, why do people seek it? We can use folk psychology as starting point, e.g. consumption of Ben and Jerry's in response to relationship difficulties.

Tharkun 9y ago

So I recently found out I'm one of those many people with high blood pressure. This knowledge has been stressing me out (I don't want to die yet). I'm reasonably active as far as software engineers go: 10k+ steps daily and exercise 2-3 times/week. My BMI is 28, which is in the overweight category, but I carry a fair amount of muscle along with my flab. My diet is the hardest part to control. I live alone and spend a lot of time at the office, so I often eat takeout Chinese and other convenience food. My point is that a lot of us HN-y folks probably lead comparable lifestyles. The kind that we may think aren't too unhealthy, but for at least some of us, that assumption is wrong. Please keep an eye on your blood pressure and your waistline. I wish I had started paying attention to this much sooner. Now I'm not sure whether I can still reverse the outcome.

kiliantics 9y ago
Could be the Chinese food? Most takeout or food that you don't cook yourself is high in sodium, which raises your blood pressure. If you cook for yourself with non-processed ingredients and without over-seasoning - and stay well-hydrated - then maybe you'd be fine. As someone that moved to the USA and started eating out a lot, I quickly realised my sodium intake shot up drastically and that I should cook for myself more to be healthy
kayoone 9y ago
I have been diagnosed with borderline high bp (around 140/90, sometimes a bit lower, sometimes higher) 5 years ago and tried everything to reverse it, as the Doctor did not want to put me on meds so early. Lost 10kg (BMI 23.5), 60km of cycling a week, 2x exercise a week, reasonably good diet, no smoking, little alcohol. From all those measures my BP did not improve a lot, the systolic is nowadays mostly okay, but i seem to have a problem with the diastolic bp which is often in the 90-95 range. Right now i am undergoing more checks again and will probably resort to meds now, which i wanted to avoid (which otherwise healthy, fit 35 year old wants to start taking bp meds) but it seems like i can't and i don't want to damage myself more than i already have. Until now, no real cause has been found, it could even be some nervous disorder because of high stress times i had in the past, but nobody knows. I also have no family history of high bp, so it still puzzles me and freaks me out to the point i got an underlying anxiety. If losing weight etc. does not help much, also get your kidneys and thyroid checked. I have some kidney checks coming up and it freaks me out... The good thing is that it made me a lot more conscious of what i eat, drink and do, i just wish i would have monitored it earlier because i don't even know when it started.

galfarragem 9y ago

Age factor must be also relevant: A friend of my father has the same lifestyle and food habits today at 60's as during his 40's and 50's. He always had normal blood pressure until recently.

anon1253 9y ago

I've had high blood pressure since 24. I've had every possible diagnostic test, tried medication (no avail). I'm not overweight and do walk about 50 minutes a day, eat as healthy as can be expected. And still it averages around 170/90. I gave up on it. If global disaster doesn't kill me first, it'll probably be a heart attack around 50. There are worse ways to go. Seriously, even lifestyle changes for the relatively healthy only seem to make a 10 mmHg difference, so eh. Whatever.

vfc1 9y ago
High blood pressure is a largely diet-related western only disease. It's not normal that it rises with age either, just something we got used to it. If you want to cure your blood pressure, watch this video till the end - https://nutritionfacts.org/video/how-not-to-die-from-high-blood-pressure/ https://nutritionfacts.org/video/how-not-to-die-from-high-bl... Then if you want the details, have a look at this playlist - https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exRO1DoEP0BAzdy https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exR...
owebmaster 9y ago
Try intermittent fasting and/or keto diet. My pressure changed from 140/90 to 120/70 only with the diet. Needless to say that literally all aspects of my life improved with this change. Come to the Church of Intermittent Fasting®.
chiefalchemist 9y ago
What does the data say about the risks to someone like you (i.e., otherwise healthy, healthy lifestyle, etc.)? Certainly if you didn't take care of yourself the risk would increase. But, perhaps, high BP isn't as risky if it's the only risk you have.
abraham_s 9y ago
Have you ruled out sleep apnea?

chiefalchemist 9y ago

I think it's fair and necessary to ask: Are the (negative) effects of high blood pressure the same for all genders across all gene pools? Also, what is the breakdown of high blood pressure being a disease? Vs being a symptom (of another disease)? We need deeper data.

nickjj 9y ago

White coat syndrome cannot be ignored too. This is where your BP can increase by a lot just by being in a doctor's exam room. I went in for a checkup a few years ago and they took my BP and it was like 140/93 with an 87 heartbeat (I was 32 and in decent shape), so my doctor was like, hey I don't want to put you on any medication but your BP looks a little high, let's chart your BP at home for the next 2 months and see how it goes. So I grabbed a BP machine and about 3 times a week I took my BP, alternating arms and doing it at various times in the day. I could see that my BP was a little high for weeks, but by the end of the 2 months I had a 2 week stretch where it was about 120/80 steady. I took the same BP machine I bought and took it to the follow up exam and it was 138/87. That's a pretty big spike. Now I take it myself twice a month or so (just for good measure) and it's usually 120/80ish with a resting heart beat of 58-62. My dentist likes to take your BP before doing any type of work and it was 135/88 before a cleaning too. I don't know about you, but I generally don't like getting my BP taken. It causes some anxiety. I wouldn't immediately discount high BP to white coat syndrome, but you should ask your doctor if you can track your BP at home if you're on the cusp of high BP.

vwcx 9y ago
Can you recommend a particular BP machine? I have $100 in an FSA I need to spend in the next 16 hours and I've had a similar experience to you with white coat syndrome.
- nickjj 9y ago
  My doctor recommended this one https://www.amazon.com/gp/product/B000NY6JXA https://www.amazon.com/gp/product/B000NY6JXA (it's $42). Keep in mind, that I'm not a doctor and I don't know if this one will work for you. I would definitely ask your doctor. Maybe run this one by him/her for a confirmation.
YeGoblynQueenne 9y ago
I've read a couple of studies [1] [2] [3], relating specifically to home BP monitoring for kidney patients. The studies seemed to indicate that home BP monitoring ("ambulatory BP monitoring", ABPM) is more accurate than office, or dialysis unit, monitoring. I think one part of this may be because ABMP allows for more frequent measurements to be taken throughout the day and under similar circumstances each time. There may also be a factor of allowing yourself to relax a bit before taking your BP. Guidelines for BP measurement instruct you to sit still for a few minutes, before taking your BP, which is something that is often not convenient to do in a doctor's office (for instance, if your BP is taken the moment you walk in etc). ___________ [1] Ambulatory blood pressure in chronic kidney disease; https://www.ncbi.nlm.nih.gov/pubmed/23595357 https://www.ncbi.nlm.nih.gov/pubmed/23595357 "ABPM has been shown to be a better tool for predicting CV risk, CKD progression, end stage renal disease (ESRD) or death than office-based pressures." [2] Home blood pressure monitoring in CKD; https://www.ncbi.nlm.nih.gov/pubmed/24529535 https://www.ncbi.nlm.nih.gov/pubmed/24529535 "Home BP monitoring provides more data than conventional clinic or dialysis-unit BP measurements and is relatively easy to accomplish, is cost-effective, and has been shown to have an increasing role in the management of BP in the CKD population." [3] "The complex relationship between CKD and ambulatory blood pressure patterns."; https://www.ncbi.nlm.nih.gov/pubmed/25704346 https://www.ncbi.nlm.nih.gov/pubmed/25704346 "ABPM has been shown to be superior to clinical BP measurement for correlating with end-organ damage and prognosis in CKD."

rskar 9y ago

I wonder if the world-wide trend on high blood pressure is aligned with that of vitamin D?: - https://naldc.nal.usda.gov/download/17956/PDF https://naldc.nal.usda.gov/download/17956/PDF - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/ - http://www.journals.uchicago.edu/doi/full/10.1086/691683 http://www.journals.uchicago.edu/doi/full/10.1086/691683 - http://ajcn.nutrition.org/content/87/4/1080S.full http://ajcn.nutrition.org/content/87/4/1080S.full - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/