tag:blogger.com,1999:blog-20580178732357585122024-03-16T19:51:10.062+01:00chronic healthOur best bet for healthy aging is to escape the flawed health care system. It makes disease treatment more profitable than prevention. It neglects aging as a treatable cause of diseases. And it denies access to personalized lifestyle medicine. This blog is about how you can overcome these limitations. It is about challenging half-truths and outdated ideas. It is focused on evidence-based, personalized lifestyle medicine for lifelong health. Delivered by a feisty public health scientist.Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-2058017873235758512.post-87696718825869974002023-07-13T16:44:00.000+02:002023-07-13T16:44:16.120+02:00Nitrate: A Confusing Controversy That Might Harm You More Than It Helps.<p><span style="font-size: medium;"> </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC3eofzOP9xZNETmJgEaW8LUFvEQIpK45JN_A6Bsm3K9qlQL0t8hzyEeHJfJOg-Ppd0pZoXY6yfLU-7y4FqKDPkdgiaSM4lwrTndBLMFftlOwdmWNHQMbmXsm3Sxs7OTdgvvAtw_KwrYUpcMn0xTdfkkcAWKFoPor8u4YKLyN25yOUHB2woyIgmgaGuD4/s8192/drinking_water.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="5464" data-original-width="8192" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC3eofzOP9xZNETmJgEaW8LUFvEQIpK45JN_A6Bsm3K9qlQL0t8hzyEeHJfJOg-Ppd0pZoXY6yfLU-7y4FqKDPkdgiaSM4lwrTndBLMFftlOwdmWNHQMbmXsm3Sxs7OTdgvvAtw_KwrYUpcMn0xTdfkkcAWKFoPor8u4YKLyN25yOUHB2woyIgmgaGuD4/w400-h266/drinking_water.jpg" width="400" /></span></a></div><span style="font-size: medium;"><br /></span><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;">Is nitrate carcinogenic or cardioprotective? Let’s dive into a controversy that pits health organisations against themselves.</span></b></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">A few days ago, I came across an alarmist blog post with this <a href="https://www.ernaehrungsmedizin.blog/2018/04/05/nitrat-im-trinkwasser-darmkrebs-aus-dem-wasserhahn/#:~:text=Insgesamt%20liegt%20der%20Nitratgehalt%20im,28%20%25%20der%20Messtellen%20%C3%BCberschritten." style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">headline</a>:</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;">“Colon Cancer On Tap. Nitrate In Drinking Water.”</span></b></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The post claimed that nitrate in our public drinking water supplies is a major cancer risk. It urged health organisations to reduce the maximum permissible limit of nitrate in our water.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Unfortunately, there are too many of these purveyors of panic around.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> And the health organizations are not helpful in containing them. To the contrary.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span></span></span></p><a name='more'></a><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">National health organizations in the US and EU set the nitrate limit for public drinking water at 50 mg/litre. They consider everything above that as a cancer risk.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">And here comes the about-face:</span> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The same health organizations endorse the regular consumption of beet root juice FOR ITS HIGH NITRATE CONTENT (on average 5 times the 50 mg threshold per serving) which is supposed to be protective against cancer (particularly those of the digestive tract from throat to intestine), and cardiovascular disease.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">If they want to confuse the consumer, they are doing a great job.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">After all nitrate is nitrate. Or is it?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span></span></span></p><!--more--><p></p><h2 style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">What Is Nitrate, And How Does It Work?</span> </span></h2><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Nitrate is a simple molecule that consists of one nitrogen atom and 3 oxygen atoms (NO3).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">To get to its health promoting effect the body needs to strip it of 2 of its oxygen atoms, one at a time: First from nitrate (NO3-) to nitrite (NO2-), and then, finally, to nitric oxide (NO).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Now there are three things you should know to realize what this entire controversy is all about.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">And I promise, I won’t give you a lecture in chemistry.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-style: var(--artdeco-reset-typography-font-style-italic); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b>First, the body produces its own NO</b></span>. Far more than it ever could convert from dietary nitrate (about 10 times as much [1]).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The body achieves this feat with an enzyme that rips NO from some amino acid (L-arginine, if you need to know).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The cells that contain this enzyme then use NO to modulate their direct surroundings in a health promoting way. No nitrate required.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="font-size: large;"></span></p><blockquote><i>For example, the layer of cells that line your arteries, (called the endothelium), produce NO to keep the arteries wider and more flexible (the correct term is compliant, but use whatever word you need to imagine elastic, not stiff, arteries).</i></blockquote><p></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><blockquote></blockquote><blockquote></blockquote></span></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">This is where the cardiovascular benefits of NO come into play. The more flexible the arteries (particularly the large ones that carry the blood from the heart to the body’s limbs), the lower the blood pressure. The wider the small arteries that supply the heart, the better the blood supply to the heart.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;"> </span><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-size: large; font-style: var(--artdeco-reset-typography-font-style-italic); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">The second thing you need to know</span></b><span style="font-size: large;"> is that the human body does not have the ability to turn nitrate into nitrite.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Remember what I said about the step-by-step reduction from nitrate to nitrite to NO?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">So if our body is unable to do step 1, how do we get to the health promoting NO?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Via a large detour.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">This detour relies on someone else to reduce nitrate to nitrite: a population of specific bacteria which resides on the top of our tongue (and in other parts of our gut).</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Ever heard of the microbiome? These guys are part of it.</i></b></span></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="font-size: large;">When you drink nitrate-loaded beet root juice, you swallow it, and it disappears too fast for these bacteria to act on it.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">But once the nitrate enters your blood stream it is delivered and concentrated in your salivary glands.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">They excrete the nitrate into the oral cavity via their saliva production. The bacteria have now ample time to reduce it to nitrite.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Ultimately you swallow the nitrite and (part of) it will appear as such in the blood stream.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">This whole detour is called the entero-salivary circulation.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">You don’t need to remember this tongue twister.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>What you should remember is that you can easily monkeywrench that system:</b></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"></span></p><blockquote>By regularly killing these helpful microbes. Any antiseptic mouthwash (particularly those containing chlorhexidine) will do that. No kidding.</blockquote><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-size: large; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><i>The third thing you need to know</i></b></span><span style="font-size: large;"> is that NO is a highly volatile molecule with a half life measured in milliseconds [2]. That is, it will disappear VERY quickly.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">How far can you travel in, say, 2 milliseconds to do your job?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Not very far. Not even in the realm of cells whose size is measured in micrometers (1 micrometer is one thousandth of a millimeter).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Considering that the acidity of the stomach is an ideal environment to turn nitrite into NO, its ultra-short half-life makes it impossible for NO to show up in the blood stream and relax the arteries.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">But that’s exactly what a nitrate pill (containing nitroglycerine) does to an angina patient’s heart. It dilates his heart’s blood vessels and thereby relieves the anginal pain. </span></p><span></span><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"><span></span></span></p><!--more-->How do we reconcile these two contradictory observations?<p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">Here is what we know today:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">Nitrite circulates in the blood as a kind of emergency resource. Once the emergency occurs, it sheds one of its oxygen atoms, turns into NO and comes to the rescue.</span><span style="font-size: large;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">In the cardiovascular system, the emergency alarm sounds when two conditions come together: too little oxygen, and to much acidity.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">If enough nitrite is around, NO production will come to the rescue.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s exactly what happens in a heart that does not get enough oxygen. And that’s why the oral delivery, or, faster still, the injection of nitrite works so well to relieve the anginal pain that tells the heart’s owner, in a very unpleasant way, that something is wrong.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">These three factors – the presence of circulating nitrite, hypoxia (too little oxygen), and acidity – are at work wherever nitrate has a beneficial effect:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"></p><ul style="text-align: left;"><li><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Decreasing the risk of blood clots</i></b></span></span></li><li><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Dilating arteries</i></b></span></span></li><li><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Relieving anginal pain</i></b></span></span></li><li><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Improving exercise performance in athletes</i></b></span></span></li><li><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>Improving exercise tolerance in heart failure</i></b></span></span></li></ul><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">All these effects have been well established [3]. The same goes for the health promoting effects of eating foods that are high in nitrate content.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">So, why are we afraid of nitrate in the drinking water? Why don’t we actually fortify water with nitrate? Like we fortify salt with iodine, or milk with calcium?</span><span style="font-size: large;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Because, as everything else in biology or medicine, nothing is as simple as we often think it is.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"><span></span></span></p><!--more-->Now, first to the biology, and then to the evidence.<p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">NO is not the only “fate” of nitrite. There are other more complex molecules that the body can produce from nitrite. Some of those are the so-called N-nitroso compounds (NOC).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The whole process is called nitrosation.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">These NOC molecules are known to increase the risk for certain cancers.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">What is also known is what inhibits nitrate and nitrite to go down the path to NOC:</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">the concurrent delivery of Vitamin C and/or many of the flavonoids that are components of these nitrate-rich vegetables. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"><span></span></span></p><!--more-->Now to the “supporting” evidence of the alarmist bloggers.<p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">The post that I mentioned in the beginning cites a large observational study that investigated how the exposure to public drinking water with high vs. low nitrate “contamination” affects cancer risk [4].</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The number of participants sounds impressive: 1.7 million people were followed for their colorectal cancer events for 15 years.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">And lo-and-behold those with an exposure to water in the highest quintile of nitrate content had a 16% increased risk of cancer compared to those people in the lowest exposure quintile.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">There are so many things wrong with this study, that I would need a separate post to dissect it.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">One of it being the fact that it is an observational study that observed the association between an exposure (that couldn’t even be measured reliably) and an outcome (cancer).</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>When will those writers who draw causal conclusions from observational study finally get it that association can NEVER prove causation.</b></span></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">It is a statistical fact that you learn in university statistics course 101.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">But let’s be generous, and NOT question the questionable.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"><br /></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">Let’s just look at the figures: 16% sounds impressive.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Spoiler alert, it isn’t impressive at all when you look at the absolute figures.</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Of the 1.7 million people, almost 6000 developed cancer.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That is 0.3%, or 3 of every thousand people.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">At this rate, the 16% difference translates into a difference of 5 people for every 10.000 people.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="font-size: large;">So, if you take 10.000 people, 30 might get cancer if they drink “highly nitrate-contaminated” water, as opposed to “only” 25 of 10.000 people who drink the least-contaminated water.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;"><span></span></span></p><!--more-->I don’t know how you feel about this, but to me the nitrate in drinking water isn’t a clear and present danger.<p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">A recent review of the evidence comes to the conclusion that …</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>“…most adverse health effects related to drinking-water nitrate are likely due to a combination of high nitrate ingestion and factors that increase endogenous nitrosation.”</b> [5]</span></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Would I recommend any nitrate supplement if there was any?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="font-size: large;">No, because drinking beet root juice, is a clean and safe alternative. It delivers the nitrate, and it delivers what prevents the body from turning nitrate into something potentially cancerous.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s why we use beet-root juice as an intervention option in our “<a href="http://www.adiphea.com/" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">science kit”</a> for biohacking lifelong health and functional longevity. You can read more about it on our <a href="http://www.adiphea.com/" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">website</a>.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">To monitor the effects on vascular function, aging and blood pressure we use the <a href="https://amzn.to/3JSKFy0" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">WIFI-capable devices</a> of @Withings.</span></p><span><!--more--></span><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: large;">As Hippocrates said:</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>"Let food be thy medicine and medicine be thy food."</b></span></span></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">And let beet juice be thy drink.</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="font-size: medium;"><br /><b><a href="http://www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=dr-lutz-kraushaar">Follow Me On LinkedIn</a></b><br /></span><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span></span></span></p><!--more--><h2 style="text-align: left;"><span style="font-size: large;">PS:</span></h2><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">This post contains referral links for the <a href="https://amzn.to/3JSKFy0" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">Withings devices on Amazon</a>. If you purchase the device from there, I will receive a small commission at no additional charge to you.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><h2 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>Hashtags</b></span></h2><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/nitrate" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">#nitrate</span></a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/beetroot" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">#beetroot</span></a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/lifestylemedicine" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">#LifestyleMedicine</span></a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><h2 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b>References</b></span></span></h2><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span><span style="font-size: large;">[1] Ghasemi A. Quantitative Aspects Of Nitric Oxide Production From Nitrate And Nitrite. EXCLI J 2022;21:470–86. doi:10.17179/excli2022-4727.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">[2] Thomas DD. The biological lifetime of nitric oxide: Implications for the perivascular dynamics of NO and O2. Proc Natl Acad Sci 2001;98:355–60. doi:10.1073/pnas.011379598.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">[3] Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science - why dietary nitrate is hard to Beet! part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol 2016. doi:10.1111/bcp.12918.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">[4] Schullehner J, Hansen B, Thygesen M, Pedersen CB, Sigsgaard T. Nitrate in drinking water and colorectal cancer risk: A nationwide population-based cohort study. Int J Cancer 2018;143:73–9. doi:10.1002/ijc.31306.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">[5] Ward MH, Id RRJ, Brender JD, Kok TM De, Weyer PJ, Nolan BT, et al. Drinking Water Nitrate and Human Health : An Updated Review 2018:1–31. doi:10.3390/ijerph15071557.</span></p>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-2396126287090841632023-07-10T18:17:00.000+02:002023-07-10T18:17:16.064+02:00The Hypertension Myth: Breaking the 130/85 Spell!<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMUDyiysJ0IMINou4iFh9GOOQCnfBTg08DRmkrvYn-7AgszpaLSDXRxQUwlBTo_O92BAj4LUZRVH3MkBfe4-3driq6_pwaQV5qlNwzlM73rdDAOqCVAGdtJIVOjeim1mP4ZCKLAlBx_SdOwLb1Is6pcCputf28I4Cq4-gi3LK5FqChV_k4DEwcxqZ7I3I/s5400/national-cancer-institute-0brH8nlXv0M-unsplash.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3600" data-original-width="5400" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMUDyiysJ0IMINou4iFh9GOOQCnfBTg08DRmkrvYn-7AgszpaLSDXRxQUwlBTo_O92BAj4LUZRVH3MkBfe4-3driq6_pwaQV5qlNwzlM73rdDAOqCVAGdtJIVOjeim1mP4ZCKLAlBx_SdOwLb1Is6pcCputf28I4Cq4-gi3LK5FqChV_k4DEwcxqZ7I3I/w400-h266/national-cancer-institute-0brH8nlXv0M-unsplash.jpg" width="400" /></a></div><br /><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Why you shouldn't blindly trust the numbers that define hypertension.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">You've probably heard that 130/80 is the new threshold to hypertension. But what if I told you that this number is not based on solid science?</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">Meet John, a victim of the blood pressure myth</span>.</span></b></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">John is a 57-year old successful entrepreneur who has been worried about his blood pressure spikes. He noticed them when he recently started to monitor his blood pressure at home. While he has been taking an antihypertensive medication, he would like to modify his lifestyle habits in the hope that his doctor might someday be able to deprescribe his meds.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"></p><blockquote><span style="font-size: medium;">The American Heart Association (AHA) has defined a systolic pressure (the upper value) of 130 mmHg and/or a diastolic pressure of 80 mmHg as the threshold above which a person should be treated for hypertension [1].</span></blockquote><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">In Europe we see it a little more relaxed, drawing the “red line” at 140/90 mmHg [2].</span></p><span><span style="font-size: medium;"><a name='more'></a></span></span><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">These numbers are not magical biological thresholds above which one is doomed to die early, or suffer a heart attack, stroke, kidney or heart failure.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Yes, many studies have shown these nasty events to be associated with elevated blood pressure. <span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">But association can never prove causation</span>.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s one of the statistical facts that your doctor, the associations, and the media often fail to point out.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">But that’s not the worst omission. There are two more.</span></p><h3 class="reader-text-block__heading2" style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The Omitted Truths</span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">First, the correlation between elevated blood pressure and elevated event risk is not as linear as it is typically portrayed.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Figure 1A represents this portrayal, 1B shows the actual data, and 1C illustrates at which blood pressure level the risk really starts to increase, based on your gender and the age at which you hit these levels [3].</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <b>Figure 1</b></span></p><div class="reader-image-block reader-image-block--full-width" style="background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; clear: both; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; margin-bottom: var(--spacing-four-x); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><figure class="reader-image-block__figure" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: var(--artdeco-reset-base-display-block); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-image-view-model " style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-view-attr__img-wrapper ivm-view-attr__img-wrapper--use-img-tag display-flex
" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: flex !important; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><img alt="No alt text provided for this image" class="ivm-view-attr__img--centered reader-image-block__img evi-image lazy-image ember-view" id="ember741" loading="lazy" src="https://media.licdn.com/dms/image/D4E12AQEjkck-YT4tmg/article-inline_image-shrink_1000_1488/0/1689003087192?e=1694649600&v=beta&t=FZI4eOIL9mAfA_T1F48Wvw0ykyz74-YJsvtiYkdQ2GQ" style="background-position: 50% center; background-size: cover; border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); height: auto; margin: var(--artdeco-reset-base-margin-zero); max-width: 100%; object-fit: cover; object-position: center center; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" /></span></div></div></figure></div><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The difference between figure 1A and C is due to the statistical methods applied to interpret the raw data (figure 1B). Quite obviously 1C represents the data better than 1A.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The second, and most important, omission the purveyors of hypertension thresholds are guilty of is to hide the answer to an obvious question:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;">Does the lowering of blood pressure to, or below, those thresholds reduce the risk of death or cardiovascular events?</span></b></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">After all, the objective of treating you with antihypertensive drugs is to decrease your risk of death and of cardiovascular events.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span></span></span></p><!--more--><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The Cochrane Collaboration, medical science’s white knight of performing systematic reviews and meta-analyses, investigated this question.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">They were interested to see whether more aggressive reduction of blood pressure (defined a reduction below 135/85 mmHg) delivers better results than treating to “standard target” defined as 140-160 / 90-100 mmHg).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">“Better results” was defined to mean fewer number of deaths and of serious cardiovascular events, such as heart attack and stroke. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">They pooled the data of 11 randomized controlled trials which had to meet strict selection criteria to minimize potential bias.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The trials included almost 39,000 patients and 143,000 patient years. The patients’ age ranged from 20 to 80.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Here are the astonishing results:</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"></p><ol style="border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); line-height: 1.75; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><li style="border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: 0.8rem 0px 0.8rem 3.2rem; padding-left: 0.8rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">There was no effect on total mortality (the risk of dying from any cause).</span></li><li style="border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: 0.8rem 0px 0.8rem 3.2rem; padding-left: 0.8rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">There was no effect on cardiovascular mortality (the risk of dying from cardiovascular disease).</span></li><li style="border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: 0.8rem 0px 0.8rem 3.2rem; padding-left: 0.8rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">There was no effect on kidney failure.</span></li></ol><p></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">There were however 16% fewer heart attacks, 12% fewer strokes and 24% fewer heart failure events in the more aggressively treated groups.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s how these results are typically communicated to you, the patient. Those percentages sound impressive.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Here is why they are not:</span></p><h3 class="reader-text-block__heading2" style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The Deception With Percentages</span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">They are relative risk reductions (RRR), not absolute risk reduction (ARR).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Let’s look at the difference:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">In the Cochrane Analysis the absolute risk for heart attack was 2.5% in the group treated to standard target.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That is, of 100 people in that group 2-and-a-half (let’s be liberal and round it up to 3) suffered a heart attack.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Whereas in the aggressively treated group 2.1 suffered a heart attack (let’s round this down to 2). The ARR is 0.4% (2.5 – 2.1).</span></p><div class="reader-image-block reader-image-block--full-width" style="background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; clear: both; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; margin-bottom: var(--spacing-four-x); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><figure class="reader-image-block__figure" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: var(--artdeco-reset-base-display-block); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-image-view-model " style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-view-attr__img-wrapper ivm-view-attr__img-wrapper--use-img-tag display-flex
" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: flex !important; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><img alt="No alt text provided for this image" class="ivm-view-attr__img--centered reader-image-block__img evi-image lazy-image ember-view" id="ember742" loading="lazy" src="https://media.licdn.com/dms/image/D4E12AQG9CxsBmV6zJg/article-inline_image-shrink_1000_1488/0/1689004196448?e=1694649600&v=beta&t=KAX6AQTF-kcFKbxUP1Lw5QQaOytrDrt1USGSsLlplqg" style="background-position: 50% center; background-size: cover; border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); height: auto; margin: var(--artdeco-reset-base-margin-zero); max-width: 100%; object-fit: cover; object-position: center center; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" /></span></div></div></figure></div><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">When you translate this ARR into the number of people your doctor needs to treat more aggressively to prevent one single heart attack (compared to standard target treatment), you arrive at 250.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">This number is called the “Number Needed To Treat” (NNT).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Which you can express as “249 of every 250 more aggressively treated patients will not have any benefit of this aggressive treatment”.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> Unsurprisingly, the Cochrane Collaboration came to the conclusion that:</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><b><i>“… the benefits of trying to achieve a lower blood pressure target rather than a standard target (≤ 140/90 mm Hg) do not outweigh the harms associated with that intervention.”</i></b></span></blockquote><span><span style="font-size: medium;"><!--more--></span></span><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><br /></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Coming back to John, our worried hypertensive patient. These numbers don’t tell him what to do.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That is the crux with these studies. They help health insurers and ministers weigh the commercial costs of treatments vs. their benefits.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Their “patient” is the population. They are not interested in the individual patient. But you are, and, hopefully, so is your doctor. </span></p><h3 class="reader-text-block__heading2" style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The Solution</span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s why John is now embarking on a N-of-1 study, in which we together turn him into a “clinical trial of 1”.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">My team and I have operationalized this gold-standard method for lay-people to use. Think of it as a <a href="http://www.adiphea.com/" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">science kit for biohacking lifelong health and function</a>.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">John and I will be monitoring his blood pressure, and most importantly, his arterial compliance. The latter is a key indicator of vascular health.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Read more about this <a href="https://www.adiphea.com/en/pulse-wave-velocity-is-key-healthy-aging/" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">here</a>.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The tools to do this are readily available. We use Withings’ WIFI capable <a href="https://amzn.to/44ADSRn" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">smart scale</a> to record daily his pulse wave velocity (PWV), and the same company’s <a href="https://amzn.to/3XIoGzE" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">blood pressure monitor</a>.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Both record their data automatically into our cloud-based <a href="http://www.adiphea.com/" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">“science kit”</a>. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">We’ll use the arsenal of lifestyle medicine to “trial-and-error” his way to an optimal configuration of dietary and exercise habits that match his genetic predisposition. And that hopefully solves his hypertension problem. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Best of all, we can do this even though John and I live far apart.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">His, and possibly your, takeaway from this post: It should put your fear of exceeding the artificial hypertension thresholds into perspective.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><br style="box-sizing: inherit;" /></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;">PS:</span></b></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">This post contains referral links for the Withings devices on Amazon. If you purchase the device from there, I will receive a small commission at no additional charge to you.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">PPS</span>:</span></b></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">If you like regular updates to my posts, follow me on <a href="http://www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=dr-lutz-kraushaar" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">LinkedIn</a></span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> <span style="font-size: var(--artdeco-reset-base-font-size-hundred-percent);">References</span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[1] Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med 2020;30:160–4. doi:10.1016/j.tcm.2019.05.003.</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[2] Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertensi. 2023. doi:10.1097/HJH.0000000000003480.</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[3] Port S, Demer L, Jennrich R, Walter D, Garfinkel A. Systolic blood pressure and mortality. Lancet 2000;355:175–80. doi:10.1016/S0140-6736(99)07051-8.</p>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-4989950687537658632023-07-08T10:29:00.002+02:002023-07-09T15:08:55.479+02:00Why You Shouldn't Trust Your Doctor's Blood Pressure Readings<h1 style="text-align: left;"> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA3uweEzp83yAINW4tWk1otvwsZykCzMEv1c5PkNQLfZtO-ng4fOe52m3YigFmXFb1OqGkaEt90niHmap1F-39WLisY7kT0hKWvmnjVQjx-3IKC5Cl-4HgV1EA4ZHAGOMf8NGoCJvJuKhh5dqMn9pFEzW_dCOSarlAlXRPRxKejS51Gk18z3seDr0LkSw/s6000/BP_Office_cdc-LbUOh89q4Es-unsplash.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3991" data-original-width="6000" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA3uweEzp83yAINW4tWk1otvwsZykCzMEv1c5PkNQLfZtO-ng4fOe52m3YigFmXFb1OqGkaEt90niHmap1F-39WLisY7kT0hKWvmnjVQjx-3IKC5Cl-4HgV1EA4ZHAGOMf8NGoCJvJuKhh5dqMn9pFEzW_dCOSarlAlXRPRxKejS51Gk18z3seDr0LkSw/w640-h426/BP_Office_cdc-LbUOh89q4Es-unsplash.jpg" width="640" /></a></div><br /></h1><div><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 0px 0px 1.6rem; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">When Monica, a 50 years-old mother of two, visited her doctor for a routine check-up she was told her blood pressure was 142/83 mmHg. That made her hypertensive, at least in the eyes of the health care system.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Her doctor prescribed a blood pressure drug and asked her to see him again in 2 month’s time.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Upon her follow-up visit Monica’s blood pressure had come down to 132/82 mmHg. The doctor recommended to continue taking the drug as it obviously kept her blood pressure in a healthier range.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><span></span></span></p><a name='more'></a><p></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">What neither Monica nor her doctor realised was that she (a) quite possibly wasn’t hypertensive at her first visit, and that (b) the drop in blood pressure was unlikely to reflect the true effect of the drug, if there was an effect at all.</span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-weight: var(--artdeco-reset-typography-font-weight-bold);"><span style="font-size: medium;">How reliable are hypertension diagnoses based on office blood pressure measurements?</span></span></h3><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Blood pressure is highly variable as it changes from one heartbeat to the next. This high variability has raised the question how reliable the typical one-visit snapshots at your doctor’s office really are.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Researchers of the Center for Outcomes Research and Evaluation of Yale New Haven Hospital and Yale University set out to answer this question [1]. They looked at the visit-to-visit variability of 7.7 million blood pressure readings taken from more than 537,000 adults.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">That makes it the largest ever study of blood pressure measurements performed at consecutive visits within a 90-day window. </span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">The results show an average variability – expressed as a standard deviation (SD) – of 10.57 mmHg.</span></p><h4 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-weight: var(--artdeco-reset-typography-font-weight-bold);"><span style="font-size: medium;">What does that mean for you?</span></span></h4><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><span face="Helvetica, Arial, sans-serif">Let us </span><span style="font-family: arial;">assume</span><span face="Helvetica, Arial, sans-serif"> your true systolic blood pressure is 125 mmHg.</span></span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"></p><blockquote><span style="font-family: arial; font-size: medium;"><i>By the way, you can never know your true blood pressure, because of inevitable inaccuracies of measurements and the aforementioned beat-to-beat variability. That’s why researchers work with averages and standard deviations. </i></span></blockquote><p></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">So, let’s say you and 99 other people with “true” systolic pressure of 125 mmHg have your blood pressure measured at your doctor’s office.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Approximately 31 (one third) of you will have a reading in excess of 130 mmHg, which is currently the defining threshold for hypertension (in the US; in Europe we see it a little more relaxed, with 140 mmHg being considered the “red line).</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">That is, you have a one-in-three chance of being suspected of having hypertension or pre-hypertension even if your blood pressure is normal.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><span></span></span></p><!--more--><p></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Now let’s further assume that these 31 people - whose blood pressure is perfectly fine -– will be invited by their doctor for a follow-up visit within 3 months’ time. How many do you think will still have a reading above the “red line”?</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Again, one third of this purportedly hypertensive cohort. That is, ten people will have a second reading that puts them into the hypertensive, respectively pre-hypertensive range (depending on where you reside).</span></p><figure class="slate-resizable-image-embed slate-image-embed__resize-full-width" contenteditable="false" data-imgsrc="https://media.licdn.com/dms/image/D4E12AQHEgG7eEgBtgA/article-inline_image-shrink_1000_1488/0/1688746165814?e=1694044800&v=beta&t=F-I2FeLOaoazaOE-QSy6ltN2bxV735_XN7tPd-iixQA" style="background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; clear: both; color: rgba(0, 0, 0, 0.9); cursor: text; display: var(--artdeco-reset-base-display-block); font-family: Helvetica, Arial, sans-serif; font-size: 13px; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: relative; text-align: center; transition: margin 223ms ease 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><ul class="slate-image-embed__toolbar" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; display: flex; font-size: var(--font-size-large); height: 48px; justify-content: center; left: 0px; line-height: 1.75; margin: 0px; opacity: 0; padding: 0px 0px 8px; position: absolute; top: 0px; transition: all 332ms ease-in 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;"><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Align to the left" class="slate-image-embed-button slate-image-embed-button__resize-left artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; overflow: hidden; padding: 0px; touch-action: manipulation; transition-duration: 167ms; transition-property: background-color, box-shadow, color; transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align to the left</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-left"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zm-6 6h6V7h-6zm0 4h6v-2h-6zm0 4h6v-2h-6zM3 21h18v-2H3zM13 7H3v10h10z"></path></svg></li-icon></button></li><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); 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transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align in the middle</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-center"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zM3 21h18v-2H3zM7 7v10h10V7z"></path></svg></li-icon></button></li><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Resize to full width" aria-pressed="true" class="slate-image-embed-button slate-image-embed-button__resize-full-width artdeco-button artdeco-button--circle slate-image-embed-button__active" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; 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font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align to the right</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-right"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zM9 7H3v2h6zm0 4H3v2h6zm0 4H3v2h6zm-6 6h18v-2H3zm8-4h10V7H11z"></path></svg></li-icon></button></li></ul><div class="publishing-slate-image-embed__button-wrapper" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: absolute; right: 1.6rem; top: 1.6rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Add a link to the embedded image" class="slate-image-embed__link-button artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; opacity: 0; overflow: visible; padding: 0px; position: absolute; right: 0px; top: 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle; width: 4rem; z-index: 0;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; right: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Add a link to the embedded image</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="link"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M19.83 4.17a4 4 0 00-5.66 0l-2 2A4 4 0 0011 9a4 4 0 00.56 2l-.54.54a4 4 0 00-4.85.63l-2 2a4 4 0 005.66 5.66l2-2A4 4 0 0013 15a4 4 0 00-.56-2l.54-.54a4 4 0 004.85-.63l2-2a4 4 0 000-5.66zM11 15a2 2 0 01-.59 1.41l-2 2a2 2 0 11-3-2.6l.22-.22 2-2A2 2 0 019 13a2.24 2.24 0 01.51.07l-1.22 1.22a1 1 0 000 1.41 1 1 0 001.41 0l1.22-1.22A2.24 2.24 0 0111 15zm7.41-6.59l-2 2A2 2 0 0115 11a2.24 2.24 0 01-.51-.07l1.22-1.22A1 1 0 0016 9a1 1 0 00-.29-.7A1 1 0 0015 8a1 1 0 00-.7.29l-1.23 1.22A2.24 2.24 0 0113 9a2 2 0 01.59-1.41l2-2a2 2 0 013 2.6z"></path></svg></li-icon></button></div><div class="publishing-slate-image-embed__button-wrapper" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: absolute; right: 1.6rem; top: 1.6rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Add alt text to image" class="slate-image-embed__desc-button artdeco-button artdeco-button--1 align-items-center" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-large) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.4rem; font-weight: 600; justify-content: center; line-height: 2rem; margin-bottom: 0px; margin-right: 0.8rem; max-width: 480px; min-height: 2.4rem; min-width: 0px; opacity: 0; overflow: hidden; padding: 0.8rem 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle;"><li-icon aria-hidden="true" class="mr1" size="small" style="box-sizing: border-box; display: inline-block; margin-right: 0.4rem; overflow: hidden; position: relative;" type="pencil"><svg class="mercado-match" data-supported-dps="16x16" fill="currentColor" focusable="false" height="16" viewbox="0 0 16 16" width="16" xmlns="http://www.w3.org/2000/svg"><path d="M14.13 1.86a3 3 0 00-4.17 0l-7 7L1 15l6.19-2 6.94-7a3 3 0 000-4.16zm-8.36 9.71l-1.35-1.34L9.64 5 11 6.35z"></path></svg></li-icon><span class="t-sans" face="var(--artdeco-typography-sans)" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">Add alt text</span></button><button aria-label="Delete image" class="publishing-slate-image-embed__delete-button artdeco-button artdeco-button--2 artdeco-button--circle" data-test-embed-image-delete-button="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; opacity: 0; overflow: hidden; padding: 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Delete image</div><li-icon aria-hidden="true" size="small" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="cancel"><svg class="mercado-match" data-supported-dps="16x16" fill="currentColor" focusable="false" height="16" viewbox="0 0 16 16" width="16" xmlns="http://www.w3.org/2000/svg"><path d="M14 3.41L9.41 8 14 12.59 12.59 14 8 9.41 3.41 14 2 12.59 6.59 8 2 3.41 3.41 2 8 6.59 12.59 2z"></path></svg></li-icon></button></div><img alt="Normotensives vs hypertensives" class="slate-image-embed__resize-full-width" data-media-urn="urn:li:digitalmediaAsset:D4E12AQHEgG7eEgBtgA" height="382" src="https://media.licdn.com/dms/image/D4E12AQHEgG7eEgBtgA/article-inline_image-shrink_1000_1488/0/1688746165814?e=1694044800&v=beta&t=F-I2FeLOaoazaOE-QSy6ltN2bxV735_XN7tPd-iixQA" style="background: var(--artdeco-reset-base-background-transparent); border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text); display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); height: auto; margin: 0px auto; max-width: 720px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); transition: outline 223ms ease 0s, width 223ms ease 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" width="678" /><figcaption contenteditable="true" data-placeholder="Add caption for image (optional)" spellcheck="false" style="align-items: center; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text-low-emphasis); display: flex; font-size: var(--font-size-small); justify-content: center; margin-top: 1.6rem; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" tabindex="0"></figcaption></figure><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"> </p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">So, here is the potential for 31 unnecessary follow-up consultations, 10 unjustified diagnoses of a chronic condition, and all the medication and treatment costs that come with it. Not to mention the needless anxiety that many of the misdiagnosed people will suffer</span></p><span style="font-size: medium;"><span></span><span><!--more--></span></span><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-weight: var(--artdeco-reset-typography-font-weight-bold);"><span style="font-size: medium;">How reliably can office blood pressure measurements identify a drug’s effect?</span></span></h3><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Instead of only looking at how reliably doctors can identify hypertension, the researchers also asked how reliably doctors can detect and quantify the effects of blood pressure medication. </span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Again, the results are an eye-opener. </span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">The researchers looked at how blood pressure readings changed over a visit-to-visit window of less than 90 days. That is the typical timeframe for a doctor to check how a new or modified prescription affects a patient’s blood pressure.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">The mean visit-to-visit change in untreated individuals and individuals with no between-visit change of treatment was very close to zero (as would be expected). But the standard deviation (the measure of variability) was pretty high at 15 mmHg.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">If you take these data and run a simulation (as I have done in preparation of this post) in which you assume that a blood pressure lowering intervention will result in a true 10 mmHg drop of systolic blood pressure between 2 visits, you’ll find that fully 38% of the treated individuals will show a blood pressure reduction of less than 5 mmHg, or even an increase.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"> </span></p><figure class="slate-resizable-image-embed slate-image-embed__resize-full-width" contenteditable="false" data-imgsrc="https://media.licdn.com/dms/image/D4E12AQEg6x9-rmeiqA/article-inline_image-shrink_1000_1488/0/1688746227841?e=1694044800&v=beta&t=eQazjLQmUA4LepdZOw3m9nTeLKPHLBRJoRAEN1LeaqA" style="background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; clear: both; color: rgba(0, 0, 0, 0.9); cursor: text; display: var(--artdeco-reset-base-display-block); font-family: Helvetica, Arial, sans-serif; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: relative; text-align: center; transition: margin 223ms ease 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><ul class="slate-image-embed__toolbar" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; display: flex; font-size: var(--font-size-large); height: 48px; justify-content: center; left: 0px; line-height: 1.75; margin: 0px; opacity: 0; padding: 0px 0px 8px; position: absolute; top: 0px; transition: all 332ms ease-in 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;"><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Align to the left" class="slate-image-embed-button slate-image-embed-button__resize-left artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; overflow: hidden; padding: 0px; touch-action: manipulation; transition-duration: 167ms; transition-property: background-color, box-shadow, color; transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align to the left</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-left"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zm-6 6h6V7h-6zm0 4h6v-2h-6zm0 4h6v-2h-6zM3 21h18v-2H3zM13 7H3v10h10z"></path></svg></li-icon></button></li><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Align in the middle" class="slate-image-embed-button slate-image-embed-button__resize-middle artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; overflow: hidden; padding: 0px; touch-action: manipulation; transition-duration: 167ms; transition-property: background-color, box-shadow, color; transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align in the middle</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-center"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zM3 21h18v-2H3zM7 7v10h10V7z"></path></svg></li-icon></button></li><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Resize to full width" aria-pressed="true" class="slate-image-embed-button slate-image-embed-button__resize-full-width artdeco-button artdeco-button--circle slate-image-embed-button__active" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; overflow: hidden; padding: 0px; touch-action: manipulation; transition-duration: 167ms; transition-property: background-color, box-shadow, color; transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Resize to full width</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-full-width"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zM3 21h18v-2H3zm0-4h18V7H3z"></path></svg></li-icon></button></li><li style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); list-style-type: inherit; margin: 0px 4px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Align to the right" class="slate-image-embed-button slate-image-embed-button__resize-right artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; overflow: hidden; padding: 0px; touch-action: manipulation; transition-duration: 167ms; transition-property: background-color, box-shadow, color; transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1); vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Align to the right</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="content-align-right"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M21 3v2H3V3zM9 7H3v2h6zm0 4H3v2h6zm0 4H3v2h6zm-6 6h18v-2H3zm8-4h10V7H11z"></path></svg></li-icon></button></li></ul><div class="publishing-slate-image-embed__button-wrapper" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: absolute; right: 1.6rem; top: 1.6rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Add a link to the embedded image" class="slate-image-embed__link-button artdeco-button artdeco-button--circle" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; opacity: 0; overflow: visible; padding: 0px; position: absolute; right: 0px; top: 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle; width: 4rem; z-index: 0;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; right: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Add a link to the embedded image</div><li-icon aria-hidden="true" size="large" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="link"><svg class="mercado-match" data-supported-dps="24x24" fill="currentColor" focusable="false" height="24" viewbox="0 0 24 24" width="24" xmlns="http://www.w3.org/2000/svg"><path d="M19.83 4.17a4 4 0 00-5.66 0l-2 2A4 4 0 0011 9a4 4 0 00.56 2l-.54.54a4 4 0 00-4.85.63l-2 2a4 4 0 005.66 5.66l2-2A4 4 0 0013 15a4 4 0 00-.56-2l.54-.54a4 4 0 004.85-.63l2-2a4 4 0 000-5.66zM11 15a2 2 0 01-.59 1.41l-2 2a2 2 0 11-3-2.6l.22-.22 2-2A2 2 0 019 13a2.24 2.24 0 01.51.07l-1.22 1.22a1 1 0 000 1.41 1 1 0 001.41 0l1.22-1.22A2.24 2.24 0 0111 15zm7.41-6.59l-2 2A2 2 0 0115 11a2.24 2.24 0 01-.51-.07l1.22-1.22A1 1 0 0016 9a1 1 0 00-.29-.7A1 1 0 0015 8a1 1 0 00-.7.29l-1.23 1.22A2.24 2.24 0 0113 9a2 2 0 01.59-1.41l2-2a2 2 0 013 2.6z"></path></svg></li-icon></button></div><div class="publishing-slate-image-embed__button-wrapper" data-slate-ignore="true" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: absolute; right: 1.6rem; top: 1.6rem; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><button aria-label="Add alt text to image" class="slate-image-embed__desc-button artdeco-button artdeco-button--1 align-items-center" data-slate-ignore="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-large) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.4rem; font-weight: 600; justify-content: center; line-height: 2rem; margin-bottom: 0px; margin-right: 0.8rem; max-width: 480px; min-height: 2.4rem; min-width: 0px; opacity: 0; overflow: hidden; padding: 0.8rem 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle;"><li-icon aria-hidden="true" class="mr1" size="small" style="box-sizing: border-box; display: inline-block; margin-right: 0.4rem; overflow: hidden; position: relative;" type="pencil"><svg class="mercado-match" data-supported-dps="16x16" fill="currentColor" focusable="false" height="16" viewbox="0 0 16 16" width="16" xmlns="http://www.w3.org/2000/svg"><path d="M14.13 1.86a3 3 0 00-4.17 0l-7 7L1 15l6.19-2 6.94-7a3 3 0 000-4.16zm-8.36 9.71l-1.35-1.34L9.64 5 11 6.35z"></path></svg></li-icon><span class="t-sans" face="var(--artdeco-typography-sans)" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">Add alt text</span></button><button aria-label="Delete image" class="publishing-slate-image-embed__delete-button artdeco-button artdeco-button--2 artdeco-button--circle" data-test-embed-image-delete-button="true" style="align-items: center; background-attachment: initial; background-clip: initial; background-image: none; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-color: initial; border-radius: var(--corner-radius-full) !important; border-style: none; border-width: initial; cursor: pointer; display: inline-flex; font-family: inherit; font-size: 1.6rem; font-weight: 600; height: 4rem; justify-content: center; line-height: 2rem; margin-bottom: 0px; max-width: 480px; min-height: 3.2rem; min-width: auto; opacity: 0; overflow: hidden; padding: 0px; touch-action: manipulation; transition: all 332ms ease-in 0s; vertical-align: middle; width: 4rem;"><div class="uploaded-image-control-button-tooltip uploaded-image-control-button-tooltip-hidden" style="background-color: var(--color-background-container); border-radius: var(--corner-radius-medium); border: var(--artdeco-reset-base-border-zero); bottom: 54px; box-shadow: var(--elevation-raised); box-sizing: border-box; color: var(--color-text); font-size: 1.5rem; font-weight: 400; margin: var(--artdeco-reset-base-margin-zero); opacity: 0; padding: 0.8rem; pointer-events: none; position: absolute; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: max-content;">Delete image</div><li-icon aria-hidden="true" size="small" style="box-sizing: border-box; display: inline-block; overflow: hidden; position: relative;" type="cancel"><svg class="mercado-match" data-supported-dps="16x16" fill="currentColor" focusable="false" height="16" viewbox="0 0 16 16" width="16" xmlns="http://www.w3.org/2000/svg"><path d="M14 3.41L9.41 8 14 12.59 12.59 14 8 9.41 3.41 14 2 12.59 6.59 8 2 3.41 3.41 2 8 6.59 12.59 2z"></path></svg></li-icon></button></div><img alt="No alt text provided for this image" class="slate-image-embed__resize-full-width" data-media-urn="urn:li:digitalmediaAsset:D4E12AQEg6x9-rmeiqA" src="https://media.licdn.com/dms/image/D4E12AQEg6x9-rmeiqA/article-inline_image-shrink_1000_1488/0/1688746227841?e=1694044800&v=beta&t=eQazjLQmUA4LepdZOw3m9nTeLKPHLBRJoRAEN1LeaqA" style="background: var(--artdeco-reset-base-background-transparent); border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text); display: inline-block; font-size: var(--artdeco-reset-base-font-size-hundred-percent); height: auto; margin: 0px auto; max-width: 720px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); transition: outline 223ms ease 0s, width 223ms ease 0s; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" /><figcaption contenteditable="true" data-placeholder="Add caption for image (optional)" spellcheck="false" style="align-items: center; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: var(--color-text-low-emphasis); display: flex; font-size: var(--font-size-small); justify-content: center; margin-top: 1.6rem; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" tabindex="0"></figcaption></figure><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><br style="box-sizing: border-box;" /></span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b><span style="font-size: medium;">Why is this important?</span></b></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Because a 5 mmHg drop is the accepted threshold for a clinically relevant change in blood pressure. That is, a change that meaningfully reduces the risk of major cardiovascular events.</span></p><blockquote style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding: 0px 0px 0px 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><i>As an aside: the 38% of my simulation is even more optimistic than the 42% which the researchers pulled out from their real-life data. I am always skeptical about published numbers, that’s why I love to run simulations to check whether the data make sense. </i></span></blockquote><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"> <b>Again, what does that mean for you?</b></span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">For 4 out of 10 patients who have been prescribed an antihypertensive drug, the follow-up measurement of the drug’s effect will underestimate its true effect. </span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Keep in mind that the “4 out of 10” is probably an optimistic figure because the simulated drop of 10 mmHg exceeds what is typically achievable with any single drug [2].</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">The doctor’s knee-jerk reaction will probably be to either increase the dose or add another drug to the treatment combo.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"> <span></span></span></p><!--more--><p></p><h3 style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The Alternative To Office Blood Pressure Measurements</span></span></h3><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">What should be the reaction in both of the scenarios that I described above?</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">Not to rely on office blood pressure measurements.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">I am not kidding. And I am not the only one saying this.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">The hypertension societies around the world are warming up to the idea that regular and frequent home blood pressure monitoring (HBPM) is more informative than the occasional BP recording at the doctor’s office. That’s what the 2023 guidelines of the European Society of Hypertension tell us [3].</span></p><blockquote style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border-left: .4rem solid var(--color-brand-accent-4); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding: 0px 0px 0px 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><i>The holy grail of HBPM is continuous cuffless blood pressure measurement through wearables. We are not there yet, but we are getting close. And I will address the pros and cons of this technology in one of my next posts.</i></span></blockquote><h4 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"> <span style="font-weight: var(--artdeco-reset-typography-font-weight-bold);">What You Can Do Today</span></span></h4><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">One convenient way of doing HBPM is by using a self-inflating WIFI-capable device that has also been validated.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">In my team we are working with the <a href="https://amzn.to/3NQIrk6" rel="noopener nofollow" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: border-box; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);" target="_blank">Withings BPM Connect</a> device, which directly communicates with our DIY lifestyle medicine platform.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">My team and I have developed this platform to democratize access to individualized lifestyle medicine, making it accessible to lay-users and their doctors.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">For the hypothetical Monica HBPM and <a href="http://www.adiphea.com/" rel="noopener nofollow" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: border-box; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);" target="_blank">our platform</a> would certainly have been helpful. First, in finding out whether she is hypertensive, second, in testing how a change in her dietary or exercise habits might affect her blood pressure. All that before starting on any medication. </span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><b>PS</b></span><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">:</span></span></h3><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">This post contains referral links for the Withings device on <a href="https://www.amazon.de/-/en/Withings-Blood-Pressure-Monitor-Connect/dp/B07SJV1HNR/ref=sr_1_5?crid=35DQNNVAQ6JI1&keywords=withings+bpm+connect&qid=1688802842&sprefix=withings+bpm+connect%252Caps%252C181&sr=8-5&_encoding=UTF8&tag=adiphea-21&linkCode=ur2&linkId=5ed71fecbbf1928cf43259161dec59b0&camp=1638&creative=6742&language=de_DE" rel="noopener nofollow" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: border-box; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);" target="_blank">Amazon (Germany)</a> and <a href="https://www.amazon.co.uk/Withings-BPM-Connect-Pressure-Monitor/dp/B07SJV1HNR/ref=sr_1_2?crid=HFOAODWVXRO5&keywords=withings+bpm+connect&qid=1688746599&sprefix=withings+bpm+connect%2Caps%2C121&sr=8-2" rel="noopener nofollow" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: border-box; font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);" target="_blank">Amazon (UK)</a>. If you purchase the device from there, I will receive a small commission at no additional charge to you.</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;"><br /></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none; font-weight: bold;"><span style="font-size: medium;">PPS:</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="font-size: medium;"><span style="background: none;">You may follow me on </span><span class="q-inline" style="box-sizing: border-box; display: inline;"><a class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" href="http://www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=dr-lutz-kraushaar" rel="noopener nofollow" style="-webkit-tap-highlight-color: rgba(255, 255, 255, 0.6); background: none; border-radius: inherit; box-sizing: border-box; color: #195faa; cursor: pointer; position: relative; text-decoration-line: none;" target="_blank" title="www.linkedin.com">LinkedIn</a><span class="q-inlineBlock qu-width--16 qu-height--16" style="box-sizing: border-box; display: inline-block; flex-shrink: 0; height: 16px; line-height: 16px; margin-left: 2px; width: 16px;" width="16"></span></span><span style="background: none;">and on <a href="https://lutzkraushaar.medium.com/" target="_blank">medium</a> for regular updates</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="font-size: medium;"><span></span></span></p><!--more--><span style="font-size: medium;"><span style="background: none;"><br /></span></span><p></p><h3 style="background-color: white; box-sizing: border-box; color: #282829; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; text-align: left; word-break: break-word;"><span style="background: none; font-weight: bold;"><span style="font-size: medium;">Hashtags</span></span></h3><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none;"><span style="font-size: medium;">#ScienceKitForHealth</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none;"><span style="font-size: medium;">#Blood Pressure</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none;"><span style="font-size: medium;">#Hypertension</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none;"><span style="font-size: medium;">#HomeBloodPressureMonitoring</span></span></p><p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start" style="background-color: white; box-sizing: border-box; color: #282829; direction: ltr; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif; margin: 0px 0px 1em; overflow-wrap: anywhere; padding: 0px; word-break: break-word;"><span style="background: none;"><span style="font-size: medium;">#Withings</span></span></p><div><span style="background: none;"><span><!--more--></span><span style="font-size: medium;"><br /></span></span></div><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; line-height: 1.75; margin: 1.6rem 0px; padding: 0px; text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span style="font-size: medium;">References</span></h3><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">[1] Lu Y, Linderman GC, Mahajan S, Liu Y, Huang C, Khera R, et al. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circ Cardiovasc Qual Outcomes 2023:305–15. doi:10.1161/circoutcomes.122.009258.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">[2] Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med 2009;122:290–300. doi:10.1016/j.amjmed.2008.09.038.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: border-box; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: Helvetica, Arial, sans-serif; font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">[3] Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). 2023. doi:10.1097/HJH.0000000000003480.</p></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-37300561791987248422023-07-06T14:51:00.000+02:002023-07-08T10:33:56.520+02:00What are the odds that your blood pressure medication will really help you?<p style="text-align: left;"><span style="color: var(--color-text); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-weight: var(--font-weight-bold);"><span style="font-size: medium;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi8Qj0Zsa0bsP376VONyQf442Te2GmGaQYC4AHg2CdY5DgVQdTbFvUBYFflvOFG6UmWy7GvblMsq4PuPUdoExg2mdi58FULbdpMlOaOGoP21yVLxCvVw5n1vl0zeTqbChyB9cUQPeiOcx4HYVY_I5WT4Toc2SuxfJn_yhH2OUE3Dqbs138kaRpaWsWm-0M" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="565" data-original-width="849" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEi8Qj0Zsa0bsP376VONyQf442Te2GmGaQYC4AHg2CdY5DgVQdTbFvUBYFflvOFG6UmWy7GvblMsq4PuPUdoExg2mdi58FULbdpMlOaOGoP21yVLxCvVw5n1vl0zeTqbChyB9cUQPeiOcx4HYVY_I5WT4Toc2SuxfJn_yhH2OUE3Dqbs138kaRpaWsWm-0M=w400-h266" width="400" /></a></span></div><span style="font-size: medium;"><br /><br /></span><p></p><p style="text-align: left;"><span style="color: var(--color-text); font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif;"><span style="font-size: medium;"><b>The answer might surprise you, not to mention a lot of people who have been labeled chronically ill.</b></span></span></p><div class="relative reader__grid mt6" style="background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); float: none; font-family: -apple-system, system-ui, "system-ui", "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; margin-top: 3.2rem !important; overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); position: relative !important; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div data-scaffold-immersive-reader-content="" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="reader-article-content reader-article-content--content-blocks" dir="ltr" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Because that’s what it really amounts to:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Hypertension is a chronic disease, or rather a chronic condition.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">When that label comes at <span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-weight: var(--artdeco-reset-typography-font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">an arbitrarily defined threshold of blood pressure</span> then you are absolutely justified to seek an answer to this post’s title question. Particularly when economic interests are involved.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Such as the annual US$ 20 Billion market for anti-hypertensive medication.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That market virtually grew overnight when in 2017 the American College of Cardiology and the American Heart Association lowered the threshold for hypertension from 140/90 to 130/80 mmHg.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">31 million Americans “became” chronically diseased “overnight”. The prevalence of hypertension among adults aged 40 and over jumped from 37% to close to 60% [1].</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span style="color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal);">Here is why I don’t agree with this threshold-fixing.</span></span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="color: var(--color-text);"><span style="font-size: medium;">The True Risk Of Elevated Blood Pressure</span></span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Lowering elevated blood pressure, whatever “elevated” means, should reduce cardiovascular death (mortality) and disease (morbidity).</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Only it doesn’t, a least not in the way it is portrayed to the public.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The gospel coming from, among others, the Framingham study tells us that there is a continuous increase of death risk as a function of blood pressure. With no detectable lower bound down to systolic pressure of 115 mmHg.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Courtesy of a study by Port et al. [2], the graph below shows how this statement is typically presented as a result of a statistical method that we call a logistic regression.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> </p><div class="reader-image-block reader-image-block--full-width" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; clear: both; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin-bottom: var(--spacing-four-x); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><figure class="reader-image-block__figure" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: var(--artdeco-reset-base-display-block); font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-image-view-model " style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-view-attr__img-wrapper ivm-view-attr__img-wrapper--use-img-tag display-flex
" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: flex !important; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><img alt="No alt text provided for this image" class="ivm-view-attr__img--centered reader-image-block__img evi-image lazy-image ember-view" id="ember7964" loading="lazy" src="https://media.licdn.com/dms/image/D4E12AQEe96yqzYhh4w/article-inline_image-shrink_1500_2232/0/1688483978441?e=1694044800&v=beta&t=CphaNJ56E5ZLVvjzaeX5nuNTM8dj4QEp7T5bgDi7OlU" style="background-position: 50% center; background-size: cover; border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--artdeco-reset-base-font-size-hundred-percent); height: auto; margin: var(--artdeco-reset-base-margin-zero); max-width: 100%; object-fit: cover; object-position: center center; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" /></div></div></figure></div><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><br style="box-sizing: inherit;" /></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> </p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">What this picture does not tell you is that the choice of statistic (logistic regression) produces a smoothed line over the raw data.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span style="color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal);">That’s a problem when those raw data look like this:</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> </p><div class="reader-image-block reader-image-block--full-width" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; clear: both; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin-bottom: var(--spacing-four-x); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><figure class="reader-image-block__figure" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: var(--artdeco-reset-base-display-block); font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-image-view-model " style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><div class="ivm-view-attr__img-wrapper ivm-view-attr__img-wrapper--use-img-tag display-flex
" style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; display: flex !important; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><img alt="No alt text provided for this image" class="ivm-view-attr__img--centered reader-image-block__img evi-image lazy-image ember-view" id="ember7965" loading="lazy" src="https://media.licdn.com/dms/image/D4E12AQEc4fugj0yqlA/article-inline_image-shrink_1500_2232/0/1688483994192?e=1694044800&v=beta&t=-mlBHl7VWWfedH9FnOseutKP61hnl6rTwoKKVs5tFCo" style="background-position: 50% center; background-size: cover; border-radius: 0px; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--artdeco-reset-base-font-size-hundred-percent); height: auto; margin: var(--artdeco-reset-base-margin-zero); max-width: 100%; object-fit: cover; object-position: center center; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline); width: 720px;" /></div></div></figure></div><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><br style="box-sizing: inherit;" /></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> </p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">It is easy to see that the smooth line of the first graph does not describe the reality very well.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Cardiovascular and non-cardiovascular deaths show no significant upwards trend until about 160 mmHg. From then on the risk increases exponentially.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">In such a situation a splined logistic regression is the more appropriate statistic model to use. That’s the type that accounts for a segmentally different relation between death and blood pressure.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">When applying the more appropriate statistic there is no more significant association between death and “hypertension” up to the age-adjusted 70th percentile of blood pressure.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">You are probably less interested in the finer points of statistics, than you are interested in a tool to help you answer the question: what is that 70th percentile for my age and gender.</span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"><span style="font-weight: var(--artdeco-reset-typography-font-weight-normal);"> </span><b>Calculate Your Personal Risk</b></span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">You can calculate your age-adjusted 70th percentile of systolic blood pressure using the following formula:</span></p><blockquote class="reader-text-block__quote" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border-left: .4rem solid var(--color-brand-accent-4); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; padding-left: 1.6rem; quotes: var(--artdeco-reset-base-quotes-none); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><ul style="text-align: left;"><li><span style="font-size: medium;">For men: 120 + (2/3 x age); example for a 50-year old man: 120 +(2/3 x 50) = 153 mmHg</span></li><li><span style="font-size: medium;">For women: 114 + (5/6 x age); example for 50-year old woman: 114 +(5/6 x 50) = 156 mmHg</span></li></ul></blockquote><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">You can find the Port paper from the bibliography below and even download it from the journal Lancet, one of the most respected medical journals.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span style="color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal);">I bet, when you compare your 70th percentile threshold with your actual blood pressure your worries, if you have any, may become a lot more moderate.</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;"> <span style="color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal);">OK, so much about death, but what about cardiovascular disease? You don’t want to get that either.</span></span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The answer is surprisingly similar.</span></p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="color: var(--color-text);"><b><span style="font-size: medium;">The Numbers Needed to Treat and to Harm</span></b></span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">A very recent study looked at the number needed to treat (NNT) and the number needed to harm (NNH) in the context of blood pressure medication [3].</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The NNT describes how many people need to take a drug to prevent one single event (in our context: heart attack, stroke etc.) compared to not taking the drug.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The NNH tells you how many people will need to take the drug to observe one harmful event or side effect.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Ideally the NNT is as small as possible, and the NNH as large as possible. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">In our case, no benefit of taking BP lowering medication was observable (over 3.5 years of monitoring) for people with a systolic blood pressure (SBP) <140 mmHg.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">At a SBP between 140 mmHg and 159 mmHg, the NNT was 47 and the NNH was 39. That is, 47 people need to be treated to prevent 1 major adverse cardiovascular event (MACE), whereas the remaining 46 would have experienced no event, even if they didn’t take the drug. </span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">And for every 39 drug-treated individuals there is one harmful event or side effect.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">It has always escaped me why those who should inform the lay public about the benefits and harms of what they prescribe, shy away from these very illustrative numbers.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">An earlier meta-analysis of studies which investigated the outcomes in treated vs. untreated hypertension (140-160 mmHg systolic & 90-100 mmHg diastolic) concluded that there was no benefit from treatment for heart disease, stroke or total cardiovascular events.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Oh, yes, and almost 10% of treated patients discontinued treatment, because of negative side-effects.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Mind you, this meta-analysis was performed by evidence-based medicine’s non-profit white knight, the Cochrane Collaboration [4].</span></p><h3 class="reader-text-block__heading2" style="--artdeco-reset-typography_getfontsize: 2.4rem; --artdeco-reset-typography_getlineheight: 1.33333; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); line-height: var(--artdeco-reset-typography_getLineHeight); margin: 3.2rem 0px; outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Hypertension: Not To Be Taken Lightly</span></span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">The latest iteration of the European Society Of Hypertension (ESH) guideline for managing arterial hypertension reflects this cumulative evidence. It sets the “red line” for drug treatment at 140/90 mmHg.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">But it also makes one thing very clear:</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Elevated blood pressure is a warning not to be taken lightly. For 9 out of 10 hypertensive persons, their condition is self-inflicted. Too much weight, too little exercise and a lot of other unhealthy habits are the dominant causes of hypertension.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">Which also means, correcting these causes may very well drive your blood pressure down, too.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">That’s why all the guidelines agree on lifestyle change as the first line of defense against the potentially debilitating consequences of long-standing hypertension.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="font-size: medium;">So, if you succeed in managing your blood pressure through lifestyle adjustments, you wouldn’t need to worry about the odds of your drugs helping, or harming, you in the first place.</span></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><br style="box-sizing: inherit;" /></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">Hashtags</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/hypertension" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">#hypertension</a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/hypertensionawareness" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">#hypertensionawareness</a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><a href="https://www.linkedin.com/feed/hashtag/nnt" style="background-color: var(--artdeco-reset-link-background-color-transparent); border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); font-weight: var(--font-weight-bold); margin: var(--artdeco-reset-base-margin-zero); overflow-wrap: break-word; padding: var(--artdeco-reset-base-padding-zero); text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">#NNT</a></p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"> </p><h3 style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); text-align: left; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);"><span style="background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; font-size: var(--artdeco-reset-base-font-size-hundred-percent); margin: var(--artdeco-reset-base-margin-zero); outline: var(--artdeco-reset-base-outline-zero); padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">References</span></h3><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[1] Kaul S. Evidence for the Universal Blood Pressure Goal of <130/80 mm Hg Is Strong: Controversies in Hypertension - Con Side of the Argument. Hypertension 2020;76:1391–9. doi:10.1161/HYPERTENSIONAHA.120.14648.</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[2] Port S, Demer L, Jennrich R, Walter D, Garfinkel A. Systolic blood pressure and mortality. Lancet 2000;355:175–80. doi:10.1016/S0140-6736(99)07051-8.</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[3] Mao Y, Ge S, Qi S, Tian QB. Benefits and risks of antihypertensive medication in adults with different systolic blood pressure: A meta-analysis from the perspective of the number needed to treat. Front Cardiovasc Med 2022;9:1–12. doi:10.3389/fcvm.2022.986502.</p><p class="reader-text-block__paragraph" style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background: var(--artdeco-reset-base-background-transparent); border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: var(--color-text); font-size: var(--font-size-large); font-weight: var(--artdeco-reset-typography-font-weight-normal); line-height: 1.75; margin: 1.6rem 0px; padding: var(--artdeco-reset-base-padding-zero); vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">[4] Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742. doi:10.1002/14651858.CD006742.pub2.</p></div></div></div></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-70217697594369457402019-04-05T11:21:00.003+02:002019-04-05T11:21:56.336+02:00How do you keep your cardiovascular system healthy from your fifties onwards?<div class="ui_qtext_para u-ltr u-text-align--start" style="color: #333333; direction: ltr !important; font-family: q_serif, Georgia, Times, "Times New Roman", "Hiragino Kaku Gothic Pro", Meiryo, serif; font-size: 15px; margin-bottom: 1em; padding: 0px;">
<b>Through robustification!</b></div>
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By making your cardiovascular system robust against aging.</div>
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Systems biology defines robustness as “… a property that allows a system to maintain its functions against internal and external perturbations.” [1]</div>
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When that “system” is your cardiovascular one, and the “perturbation” is aging then cardiovascular robustness is your ability to maintain cardiovascular function.</div>
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Measuring the latter gives you a benchmark to guide you to finding the strategies that work for YOU.</div>
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That’s important because not everything does. I’ll get back to that in a minute.</div>
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The other nice thing about robustification function is that it is your best bet at maintaining health AND living a little longer in good health.</div>
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Just look up the medical definitions of aging and chronic cardiovascular disease. Both share “progressive loss of function” as their key criterion.</div>
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So, why haven’t you heard before about robustness in the context of cardiovascular health? Because most medical practitioners and the majority of biomedical scientists haven’t taken note either.</div>
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Which is what all systems biologists find rather amusing. And which is why I have made it my vocation to change that (the “taking note” part, not the amusement). </div>
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If you really want to read the heavier stuff on this you’ll find it for example in the Journal of Applied Physiology or others [2,3].</div>
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The CV system is unique in that it is the only system of the human organism that connects each and every cell. After all, the CV system’s chief task is to supply every cell of every tissue in every organ with the nutrients, the oxygen and the signaling molecules they need.</div>
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To accomplish that, Mother Nature has designed this system as a closed hydraulic system:</div>
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Its center piece is a pulsating pump (the heart) that pushes blood through a network of elastic tubes (the arteries).</div>
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Keep in mind that it is not the pump that does most of the pushing but the arteries. They expand to receive the heart’s output, and then recoil to push this “bolus” of blood further downstream.</div>
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This ability to expand and to recoil, together with the arteries’ ability to change their geometry, is what determines CV function.</div>
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In fact, what typically deteriorates first is not the heart. It’s the arteries.</div>
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With aging, arteries become stiffer. They progressively lose their elasticity (the correct term is ‘compliance’ but elasticity is easier to visualize), which puts more and more strain on the heart, until that strain becomes intolerable.</div>
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Long story short: the physical parameters that define arterial function (predominantly compliance and resistance) are the ones that tell you how slowly or fast you age.</div>
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Keep those functional parameters in the green zone, and you will have made your CV system robust against aging.</div>
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The only problem: you can’t measure them, yet.</div>
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My team and I have developed tools to do just that.</div>
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We use a common medical blood pressure measurement technique, such as the ones you know from your doctor’s office, or that you may even use at home to measure your blood pressure.</div>
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Until this technology becomes available to everyone, you can only go by what you have right now.</div>
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And what you have is blood pressure.</div>
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Blood pressure is determined by all those functional markers that I mentioned earlier.</div>
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Stiffer arteries means higher pressure.</div>
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Greater resistance to flow (for example when arteries are narrowed) means higher pressure.</div>
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Now I come back to the point I made earlier: what works for YOU.</div>
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Only if you monitor your CV function will you have a guide to what works for you and what doesn’t. Absent any method to monitor function, your second best bet is blood pressure monitoring.</div>
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Not every type of exercise, not every dietary or other strategy works the same in any two people.</div>
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Here is an example.</div>
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Green et. al. investigated the change of CV function (measured as flow mediated dilation, FMD, an indicator for arterial compliance) in 800 individuals following an 8-weeks exercise intervention. The result was a 7% increase in FMD on average. For that marker ‘FMD’ 7% is impressive [4].</div>
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Now look at the graph below, which breaks down the result for every one of the participants:</div>
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<img class="landscape ui_qtext_image zoomable_in zoomable_in_feed" height="209" master_h="558" master_src="https://qph.fs.quoracdn.net/main-qimg-b8f8d8fd7491e74fde8d96198245eb1d" master_w="850" src="https://qph.fs.quoracdn.net/main-qimg-a1d9f845a4e78af3cba477049144cc4b" style="animation-duration: 0.001s; animation-name: insQ_100; border-radius: 3px; border: 0px; color: transparent; max-width: 100%;" width="320" /></div>
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Each vertical bar in this graph represents the change in function of one participant.</div>
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Hardly anyone had a 7% change. In fact, the range goes from getting worse to improving by almost 15%.</div>
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Now you understand why you shouldn’t go blindly with the recommendations doled out by people who simply parrot what has been published in scientific research.</div>
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Aside from the dangers of getting mislead by the pseudo-scientific prattling of food fundamentalists, hardcore exercisers and people in general who present more aspirational versions of themselves, there is an actual need to monitor the effects of whatever you do.</div>
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In answering a Quora question related to <span class="qlink_container"><a href="https://www.quora.com/At-what-point-should-I-admit-that-medication-is-the-only-way-to-control-my-blood-pressure/answer/Lutz-Kraushaar" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #2b6dad; text-decoration-line: none;">improving blood pressure</a></span> I have compiled a little chart that tells you where your CV system’s functional markers should be.</div>
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Monitor them regularly and compare their development against anything you do to improve CV health. You will soon find out what works for you.</div>
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Now here comes my personal anecdotal evidence.</div>
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I am 62, my wife is 64.</div>
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We have exercised for the past 20 years almost every day.</div>
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For the past 5 years we have practiced intermittent fasting (last meal of the day is at latest 15:00 – 16:00, following day’s breakfast comes at 09:00 after 60-90 minutes exercise, including high-intensity cardio routines and strength training). Breakfast consists of a smoothie that I designed to specifically address arterial function.</div>
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Our CV function places us at a biological age of around 40. The same goes for blood biomarker profiles.</div>
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Additionally, my wife has preserved the looks and the figure of a much younger age, as you can see from the admittedly amateurish <span class="qlink_container"><a class="external_link" data-qt-tooltip="youtu.be" href="https://youtu.be/hkAHuJfhFPo" rel="noopener nofollow" style="background-attachment: initial; background-clip: initial; background-image: url("//qsf.fs.quoracdn.net/-3-images.new_grid.external_link.svg-26-7f84ed22dfd7e97b.svg"); background-origin: initial; background-position: 100% 50%; background-repeat: no-repeat; background-size: 10.5px; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">video clip</a></span> I made a few days ago.</div>
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Will that work for you?</div>
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It will in all likelihood do you no harm and probably improve your CV robustness. But the most essential point is: monitor your intervention’s effect on the markers of CV function. Even if you have only blood pressure to go by.</div>
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And if you are successful, you might even inspire others to pose that same question of yours already at a younger age. Because CV function begins to decline in mid-twenties already.</div>
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The earlier you start, the better.</div>
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Good luck.</div>
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<br /></div>
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<b><i><span style="font-size: x-small;">Bibliography</span></i></b></div>
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<span style="font-size: x-small;">1. Kitano H. Towards a theory of biological robustness. <i>Mol Syst Biol</i> 2007;<b>3</b>:137.</span></div>
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<span style="font-size: x-small;">2. Kraushaar LE, Dressel A. The cardiovascular robustness hypothesis: Unmasking young adults’ hidden risk for premature cardiovascular death. <i>Med Hypotheses</i> 2018;</span></div>
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<span style="font-size: x-small;">3. Kraushaar LE, Dressel A, Massmann A. A novel principled method for the measurement of vascular robustness uncovers hidden risk for premature CVD death. <i>J Appl Physiol</i> 2018;japplphysiol.00016.2018.</span></div>
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<span style="font-size: x-small;">4. Green DJ, Eijsvogels T, Bouts YM, Maiorana AJ, Naylor LH, Scholten RR, Spaanderman MEA, Pugh CJA, Sprung VS, Schreuder THA, Jones H, Cable T, Hopman MT, Thijjssen DH. Exercise Training and Artery Function in Humans: Non-Response and Its Relationship to Cardiovascular Risk Factors. <i>J Appl Physiol</i> 2014;</span></div>
Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-62299398614009778422019-03-19T09:32:00.002+01:002019-03-19T09:32:43.493+01:00Weight Loss Aside, What Health Benefits From Intermittent Fasting?<!--[if gte mso 9]><xml>
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<!--StartFragment-->
<br />
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">I have been asked this question often enough to address it here.</span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Whether,
and to which extent intermittent fasting (IF) transforms human health still
needs to be seen, but there are some indications for beneficial effects. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">IF refers
to dietary patterns in which individuals (a) have no or very little energy
intake for extended periods of time (e.g. 16–48 h), while having normal energy
intake between these periods, and (b) follow this interval pattern on a
recurring basis.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Naturally
it is much easier to test the effects of such dietary patterns in shorter lived
animals than in humans. Mice, with an average lifespan of 3 years, can give us
much faster insight into intervention effects on health and life expectancy. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Some of the
more promising effects of IF in animal models is improved glucose handling
(relevant for preventing diabetes), and in aging related diseases such
cardiovascular disease, Alzheimer’s dementia, and frailty.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">One of the
key pathways through which IF seems to work is cellular senescence, the aging
of cells, that ultimately leads to functional decline and death. The fasting
promotes an upregulation of the cellular repair mechanisms that are essential
for keeping cells functional and preventing cell cycle arrest.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">There is
still a lot to be investigated because outcomes vary by animal model, IF
protocol, age at which IF is introduced, and duration of the intervention. The
same will probably hold true for humans.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Taken
together, what we can safely say is that IF doesn’t harm you, in all likelihood
improves glucose handling and potentially has some protective effects against
cellular aging. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">To which
extent these effects prevent disease events (such as heart attacks, stroke,
dementia) remains to be seen. We simply have insufficient data to claim either
way. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">The problem
is that trials capable of showing such effects need to be of durations that are
longer than what human participants willingly endure. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">That’s why
IF became a surrogate, and more tolerable, protocol for caloric restriction
(CR) in the first place. CR refers to continuous restriction of energy intake
to 30-50% below normal, while ensuring adequate nutrient supply. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">This
protocol has produced substantial expansion of life expectancy in primitive organisms,
such as C. elegans (a microscopic round worm whose life is measured in days
rather than in years). <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">But the
higher up you go on the complexity ladder of species, the lower the returns. Still,
in primates, our closest relatives, significant beneficial effects on health
and life expectancy have been documented.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Unless you
are really prepared to adopt a CR or IF lifestyle for good, my guess is that you
may experience some subjective effects on health, but they will dissipate
rather quickly, once you return to “normal”. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Let me give
you a personal example. My wife and I have made IF a regular affair. Last meal
of the day is latest at 16:00, first meal of the following day comes at
sometime between 09:00 and 11:00, and always after 60-90 minutes pre-breakfast moderate-to-high
intensity workouts. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Let’s call
this a n=2 experiment/trial. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">It gives us
a 17-19 hours food-free period. Deduct from this 4 hours for the post-prandial
period (the period of nutrient absorption following the day’s last meal) and we
have a net fasting period of 13-15 hours. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">We have
been doing this for approximately 5 years now. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">With my
research focus on healthy aging and cardiovascular functionomics, I have, of
course, designed this “trial” in accordance with best evidence, and I have the
advantage of being able to monitor physiological functions for the 2 of us
regularly, using a medical device that I specifically developed (together with
my team) for this purpose.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Cutting a long
story short: at 64 my wife has the cardiovascular function and fitness of a
35-years old woman, the body contour many 40-year olds wouldn’t mind to have
(Just put a few seconds of, admittedly amateurish, video clips together, to <a href="https://youtu.be/hkAHuJfhFPo" target="_blank">prove my point</a>).
<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">At 2 years
younger than her, I am not that lucky, but still can compete in the age range
of men 20 years younger than I. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">I attribute
this to the summation of physical exercise, IF and dietary quality. In science
speak, this is, however, only anecdotal evidence.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">So, if you
want to find out for yourself, go with the Nike motto: <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><b>Just Do It.
</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--><br />Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-26221306656372020812019-03-10T17:18:00.003+01:002019-04-05T15:01:19.422+02:00The Whole Superfood Thing is Way Overblown!<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">This whole
„superfood“ thing is way overblown. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEignvXAISC7Cv0KPZ9Fxq1VLA96mUukMnbFTYf2fsr7YgZybb_by61SHgTSy2N2gTszfpiwLH2mbVF59Du-E23oH4iaCB2N7Y3JpGr4MpSSvgYAQOvsHZRokpRqsnS6Nb1QpKoDjuDnx3o/s1600/shutterstock_109977452.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="775" data-original-width="1000" height="248" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEignvXAISC7Cv0KPZ9Fxq1VLA96mUukMnbFTYf2fsr7YgZybb_by61SHgTSy2N2gTszfpiwLH2mbVF59Du-E23oH4iaCB2N7Y3JpGr4MpSSvgYAQOvsHZRokpRqsnS6Nb1QpKoDjuDnx3o/s320/shutterstock_109977452.jpg" width="320" /></a></div>
<br />
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">It is not
just overblown, it is a confession of failure.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Failure on the part of preventive medicine, of public health, of all
of us. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">When we
celebrate avocados, apples or anchovies as superfoods what does that make us – us,
mankind, the most intelligent animal on this planet? <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">It makes us
stupid. Seriously!<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Why?
Because we have come to a point where something that grows on trees, germinates
in soil, or swims in the sea is proclaimed a superfood.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">“Super”
compared to what? <o:p></o:p></span></div>
<div class="MsoNormal">
Quite
obviously to what we are eating most of the time. Next to pizza and potato
chips almost anything edible that you pluck from a tree, dig out of the soil or
catch in the sea is a superfood.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Medicine
and public health don’t talk about superfoods. </span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Don’t even acknowledge it as a
valid term. If they did, it would be the Trumpism of public health: Dressing up
a failure as a victory. AND THEN BELIEVING IT, TOO.</span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">No
matter how much lipstick you put on a pig. It still is a pig.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">How did we
get here? <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">If you ask
the left leaning folk, it’s of course the food industry. The evil purveyors of cereals,
snacks and sodas. Villains going by the names of McDonalds, Nestle, Pepsi.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">No doubt, these
companies’ marketing messages contain a high dose of “alternative facts”. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">But it’s
not that we buy their dreck because they lie to us. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">WE BUY
BECAUSE WE ENJOY IT. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">We create
the demand, and they service that demand. So what solution do the left leaning
folk offer? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Taxation. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Forgive
them. It’s their thing. Their only thing. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">They claim
the numbers are on their side. And, to some extent, they are.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Increase
tobacco tax, and fewer people smoke cigarettes. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Increase
sugar tax, and people start to go easy on their sweet tooth. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Across a
population taxation translates into some measurable health gains: fewer cases of heart
attacks, diabetes, cancer. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Now, I
don’t know about you, but with me, this tax thing doesn’t sit well. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">For two
reasons. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">First,
taxes punish all those of us who manage to have a healthy relation with enjoyable
junk. We indulge occasionally, but we don’t drown ourselves in chips,
cheeseburgers and chocolate pies on a daily basis. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">If YOU can
handle these things AND stay healthy and fit, why should YOU be punished for other
people’s sins?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Second, such
an “amusement” tax is pure hypocrisy. Just think about the withdrawal symptoms
a government would suffer if, all of a sudden, nobody consumed those taxed
sugars and junk foods anymore. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Well, we
all know, this is not going to happen. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">That leaves the government, and the lefties, in the role of cops who tell the
junkies on their beat to NOT DO DRUGS - and then happily collect a percentage from
the dealers’ trades. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span>
<span lang="EN-US" style="mso-ansi-language: EN-US;">Taxation is
all stick, no carrot.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Do the right-leaning
folk have a better solution? <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Ask them
and they will talk about freedom of choice. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Everybody should
have the freedom to choose what they put into their mouth. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">If you choose
the things that make you fat, sick, and ultimately a nursing case, then you are
obviously not the brightest bulb in the chandelier. </span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">The numbers are on their side,
too. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">The
diseases of over-indulgent lifestyles follow an educational gradient. </span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">In plain
English: the lower the education, the lower the rank on the social ladder, and the
fatter and sicker the people are and the shorter their lives because of that. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">So much about the
no-stick, no-carrot approach.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Where left-
and right-leaning folk agree is education. Educate the people. Tell them about
their risks, about the consequences of living on the sofa with junk food in one
hand and the remote control in the other. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Not a bad
idea. If it wasn’t for the naïve expectation that education is enough. </span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">That people
who are made to know about their risk will suddenly and willingly jump into
line. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">If that was
the case, we wouldn’t have the epidemics of obesity, of avoidable heart disease
and cancer.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">But we do. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">And the
last 30 years of education haven’t changed that. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Neither has
public health. They do what Einstein had once described as the definition of
insanity (or was it stupidity?): Doing the same thing again and again and
hoping for a different outcome. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">It’s doomed
to fail. That’s where I started this article: the confession of failure. So,
what all these articles about superfood really are telling you – in this modern
way of blowing everything out of proportion because otherwise we wouldn’t
listen – is that the least processed food may actually be far better for you than
anything the food industry has to offer. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">That’s
where the discussion about superfoods becomes meaningful. By alerting you to
the fact that what nature provides can hardly be improved upon. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">It’s “super”
in itself. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">So, just be
aware of what makes natural food exponentially less super, and you should be
alright. No need for gurus’ advice on superfoods.<o:p></o:p></span></div>
<!--EndFragment--><br />Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-84296065453478869432018-07-19T12:35:00.000+02:002018-07-19T12:35:07.715+02:00Fake Science: Deviant Science? Or Deviant Journalism?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDG9dW_86NaPr7-oDte6rkCqpm1n0JTxaYIlI_GsR-xBu0xoTGMdeIQYoTc8fm5zSmW942WNawwzyTwT9Lk8v4G0AkPW74ID3uNRuj47NNfyUPKDYHDh32rCFhwUTrqNgx2c1JP8JkTQc/s1600/iStock_000018588277XSmall_adj.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="296" data-original-width="280" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDG9dW_86NaPr7-oDte6rkCqpm1n0JTxaYIlI_GsR-xBu0xoTGMdeIQYoTc8fm5zSmW942WNawwzyTwT9Lk8v4G0AkPW74ID3uNRuj47NNfyUPKDYHDh32rCFhwUTrqNgx2c1JP8JkTQc/s200/iStock_000018588277XSmall_adj.jpg" width="189" /></a></div>
<br />
<span style="font-size: large;">Today, the German media are treating us to science-gate. </span><br />
<span style="font-size: large;">A story about pseudoscientific studies, predatory journals and their publishers.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">With the typical subliminal insinuations of an entire science community being untrustworthy.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Do they have a point? Or don’t they?</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">I believe they don’t. But I am biased. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">"Biased" is something I shouldn’t be as a scientist. </span><br />
<span style="font-size: large;">But remaining unbiased is so damned difficult when some media hacks and talking heads rehash an old, well-known and controlled phenomenon to taint an entire profession’s credibility.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Had those hacks just searched google for “predatory publishing” or “predatory journals” they could have discovered that phenomenon 8 years ago. </span><br />
<span style="font-size: large;"><a href="https://en.wikipedia.org/wiki/Predatory_open-access_publishing" target="_blank">Wikipedia</a> has devoted an article on the matter. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">But claiming “investigative journalism” is a lot cooler than reading <a href="https://en.wikipedia.org/wiki/Predatory_open-access_publishing" target="_blank">Wikipedia</a>. </span><br />
<span style="font-size: large;">And English is also not part of every German journalist’s toolbox. Otherwise, they would have discovered <a href="https://beallslist.weebly.com/" target="_blank">Jeffrey Beall’s</a> list of predatory journals and publishers. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Already in 2010. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Since then, the University of Colorado Denver librarian and researcher keeps his list of questionable journals painstakingly up to date. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">No scientist who takes his research work and academic career serious will publish his manuscripts in any of those journals. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Every one of my colleagues would rather not publish at all than work with any of those journals. </span><br />
<span style="font-size: large;">Not as an author and not as an editor.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">But I also know why predatory publishing thrives. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Part of the blame falls on the reputable publishers and their business model. </span><br />
<span style="font-size: large;">It is insanely attractive to anyone who is after profit margins that exceed even those of Google. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">That’s what the media monkeys either don’t get, or don’t tell their consumers.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">You’ll immediately see it when you compare the science publishers’ business model to that of a regular newspaper publisher. </span><br />
<span style="font-size: large;">The latter employs and (hopefully) pays its writers. </span><br />
<span style="font-size: large;">The publisher also needs to employ the editors. </span><br />
<span style="font-size: large;">And he has to do the selling and marketing. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">None of that burdens the science publisher. </span><br />
<span style="font-size: large;">His authors are the ones who hand in their manuscripts. </span><br />
<span style="font-size: large;">His editors are the authors’ peers who review the manuscripts, and who help improve them before these manuscripts will be published. If they get published at all. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">It’s called peer review. And nobody gets paid for it. </span><br />
<span style="font-size: large;">Neither the authors nor the editors. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">How many weekends do we spend reviewing papers. </span><br />
<span style="font-size: large;">Voluntarily, of course. </span><br />
<span style="font-size: large;">Because the publishers flatter us about our competencies. </span><br />
<span style="font-size: large;">And because we feel that we have to give back to the science community on whose members’ reviews of our own manuscripts we depend. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Until this point, the science publisher has zero costs. </span><br />
<span style="font-size: large;">Other than what is necessary to manage the flood of manuscripts vying to be published. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And here comes the real genial part of this business model.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">The research work that is the subject of a manuscript has typically been paid for by some public institution. </span><br />
<span style="font-size: large;">These institutions are mostly the same that finance our universities and their libraries which have to pay the subscription fees for these journals.</span><br />
<br />
<span style="font-size: large;">In other words: those who pay for the research, have to pay for the right to read the papers that describe and present the research results. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">No wonder the business model “scientific publishing” churns out better profits than even Google.</span><br />
<span style="font-size: large;">And we scientists are doing all the work.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">That there is no shortage of willing authors is due to academia’s career model. Publish or perish is what describes it in three words. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And mind you, getting a manuscript to be published is not a walk in the park. </span><br />
<span style="font-size: large;">Even in low-impact-factor journals the majority of manuscripts received will not make it from the assistant editor’s desk though the peer review and to publishing.</span><br />
<br />
<span style="font-size: large;">That’s why we often need to submit our manuscripts to several journals. Not at the same time, mind you. </span><br />
<span style="font-size: large;">Because journals frown on parallel submissions, and sanction it heavily if we dare to do it. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Despite all these obstacles, publishing in predatory journals is not an option for the overwhelming majority of us. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Not least because of pride. Nobody wants to refer to a paper that has been published in a journal that colleagues immediately recognize as a pseudo-journal. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Only journalists don’t know that. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Which bespeaks deviant journalism rather than deviant science. </span>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-1689182742773756582018-07-19T10:09:00.000+02:002018-07-19T10:09:45.252+02:00Fake Science. Wissenschaft auf Abwegen? Oder Journalismus auf Abwegen?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjfKEZjsIygGd2M1Ew0-2yXvLY5W_Z6caqlCjvT3W73uwXRcbg6QNkqaHl4RfsyfuHztKVMF7YJd5hUAQ-rZRsoAmnQjPcOqY_u6N9I_hIfV3BlUMJ0o34Iut0DogkOoeeU9pvMCvQYdk/s1600/iStock_000018588277XSmall.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="297" data-original-width="404" height="146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjfKEZjsIygGd2M1Ew0-2yXvLY5W_Z6caqlCjvT3W73uwXRcbg6QNkqaHl4RfsyfuHztKVMF7YJd5hUAQ-rZRsoAmnQjPcOqY_u6N9I_hIfV3BlUMJ0o34Iut0DogkOoeeU9pvMCvQYdk/s200/iStock_000018588277XSmall.jpg" width="200" /></a></div>
<br />
<span style="font-size: large;">Mit sogenannten Recherchen und Reportagen über pseudowissenschaftliche Studien und scheinwissenschaftliche Verlage ziehen schadenfreudige Journalisten heute den deutschen Wissenschaftsbetrieb in ein schlechtes Licht. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Zu Recht oder zu Unrecht? </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Ich behaupte, zu Unrecht, aber ich bin voreingenommen. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Als Wissenschaftler sollte man das zwar nicht sein. </span><br />
<span style="font-size: large;">Aber Unvoreingenommenheit fällt schwer, wenn Zeitungsschreiber und Fernsehschwätzer ein altes, längst bekanntes und gut kontrolliertes Phänomen sensationalisieren, um damit einen ganzen Berufsstand dem Generalverdacht der Unglaubwürdigkeit auszusetzen. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Hätten sie nur mal nach dem Stichwort "predatory publishing" oder "predatory journals" gegoogelt, hätten sie sich schon vor 8 Jahren mit dem Phänomen der "Raubverlage" vertraut machen können. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Sogar auf <a href="https://en.wikipedia.org/wiki/Predatory_open-access_publishing" target="_blank">Wikipedia</a>. Aber Enthüllungsjournalismus ist eben cooler als Wikipedia zitieren. Und Englisch ist halt auch nicht Jedermann's Ding. Sonst wären sie nämlich schon 2010 auf der Jeffrey Beall's <a href="https://beallslist.weebly.com/" target="_blank">Webseite</a> gelandet, der in akribischer Kleinarbeit seine Liste der Raubverlage und ihrer "Fachzeitschriften" bis heute aktuell hält. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Kein Wissenschaftler, der seine Forschungsarbeit und seine akademische Karriere ernst nimmt, veröffentlicht in solchen Verlagen. </span><br />
<span style="font-size: large;">Ich kenne in meinem Kollegenkreis niemanden, der diese Raubverlage nicht meidet, wie der Teufel das Weihwasser. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Weder eine Publikation noch eine Rolle als Editor in einem dieser Verlage würden wir auch nur einen Moment lang erwägen. </span><br />
<span style="font-size: large;">Ich weiss, dass ich hier für die deutliche Mehrheit meiner naturwissenschaftlichen Kollegen spreche. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Ich weiss aber auch, warum dieses Phänomen der Raubverlage entstand, und warum sie gedeihen wie das Unkraut im Garten. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Nicht zuletzt tragen die wissenschaftlichen Verlage selbst zum Florieren ihrer räuberischen Kollegen bei. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Was dem Medienkonsumenten nämlich verschwiegen wird, ist das Geschäftsmodell der Wissenschaftsverlage, das man entweder als genial oder als ausbeuterisch bezeichnen kann. Oder als beides. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Anschaulich wird das im Vergleich mit einem "normalen" Zeitungsverlag. Der muss seine Autoren beschäftigen (und bezahlen). Der beschäftigt auch die Editoren, die die Autorenarbeiten querlesen und korrigieren. Der Zeitungsverlag muss sich auch um den Verkauf seiner Zeitungen kümmern. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Beim Wissenschaftsverlag läuft das alles ganz anders.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Die Autoren muss der nicht bezahlen, denn das sind ja die Wissenschaftler, die die Artikel schreiben. </span><br />
<span style="font-size: large;">Seine Editoren muss er auch nicht bezahlen, denn das sind wiederum Wissenschaftler, die die Arbeiten ihrer Kollegen querlesen und kommentieren. </span><br />
<span style="font-size: large;">Freiwillig und unbezahlt natürlich. Peer review nennt sich dieser Prozess, den jede wissenschaftliche Arbeit durchlaufen muss. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Wie viele Wochenenden verbringen wir mit freiwilliger und unbezahlter Peer Review, zu der wir von den Verlagen natürlich "eingeladen" werden, weil die uns mit der Wertschätzung unserer Kompetenz bauchpinseln. </span><br />
<span style="font-size: large;">Und weil wir natürlich auch was zurückgeben wollen an den Wissenschaftsbetrieb, dessen Mitglieder unsere Arbeiten querlesen und kommentieren. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Bis dahin also hat der Wissenschaftsverlag null Ausgaben. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Und hier beginnt das wirklich Geniale: </span><br />
<span style="font-size: large;">die Forschungsarbeiten, die Gegenstand der Manuskripte der Autoren sind, werden mehrheitlich von öffentlichen Forschungsgeldern finanziert. </span><br />
<span style="font-size: large;">Forschungsgelder, die von Einrichtungen des Bundes oder der Länder kommen, jener Einrichtungen, die auch die Hochschulen finanzieren, deren Bibliotheken die Abonnements der Fachzeitschriften bezahlen müssen. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Mit anderen Worten, diejenigen die die Forschungsarbeiten bezahlen, müssen dann auch noch dafür bezahlen die Arbeiten lesen zu dürfen. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Kein Wunder also, dass das Geschäftsmodell "wissenschaftlicher Fachverlag" noch bessere Gewinnspannen hat als Google. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Und wir Wissenschaftler machen die ganze Arbeit. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Dass die Verlage keinen Mangel an willigen Autoren haben ist dem akademischen Karrierebetrieb zu verdanken. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Publish or perish ist dessen Motto, was soviel heißt wie "wenn du keine veröffentlichten Manuskripte vorweisen kannst, wird's auch nix mit der Karriere in Akademia". </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Selbst bei Fachzeitschriften mit relativ niedrigem Impact Factor schafft es nur ein Bruchteil der eingereichten Manuskripte vom Tisch des Redakteurs durch das Peer Review und in die Veröffentlichung. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Deshalb müssen wir für unsere Manuskripte häufig bei mehreren Verlegern anklopfen, natürlich nie zur gleichen Zeit, denn das verbitten die sich und sanktionieren es auch heftig, sollte man es trotzdem tun. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Dennoch ist für die allermeisten wissenschaftlichen Kollegen die Veröffentlichung in Raubverlagen keine Option. </span><br />
<span style="font-size: large;">Alleine schon aus Stolz. </span><br />
<span style="font-size: large;">Keiner von uns will auf eine Veröffentlichung in einem Verlag verweisen, den alle Kollegen sofort als Raubverlag erkennen. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Nur die Journalisten kennen sich da natürlich nicht so aus, was aber eher für Journalismus auf Abwegen spricht als für Wissenschaft auf Abwegen. </span><br />
<br />Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com097956 Werbach, Germany49.6710091 9.641414199999985649.5888331 9.4800526999999857 49.753185099999996 9.8027756999999855tag:blogger.com,1999:blog-2058017873235758512.post-90905006367171029882018-07-08T11:43:00.001+02:002018-07-08T11:47:15.101+02:00Functionomics, your necessary back-up plan for a longer better life.<b><span style="font-size: large;">The first person to live up to 150 years has already been born.</span></b><br />
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<br />
<br />
<span style="font-size: large;">That's what Steven Austad, David Sinclair and Stuart Kim think.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">All three are Professors: </span><br />
<span style="font-size: large;">Of Biology, of Genetics and of Developmental Biology respectively.</span><br />
<span style="font-size: large;">Sinclair at Harvard Medical School and Kim at Stanford University.</span><br />
<span style="font-size: large;">Just in case you thought I quote some nutcase science colleagues.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Now, imagine, you being that person living to 150.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">You'd only enjoy the privilege if you could live <i>fully functional</i> 150 years.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">That's quite the opposite of how we experience aging today: a gradual loss of function.</span><br />
<span style="font-size: large;">It typically leads to dementia, heart disease, cancer, diabetes, frailty, you name it.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Treat that loss of function before it has deteriorated into any of those chronic diseases, and you not only prevent the diseases but you also extend your fully functional lifespan.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Treatment of function means an extension of lifespan and freedom from disease.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">No need to be a professor to get that point.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">But you apparently need to be in medicine to NOT GET IT.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">With its refusal to acknowledge aging as a medical condition, medicine is guilty of causing bodily harm:</span><br />
<span style="font-size: large;">By withholding the treatment for functional decline until this treatable condition has deteriorated into one or several incurable diseases.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">These diseases are not called chronic for nothing.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">That's why I am an advocate for treating aging like a disease.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">That's why our professors are big fans of two cool strategies:</span><br />
<span style="font-size: large;">Strengthening the innate repair mechanisms and bio-engineering the necessary repair or replacement technologies.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">Back to the question whether you will make it to 150.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Probably not.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Because by the time these new strategies will have found their way into the clinic, you'll be dead.</span><br />
<span style="font-size: large;">I am pretty sure I will be.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span>
<br />
<blockquote class="tr_bq">
<span style="font-size: large;">Initial exuberance about any new biomedical insight is rarely justified. Just check back at the decoding of the human genome. </span></blockquote>
<blockquote class="tr_bq">
<span style="font-size: large;">Genomics was then hyped as THE hack for personalized disease prediction and prevention. Ten years later the sobering realization: "The numerous genetic variants that mediate disease risk … are thus meager in their predictive power. " [1].</span></blockquote>
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">So, don't bet on getting any lifespan extension treatments within your lifetime.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><b><br /></b></span> <span style="font-size: large;"><b>UNLESS</b>…</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">… you start with a third strategy. It's called <i>robustification against aging</i>.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">It simply means to slow down, stop or even reverse the functional decline that comes with age.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">Now imagine, if we could quantify and measure your organism's robustness against all the things that <i>can</i> go wrong under the hood we can keep it robust.</span><br />
<span style="font-size: large;">The best part is, we do not need to know the myriad of things that eventually <i>will</i> go wrong under the hood.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">Surprisingly, measuring function is something sorely neglected in medical science.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">That's where <i class="">functionomics</i> enters the stage.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Let's take the cardiovascular system as an illustrative example.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">This system's failure is the cause of roughly half of all deaths (which is one reason why I have made it my <a href="http://www.lutzkraushaar.com/" target="_blank">priority</a>).</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Its purpose is to deliver oxygen and nutrients to each and every cell of all organs.</span><br />
<span style="font-size: large;">And then to carry away all the cells' waste products that come from metabolizing these nutrients and oxygen.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">It has a second purpose: to unburden the heart, by actively pumping the blood through its conduits (the arteries).</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">The cardiovascular system does its job as a purely hydraulic system. </span><br />
<span style="font-size: large;">Therefore cardiovascular function can be fully described by the same physical parameters that engineers use to build hydraulic systems.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">The tool to describe and quantify the cardiovascular hydraulics is <i>cardiovascular</i> <i class="">functionomics</i>.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">It's a profile of all the functional parameters that together determine your system's functional capacity. Much like your genomic profile determines your inheritance.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Translate that functionomic profile into a correction factor of your calendar age, and we have two vital things.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;"><i>First</i>, we know how robust you are against threats to this system.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><i>Second</i>, we have a benchmark that can tell us how good we are in robustifying you, say, with a drug or exercise or diet.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">We do not need to know what exactly it is that might be threatening YOUR system, as long as we know that YOU are robust enough to withstand anything that CAN happen.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">What is the net effect of 'robustification the <i>functionomics</i> way'?</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">It buys you time.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">It may be only a couple of years, say, a decade.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">But 10 years of staying functionally fit may make a sizable difference, between on the one hand living long enough and in good enough health to benefit from future technologies of rejuvenation, and on the other hand missing that boat.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">Because, even if our professors' exuberance may be a bit overboard, we are pretty close to some exciting new life and health extension technologies. </span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;">And if it wasn't for medicine, we would be much further ahead on that path by now.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">That's why I conceived of functionomics.</span><br />
<span style="font-size: large;"><br /></span> <span style="font-size: large;"><br /></span> <span style="font-size: large;">It may make you, and me, the first ones to make it to a healthy 150 after all.</span><br />
<span style="font-size: large;"><br /></span>
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<b>Bibliography</b><br />
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope return"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri; mso-no-proof: yes;"><br /></span></div>
Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com097956 Werbach, Germany49.6710091 9.641414199999985649.5888331 9.4800526999999857 49.753185099999996 9.8027756999999855tag:blogger.com,1999:blog-2058017873235758512.post-30049964765240034322018-07-02T10:00:00.000+02:002018-07-02T10:00:06.668+02:00Is Robustification Against Aging An Alien Concept?<br /><br /><span style="font-size: large;"><b>Remember the movie Cocoon? </b></span><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAPaOK0wwD0N6DJpfHmWujlZB4OKdX_Hv_iUALX1J_tfCs0PSQNk1klVYF6F5HpFQQBP1DPYL940HF6TwZM87p5q6D-obYSCSYyG2N_nIFfdNtgYnFdJm_GZz_yRzFBR2KvlFEy3T2vF4/s1600/shutterstock_104809859_man_old-young.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAPaOK0wwD0N6DJpfHmWujlZB4OKdX_Hv_iUALX1J_tfCs0PSQNk1klVYF6F5HpFQQBP1DPYL940HF6TwZM87p5q6D-obYSCSYyG2N_nIFfdNtgYnFdJm_GZz_yRzFBR2KvlFEy3T2vF4/s320/shutterstock_104809859_man_old-young.jpg" /></a><br /><br /><br /><br /><span style="font-size: large;">Some nursing home residents accidentally discover the rejuvenating force of benevolent alien visitors. <br /><br />In the end they are given a choice:<br /><br />join the aliens for a supposedly eternal life, free from sickness, frailty and death, <br /><br />or stay on Earth with the admittedly bleaker prospects that the rest of us face…</span><a href="https://www.lutzkraushaar.com/blog/is-robustification-against-aging-an-alien-concept"><span style="font-size: large;">continue</span></a><div>
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Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com0tag:blogger.com,1999:blog-2058017873235758512.post-87050587225577111062018-06-26T12:25:00.000+02:002018-06-26T12:34:41.774+02:00How preventive medical treatment has become a risk factor.<span style="font-size: large;"><b>First, do no harm! </b></span><br />
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<span style="font-size: large; text-align: center;">It's a pledge that medicine does not live up to. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgc7DXM6obmVj0T3DgdbwVlGrR5hrMVdTG-7aBiRRbGY4xp3kUEnovGgtgDmzlsxZ7RBgc7Sj8c9nSFf9l8mjA0LbS6RZUoTf5_pYesqq3oMvMCt2M5PHjPpX6deECwAgO4cYVPECQmUY/s1600/iStock-519158060RiskFactorMedicine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1044" data-original-width="1600" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgc7DXM6obmVj0T3DgdbwVlGrR5hrMVdTG-7aBiRRbGY4xp3kUEnovGgtgDmzlsxZ7RBgc7Sj8c9nSFf9l8mjA0LbS6RZUoTf5_pYesqq3oMvMCt2M5PHjPpX6deECwAgO4cYVPECQmUY/s320/iStock-519158060RiskFactorMedicine.jpg" width="320" /></a></div>
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<span style="font-size: large;">Much of what medical science offers, be it a drug, a treatment or some advice about supplements or diets, will probably not work for you and possibly do you some harm. </span><br />
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<span style="font-size: large;">If I was the only one telling you this, you could be forgiven for just waving me off. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">But if a Stanford professor of medicine, health research and statistics tell you "Why most published research findings are false" you may want to <a href="https://www.lutzkraushaar.com/blog/info-adiphea-com" target="_blank">listen …</a></span>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com097956 Werbach, Germany49.6710091 9.641414199999985649.5888331 9.4800526999999857 49.753185099999996 9.8027756999999855tag:blogger.com,1999:blog-2058017873235758512.post-50638553106742686372012-09-03T07:30:00.000+02:002016-03-10T13:45:23.683+01:00Why We Are Slaves Of Food Obsession.<br />
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A 95 years old psychology article holds the key to solving the obesity epidemic. It's not about a long forgotten medicine or an ancient psycho-trick. It's a simple observation about the dynamics of feeding. Vindicated by neurohormonal research, here is what it means to your struggle with extra pounds.
<a href="http://twitter.com/home/?status=%20Why%20We%20Are%20Slaves%20Of%20Food%20Obsession.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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When Wallace Craig dissected the feeding behavior of doves, his experimental animal of choice, he discovered the existence of two distinct phases - an appetitive and a consummatory phase [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Craig,%201917%20#9401%22">1</a>]. He defined appetite as "a state of agitation", which continues until food is presented, whereupon phase 2 begins. That's the phase you and I call eating. It's followed by a third phase of relative rest, which Craig called the state of satisfaction. You are forgiven if you now ask "what science nugget could possibly be hidden in this platitude". But the best-hidden gems are often those, which are in plain sight. In this case it's nothing less than the model explaining why so many of us wear dress sizes, ranging from "XL" to "Oh my God, look at this!", while none of us actually wants to be seen in them. </div>
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Before I get to the beauty of Craig's observation, let me also tell you what's the acid test for any biological model: it must make sense in evolutionary biology. If it does, it still may not be the final word, but if it doesn't we can safely discard it into the heap of wishful thinking. Keeping this in mind, let's get cracking.</div>
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When Craig published his paper in 1917 he described the behaviors of his doves as instinctive. In other words, being driven by some innate processes which require no conscious decision making nor any degree of intellect. Today we know a lot more about those "innate processes", particularly that they are the result of a complex conversation between neurons and hormones playing out in the recesses of the animal brain. Not only do we know the chains of command running from brain centre to periphery we also know the hormones (at least some of them) by names, such as Neuropeptide Y (NPY) or Leptin. You don't need to remember them. What you need to remember is that "instinctive" has matured from a black box stage to the stage of neurohormonal mechanisms, which can be tested quantitatively in the lab with experimental animals. </div>
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As you may have guessed, I didn't mention NPY and leptin by chance. Both are relatively new kids on the block, with NPY having been discovered in 1982, followed by leptin 12 years later. Now what do they have to do with eating behavior?</div>
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NPY is the most potent "orexigenic" peptide currently known. That's science speak for appetite stimulating peptide. Now you also know what it means when I tell you that leptin's effect is just the opposite, that is, anorexigenic, or appetite suppressant. Inject NPY into the right places of a rat's brain and it will turn into a voracious eater. Give obese rats leptin, and they slim down. </div>
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Wonderful, you might say, so we do have a cure for obesity. That's what researchers thought, too. But it turned out that leptin administration does not help overweight people to lose weight. That's one of the problems with animal experiments: What works in rats does not necessarily work in man, even if our behaviors are often indistinguishable. </div>
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Back to our feeding issue. With ethics boards being as they are, we won't get their approval for experimental NPY injections into people's brains just to watch their eating behaviors. But we do know that NPY is operational in humans as much as in rats and many other animals, and within the same brain centers. So, a rat model is still our best bet at studying how hormones affect human feeding habits. </div>
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Now, one of behavioral sciences' problems with animal experiments in the lab is that an animal, which is kept in a cage, is not a good model for that animal's behavior under free-living conditions. Of relevance to our topic is the free-living animal's need to procure food before it can consume it. This go-and-get-food stage typically involves a fair amount of foraging or hunting, depending on the type of animal and its position on the food chain. It's what Craig had called the state of agitation of his captive doves. How is all this relevant to NPY's orexigenic role? Well, in 1995 Seely and his colleagues wanted to know exactly how NPY does its fattening job [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Seeley,%201995%20#18345%22">2</a>]. In an experiment they discovered that NPY injection did not increase the amount of food rats ingested from an orally injected sugar solution. What they did increase was their trips to a bottle from which they had been trained to take food (sugar solution). In other words, NPY sort of activated the rats go-get-food autopilot, but it didn't drive them to ingest more food when this food was presented intra-orally. </div>
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That's when the first suspicions arose that the equation "NPY=feeding frenzy" is not as straight forward as it had seemed. In an ingeniously designed experiment with lab rats Ammar and colleagues wanted to see whether and how NPY and leptin affect the appetitive and the consummatory aspect of feeding behavior differently [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Ammar,%202000%20#9372%22">3</a>]. </div>
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The results of this experiment show a much more complex hormonal effect of NPY and leptin than what had previously been thought. While NPY infusion made rats increase their physical activity to get food it inhibited their intake of food, when it was made available to them by oral infusion while they were on the "go-get" for food. Just the opposite was the case with leptin. While leptin made rats drop their efforts to get food, it made them increase their intake of food when it was delivered by oral infusion. The researchers experimented with male rats exclusively, not because they thought that females would react differently, but because they wanted to see how specific the effect of NPY is on the animal's drive to become physically active. So they used the one stimulus with the best track record of throwing males off any course of action, regardless whether those males are rats or men: the presence of a sexually receptive female. Now, this must be very illuminating to my female readers: under the influence of NPY male rats were "more into food than into females" so to speak. Definitely more than when NPY was taken out of the equation. </div>
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Just as an aside: what does this mean for women's belief that men are operating under one of three mindsets: "I'm hungry, I'm thirsty, I'm horny"? It means that the order of priority is obviously determined more by hormones such as NPY, than by female manipulation. Of course, as I already mentioned, rats are not necessarily a template for human biology. Which is why we should hope, for the sake of female rodents, that their male peers' mindsets are a little more sophisticated than what human females observe in their male counterparts. </div>
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But let's not talk rats for a while, let's talk humans. More specifically humans in what was their natural habitat throughout 99% of our evolution: the pre-agricultural world which our ancestors had roamed as hunter/gatherers. In this world it will have made great sense to be kick-started into a go-get-food mood when one's energy reserves began to deplete. And it would have made equally great sense to have one's pre-occupation with food knocked down a few pegs once energy reserves have been replenished. </div>
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Interestingly, the circuitry which accomplishes this behavioral feat has been preserved over the eons of evolution, from mouse to man. And in this circuitry we find the same hormones, NPY and leptin, playing essentially the same roles, too. Obviously this neurohormonal architecture has been a recipe for survival throughout the evolution of species. It is easy to see how evolution had trained this architecture to align every species' feeding behavior (a) with its energy needs, (b) with the energy density of the food available to it, and (c) with the effort necessary to get this food.</div>
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Now here is where it all comes together in our obesity plagued times: in our modern environment this inherited circuitry has turned from an asset into a liability. What use is NPY's drive to get physically active for the procurement of food, when the necessary physical activity has been reduced from spear-hunting a deer to opening the fridge? What use is NPY signaling the reduction of energy stores when your and my stores are too high in the first place? What use is leptin's stimulative effect on eating once food is available, when food is available everywhere and all the time? Not only have these drives become useless, they have become hazardous to our health. I'll spare you the proof: The much quoted statistics of overweight and obesity. </div>
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When Wallace Craig first painted the architecture of feeding 95 years ago, obesity wasn't a problem at all. Now you might say "Wait a minute, his generation wasn't exactly the hunter/gatherer type. If all this talk about hormones and feeding behavior is correct, why were they not fat?" Good point. One part of the answer is, that the obesity epidemic has been paralleled by an epidemic of rapidly declining physical activity. The other part of the answer is, again, a hormonal circuitry. A much more dangerous one. I will address it in my next post, and then we will construct a comprehensive model of feeding behaviour which not only explains your personal failures, or triumphs, in your personal war against the XL sizes. It will also explain why and how, despite all those inherited neurhormonal mechansims driving our feeding behavior, you still can win this war.
<a href="http://twitter.com/home/?status=%20Why%20We%20Are%20Slaves%20Of%20Food%20Obsession.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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1.<span class="Apple-tab-span"> </span>Craig W: <b>Appetites and Aversions as Constituents of Instincts</b>. <i>Proc Natl Acad Sci U S A </i>1917, <b>3</b>(12):685-688.</div>
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2.<span class="Apple-tab-span"> </span>Seeley RJ, Payne CJ, Woods SC: <b>Neuropeptide Y fails to increase intraoral intake in rats</b>. <i>Am J Physiol </i>1995, <b>268</b>(2 Pt 2):R423-427.</div>
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3.<span class="Apple-tab-span"> </span>Ammar AA, Sederholm F, Saito TR, Scheurink AJ, Johnson AE, Sodersten P: <b>NPY-leptin: opposing effects on appetitive and consummatory ingestive behavior and sexual behavior</b>. <i>American journal of physiology Regulatory, integrative and comparative physiology </i>2000, <b>278</b>(6):R1627-1633.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft_id=info%3Apmid%2F16586767&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Appetites+and+Aversions+as+Constituents+of+Instincts.&rft.issn=0027-8424&rft.date=1917&rft.volume=3&rft.issue=12&rft.spage=685&rft.epage=8&rft.artnum=&rft.au=Craig+W&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Craig W (1917). Appetites and Aversions as Constituents of Instincts. <span style="font-style: italic;">Proceedings of the National Academy of Sciences of the United States of America, 3</span> (12), 685-8 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/16586767" rev="review">16586767</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=The+American+journal+of+physiology&rft_id=info%3Apmid%2F7864237&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Neuropeptide+Y+fails+to+increase+intraoral+intake+in+rats.&rft.issn=0002-9513&rft.date=1995&rft.volume=268&rft.issue=2+Pt+2&rft.spage=&rft.epage=7&rft.artnum=&rft.au=Seeley+RJ&rft.au=Payne+CJ&rft.au=Woods+SC&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Seeley RJ, Payne CJ, & Woods SC (1995). Neuropeptide Y fails to increase intraoral intake in rats. <span style="font-style: italic;">The American journal of physiology, 268</span> (2 Pt 2) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/7864237" rev="review">7864237</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=American+journal+of+physiology.+Regulatory%2C+integrative+and+comparative+physiology&rft_id=info%3Apmid%2F10848532&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=NPY-leptin%3A+opposing+effects+on+appetitive+and+consummatory+ingestive+behavior+and+sexual+behavior.&rft.issn=0363-6119&rft.date=2000&rft.volume=278&rft.issue=6&rft.spage=&rft.epage=33&rft.artnum=&rft.au=Ammar+AA&rft.au=Sederholm+F&rft.au=Saito+TR&rft.au=Scheurink+AJ&rft.au=Johnson+AE&rft.au=S%C3%B6dersten+P&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Ammar AA, Sederholm F, Saito TR, Scheurink AJ, Johnson AE, & Södersten P (2000). NPY-leptin: opposing effects on appetitive and consummatory ingestive behavior and sexual behavior. <span style="font-style: italic;">American journal of physiology. Regulatory, integrative and comparative physiology, 278</span> (6) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/10848532" rev="review">10848532</a></span>
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Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com10tag:blogger.com,1999:blog-2058017873235758512.post-63375148159846259182012-08-20T07:30:00.000+02:002012-08-21T10:13:20.354+02:00The Truth About The Genetics Of Obesity.<br />
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Evolutionary selection favored those who became fat easily. That's the essence of the "thrifty gene hypothesis". It's like Madonna. On the wrong side of 50, and ripe to be dethroned by something with greater sex appeal. In this case the contender's name is the "drifty gene hypothesis". Here is why you shouldn't be too dazzled about it.
<a href="http://twitter.com/home/?status=%20the%20truth%20about%20the%20genetics%20of%20obesity.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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Exactly 50 years ago, Neel suggested that the high rate of diabetes in our society is the result of evolutionary selection which favored those of our ancestors whose genes made them store fat more efficiently during periods of food abundance [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Neel,%201962%20#660%22">1</a>]. It's such a marvelously simple explanation that it doesn't take the brains of an Einstein to chatter about it at any dinner party where one wants to be remembered as quite the hobby geneticist. But to every party there is a party pooper. In this case two of them. John R. Speakman and Klaas R. Westerterp are telling us that the high prevalence rate of obesity and diabetes actually disproves the thrifty gene hypothesis [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Speakman,%202012%20#18172%22">2</a>].<br />
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In a nutshell their argument goes like this: our human and hominin ancestors have gone through so many feast and famine cycles over the past 2 million years, that, if it was for genetic selection, we should by now all be carriers of the genes that made caveman survive and modern man fat and diabetic. Since this is clearly not the case, the TGH can't be correct. </div>
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I'm a sucker for theories which challenge common wisdoms, so I enthusiastically read the authors' arguments. Now, let's see how this enthusiasm evaporated.</div>
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To a considerable extent, obesity is determined by genes. If you want to put a number on it, genetic factors explain about 60% of the variance in obesity metrics, such as the body mass index (BMI). That's the numbers we are getting from studies, which compare such metrics between identical twins and other sibling types [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Segal,%202002%20#18239%22">3</a>]. Just as an aside: When you consider genes as the one condition which you can't change, 60% heritability still leaves a lot of wiggling room for you to fashion your own fate. That's good because obesity comes with a host of nasty diseases, none of which makes your life longer or more pleasant. Think diabetes. Of course, you know all that, and it is not really our subject here. We want to know why there is such a high prevalence of obesity prone people.</div>
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To answer this question Speakman and Westerterp compiled some insights from genetics and put them through a mathematical blender. That sounds far simpler than it really was. For that blender to give you an intelligent answer you need to feed it with intelligent data. Otherwise it's the old nonsense-in-nonsense-out" paradigm. In our case at hand there are three data segments which need to be considered. </div>
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First, there is biology: what happens to a human organism when it is exposed to fasting? How long will it survive?</div>
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Second, there is genetics: what do we know about those 60% of genetic causes? Are they concentrated in a handful of genes, or are they spread over hundreds? And what do we know about the mutation rates of genes? Obviously, the more causative genes, and the smaller the mutation rates the longer it will take for any genetic mutation (or allele) to become fixed in the genetic pool. "Fixed" being geneticist speak for "(almost) everybody has it".</div>
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Third, there is evolution & environment: how often did famines happen, and how many of our ancestors were affected by them at any one event?</div>
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Get the figures slightly wrong in any of those three segments and your result will be off track. And so will be your conclusions. </div>
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To get intelligent data, the two authors first went through an exemplary exercise of modeling what happens to a human organism when it is exposed to a zero-intake famine. That's not as straight forward as you might think, because our metabolism goes through at least three distinct phases when fasting in the extreme. These three phases are determined by our organism's way of storing energy reserves. </div>
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First, there is glucose, the building block of virtually all carbohydrates in our food. While our brain thrives almost exclusively on glucose, the body's glucose stores are remarkably small. Glucose is predominantly stored in the form of glycogen in muscle and liver tissue. It is these reserves which are tapped first, and they are typically depleted within 24 hours. If you are a marathon runner you do this depletion business a lot faster, say after 20 miles or so. </div>
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Since your brain still needs glucose, your body then starts to produce its own. Largely from lactate and glycerol, a component of fat. Which brings us to the second phase, where the body metabolizes its fat reserves. But even fat reserves don't last forever. Once they are depleted, the body begins to cannibalize its protein. Actually, weight loss in phase 2 is never a pure loss fat only. Proteins are being burnt at the same time but a at a lesser rate, until fat reserves have been depleted. And that's where fasting gets critical, because to your body, burning proteins for energy is like burning banknotes for warming your house: you go broke in no time. And "broke" means "dead" to your body. </div>
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Since time to death is a critical element in the mathematical model, the authors went through an exemplary effort of mapping the course from fully fed to fully dead. Interestingly, everybody reacts differently to this fasting business. Some people survive longer than others, even when they have the same BMI to start with. That's why Speakman and Westerterp applied three different models to predict survival time, all models representing those known different ways of adapting to starvation. For a severely obese 1.64 m tall female weighing 100 kg, the models predicted a survival time of 249-289 days. Imagine, that's about 8-9 months with no food at all. </div>
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Onto the genetics assumptions. The one thing we know for sure is that obesity is a multi-gene condition. Very multi-gene in fact, because genome-wide association studies (GWAS) have thrown up about 30 odd genes with a combined effect of explaining only 7% of those 60% of weight variance. So, we are assuming that the unexplained difference resides within another 200 or so genes, which we haven't even identified yet. Speakman translated this knowledge into an assumption of each individual gene having a net effect on fat storage of about 80g. That is, a carrier of a gene's "thrifty mutation" (or allele) would store 80g more fat than his peer with the "lean" version of the gene, with those 80g, translating into a 0.25% better chance of surviving a famine. With these assumptions the authors could then calculate how many famines it would take to weed out the unlucky ones whose "lean" genes didn't give them the 80g advantage. That calculation in itself is no rocket science. The authors took a given population size of 5 million people, exposed them to a virtual famine, after which the population had been appropriately decimated, and the percentage of "thrifty gene" carriers among the survivors had increased. They all mated happily after that until the population again reached 5 million. Then the next virtual famine struck, and so on. </div>
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How many famines would it take to eliminate the lean gene from the gene pool? Under the authors' assumptions about 6000 famine events. </div>
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They then made their final assumption: one famine happening every 150 years. That's 900000 years altogether for those 6000 famine events. Their conclusion: if the thrifty gene hypothesis and its assumption of selection pressure from catastrophic events was correct, we all should be obese today. Since we are not, the TGH is false. </div>
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The alternative explanation, which the authors offer is a "drifty gene hypothesis" as opposed to the thrifty version. "Drifty" referring to genetic drift, meaning that mutations of the genes, which regulate fat storage were never really subject to selection pressure, and what we see today is simply the result of a natural drift of genetic mutations over the eons of human existence. </div>
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The authors argue further that excessive fat storage was a distinct disadvantage for our earliest hominin ancestors, for reasons of predation. Think of it like that: while neither a fat man nor a lean man can outrun a saber toothed tiger, it's enough for the lean guy to run just a little faster than his fat bro'. Call it a stone-age version of the "first come, first serve" principle, at least from the tiger's perspective: the first man I get is the first man to serve me as breakfast. </div>
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The authors then suggest that once our ancestors discovered fire and spears and other things which placed them on top of the food chain, the selective pressure for the lean gene had vanished. Its thrifty sibling started to flourish, not because it was favored by famine-based selection pressure, but simply because man had taken tiger and co. out of the equation, and with it the selective pressure to NOT get fat. During those zillions of generations which separate the man-known-for-throwing-spears from the man-known-for-throwing-tantrum-when-the-iphone-doesn't-work, those 200 odd genes accumulated just enough mutations for many, but not all, of us to become obese and diabetic. </div>
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Up to this point one might buy into Speakman's and Westerterp's story. But here is the twist: </div>
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Speakman has written about the subject before. With a different tagline. In his 2006 paper he suggested that the selection pressure of famines in human history was too small to have caused the effects attributed to it by the thrifty gene hypothesis [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_4%22%20%5Co%20%22Speakman,%202006%20#18236%22">4</a>]. According to that paper, famines with severe mortality rates were rare and, most tellingly, a phenomenon of agricultural societies. </div>
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Indeed, the consensus view on famines in pre-agricultural vs. agricultural societies is that our hunter/gatherer ancestors were better fed and better protected against famines than their agricultural descendents. The hunter simply doesn't depend on a crop. Whereas when a crop fails, food shortage is inevitable for the agriculturalist. But even then, a true famine, where there is no food at all, typically requires a back-to-back failure of crops in consecutive years. And even then, as Speakman pointed out in his 2006 paper, mortality rates rarely exceeded 10% of the population, with those 10% coming almost exclusively from those who are either too young or too old to reproduce and thereby contribute to the gene pool after the famine is over. The author's message in 2006: Genetic mutations towards thrifty genes didn't have sufficient advantage or time to spread. </div>
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This little twist shows us that somebody is taking potshots at TGH: </div>
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Shot 1 (2006): Famines haven't been with us for long enough nor with sufficient severity to have exerted the selective pressure on which the thrifty gene hypothesis rests. Ergo, TGH is wrong.</div>
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Shot 2: Famines were so numerous and severe during human history that their combined selective pressure on the thrifty genes was sufficient to have made them a fixture in EVERYBODY'S genetic make-up. Since this is not the case, the TGH is wrong.</div>
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Science shouldn't be about taking potshots. Science is about the testing of falsifiable hypotheses in reproducible experiments. A mathematical model, such as the one presented in Speakman's most recent paper does not qualify as such. </div>
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Here is why: Given that mutations happen at the rate of 1.1 per 30-100 million base pairs, we all carry about 100 to 200 mutations in our DNA [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_5%22%20%5Co%20%22Xue,%202009%20#18234%22">5</a>]. Not necessarily do those mutations affect actual genes coding for proteins. And if they do, most mutations confer a slight disadvantage, many have no effect on an organism's fitness, and only a few are favorable. Natural selection will weed out the deleterious ones, quickly fix the favorable ones and let the neutral ones accumulate at the given mutation rate. To complicate matters, all those processes happen at vastly different rates depending on the location on the DNA. That much we do know. What we don't know is how much these rates differ. We certainly can't know it for those genes, which we haven't even identified yet, as is the case for most of the hypothesized fat storage genes. That's why the mathematical model with which Speakman supports his argument against the validity of the thrifty gene hypothesis is in all likelihood not reflective of what has happened throughout evolution. Which means, it doesn't add any quantitative or objective evidence against the TGH. </div>
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In my next post I will tell you why I believe that the entire discussion misses the point. What we really want to know now is how to help people avoid becoming fat and diabetic in the first place. Decoding the genome and its evolutionary history doesn't do that trick. Because genes do not make us fat and diabetic, genes make proteins, nothing else. One part of those proteins are the hormones. They drive our moods and emotions, our likes and our dislikes and, believe it or not, all our behaviors, from feeding to physical activity. For those latter two I have suggested an explanatory model in my dissertation thesis. </div>
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This model tries not only to explain why we eat too much and move too little, despite having the best intentions to do otherwise, and while being aware of all the life threatening consequences. But, more importantly, without having to have a complete understanding of all those hormonal happenings, the model suggests a practical and testable solution to oppose those genetically encoded mechanisms for a longer and healthier life. Think of your car: You don't need to understand the mechanism of its gearbox to operate it for an optimal ride. </div>
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Achieving the same thing with your life could turn out to be a gratifying pastime while my geneticist colleagues work on unraveling the enigma of the genetics of obesity. Whatever newer and sexier model they develop to explain the genetic origins of obesity, we might look at it like we look at Madonna and her variants: offering lots of entertainment value, but little of practical use.
<a href="http://twitter.com/home/?status=%20the%20truth%20about%20the%20genetics%20of%20obesity.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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1.<span class="Apple-tab-span"> </span>Neel JV: <b>Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"?</b> <i>Am J Hum Genet </i>1962, <b>14</b>:353-362.</div>
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2.<span class="Apple-tab-span"> </span>Speakman JR, Westerterp KR: <b>A mathematical model of weight loss under total starvation and implications of the genetic architecture of the modern obesity epidemic for the thrifty-gene hypothesis</b>. <i>Disease models & mechanisms </i>2012.</div>
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3.<span class="Apple-tab-span"> </span>Segal NL, Allison DB: <b>Twins and virtual twins: bases of relative body weight revisited</b>. <i>Int J Obes Relat Metab Disord </i>2002, <b>26</b>(4):437-441.</div>
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4.<span class="Apple-tab-span"> </span>Speakman JR: <b>Thrifty genes for obesity and the metabolic syndrome--time to call off the search?</b> <i>Diabetes & vascular disease research : official journal of the International Society of Diabetes and Vascular Disease </i>2006, <b>3</b>(1):7-11.</div>
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5.<span class="Apple-tab-span"> </span>Xue Y, Wang Q, Long Q, Ng BL, Swerdlow H, Burton J, Skuce C, Taylor R, Abdellah Z, Zhao Y<i> et al</i>: <b>Human Y chromosome base-substitution mutation rate measured by direct sequencing in a deep-rooting pedigree</b>. <i>Curr Biol </i>2009, <b>19</b>(17):1453-1457.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=American+journal+of+human+genetics&rft_id=info%3Apmid%2F13937884&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Diabetes+mellitus%3A+a+%22thrifty%22+genotype+rendered+detrimental+by+%22progress%22%3F&rft.issn=0002-9297&rft.date=1962&rft.volume=14&rft.issue=&rft.spage=353&rft.epage=62&rft.artnum=&rft.au=NEEL+JV&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">NEEL JV (1962). Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? <span style="font-style: italic;">American journal of human genetics, 14</span>, 353-62 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/13937884" rev="review">13937884</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Disease+models+%26+mechanisms&rft_id=info%3Apmid%2F22864023&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=A+mathematical+model+of+weight+loss+under+total+starvation+and+implications+of+the+genetic+architecture+of+the+modern+obesity+epidemic+for+the+thrifty-gene+hypothesis.&rft.issn=1754-8403&rft.date=2012&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Speakman+JR&rft.au=Westerterp+KR&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Speakman JR, & Westerterp KR (2012). A mathematical model of weight loss under total starvation and implications of the genetic architecture of the modern obesity epidemic for the thrifty-gene hypothesis. <span style="font-style: italic;">Disease models & mechanisms</span> PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22864023" rev="review">22864023</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=International+journal+of+obesity+and+related+metabolic+disorders+%3A+journal+of+the+International+Association+for+the+Study+of+Obesity&rft_id=info%3Apmid%2F12075568&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Twins+and+virtual+twins%3A+bases+of+relative+body+weight+revisited.&rft.issn=0307-0565&rft.date=2002&rft.volume=26&rft.issue=4&rft.spage=437&rft.epage=41&rft.artnum=&rft.au=Segal+NL&rft.au=Allison+DB&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Segal NL, & Allison DB (2002). Twins and virtual twins: bases of relative body weight revisited. <span style="font-style: italic;">International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 26</span> (4), 437-41 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/12075568" rev="review">12075568</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Diabetes+%26+vascular+disease+research+%3A+official+journal+of+the+International+Society+of+Diabetes+and+Vascular+Disease&rft_id=info%3Apmid%2F16784175&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Thrifty+genes+for+obesity+and+the+metabolic+syndrome--time+to+call+off+the+search%3F&rft.issn=1479-1641&rft.date=2006&rft.volume=3&rft.issue=1&rft.spage=7&rft.epage=11&rft.artnum=&rft.au=Speakman+JR&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Speakman JR (2006). Thrifty genes for obesity and the metabolic syndrome--time to call off the search? <span style="font-style: italic;">Diabetes & vascular disease research : official journal of the International Society of Diabetes and Vascular Disease, 3</span> (1), 7-11 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/16784175" rev="review">16784175</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Current+biology+%3A+CB&rft_id=info%3Apmid%2F19716302&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Human+Y+chromosome+base-substitution+mutation+rate+measured+by+direct+sequencing+in+a+deep-rooting+pedigree.&rft.issn=0960-9822&rft.date=2009&rft.volume=19&rft.issue=17&rft.spage=1453&rft.epage=7&rft.artnum=&rft.au=Xue+Y&rft.au=Wang+Q&rft.au=Long+Q&rft.au=Ng+BL&rft.au=Swerdlow+H&rft.au=Burton+J&rft.au=Skuce+C&rft.au=Taylor+R&rft.au=Abdellah+Z&rft.au=Zhao+Y&rft.au=Asan&rft.au=MacArthur+DG&rft.au=Quail+MA&rft.au=Carter+NP&rft.au=Yang+H&rft.au=Tyler-Smith+C&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Xue Y, Wang Q, Long Q, Ng BL, Swerdlow H, Burton J, Skuce C, Taylor R, Abdellah Z, Zhao Y, Asan, MacArthur DG, Quail MA, Carter NP, Yang H, & Tyler-Smith C (2009). Human Y chromosome base-substitution mutation rate measured by direct sequencing in a deep-rooting pedigree. <span style="font-style: italic;">Current biology : CB, 19</span> (17), 1453-7 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/19716302" rev="review">19716302</a></span>
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Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com6tag:blogger.com,1999:blog-2058017873235758512.post-78662838679715210202012-08-06T07:30:00.000+02:002012-08-13T17:24:33.056+02:00What Infants Teach Us About Preventing Obesity.<br />
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Public health has been telling you for years: you are fat because you move too little and eat too much. And yes, it's your fault if you don't break a sweat every day to keep your waist line in check. But research says, that's not the entire truth. In fact, public health might have taken the easy way out, and here is how it could finally make amends.
<a href="http://twitter.com/home/?status=%20What%20Infants%20Can%20Teach%20Us%20About%20Preventing%20Obesity.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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If an alien scientist came to earth to study us in the same way in which we study lab rats, he would come to the same simple conclusion as we do: give those animals more than enough food, take away the need to move around, and what you'll get is a population of mostly overweight individuals. I say "mostly" because there are always the odd ones who fall away from the norm. What fascinates me most in this image is the fact that, while mice and rats probably do not communicate among each other the benefits of staying slim, we humans do so and still, the result is the same. What our alien researcher sees is biology trumping consciousness. For a good reason. Neither rats nor humans would survive in their natural habitat without the ability to store excess calories as fat, which then sees them through the inevitable lean periods. It gave our ancestors a good shot at survival, with no or little chance to become overweight. At least not then.</div>
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Today, obesity is the new normal. I won't bore you with the percentages. You hear and read about them in the media almost daily, with one or the other pundit citing the ever increasing number of people who are overweight or outright fat (the politically correct term being "obese"). Not that any of those pundits offers any solution or view of things other than that too little exercise and too much food are the cause. Those platitudes are typically topped off with denouncing people's weakness to do something about it, such as exercising more and eating less. When you look at the effectiveness of public health calls for exercising more and eating less, you'll find that overweight and obesity have increased nicely alongside those calls. Which simply means one thing: we need to do something differently. </div>
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Now, remember, I said there are always some odd individuals who seem to escape the fate of the majority of our experimental animals, be that rats in the lab or humans in free living conditions. It is here where we ought to look at what makes them so different. And whether this difference is in their genetic program or in their mental ability to override this program. </div>
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The funny thing is, the answer to this question has been relatively clear for years, but hardly anybody seems to draw the right conclusions from it. Just about a week ago, another wonderful study has emerged on this subject. </div>
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Britt Eriksson and her colleagues investigated the correlation between body composition development and energy expenditure through physical activity in 1.5 year old infants [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Eriksson,%202012%20#18077%22">1</a>]. That's not a first, but the way they did it is. When you look at energy expenditure of any individual it is necessary to know how much of this energy expenditure comes from basal metabolic rate (BMR). This BMR tells us how much energy an organism needs to maintain life under resting conditions. There are large differences in these rates between individuals, such that two persons who share the same body weight, height and composition and who do the same type of exercise may burn substantially different amounts of calories, simply because one person has a higher basal metabolic rate than the other. So, If you want to know exactly how much of an individual's total energy expenditure is coming from physical activity, you better have accurate knowledge about his basal metabolic rate because you need to subtract it from total energy he or she burns. In previous studies of infants, physical activity levels (PAL) had been estimated based on predicted BMR rather than on actually measured BMR. Obviously, if your BMR prediction is incorrect so will be your conclusions about PAL. That's why Eriksson and her colleagues objectively measured basal metabolic rates. They did so by analyzing carbon dioxide production and oxygen consumption while infants slept under a ventilated hood system. Add to this the researchers' way of measuring total energy expenditure with the gold standard doubly labeled water method, and what you get is the most accurate differentiation between BMR and PAL possible in living humans.</div>
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Our researchers did all those measurements on 44 children aged 1.5 years. All of them had participated in a body composition study when they were 1 and 12 weeks old. Body composition was again measured in the current study. Before we look at the correlation between body fatness and PAL in those 1.5 year old children, let's recall what is normal in human development during infancy. </div>
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Healthy infants typically gain body fat, expressed as a percentage of bodyweight, during the first 6 months of life, after which the total body fat percentage (TBF%) slowly decreases. By the way, that was the case in only about 20% of the infants in this study. The majority increased their body fat percentage but with large differences between individuals. At age 1.5 years TBF% varied between 21% and 35%. And these changes in body fat correlated with the physical activity levels of the infants, such that those with a higher PAL had decreased their body fat percentage more than those with a lower PAL. The beauty of investigating these associations in infants is that you don't need to worry about your study subjects' volitional exercise habits, such as treadmill running, mountain biking or kicking ass instead of writing anonymous comments to blog posts. All their physical activity is non-exercise activity. I'll get to this important distinction in a moment. The point here is: genetic influences show up relatively unmasked. If there are such large inter-individual differences in body fat development already being evident in the earliest years of life, we have every reason to assume that there is a phenotype and a genotype which is better protected against fat gain than others. We also know that body fat percentage in the youngest years tracks into adolescence and on into adulthood. </div>
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Which of course also means that we should see such differences in adults, too. In fact we have been seeing them for more than 10 years, but somehow these observations don't make it into the media where the doom and gloom prophets of obesity have our ears and eyes but no solutions to offer.</div>
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Back to those studies: Levine and colleagues put 16 non-obese young adults, aged 25-36, on an 8-weeks supervised diet which provided a daily excess of 1000 Kcal over what each individual needed for weight maintenance [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Levine,%201999%20#18080%22">2</a>]. The participants had to maintain their usual level of exercise throughout the experiment. Physical activity and body composition were measured with the same gold standard methods, which the Eriksson group used on their infants. As a group, the participants of the overfeeding experiment stored 44% of the excess kcal as fat, and dissipated 53% through increased energy expenditure. </div>
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But those average values over a group of people don't interest us here. What we want to know is how much difference was there between participants. Well, fat gain varied more than 10-fold from a minimal increase of 360 Grams to a whopping 4.23 kg. Think about this for a moment: you let 16 people gorge themselves on a daily excess of 1000 kcal for 8 weeks and what you get is one whose weight remains virtually the same, while another gains more than 9 pounds, and all the other 14 show up anywhere in between those two.</div>
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The laws of physics tell us that energy cannot be lost or created, it can only be converted from one form to another. What this means to our weight gain experiment is that those who didn't store the energy as fat must have burned it somehow through physical activity. But how could that have happened if all participants kept their exercise on an even keel throughout the experiment? Had an enormous increase of BMR protected them against weight gain? Our researchers didn't think so, because experiments on BMR response to over- and underfeeding have been fairly consistent, showing only small changes in the range of 5%. Levine's participants were no exception to that rule. So, what happened? </div>
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The answer is in the details of what constitutes physical activity. There are two components, one of which you certainly know: exercise. Then there is the other, which I just mentioned a few lines earlier. It's called NEAT, which is short for non-exercises activity thermogenesis. In a less convoluted way it means the energy you burn through acitivities of daily living, fidgeting, spontaneous muscle contractions and maintaining or adjusting posture while not lying down. In other words, the energy you burn through physical activity which is not volitional exercise. </div>
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NEAT accounted for over 70% of the increase in daily energy expenditure, with an average increase of 336kcal/day. Mind you, this was the average over the entire group. Far more interesting, again, is the range, which spanned from a decrease of 98 kcal/day to an increase of 692 kcal/day. It's the same picture we saw in the fat weight development. And yes, the larger a participant's increase in NEAT the smaller his weight gain. The fellow with the 692 kcal/ increase subconsciously moved around more often. He had increased his strolling-equivalent activity by an average of 15 minutes per waking hour! Interestingly, the 4 female participants in this study had the smallest changes in NEAT. While this study is certainly underpowered to tell us anything about gender differences, its observations fits neatly with an another observation: The age-dependent increase of obesity risk is steeper for women than for men. </div>
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Now, back to the study results. If NEAT is NON-VOLUNTARY activity energy expenditure, then conscious rationally driven behavior has nothing to do with it. It's purely physiology talking. It's our genes' handwriting. And if this handwriting reveals such a substantial effect on weight development, shouldn't we look at means to increase NEAT, rather than keeping our current tunnel vision on exercise, which we already know is so difficult to adopt for most people? Let's put some effort into designing "obligatory" NEAT into our life. Or rather, designing NEAT killers (such as remote controls) out of it. </div>
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To our alien researcher, this might just be the next experiment, as it is for his human peers who are already experimenting with running wheels and wheel locks in their lab rats' cages. After all, a 332 kcal/day deficit translates into almost 14 kg of fat over a year. That's certainly something which public health ought to be interested in. </div>
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1.<span class="Apple-tab-span"> </span>Eriksson B, Henriksson H, Löf M, Hannestad U, Forsum E: <b>Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children</b>. <i>The American Journal of Clinical Nutrition </i>2012.</div>
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2.<span class="Apple-tab-span"> </span>Levine JA, Eberhardt NL, Jensen MD: <b>Role of Nonexercise Activity Thermogenesis in Resistance to Fat Gain in Humans</b>. <i>Science </i>1999, <b>283</b>(5399):212-214.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=The+American+journal+of+clinical+nutrition&rft_id=info%3Apmid%2F22836033&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Body-composition+development+during+early+childhood+and+energy+expenditure+in+response+to+physical+activity+in+1.5-y-old+children.&rft.issn=0002-9165&rft.date=2012&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Eriksson+B&rft.au=Henriksson+H&rft.au=L%C3%B6f+M&rft.au=Hannestad+U&rft.au=Forsum+E&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Eriksson B, Henriksson H, Löf M, Hannestad U, & Forsum E (2012). Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children. <span style="font-style: italic;">The American journal of clinical nutrition</span> PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22836033" rev="review">22836033</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Science+%28New+York%2C+N.Y.%29&rft_id=info%3Apmid%2F9880251&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Role+of+nonexercise+activity+thermogenesis+in+resistance+to+fat+gain+in+humans.&rft.issn=0036-8075&rft.date=1999&rft.volume=283&rft.issue=5399&rft.spage=212&rft.epage=4&rft.artnum=&rft.au=Levine+JA&rft.au=Eberhardt+NL&rft.au=Jensen+MD&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Levine JA, Eberhardt NL, & Jensen MD (1999). Role of nonexercise activity thermogenesis in resistance to fat gain in humans. <span style="font-style: italic;">Science (New York, N.Y.), 283</span> (5399), 212-4 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/9880251" rev="review">9880251</a></span>
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Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com4tag:blogger.com,1999:blog-2058017873235758512.post-90005573267697509052012-07-23T07:30:00.000+02:002012-07-24T10:56:25.463+02:00Why Medicine Might Be Wrong About Salt, Fat & BMI<br />
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Salt and fat kill you early, and your BMI tells you how early. That has been the wisdom for years, but wisdoms have an expiry date, too. Particularly medical wisdoms. Recent research says those three are probably well beyond their use-by date.
<a href="http://twitter.com/home/?status=%20Why%20Medicine%20Is%20Wrong%20About%20Salt,%20Fat%20and%20BMI.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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We live in interesting times. Admitted, my view of times is myopic, it's focused on the biomedical. So, I'm obviously not referring to Greece teetering on the economic brink. In biomedicine our Greeks are the cherished wisdoms about salt, fat and BMI. Similarity 1: They are not doing so well. Similarity 2: Their balance sheet screams bankruptcy. Similarity 3: Our authorities won't kick them out for fear of a domino effect.<br />
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Actually, medical history is full of interesting times. Remember, when a young doctor suggested that simply washing hands between dissecting cadavers and helping women give birth would seriously reduce the regular 1-in-five death rate from childbed fever? </div>
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Of course, you won't remember this: the place was the Vienna General Hospital in Austria, the year was 1849 and the young doctor's name was Ignaz Semmelweis. While he didn't publish his observations, one of his students did, in the grand old dame of British medical journals, the Lancet [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Routh,%201849%20#18010%22">1</a>]. At that time infection was known per se, but it was believed to work like this: a "peculiar morbid atmospheric influence which extends beyond the range of personal communication". Semmelweis believed in washing hands. And he had the numbers to prove his belief. After introducing a hand-washing rule in his department, childbed deaths dropped by 75%. The response of Semmelweis' peers and superiors to his challenging notion is today known as the Semmelweis reflex. Unlike Semmelweis it is very much alive. It is the reflex-like rejection of new insights because they disagree with entrenched beliefs. </div>
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Semmelweis' observations were one of the initial steps in the development of the germ theory of disease. Three more names are attached to its development, Louis Pasteur, Robert Koch and Joseph Lister. The latter was the first to apply this new theory to surgical procedures. So, the next time you gargle with Listerine, you might want to say a silent thank you to all the men and women of science who had the guts to challenge those pompous idiots who, in true Semmelweis-reflex mode, did everything to discredit the new insights. And they usually are quite successful. Who wants to argue with a praetorian guard of honorable old professors. In Semmelweis' case, they got him barred from medical practice, they publicly ridiculed him and ultimately drove him to insanity. All the while women continued to die in childbed. Unsurprisingly, because medical textbooks continued to teach the old views on childbed fever until the 1890s. But once germ theory, and with it hygiene, was adopted into medicine and daily life, the mortality landscape changed dramatically. Infectious diseases disappeared from the pole position of the death tables, and the 1900s witnessed the emergence of their replacements: cardiovascular disease (CVD) in all its flavors, from hypertension and atherosclerosis to heart attack, stroke and heart failure. </div>
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Recently, potential triggers for those Semmelweis reflexes have been coming out of research, though probably not as dramatic in consequence as the infection theory. </div>
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<b>Salt is no evil</b></div>
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I have written about the potentially <a href="http://bit.ly/drlutz_SaltAndStroke" target="_blank">flawed obsession with trying to get everybody to reduce salt intake</a> in order to reduce blood pressure and stroke in the entire population. The latest nail in this obsession's coffin is Alderman and Cohen's review of 23 observational studies and 7 randomized controlled trials (RCT), all investigating the effects of salt intake on parameters of health [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Alderman,%202012%20#17826%22">2</a>]. The observational studies accumulated data on 360,000 participants and recorded 26,000 disease events. While 7 studies showed a direct relationship between increasing sodium and increasing CVD events, another 6 studies demonstrated the opposite: a clear inverse relationship. Two studies showed a J-shaped relationship, in which low and high intakes increased disease risk, whereas 8 studies didn't show any relationship or only inconsistent results. </div>
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Only 9 of the 23 studies measured salt intake objectively, that is by measuring participants' urinary sodium excretion. I mention this because the other 14 studies relied on self-reported sodium intake, which is prone to recall errors. Of those 9 studies with objective measurements, only 1 showed a direct association, whereas in three studies higher intake was associated with fewer disease events. Two studies showed a J-shaped relationship and one didn't show any relation. </div>
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Is it now wise to simply balance those scores, like in football, and let the highest scorer win the tournament? In our case the team "inverse relation" would win hands down over its competitors "direct relation" "J-shaped relation" and "no relation". Should we draw our conclusions in this way? No, science does not work this way. And it's not the way the authors chose. When they looked a little closer at the sodium intake ranges in each of the RCT's they found that the seemingly conflicting results of the observational studies could be reconciled easily. </div>
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It turns out that it all depends on the baseline intake from which you increase or decrease your salt consumption. The safe range being actually quite large, between 2.5-6.0 g/day. Go below or above that and you will face some increased risk. Interestingly, this range is way in excess of the current authoritative recommendation of "less than 2.0g/day". What is also rarely mentioned by those "authoritative guidelines" are some other side effects of lowering salt intake. In several of those RCTs salt reduction came with an increase in blood cholesterol, insulin resistance, adrenaline secretion and sympathetic nerve activity. None of those effects is beneficial to health. That's curious because all, except for cholesterol, tend to raise blood pressure. So the net effect of salt reduction, or increase, in you is always a composite of all those biochemical responses to sodium intake change. </div>
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Want to bet whether these insights will trigger the Semmelweis reflex in some of those who have built their career on maligning salt? On to the next subject:</div>
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<b>Fat isn't so bad either</b></div>
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Khaw and colleagues wanted to know the answer to an old question: does the fat in your diet give you heart disease [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Khaw,%202012%20#18013%22">3</a>]? The belief that dietary fat and heart disease march lock-step is so ingrained that you are forgiven to wonder why anybody would spend time and effort on this question. Well, that's because a recent meta-analysis of 21 studies, following 347,000 people for 5 to 23 years, could NOT find any association between the two [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_4%22%20%5Co%20%22Siri-Tarino,%202010%20#18014%22">4</a>].</div>
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Since all of the previous studies had been of an observational nature, which does not allow for conclusions of causality, the researchers used data from a prospective trial which had investigated the correlation of diet with cancer outcome, the European Prospective Investigation into Cancer (EPIC)-study. They looked at the fats in the blood of 10,000 participants aged 40–79 years, and they followed them from 1993–1997 through 2011. During this period 2,424 participants were diagnosed with heart disease. From among the remaining 10,000 participants the researchers chose 4,930 disease-free controls for a comparative evaluation. They checked whether, and how strongly, saturated and unsaturated fatty acids in the blood correlated with heart disease. </div>
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Since the fatty acid composition in the blood mirrors dietary fatty acid intake, this is as close as you can get to a conclusion about how the intake of type of fat affects your risk of heart disease. Of course, you need to adjust for other risk factors, such as age, sex, BMI, smoking, physical activity, alcohol intake, diabetes, blood pressure, cholesterol and other known risk factors for heart disease. </div>
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The researchers did those adjustments, and they found the saturated fatty acids to be only weakly related with heart disease. But that's not the surprising find. The real surprise was about the unsaturated fatty acids of the famous omega-3 and omega-6 persuasion. You have always heard how omega-3, the fish-oil variant is so good for your heart and the omega-6 is not. Well, listen to this: omega-6 turned out to be protective against heart disease, and omega-3 wasn't. That's contrary to our hitherto held beliefs that popping fish oil pills will make you a Methusalem, and that reducing omega-6 intake will do wonders against inflammation in your arteries. See a Semmelweis reflex on the horizon?</div>
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<b>BMI is a useless crutch</b> </div>
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There is probably no other number which has become so much engrained in our medical psyche as the BMI. This relation of bodyweight over height squared is the human equivalent of a meat stamp: if it's below 25 you are the prime cut which every health insurer wants on his client list. Bring it above 30 and you are a fat and soon-to-be sick bum whom nobody wants to talk to, unless your name is John Candy. In our society where we determine the winner of a Formula-1 race with millisecond precision, we accept being stamped at-risk with the accuracy of 20/100 vision (20/20 being the normal, and 20/200 being the cut-off for legal blindness). </div>
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The problem with BMI is, it doesn't differentiate between muscle and fat tissue, which makes a body-builder look fat, and bad, on the chart. BMI also doesn't tell you where your fat resides, on your buttocks or on your waist. The latter is certainly worse for your health than the former. Still BMI is THE number to judge you by. Maybe not any more. </div>
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Krakauer and Krakauer have developed a new measure from looking at the numbers of the National Health and Nutrition Examination Survey (NHANES) 1999-2004, and correlating those numbers with the death statistics. They wanted to blend weight, height and body shape into a more informative indicator of disease risk. Which is why they called it A Body Shape Index, ABSI. They also wanted this number to be easy to calculate from parameters which everyone can measure. Which is why the ABSI only calls for waist circumference to be measured in addition to the BMI's parameters of height and weight. I won't bore you with the details of statistical development of this ABSI, but suffice it to say, it's been done beautifully and very thoroughly. Then, after adjusting for other known risk factors, such as age, smoking, diabetes, blood pressure and cholesterol, the authors correlated BMI, WC and ABSI with death. While WC and BMI didn't show any correlation ABSI was strongly correlated. That's surprising, given the relatively short follow-up period of 5 years. </div>
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Of course, there area lot more questions to be answered before the ABSI will make it into medicine's hall of fame. The most important: Does lowering the ABSI translate into increasing health, or improving risk or extending lifespan? </div>
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So, be prepared for quite some time to pass before your doctor tells you that your ABSI requires some serious attention. Once that happens, you might remember this post and look up the time that has passed between its publication and your encounter with the ABSI in a medical environment. You will then see that medical science grinds slowly. But ultimately it grinds. </div>
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<span style="background-color: white;">In this case, medical science might grind a little slower, because the ABSI isn't the brainchild of a biomedical or public health scientist. It's developer is an assistant professor in the Department of Civil Engineering of the City College of New York. </span></div>
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Now, how can a civil engineer's index beat our beloved BMI when biomedicine's best brains have been laboring over a BMI replacement for years?</div>
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Great potential for a Semmelweis effect, don't you think?
<a href="http://twitter.com/home/?status=%20Why%20Medicine%20Is%20Wrong%20About%20Salt,%20Fat%20and%20BMI.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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1.<span class="Apple-tab-span"> </span>Routh CH: <b>On the Causes of the Endemic Puerperal Fever of Vienna</b>. <i>Medico-chirurgical transactions </i>1849, <b>32</b>:27-40.</div>
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2.<span class="Apple-tab-span"> </span>Alderman MH, Cohen HW: <b>Dietary Sodium Intake and Cardiovascular Mortality: Controversy Resolved?</b> <i>Am J Hypertens </i>2012, <b>25</b>(7):727-734.</div>
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3.<span class="Apple-tab-span"> </span>Khaw K-T, Friesen MD, Riboli E, Luben R, Wareham N: <b>Plasma Phospholipid Fatty Acid Concentration and Incident Coronary Heart Disease in Men and Women: The EPIC-Norfolk Prospective Study</b>. <i>PLoS Med </i>2012, <b>9</b>(7):e1001255.</div>
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4.<span class="Apple-tab-span"> </span>Siri-Tarino PW, Sun Q, Hu FB, Krauss RM: <b>Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease</b>. <i>Am J Clin Nutr </i>2010, <b>91</b>(3):535-546.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Medico-chirurgical+transactions&rft_id=info%3Apmid%2F20895917&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=On+the+Causes+of+the+Endemic+Puerperal+Fever+of+Vienna.&rft.issn=0959-5287&rft.date=1849&rft.volume=32&rft.issue=&rft.spage=27&rft.epage=40&rft.artnum=&rft.au=Routh+CH&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Routh CH (1849). On the Causes of the Endemic Puerperal Fever of Vienna. <span style="font-style: italic;">Medico-chirurgical transactions, 32</span>, 27-40 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/20895917" rev="review">20895917</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=American+journal+of+hypertension&rft_id=info%3Apmid%2F22627176&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Dietary+sodium+intake+and+cardiovascular+mortality%3A+controversy+resolved%3F&rft.issn=0895-7061&rft.date=2012&rft.volume=25&rft.issue=7&rft.spage=727&rft.epage=34&rft.artnum=&rft.au=Alderman+MH&rft.au=Cohen+HW&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Alderman MH, & Cohen HW (2012). Dietary sodium intake and cardiovascular mortality: controversy resolved? <span style="font-style: italic;">American journal of hypertension, 25</span> (7), 727-34 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22627176" rev="review">22627176</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=PLoS+medicine&rft_id=info%3Apmid%2F22802735&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Plasma+Phospholipid+Fatty+Acid+Concentration+and+Incident+Coronary+Heart+Disease+in+Men+and+Women%3A+The+EPIC-Norfolk+Prospective+Study.&rft.issn=1549-1277&rft.date=2012&rft.volume=9&rft.issue=7&rft.spage=&rft.epage=&rft.artnum=&rft.au=Khaw+KT&rft.au=Friesen+MD&rft.au=Riboli+E&rft.au=Luben+R&rft.au=Wareham+N&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Khaw KT, Friesen MD, Riboli E, Luben R, & Wareham N (2012). Plasma Phospholipid Fatty Acid Concentration and Incident Coronary Heart Disease in Men and Women: The EPIC-Norfolk Prospective Study. <span style="font-style: italic;">PLoS medicine, 9</span> (7) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22802735" rev="review">22802735</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=The+American+journal+of+clinical+nutrition&rft_id=info%3Apmid%2F20071648&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Meta-analysis+of+prospective+cohort+studies+evaluating+the+association+of+saturated+fat+with+cardiovascular+disease.&rft.issn=0002-9165&rft.date=2010&rft.volume=91&rft.issue=3&rft.spage=535&rft.epage=46&rft.artnum=&rft.au=Siri-Tarino+PW&rft.au=Sun+Q&rft.au=Hu+FB&rft.au=Krauss+RM&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Siri-Tarino PW, Sun Q, Hu FB, & Krauss RM (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. <span style="font-style: italic;">The American journal of clinical nutrition, 91</span> (3), 535-46 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/20071648" rev="review">20071648</a></span>
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<br /></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com5tag:blogger.com,1999:blog-2058017873235758512.post-10697286279354899382012-07-16T07:30:00.000+02:002012-07-18T09:28:37.203+02:00How The Media Monkeys Get You Panicked About Sitting Too Long!<br />
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From "man is made to move" to "man is not made to sit" is a very recent transition of scientific insight. Let's get our readers panicked over more than not doing exercise, is the response of the media. Here is why you should sit down and get the facts straight before jumping up in fear.
<a href="http://twitter.com/home/?status=%20How%20the%20media%20monkeys%20get%20you%20panicked%20about%20sitting%20too%20long%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span class="s1">"</span><a href="http://www.telegraph.co.uk/health/healthnews/9386569/Limit-TV-watching-to-2-hours-to-live-longer-say-scientists.html" target="_blank">It is now well known that spending too much time sitting down is bad for the heart, even if one takes regular exercise</a>.<span class="s1">"</span></div>
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That's what the Daily Telegraph told us on 10 July this year. Behind this piece of insight is a study published by Katzmarzyk and colleagues a few days earlier. The authors investigated the question what effect the daily time we spend sitting down has on health and life expectancy. In the USA, that is. </div>
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Maybe the Daily Telegraph lives in a different knowledge universe, but in the one where biomedical research counts, the association between sitting and heart disease is not as clear as the reporters make it out to be. Call me a fusspot, but the only study design, which allows us to draw conclusions about causality, are those where we expose a randomly assembled group of individuals to a certain intervention (in this case: sitting down for extended hours every day) and then we compare the outcome in that group with the outcome of another randomly assembled group which didn't get our intervention. Assuming the two groups didn't differ in any meaningful way from each other at the outset of our experiment, we can, at the end of it, ascribe a possible difference in outcome between the groups to our intervention. That's what I want you to keep in mind while I walk you through the study which had prompted the Daily Telegraph to tell you that sitting too long will cut your life expectancy. </div>
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Let's first look at the background to the authors' research question, which was "To determine the impact of sitting and television viewing on life expectancy in the USA" [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Katzmarzyk,%202012%20#17869%22">1</a>]. Over the past 60 years we have accumulated a vast body of evidence for the benefits of physical activity on health. The results of this research are reflected in every guideline on how and how much we should exercise. You could say "made to move" is written all over our genes. Only very recently are we discovering a sub-clause, written in small-print, saying "man is not made to sit", which we interpret to mean that cramming movement into a brief period of time every day doesn't help us much if sitting around is what we do for the rest of the day. Katzmarzik and Lee simply wanted to extract from the available evidence how a violation of this newly discovered sub-clause impacts our health and longevity.</div>
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So, they set out to identify all the studies from which reliable data could be gleaned about the effects of sitting and television time on the risk of dying. Only 5 studies matched those criteria. From these they pooled the relative risk results into a meta-analysis. Then they looked at the sedentary behaviors of the U.S. population. For that purpose they consulted the data of the National Health And Nutrition Surveys (NHANES), and they also looked at the latest life tables for this population as published by the World Health Organization (WHO). We don't need to go into the statistic intricacies of the procedure. They are a very thorough and methodical attempt at coming up with an educated guess about the impact of extended sitting on the life expectancy of a population. By way of analogy: the authors threw all those data into the statistics blender and came up with what we call the population attributable fraction, or PAF, which tells you how many deaths (or disease cases) could be avoided in a population if the risk factor or exposure were eliminated, in our case, the exposure being extended sitting time. </div>
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Fast forward to the results, which the authors comment as follows: "The results of this study indicate that limiting sitting to less than 3 hrs/day and limiting television viewing to less than 2 hrs/day may increase life expectancy at birth in the USA by approximately 2.0 and 1.4 years respectively, assuming a causal relationship." That's what I like about the authors, whose work I have been following for quite some time. They point out that this conclusion is only valid UNDER THE ASSUMPTION that sitting and dying early are causally related. They also go on to emphasize that this is "...a <i>theoretical</i> estimate..." (emphasis in italics by the authors) and that "This should not be interpreted to mean that people who are more sedentary can expect to live 1.4 or 2.0 years less than someone who does not engage in these behaviours as much." That's obviously addressed at those media types who, of course find it far more sexy to tell you that spending too much time on your butt cuts down your life expectancy. </div>
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Now, instead of picking the raisins out of this nicely done study, I want to walk you briefly through the 5 studies from which the authors extracted their results. After that, you can still judge for yourself how much trust you want to put into the Daily Telegraph interpretation. </div>
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The first of the 5 studies was conducted by the same lead author, Dr Katzmarzyk. It was a study of 17,013 adults of the 1981 Canada Fitness Survey (CFS) who had been followed for up for 12 years [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Katzmarzyk,%202009%20#17874%22">2</a>]. At baseline, the survey participants had been asked, among other things, about their time spent sitting. Death from cardiovascular and other causes were the outcome measure. In such a study it wouldn't make sense to simply correlate sitting time with death. After all, there are a lot of other factors which determine our demise. Age being one of them. My chances to die in the next 12 years are quite a bit greater if I'm 70 than if I'm 35. So, believe me when I say that the authors adjusted as much as possible for such factors. And it is this "as much as possible" where we begin to find hairs in the soup. </div>
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First of all, cardiovascular disease (CVD) is a main cause of death today. So, we should account for all those people who already had CVD when they entered the study. But that's not as simple as it sounds. CVD has a mean streak in that it remains asymptomatic for years, often decades, before it hits you with a heart attack or stroke. So, eliminating those cases who had reported such events at baseline, doesn't mean our survey participants had a clean bill of cardiovascular health. At the average age of over 40, there will certainly have been quite a number of people who had such silent stages of CVD. The principal manifestation of "silent" cardiovascular diseases are those atherosclerotic plaques which narrow the arteries and arterioles. While the authors used the PAR-Q (physical activity readiness questionnaire) which asks, in five questions, about symptoms of CVD, silent CVD would have flown below that radar. So, not accounting for those silent cases may, in all likelihood, have biased the results. Think about it, if those with silent CVD don't move as much, simply because exercising causes them discomfort (which happens when narrowed arteries don't supply enough blood to a working muscle, or heart), it is not the sitting time, but the silent CVD which correlates with an earlier death. </div>
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On to the 2nd study: Author Patel and colleagues looked at 123,216 adults, aged 60+, of the CPS-II nutrition cohort, who had been followed up for 14 years [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Patel,%202010%20#12085%22">3</a>]. Again the results support an association between sitting time and CVD mortality, but, again, silent asymptomatic disease had not been assessed. Interestingly, in this study the association was far stronger in women than in men. Tellingly, age 60+ is also the age at which women start to "catch up" with their male peers in respect to CVD risk.</div>
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In the third study, Dunstan and colleagues had looked at the correlation between television viewing time and death among 8,800 adults aged 50+ with a median follow-up period of 6.6 years. In contrast to the previous 2 studies, the authors were able to adjust for known CVD risk factors such as hypertension, blood lipids, blood glucose and diabetic status. Those who reported sitting in front of the TV for more than 4 hours per day, had a 50% higher risk of dying from any cause and an 80% higher risk of dying from CVD causes. But adjusting for risk factors of CVD is not the same as adjusting for CVD. </div>
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In the fourth study, Stamatakis and colleagues had looked at the data of 4512 people, aged 57+, of the Scottish Health Survey, who had been interviewed in 2003 and followed up until 2007. Those who had reported watching more than 2 hours of TV per day had an increased risk of CVD events (not of CVD death), and only those who had reported watching TV for more than 4 hours per day had a statistically significant risk increase of dying from any cause.</div>
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In the fifth and final study Wijndaele investigated the data of 13,197 adults aged 60+ of the EPIC study cohort. Those people had been assessed at the 1998-2000 baseline and followed up for 9.5 years. Like in the other 4 studies, the association between increased TV viewing time and all-cause and CVD death was evident. This observation prompted the authors to say that: "Given the high prevalence of excessive TV watching, ... these results indicate the importance of public health recommendations aimed at decreasing TV time and possibly overall sedentary behaviour." So, will throwing away your TV make you live longer? </div>
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You'll probably appreciate the difference between Wijndaele's and Katzmarzyk's way of interpreting essentially similar results. I personally go with Katzmarzyk's more careful interpretation. It does not outright assume a causal correlation to exist. There are still too many question marks. For example: We know that self-reported physical activity, self-reported screen time, well, self reported anything, is inherently fraud with over- and under-reporting of facts. Dunstan and colleagues were adamant at pointing out that this couldn't have affected their results. But when you look at how well, or how poorly, their questionnaire really performs, you will be forgiven to be less enthusiastic than the authors. Use that questionnaire twice on the same person to assess same-level PA, and chances are you'll get two different answers. That's not just me being the party pooper, it has been confirmed in validation studies which have shown, at best, only a moderate level of agreement between two rounds of questioning (the parameter is the intraclass correlation coefficient, or ICC) [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_4%22%20%5Co%20%22Brown,%202004%20#17879%22">4</a>]. If repeated questioning is already fraud with inconsistencies, how large, do you think, such inconsistencies will be between the answers of any given respondent and his actual physical activity level? </div>
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So, what are we to make of all this? I can only give you my personal opinion. I tend to believe that there is a threshold volume and intensity of DAILY physical activity, which protects you against the effects of extended sitting time. Only we can't see this level in the 5 discussed studies for obvious reasons. Their ways of assessing PA were not accurate enough.</div>
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I have to admit, that my belief is biased: I don't know about you, but less than 3 hours of sitting time appears unachievable for most of us today. And while I'm working at a desk, which allows me to alternate between standing and sitting, seen through the lenses of these 5 studies, I still have what those studies proclaim to be a risk factor for premature death: extended sitting time. But I also do exercise on a daily basis at an intensity and with a volume which far exceeds what 90% of the population is doing. That's why I love to think of this effort as being CVD-protective. This belief is founded in a large body evidence which essentially says: exercise triggers biochemical reactions and mechanisms with a vast array of protective effects. In a dose-dependent way. </div>
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Fortunately, I'm able to measure the effects of my personal dose of exercise in my health lab. And from doing the same thing for our clients, I happen to know that everyone is unique in his response to intervention, be that exercise or diet or a pharmacological treatment. Which is why I am quite confident when I tell you not to lose any sleep over those attention grabbing headlines. Especially, when they suggest cause-effect relationships from studies which simply can't establish such relationships. In the case at hand, none of the 5 studies could have adjusted for pre-existing silent CVD. CVD is a cause of premature death and, as I have argued, it can be a reason for people to avoid exercise and spend more time sitting, simply because exercise causes them discomfort. So, here is my question: Are people dying early because they sit too long, or are they sitting so long because they'll die earlier? Stay skeptic!
<a href="http://twitter.com/home/?status=%20How%20the%20media%20monkeys%20get%20you%20panicked%20about%20sitting%20too%20long%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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1.<span class="Apple-tab-span"> </span>Katzmarzyk PT, Lee IM: <b>Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis</b>. <i>BMJ Open </i>2012, <b>2</b>(4).</div>
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2.<span class="Apple-tab-span"> </span>Katzmarzyk PT, Church TS, Craig CL, Bouchard C: <b>Sitting time and mortality from all causes, cardiovascular disease, and cancer</b>. <i>Med Sci Sports Exerc </i>2009, <b>41</b>(5):998-1005.</div>
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3.<span class="Apple-tab-span"> </span>Patel AV, Bernstein L, Deka A, Feigelson HS, Campbell PT, Gapstur SM, Colditz GA, Thun MJ: <b>Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults</b>. <i>Am J Epidemiol </i>2010:kwq155.</div>
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4.<span class="Apple-tab-span"> </span>Brown WJ, Trost SG, Bauman A, Mummery K, Owen N: <b>Test-retest reliability of four physical activity measures used in population surveys</b>. <i>J Sci Med Sport </i>2004, <b>7</b>(2):205-215.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=BMJ+open&rft_id=info%3Apmid%2F22777603&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Sedentary+behaviour+and+life+expectancy+in+the+USA%3A+a+cause-deleted+life+table+analysis.&rft.issn=&rft.date=2012&rft.volume=2&rft.issue=4&rft.spage=&rft.epage=&rft.artnum=&rft.au=Katzmarzyk+PT&rft.au=Lee+IM&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Katzmarzyk PT, & Lee IM (2012). Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. <span style="font-style: italic;">BMJ open, 2</span> (4) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22777603" rev="review">22777603</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Journal+of+science+and+medicine+in+sport+%2F+Sports+Medicine+Australia&rft_id=info%3Apmid%2F15362316&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Test-retest+reliability+of+four+physical+activity+measures+used+in+population+surveys.&rft.issn=1440-2440&rft.date=2004&rft.volume=7&rft.issue=2&rft.spage=205&rft.epage=15&rft.artnum=&rft.au=Brown+WJ&rft.au=Trost+SG&rft.au=Bauman+A&rft.au=Mummery+K&rft.au=Owen+N&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Brown WJ, Trost SG, Bauman A, Mummery K, & Owen N (2004). Test-retest reliability of four physical activity measures used in population surveys. <span style="font-style: italic;">Journal of science and medicine in sport / Sports Medicine Australia, 7</span> (2), 205-15 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/15362316" rev="review">15362316</a></span>
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<br /></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com1tag:blogger.com,1999:blog-2058017873235758512.post-11939451173232682082012-07-09T07:30:00.000+02:002012-07-15T10:18:45.354+02:00Supplements: Nutrition Science Or Nutrition Crap?<br />
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Nutritionists claim they are doing science, consumers buy it, and the supplements industry makes a healthy living from it. Only you probably won't. Here is why: </div>
<a href="http://twitter.com/home/?status=%20supplements,%20more%20nutrition%20crap%20than%20nutrition%20science.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="background-color: white;">One of the enduring diet questions is whether supplements are a good tool to (a) improve health, and (b) compensate for nutritional deficits of an enjoyable but less than healthy dietary habit. </span><br />
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To most people, the answer seems to be a resounding "Yes". In the U.S. more than 65% of the population are <a href="http://www.nutraceuticalsworld.com/issues/2010-04/view_features/dietary-supplements-2010/" target="_blank">regular supplement users</a>. They spend north of <a href="http://www.researchandmarkets.com/research/26195b/nutritional_and_di" target="_blank">28 Billion US$ annually</a> on their pills and potions. To put this into perspective: 28 Billion is more than the gross domestic product of Cyprus - the latest EU country in need of being bailed out. While Cyprus circles the drain, the supplement industry doesn't. In fact it is growing by 10% annually. A growth, which, in 2008, Dr. Daniel Fabricant, then vice president of the Natural Products Association (NPA), had <a href="http://www.nutraceuticalsworld.com/issues/2010-04/view_features/dietary-supplements-2010/" target="_blank">correctly predicted</a>. He knew the drivers of that growth: "...the products that grow are the ones with science behind them. When there’s good science like there is behind ... vitamin D and omega 3s, that’s really where the dollar is going to be spent.” So, let's have a look at how good that science really is. </div>
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Remember the time when Vitamin E and beta Carotene - the thing in veggies and fruits, which your body turns into Vitamin A - were found to be associated with decreased risk of lung cancer. The year was 1981 and the knowledge of that time had been summarized in the journal Nature [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Peto,%201981%20#17799%22">1</a>]. You must keep in mind: if it's in Nature, it's like God's gospel. Also keep in mind, that those studies were observational by design, that is, they observed an association between increased beta-carotene intake and lower incidence of lung cancers. Such observations do not allow us to say that one causes the other, even though the media types are typically quick in doing just that. So, the natural conclusion from these association studies was: give smokers, those people who have the highest risk of getting lung cancer, a Vitamin supplement to reduce their risk. </div>
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Then, in 1985, a group of Finnish researchers (The Alpha-Tocopherol, Beta Carotene Cancer Prevention Group, ATBC) did the one and only thing, which can establish a cause-effect relationship: a study in which male smokers, the people at highest risk for lung cancer, were given the supplement and another group wasn't [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22,%201994%20#3963%22">2</a>]. In fact, the 29,000 participants had been randomized into one of 4 equal-sized groups, with group A receiving Vitamin E, group B receiving Vitamin A , group C receiving both Vitamins and group D getting simply a placebo. In 1994 the results came out. Certainly not in favor of the supplement. The guys on beta-carotene had an 18% higher rate of developing lung cancer than their peers who did not get this Vitamin. Actually, this rate was seen accelerating over time.</div>
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Another large trial, the beta-carotene and retinol efficacy trial (CARET) did essentially the same thing. It investigated the effect of beta-carotene on lung cancer risk in more than 18,000 participants at elevated risk due to their being smokers or having been exposed to asbestos. CARET was done in the U.S., and it delivered more sobering results: A 28% increase in lung cancer risk among those who had been randomized to receive the beta-carotene supplement [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Goodman,%202004%20#17785%22">3</a>]. The trial was halted, and follow-up observations showed a gradual reversal of elevated risk. That's a clear indication that the increased risk of lung cancer was attributable to the supplementation with beta-carotene and vitamin E. </div>
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While these results certainly put a damper on the enthusiasm for vitamin A & E, the truly interesting finding is often overlooked and underreported: For the placebo guys in the ATCB study, there was a clear inverse relationship between intake of FOODS high in Vitamin E & A and the risk of lung cancer. The group with the lowest intake of those veggies and fruits, which deliver Vitamin E & A, had a 50% higher risk of developing lung cancer compared to those guys with the highest intake of fruits and veggies. </div>
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These observation have been confirmed in the EPIC study which investigated the effects of diet on cancer. Also here, a high intake of fruit and vegetables, not supplements, was found to reduce smokers' risk of lung cancer considerably [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_4%22%20%5Co%20%22Gonzalez,%202010%20#12556%22">4</a>]. </div>
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With these facts about nutrition science, and how the supplement industry uses it, I simply wanted to set the mood. Now, let's look at how this science is doing in the vitamin D and omega-3 department as emphasized by Dr. Fabricant.</div>
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Vitamin D supplements are believed to improve or maintain bone health in older adults, particularly in women. Indeed, what comes out of science labs seems to support this notion. Dr. Bischoff-Ferrari and her colleagues evaluated 11 randomized controlled trials to answer the question whether vitamin D supplementation reduces fracture risk in women aged 65 and older. It does. But only in those with the highest daily intake, more than 800IU. Good news for the supplement industry? You bet. But is it good news for you, too? Maybe not. Vitamin D needs to be taken with calcium to be effective. But high calcium intake by way of supplements appears to increase the risk for heart attacks, whereas dietary calcium intake, say from milk and cheese, does not [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_5%22%20%5Co%20%22Li,%202012%20#17362%22">5</a>]. </div>
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In view of all this evidence the United States Preventive Services Task Force (USPSTF) recently issued its <a href="http://www.uspreventiveservicestaskforce.org/draftrec3.htm" target="_blank">draft recommendation</a>, which says that there is insufficient evidence to "...to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation...". But rest assured, the supplement industry has all the evidence and science, which the USPSTF has not. Or so they want you to believe. </div>
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Let's move over to the famous fish oils and their Omega-3s.</div>
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The Omega-3 fatty acids are often praised as the constituents of fish oil, which protect against heart disease. At least that's what the supplement industry says. Science says something else. A double-blind prospective study of 2500 men and women aged 45 to 80, who had experienced a heart attack or stroke, investigated whether omega3- supplementation would prevent further cardiovascular events [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_6%22%20%5Co%20%22Galan,%20%20#13148%22">6</a>]. It didn't. </div>
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You might ask, why this study looked only at people who had already cardiovascular disease. Maybe they are so far down the drain, that fish oil can't do its trick any more. Wouldn't it be nice to know whether omega-3 is protective in people who do not have cardiovascular disease? Yeah, it would. It would also be nice for you to tell me how to run such a study. Realistically. You would have to enroll thousands of healthy people, randomize them into those who MUST NOT EVER get their hands on omega-3 supplements and those who MUST take it every day for many years. Go find those people. Then, after many years, you would have to compare the outcome between the two groups. And you also would have to rule out those outcomes to be affected by such factors as physical activity and all the different food habits those thousands of people have. Of course, you would need funding for this type of research. Only, who will give you the funds? Certainly not the pharmaceutical industry. It pumps billions into research, yes, but only for proprietary chemicals. There is nothing proprietary about a vitamin, which every Tom, Dick and Harry can put into a pill. Which is why even the supplements industry won't give you a single dollar for your research. Now you know why such studies are not being performed. And why nutrition science is so fickle with its results. </div>
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What's the taking home point: When it comes to nutrient-health interactions, it is obviously not as simple as boiling down the effects of food to an individual vitamin or other nutrient. Neither is it as simple as stuffing this nutrient into a pill and shoving it down your throat. In the words of Einstein: "Make things as simple as possible, but not simpler." Reducing the effects of food to individual vitamins or other nutrients is obviously an oversimplification. When, as a result of oversimplification, nutrition science makes you jump from one supplement to the next, what does the supplement industry do? They are laughing their way to the bank. And, as we have seen, Mr Fabricant knows why. He is no more with the NPA, though. He has switched sides to <a href="http://www.naturalproductsinsider.com/blogs/np-moves/2011/02/daniel-fabricant-moves-from-npa-to-fda.aspx" target="_blank">work now for the FDA</a> as director of its Dietary Supplement Programs division. Let's hope the FDA's view on nutrition science remains as skeptical as it ought to be. In the interest of your health.
<a href="http://twitter.com/home/?status=%20supplements,%20more%20nutrition%20crap%20than%20nutrition%20science.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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1.<span class="Apple-tab-span"> </span>Peto R, Doll R, Buckley JD, Sporn MB: <b>Can dietary beta-carotene materially reduce human cancer rates?</b> <i>Nature </i>1981, <b>290</b>(5803):201-208.</div>
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2.<span class="Apple-tab-span"> </span><b>The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group</b>. <i>N Engl J Med </i>1994, <b>330</b>(15):1029-1035.</div>
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3.<span class="Apple-tab-span"> </span>Goodman GE, Thornquist MD, Balmes J, Cullen MR, Meyskens FL, Jr., Omenn GS, Valanis B, Williams JH, Jr.: <b>The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements</b>. <i>J Natl Cancer Inst </i>2004, <b>96</b>(23):1743-1750.</div>
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4.<span class="Apple-tab-span"> </span>Gonzalez CA, Riboli E: <b>Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study</b>. <i>Eur J Cancer </i>2010, <b>46</b>(14):2555-2562.</div>
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5.<span class="Apple-tab-span"> </span>Li K, Kaaks R, Linseisen J, Rohrmann S: <b>Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)</b>. <i>Heart </i>2012, <b>98</b>(12):920-925.</div>
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6.<span class="Apple-tab-span"> </span>Galan P, Kesse-Guyot E, Czernichow Sb, Briancon S, Blacher J, Hercberg S: <b>Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial</b>. <i>BMJ</i>, <b>341</b>.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Nature&rft_id=info%3Apmid%2F7010181&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Can+dietary+beta-carotene+materially+reduce+human+cancer+rates%3F&rft.issn=0028-0836&rft.date=1981&rft.volume=290&rft.issue=5803&rft.spage=201&rft.epage=8&rft.artnum=&rft.au=Peto+R&rft.au=Doll+R&rft.au=Buckley+JD&rft.au=Sporn+MB&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Peto R, Doll R, Buckley JD, & Sporn MB (1981). Can dietary beta-carotene materially reduce human cancer rates? <span style="font-style: italic;">Nature, 290</span> (5803), 201-8 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/7010181" rev="review">7010181</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=The+New+England+journal+of+medicine&rft_id=info%3Apmid%2F8127329&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=The+effect+of+vitamin+E+and+beta+carotene+on+the+incidence+of+lung+cancer+and+other+cancers+in+male+smokers.+The+Alpha-Tocopherol%2C+Beta+Carotene+Cancer+Prevention+Study+Group.&rft.issn=0028-4793&rft.date=1994&rft.volume=330&rft.issue=15&rft.spage=1029&rft.epage=35&rft.artnum=&rft.au=The+Alpha-Tocopherol+Beta+Carotene+Cancer+Prevention+Study+Group&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">The Alpha-Tocopherol Beta Carotene Cancer Prevention Study Group (1994). The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. <span style="font-style: italic;">The New England journal of medicine, 330</span> (15), 1029-35 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/8127329" rev="review">8127329</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Journal+of+the+National+Cancer+Institute&rft_id=info%3Apmid%2F15572756&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=The+Beta-Carotene+and+Retinol+Efficacy+Trial%3A+incidence+of+lung+cancer+and+cardiovascular+disease+mortality+during+6-year+follow-up+after+stopping+beta-carotene+and+retinol+supplements.&rft.issn=0027-8874&rft.date=2004&rft.volume=96&rft.issue=23&rft.spage=1743&rft.epage=50&rft.artnum=&rft.au=Goodman+GE&rft.au=Thornquist+MD&rft.au=Balmes+J&rft.au=Cullen+MR&rft.au=Meyskens+FL+Jr&rft.au=Omenn+GS&rft.au=Valanis+B&rft.au=Williams+JH+Jr&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Goodman GE, Thornquist MD, Balmes J, Cullen MR, Meyskens FL Jr, Omenn GS, Valanis B, & Williams JH Jr (2004). The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements. <span style="font-style: italic;">Journal of the National Cancer Institute, 96</span> (23), 1743-50 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/15572756" rev="review">15572756</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=European+journal+of+cancer+%28Oxford%2C+England+%3A+1990%29&rft_id=info%3Apmid%2F20843485&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Diet+and+cancer+prevention%3A+Contributions+from+the+European+Prospective+Investigation+into+Cancer+and+Nutrition+%28EPIC%29+study.&rft.issn=0959-8049&rft.date=2010&rft.volume=46&rft.issue=14&rft.spage=2555&rft.epage=62&rft.artnum=&rft.au=Gonzalez+CA&rft.au=Riboli+E&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Gonzalez CA, & Riboli E (2010). Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. <span style="font-style: italic;">European journal of cancer (Oxford, England : 1990), 46</span> (14), 2555-62 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/20843485" rev="review">20843485</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Heart+%28British+Cardiac+Society%29&rft_id=info%3Apmid%2F22626900&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Associations+of+dietary+calcium+intake+and+calcium+supplementation+with+myocardial+infarction+and+stroke+risk+and+overall+cardiovascular+mortality+in+the+Heidelberg+cohort+of+the+European+Prospective+Investigation+into+Cancer+and+Nutrition+study+%28EPIC-Hei&rft.issn=1355-6037&rft.date=2012&rft.volume=98&rft.issue=12&rft.spage=920&rft.epage=5&rft.artnum=&rft.au=Li+K&rft.au=Kaaks+R&rft.au=Linseisen+J&rft.au=Rohrmann+S&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Li K, Kaaks R, Linseisen J, & Rohrmann S (2012). Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Hei <span style="font-style: italic;">Heart (British Cardiac Society), 98</span> (12), 920-5 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22626900" rev="review">22626900</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=BMJ+%28Clinical+research+ed.%29&rft_id=info%3Apmid%2F21115589&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Effects+of+B+vitamins+and+omega+3+fatty+acids+on+cardiovascular+diseases%3A+a+randomised+placebo+controlled+trial.&rft.issn=0959-8138&rft.date=2010&rft.volume=341&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Galan+P&rft.au=Kesse-Guyot+E&rft.au=Czernichow+S&rft.au=Briancon+S&rft.au=Blacher+J&rft.au=Hercberg+S&rft.au=SU.FOL.OM3+Collaborative+Group&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Galan P, Kesse-Guyot E, Czernichow S, Briancon S, Blacher J, Hercberg S, & SU.FOL.OM3 Collaborative Group (2010). Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. <span style="font-style: italic;">BMJ (Clinical research ed.), 341</span> PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/21115589" rev="review">21115589</a></span>
</div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com25tag:blogger.com,1999:blog-2058017873235758512.post-40393819517947530882012-06-28T07:30:00.000+02:002012-06-29T01:25:59.038+02:00Will The Polypill Prevent Your Heart Attack?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZnJlWxcCAfhIdT62RaspThlRSmxmU2GDZ7znp6OKsuimGI2PvOaw2m1nKwGc8NdW4sKHD4yj0OwU_yBEWUEM-vLkfWI2bl_HexBowHpCBaTDghs4jKdZbcYr6GkHRS7s6X4JpH2BJ_pE/s1600/iStock_000011190602XSmall.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZnJlWxcCAfhIdT62RaspThlRSmxmU2GDZ7znp6OKsuimGI2PvOaw2m1nKwGc8NdW4sKHD4yj0OwU_yBEWUEM-vLkfWI2bl_HexBowHpCBaTDghs4jKdZbcYr6GkHRS7s6X4JpH2BJ_pE/s200/iStock_000011190602XSmall.jpg" width="172" /></a></div>
Giving the polypill to everybody above the age of 55 kills two birds with one stone: cardiovascular risk and preventive medicine. That's what the proponents of the polypill say. The medical establishment is in uproar. Here is why you should be, too. But for a different reason. <a href="http://twitter.com/home/?status=%20will%20the%20polypill%20prevent%20your%20heart%20attack.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a><br />
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We are typically sold on the notion, that heart disease and stroke have become today's major killer, for one simple reason: We live far longer than our ancestors of a hundred years ago, whose major cause of death were infectious diseases. Their eradication has brought upon us the blessings of longer lives, and with it the detriments of aging related cardiovascular disease. It's root cause is elevated cholesterol, a theory enshrined in the so-called lipid hypothesis. Questioning it is to the medical establishment what Galileo's theories were to the catholic church: plain heresy. After all, cholesterol lowering drugs, the statins, are a blessing to mankind and substantial reducer of cardiovascular death. </div>
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This is what nearly everyone believes. <br />
<a name='more'></a>The Chinese Tao has a quote for such situations. It goes something like this: "when everyone knows something is good, this is bad already." You might reject my suggestion that such ancient wisdom could possibly apply to modern medicine. So, let's get cracking at those facts which everyone knows. </div>
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<b>Claim 1: Heart disease, stroke and cancer are today's major killers</b> </div>
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Undeniably. Cardiovascular disease accounts for roughly one in three deaths (30%), followed by cancer, which kills another one in four (23%) [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Kochanek,%202011%20#17711%22">1</a>]. Which means your chance of dying of any one of those two clusters is fifty-fifty. By the way, these data, and the ones which follow, are drawn from U.S. statistics. Unfortunately they are typical for the rest of the developed world and pretty close to what the developing nations experience, too. </div>
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<b>Claim 2: One hundred years ago, Infectious diseases were the main killers</b></div>
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Yes, indeed. In 1900, one third of all deaths were due to tuberculosis and influenza alone. </div>
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<b>Claim 3: Since we eliminated those infectious diseases we have a longer life expectancy and therefore we simply die of aging related diseases.</b><br />
This is where it starts to get hairy. First, you must NOT confuse life expectancy with life span. Life expectancy is typically quoted as life expectancy at birth. It is an average value of all the years lived divided by the number of those born alive. You can imagine how this number is very sensitive to the rate of infant deaths and of deaths during the early adult years. Particularly when one third of all newborns die within the first 12 months. Which was a typical infant death rate, not only in ancient Rome but throughout most of modern history until the 17th century. While this infant mortality rate made Roman's have an average life expectancy at birth of a little less than 30 years, a considerable part of the population lived to their sixties and seventies. In fact, very few people will have died at age 30, most either having done so way earlier or much later. Back to 1900. </div>
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In 1900, U.S. females had a life expectancy at birth of 51 years, whereas those who reached 50 had a remaining life expectancy of another 22 years, to reach 72. Today these numbers stand at 80 years life expectancy at birth and 82 years at the age of 50. Which means two things: First, while life expectancy at birth has increased dramatically by more than 30 years over the past 100 years, life span hasn't increased that much. Second, life expectancies at birth and at age 50 have become virtually the same. The reason is a substantial reduction in infectious diseases, which killed considerable numbers of infants, of women giving birth, and of young adults. Which brings us to ...</div>
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<b>Claim 4: Cardiovascular disease and cancer are diseases of old age, which is why they are more prominent today than 100 years ago. </b><br />
When we compare today's death rates with those of the past, we need to keep in mind that the age distribution in 1900 was substantially different to what it is today. In 1900 there were a lot less people of age 65 and older than there are today. So, we need to answer the question, what would the CVD mortality have been in 1900 if the population had had the same age distribution as ours has today. Thankfully, the U.S. CDC provides us with a standardization tool, which allows us to answer this question. They simply use the U.S. population at the year 2000 as the standard to which all other population data can be standardized. The process is called "adjustment for age" and, when applied to mortality rates, they become truly comparable as so-called age-adjusted mortality rates. So, in the future, when you read something about mortality rates or disease rates, make sure to check which rates he uses for comparison. If he doesn't say which is which, you need to be very skeptical about his interpretation. </div>
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Now here comes the surprise: The mortality rate for cardiovascular disease in 1900 was 22% vs. today's 31%. At first blush, this doesn't sound that much different. But think about it: If CVD is merely the disease of old age, why should there be a difference at all? And if there is a difference, why should we be dying of this disease at a 50% higher rate when we have all the medical technology, and the statins, which our grand parents didn't have. </div>
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The entire issue becomes even weirder when you look at the development of the CVD mortality rate over the 11 decades from 1900 to today (Figure 1). CVD rose to a 60% prominence in 1960 before steeply falling to today's level. You can see that in the 1950s and 1960s people died of "age-related" heart attacks and strokes at a 50% higher rate than 50 years earlier. Another 60 years later we die at a quarter the rate of the 1960s. Which begs the question: What happened?<br />
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<tr><td class="tr-caption" style="text-align: center;">Figure 1</td></tr>
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Actually, there are two parts to this question: If heart disease is age-related, why was there such a dramatic rise in age-adjusted mortality over the first half of the past century, when there should have been none. I have my theories, but I will keep them for one of my next posts.</div>
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Far more pertinent to this post's subject is the second part of the question: What did happen in the 1960s and thereafter? If you think the answer is "statins happened, stupid", then you are in for a surprise. The first statin to hit the market was Merck's Lovastatin. In 1987! Its the red vertical line in the chart of figure 1. Almost 30 years after CVD mortality rate began its steep descent. A descent, which did not accelerate with the introduction of statins to the market. </div>
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Now, don't get me wrong, I'm not saying statins do not reduce the risk of dying from CVD, or the risk of experiencing a non-fatal heart attack or stroke. There is quite some evidence to their benefits. My point is that, whatever statins do, they do not show up on our mortality radar as the grand reducer of CVD death. Not within the current medical practice of risk estimation and subsequent risk-based treatment. </div>
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Enter the proponents of the polypill, which contains a statin, a blood pressure lowering medication, and an aspirin. Are these proponents right to say, give a statin to everyone, who has hit the age of 55? Well, they have a point. Wald and colleagues ran a computer simulation to compare the most simple of all screenings, age, vs. the UK's National Institute of Health guidelines, which recommend screening everybody from age 40 at five-yearly intervals until people reach the risk threshold of a 20% chance of a cardiovascular event in the next 10 years [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Wald,%202011%20#15377%22">2</a>]. That's the cut-off for treatment. Astonishingly, the benefits are virtually the same. What this screening routine buys at the costs for doctor visits and blood tests, we get free of charge with the age threshold. </div>
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This paper was so counterintuitive to the established way of medical thinking, that the authors' paper, first submitted to the British Medical Journal in 2009, went through a 2-years Odyssey of being rejected by 4 Journals and 24 reviewers, before finally being published in PLoS One in 2011. </div>
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But costs from a societal perspective are not the costs which interest you. You might be more interested to know, that even at an elevated risk of CVD, 25 people would have to swallow a statin for 5 years to prevent just 1 heart attack. How much larger will this number be, the number needed to treat (NNT), as we call it, if you are simply 55 but with no other CVD risk factor? You won't get an answer anytime soon. Big Pharma is not interested to finance a study, which could deliver the answer. They don't earn much money from polypills which only use generic statins, those whose patent protection has expired. </div>
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To me the NNT is definitely too high. I won't take the polypill, though I just crossed that age threshold a few days back. I pursue another path to health and longevity. And I believe, you might want to look at my reasoning for that path. I will introduce it progressively over the next few posts. Not that I evangelize it, not to worry. I simply believe there is a third alternative to the risk-oriented practice of preventive medicine and to the kitchen-sink approach of its polypill wielding opponents. This third alternative is heresy to both. But with heresy I'm in good company. Dr. Ignaz Semmelweis was a heretic when he suggested in the mid 1800s that the high rate of deadly childbed fever was due to physicians not washing their hands between dissecting dead bodies and helping women deliver their children. It took about 50 years for his ideas to become medical mainstream. </div>
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That's because new ideas become accepted in medicine not upon proof of being better than the old ones, but upon the old professors, who have built their careers on the old ideas, dying out. So, let's try to survive them. </div>
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1.<span class="Apple-tab-span"> </span>Kochanek, K.D., et al., <i>Deaths: Preliminary Data for 2009</i>, in <i>National Vital Statistics Reports </i>2011, U.S. Department of Health And Human Services.</div>
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2.<span class="Apple-tab-span"> </span>Wald, N.J., M. Simmonds, and J.K. Morris, <i>Screening for future cardiovascular disease using age alone compared with multiple risk factors and age.</i> PLoS ONE, 2011. <b>6</b>(5): p. e18742.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=PloS+one&rft_id=info%3Apmid%2F21573224&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Screening+for+future+cardiovascular+disease+using+age+alone+compared+with+multiple+risk+factors+and+age.&rft.issn=&rft.date=2011&rft.volume=6&rft.issue=5&rft.spage=&rft.epage=&rft.artnum=&rft.au=Wald+NJ&rft.au=Simmonds+M&rft.au=Morris+JK&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Wald NJ, Simmonds M, & Morris JK (2011). Screening for future cardiovascular disease using age alone compared with multiple risk factors and age. <span style="font-style: italic;">PloS one, 6</span> (5) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/21573224" rev="review">21573224</a></span>
</div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com3tag:blogger.com,1999:blog-2058017873235758512.post-90368977096581184552012-06-25T07:30:00.000+02:002012-06-26T17:34:29.819+02:00Why Risk Screening For Heart Disease Is As Good As Crystal Ball Gazing<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicE0tersPoh90IXcGxa-Od7YSLox6tkl6YMynCpOII4dRPfMpVmqWmeFL8PGJlq9FTxb6Efchh7jKfb9XGn7IrB_8iGTgaMXt8la7gAYLeXZW7lfHeLzvdjy5N4jvO3Hhczs39OjT9Nro/s1600/iStock_000010119850XSmall.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicE0tersPoh90IXcGxa-Od7YSLox6tkl6YMynCpOII4dRPfMpVmqWmeFL8PGJlq9FTxb6Efchh7jKfb9XGn7IrB_8iGTgaMXt8la7gAYLeXZW7lfHeLzvdjy5N4jvO3Hhczs39OjT9Nro/s200/iStock_000010119850XSmall.jpg" width="133" /></a></div>
If weather forecasts were as reliable as cardiovascular risk prediction tools, meteorologists would miss two thirds of all hurricanes, expect rain for 8 out of 10 sunny days, and fail to see the parallels to fortune telling. </div>
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When you are older than 35 and visit your doctor, there is a good chance he will evaluate your risk of suffering a heart attack or stroke over the next 10 years. The motivation behind this risk scoring is to prevent such an event while you still can. After all, these cardiovascular diseases are the number one causes of disability and death. In Europe alone 1.8 Million people die from it every year. In fact, they die prematurely, which means at an age younger than 75.
<a href="http://twitter.com/home/?status= risk screening for heart disease is like crystal ball gazing. via@http://drlutz.blogspot.com " target="_blank"> [tweet this].</a>
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That's why, at first blush, it sounds reasonable to develop risk prediction scores to help doctors identify the high-risk patient whose asymptomatic state makes him blissfully unaware of being a walking time bomb. Forewarned is forearmed, or something like that the reasoning goes. But what if the forewarning part is as reliable as a six weeks weather forecast and the forearming as effective as the wish for world peace?<br />
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As with any medical technology, risk prediction tools should be judged by their ability to improve YOUR health outcome before they are used on YOU. While the latest publication about the UK QRISK score is an upbeat evaluation of its improved performance, it fails to convince me that using these tools actually makes sense [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Collins,%202012%20#17662%22">1</a>]. </div>
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Let's look at the data first: </div>
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The QRISK score was developed for the UK population, because the grand dame of risk prediction scores, the Framingham Risk Score (FRS), doesn't do so hot in northern European people. FRS was seen to over-predict the risk in the UK population by up to 50%. In an effort to do better than that, QRISK was developed. It packs a lot more variables into its score than FRS. In its latest version, QRISK includes the risk factors age, smoking status (with a 5-level differentiation), ethnicity, blood pressure, cholesterol, BMI, family history, socioeconomic status, and various disease diagnoses. An algorithm calculates your risk, expressed as a %-chance to suffer a heart attack or stroke over the next 10 years. </div>
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In clinical practice a 20% risk is defined as the critical threshold that separates the high-risk person from those in the low-to-moderate risk categories. 20% is an entirely arbitrary number, selected simply for convenience's sake and economic reasons. Set it too high, and you identify too few at-risk people, set it too low and you have to deal with too many false positives, that is, people who you would treat for elevated risk but who will not suffer an event even if you didn't treat them. The latter is clearly a strain on limited health budgets.</div>
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Now, let's see how QRISK at a threshold of 20% risk would work for you, provided you are between 30 and 84 years old, which is the age range to which QRISK is applicable. Let's also assume you are female. </div>
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For every 1000 women, 40 will suffer a first heart attack or stroke over the next 10 years. Of these 40 obviously high-risk, women, QRISK identifies 17 correctly. Which means the remaining 23, or 60% of all those who will suffer a heart attack or stroke, fly below the QRISK radar. But that's not the intriguing part. We get to that by looking at the group of women who are identified as high-risk. </div>
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If the 20% risk score threshold predicts correctly, then about 20 of every 100 women identified as high-risk will suffer a first event over the next 10 years. After all, that's what a 20% risk means: Of a hundred women having the same profile, 20 will eventually suffer a first heart attack or stroke over the next 10 years. Which brings us to the really juicy part: In the population from which QRISK was developed, 16% of the high-risk women actually did suffer that predicted heart attack or stroke. </div>
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You are forgiven if you don't immediately see, why I call this the juicy part. But think about it this way: The QRISK numbers were not plugged from an observational study, which simply observes and follows women for 10 years, without doing anything to or with them. These numbers represent women who were identified to be at high risk by the very health care system, which claims to do the risk scoring to protect them from such events in the first place. So, what happened to actually preventing those events? 16% vs. 20% doesn't sound like a terrific preventive job. </div>
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By the way, for men the figures are very much the same. The reason why I chose women is because there is an inconsistency in the study's published tables which compare the events in two age groups - the 35-74 year old men, and the 30-80 year old men. The number of heart attacks and strokes is given as 54 and 50 for the first and second group respectively. But it can't be that there are less events in the 30-80 year range than in the 35-74 year range. Since there is no such detectable inconsistency in the numbers for women, I chose them as the example. </div>
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Back to the risk score and a summary of its performance. First, the score misses 60% of all cases right off the bat. Second, among the correctly identified future sufferers of heart attacks and strokes, the subsequent treatment only prevents a small minority of events, which amounts to about 4% of all cases happening over the 10-year period. If our preventive interventions were worth their salt, we should see no, or only a few, cases happening in the high-risk group. Because this is the group, which is supposed to benefit from intensive treatment and intervention. </div>
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This public health strategy of targeting the high-risk part of the population with an intervention is appropriately called the high-risk strategy. As we have seen, it makes public health miss the majority of disease events, which it set out to prevent in the first place. So what is the alternative? It's called the population strategy. And, yes, it means targeting the entire population in an effort to reduce all people's exposure to whatever are the causes of the disease. That entails necessarily a one-size-fits-all approach to health. Which you encounter in the form of those exercise and diet recommendations preached to us from every public health pulpit. </div>
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In theory, this strategy could potentially have a large effect on the health of the entire population, materializing as a substantial reduction in the number of heart attacks and strokes. But when you look at it from YOUR point of view, you have to invest the sizeable effort of changing your eating and exercising habits, while you'll find the benefits hardly perceivable. After all, health is when you don't feel it. A prevented disease is never perceived as such. In public health, this situation, where an individual's large perceived sacrifice yields only an imperceptibly small personal benefit, is called the prevention paradox. It's a more academic way of saying it doesn't work either.<br />
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The data are certainly there to prove my case. In my <a href="http://drlutz.blogspot.de/2012/06/are-you-unique-medical-case_21.html" target="_blank">previous post</a> I highlighted how little change in health behaviors has happened over the past 20 years. And the little change, that did happen, went mostly into the wrong direction. </div>
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Which is why we will continue to see most of us dying, ironically, from preventable diseases: heart disease, stroke, diabetes, many cancers. Which is why I'm questioning the current clinical practice of risk scoring. After all, it costs money and time.<br />
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It's this question which has lead some researchers to suggest giving everybody above the age of 50 a so-called polypill. A pill which reduces blood pressure and cholesterol, and which delivers a low dose of aspirin. It aims at killing three birds with one stone: hypertension, hypercholesterolemia and thrombotic events, all of which are causally related to heart attack and stroke. But to me, the polypill is preventive medicine's declaration of bankruptcy.<br />
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In my next post, I will talk about this, about how preventive medicine may really work, and, most importantly, what it means to you. Practically and presently. Because we already have the tools to help you prevent your heart attack or stroke. And those tools don't go by the name of any known risk score. if you are still keen on scoring your risk, we have a tool on our website for you to do that. It also shows you, how your risk would be if all risk factors were in the green zone, or how your risk will be if you maintain your current status over the next ten years. You can play around with it <a href="http://www.adiphea.com/en/training/programs/gesundheitscheck.html" target="_blank">here</a>, and make a couple of other tests, too. But don't get fooled by numbers. Your greatest risk is to take those risk scores too seriously. </div>
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Reference:</div>
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1.<span class="Apple-tab-span"> </span>Collins, G.S. and D.G. Altman, Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2. BMJ, 2012. 344.</div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=BMJ+%28Clinical+research+ed.%29&rft_id=info%3Apmid%2F22723603&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Predicting+the+10+year+risk+of+cardiovascular+disease+in+the+United+Kingdom%3A+independent+and+external+validation+of+an+updated+version+of+QRISK2.&rft.issn=0959-8138&rft.date=2012&rft.volume=344&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Collins+GS&rft.au=Altman+DG&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Collins GS, & Altman DG (2012). Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2. <span style="font-style: italic;">BMJ (Clinical research ed.), 344</span> PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22723603" rev="review">22723603</a></span></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com2tag:blogger.com,1999:blog-2058017873235758512.post-49159812632998841112012-06-21T08:14:00.001+02:002012-06-22T07:25:26.581+02:00Are You A Unique Medical Case?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNeyeyldLePU-TKfAd97HVg2_rw3DDOdW2LcF7g3VT-xh2G1WzsWDmLLW2XBET2m7p58oexhAWAALWjE8ZrsaQpZVY11VM8DL1yICdcJSRlKLl-EdCBlfMpGsBWPjeIGe3oBGMYaM6Ug/s1600/thumbnail_sm.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNeyeyldLePU-TKfAd97HVg2_rw3DDOdW2LcF7g3VT-xh2G1WzsWDmLLW2XBET2m7p58oexhAWAALWjE8ZrsaQpZVY11VM8DL1yICdcJSRlKLl-EdCBlfMpGsBWPjeIGe3oBGMYaM6Ug/s200/thumbnail_sm.png" width="140" /></a></div>
Research says yes, public health doesn't listen, and you suffer the consequences: too little benefits from generic interventions. And it could be so simple.<br />
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<a name='more'></a>Different people always react differently to the same type of treatment. In my previous post I showed you the wide range of blood pressure changes in over 700 participants of the HERITAGE study's 20-weeks endurance exercise program (Figure 1). Unfortunately, most studies do not present their results in a way, which would allow us to construct such charts as in figure 1. But when they do, the charts look virtually the same. Figure 2 shows you how 30 obese men changed their bodyweight and fat weight as a consequence of a 12-weeks supervised exercise program [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22King,%202007%20#3927%22">1</a>]. As you can see, the mean change of 3.7 kg for both values (the horizontal red line) doesn't tell you anything about how these 30 men reacted INDIVIDUALLY to the program.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgiqbrEO8UrQK161OPD74JlKF8C6ZAKqy-JJ_exoZAKIGebKEtKFs61AFf0-m0jmtw183VyVXiNacirEGC2omlYmzscfEsJcwPIsvlkONJHAGHkxRS7MdCCCj7aJFUXCn4eknmiGNwjoU/s1600/normality-vs-AR-plos.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgiqbrEO8UrQK161OPD74JlKF8C6ZAKqy-JJ_exoZAKIGebKEtKFs61AFf0-m0jmtw183VyVXiNacirEGC2omlYmzscfEsJcwPIsvlkONJHAGHkxRS7MdCCCj7aJFUXCn4eknmiGNwjoU/s200/normality-vs-AR-plos.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Figure 1</td></tr>
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When your doctor tells you what exercise to do, what diet to follow or what drug to take, she refers to studies, which report their outcomes in terms of mean values for groups of participants. But as you know now, these values don't answer your question: What would my outcome have been, had I participated in this study? Which is the same as asking, what your results will be if you follow your doctor's advice. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiSPpXqH9eYBGjubXjeix1X0vUoeNUznzS6-QQ8ObzVxokaV1gVo4bZXaYF2UMvX3A0vuFNt-pDOoPOJWR9t7RpKJGr2o2P20gvQBqDmJksYpOUB7viRoQGh7IRgUlKOsDJndUzWR9AXk/s1600/weightloss-king.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="115" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiSPpXqH9eYBGjubXjeix1X0vUoeNUznzS6-QQ8ObzVxokaV1gVo4bZXaYF2UMvX3A0vuFNt-pDOoPOJWR9t7RpKJGr2o2P20gvQBqDmJksYpOUB7viRoQGh7IRgUlKOsDJndUzWR9AXk/s200/weightloss-king.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Figure 2</td></tr>
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The honest answer is: nobody knows. Augmented by: in all likelihood you will see some benefit; if you are very lucky you'll see an extremely large benefit. Or you might be unlucky and see no benefit at all. Call this the uncertainty principle of medicine. </div>
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You won't hear your doctor talking about it. Particularly not when he recommends lifestyle change as your first line of defense against heart attack, stroke or diabetes. For two reasons: First, public health is not concerned with your point of view. I'll get to this in a moment. Second, doctors know that lifestyle change is hard to sell as it is. So, why make it even harder by telling you the truth about the uncertainty of benefits. Think about it, we all like to enjoy now and pay later, if at all. That's certainly the case when it comes to cigarettes, salt, sugar and a sedentary lifestyle. To forgo these pleasures in favor of health benefits, which may or may not materialize decades from now, is simply not how we are wired. </div>
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But public health does not seem to get it. Even the American Heart Association's (AHA) latest invention, the seven health metrics, is nothing but the same song and dance, which has not had any impact on the health of the population. Let's look at it in a little more detail: </div>
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The AHA has defined 7 metrics to help you navigate your way to chronic health. 4 of those metrics are behavioral - smoking, physical activity, BMI and diet. The remaining 3 are biomarkers: blood pressure, fasting glucose and total cholesterol. </div>
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Have all 7 in the green zone and you should do well with health. Exactly how well, that was the question Dr. Yang and colleagues had asked in a study which investigated (a) how many U.S. residents meet how many of those metrics and (b) how much of the U.S. population's death burden can be attributed to these risk factors [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Yang,%202012%20#16460%22">2</a>]. Fast forward to the results. More than half of the population, 52.2%, meet only 3 or less of those 7 metrics. That's a 4 % increase compared to 20 years ago. Another 25% meet just 4 metrics. At the same time the percentage of people who meet at least 6 of the 7 metrics has gone down from 10.3% to 8.7%. The percentage of obese people has increased by 50%, and the rate of physical inactivity (that is, people who do not exercise at all!) has doubled from 15.6% to 31.9%. Compared with people who meet no more than 1 metric, those who meet at least 6 reduce their risk of dying by 50%. </div>
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When you look at these correlations, you'll certainly agree with the researchers' statement that "<span class="s1">the presence of a greater number of cardiovascular health metrics was associated with a graded and significantly lower risk of total and CVD mortality</span>". That's nice to know, but you are probably not so much interested in the number of deaths in the population, which are attributable to whatever health metric score is the flavor of the day. You are interested to know the answer to three questions: (a) what does it mean to you, if you don't meet those metrics, (b) how does your effort of getting these metrics into the green zone reduce your risk, and (c) which strategy should you use to lower your risk most effectively.</div>
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Fortunately, with a little bit of digging into published numbers, we can get fairly good answers to these questions. So, let's start with the first one: </div>
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Dong and colleagues had done a fairly similar investigation asking how the number of AHA health metrics correlated with cardiovascular events (heart attack and stroke) in the Northern Manhattan Study Cohort [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22Dong,%202012%20#17366%22">3</a>]. The study's almost 3000 persons were on average 69 years old when they entered the study, and they were followed up for 11 years. Of those who had met at least 4 health metrics, 28% suffered a cardiovascular event during that time, vs. 32% of those who only met 3 or less metrics. </div>
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That's a 4% improvement. </div>
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I don't know, how you feel about it, but my experience with our health lab's clients is that a 4% risk reduction doesn't make them go nuts about exercise and health food. I sympathize, because life is not all about self-flagellation with veggie burgers, tofu swill and weekly marathons. Which is why it is justified to go for the biggest possible health benefit that is achievable with the smallest possible effort. The answer hinges around the question of what is the most critical health metric. Back to Yang's investigation. </div>
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He had asked the question, which of the seven metrics, if met, would yield the largest reduction in deaths? </div>
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If your bet was on smoking and obesity, you might be surprised to hear that blood pressure turned out to be a far more effective executioner, being responsible for 30% of the deaths in this cohort. With 24%, smoking took 2nd place, and obesity didn't show up as a killer at all. Which does not mean obesity doesn't cause death. You have to keep in mind that the average age of the Yang study cohort was 45 years, and the median observation period was 14 years. </div>
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Again, what does all that mean for you? Principally you decide for yourself. I can only tell you what I practice with our clients in our health lab. For each case we define a benchmark biomarker depending on the individual's health profile. In many cases that's blood pressure or, better still, a biomarker of arterial function (I'll talk about the amazing role of arterial function in one of my next posts). We then agree on a certain exercise and dietary strategy, the effect of which we carefully measure in terms of change of the chosen biomarker. If that change does happen, and if it goes into the right direction, that's fine. If the client turns out to be one of the fringe cases, we need to adjust the strategy. We do that until we get it right. That's individualized prevention. While it does not eliminate the uncertainty principle of medicine, it makes prevention efforts far more effective and much more rewarding. It certainly beats following some generic advice drawn from studies, whose mean effect values conceal a wide range of possible effects. </div>
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Let's see when public health will finally see the light. Fortunately you don't need to wait for that to happen. Arm yourself with one of those home measurement devices, and actively measure and chart your progress against your chosen lifestyle change strategy. You'll see very soon, how unique you are as a medical case. </div>
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1.<span class="Apple-tab-span"> </span>King, N.A., et al., <i>Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss.</i> Int J Obes (Lond), 2007.</div>
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2.<span class="Apple-tab-span"> </span>Yang, Q., et al., <i>Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults.</i> JAMA: The Journal of the American Medical Association, 2012.</div>
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3.<span class="Apple-tab-span"> </span>Dong, C., et al., <i>Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death across Whites, Blacks and Hispanics: the Northern Manhattan Study.</i> Circulation, 2012.<br />
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References<br />
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=International+journal+of+obesity+%282005%29&rft_id=info%3Apmid%2F17848941&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Individual+variability+following+12+weeks+of+supervised+exercise%3A+identification+and+characterization+of+compensation+for+exercise-induced+weight+loss.&rft.issn=0307-0565&rft.date=2008&rft.volume=32&rft.issue=1&rft.spage=177&rft.epage=84&rft.artnum=&rft.au=King+NA&rft.au=Hopkins+M&rft.au=Caudwell+P&rft.au=Stubbs+RJ&rft.au=Blundell+JE&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">King NA, Hopkins M, Caudwell P, Stubbs RJ, & Blundell JE (2008). Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss. <span style="font-style: italic;">International journal of obesity (2005), 32</span> (1), 177-84 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/17848941" rev="review">17848941</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=JAMA+%3A+the+journal+of+the+American+Medical+Association&rft_id=info%3Adoi%2F10.1001%2Fjama.2012.339&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Trends+in+Cardiovascular+Health+Metrics+and+Associations+With+All-Cause+and+CVD+Mortality+Among+US+Adults&rft.issn=&rft.date=2012&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Yang%2C+Q.&rft.au=Cogswell%2C+M.+E.&rft.au=Flanders%2C+W.+D.&rft.au=Hong%2C+Y.&rft.au=Zhang%2C+Z.&rft.au=Loustalot%2C+F.&rft.au=Gillespie%2C+C.&rft.au=Merritt%2C+R.&rft.au=Hu%2C+F.+B.&rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CHealth%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Yang, Q., Cogswell, M. E., Flanders, W. D., Hong, Y., Zhang, Z., Loustalot, F., Gillespie, C., Merritt, R., & Hu, F. B. (2012). Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults <span style="font-style: italic;">JAMA : the journal of the American Medical Association</span> DOI: <a href="http://dx.doi.org/10.1001/jama.2012.339" rev="review">10.1001/jama.2012.339</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Circulation&rft_id=info%3Apmid%2F22619283&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Ideal+cardiovascular+health+predicts+lower+risks+of+myocardial+infarction%2C+stroke%2C+and+vascular+death+across+whites%2C+blacks%2C+and+hispanics%3A+the+northern+Manhattan+study.&rft.issn=0009-7322&rft.date=2012&rft.volume=125&rft.issue=24&rft.spage=2975&rft.epage=84&rft.artnum=&rft.au=Dong+C&rft.au=Rundek+T&rft.au=Wright+CB&rft.au=Anwar+Z&rft.au=Elkind+MS&rft.au=Sacco+RL&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Dong C, Rundek T, Wright CB, Anwar Z, Elkind MS, & Sacco RL (2012). Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. <span style="font-style: italic;">Circulation, 125</span> (24), 2975-84 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22619283" rev="review">22619283</a></span>
</div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com2tag:blogger.com,1999:blog-2058017873235758512.post-63528591002838851102012-06-18T07:30:00.000+02:002012-06-19T09:35:34.150+02:0010 Good Reasons Not To Exercise?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF50LlO2lqAlQ1zrdPFjJAU1j2-hct-WQMnU_c7kNfFNIQEkd34wmcqprj0o7rC7Yt8PUKQeh9X0BYRnzAeR0ejGvH63Mamc0n-UsKYVdRxhlnHEGILGB0DQav2tW3-Xku3lyJihcAeNM/s1600/couch-potato.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF50LlO2lqAlQ1zrdPFjJAU1j2-hct-WQMnU_c7kNfFNIQEkd34wmcqprj0o7rC7Yt8PUKQeh9X0BYRnzAeR0ejGvH63Mamc0n-UsKYVdRxhlnHEGILGB0DQav2tW3-Xku3lyJihcAeNM/s200/couch-potato.jpg" width="133" /></span></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Exercise may actually be bad for you! A professor says he stumbled upon this "potentially explosive" insight. The New York Times has been quick to peddle it. And couch potatoes descend on it like vultures on road kill. But professors can get it wrong, too. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Before we judge the verity of the "exercise may be bad" claim, let's first look at how the media present it to us. We shall use the recent article in The New York Times, headlined "<a href="http://well.blogs.nytimes.com/2012/05/30/can-exercise-be-bad-for-you/?hp" target="_blank">For Some, Exercise May Increase Heart Risk</a>". The first paragraph confronts us with a journalist's preferred procedure for feeding us contentious scientific claims: presenting an authoritative author with stellar academic credentials and a publication list longer than your arm. While that is certainly better than having, say, Paris Hilton as the source of scientific insights, it is a far cry from actually investigating such claims. Which is what we want to do now.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The basis of the exercise-may-be-bad claim is a study which investigated the question "whether there are people who experience adverse changes in cardiovascular risk factors" in response to exercise [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Bouchard,%202012%20#17586%22">1</a>]. The chosen risk factors in question were some of the usual suspects: systolic blood pressure, HDL-cholesterol, triglycerides and insulin. The research question: Are there people whose risk factors actually get worse when they change from sedentary to more active lifestyles? </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Sounds simple enough to investigate. Put a group of couch potatoes on a work-out program for a couple of weeks and see how their risk factors change. Only it is not that simple. In the realm of biomedicine, every measurement of every biomarker is subject to (a) errors in measurement and (b) other sources of variability. This makes it virtually impossible for you to see exactly the same results on your lab report for, say, blood pressure, cholesterol, glucose or any other parameter, when you get them measured two or more days in a row. Even if you were to eat exactly the same food every day and to perform exactly the same activities. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Now imagine, if you conducted an intervention study on your couch-potato subjects and you found their risk factors changed after a couple of weeks of doing exercise, you could theoretically be seeing nothing else but a random variation caused by the error inherent in such measurement. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">To avoid falsely interpreting such a variation as a change into one or the other direction, it makes good sense to know the bandwidth of these errors for each biomarker, before you embark on interpreting the results of your study. Which is what the authors of this particular study did. They took 60 people and measured their risk factors three times over three weeks. From these measurements they were able to calculate the margin of error. Actually, they didn't do this for this particular paper, they had done this measurement as an ancillary study in the HERITAGE study performed earlier. The HERITAGE study had investigated the effects of a 20-weeks endurance training program on various risk factors in previously sedentary adults. Whether heritability plays a role in this response was a key question. That's why this study recruited entire families, that is, parents up to the age of 65, together with their adult children. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I mention this because the paper, which we are deciphering now, is a re-hash of the HERITAGE study's results, to which the authors added the data of another 5 exercise studies. That's what is called a meta-analysis. In this case it covers more than 1600 people, with the HERITAGE study delivering almost half of them. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Fast forward to answering the question of how many of those participants had experienced a worsening of at least 1 risk factor. Close to 10%. That is, about 10% of the participants had an adverse change of a risk factor in excess of the margin of error, which I mentioned earlier. I'm going to demonstrate the results, using systolic blood pressure and the Heritage study as the example. I do this exemplification for three reasons: First, blood pressure is the more serious of the investigated risk factors. Secondly, the HERITAGE study delivers most of the participants, and thirdly, the effects seen and discussed with respect to blood pressure and HERITAGE apply similarly to the other 5 studies and risk factors. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">But before we go there I need to familiarize you with a basic concept of statistics. It is called the "normal distribution of data". It is an amazing observation of how data are distributed when you take many measurements. Let's take blood pressure as an example. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">If you were to measure the blood pressure values for every individual living in your village, city or country, you could easily calculate the average blood pressure for this group of people. You could put all those data into a chart such as the one in figure 1. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2F8ZTrPxenXDUHUo1WY-JtwcIVEfClhwH_hxjaGGhnfMAacXhw3lbBkEMxHl-gROKxwpTsDQCYh0hYqbpGPtZMLdQOIkp8KjxGOpRNe3ydEAbkTuVrVSPtWt75hyphenhyphenB4u5enjvNaFV_TMM/s1600/bell-curve-bp.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="137" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2F8ZTrPxenXDUHUo1WY-JtwcIVEfClhwH_hxjaGGhnfMAacXhw3lbBkEMxHl-gROKxwpTsDQCYh0hYqbpGPtZMLdQOIkp8KjxGOpRNe3ydEAbkTuVrVSPtWt75hyphenhyphenB4u5enjvNaFV_TMM/s200/bell-curve-bp.png" width="200" /></span></a></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">On the x-axis, the horizontal axis, you write down the blood pressure values, and on the y-axis (the vertical axis) you write down the number of observations, that is, how often a particular blood pressure reading has been observed. You will find that most people have a blood pressure value pretty close to the average. Fewer people will have values, which lie further away from this average, and very few people will have extreme deviations from the average. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It so turns out, that when you map almost any naturally occurring value, be it blood pressure, IQ or the number of hangovers over the past 12 months, the curve, which you get from connecting all the data points in your graph, will look very similar in shape. Some curves are a bit flatter and broader, while others are a bit steeper and narrower. But the underlying shape is called the "normal distribution", and it means just that: It's how data are normally distributed over a range of possible values. The curve's shape being reminiscent of a bell, has lead to this curve being called the "bell curve". </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In statistics, especially when we use them to interpret study data, we always go through quite some effort to ensure that the data we measure are normally distributed. That's because many statistic tools don't give us reliable answers if the distribution is not normal.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Back to our famous study. What you see in figure 2 is how the authors present their results for the blood pressure response of the HERITAGE participants. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgiqbrEO8UrQK161OPD74JlKF8C6ZAKqy-JJ_exoZAKIGebKEtKFs61AFf0-m0jmtw183VyVXiNacirEGC2omlYmzscfEsJcwPIsvlkONJHAGHkxRS7MdCCCj7aJFUXCn4eknmiGNwjoU/s1600/normality-vs-AR-plos.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgiqbrEO8UrQK161OPD74JlKF8C6ZAKqy-JJ_exoZAKIGebKEtKFs61AFf0-m0jmtw183VyVXiNacirEGC2omlYmzscfEsJcwPIsvlkONJHAGHkxRS7MdCCCj7aJFUXCn4eknmiGNwjoU/s200/normality-vs-AR-plos.png" width="200" /></span></a></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">For each individual (x-axis) they drew a thin bar representing the height of that person's change in blood pressure after 20 weeks of exercise. Bars extending below the x-axis represent reduced blood pressure, and those extending above the x-axis represent increased blood pressure. The bars in red are those of the people whose blood pressure increase was in excess of the error margin of about 8mmHg. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Now, Claude Bouchard, the lead author of the paper, is being quoted in the NYT as saying that the counterintuitive observation of exercise causing systolic blood pressure to worsen "is bizarre". </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Here is why it is neither counterintuitive nor bizarre: When we accept the blood pressure values of our study population to be distributed normally, we have every reason to expect the change in blood pressure to be distributed normally, too. Specifically, since all participants went through the same type of intervention. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJUFpTPVHPRVg4Me_rhbh_mM6FMVCgLID2HI8Imhb9FoWLjZvwwbraSQIHG2zQIcWYjLcNiz-4jwkGWBz4qLi4sR-EHurwiXnGIY4J2Voi1dg6au6zdW3GPHw8AtzrSsE_1I0eSAURNjk/s1600/normality-vs-AR-plos-smul.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJUFpTPVHPRVg4Me_rhbh_mM6FMVCgLID2HI8Imhb9FoWLjZvwwbraSQIHG2zQIcWYjLcNiz-4jwkGWBz4qLi4sR-EHurwiXnGIY4J2Voi1dg6au6zdW3GPHw8AtzrSsE_1I0eSAURNjk/s200/normality-vs-AR-plos-smul.png" width="200" /></span></a></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">If we now run a computer simulation, using the same number of people, the same mean change in blood pressure, and the same error values, then we can construct a curve for this group, too. Which is what you see in figure 3. Eerily similar to the one in figure 2, isn't' it? </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">That's because we are looking at a normal distribution of the biomarker called 'blood pressure change'. It is an inevitable fact of nature that a few of our participants will change "for the worse". And I'm putting this in inverted comma because we don't really know whether this change is for the worse. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">After all, we are talking risk factors, not actual disease events. In the context of this study you need to keep in mind, that all participants had normal blood pressure values to begin with. The average was about 120mmHg. The mean change was reported as 0.2 mmHg. That's not only clinically insignificant, that's way below the measurement capability of clinical devices. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">When I started to dig deeper into this study, I found quite a number of inconsistencies with earlier publications. For example, in the latest paper, the one discussed in the NYT, the number of HERITAGE participants was stated as 723. In a 2001 paper, which investigated participants' blood pressure change at a 50-Watt work rate, the number was stated as 503 [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Wilmore,%202001%20#17605%22">2</a>]. In the same year Bouchard had published a paper putting this number at 723 [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_3%22%20%5Co%20%22BOUCHARD,%202001%20#17597%22">3</a>]. Anyway, the observation that the blood pressure change during exercise was significantly larger (about -8 mmHg) than the marginal change of resting blood pressure indicates that there probably was some effect of exercise. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">So, what's the take-home point of all this? With the "normal distribution" being a natural phenomenon that underlies so many biomarkers, it is neither bizarre nor in any other way astonishing to find "adverse" reactions in everything from pharmaceutical to behavioral interventions and treatments. Whether such reactions are truly adverse can't be answered by a study like the one, which is now bandied about in the media. That's because risk factors are not disease endpoints. They are actually very poor predictors of the latter, as I have explained in my post "<a href="http://drlutz.blogspot.de/2012/04/when-risk-scores-for-heart-attack.html" target="_blank">Why Risk Factors For Heart Attack Really Suck</a>". </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">So, keep in mind, that there is no treatment or intervention, which has the same effect on everybody. Pharmaceutical research uses this knowledge, for example, when determining the toxicity of a substance. This toxicity is often defined as the LD50 value, that is, the lethal dose, which kills 50% of the experimental animals. Meaning, the same dose which kills half the animals, leaves the other half alive and kicking. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">And correspondingly, the same dose of exercise, which cures your neighbor from hypertension, may have no effect on you. Because you belong to those 10% who react differently. But are these 10 good reasons not to exercise? How to deal with this question will be the subject of my next post. Until then, stay skeptical. </span></div>
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<a href="http://twitter.com/home/?status=%2010%20good%20reasons%20not%20to%20exercise.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="font-family: Arial, Helvetica, sans-serif;">1.<span class="Apple-tab-span"> </span>Bouchard, C., et al., <i>Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?</i> PLoS ONE, 2012. <b>7</b>(5): p. e37887.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">2.<span class="Apple-tab-span"> </span>Wilmore, J.H., et al., <i>Heart rate and blood pressure changes with endurance training: the HERITAGE Family Study.</i> Medicine and Science in Sports and Exercise, 2001. <b>33</b>(1): p. 107-16.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">3.<span class="Apple-tab-span"> </span>BOUCHARD, C. and T. RANKINEN, <i>Individual differences in response to regular physical activity.</i> Medicine and Science in Sports and Exercise, 2001. <b>33</b>(6): p. S446-S451.</span></div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=PloS+one&rft_id=info%3Apmid%2F22666405&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Adverse+metabolic+response+to+regular+exercise%3A+is+it+a+rare+or+common+occurrence%3F&rft.issn=&rft.date=2012&rft.volume=7&rft.issue=5&rft.spage=&rft.epage=&rft.artnum=&rft.au=Bouchard+C&rft.au=Blair+SN&rft.au=Church+TS&rft.au=Earnest+CP&rft.au=Hagberg+JM&rft.au=H%C3%A4kkinen+K&rft.au=Jenkins+NT&rft.au=Karavirta+L&rft.au=Kraus+WE&rft.au=Leon+AS&rft.au=Rao+DC&rft.au=Sarzynski+MA&rft.au=Skinner+JS&rft.au=Slentz+CA&rft.au=Rankinen+T&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Bouchard C, Blair SN, Church TS, Earnest CP, Hagberg JM, Häkkinen K, Jenkins NT, Karavirta L, Kraus WE, Leon AS, Rao DC, Sarzynski MA, Skinner JS, Slentz CA, & Rankinen T (2012). Adverse metabolic response to regular exercise: is it a rare or common occurrence? <span style="font-style: italic;">PloS one, 7</span> (5) PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22666405" rev="review">22666405</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Medicine+and+Science+in+Sports+and+Exercise&rft_id=info%3Adoi%2F10.1097%2F00005768-200101000-00017&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Heart+rate+and+blood+pressure+changes+with+endurance+training%3A+the+HERITAGE+family+study.&rft.issn=&rft.date=2001&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Wilmore%2C+J.+H.&rft.au=Stanforth%2C+P.+R.&rft.au=Gagnon%2C+J.&rft.au=Rice%2C+T.&rft.au=Mandel%2C+S.&rft.au=Leon%2C+A.+S.&rft.au=Rao%2C+D.+C.&rft.au=Skinner%2C+J.+S.&rft.au=Bouchard%2C+C.&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Wilmore, J. H., Stanforth, P. R., Gagnon, J., Rice, T., Mandel, S., Leon, A. S., Rao, D. C., Skinner, J. S., & Bouchard, C. (2001). Heart rate and blood pressure changes with endurance training: the HERITAGE family study. <span style="font-style: italic;">Medicine and Science in Sports and Exercise</span> DOI: <a href="http://dx.doi.org/10.1097/00005768-200101000-00017" rev="review">10.1097/00005768-200101000-00017</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Med+Sci+Sports+Exerc&rft_id=info%3Adoi%2F10.1097%2F00005768-200106001-00013&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Individual+differences+in+response+to+regular+physical+activity&rft.issn=&rft.date=2001&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Bouchard%2C+C.&rft.au=Rankinen%2C+T.&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Bouchard, C., & Rankinen, T. (2001). Individual differences in response to regular physical activity <span style="font-style: italic;">Med Sci Sports Exerc</span> DOI: <a href="http://dx.doi.org/10.1097/00005768-200106001-00013" rev="review">10.1097/00005768-200106001-00013</a></span>
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<br /></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com4tag:blogger.com,1999:blog-2058017873235758512.post-28933779097327815302012-06-14T07:30:00.000+02:002012-06-15T09:56:40.059+02:00Why You Should Arm Your Bullshit Alarm Before Reading Diet News.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQxyldVr2WZWGRyGnGjFFMtH9SNlHiOlNWTro3RHKJBA8kbARMWc_ONup2LscsT8EYZmN07pPrLWPZ_SKUcoNXQQzYEFGGnsmLKH2TlV-R5IS2TT3QkwTAl24m2BF-WLV2lOl0wcf63ZU/s1600/iStock_000011141865XSmall.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQxyldVr2WZWGRyGnGjFFMtH9SNlHiOlNWTro3RHKJBA8kbARMWc_ONup2LscsT8EYZmN07pPrLWPZ_SKUcoNXQQzYEFGGnsmLKH2TlV-R5IS2TT3QkwTAl24m2BF-WLV2lOl0wcf63ZU/s200/iStock_000011141865XSmall.jpg" width="133" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the fight over best diet for health and weight loss, it's protein lovers vs. vegetarian zealots. So far, a clear winner has not emerged. Only one loser: you, the victim of biased research. Here is an example of why you should keep your bullshit alarm on high alert when reading about weight loss diets.
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<a href="http://twitter.com/home/?status=%20arm%20your%20bullshit%20alarm%20before%20reading%20about%20weight%20loss%20diet.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="font-family: Arial, Helvetica, sans-serif;">Ellen M. Evans and colleagues wanted to know whether overweight men and women differ in their body composition responses to different weight loss diets [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Evans,%202012%20#17565%22">1</a>]. So they enrolled 58 men and 72 women with a BMI greater than 26, and randomized them into two diet groups. </span><br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;">One group was instructed to follow a high-protein low-carbohydrate diet, which delivered 1.6 g of protein per kg bodyweight per day. The high-carb group received only half that amount of protein, and both groups' fat intake was capped at 30% of total energy intake. Both diets contained the same amount of fiber. Women received a daily total of 1700 calories, men 1900 calories. The intervention lasted for 4 months, followed by an 8-months weight maintenance period. Fast forward to the 12-months results:</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Both diet groups and both genders lost about 10% of their body weight. But expressing weight loss in kilos of body weight can be a deceptive thing. Ideally we want that loss to be fat loss rather than loss of lean mass, that is, muscle mass. In the study at hand, for men on the high-carb diet, a little over one third of their weight loss came from lean body mass. Meaning, of the 14 kilos, which they lost on average, 5 Kilos came from a reduction in muscle tissue. The high-protein guys maintained their muscle mass to a greater extent: only 20% of their weight loss came from wasted muscle. For the women the picture looked almost identical: muscle mass contributed 37% to the weight loss of the high-carb women, compared to 23% in the high-protein group. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">You would be forgiven if you now agreed with the authors' statement that the high-protein diet "...was more effective in reducing percent body fat...". Or in other words, a high-protein diet is superior to a high-carb alternative, as losing lean mass isn't a good thing in weight loss. I'll get to that point shortly in a little more detail. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Before we go there, let me state, that, being a firm supporter of the high-protein low-carb dietary philosophy, I loved to read this study. But I'm an equally firm supporter of proper scientific methods. And they have been prostituted in this case, which is why I love this study a lot less than its results. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Here is why: When I read the tables in which the authors present the results, I was impressed by the fact that both groups not only managed to rescue the 4-months weight loss to the 12-months finish line, but even increased this weight loss a little. When you have read literally hundreds of studies on weight loss interventions, as I have done, you'll find this observation to be in stark contrast to what we typically see: a reversal of weight loss. That is, at least a partial post-intervention regain of the weight lost during the dietary period. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We find the explanation for this miraculous exception in the number of participants. Or rather in the number of disappearing participants. Of the 66 participants who started in the high-carb group, only 30 made it to the finish line 12 months later. That's a drop-out rate of more than 50%! And of the 64 participants in the high-protein group 23, or 36%, had dropped out by month 12. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">High drop-out rates are nothing unusual in weight loss trials, but it is good practice for researchers to tell their readers, how they accounted for these drop outs in the statistics, with which they interpret the data. Nothing of that in this paper. So, we don't know whether the drop-outs simply did not show up for their measurements, or whether the researchers did not consider the data of those participants, who failed to achieve some arbitrary weight loss threshold. The latter is an absolute no-no. It enables researchers to skew the results every which way they want. And the former is reason to investigate whether the drop-outs differed in some way significantly from the adherent participants. Such differences often affect the interpretation of the results. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">One interpretation emerges right away, when checking the differences of relative fat loss while considering the drop-out rates: the smaller relative loss of muscle mass in the high-protein diet is not significantly different from the loss observed in the high-carb group. That does not mean, there is no difference between these two diet types. It only means, the study was underpowered to detect such difference, if there was any. And if it was underpowered to detect the difference between diet groups, it was certainly underpowered to differentiate between men and women in this respect. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">If you still want the final verdict on high-carb vs. high-protein, I'm afraid I can't give it to you, even though I'm heavily leaning in favor of the high-protein version. I base my judgment on a 2009 systematic review of all randomized controlled trials, which were performed between 2000 and 2007, and which had pitted high-carb vs. high-protein strategies [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_2%22%20%5Co%20%22Hession,%202009%20#14336%22">2</a>]. This review demonstrated that high-protein diets are more effective with respect to weight loss and probably with respect to cardiovascular risk factors than high-carb diets. At least over observation periods of 6 to 12 months. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Only long-term observations, comparing hard endpoints, can decide which diet may be better. Those studies are a long way off. To complicate matters, we might find that different people react differently to the same type of dietary strategy. Until we know better, we need to go with what we know: </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The preservation of lean body mass certainly is a key aspect. Muscle tissue is an important endocrine organ, which, when exercised, produces potent anti-inflammatory substrates and hormones. These are the key elements of physical activity's protection against the initiating step of heart disease: atherosclerosis. Muscle tissue is also the body's primary site to store dietary carbohydrate in the form of glucose. The other site being the liver. With a high-carb diet, these storage sites are easily overwhelmed, which leads to conversion of carbs to fat. When, ironically, a high-carb diet nibbles away at the body's carb storage sites, you can imagine what this means to the body's relative fat content. Another aspect is that muscle tissue consumes energy, even at rest. The loss of this "burner" during weight loss makes weight rebound more likely.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">So, if all these matters are known and understood, why perform a study, which is underpowered and fraud with questionable interpretations? Why produce the food equivalent of a scientology propaganda piece? </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Beats me. Maybe because part of the study's funding came from the National Cattlemen's Beef Association and The Beef Board. Both of which are, of course, entirely neutral to the outcome of research funded by them, and unbiased to its interpretation. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It also beats me, why a respected journal and its peer reviewers facilitate the publication of such a study. Maybe because its senior author, Professor DK Layman, is a leading researcher in nutrition science, and... </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">...the Egg Nutrition Center's director of research. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">As much as my dietary preferences place me in the protein camp of this contest, my bullshit alarm is set to high-sensitivity. And so should yours be. </span></div>
<a href="http://twitter.com/home/?status=%20arm%20your%20bullshit%20alarm%20before%20reading%20about%20weight%20loss%20diet.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="font-family: Arial, Helvetica, sans-serif;">1.<span class="Apple-tab-span"> </span>Evans, E., et al., <i>Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial.</i> Nutrition and Metabolism, 2012. <b>9</b>(1): p. 55.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">2.<span class="Apple-tab-span"> </span>Hession, M., et al., <i>Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities.</i> Obesity Reviews, 2009. <b>10</b>(1): p. 36-50.</span></div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Nutrition+and+Metabolism&rft_id=info%3A%2Fdoi%3A10.1186%2F1743-7075-9-55&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Effects+of+protein+intake+and+gender+on+body+composition+changes%3A+a+randomized+clinical+weight+loss+trial&rft.issn=&rft.date=2012&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=&rft.au=Evans%2C+Ellen&rft.au=Mojtahedi%2C+Mina&rft.au=Thorpe%2C+Matthew&rft.au=Valentine%2C+Rudy&rft.au=Kris-Etherton%2C+Penny&rft.au=Layman%2C+Donald&rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CHealth%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Evans, Ellen, Mojtahedi, Mina, Thorpe, Matthew, Valentine, Rudy, Kris-Etherton, Penny, & Layman, Donald (2012). Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial <span style="font-style: italic;">Nutrition and Metabolism</span> : <a href="doi:10.1186/1743-7075-9-55" rev="review">doi:10.1186/1743-7075-9-55</a></span>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Obesity+Reviews&rft_id=info%3Adoi%2F10.1111%2Fj.1467-789X.2008.00518.x&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Systematic+review+of+randomized+controlled+trials+of+low-carbohydrate+vs.+low-fat%2Flow-calorie+diets+in+the+management+of+obesity+and+its+comorbidities&rft.issn=14677881&rft.date=2009&rft.volume=10&rft.issue=1&rft.spage=36&rft.epage=50&rft.artnum=http%3A%2F%2Fdoi.wiley.com%2F10.1111%2Fj.1467-789X.2008.00518.x&rft.au=Hession%2C+M.&rft.au=Rolland%2C+C.&rft.au=Kulkarni%2C+U.&rft.au=Wise%2C+A.&rft.au=Broom%2C+J.&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Hession, M., Rolland, C., Kulkarni, U., Wise, A., & Broom, J. (2009). Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities <span style="font-style: italic;">Obesity Reviews, 10</span> (1), 36-50 DOI: <a href="http://dx.doi.org/10.1111/j.1467-789X.2008.00518.x" rev="review">10.1111/j.1467-789X.2008.00518.x</a></span>
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<br /></div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com1tag:blogger.com,1999:blog-2058017873235758512.post-32531753343991643042012-06-11T07:30:00.000+02:002012-06-12T13:11:51.454+02:00Can Chocolate Save You From Heart Attack?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqQMA1daQaTzxw9uIUKd6-eUPWx5GKL1KwPse1yomlBqab_gIgpC6Q6i_P63JIkOxie32owiCH5QYedaJ6YfGOTiWgDzttyH9fyN6loZCBZpoA28VvDQj7AF493Fpfc0e0IAlF3nF7864/s1600/chocolate_woman_small.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqQMA1daQaTzxw9uIUKd6-eUPWx5GKL1KwPse1yomlBqab_gIgpC6Q6i_P63JIkOxie32owiCH5QYedaJ6YfGOTiWgDzttyH9fyN6loZCBZpoA28VvDQj7AF493Fpfc0e0IAlF3nF7864/s200/chocolate_woman_small.jpg" width="133" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;">The media says yes. Science says maybe. In the end, you decide. Here are the facts:</span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">A truffle treatment for heart disease is imminent. That's what a <a href="http://www.nydailynews.com/life-style/health/dark-chocolate-cuts-heart-deaths-study-shows-benefits-high-risk-cardiac-patients-article-1.1089752" target="_blank">recent article</a> suggests, headlined in the New York Daily News as: "Dark chocolate cuts heart deaths; Study shows benefits for high risk cardiac patients." </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">The funny thing is, the cited study does not show what the media geniuses claim it does. So, let's look at this master piece of research journalism and ...</span><br />
<a name='more'></a><span style="font-family: Arial,Helvetica,sans-serif;">do a little fact check.
<a href="http://twitter.com/home/?status=%20can%20chocolate%20save%20you%20from%20heart%20attack%20or%20stroke.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="font-family: Arial,Helvetica,sans-serif;">The cited study was performed by Ella Zomer and colleagues in Australia [<a href="http://www.blogger.com/%5Cl%20%22_ENREF_1%22%20%5Co%20%22Zomer,%202012%20#17471%22">1</a>]. The researchers wanted to answer the question, what the daily consumption of dark chocolate would do to the heart health of a given population. Contrary to what you might believe, the researchers didn't pit chocolate eaters against abstainers. They simply ran an algorithmic model on the computer. In this case, a 10-year forward projection of what might happen, heart-wise, in a given population. Nothing wrong with that, as long as we keep in mind that such models are based purely on assumptions. You need to know those assumptions before you start investing a part of your daily food budget into chocolate. So, let's take a more detailed look than the anonymous AFP writer did, whose master piece the NYDN bought to educate their readers.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">The researchers selected the data sets of 2013 AusDiab study participants who were free from cardiovascular disease and diabetes, but who had the metabolic syndrome. The latter is not a disease in itself but an arbitrary risk definition along 5 risk factors: abdominal obesity, elevated triglycerides, blood sugar and blood pressure, and low "good" cholesterol (high-density lipoprotein, HDL). Have any three of those 5, and you are said to have the metabolic syndrome. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">To calculate the risk of suffering a heart attack or stroke, the researchers used the algorithms developed from the Framingham study. Those risk calculations are widely used in clinical practice. They inform your doctor about the need and urgency of treating you to prevent a heart attack or stroke. I have written about the sense and nonsense of such risk factors in my earlier post "<a href="http://bit.ly/drlutz_riskscoressuck" target="_blank">When risk factors for heart attack really suck!</a>". Now, in order to calculate what the blissful consumption of chocolate will do to prevent such heart attacks, we need some more data. The researchers took those from 13 studies, which investigated the effects of chocolate consumption on blood pressure and on cholesterol levels. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Now here is the first problem: While the Framingham study's algorithms have been tuned on the correlation of risk factors with with hard outcomes </span><span style="font-family: Arial,Helvetica,sans-serif;">(real heart attacks and strokes) </span><span style="font-family: Arial,Helvetica,sans-serif;">for more than half a century, the longest clinical trial on the effects of chocolate lasted just 18 weeks. Meaning, for the effects of chocolate consumption, we don't have anything remotely equivalent to the Framingham data. And we will probably never have, because it is difficult to imagine a study in which we expose half the participants to a daily chocolate load for many years, while the other half doesn't get any, with us waiting and watching what happens in terms of heart disease. Which is to say, the 13 studies used by the researchers are the next best choice. It informs us about the effects of chocolate consumption on blood pressure and cholesterol. The researchers plugged those data into the mathematical model, together with the Framingham algorithms and the life tables available for their Australian population. The entire model is based on a so-called "Markov model", which is simply a probability-based simulation of processes over time. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Now that we are clear about the methods and assumptions, let's look at what you read in the article: </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">"Australian researchers have found that eating a block of chocolate daily over 10 years has 'significant' benefits for high risk cardiac patients and could prevent heart attacks and strokes." Well, didn't I just tell you that the participants' data sets had been selected such that only those who were not cardiac patients, were considered in the model? Yep, that's what it says in the methods section of the study. But methods are tedious to read and, admittedly, a bit difficult to understand sometimes, so we forgive our writer for this little slip-up. Also, none of the participants had eaten a chocolate bar daily for 10 years, so really nobody could "have found" what that would have done for heart risk. But let's not dwell on such trifles. On to the next paragraph:</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">"A study .... found that the consumption of ... chocolate ... was an effective measure to reduce risk." Whoa, that one we can't forgive. What we do have are 13 studies, which show that a daily chocolate consumption of about 100 grams (3.5 ounces) reduces systolic blood pressure in hypertensive people by 5 mmHg on average, and total cholesterol by 0.21 mmol/L (8mg/dL). What these studies do not show, is a reduction of risk for heart disease, that is, a reduction of real heart attacks and strokes. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Given the size of the improvements, I have serious doubts about those effects anyway. What I observe as blood pressure measurements in the daily clinical practice, a 5mmHg difference is within the error margin of many physicians' and nurses' measurement skills. And a 0.21 mmol/L difference in cholesterol is deep within the bandwidth of variations, which most people would see if they were to measure their cholesterol levels for a few days in a row. We have done that in our lab, and found the intra-individual variability to be way above those 0.21 mmol/L. In other words, if your cholesterol level is measured today, and tomorrow, and day after tomorrow, the values will vary by more than those 0.21 mmol/L, even if your blood was drawn at the same time of day, and always after an overnight fast. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">On to the next paragraph: "Lead researcher Ella Zomer said the team found 70 fatal and 15 non-fatal cardiovascular events per 10,000 people could be prevented over 10 years if patients at risk of having a heart attack or stroke ate dark chocolate." Throwing out numbers always looks good, but what do these numbers mean for YOU? I operate under the assumption that you are not interested in the 85 events among the 10,000 people, but that your interest is with the ONE possible event in YOU, right? </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">OK, let's look at that. Of course, I don't have the data set of Zomer and colleagues, but we can make quite an educated calculation using the Framingham risk algorithm, the average risk profile of the participant and the researchers' statement of the effect size: 85 prevented events per 10,000 people. And here is what it means to you: </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">If your profile is that of the average participant (that is, you are 53 years old, have a systolic blood pressure of 141 mmHg, total cholesterol of 6.1 mmol/L and HDL-cholesterol of 1.2 mmol/L), your chance of suffering a heart attack or stroke over the next 10 years would be roughly 10%. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Eating chocolate every day would reduce this risk by a whopping 0.3% to 9.7%. Wow. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">So, over to you: do you agree with the article's next paragraph, where it quotes the researchers as saying that "Our findings indicate dark chocolate therapy could provide an alternative to or be used to complement drug therapeutics in people at high risk of cardiovascular disease."? I can already hear people telling their friends about the chocolate therapy they are on. Sounds fully compliant with the researchers' next statement "... here is a dietary alternative which may be quite appealing to a lot of people. In fact, chocolate studies have shown really good compliance rates." </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Well, except for the morsel about compliance rate, I don't buy it. Think about it. 100 grams of chocolate pump 550 kcal into your body (coincidentally the same as a Big Mac), delivered by 50 grams of sugar and 36 grams of fat, most of it saturated. And one more thing: the ingredient which, we believe, is the cause of chocolate's beneficial effect is the flavanol content. I won't go into details about this member of the flavonoid family, but suffice it to say, you'll find it in effective doses only in chocolates with at least a 70% cocoa. That is bitter chocolate. Also known as dark chocolate. But the latter name is already a potential for deception by the manufacturer. The flavanols are inherently bitter, which is where bitter chocolate originally got its name. To make it more pleasant to your taste buds, manufacturers can take the flavanols out and compensate by making the chocolate darker by other means. The end effect is a dark chocolate, which delivers all the sugar and fat and calories but none of the benefits for which you might have chosen it. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Also, the flavanol content of cocoa can vary substantially, depending on where it comes from. No wonder, you find nothing written about your favorite chocolate's flavanol content on its nutrition label. And by the way, you encounter the flavonoid superfamily, of which chocolate's flavanols are a member, in virtually all fruits and vegetables. Often in concentrations which far exceed what chocolate has to offer. </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">So here is what we see in this article of the New York Daily News: there is public health, there is you and then there is the media. To public health, 85 avoided heart attacks and strokes per 10,000 people is worth something, particularly when public health doesn't need to pay for it. Because you do, by buying your "chocolate therapy". Public health couldn't care less whether your 0.3% risk reduction is meaningful for YOU. But you care, I presume. Which is why I find it regrettable that you have to deal with the degree of misinformation doled out by those media geniuses, who, like public health, are not interested in YOU. They are interested in your subscription and your dollar. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">So, if you think that some of your friends would benefit from knowing about this, then send them this post. If you or they have an elevated risk for heart disease, there are many proven ways to reduce that risk. Eating chocolate is not one of them.
<a href="http://twitter.com/home/?status=%20can%20chocolate%20save%20you%20from%20heart%20attack%20or%20stroke.%20via@http://drlutz.blogspot.com%C2%A0" target="_blank"> [tweet this].</a>
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<span style="font-family: Arial,Helvetica,sans-serif;">1.<span class="Apple-tab-span"> </span>Zomer, E., et al., <i>The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model.</i> BMJ, 2012. <b>344</b>(may30 3): p. e3657-e3657.</span></div>
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=BMJ&rft_id=info%3Adoi%2F10.1136%2Fbmj.e3657&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=The+effectiveness+and+cost+effectiveness+of+dark+chocolate+consumption+as+prevention+therapy+in+people+at+high+risk+of+cardiovascular+disease%3A+best+case+scenario+analysis+using+a+Markov+model&rft.issn=1756-1833&rft.date=2012&rft.volume=344&rft.issue=may30+3&rft.spage=0&rft.epage=0&rft.artnum=http%3A%2F%2Fwww.bmj.com%2Fcgi%2Fdoi%2F10.1136%2Fbmj.e3657&rft.au=Zomer%2C+E.&rft.au=Owen%2C+A.&rft.au=Magliano%2C+D.&rft.au=Liew%2C+D.&rft.au=Reid%2C+C.&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Zomer, E., Owen, A., Magliano, D., Liew, D., & Reid, C. (2012). The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model <span style="font-style: italic;">BMJ, 344</span> (may30 3) DOI: <a href="http://dx.doi.org/10.1136/bmj.e3657" rev="review">10.1136/bmj.e3657</a></span>
</div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com3tag:blogger.com,1999:blog-2058017873235758512.post-91650168473215146462012-06-07T07:30:00.000+02:002012-06-10T17:30:03.080+02:00Can A Genetic Test Say Why You Are Fat?<div style="font-family: Arial,Helvetica,sans-serif;">
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With the decoding of the human genome came the hope of getting a lever on the chronic diseases, which kill most of us today: heart disease, stroke, diabetes and many cancers. And since overweight and obesity are a common cause of those diseases, many obese people were, and still are, yearning for that exculpatory headline: "It's all in your genes!" Why and how this headline is unlikely to ever appear in any serious media, was a subject of my earlier post "<a href="http://bit.ly/IbMJMY" target="_blank">It's not your genes, stupid!</a>". <br />
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Now, a group of researchers have looked at the data of a 30-year investigation of health and behavior, ...<br />
<a name='more'></a>which you might call the New Zealand equivalent of the famous U.S. Framingham study [1]. If you ever wondered whether it would make sense to get your children, or yourself, tested for your genetic risk of obesity, you will be surprised to learn what this study tells you. But one step at a time. Let's first have a look at this outstanding piece of research.
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The study population consists of all the 1037 babies born in Dunedin, New Zealand, between 1st April 1972 and 31st March 1973 at the Queen Mary Maternity Hospital. <a href="http://dunedinstudy.otago.ac.nz/studies/main-study/description" target="_blank">Comprehensive health assessments</a> were done at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32 and 38. These investigations will be extended into the future and into the next generation. This is a massive and admirable effort. With data having been collected about virtually all aspects of health and behavior, this project provides a rare opportunity to match those data with genetic information. While genetic profiling wasn't possible in the seventies, it is possible and feasible now. And since study participants' genetic make-up hasn't changed since the time of their conception, we can retrospectively look at the correlation of biomarkers and genes, in this case those that correlate with obesity. To understand this study let me familiarize you with some facts and terms first.<br />
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So-called genome-wide association studies (GWAS) have thrown up more than 30 individual single-nucleotide polymorphisms (SNP, pronounced 'snip'), that's geneticists' speak for a variation of a single building block (nucleotide) of a gene. The draw-back: Those SNPs individually correlate only very weakly with obesity. That is, while there is a statistical correlation with obesity, there are obese people who don't carry the SNP, and there are carriers of the SNP who are not obese. To complicate matters a little further, not all SNPs which show statistical correlations in one population, say the U.S., do so in another, say New Zealand. Which is why the Dunedin researchers developed a risk score from the 32 SNPs known from other studies. Of those 32 they could find 29 in their study cohort, and so they developed their score from those 29 SNPs. Participants were grouped according to their score into either high- or low-risk. <br />
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The next step was to look at how the participants' genetic risk score (GRS) correlated with BMI in each decade, starting from 15-18 years of age, followed by 21-26 years, and then from 32-38 years. In the second decade (ages 15-18), people with a high risk score had 2.4 times the risk of being obese than those who scored low on the GRS. Had this been you, having a high risk score would have made you almost two and a half times more likely to be obese as a teenager compared to your buddies of the low-risk persuasion. That sounds like a lot, and you might be tempted to think that screening your child for genetic risk would help you to be more vigilant in watching over his or her BMI while he or she is still under your care. <br />
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The authors certainly seem to think so when they say that "These findings have implications for clinical practice..." and that "the results suggest promise for using genetic information in obesity risk assessments." I respectfully disagree, and so might you. <br />
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Let's simply take your point of view for a moment, and not the one of public health, where we are interested in one patient only, the population under our care. In contrast, the only patient you are interested in is you, or maybe your child. This value of a relative risk of 2.4 doesn't tell you much. What you rather want to know is, what a high- or low-risk score means to you. And the right question to ask would be along the line of "what are the chances of becoming obese when my risk score is high?". And also, "what are my chances of not becoming obese when my risk score is low?". The answers to these 2 questions come in the shape of values, which we call positive predictive value (PPV) and negative predictive value (NPV). Unfortunately the Dunedin researchers don't report those values. But we can calculate them, which I did. <br />
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And here is the surprising answer: if you had a high score, your risk of being obese as an adolescent is just about 10%. In other words, even with a high-risk score, you stand a 90% chance of not being obese as an adolescent. And if your risk score had been low you would have a 95% chance of not becoming obese. Beats me, but I can't see the benefit of genetic testing. <br />
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I deliberately talk only about the risk at the age of adolescence. There is a simple reason for this. The researchers found that the relative risk of obesity between the high- and low-risk categories diminished progressively from 2.4 in the second decade to 1.6 in the fourth (ages 32-38). That means, our looking at adolescents affords us a look at a time when study participants' exposure to environmental and behavioral influences had been relatively short. Over the years, environment and behavior further diminish the predictive power of the genetic score. Which is akin to saying: your lifestyle choices give you a greater power over your BMI than your genes. And by extension, the choices you make for your children's lifestyle beats their genes easily, too. In other words, it's not so much the luck of the draw, which determines your body weight, but rather your skill of playing the deck of (genetic) cards, which we have been dealt at the moment of conception. The study's data say the same thing just in other words: At birth the high-risk babies were not any heavier than their low-risk peers. Only once they were exposed to the outside world, did BMI careers begin to divert. For some of them.<br />
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This tells us one thing: when it comes to obesity, habits and environment are the key, not a potpourri of SNPs. Of course, if you are in the business of peddling genetic tests, you will disagree. And also when selling guilt-free conscience to obese readers is what pays your bills. Which is why I'm curious to see how the media will portray this study. Let's stay tuned.
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1. Belsky, D.W., et al., Polygenic Risk, Rapid Childhood Growth, and the Development of ObesityEvidence From a 4-Decade Longitudinal StudyPolygenic Risk for Adult Obesity. Archives of Pediatrics and Adolescent Medicine, 2012. 166(6): p. 515-521.
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<span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Archives+of+pediatrics+%26+adolescent+medicine&rft_id=info%3Apmid%2F22665028&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Polygenic+Risk%2C+Rapid+Childhood+Growth%2C+and+the+Development+of+Obesity%3A+Evidence+From+a+4-Decade+Longitudinal+StudyPolygenic+Risk+for+Adult+Obesity.&rft.issn=1072-4710&rft.date=2012&rft.volume=166&rft.issue=6&rft.spage=515&rft.epage=21&rft.artnum=&rft.au=Belsky+DW&rft.au=Moffitt+TE&rft.au=Houts+R&rft.au=Bennett+GG&rft.au=Biddle+AK&rft.au=Blumenthal+JA&rft.au=Evans+JP&rft.au=Harrington+H&rft.au=Sugden+K&rft.au=Williams+B&rft.au=Poulton+R&rft.au=Caspi+A&rfe_dat=bpr3.included=1;bpr3.tags=Health%2CCardiovascular%2C+Epidemiology%2C+Public+Health">Belsky DW, Moffitt TE, Houts R, Bennett GG, Biddle AK, Blumenthal JA, Evans JP, Harrington H, Sugden K, Williams B, Poulton R, & Caspi A (2012). Polygenic Risk, Rapid Childhood Growth, and the Development of Obesity: Evidence From a 4-Decade Longitudinal StudyPolygenic Risk for Adult Obesity. <span style="font-style: italic;">Archives of pediatrics & adolescent medicine, 166</span> (6), 515-21 PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22665028" rev="review">22665028</a></span>
</div>Dr. Lutz E. Kraushaarhttp://www.blogger.com/profile/08280710788604442951noreply@blogger.com1