Sunday, July 01, 2007

Roger Keeling Letter

Hi. Roger Keeling, who lives in Portland, Oregon, has written me several emails regarding his own experiences with Hypertension. I am posting, below, an excerpt from his latest letter, where he discusses his own concerns about Hypertension treatments, and notes a book he found exceptionally helpful.

I encourage others who read this blog to send me similar emails, and I will post those, as well. There does not seem to be enough of a dialogue among patients about Hypertension issues--perchance we can start one here!

The excerpt:

I may surprise you by noting that a bit of skepticism has crept in to my brain… with the idea that by merely reducing BP, one smoothly increases one's odds against strokes and heart attacks. That applies to BP reductions from drugs as well as from other methods.

I have, all along, been under the illusion that the health effects of hypertension are completely connected to one's absolute BP readings. That is, if your chance of dying in a given year from a stroke or heart attack is X at an average BP of 120/80; and if that risk becomes 2X should your BP jump to 150/100; then if you can get your BP back down to an average of 120/80 by one means or another, your risk will decline back to X.

Ain't true. My first clue of that was something you wrote, the observation that without treatment, your chance of a major "incident" (morbidity or mortality) in the next five years was about 17%; and if you took your drugs like a good little boy, and kept your BP down (and suffered every damned minute of it), your risk only dropped to about 12%. I thought, "Well, that must mean that if you'd been one of those blessed people who never develop hypertension, your normal risk would have been around 12% at your age and condition." But now I don't think that's the case.

I say all of this because I recently found a book that is, well, stunning. It is -- absolutely -- the best book on this topic I've seen. A couple of weeks ago I resolved to buy The DASH Diet book, which everyone in the medical community praises. Another book I got was "The High Blood Pressure Solution," by
Richard Moore, M.D., Ph.D. Just from reading his Preface and Preface to the 2nd Edition, I now understand (for the first time!) what the hell has been happening to my body. He does something no one, certainly none of the $&%*$# doctors, ever did. Something none of the other written materials, including brochures and the like on hypertension, ever did. He explains the CAUSE of "essential" hypertension. "Essential" means, in effect, "we haven't got a fucking clue," but in truth science DOES have a clue, and a good one.

Thing is,
Moore is a biophysicist (now retired, I think, but previously of the University of Vermont Medical School, and a graduate of Purdue). So he was primarily interested in what goes on at the cellular level. He and the teams he's worked with -- and the research he draws upon, all of it from peer-reviewed research journals, many of them well known (e.g., JAMA, Lancet, etc.) -- comes from this fundamental level of focus. So he talks, in language fully accessible to any intelligent layperson (very comparable, say, to Issac Asimov's "Intelligent Man's Guide to Science," that kind of thing), all about what's going on at the cellular level, and what the best research has shown. It's no big mystery at all! It's the potassium-sodium balance, what he called the K-Factor with his co-author back in the 80s when he wrote his first book ("The K-Factor", naturally).

Here's the thing: the entire nation of
Finland (that's right: the WHOLE country) adopted one of the primary recommendations that he emphasized in his first book. They mandated the use of a potassium-sodium-magnesium mixture to replace straight salt in all processed foods (including what's used at McDonald's, for example). The result was a better-than 60% decline in stroke and heart attacks in the country, reported after 10 years of the new diet (in 1996). Moore notes that 15% is attributable to better medications. The rest goes to the use of "pansalt." This drop occurred even though smoking by women had increased over those years, and obesity in Finnish men was up also. So this isn't something that's untried or unproven.

Anyhow, I not only have hypertension, but -- starting a year or two ago -- I was diagnosed with Type II diabetes. And my cholesterol, which was always really good, shot up after taking one anti-hypertensive drug. I was tested again this week, and happily it's back down to an admirable 138 (but, the triglycerides did NOT drop, and my HDL “good” cholesterol dropped some 8 points).
Moore explains it all! He explains why the drugs did what they did. He explains how diabetes is connected to all of this. He explains what happened to me back in 2002, when I first had my hypokalemia (low potassium) crisis that sent me to the ER ... something none of the friggin' doctors would do for me at the time. This is true: I never got a single clue from any of them. Not a word! They just didn't know, yet wouldn't tell me that they didn't know.

So I'm strongly -- emphatically -- encouraging everyone I encounter who has any problems along these lines to go get
Moore's book. Interestingly, one thing he does is explain (with terrific references to the original studies, some of them among the largest ever conducted) how the link between forcibly lowering your BP via drugs and reducing your chances of dying aren't all that strong. There are benefits, of course, but THIS explains why forcing your BP back to the "normal" range does not, in fact, reduce your chances of a stroke or heart attack back to the same level it would have been had your BP never gone up in the first place (and, in fact, may improve your chances only by a total of about 10%).

He also explains how you can
REALLY improve your chances, a lot. Really beat the thing.

You may roll your eyes, because at one level is sounds just like what you've surely already been told: cut out all salt, go on a very veggie-rich diet, etc. But the difference is,
Moore is quite specific about what the goal is: getting a total ratio of 1:4 for salt:potassium, preferably from foods (rather than pills). This is where you get back to what happened in Finland. They didn't do anything nearly that extreme, yet still managed to reduce their stroke and heart attack rates by over 60%.

Best regards,

Roger Keeling
Portland, OR.

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