September 29th, 2015

New Blood Pressure Target Misses the Mark



An initial report from the Systolic Blood Pressure Intervention Trial (SPRINT) from the National Institutes of Health (NIH) could be used to justify more aggressive drug therapy for high risk individuals with high blood pressure. Since high blood pressure is a major risk factor for a heart attack or stroke results from the study make some sense, but what the study fails to address is if drug therapy is the ideal approach or even necessary to achieve normal blood pressure.

Despite the fact that virtually every authoritative medical organization (including the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure) has recommended that non-drug therapies be used in place of drugs in the treatment in all but moderate to severe hypertension, the reality is that drugs to lower blood pressure are among the most commonly prescribed medicines in the United States with more than 700 million prescriptions filled annually.

Background Data:

Blood pressure refers to the resistance produced each time the heart beats and sends blood coursing through the arteries. The peak reading of the pressure exerted by this contraction is the systolic pressure. Between beats the heart relaxes, and blood pressure drops. The lowest reading is referred to as the diastolic pressure. A normal blood pressure reading for an adult is: 120 (systolic) / 80 (diastolic). High blood pressure (BP) readings can be divided into the following levels:

  • Prehypertension (120-139/80-89)
  • Borderline (120-160/90-94)
  • Mild (140-160/95-104)
  • Moderate 140-180/105-114)
  • Severe (160+/115+)

High BP is most often the result of any number of factors that damage blood vessels and ultimately disrupt the regulation of the degree of constriction of blood vessels and fluid volume. Since the systolic pressure largely reflects the flexibility or stiffness of blood vessels, it is a strong predictor of vascular problems caused by high blood pressure, especially among older individuals.

Although genetic factors play a role in high BP, there is little debate that dietary and lifestyle factors are the underlying cause in almost all cases of high BP.

Some key dietary factors include: being overweight or obese; high sodium-to-potassium ratio; low-fiber, high-sugar diet; low omega-3 fatty acid intake; and a diet low in calcium, magnesium, and vitamin C. Important lifestyle factors that may cause high BP include stress, lack of exercise, and smoking.

New Data:

The NIH sought to address some of the issues in drug therapy for patients with high BP in the SPRINT. Studies with older medications, primarily beta-blockers, indicated that the drugs may actually increase mortality when used to lower blood pressure. These results and issues with newer drugs like calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors led to the recommendation by many expert organizations to try to achieve a target systolic reading of 140 mm Hg in patients over the age of 60. In fact, less than two years ago, a National Heart, Lung and Blood Institute panel told physicians to aim for a systolic blood pressure of 140 mm Hg in subjects under 60 and 150 mm Hg for people ages 60 and older because there were no convincing data showing lower is better. One concern was older people might be especially vulnerable to side effects and drug interactions caused by higher dosages of blood pressure lowering drugs.

In the trial, the goal was to achieve a target systolic pressure of 120 mm Hg in 9,300 men and women over the age of 50 who were at high risk for heart disease or had kidney disease and compare it to those with a goal of 140 mm Hg. Originally, the study was designed to run until 2017, but researchers halted the study prematurely because the results were of such great significance. Hitting this new target reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the previous target systolic pressure of 140 mm Hg.

Though the full results of the study have not yet been released, what is known is that in those assigned to get their pressure below 140 mm Hg took, on average, two drugs. Those assigned to below 120 mm Hg took an average of three drugs. Given the long list of side effects that these drugs have it is hard to imagine that more aggressive therapy did not lead to more severe side effects, however study looked at side effects and apparently the reviewers have concluded that the benefits outweighed any side effect issues. Many experts are recommending caution until the full results of the trial are made public.


First, I agree with the overall finding that it is very important to get blood pressure below 120/80 mm Hg. But rather than using drugs to accomplish this goal, I think that it is far better to utilize natural approaches. Why? All of the current classes of blood pressure lowering drugs possess significant side effects and 80% of people with high BP can lower their blood pressure without drugs. Writing even more prescriptions for high blood pressure drugs could have disastrous consequences. These drugs are not without serious side effects. For example, a 2013 study showed that women taking blood pressure lowering drugs called calcium-channel blockers, like Norvasc (amlodipine), for 10 years, or more had a 2.5 times higher risk of developing breast cancer than those who never took the medicine or who used other blood pressure treatments.

The bottom line is that I think drug therapy should be secondary to natural approaches, not the first option. The fact that more than 80% of patients with high BP are in the prehypertension to moderate range, what the drug companies won’t tell you and most physicians ignore, is that most cases of high BP can be brought under control with changes in diet, lifestyle, and proper use of dietary supplements. In fact, in head-to-head comparisons, many non drug therapies such as diet, exercise, relaxation therapies, and dietary supplements have proved superior to drugs in cases of prehypertension to mild high BP and are without side effects.

For moderate through severe hypertension, drug therapy may be necessary, but should be ideally used as a bridge therapy until dietary, lifestyle, and supplement strategies to lower blood pressure take hold. In patients with moderate through severe hypertension, drug therapy is appropriate, but should still be thought of as a secondary approach.

In regards to some specific recommendations to lower blood pressure, for most people with high BP, achieving ideal body weight is their most important health goal. Even modest amounts of weight loss often produce a significant reduction in blood pressure.

Another key factor is salt intake. Between 40% and 60% of hypertensives are salt sensitive. In other words, in about half of patients with high BP, sodium restriction (e.g., less than 1,200 mg daily) is effective in lowering BP.

Can dietary changes alone really lower blood pressure? Absolutely. In fact, another NIH funded series of studies were titled “Dietary Approaches to Stop Hypertension” (DASH). These studies showed quite convincingly that diet alone is very effective in achieving normal blood pressure in many patients with high BP.

Special foods for people with high blood pressure include celery; garlic and onions; nuts and seeds; cold-water fish, e.g. salmon and mackerel, or fish oil products concentrated for the omega 3 fatty acids EPA and DHA; green leafy vegetables and sea vegetables for their calcium and magnesium; ground flaxseeds, whole grains, and legumes for their fiber; foods rich in vitamin C, such as broccoli and citrus fruits; and foods rich in active flavonoids including berries, cherries, grapes, and legumes.

Here are some key nutritional supplements to consider in high BP:

Foundation Supplements. High potency multiple; Vitamin D3 2,000-5,000 IU/day; Fish oil, EPA+DHA 3,000 mg/day.

Magnesium supplementation has been shown to lower blood pressure, particularly in patients who are already on high blood pressure medication. Dosage: 150 to 250 mg three times daily. The best forms are magnesium citrate, malate, glycinate, and aspartate.

WARNING: People with kidney disease or severe heart disease (such as high-grade atrioventricular block) should not take magnesium unless under the direct advice of a physician.

Bonito Peptides (e.g., PeptAce), a purified mixture of small peptides (proteins) derived from fish bonito relaxes the arterial walls and helps to reduce fluid volume. Clinical studies have shown these peptides from bonito are effective in improving blood pressure control In patients with mild hypertension The degree of blood pressure reduction in these studies was quite significant, typically reducing the systolic by at least 10 mm Hg and the diastolic by 7 mm Hg. Dosage: 1,500 mg daily.

Celery Seed Extract (standardized to contain 85% 3-n-butylphthalide [3nB]) has also been shown to help improve blood pressure control. 3nB is a compound that is unique to celery and is responsible for the characteristic flavor and odor of celery. It was discovered as the active component of celery in response to investigations by researchers seeking to explain some of the traditional effects of celery including lowering of blood pressure and relief of joint pain. Dosage: 75 to 150 mg twice daily.

Grape Seed Extract (standardized to contain 95% procyanidolic oligomers) was shown to normalize high blood pressure in patients with initial blood pressure in the range of 150/95 mm Hg when combined with standard dietary guidelines. Dosage: 300 mg daily.

Olive leaf extract has been shown in clinical trials to work as effective as the conventional antihypertensive drug Captopril in lowering blood pressure, but without side effect. Dosage: 500 mg (17% to 23% oleuropein content) twice daily.

Hibiscus tea or extracts have demonstrated antihypertensive properties in clinical trials. In double-blind studies, hibiscus extract showed similar blood pressure lowering effect to popular antihypertensive drugs. Butunlike the drugs, which carry a significant side effect profile, hibiscus has a 100% tolerability and safety response. Typical reductions in systolic blood pressure are 15-20 mm Hg in subjects with initial readings of 140 mm Hg. Dosage: for the tea, three 240 ml servings/day; for an extract, take enough to supply 10-20 mg anthocyanidins daily.

Coenzyme Q10 (CoQ10) can help lower blood pressure in some cases. Dosage: 200 to 400 mg daily.

Garlic preparations can lower pressure. Dosage: should provide a total allicin potential of at least 4,000 mcg daily.


Press Release: Landmark NIH study shows intensive blood pressure management may save liveshttp://www.nih.go. v/news/health/sep2015/nhlbi-11.htm

September 22nd, 2015

Artificial Sweeteners Promote Obesity

Artificial SweetenersIntroduction:

Many people consume artificial sweeteners, especially in “diet” soft drinks, thinking it will help them reduce calories and lose weight. However, numerous studies over the years have challenged this conventional wisdom. In fact, the latest evaluation of the data indicates that consuming artificial sweeteners actually promotes weight gain.

Background Data:

There are six approved artificial sweeteners in use in the United States: sucralose, aspartame, saccharin, acesulfame potassium, neotame and advantame. Although these sweeteners do not impact blood sugar levels directly, data from several population-based studies have found that consumption of artificial sweeteners, mainly in diet sodas, is linked to development of weight gain, metabolic syndrome, and even type 2 diabetes.

There is also a growing amount of scientific data that shows that these artificial sweeteners are not inert ingredients that do not affect human metabolism or body processes. In fact, there are valid mechanisms that now explain why these artificial sweeteners promote poor health outcomes.

New Data:

An article published in the medical journal Physiology & Behavior on June 19, 2015, detailed how artificial sweeteners promote metabolic dysregulation. Three key mechanisms were highlighted:

  • Artificial sweeteners interfere with learned responses that contribute to controlling appetite and blood sugar levels.
  • Artificial sweeteners increase the number and activity of receptors that transport glucose from the gastrointestinal tract, thereby stressing blood sugar control mechanisms.
  • Artificial sweeteners disrupt the human gut microflora in a manner that promotes insulin resistance and glucose intolerance.

Of these mechanisms, the one that is most intriguing is perhaps the impact that artificial sweeteners have in alteration of the gut bacterial flora (human microbiome) in a manner that ultimately leads to insulin resistance. With insulin resistance comes reduced activity of intracellular enzymes throughout the body that ultimately lead to loss of appetite control, weight gain, increased abdominal obesity, and the subsequent development of the metabolic syndrome and eventually type 2 diabetes.

Animal studies have convincingly shown the link to the artificial sweeteners causing their adverse effects on insulin sensitivity by including a group also receiving an antibiotic with the artificial sweeteners.

Human clinical studies with moderate exposure to artificial sweeteners (dose equivalent to human subjects consuming approximately 2–3 diet soft drinks per day) show them to disrupt the gut microflora and cause increased fasting blood sugar levels presumably in the same manner as the animal studies.

How does the change in gut microbiome lead to insulin resistance? Researchers have been able to show the change in gut flora leads to an increased absorption of glucose from the diet. That alone may explain the development of insulin resistance, but there are undoubtedly other mechanisms involved (please see my newsletter, Probiotic Supplementation Promotes Weight Loss for more information).


My takeaway message from the data on artificial sweeteners is that they are indeed adding fuel to the fire. Stay away from them.

What about natural low or zero calorie sweeteners? They do not appear to negatively affect the gut flora. In fact, they appear to support a healthy microbiome, especially the polyols like xylitol. Here is a quick overview of natural sweeteners to use in place of artificial sweeteners:

Stevia: Extracted from the Stevia rebaudiana plant, stevia glycosides are 300 times sweeter than sucrose. Preliminary studies show that stevia may have blood sugar lowering and blood pressure lowering effects. It does exert a mild to unpleasant aftertaste depending upon purity.

Luo han guo (monk fruit): The fruit extract from this plant native to southern China is nearly 300 times sweeter than sugar and has been used as a natural sweetener in China for nearly 1,000 years. Has less of an aftertaste than stevia.

Xylitol and other polyols (maltitol, sorbitol, mannitol, erythritol): Polyols are roughly 60% as sweet as sucrose. They are poorly absorbed from the intestinal tract so larger amounts, for example, a single intake of more than 10 to 30 g, or a total daily intake of more than 40 to 80 g, may produce a laxative effect. Polyols are often combined with stevia or monk fruit extract to reduce aftertaste as well as to provide some bulk.


Pepino MY. Metabolic effects of non-nutritive sweeteners. Physiol Behav. 2015 Jun 19. pii: S0031-9384(15)00372-8. [Epub ahead of print]

Dr. Michael Murray

September 15th, 2015

Double-Blind Study Shows Resveratrol May Help Prevent Alzheimer’s Disease

Resveratrol BenefitsIntroduction:

Resveratrol is a plant compound similar to flavonoids. It is found in low levels in the skin of red grapes, red wine, cocoa powder, baking chocolate, dark chocolate, peanuts, and mulberry. Red wine is perhaps the most recognized source of resveratrol, however, red wine contains at the very most only one milligram per glass. Most resveratrol supplements use Japanese knotweed (Polygonum cuspidatum) as the source with dosage recommendations often 500 mg of resveratrol up to four times daily. So it would take several thousands glasses of wine to provide the level of reservatrol that is provided through supplementation.

There has been a great deal of hype regarding resveratrol supplements, but there have also been some positive clinical studies showing positive results in improving memory and brain function in elderly subjects. A new study from Georgetown University’s Department of Neurology and researchers from 21 medical centers across the United States shows that reservatrol supplements may offer significant protection against Alzheimer’s disease.

Background Data:

Resveratrol has received a lot of attention as a longevity aid, but its scientific basis relies primarily on test tube and animal studies. There is only a handful of published human studies at this time, but the results are very encouraging.

Resveratrol activates an enzyme known as sirtuin 1 which plays an important role in the regulation of cellular life spans; it also promotes improved insulin sensitivity. Either of these two effects might explain its ability to extend lifespan.

In terms of brain health, a 2010 clinical study in humans showed that resveratrol supplementation at a single dosage of 250 or 500 mg could improve blood flow to the brain, but it had no effect on mental function in this study. In a 2014 study conducted in Germany, the use of a resveratrol supplement resulted in a significant impact on the ability to remember words compared with placebo. Resveratrol users also showed a significant increase in functional connectivity of the hippocampus – the area of the brain involved with the formation, organization, and storage of memory.

New Data:

A randomized, placebo-controlled, double-blind, multicenter study was conducted to examine the safety and effectiveness of resveratrol in 119 individuals with mild to moderate Alzheimer disease (AD).

The patients were randomized to receive either a placebo or resveratrol capsules. The initial dosage was 500 mg orally once daily, with dose escalation by 500-mg increments every 13 weeks until the final dosage of 1,000 mg twice daily was achieved. Brain MRI and cerebrospinal fluid (CSF) collection were performed at baseline and after 52 weeks of treatment.

Resveratrol and its major metabolites were measurable in the blood (plasma) and CSF in the subjects in the resveratrol treated group. The researchers looked at several biomarkers of Alzheimer’s including the level of beta-amyloid in the CSF. When beta-amyloid accumulates, it leads to significant damage to brain cells and the characteristic lesions of AD. Interestingly, although accumulation of amyloid-beta in the brain is a hallmark of AD, these patients actually have lower levels of this protein in the CSF. When the researchers look at the level of beta-amyloid in the CSF in the patients in the study, they found that subjects in the resveratrol group had higher levels of beta-amyloid proteins in their spinal fluid than those in the placebo group. The results suggest that resveratrol apparently helps prevent beta-amyloid accumulating in the brain and promotes its transport out of the brain so that it can be effectively broken down.

Resveratrol and its major metabolites clearly penetrated the blood-brain barrier as they were found in the CSF. An additional finding of interest was that the patients taking resveratrol lost about two pounds during the one-year study, while the placebo group gained about 1 pound. The brain MRI results showed that the resveratrol group had a smaller brain volume than the placebo group. The explanation being that the inflammation within the brain linked to AD can cause swelling and a larger brain volume. So, a smaller brain volume in this case (AD) is a positive sign.

These results clearly indicate a potential role of resveratrol supplementation in preventing AD.


Over the past few months and years I have featured several newsletters highlighting studies that reflect nutritional approaches for improving brain health, memory, and/or the prevention of age-related mental decline or AD. There are a lot of natural products to choose from, but the basic underlying goals and effects are quite similar. You have to reduce inflammation, control blood sugar levels, provide necessary building blocks with super nutrition, and protect the brain from damage by consuming antioxidants from the diet and through supplementation.

While resveratrol shows some compelling data as detailed above, my feeling is that it can’t do the job well enough by acting alone. It needs to be part of bigger approach that focuses on diet, lifestyle, and proper supplementation. In regards to diet, the Mediterranean or New Nordic Diet look very helpful. In regards to supplementation, there are four primary recommendations I make to people to help them design a foundation nutritional supplement program that also, not surprisingly are very important in preventing AD:

#1. Take a high quality multiple vitamin and mineral supplement providing at least the recommended dietary intake for all vitamins and minerals.

#2. Take enough vitamin D3 (typically 2,000-4,000 IU daily) to elevate your blood levels to the optimal range (50-80 ng/ml).

#3. Take extra plant-based antioxidants like flavonoid-rich extracts like grapeseed or pine bark extract; curcumin (Theracurmin); a “greens drink” product; resveratrol; or some other broad-spectrum antioxidant.

#3. Take a high quality fish oil product to provide 1,000 mg EPA+DHA daily for general health or up to 3,000 mg EPA+DHA if you have an inflammatory condition, cardiovascular disease, depression, ADHD, multiple sclerosis, or any other brain or nerve disorder; or any of the 60+ health conditions shown to respond or be prevented by fish oils.

Also, realize that in the study described above, benefits to the brain in these patients may have been secondary to improvements in blood sugar control as resveratrol has also been shown to improve insulin action. This potential link highlights the importance of using PGX, which I think is the most important supplement in North America today given its effects in supporting proper blood sugar control and weight loss. Some researchers have referred to AD as “diabetes of the brain.”


Turner RS, Thomas RG, Craft S, et al. A randomized, double-blind, placebo-controlled trial of resveratrol for Alzheimer disease. Neurology. 2015 Sep 11. [Epub ahead of print]

Dr. Michael Murray