Diuretics first line against heart failure -study

[kebaldwin]

Diuretics first line against heart failure -study
Mon May 1, 2006 6:06 PM ET



WASHINGTON (Reuters) - Cheap diuretics are the best first step in treating high blood pressure to prevent heart failure, U.S. researchers reported on Monday.

Their study, published in the American Heart Association journal Circulation, supports a 2002 U.S. government report recommending that patients with high blood pressure should start taking a diuretic first, and only add drugs such as ACE inhibitors or beta-blockers if their blood pressure needs to be lowered further.

Diuretics, or water pills, lower blood pressure by ridding the body of excess water, often making patients urinate more often. In 1982 they were prescribed in 56 percent of the cases of high blood pressure treated by drugs, but by 1992 they were prescribed in only 27 percent of the cases.

Use has been creeping back up since the 2002 report by the U.S. National Heart, Lung and Blood Institute.

"This study provides evidence for the superiority of diuretics over calcium channel blockers and ACE inhibitors as the base of an anti-hypertensive regimen to prevent heart failure," said Dr. Barry Davis of the University of Texas School of Public Health in Houston, who led the study.

High blood pressure forces the heart to pump harder to keep blood circulating. Over time, this added workload can cause heart failure, in which the heart becomes bigger but flabbier and blood backs up.

Heart failure patients become increasingly tired and short of breath and lose kidney function. Half die within five years of diagnosis.

"Over 90 percent of people who develop heart failure first had high blood pressure," said Davis.

"Diuretics are better than calcium channel blockers at preventing heart failure, and better, at least in the short term, than ACE inhibitors," Davis said in a statement.

"One reason diuretics may have an advantage over other drugs is that they are good at decreasing the volume that the heart has to deal with, and the other drugs don't do that. ACE inhibitors remodel the heart, which may have a more long-term effect on preventing heart failure."

His team analyzed data from the giant Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT, in which several drug companies donated their name-brand products for use.

The cheaper, generic, diuretics did the best job of lowering cholesterol and preventing heart failure.

During the first year of the study, patients given a calcium-channel blocker or ACE inhibitor were 40 percent more likely to be hospitalized or die from heart failure as patients taking a diuretic.

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2006-05-01T220552Z_01_N01192701_RTRUKOC_0_US-BLOODPRESSURE.xml

[kebaldwin]

What happened to the atkins diet as the first line of defense?

[Whoa182]

People don't even follow the governments food pyramid! So one thing you can't say is that what the government recommends people to eat is unhealthy. I don't think its optimal, but I don't think it is causing the problems we see today because people dont follow the damn thing to start with!

I can't name one person that I know in my family or friends that has a diet which in anyway resembles what the government recommends. Almost all fail to get enough vegetables/fruits/nuts into their diet.

What happened to the atkins diet as the first line of defense?

Not enough long term evidence, it would be stupid for everyone to go on atkins. In time we'll know whether it is safe or not.

People need to just have a healthy balanced diet, you don't have to go onto any type of eating regime! They just need to eat lots of vegetables, some fruits, wholegrains, Nuts/seeds, fish and olive oil and meat occasionally. Then there would be a lot more people in better health.


I have nothing to gain in defending the food pyramid but saying that its the cause of obesity when people dont even follow the thing is just silly and unfair. No one takes any notice of it.

[kebaldwin]

There are thousands, tens of thousands of people that followed the low fat diet and got very seriously unhealthy. They switched to a low carb diet and supplements and got very healthy. They lost a lot of weight, no longer needed prescription drugs, are able to get twice as much out of each day.

And you think there is

Not enough long term evidence

Tell me something. Exactly how unhealthy were you -- before you started your diet? What was your starting weight, approximate body fat, etc? What prescription drugs were you on? What all health problems did you have?

Then exactly what health improvements have you seen?

[catfishghj]

sorry, Whoa, but there are no long term safety studies of the food pyramid or what you are recomending, so I don't see how anyone could consider them above Atkins. He was a cardioligist and used the diet to successfully treat many patients. The whole grains have only shown a benefit when they replace refined grains. My personal belief is that they have no place in a healthy diet.

[Whoa182]

There are thousands, tens of thousands of people that followed the low fat diet and got very seriously unhealthy. They switched to a low carb diet and supplements and got very healthy. They lost a lot of weight, no longer needed prescription drugs, are able to get twice as much out of each day.

Well great for them, but where did I say that people should follow a low fat diet? I think there should be no less than 20% of fat in a persons diet, but I recommend 30% of their calories from fat. Fat helps absorption of important nutrients. It's stupid that people get the wrong msg and avoid all kinds of fat.


Tell me something. Exactly how unhealthy were you -- before you started your diet? What was your starting weight, approximate body fat, etc? What prescription drugs were you on? What all health problems did you have?

Then exactly what health improvements have you seen?

I started at 118lbs ~ I have always been active as as a kid and teens by going over the park to pllay football atleast 5 hours daily. most of the time I would just eat cereal like Shredded Wheat 2-3 times a day (atleast I got my vitamins! lol), beans, chips, yogurts, fruit juices, some fruit, chocolate, crisps etc...

These are just general problems that I had

Allergies - Totall disappeared
Frequent Headaches - disappeared
Stomach problems - disappeared
Frequent colds/flu - Never get sick anymore
Acne - Acne breakouts stopped and cleared up shortly after
IBS - No problems anymore
Lack of concentration and motivation - Improved, now doing Biosciences and then will probably go into Medicine. I feel this path would never of happened if I didnt make a lifestyle change.

Atkins isnt the only way to improve health, people just need a healthy balanced diet that contains all the essential nutrients and not eat excessively. Why can't just lowering fat a bit help in reducing total caloric intake? which we know is benificial. It would be harder to consume 700 calories of vegeteables than 700 calories of fat right?

[shortstuff]

kebaldwin: you're talking to a 22 year old male who is 5'7" and thinks 110 pounds is a healthy weight for him.

I hope that will help you sort out where this person is coming from.

shortstuff

[Whoa182]

113lbs

and I am VERY healthy :)

[Nancy LC]

[B][COLOR=Red]
I can't name one person that I know in my family or friends that has a diet which in anyway resembles what the government recommends. Almost all fail to get enough vegetables/fruits/nuts into their diet.

Well, first of all, the food pyramid pushes grains like crazy. If, as some doctors are finding, 30% of people can't properly digest grains, this is a crazy food scheme to follow. It'll lead them to lyphomas, colon cancer, autoimmune diseases, GI problems, neurological disorders, diabetes and so much more.

Why are those grains figuring so heavily in the USDA food pyramid? What is there in grains you can't get more easily in other foods? I'll tell you: Nothing.

The food pyramid pushes a very unhealthy way of eating. I'm not one to believe in conspiracy theories but if I were, I'd say the USDA food pyramid is designed to get people off the Social Security rolls more quickly. :lol:

[kebaldwin]

The food pyramid pushes a very unhealthy way of eating. I'm not one to believe in conspiracy theories but if I were, I'd say the USDA food pyramid is designed to get people off the Social Security rolls more quickly. :lol:

My understanding is the USDA includes the word "Agriculture" who's goal is to sell more US grown agriculture, in other words, grains. So if they come out with a food pyramid telling everyone to eat mostly grains ...

[Whoa182]

wow I did not know that lol :eek: I havent found anything to support what you said yet, but still going to look later.

Im looking on PubMed at the moment and most, if not all are showing up positive results :s

Here are 3, you can see them on pubmed by typing in whole grains.

Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women.

"Our data indicate that whole grains and a low-glycemic index diet may reduce systemic inflammation among women with type 2 diabetes."

Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults.

"Fasting glucose concentrations and body mass index decreased across increasing quartile categories of whole-grain intake (P for trend = 0.01 and 0.03, respectively), independent of confounders, whereas intake of refined grain was positively associated with higher fasting glucose concentrations (P for trend = 0.04) and a higher prevalence of the metabolic syndrome (P for trend = 0.01). CONCLUSION: Whole-grain intake is a modifiable dietary risk factor, and older and young adults should be encouraged to increase their daily intake to > or = 3 servings/d."

Whole grains, bran, and germ in relation to homocysteine and markers of glycemic control, lipids, and inflammation 1.

"The results suggest a lower risk of diabetes and heart disease in persons who consume diets high in whole grains."

Lots of positive studies:

http://www.ncbi.nlm.nih.gov/

keyword: Whole Grains

EDIT:

My understanding is the USDA includes the word "Agriculture" who's goal is to sell more US grown agriculture, in other words, grains. So if they come out with a food pyramid telling everyone to eat mostly grains ...

I don't think that even matters... what matters is health studies are showing positive results with whole grains. Look above, look for yourself on pubmed

[Whoa182]

I don't have a High whole grain intake btw, I don't think I need to.

[kebaldwin]

Whoa

You must think that I am anti-low calorie and anti-veggies and such. I am not. The problem is -- you have never had the health problems that most of us have had -- so you have no idea what it is like to deal with them.

I actually agree that if people could eat a lot more veggies and eat fruit instead of dessert then their health would improve greatly.

I have nothing against anyone that wants to eat less and exercise more. This too could make the average person much healthier.

The reason both of these work is that they are eating a lower glycemic diet - and burning more of the carbohydrates that they eat - which means their blood sugar and insulin levels are lower.

I think this is what most low carb diets want to accomplish. And for people of normal weight and health (i.e. they don't have syndrome X / metabolic syndrome / pre type 2 diabetes) -- is a very good idea.

Where you and I differ is that you think (1) anyone should just be able to eat healthy and (2) they will instantly be healthy.

The problem is -- people are addicted to high glycemic foods. Try to keep some people away from french fries and bread -- and it's like they are crack cocaine addicts. So how do you deal with an addiction? For many, it is to go "cold turkey" and completely avoid them.

Would you tell an alcoholic to just cut back to one beer or drink per day?

Would you tell a smoker to just cut back to one cigarette per day?

I don't see any difference in telling someone addicted to high glycemic foods to just cut back.

They can't. That is why it is an addiction. Most of these people know they should not eat desserts, candy, etc. -- but they do so anyways. But most do not know just how dangerous high glycemic foods are.

I know that if I completely avoid all carbs -- then my cravings are minimal. If I have just one bite -- I lose control and want to eat everything high glycemic. I would imagine the alcoholic, smoker, and drug addict feels the same way about their addiction.

Badgering people to stop does nothing except make them mad and withdrawn. You have to find a way to help them break the addiction and habit.

The low carb diet has proven that you can eat an enormous amount of calories, but very low carbohydrate, and lose a tremendous amount of weight - and make a huge improvement in health. I don't know of any other diet that can make these claims.

Once people have lost their weight and regained their health then they should move on to an Atkins maintenance, regular low carb, mediterranean diet -- like what the food pyramid should be.

And I am afraid that this may be the hardest part of the diet. How do you just eat a reasonable amount of food, not get cravings, and not start eating more and more and more each day until you fat and unhealthy again?

But what other diet allows an obese person to lose weight so quickly while dealing with their addiction to food?

They've done studies at several weight loss clinics where they compared the Atkins diet and the "just eat right" diet. The Atkins diet wins every time. Not only did the people lose more weight but their health, as measured by blood tests, improved much more than the "just eat right" folks.

So my advice to people that are not addicted to high glycemic foods and can eat right and can simply cut back -- to do so. Back when I was a teenager I could do that.

Unless you start to understand that most people are not like this, and can not do this -- people on this message board will not respect you. They've heard "just eat right and exercise more" before, they've tried it, and it does not work.

But many have seen dramatic success with low carbing. Perhaps you should open your mind and think about all of this.

[kebaldwin]

"Our data indicate that whole grains and a low-glycemic index diet may reduce systemic inflammation among women with type 2 diabetes."

People create studies all the time that are not true. Most of us on this forum are pre type 2 diabetics and we have proved just the opposite. We know for a fact that at least for most people, this is not true.

[arc]

Those studies are comparing whole grains to refined grains, not no grains. I agree that if you are going to eat grains, eat whole grains (taking into account the effect of the phytates that whole grains have). However, grains are totally unnecessary and any nutrients in them can be had in better quantities (and without the phytates) in LC veggies.

[Whoa182]

Ok well your right kebaldwin, I can never understand what most people go through with metabolic disorders. But what I am interested in is prevention, not treating obesity with the latest food pyramid put out by the government. Will that food pyramid if followed correctly cause a massive rise in obesity. Your right I can't tell how well a person could cope on that sort of diet when they have already developed metabolic problems.

Hey, I even think that the food pyramid is *** up and wrong. Fats should not be where they are, especially since they are essential for living and carbs are not.

I would never tell anyone to live on a CR diet in my family or my friends because I wouldnt like to take responsibility if anything went wrong, I don't recommend it because it can be dangerous. This is why I am unsure about limiting lots of food groups that many different diets ask you to do. I think the traditional mediterranean diet is the best way of eating that most people could manage.

It's totally unrealistic to get the majority of people to eat low carb, which i think is healthy but I don't believe its at all nesseccery to take it to the extremes.

Low fat, the problem with this is people avoid all fats. They think they can just pig out on carb foods and not gain weight. this is stupid and partly the governments fault.

If this health crisis is going to be fixed it will have to start from the schools early on in life, never know, the next generation might be the healthiest. As for parents and teenagers now, there is little hope that any dietary advice will have a major impact in their dietary habbits. The government have failed and let out a whole bunch of uneducated school kids that are going to have children later on and feed them the same junk food.

So its going to take quite a bit of time before we see dramatic changes.

Those studies are comparing whole grains to refined grains, not no grains. I agree that if you are going to eat grains, eat whole grains (taking into account the effect of the phytates that whole grains have). However, grains are totally unnecessary and any nutrients in them can be had in better quantities (and without the phytates) in LC veggies

Well true... good point! I don't really have many grains because I get all I need from vegetables/nuts/fish etc... But you have to start somewhere and if people change from white flour bread to wholemeal, then that is a start in the right direction/.

[MoseyMan]

I would think being in peetosis is better than any diuretic. :D

I prefer celtic sea salt because it doesnt make you retain water. It also helps the body with heat regulation. It did wonders for me in the summer, the heat used to be untolerable, and now it doesnt bother me a bit.

[LC FP]

Whoa, when I was 22 some college friends advised me that "it's the carbos, man!" and that I should avoid them. They had read a new book by a Dr. Atkins called "Diet Revolution" published in 1972. I told my friends they were crazy, it was the fat that should be avoided. Everybody was talking about fat back then. I never looked into it, in fact obesity wasn't a big problem back then, and diabetes was a fairly rare disease.

I'm not implying that CR will go the way of low fat. I doubt that it's an unhealthy way to eat, or will lead to any chronic diseases. My guess is that it will be just too hard for most people to follow. For that reason health "experts" probably won't recommend it too strongly, and the food industry won't push it.

LC still has to be proven, in my opinion, and I have seen some medical disasters "associated" with LC just in people that I know. The problem with LC now is that a lot of people are doing their "own version" of it, and probably are making some very basic mistakes.

LC will need to be adopted by the establishment at least to some degree and reliable information will need to become more readily available for those too lazy to read a good LC book and follow it before the benefits are accepted by the general public. Bill Clinton's near MI while apparently following SBD was a typical example of how just one adverse event can sink an otherwise beneficial movement.

[Abd]

People don't even follow the governments food pyramid! So one thing you can't say is that what the government recommends people to eat is unhealthy. I don't think its optimal, but I don't think it is causing the problems we see today because people dont follow the damn thing to start with!

I can't say it? Watch me:

Government recommendations have harmed the health of the public through recommendations that were not based in solid science.

The argument was made that people don't follow the Food Pyramid. Some people try to, and the Food Pyramid is used extensively in marketing; if it had no influence, why would companies waste ink and label space on it?

The question is what the *effect* of the recommendations is, not whether or not people follow the Pyramid. The big message, since the Pyramid's beginning, was, "Stay away from more than a little fat." And this message was reinforced, over and over, by doctors and the media. And, of course, the big bad ugly unhealthy food was *saturated* fat.

Did I follow the Food Pyramid? No, never paid that much attention to it. But did the recommendations about fat have an effect on me? Absolutely. Something like fifteen years ago I got my first high cholesterol test, over 200. My doctor told me I had to change my diet. So I did. Not completely, not perfectly, but substantially. Stopped eating butter. Stopped this and stopped that, stopped eating the fat from meat, started eating more grains, etc.

And, over the next fifteen years my weight steadily crept up and my cholesterol went up and down, eventually up quite a bit. I ascribe this, very definitely, to following the recommendations that I cut way down on fat in my diet. And, as most of us now know, that was the exact opposite of what I needed.

Besides, the food was much less satisfying. Fat sates.

I used to think that fat gave me reflux. Actually, turns out, it wasn't the fat. It was fat plus a lot of carbs. Fat alone does not seem to be a problem, and I naturally stop eating it when I've too much.

[HairOnFire]

I'm not implying that CR will go the way of low fat. I doubt that it's an unhealthy way to eat, or will lead to any chronic diseases. My guess is that it will be just too hard for most people to follow.

Isn't CR still primarily a moderate- or high-carb diet? Doesn't it contain grains and starchy veggies? This could be the problem with carb-sensitive people following it - it is still too high in carbs for compliance, and people might binge more easily on it, especially since it would contain carbs AND be restricted-calorie.

There is a CR yahoo group where many of the members are following the Zone diet because it is easier for compliance.

For me personally, I'd always be looking for more food on low-calorie, moderate- or high-carb. It didn't work for me in the last 5-6 years, and I doubt it would work for me in the future as I get closer to menopause.