KTH Flashback: A Tale of Two Surveys, or Dentistry’s Role in Healthcare

Originally posted August 16, 2017; updated

physicianOnce upon a time – last year, to be exact – a Pew survey suggested that for all the problems with American healthcare these days, people just lurve their physicians.

According to the survey, almost 90% of those who saw a doctor in the past year felt their provider “really cared about their health and well-being.” Nearly all thought they received all the info they needed from them.

At the same time, about half of adults think kids today are less healthy than a generation ago, and roughly 42% think adults’ health is worse, too.

No, we’re not sure either how those two things jibe. (The latter, though, does jibe with previous findings.)

Meantime, a 2017 survey from a consulting firm found that people aren’t really all that fond of their dentists – at least if you measure that in terms of whether they would recommend doing business with their current dental provider.

The study found that overall, the typical dental provider earned an NPS of 1. To put this into perspective, other industry NPS averages are 36 for insurance, 39 for financial services, and 46 for retail.

That’s pretty bad.

Yet when you think about how dentistry is still often practiced today, it kind of makes sense. Despite the ever clearer relationships between oral and systemic health, dentists just aren’t seen as healthcare providers. Most of the time, they’re viewed more as mouth mechanics – someone you see when something goes wrong, hardly a player in your quest for good health.

Because of this, there can also be suspicion – sometimes with good cause – that the dentist is trying to upsell them treatments or recommending procedures they may not really need. After all, if a dentist is just there to fix problems, its profitable to find more problems to fix or more expensive ways of fixing them.

But it doesn’t have to be this way. And, happily, more dentists are beginning to see themselves as more than fixers but true partners in health. More are also beginning to really appreciate the relationships between oral and systemic health. They may not necessarily be practicing biological dental medicine, but it’s a start.

One of the things we pride ourselves on is the relationships we build with our clients. It’s important for us to get to know them as individuals – to be able to provide the customized care they need and deserve. We view them as partners in the process, as they are ultimately the authors of their own health and well-being. We give information; they learn; they choose which path to take to achieve their goals in a way that aligns with their needs, values, and beliefs.

Only then comes treatment. And just as much as we give information, we give time.

That’s why, apparently unlike the people who answered the second survey, our patients do refer friends and family to us consistently.

We’re proud to be an outlier.

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Gummy Supplements: Big Business? Yes. Big Nutrition? Not So Much

Once upon a time, gummy and other chewable vitamins were just kid stuff. Now, they’re very big business. As the New York Times reported last year,

Millions of people are hooked on gummies as a health supplement. Gummy multivitamins accounted for 7.5 percent of the $6 billion multivitamin market in the United States in 2016, according to estimates from the Nutrition Business Journal and projections from IBISWorld, a research company. And gummy products over all now account for $1 billion of the $41 billion supplement market in the United States, a more than 25 percent jump in sales since 2015, according to IBISWorld.

And why not?

Mintel’s 2016 Vitamins, Minerals and Supplements Report underscored that supplement shoppers are looking to formats like gummies because they like taking vitamins and minerals in fun and easy delivery methods. The report noted that innovative delivery platforms such as gummies, and other confectionery methods, “provide an appreciated departure from consumers’ routine, allowing [the consumer] to have a more sensorial, enjoyable experience than with a tablet.”

Ah, yes. We’re all looking for “a more sensorial” experience with our vitamins.

handful of gummy vitaminsBut sure, gummies are easier to take than pills. They also taste good, as they should, considering how they’re typically made with sugar. While the total amount is low – a few grams per serving – if you’re taking several different gummy supplements or are grazing on them throughout the day (they’re “healthy,” after all), you could easily flirt with or surpass the maximum sugar intake for good dental health. That max is just 3% of your total daily calories from sugar. For the average adult, that works out to about 15.5 grams a day.

Thats the equivalent of less than half a can of Coca Cola or about 4 ounces of grape juice.

More, the nature of manufacturing these supplements typically means they pack less of a nutritional punch than conventional supplements. As Neutraceuticals World reported,

Director of product development for MegaFood (the Derry, NH-based brand from FoodState), Stacey Gillespie, discussed some of the difficulties with the gummy format. “Outside of the fact that there are a limited number of qualified and experienced manufacturers of gummy vitamins today, one of the biggest hurdles is the limited amount of active nutritional ingredients you can add to the gummy matrix, compared to the amount you can include in a tablet and/or capsule,” she said. “For example, to deliver 250 mg of vitamin C in a gummy, you would need three to four pieces to equal one serving, versus one tablet or capsule to deliver 250 mg vitamin C.”

Consider how many pieces you’d need to consume if you actually wanted to take a therapeutic dose of say 1000 mg or more.

That’s a whole lot of gummies.

This manufacturing issue may be one of the reasons why ConsumerLab.com has found

that some gummy supplements – particularly gummy multivitamins – do not contain their listed amounts of vitamins or minerals, or contain impurities. We continue to find more problems with candy-like vitamins like gummies than with traditional forms, such as tablets and caplets. Manufacturing challenges associated with candy-like products likely explain the higher incidence of problems.

Then there’s the fact that gummy candies more easily get stuck on and between the teeth, where oral pathogens can feast on their sugar content. As they say, what goes in must come out, and the end result of that feasting is quite acidic, contributing ultimately to tooth decay.

“Even if the gummies don’t have sugar,” dentist Jonathan Levine told HuffPo, ” what we call ‘biofilm’ is always naturally forming on your teeth, so if they don’t get cleaned properly, plaque is bound to develop.”

That said, there are instances in which gummy vitamins may be helpful, such as for people who have difficulty swallowing pills. For those who would not otherwise take supplements at all, they may be better than nothing.

That said, it’s important to keep in mind that most of your nutritional needs should be met as Nature intended: through a nicely varied whole food diet. Supplements are just that: supplements, not replacements. More, when you get your nutrients through whole food, you get the total nutritional package that helps your body to use them more effectively and efficiently.

With gummies? Not so much.

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Nonstop Flu Shot Spin

flu shot sign

Even as we’re being told that a harsh flu season is finally starting to taper off, the powers that be continue to push vaccinations.

The CDC cautions that people who’ve been sick with one strain of the flu can get a different strain during the same season, so a flu shot can still be helpful for the unvaccinated.

The FDA is saying so, too, even as they admit that the vaccine this year wasn’t so effective.Still, says FDA Commissioner Scott Gottlieb, it’s not too late to get vaccinated. And even if you do get sick, he says,

Vaccinations have also been shown to reduce the severity of the flu in people who get sick.

But there’s a problem here: It turns out that there actually isn’t all that much evidence supporting his claim. As the authors of a 2017 study in the journal Vaccine put it,

Surprisingly, very few studies have addressed the question of whether the vaccine mitigates influenza severity among those who develop the illness despite being vaccinated.

The few studies that have found only minor differences between the vaccinated and unvaccinated who develop flu symptoms. That was the case with Vaccine study, as well, which involved over 2000 senior patients in France, nearly 57% of whom had received a flu shot.

Compared to non-vaccinated influenza patients, those who had been vaccinated had a slightly reduced maximum temperature and presented less frequently with myalgia, shivering and headache. In stratified analyses, the observed effect was limited to patients infected with A(H3) or type B viruses. After adjusting by age group, virus (sub)type and season, the difference remained statistically significant only for headache….

These results, the authors wrote, “are consistent with previous studies reporting limited or no efficacy of the influenza vaccine in reducing illness severity at onset of symptoms.”

Again, and as ever, the surest route to preventing the flu or minimizing its impact, is to focus on supporting the health of your biological terrain – your body’s internal environment.

How do you know if it’s in good shape or not? Biological Terrain Analysis gives us the big picture. As Han van de Braak has described it,

Biological Terrain Analysis (BTA) was invented by professor of hydrology Prof Louis-Claude Vincent, whose Bioelectronimètre was first used in France in 1946. His method forces one to take a contextual, broad-spectrum view beyond any chronic symptomatology a patient presents. Vincent found that the defining triad of pH, rH2 (oxidation-reduction potential at the given pH) and Ohms resistance was as equally appropriate to human health as he had found it to be to testing water quality.

Vincent’s research in France – where he established his reference bandwidths – struck a chord with eminent doctors in Germany like Dr.phil. Dr.med. Bach [and] Dr.med. Reinhold Voll. [It became a] valued technique in Germany used by medical physicians, dentists, veterinary surgeons, pharmacists and naturopathic physicians alike. Since, Vincent’s technique has been adopted in many countries around the world most notably in the USA.

The BTA process itself is simple, quick, and noninvasive. We take samples of your saliva and urine, for which Vincent’s three biomarkers – pH, rH2 and R – are measured and analyzed by computer. The results show which biological systems are in good shape and which are vulnerable, weakened or compromised. Knowing this, we can recommend bioenergetically specific therapies to improve the terrain and thereby support the body’s innate ability to self-regulate.

Yes, that’s more involved than driving down to your local Walgreen’s or Costco and getting a shot. It’s also for more than just the flu.

It’s laying the foundation for long-term overall health.

Image by Mike Mozart, via Flickr

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Detoxing Your Teeth & Gums?

You know that the popular idea of “detox” has jumped the shark when Crest starts using it in the name of one of its product lines.

Crest Gum Detoxify

We’re not exactly sure what makes this product so “detoxifying.” The main difference between it and other Crest lines seems to be that it has about twice the concentration of fluoride – itself a toxin.


But who can blame them for jumping on the bandwagon? “Detox” sells. And lately, we’ve seen it used more often than ever to sell toothpaste.

Most of these pastes are “natural” products, containing ingredients such as activated charcoal, bentonite clay, and an assortment of antimicrobial essential oils. You can find them anywhere from etsy to your local organic market.

My Magic Mud toothpaste

And there’s certainly nothing wrong with such pastes. They’re chemical-free, and ingredients such as charcoal and clay can help remove stains and brighten your smile. But while those ingredients are also known detoxers, it’s a bit of a stretch to call brushing your teeth “detox,” even if antimicrobials are used to help keep oral pathogens in check. Brushing is largely about breaking up the microbial colonies – biofilm/plaque – that grow between cleanings. We wouldn’t call flossing “detox” either.

The use of the term seems more a marketing hook than anything.

But it also brings up a point that bears some emphasis: If you have mercury amalgam “silver” fillings or other metal restorations in your mouth, you should steer clear from any toothpastes containing chelators such as bentonite clay and activated charcoal. (The Crest paste appears to contain a potential chelator, as well: sodium gluconate.) Not only does the physical action of brushing accelerate metal ion release from the restorations; such ingredients may accelerate it even further. Those metals may then be inhaled and introduced to the general circulation.

A gentler paste such as Tooth and Gum Essentials, for instance, would be a better option until you’ve had your amalgams replaced with biocompatible alternatives and have undergone full and proper detox under a professional’s guidance.

Real detox isn’t something to take so casually.

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Microbes, Microbes Everywhere

A woman goes into a public restroom and holds an open petri dish in an enclosed hand dryer for three minutes. She takes a picture of the petri dish and posts it publicly on Facebook.

And her post becomes just the latest thing to “break the internet.”

hand dryer petri dish Facebook post

Sure, some of those growths might be “pathogenic fungi and bacteria.” Or they might not be. But as many a commenter has since pointed out, they’re exactly what you would expect by just opening a petri dish anywhere. That’s what they’re made for: growing stuff, including microbes, good and bad alike.

And microbes are everywhere. One paper in the Journal of Virology estimated that there can be up to 40 million viruses and 11 million bacteria in every cubic foot of air. The researchers calculated that “we breathe in a few hundred thousand viruses every minute.”

What’s more, your very own body contains more microbes than human cells. Many are necessary to support good health. Recent research suggests that, in fact, a lack of microbial diversity may raise the risk of health problems, oral and systemic alike.

Other research has shown that, in the words of one news release, we each “emit” our “own personal microbial cloud.”

Consider what that might grow on a petri dish!

Yet the woman who posted the pic seems convinced that hand dryers are the problem. As MSN reported,

[she] says her experiment has changed the way she sanitizes after using public bathrooms.

“From now on I just wash and scrub, and dry on my clothes or shake and air dry OUTSIDE of the restroom.”

She has also since disclosed that she works for a company that develops hygiene products, which may explain a little or a lot of her original post. And of course good hygiene matters.

Yet even with good hygiene, microbes are everywhere. Whether the ones we’re exposed to will help or harm depends, as ever, on the state of the individual’s biological terrain. Bacteria, viruses, fungi, and other microbial life can only thrive if given the right environment in which to thrive – just as tomatoes, say, will only thrive when grown in the right soil under the right conditions.

The terrain is everything.

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Fat Is Not the Villain

knife and fork For decades, dietary fat has been portrayed as a villain. And for decades, that hypothesis has been challenged.

Now, recent evidence lends even more weight to the notion that sugars and refined carbs are the real demons fueling all manner of chronic disease. And more folks are beginning to pay attention.

In the article below, from the Orthomolecular Medicine News Service, Dr. Damien Downing discusses this important, imminent change to the old standard dietary advice.


Fat Is My Friend

Commentary by Damien Downing, MBBS

Throughout 2017 I kept saying “This looks like the year that the whole fat-cholesterol-heart disease hypothesis falls apart.” Well for once it looks like I was right. Today (I write on Jan 1st 2018) the annual review from Diabetes.co.uk carries 3 game-changing headlines from the past year:

  • “Saturated fat myth challenged”
  • “High carb diet ‘increases heart risks’”
  • “Eating low fat could increase early death risk”

Let’s look at the history. (Flashback effects, please.)

Interior: a scientific laboratory at Oxford University, 1956
Eccentric British scientist Professor Hugh MacDonald Sinclair is doing something with a test tube. This is a man who lived on a complete Inuit diet (no plants, no land animals) for 3 months and said it was fine, except that because of the anticoagulant effect: “When I prune the roses my boots fill up with blood.”

Professor Sinclair:
We were fortunate in having Dr. Ancel Keys recently to work with us and I had been impressed in general with his belief that total dietary fat, of whatever kind, was related to atheroma. Since then I have come to realize that Keys’s hypothesis is not correct: what matters in atheroma is, I believe, the amount and structure of the dietary fatty acids.

Sinclair actually wrote that in a letter to the Lancet (1), which was described at the time as a professional suicide note – and so it proved; he lost his job and his laboratory soon after. Mind you, as he later explained, that was exactly 10 years after Oxford University’s medical advisers had reported that a generous offer from the recently established Wellcome Trust…to establish a Wellcome Institute of Human Nutrition should be refused because; ‘in 10 years’ time there will be no human nutritional problems to work on.’

Honestly, do you laugh or cry?

Sinclair described his own theory on lipids simply:

The causes of death that have increased most in recent years are lung cancer, coronary thrombosis, and leukemia; I believe that in all three groups deficiency of EFA (Essential Fatty Acid) may be important.

Now, six decades later, researchers are finally demonstrating that he was right. What kept them?

Keys and Fats

Apparently Ancel Keys didn’t like the weather in Britain, nor his job of lecturing undergraduates, and he soon escaped to southern Italy, where he later built a villa on the proceeds of a couple of diet books. He continued to develop his theory on fats, and in 1978 first published the now-infamous Seven Countries Study (2). This showed that there was an association between high cholesterol and risk of cardiovascular disease, but made the fundamental error of assuming that association meant causation.

The Seven Countries Study sparked a vigorous debate about “causal inference” and led to the guidelines that in Britain we know as the Bradford-Hill criteria (3), although in the USA they are rightly attributed to the Surgeon General’s report on Smoking and Health of 1964 (4), which used them to nail down that smoking-and-cancer causation once and for all.

Too late to catch Ancel out, though – the fat and heart hypothesis caught on and led to 50 years and a multi-billion dollar industry of low-fat food – and to massive increases in obesity, diabetes, heart disease, cancer….

Not to mention statins of course – a $30 billion turnover per annum industry, last time I checked. No wonder Sir Rory Collins of the Cholesterol Treatment Trials (CTT) Collaboration (also at Oxford Uni) has been fighting a rearguard action for years now against, well, anybody who can think, really. He furiously attacked the BMJ (5) for publishing a paper which slightly exaggerated the 17% rate of side-effects in people taking statins into “nearly 20%”, and claimed it would cost lives (6). When asked to show the raw data on side effects he said he couldn’t because it belonged to the Pharma companies who funded the studies. (The dog ate my homework.)

Statins and Stats

One of the good guys in this is Uffe Ravnskov in Sweden, who has been challenging and questioning the fat-heart hypothesis for years. He co-authored a great paper in 2015 called How statistical deception created the appearance that statins are safe and effective.(7)

How did they do that? Using one of the oldest fairground statistical tricks in the book – confusing the difference between relative and absolute risk. This paper explains:

Consider a 5-year trial that includes 2000 healthy, middle-aged men. The aim of the trial is to see if a statin can prevent heart disease. Half of the participants are administered the statin and the other half a placebo. In most clinical trials, we find that during a period of 5 years about 2% of all healthy, middle-aged men experience a nonfatal myocardial infarction (MI). Consequently, at the end of our hypothetical trial, 2% of the placebo-treated men and 1% of the statin-treated men suffered an MI. Statin treatment, therefore, has been of benefit to 1% of the treated participants.

Thus, the Absolute Risk Reduction, which quantifies how effective a treatment is on the population at risk, was one percentage point. When it comes to presenting the findings of this hypothetical trial…using Relative Risk Reduction the directors can state that statin treatment reduced the incidence of heart disease by 50%, because 1 is 50% of 2.

A better, less fudge-able way of looking at the figures is using NNT – the Number Needed to Treat in order to benefit one person. In this example, you would need to treat 100 men with statins to prevent heart attack in one. Thennt.com is a great website and what it actually says right now about statins (in persons without known heart disease) is (8):

None were helped (life saved)
1 in 104 were helped (preventing heart attack)
1 in 154 were helped (preventing stroke)
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

It’s not great, is it? How could we all get it so wrong? I blame Ancel Keys (and the weather in Oxford – though it’s not that bad, honestly). And the food and pharmaceutical industries, for whom it’s been far from wrong; sell them junk food that makes them fat and ill, then sell them drugs that don’t make them much better, and just keep on doing it year after year.

I do blame Ancel Keys, because the other big study he was involved with was the Minnesota Coronary Experiment (1968-73), on which he was co-principal investigator. This actually showed that lowering cholesterol from the study average of 208 mg/dL to 178 mg/dL (US units) or 5.4 mmol/L to 4.6 mmol/L (UK units) will increase your risk of death by 35%. Keys must have known this in 1973, but he/they never published it. It took a re-analysis in 2016 (9) to figure it out.

Meanwhile, back at the 3 headlines:

The saturated fat myth
The first of these news items – Saturated fat myth challenged – reports on an April 25, 2017 editorial (10) in the British Journal of Sports Medicine (no idea why that journal, but it’s part of the BMJ group – the same one attacked by Rory Collins so vigorously):

Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions.

Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong. A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults.

The landmark systematic review referred to is the PURE study (11).

Take-home message? It’s in the title: Saturated fat does not clog the arteries. So tell me, did you read about that in the papers or online? It hasn’t exactly set the world on fire. I wonder why that is.

I have to add a small qualifier here, or people will challenge me with papers like this one (12) which does show a small decrease in coronary heart disease, with decreasing sat fat intake (18 percent relative risk, which means an absolute risk reduction of 1 in 1000 per person per year). This is true, but it’s not as big a story as the harm done by too much carbs.

High carb diet increases risk
The second one – High carb diet ‘increases heart risks’ – reports how leading cardiologist and former President of the World Heart Federation Dr Salim Yusuf has publicly stated, in a lecture at a major cardiology conference, that increased intake of carbohydrate is harmful.

Key quotes:

Some fats are good, some fats may be neutral but it is carbohydrate that is the worst thing.

* * *

Absolutely no evidence that low-fat milk is better for you.

* * *

If you look at dairy sources of fat, it is protective. If you look at meat sources of saturated fats, it is neutral and if you look at white meat, this is chicken and fish, there’s a trend toward benefit.

Low fat is risky
The final headline – Eating low fat could increase early death risk – also refers to the mega PURE study (135,000 people, 18 countries, 7 years follow-up). A major report appeared in the Lancet on August 29, 2017 (11): Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.

The stated conclusion was

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.


So it’s not just me, or “lunatic charlatans” like me, saying it: it’s official now. Sugar is the Devil, and Fat is our Friend. But remember, Sinclair was right – it’s not just that we all eat too much carbs, we also eat too little fat and oil. Way too little. In that Lancet letter he said “there is an enormous increase in permeability of the skin in EFA (Essential Fatty Acid) deficiency” – and capillary, and blood-brain barrier, obviously. We leak essentials out, and toxins in, triggering inflammation that we have leaked the resources to deal with. Eating fat doesn’t make you fat — it is the excess sugar and carbohydrate content in the modern diet, in the absence of adequate doses of nutrients, that causes fat buildup and leads to inflammation, metabolic syndrome, and cardiovascular disease. [13,14]

Seriously, we were built to be oil-fueled, not carb-burning. We talk about living off the fat of the land, not the sugar.

Was that really Santa Claus in the red outfit? Could it have been something from the Dark Side?

Dr. Damien Downing, who is almost certainly not from the Dark Side, practices nutritional and environmental medicine. He was co-founder of the British Society for Nutritional Medicine, and is the current president of the British Society for Ecological Medicine. Dr. Downing is author of The Vitamin Cure for Allergies and coauthor of The Vitamin Cure for Digestive Problems.


  1. Sinclair HM. Deficiencies of essential fatty acids and atherosclerosis, etcetera. Lancet 1:381-3, 1956
  2. Ancel Keys (ed). Seven Countries: A multivariate analysis of death and coronary heart disease, 1980. Cambridge, Mass.: Harvard University Press. ISBN 0-674-80237-3.
  3. Bradford-Hill, A., 1965. The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine, 58, pp.295-300. http://ift.tt/2ErRcz8
  4. US Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Public Health Service Publication No. 1103, 1964. http://ift.tt/2shrvwq
  5. http://ift.tt/2hya5lf , accessed 2018-01-05
  6. Doctors’ fears over statins may cost lives, says top medical researcher. Guardian.com, 21 march 2014 (accessed 2018-01-05) http://ift.tt/290IXXU
  7. Diamond, D.M. & Ravnskov, U., 2015. How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. Expert Rev. Clin. Pharmacol, 8(2), pp.201-210. http://ift.tt/291bVv1
  8. http://www.thennt.com/, accessed 2018-01-05
  9. Ramsden CE, Zamora D, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) BMJ 2016;353:i1246. http://ift.tt/2wcJtAQ
  10. Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. BJSM 2017: 51. 15; 1111-1113. http://ift.tt/2Enn8VA
  11. Dehghan M et al [Hundreds of authors] Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050-62. http://ift.tt/2x9syj0
  12. Zong, G. et al., 2016. Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. Bmj, 355(i5796). Available at: http://ift.tt/2Ennb3I
  13. Campbell R. Sugar Fraud. http://ift.tt/2sdk89f
  14. Smith RG. Toxic Sugar. http://ift.tt/2Eqs1gg

You can subscribe to the OMNS free of charge at http://orthomolecular.org/subscribe.html. To view previous articles, visit their archive at http://orthomolecular.org/resources/omns/index.shtml.

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So About Those New Blood Pressure Guidelines…

blood pressure dialYou’ve probably heard the one about the change in blood pressure guidelines. It was issued late last year by the American Heart Association (AHA) and the American College of Cardiology (AAC), and it garnered a lot of media attention. A lot.

Suddenly, millions of Americans became newly eligible for drugs to get their BP below the new magical number of 120/80.

Just as with lowered blood sugar thresholds for diabetes (or, ‘pre-diabetes’), and lower bone density thresholds for osteoporosis (or, ‘osteopenia’), the new ACC/AHA guidelines qualify millions of us for a ‘disease‘ we apparently did not have the day before the guidelines were released.

But what didn’t get so much attention is that large segments of the medical community disagreed with the revised guidelines.

The American Academy of Family Physicians (AAFP), for instance, refused to accept them. This organization of roughly 130,000 physicians expressed concern about how much weight was given to a single problematic study, as well as potential conflicts of interest.

More, their own reviews with the American College of Physicians (ACP) showed that while “there might be a small benefit of lower treatment targets in reducing cardiovascular events,”

no benefit was observed in all-cause mortality, cardiovascular disease mortality, myocardial infarction or renal events. Therefore, the AAFP and ACP recommended considering treatment to lower targets for some patients in the context of shared decision-making.

“Family physicians approach hypertension treatment on an individualized basis, taking into account patients’ histories, risk factors, preferences and resources,” AAFP President Michael Munger, M.D., told AAFP News. “We will maintain making informed decisions with patients while considering potential benefits and harms.”

Similarly, a recent commentary in the New England Journal of Medicine argued against a one-size-fits-all approach, as though a single health measure could ever be appropriate for all patients; as though the blood pressure goal of a 30-year old should be the same as that of an 80-year old. Such guidelines, they said, are “problematic.”

Some people with blood pressures of 130 to 139/80 to 89 mm Hg who are at higher cardiovascular risk may benefit from earlier intervention, but though such a broad-brush approach may be fine from a public health perspective, it could overburden our primary care physician workforce. Proper blood-pressure measurement is critical but time consuming. The unintended consequence may be that many people, now labeled as patients with hypertension, receive pharmacologic therapy that’s unlikely to provide benefit given their low absolute risk, and they may therefore experience unnecessary adverse events.

Dr.Kenny Lin of Georgetown University would seem to agree.

There’s some point where lower is not better, and I think we’re probably getting close to that point…. If you’re going to make something a ‘disease’ you better have the evidence to support that, and you better have something significant to offer the patient that translates into quality of life. If my patients hit a blood pressure of 130/80 I’m already talking to them about lifestyle changes. So how does redefining this as a ‘disease’ — the new hypertension — really help them? I don’t think we should be labeling people as hypertensive — or even pre-hypertensive — unless the evidence is strong that in doing so, and treating accordingly, we’re going to truly make a difference. In this case, I don’t think we have that evidence.

The situation with these guidelines offers a stark reminder of why individualized medicine matters so much.

You are a person. Blood pressure is just one piece of your total health story – just as root canal teeth, cavitations, or amalgams are just one piece. Each part of your current health status needs to be seen in the context of your total health story – all the challenges you may be facing, all the qualities that are in your favor.

The big picture matters.

PS: Dr. Brownstein offers another great critique of the creation of new patients through ever-changing health guidelines. We encourage you to hop over to his blog and check it out.

Image by Joey Parsons, via Flickr

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