#442: Dr. Nina Radford reviews the ENCORE Study and DASH Diet

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Dr. Nina Radford, Cooper Clinic director of cardiovascular medicine is interviewed by Todd Whitthorne, and gives her thoughts on the ENCORE study as discussed at the recent American College of Cardiology conference.

The ENCORE trial looked lifestyle interventions for lowering blood pressure. It’s been well described that a diet called the DASH Diet has been associated with reductions in blood pressure. The diet heavily emphasizes fruits and vegetables and has been very effective at lower blood pressure by 10- to 15 points, as much blood pressure lowering effect as many medications offer.

What isn’t known is what happens when the DASH Diet is combined with exercise and caloric restriction for weight loss. In the ENCORE study, healthy overweight individuals with slightly elevated blood pressure were put into one of three groups:

· Group 1 – DASH Diet only

· Group 2 – DASH Diet plus behavioral weight management (including supervised exercise three times weekly)

· Group 3 – Usual Care

Researchers found that the participants who followed the DASH diet and also received behavioral weight management support had the best results in managing their blood pressure.

The DASH Diet recommends 9- to 11 servings of fruits and vegetables daily. Dr. Radford urges us to not get overwhelmed by this recommendation. Our serving sizes are simply out of whack. One-half cup orange juice (4 ounces), an amount most of us would find piddling in our glass, counts as one fruit. And a couple of slices of tomatoes on your sandwich at lunch is going to be vegetable serving. We really don’t have to eat a giant vat of fruits and vegetables. At lunch, make sure the sandwich has lettuce and tomato, and substitute fruit instead of chips. The biggest obstacle in getting the recommended servings for most people is planning: we’re going to have to go to the grocery store of farmers market and make sure we have the fruits and vegetables available to us. And, when we get home we need to clean and package them up for serving so when we go to reach for a snack or make a meal, including the fruits and vegetables is easy.

Dr. Radford also briefly discusses salt intake for the average person who has slightly elevated blood pressure. In general, reducing the amount of salt we use has less impact on our blood pressure then increasing our intake of fruits and vegetables. This said, Dr. Radford suggests we start a salt reduction plan by eliminating the salt shaker from our dinner table.

The Poly Pill was also discussed that the American College of Cardiology Conference. A Poly Pill combines blood pressure medication, one cholesterol lowering medication, and low-dose aspirin combined into one product. In a large test in India, researchers found the Poly Pill performed well – it lowered blood pressure, reduced cholesterol, and made the blood less sticky. However, this “one size fits all” pill also has a downside. Researchers found that approximately one third of the participants stopped taking the medication after three months because of side effects.

Dr. Radford says there are seven or eight different classes of blood pressure drugs. Your physician picks the one they believe will work best given your specific health history and condition. The Poly Pill takes this individualization out of the picture. But, for the folks who can tolerate the Poly Pill, it’s a great possible solution to blood pressure control.

Jill Turner is VP of Operations for Cooper Concepts, the company that markets Cooper Complete nutritional supplements. Jill regularly contributes information to the Cooper blog. Email jsturner@cooperwellness.com or call 972-560-3262 with your questions and comments.

Reference Information

American College of Cardiology

http://www.acc.org/

ENCORE Study

http://www.cardiosource.com/rapidnewssummaries/summary.asp?SumID=414

Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort

http://www.bmj.com/cgi/content/full/338/mar05_2/b688

DASH Eating Plan – Your Guide to Lowering Your Blood Pressure With DASH

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

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