Tiny seeds of the flax plant, high in fiber and omega-3s, produce big drops in blood pressure and may prevent heart attacks and stroke, according to new research.

In the study, people with clogged leg arteries taking flaxseed supplements reduced their top blood pressure (systolic) reading by 10 points and the bottom (diastolic) by seven after six months. This change is the largest decrease in blood pressure ever shown by a dietary intervention, says Dr. Delfin Rodriquez of Cuba who presented the results at the American Heart Association 2012 Scientific Sessions.

The promising findings suggest that people with hypertension turn to the safe and inexpensive dietary supplement before starting drug therapy.

Flaxseed Slashes Blood Pressure The Saturday Evening Post

Millions of Americans are living with an overactive or underactive thyroid, according to the American Association of Clinical Endocrinologists (AACE). Unfortunately, many go undiagnosed until something goes terrible awry, at times wreaking havoc on one’s quality of life. In this Web exclusive interview, we offer information about diagnosing and treating thyroid disease from Dr. Jeffrey R. Garber, immediate past president of the AACE, chief of endocrinology at Harvard Vanguard Medical Associates, and associate professor of medicine at Harvard Medical School to accompany the Jul/Aug 2010 Post Investigates feature: “Thyroid: A Secret Culprit,” by Dr. Mehmet Oz.

Dr. Jeffrey GarberCourtesy AACE

Post: Who should be tested? Should it be part of a routine annual physical?
Dr. Garber: Thyroid testing was not part of President Bush Sr.’s annual physical. If you remember, his hyperthyroidism was diagnosed after he had problems breathing while jogging. Today, the American Thyroid Association recommends screening every five years, starting at age 35. Universal screening is not felt to be cost effective, but most experts would recommend testing women over 60, those with symptoms, and then targeted subgroups such as smokers or those with a personal or family history that includes autoimmune conditions.

Having symptoms of thyroid disease does not mean one has it. Making a diagnosis solely based on symptoms can be inordinately difficult. However, the diagnosis becomes straightforward by testing for it. People should target themselves based on symptoms. If you are aware of thyroid conditions and believe you are experiencing enough symptoms, it is easy for a doctor to justify testing.

In addition, doctors should target patients on the basis of other risk factors. For example, I would check someone who comes to my office saying “I feel perfectly well” if I felt a lump in their thyroid or there was a compelling history. Thyroid disease is very easy to overlook.

Post: Hypothyroidism seems to be frequently in the headlines. Any reason why?
Dr. Garber: I think we live in an era in which people are seeking holistic approaches—sometimes in a good sense, and sometimes in a way that they can get exploited, in my view. Thyroid disease lends itself to an approach by some practitioners that is generally symptom-based. The idea that a constellation of symptoms dictates a diagnosis, despite the lack of conventional proof, is where the tension comes in.

“What Your Doctor Won’t Tell You” is a great headline. What people don’t read about is the downside of taking thyroid hormone products. It is not a free ride. My major concern is the risk of over-treatment. The second concern is that by treating symptoms without a certain diagnosis, a doctor will overlook another important fact or condition. Hypothyroidism can masquerade as depression, but depression can masquerade as hypothyroidism, for example.

Then there is the cost of medicine and the cost of testing. I would never argue with someone who says they feel a certain way, but the data doesn’t support that treating marginal disease necessarily leads to benefit. If a person has borderline thyroid stimulating hormone (TSH) levels and no symptoms or compelling medical reason, such as planning a pregnancy, treatment may not be called for. If people are borderline and symptomatic, of course, try to treat it. But give it a limited time. Don’t just commit people to medicine and put them at risk for being over-medicated or being subject to costs and missing other possible reasons for what they are feeling. Fatigue is the 21st century complaint. We’ve got a lot of reasons to be tired besides our thyroid.

Thyroid drug analogs, or copies of thyroid hormone, are also being mentioned in the press. As recently as March 11, 2010, the New England Journal of Medicine featured a follow-up article on the subject. The concept is to design a thyroid hormone analog that has the benefits of, say, inducing weight loss or lowering cholesterol, but not the drawback of stimulating the heart.

Post: How far away is this concept from actual reality?
Dr. Garber: It was pretty far away until March 11. These researchers demonstrated that one particular analog did not affect the heart, and did lower cholesterol.

Another drug analog was studied in heart disease patients. Many lost weight, but 60 percent to 70 percent of the patients dropped out of the study because they felt lousy. Since the study was not designed to analyze weight loss, researchers couldn’t do a good job of finding out whether people ate less because they had a lousy appetite, which is a terrible way to lose weight, as opposed to eating less because their appetite isn’t as high.

Post: Is there a better test for thyroid hormone levels on the horizon?
Dr. Garber: Not at present. The current discussion is whether we need to take a new look at what is considered the normal range for TSH levels, depending on the situation. Data show that some TSH levels we now consider elevated—in the elderly—may not represent hypothyroidism. And, on the other hand, new guidelines are definitely going to set a lower TSH of approximately 2.5 as the upper normal in the first trimester of pregnancy.

Post: What is the link between thyroid hormone and heart attack and heart disease?
Dr. Garber: If you are profoundly hypothyroid, you often become hypertensive and hypercholesterolemic. As a result, your vessels become constricted as well. Hyperthyroidism affects the heart mostly through rhythm disturbances characterized by fast heart rates including atrial fibrillation and sinus tachycardia.

Post: Are there other new developments you would like to mention?
Dr. Garber: A recent discovery suggests there is a subgroup of people with a certain genotype that are more likely to feel better on a T3-T4 combination therapy. We are not at the point that we are going to start doing genetic testing on people, but the study found that certain people with a certain genotype were more likely to feel better on combination therapy. From a hot, new, and conceptual point of view, the discovery may provide yet another role for genetic testing.

Resources:

Click here for more information from the American Association of Clinical Endocrinologists and to find an endocrinologist near you.

Click here for an excerpt from “The Harvard Medical School Guide to Overcoming Thyroid Problems” by Dr. Jeffrey R. Garber, published by McGraw-Hill.

Thyroid Disease: A Post Web Exclusive The Saturday Evening Post

A: Doctors commonly prescribe five types of medicines that lower high blood pressure in different ways. In almost all patients, some combination of drugs (usually at least two, and sometimes more) are tolerated and are effective. As I mentioned in my March 2010 column, a new procedure involves threading a catheter into the renal artery and burning key nerves in the wall of the artery that help regulate blood pressure. Ask your cardiologist about it.

Help for Hypertension The Saturday Evening Post

A: Your husband isn’t alone—most people with high blood pressure have “essential” hypertension, which means that there is no identifiable cause for it. One promising experimental therapy involves threading a catheter into the artery that provides blood to the kidney, and then delivering electricity via electrodes at the end of the catheter to “burn” certain nerves in the arterial wall that play a key role 
in the development of hypertension, 
an approach that may restore normal blood pressure without using drugs.



Causes of High Blood Pressure The Saturday Evening Post

When you are at rest in a warm bed, arteries dilate and blood pressure tends to be low. When you stand up, your body elevates blood pressure to be sure your brain is perfused so you don’t black out. Getting out of bed in a cold room could cause an increase in pressure. How high does it get when you stand up? Does it then return to normal? Is your blood pressure cuff accurate? Discuss these questions with your doctor.

High BP in A.M. The Saturday Evening Post

Lisinopril is a generic drug that is FDA approved for two brand name products—Prinivil and Zestril. It may be prescribed alone or with other medicines to treat high blood pressure and heart failure. Lisinopril may also be given to people who have suffered a heart attack. Left untreated, high blood pressure may damage the heart, kidneys, and eyes. Taking lisinopril helps relax the blood vessels and reduce the risk of heart attack and stroke.

Lisinopril is Good for the Heart The Saturday Evening Post

You have certainly been through a bunch of medications, but there are others you have not tried. For example, carvedilol is a unique type of beta blocker that has alpha and beta blocking actions. Pure alpha blockers like Cardura (doxazosin) might work. Other diuretics might be effective, as can combinations of drugs that have different actions. Finally, you don’t mention lifestyle modifications and they should be considered. These can include a low-salt diet, potassium supplements, moderate alcohol consumption, weight loss, exercise, and relaxation techniques. Check with your cardiologist or hypertensive expert.

Systolic Hypertension The Saturday Evening Post

No genetic marker of which I am aware has yet been identified. Diastolic heart failure and congestive heart disease are linked to high blood pressure, so control of your BP would seem to be the most important thing you can do. Genetics load the gun, but environment pulls the trigger. Therefore, you can escape the bullet by changing the environment with adequate BP control.

Dodging DNA Destiny The Saturday Evening Post

Data show that measurements recorded at the same times and place each day are often lower than readings taken in the doctor’s office and closer to the average BP recorded by 24-hour ambulatory monitoring, which is considered the gold standard. Home blood pressure monitoring also helps distinguish between “white coat” (elevated readings in the doctor’s office only), “masked” (elevated readings at home only), and sustained hypertension.

An expert group of cardiovascular physicians and nurses recently published a “Call to Action” for using home blood pressure monitors, including an appeal for insurance providers to cover the cost of the devices. The American Heart Association offers these tips for getting reliable BP readings at home:

• Your healthcare professional should help you select a cuff-style upper arm monitor, make sure it’s accurate, and show you how to use it.
• Cuff size is important. To get the right one, measure around your upper arm and compare to the cuff size indicated on the monitor’s packaging.
• Sit with your back straight and supported on a high-backed dining chair, rather than a sofa. Both feet should be flat on the floor, with arm resting on a flat surface and the upper arm at heart level.
• Each time you measure, take two to three readings one minute apart. Record all the results.

To download and print a blood pressure log from the American Heart Association, visit their website americanheart.org and search for “blood pressure tracker.” For a paper version to copy as needed, send a self-addressed, stamped envelope to BP Tracker, 1100 Waterway Blvd., Indianapolis, IN 46202.

Blood Pressure Monitors Come Home The Saturday Evening Post