Interesting that including health in social settings might influence we highly social humans. Seems somewhat obvious. In the past many of us attended church or perhaps met at the pub or similar places where people gather and often converse afterwards. In our modern age with many, many distractions to our attention we don't gather much anymore socially. The politicians and societies have managed to well divide us back into tribes that were reduced to build communities. We suppress our words to avoid any offense, guarding ourselves and then become isolated with hardened opinions. These thing alone are not likely to benefit personal nor societies' health. No answers from me, only concerns about a trend of modernity.
"we currently lack substantial data about how to do it effectively."
And lacking that data we throw up our hands. WEll, to be honest, throwing up our hands would be a real start. Admit we do[nt know what we are about much of the time. Get to know our patients better. Drop the paternalism. and so forth.
Now we need to get the Governments involved to spend billions of $$ designing programs
and more billions of $$$ implementing them.
I am just .... kidding. sort of
There are insurance policies, like mine, where there is the option to be bothered, pestered, reminded via phone call or email about their personal findings according to their records, and advice for you, or pestering. I have turned that option off bc I do not need that.
Appreciate the sincerity of this post, and the emphasis on understanding each patient's background and baggage.
Would just point out that there is a possible fallacy in the post regarding salt intake..
Most of us have been spun the reduce salt to reduce blood pressure mantra by doctors. Just as we are urged to get flu shots each year. Most of us also know that the flu shots are overhyped and don't provide much benefit if any. Cochrane Org says this clearly.
As for salt reduction, the story may be similar. Cochrane has also looked into this over the years. Their most recent analyis of high quality studies (evidence to April 2018) indicates that for people with elevated blood pressure a reduced salt diet provides just a modicum of blood pressure reduction.
But Cochrane also points out that the benefits regarding mortality are unclear:
"...several studies have shown that salt reduction activates the salt conserving hormonal system (renin and aldosterone), the stress hormones (adrenalin and noradrenalin) and increases fatty substances (cholesterol and triglyceride) in the blood. Finally, recent observations in general populations indicate that a low salt intake is associated with increased mortality."
The moral here seems to be, yes you should consider reducing salt intake if your doctor recommends it. But more importantly, both you and your doctor should work to boost you in all the other things that could improve your personal health profile.
You raised an interesting point, albeit tangent to the main focus of the post.
The Changhzi Reporter Trial was about the effects of using salt substitutes, while the Cochrane review assessed the effects of low sodium diet (low salt intake), which are not perfectly equivalent.
About the evidence underlying the use of salt substitutes, a recent meta-analysis (https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332) of 21 trials (32000 patients) showed the positive effects of salt substitutes on blood pressure reduction and clinical outcomes.
The meta-analysis provides evidence in favor of the use of salt substitutes in specific settings, but does not solve the uncertainty (also raised by the Cochrane review) surrounding the recommendation for a low sodium diet.
Thanks for your reply and the additional info. From what I understand, the high potassium content of the salt substitute was a key factor in these trials, so they might also be construed as research into the benefits of potassium.
I know that in one such major trial in China (https://www.nejm.org/doi/full/10.1056/nejmoa2105675) the participants were patients who had already experienced a stroke or who were elderly and had blood pressure problems. While the results regarding reduction in morbidity were clearly positive, they did not seem really compelling. Agree with you that some uncertainty regarding salt persists and that further research would be helpful and very welcome..
The community social groups are a good idea. I wouldn't start by reducing salt though. The food pyramid and government guidelines are as corrupt as everything that led up to covid guidelines. Try the Low Carb Down Under channel on Youtube, eat real food only, like a good steak, and make sure to include salt. Your body will reduce any unnecessary salt, but it can't produce it when not consumed. And you need it for healthy body processes. You might want to add additional magnesium and potassium as well.
Agreed. I think salt gets a bad rap, mostly blamed for what sugar and other processed carbs do (causing insulin resistance which results in higher blood pressure).
While I didn't appreciate that example, I think the overall message of the article was good.
my husband read the ... south beach diet? or something like that, I have to check the book shelf (when I get off of this tread mill) He follows that pretty well.
I try my best to keep it healthy. I do not enjoy cooking (I used to, but I am taking care of my 98 year old daddy almost daily, and that is tiring, plus dealing with some other "whiny problems"), but I try.
Aug 29, 2022·edited Aug 29, 2022Liked by Camilla Alderighi
as long as it is not the US government or any money grubbing entity pushing an agenda
I would love church groups to get involved in self care.
Oh yeah, there used to be those groups in many churches, Week night meetings about weight loss, and quitting annoying bad habits like smoking, or even just being generally grumpy. I know my church has an evening for "grieving", it is very fulfilling to meet others that struggle. I would imagine groups led by an excellent medical practitioner, non judgemental just offering sound encouragement for improving health and addressing high blood pressure.
I love the idea of using culture and social groups to promote health! It’s the biggest reason I support any kind of group work with any chronic illness where our behavior makes a difference.
Interesting that including health in social settings might influence we highly social humans. Seems somewhat obvious. In the past many of us attended church or perhaps met at the pub or similar places where people gather and often converse afterwards. In our modern age with many, many distractions to our attention we don't gather much anymore socially. The politicians and societies have managed to well divide us back into tribes that were reduced to build communities. We suppress our words to avoid any offense, guarding ourselves and then become isolated with hardened opinions. These thing alone are not likely to benefit personal nor societies' health. No answers from me, only concerns about a trend of modernity.
"As a starting point, health interventions could be thought of as fitting gently into the social contexts of their recipients." Yes, love this.
"we currently lack substantial data about how to do it effectively."
And lacking that data we throw up our hands. WEll, to be honest, throwing up our hands would be a real start. Admit we do[nt know what we are about much of the time. Get to know our patients better. Drop the paternalism. and so forth.
this is excellent.
Now we need to get the Governments involved to spend billions of $$ designing programs
and more billions of $$$ implementing them.
I am just .... kidding. sort of
There are insurance policies, like mine, where there is the option to be bothered, pestered, reminded via phone call or email about their personal findings according to their records, and advice for you, or pestering. I have turned that option off bc I do not need that.
Appreciate the sincerity of this post, and the emphasis on understanding each patient's background and baggage.
Would just point out that there is a possible fallacy in the post regarding salt intake..
Most of us have been spun the reduce salt to reduce blood pressure mantra by doctors. Just as we are urged to get flu shots each year. Most of us also know that the flu shots are overhyped and don't provide much benefit if any. Cochrane Org says this clearly.
As for salt reduction, the story may be similar. Cochrane has also looked into this over the years. Their most recent analyis of high quality studies (evidence to April 2018) indicates that for people with elevated blood pressure a reduced salt diet provides just a modicum of blood pressure reduction.
But Cochrane also points out that the benefits regarding mortality are unclear:
"...several studies have shown that salt reduction activates the salt conserving hormonal system (renin and aldosterone), the stress hormones (adrenalin and noradrenalin) and increases fatty substances (cholesterol and triglyceride) in the blood. Finally, recent observations in general populations indicate that a low salt intake is associated with increased mortality."
The full Cochrane abstract is available here:
https://www.cochrane.org/CD004022/HTN_effect-low-salt-diet-blood-pressure-and-some-hormones-and-lipids-people-normal-and-elevated-blood
The moral here seems to be, yes you should consider reducing salt intake if your doctor recommends it. But more importantly, both you and your doctor should work to boost you in all the other things that could improve your personal health profile.
Thanks for your comment.
You raised an interesting point, albeit tangent to the main focus of the post.
The Changhzi Reporter Trial was about the effects of using salt substitutes, while the Cochrane review assessed the effects of low sodium diet (low salt intake), which are not perfectly equivalent.
About the evidence underlying the use of salt substitutes, a recent meta-analysis (https://heart.bmj.com/content/early/2022/07/21/heartjnl-2022-321332) of 21 trials (32000 patients) showed the positive effects of salt substitutes on blood pressure reduction and clinical outcomes.
The meta-analysis provides evidence in favor of the use of salt substitutes in specific settings, but does not solve the uncertainty (also raised by the Cochrane review) surrounding the recommendation for a low sodium diet.
Thanks for your reply and the additional info. From what I understand, the high potassium content of the salt substitute was a key factor in these trials, so they might also be construed as research into the benefits of potassium.
I know that in one such major trial in China (https://www.nejm.org/doi/full/10.1056/nejmoa2105675) the participants were patients who had already experienced a stroke or who were elderly and had blood pressure problems. While the results regarding reduction in morbidity were clearly positive, they did not seem really compelling. Agree with you that some uncertainty regarding salt persists and that further research would be helpful and very welcome..
The community social groups are a good idea. I wouldn't start by reducing salt though. The food pyramid and government guidelines are as corrupt as everything that led up to covid guidelines. Try the Low Carb Down Under channel on Youtube, eat real food only, like a good steak, and make sure to include salt. Your body will reduce any unnecessary salt, but it can't produce it when not consumed. And you need it for healthy body processes. You might want to add additional magnesium and potassium as well.
Agreed. I think salt gets a bad rap, mostly blamed for what sugar and other processed carbs do (causing insulin resistance which results in higher blood pressure).
While I didn't appreciate that example, I think the overall message of the article was good.
my husband read the ... south beach diet? or something like that, I have to check the book shelf (when I get off of this tread mill) He follows that pretty well.
I try my best to keep it healthy. I do not enjoy cooking (I used to, but I am taking care of my 98 year old daddy almost daily, and that is tiring, plus dealing with some other "whiny problems"), but I try.
Get the hell out of my barber shop!
as long as it is not the US government or any money grubbing entity pushing an agenda
I would love church groups to get involved in self care.
Oh yeah, there used to be those groups in many churches, Week night meetings about weight loss, and quitting annoying bad habits like smoking, or even just being generally grumpy. I know my church has an evening for "grieving", it is very fulfilling to meet others that struggle. I would imagine groups led by an excellent medical practitioner, non judgemental just offering sound encouragement for improving health and addressing high blood pressure.
I love the idea of using culture and social groups to promote health! It’s the biggest reason I support any kind of group work with any chronic illness where our behavior makes a difference.
It’s vital to meet people where they are and begin from there.
I’m so over “Public Health.”