Aggressively fight high blood pressure
Based on the BENEDICT study, Ruggenenti and his colleagues seek to convey three other messages: “First, early and effective treatment of hypertension is of paramount importance in people with diabetes.
Second, ACE inhibitors should be the treatment of choice to reduce blood pressure in these patients, even when they have no evidence of kidney or cardiovascular disease,” he says.
The third message? “The general practitioner should be aware of these recommendations, since they are treating the large majority of patients with diabetes but no evidence of kidney disease,” says Ruggenenti.
Kroger adds one caveat: “I think we all agree consumers should accept the notion that if they have diabetes they need to be on something to protect their kidneys, even if they have normal blood pressure.” The jury is still out as to whether ACE inhibitors or another type of drug called angiotensin receptor blockers should be the treatment of choice.
Learning from plants
Meantime evidence keeps accumulating that heart medications might be avoided, or at least minimized, if we choose our diet wisely. “The same oxygen that provides energy can have a bad, reactive form called free radicals. They attack healthy cells, creating oxidative stress,” says Kalidas Shetty, Ph.D., professor of food biotechnology at the University of Massachusetts, Amherst.
Shetty isn’t alone in his thinking. “There is a fair amount of agreement among physicians that antioxidants, which scavenge free radicals, fight heart disease,” says Kroger.
Shetty and people like him are seeking antioxidant protection from plants. “Plants are exposed to this same oxidative stress, but have a variety of compounds that protect them, using four methods,” he says.
“One method is targeting and correcting a specific defect like ACE inhibitors do. But that’s after the damage has been done,” says Shetty.
Instead it seems plants use three other techniques for preventing oxidative stress and the right diet might help us do the same. “First, directly quenching the free radicals. Second, activating or enhancing the protective antioxidant enzymes already in our system. Third, switching the energy we take in from carbohydrates and fats to a lower oxidative pressure, so we get our energy while producing fewer damaging free radicals,” says Shetty.
Try yogurt first
Now Shetty’s team has shown that chemicals in certain foods block the same enzyme as ACE inhibitors. Specifically they point to soy yogurt and dark berries, with soy blueberry yogurt offering the most antioxidant effect.
He also recommends more fibers and legumes. “My mother-in-law is a Type II diabetic; we cut down on her white rice and added a produce called mung beans. She’s down from three pills daily to a 1/2 tablet,” says Shetty.
“Berries and yogurts are not alone. Wine is another option. In fact, if you look at his recommendations, what Shetty is really advocating is the Mediterranean diet; high in fruit, veggies, and monounsaturated fats, low in simple carbohydrates,” says Kroger.
Don’t forget another benefit of such a diet. “If you are taking in lots of berries and plain yogurt (not the custard type with tons of sugar), you aren’t taking in lots of cake and French fries,” Kroger adds.
BENEDICT and food
“I think it would be great to do a combination of the BENEDICT study and ours to see if we could get ACE inhibitors from foods—and which foods. I think we will see that crossing of paths in about four or five years,” says Shetty.
In some ways that has already happened. “Our participants were also on a Mediterranen diet, including wine,” says Ruggenenti. He emphasizes that to him, a healthy diet should be an addition to ACE inhibitors for people with hypertension and diabetes—not an alternative to the drugs.
For Shetty, the bottom line is prevention. “How can we not only live longer, but do so without living sicker, with problems like high cholesterol and hypertension?” he asks.
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