One year on - take home message and TO DO !

[CherryAA]

Overall take home message - the doctor is right - these results are " exceptionally pleasing"

The thing which continue to puzzle me is why isn't my blood pressure getting better, I came off one drug, but two more to go and why is my uric acid so stubbornly high?

There is one further thing I've decided to explore as a result of thinking about this and that is whether there might be some kind of blockage in my carotid artery. It was something mentioned 20 years ago that I did nothing about . Maybe that is something else I was stupid not to follow up, maybe there is a small blockage and that's been contributing to my bp for years. I am going to have that checked out.


So to do list _

carry on doing what I'm doing 1

Ch3ck out carotid artery 3 tbs spoons apple cider vinegar 2 per day

eat macadamia, brazil nust, cauliflower

Take Vitamim D, K and magnesium

Reduce whisky intake

Keep salt and potassium as is

Lose 10-15 kg of weight


If anyone wants to check out their own figures and I've forgotten the measure and you don't recognise the range -


http://www.onlineconversion.com

or

unitslab.com can translate pretty much everything.

If no -one reads this I won't blame you ! - I will instead find it again in six months time and see if I managed to improve anything further!

 

[badcat]

I occasionally get gout in one of my big toes - Ive read several times that both fasting and LCHF can lead to increased uric acid and gout flares.
I cant remember the science of it ( just know that if i go too far with either fasting or the extremes of lchf my big toe soon lets me know).
Jason Fung has written about / acknowledged the link in his writings

 

[Brunneria]

Hi,

I am curious about my bp too. For all my low carbing and regular dog walks, my systolic has dropped beautifully, but my diastolic remains slightly higher than I would like, though still in the healthy range.

My blood pressure issues all happened last year, during which time I tried all sorts of things - salt, medication, increased exercise, yoga postures, more meditation... ended up that coffee was having the biggest impact driving mine up. As soon as I went totally tea and coffee free (even decaff had to go), my bp dropped beautifully. So worth checking various foods to see if intolerance has an impact.

(though if you do, give it time. my bp did not react like bg does to carbs. the effects took 5-10 hours to kick in, and persisted for around 3 days)

Also, interestingly, if (like me) your systolic and diastolic readings vary, you may find it interesting to read up on them separately. Only yesterday I was reading that one of the biggest causes of higher diastolic readings is obesity (that'll be me then) with a proportionate rise in the reading for every point of BMI above the healthy range.
http://onlinelibrary.wiley.com/doi/10.1038/oby.2000.32/full

 

[Bluetit1802]

@Brunneria

Have you seen this from the GP Handbook 2013

This trial, based on the UK General Practice Research Database (now called the Clinical Practice Research Datalink) followed over 125 000 people with newly diagnosed type 2 diabetes, about 10% of whom had established CVD when the diabetes was diagnosed. Follow-up was for a median of 3.5y, during which 20% of the cohort died(!) (BMJ 2012;345:e5567).

In those with diabetes: 1 Tight blood pressure control (<130/80) was not associated with improved survival when other risk factors were controlled for. 1 Low blood pressure was associated with an increased risk of death. The figures below are for those with CVD and diabetes, but are similar to those with diabetes without CVD. !

A systolic BP <110 was associated with an almost 3x increased risk of death compared with a systolic BP of 130–140 (HR 2.79, CI 1.74–4.48). ! A diastolic BP of 70 was associated with almost 2x increased risk of death compared with a diastolic BP of 80–84 (HR 1.89, CI 1.4–2.56). This fits with the results of the ACCORD trial (4700 patients with diabetes at high risk of CVD), which showed that aiming for a BP tighter than 130–140 did not reduce the risk of CV events over 5y (NEJM 2010;362:1575).

What do the guidelines say? NICE suggests target BP of <140/80. If renal, eye or CV damage: target is <130/80 (NICE 2009, CG 87). SIGN suggests target BP of <130/80 (SIGN 2010, 116). QOF incentivises us to aim for a BP below 140/80. What does this mean in practice?

1 Do not get the wrong message here! The studies are NOT saying that blood pressure control doesn’t matter: lots of evidence tells us that it does! 1 What these trials show is that really tight blood pressure control may be harmful (<110/70) and that aiming for blood pressures <130/80 may not be beneficial in diabetes, whether with or without CVD. 1 Given this, it seems reasonable to follow NICE guidance (which is the same as QOF) and aim for a BP target of systolic 130–140 and a diastolic of 80 but not much below. 1 Now we know what to aim for, we just have the challenging task of trying to reach these targets!!!

https://www.gp-update.co.uk/files/docs/GP_Update-Spring_2013_diabetes.pdf

 

[Brunneria]

Thanks @Bluetit1802
I hadn't seen that one. very interesting.

I have come across the idea that lowering to current NHS guidelines is excessive, and that 130-140 Systolic is fine - or rather there is no proven benefit of going lower.

The one thing that gives me pause in the extract you quote is that they quote the ACCORD study, which I view with deep scepticism, since one of the drugs used to control blood glucose in that study was later found to actually be contributing to CVD.

I think my interest in my diastolic bp is because most of my family all have naturally lowish bp, and have never had issues, even the T2s. Then there is me, with food intolerance that raise bp, and a mother who was hospitalised with high bp about 18 months ago - and the tablets they gave her to treat it sent her bp even higher. She was at 240/160 at one point. Fortunately they took her off the tablets and switched to a brand without the trigger ingredient, and her bp just gently dropped to normal.

 

[badcat]

Blood pressure readings can be very context specific too
Iv been diagnosd with severe white coat hypertension - basically means as soon as I go anywhere near a medic my blood pressure shoots through the roof and they can only get accurate readings by doing a 24 hour monitor.
My record high was 220/120 when it was taken in hospital out patients - the 24 hour monitor came out at 130 something over 71!
Last time I was in outpatients it came out at 162/91 - 24 hour came out 121/61 with diastolic dips into the 50s overnight so they had to decrease my bp meds. I read somewhere that over a third of people are over medicated because their doc has only used in surgery bp readings

 

[Bluetit1802]

I read somewhere that over a third of people are over medicated because their doc has only used in surgery bp readings

My GP said she mentally knocks 10 points off surgery BPs because of white coat syndrome.

 

[CherryAA]

Thanks for all your comments I take indapamide and olmotec for blood pressure. I also used to take bisoprolol but I came off that about 6 months ago.

Generally speaking my numbers are in the 130-140 / 76-84 range - which seems to fit quite nicely level with the NHS guidelines. The thing that has srprised me a little is that despite the large weight loss ( 27 kg) doesn't appear to have translated into any real improvement in blood pressure yet, - ( when I was on the bisoprolol as well I was in the 120/130/ 76-84 range). I am going to go get my carotid artery checked out - given that that contribute to blood pressure issues and it was something mentioned previously that I never followed through on - in my previous " head in the sand way "

 

[CherryAA]

Following on from the convo with @bluetit about Uric acid (BUN ) - turns out we were looking at different things (me Urea her BUN) . having looked at it again - I have realised something else about BUN.

Urea (BUN) - my range for that is 2.5-7.8 and the actual number is 4.0 - which is also a historic low for me after 12 months on LCHF .

The absolute measure is important - however the other thing to look at is your BUN to creatinine ratio both measured in mg/dL That ratio should be between 10 and 20 . Having now checked that mine is rather high at the moment being 22 - whereas it was below 20 up to and including diagnosis. It hit a high of 31 in December last year - 6 months into this diet .
my doctor SHOULD have been pointing out dehydration to me when he looked at these results - he didn't.

One of the things that this ratio signifies is how dehydrated you are . I am conscious that I used to drink unending supplies of tea with skimmed milk and now I have cut down on the skimmed milk, I forget to drink. I realised this a few months ago - and started to drink a bit more but clearly not enough . It may also be that it is this dehydration that is stopping the improvements in my overall blood pressure.

another "note to self " - DRINK MORE WATER.

 

[Kentoldlady1]

Well done on everything so far. You should be well chuffed!
May I ask how you take the vinegar? I have a bottle, had one sip and nearly upchucked. I know that you should just have it in a shot, so do you mix it with anything?

 

[Resurgam]

cherries are supposed to help with gout - I have them both fresh and frozen.

 

[CherryAA]

Well done on everything so far. You should be well chuffed!

May I ask how you take the vinegar? I have a bottle, had one sip and nearly upchucked. I know that you should just have it in a shot, so do you mix it with anything?

I generally try and add a tablespoon into a pint of water and glug that given I know I don't drink enough water either. Having said that today I've tried the swigging rout to get rid of it and you are right its disgusting. I also swigged some cod liver oil which is even worse. I finished that particular episode with a couple of slices of pickled beetroot, two onions pickled in balsamic vinegar and a tablespoon of the onion vinegar which might be a little sweet for the purpose but at least got rid of the disgusting taste of the other two. I doubt I am going to be kissing anyone anytime soon,but never let it be said that I do not embrace my theories with enthusiasm !

 

[Kentoldlady1]

I generally try and add a tablespoon into a pint of water and glug that given I know I don't drink enough water either. Having said that today I've tried the swigging rout to get rid of it and you are right its disgusting. I also swigged some cod liver oil which is even worse. I finished that particular episode with a couple of slices of pickled beetroot, two onions pickled in balsamic vinegar and a tablespoon of the onion vinegar which might be a little sweet for the purpose but at least got rid of the disgusting taste of the other two. I doubt I am going to be kissing anyone anytime soon,but never let it be said that I do not embrace my theories with enthusiasm !

Lol!!! My I just say thank you for testing all of the theories so that cowards like me dont have to!

 

[derry60]

Blood pressure readings can be very context specific too
Iv been diagnosd with severe white coat hypertension - basically means as soon as I go anywhere near a medic my blood pressure shoots through the roof and they can only get accurate readings by doing a 24 hour monitor.
My record high was 220/120 when it was taken in hospital out patients - the 24 hour monitor came out at 130 something over 71!
Last time I was in outpatients it came out at 162/91 - 24 hour came out 121/61 with diastolic dips into the 50s overnight so they had to decrease my bp meds. I read somewhere that over a third of people are over medicated because their doc has only used in surgery bp readings

I have heard of this as the doctors now recognise that for some going to the doctors can cause temporary stress, therefore for that moment in the Surgery the BP can go up

 

[Brunneria]

The last 3 times I have had my bp checked at the surgery, I have tested myself at home first, and taken a pic on my phone of the screen.

At home is usuall 20-30/10-15 lower than at the surgery.

So far, each time the nurse has seen my pic she has grinned and used that reading rather than the one from her bp monitor which clearly shows White Coat Syndrome in action.

 

[derry60]

@Brunneria

Have you seen this from the GP Handbook 2013

This trial, based on the UK General Practice Research Database (now called the Clinical Practice Research Datalink) followed over 125 000 people with newly diagnosed type 2 diabetes, about 10% of whom had established CVD when the diabetes was diagnosed. Follow-up was for a median of 3.5y, during which 20% of the cohort died(!) (BMJ 2012;345:e5567).

In those with diabetes: 1 Tight blood pressure control (<130/80) was not associated with improved survival when other risk factors were controlled for. 1 Low blood pressure was associated with an increased risk of death. The figures below are for those with CVD and diabetes, but are similar to those with diabetes without CVD. !

A systolic BP <110 was associated with an almost 3x increased risk of death compared with a systolic BP of 130–140 (HR 2.79, CI 1.74–4.48). ! A diastolic BP of 70 was associated with almost 2x increased risk of death compared with a diastolic BP of 80–84 (HR 1.89, CI 1.4–2.56). This fits with the results of the ACCORD trial (4700 patients with diabetes at high risk of CVD), which showed that aiming for a BP tighter than 130–140 did not reduce the risk of CV events over 5y (NEJM 2010;362:1575).

What do the guidelines say? NICE suggests target BP of <140/80. If renal, eye or CV damage: target is <130/80 (NICE 2009, CG 87). SIGN suggests target BP of <130/80 (SIGN 2010, 116). QOF incentivises us to aim for a BP below 140/80. What does this mean in practice? Do not like the first 3 or four lines of the first paragraph, I have CVD and have pre-diabetes argggg scary : (

1 Do not get the wrong message here! The studies are NOT saying that blood pressure control doesn’t matter: lots of evidence tells us that it does! 1 What these trials show is that really tight blood pressure control may be harmful (<110/70) and that aiming for blood pressures <130/80 may not be beneficial in diabetes, whether with or without CVD. 1 Given this, it seems reasonable to follow NICE guidance (which is the same as QOF) and aim for a BP target of systolic 130–140 and a diastolic of 80 but not much below. 1 Now we know what to aim for, we just have the challenging task of trying to reach these targets!!!

https://www.gp-update.co.uk/files/docs/GP_Update-Spring_2013_diabetes.pdf

 

[Rachox]

The last 3 times I have had my bp checked at the surgery, I have tested myself at home first, and taken a pic on my phone of the screen.

At home is usuall 20-30/10-15 lower than at the surgery.

So far, each time the nurse has seen my pic she has grinned and used that reading rather than the one from her bp monitor which clearly shows White Coat Syndrome in action.

What a simple but effective way to show white coat syndrome! My BP is always higher at the Drs!

 

[CherryAA]

Overall take home message - the doctor is right - these results are " exceptionally pleasing"

The thing which continue to puzzle me is why isn't my blood pressure getting better, I came off one drug, but two more to go and why is my uric acid so stubbornly high?

There is one further thing I've decided to explore as a result of thinking about this and that is whether there might be some kind of blockage in my carotid artery. It was something mentioned 20 years ago that I did nothing about . Maybe that is something else I was stupid not to follow up, maybe there is a small blockage and that's been contributing to my bp for years. I am going to have that checked out.


So to do list _

carry on doing what I'm doing 1

Ch3ck out carotid artery 3 tbs spoons apple cider vinegar 2 per day

eat macadamia, brazil nust, cauliflower

Take Vitamim D, K and magnesium

Reduce whisky intake

Keep salt and potassium as is

Lose 10-15 kg of weight


If anyone wants to check out their own figures and I've forgotten the measure and you don't recognise the range -


http://www.onlineconversion.com

or

unitslab.com can translate pretty much everything.

If no -one reads this I won't blame you ! - I will instead find it again in six months time and see if I managed to improve anything further!

so crossing off items on my TO DO list - I went and had my carotid arteries scanned.

It was all a tad messy - my doctor referred me to a Harley Street doctor - i called them to arrange the appointment , they said they would see me and " arrange for a scan" if necessary at yet more expense
So I went back to my doctor and said - give me the referral direct to the clinic, I do not want to see a specialist to talk about my results at a cost of £200 per session if he has nothing of value to add. 4

Fortunately my doctor understood the value of that gave me referral to the London Clinic -
had the tests done, £450 . results

NO SIGN OF ATHEROSCLEROSIS AT ALL. I promptly cancelled the Harley street guy.

Unsurprisingly the " odd feeling " in my neck immediately disappeared - so it looks like either - My LCHF has fixed whatever the doctor suspected years ago, OR him telling me to go check, gave me 20 years of being a bit nervous ..... ( what a berk I am sometimes )

still one down off my to do list ...

Interestingly the Stenographer doing the test said
"
oh yes - of course if you are eating a high fat diet your arteries will be MUCH healthier. In response to well why does the NHS still go for low fat then - she said . I have no idea, its clearly wrong - then shrugged ....... " When asked - do you discuss diet with people referred here she said ..... " oh no thats not my job - we are only discussing it because you brought it up" .

I banged my head on the wall when leaving....

 

[Bluetit1802]

BIG relief for you Cherry.

 

[CherryAA]

BIG relief for you Cherry.

yeah, its strange how I managed let something bother me for donkeys years. I often woke in the middle of the night thinking - am i going to have a stroke - my neck....... maybe absent LCHF I would have done.
Once again abesnt any start point I have no idea if I've improved whatever it was the first doctor saw or whether he was just seeing things himself - ho hum ...