對高血壓有害的是糖而不是鹽


  【24drs.com】減少攝取添加糖的加工食品可以減少高血壓比率以及心臟代謝疾病,一篇新文獻認為,造成與加工食品有關的高血壓風險,主要是因為糖,而不是鹽。
  
  堪薩斯市聖路克大學中美洲心臟研究院藥學博士James J. DiNicolantanio,以及紐約布朗克斯區亞伯特愛因斯坦醫學院Sean C. Lucan醫師,在Open Heart期刊發表了他們對流行病學研究與實驗的回顧結果。作者們結論指出,高糖飲食明顯造成心臟代謝風險,他們也認為,未來的飲食指引應建議,以純天然食品取代精製的加工食品。
  
  未參與該研究的俄亥俄州克里夫蘭診所Richard Krasuski醫師表示,這有一點可怕,畢竟我們長久以來一直專注於研究鹽的影響。
  
  Krasuski醫師解釋,這篇回顧文獻總結了流行病學研究以及小型介入研究這兩類型研究,雖然這兩類型研究各有其限制,整合分析可以獲得比較有力的結果。
  
  當你做這些流行病學研究時,不一定能控制所有的干擾因素;因此,Krasuski醫師形容流行病學研究主要是產生假設。
  
  相對的,小型介入研究透過操控單一因素、在短期內密集檢測假設;他解釋,這類型研究的限制是「我們不知道這些短期影響是否可代表長期影響。」
  
  Krasuski醫師表示,底限是,儘管科學不是完美的,但它整體還不錯,他也提醒讀者,閱讀結論時要了解研究內容。
  
  Krasuski醫師表示,結論是糖對心臟的危險大於鹽,確實令人「大開眼界」,不過,他也承認,這是可以預見的。他和其他心臟科專家已經注意到,逐漸減少鹽攝取量的建議並未導致預期之正面的心血管結果。
  
  DiNicolantanio醫師和Lucan醫師的文章可能會引起爭議,因為它與目前有關飲食與心血管疾病之關連的假設不同。Krasuski醫師發表後的結論指出,爭論的是鹽或糖,或許有一部份原因是與糖攝取量有關。
  
  不過,對於這篇文章提出的建議,大多數醫師可接受的是少吃加工食品。
  
  Krasuski醫師被問到會如何告訴他的病患時表示,他的建議與這篇文章的作者們一致,建議飲食要富含全穀類與蔬果,他也建議他的病患要避免吃加工食品。
  
  Krasuski醫師指出,對於心血管健康,規律運動、不抽菸、維持適當體重都很重要,不過,這些建議都不在此次回顧分析之內。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7142&x_classno=0&x_chkdelpoint=Y
  

Sugar, Not Salt, May Be at Fault for Hypertension

By Lara C. Pullen, PhD
Medscape Medical News

A reduction in the consumption of added sugars and, in particular, processed foods may translate into decreased rates of hypertension as well as decreased cardiometabolic disease. In particular, a new review article suggests that sugar, not salt, appears to contribute to the majority of the hypertension risk associated with processed food.

James J. DiNicolantanio, PharmD, from Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, published their review of epidemiological and experimental studies in Open Heart. The authors conclude that high-sugar diets may make a significant contribution to cardiometabolic risk. They also suggest that future dietary guidelines recommend that highly refined processed foods be replaced by natural whole foods.

"It is a little bit frightening that we have been focusing on salt for so long," Richard Krasuski, MD, from the Cleveland Clinic in Ohio, told Medscape Medical News. Dr Krasuski was not affiliated with the research.

Dr Krasuski explained that the review article summarized the results from two types of studies: epidemiological studies and small interventional studies. Although both types of studies have limitations, together they make a rather strong case.

"[W]hen you do these types of epidemiological studies, you are not really controlling for confounding factors." Thus, Dr Krasuski described the epidemiological studies as primarily hypothesis-generating.

In contrast, the small interventional studies test a hypothesis through manipulation of a single factor, intensely, over a short period of time. In this type of study, the limitation is that "we don't know if these acute effects transmit into long-lasting effects," he explained.

The bottom line, Dr Krasuski said, is that although the science is not perfect, it is, in its entirety, good. He cautioned readers, however, to understand the research context when reading the conclusions.

The conclusion that sugar represents a greater danger to the heart than salt, Dr Krasuski said, was an "eye opener." He acknowledged, though, that he should have anticipated it. He and other cardiologists have noticed that the recommendations to increasingly lower salt intake have not resulted in the expected positive cardiovascular outcomes.

The article by Dr DiNicolantanio and Dr Lucan will likely be controversial because it contradicts current assumptions about the relationship between diet and cardiovascular disease. "The controversy here is whether it is the salt or the sugar.... It probably is, at least partially, if not more, related to sugar consumption," Dr Krasuski concluded after reading the paper.

Nevertheless, the bottom line of the article's recommendation should be familiar and comfortable to most physicians: Eat less processed food.

When asked about what he tells his patients, Dr Krasuski stated that his recommendations are consistent with those of the authors of the current article. He recommends a diet that is full of whole grains and fruits and vegetables, and he also recommends that his patients try to avoid processed foods.

Dr Krasuski added that regular exercise, not smoking, and maintaining weight at a level close to target are also all important for cardiovascular health, although these recommendations are beyond the scope of the current review.

Dr DiNicolantanio, Dr Lucan, and Dr Krasuski have disclosed no relevant financial relationships.

Open Heart. 2014;1;e000167.

    
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