‘Cure’ for hypertension, related complications

•Researchers identify diet that gives best chance of living longer, healthier
•Beer belly linked to 1,300 prostate cancer deaths yearly as five-point hike in BMI increases risk by 10%
•How keto molecule, low carb diets reduce colorectal cancer growth in mice, by study

Medical experts have made recommendations on how to reduce the burden of hypertension in Nigeria as well as identified diets that give best chance of living longer and healthier.

A hypertension expert and Dean, Faculty of Clinical Sciences and Director, Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Prof. Mayowa Ojo Owolabi, told The Guardian that screening for hypertension should be mandatory for those above the age of 18 years. This, he said, can be implemented at all health facilities especially primary health care centers. Owolabi said hypertension treatment and control should be enhanced through a protocol-based referral system that empowers primary health care centers to participate under supervision in the initiation of treatment for uncomplicated hypertension.

A public health physician and Global Health Expert/Chief Technical Advisor, E4HDI, Dr. Nnenna Marcelina Ezeigwe, said the best option to reduce the burden of hypertension is prevention by avoiding or reducing the risk factors, including unhealthy diet, physical inactivity/sedentary behaviour, use of tobacco and tobacco products, including shisha, harmful use of alcohol and air pollution.

For diet, Ezeigwe said, deliberate efforts must be made to reduce salt intake, as well as saturated fats and trans-fat, whilst increasing intake of fruits and vegetables. She said adults should aim to engage in 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity physical activity every week. In addition, the physician said, it is absolutely important to check your blood pressure frequently to take necessary action before any damage is done. “If diagnosed, individuals should take the prescribed medications as directed by the health care professional. To reduce the likelihood of catastrophic out of pocket expenditure, individuals, families and communities are encouraged to enroll into the Community or National Health Insurance Scheme,” she said.

Medical Director Optimal Specialist Hospitals Gbaja, Surulere, Lagos State, Dr. Celestine Chukwunenye, said improvement in the socio-economic and political conditions in the country, good and balanced diets, low salt and sugar intake, regular physical exercises, six to eight hours of night sleep, drinking enough fluids orally, and avoiding hard drugs, nicotine and caffeine, are some of measures that can reduce the burden of hypertension in Nigeria.

The consultant obstetrician and gynaecologist said routine medical check up and early registration for antenatal care by pregnant women will enable early diagnosis and treatment. He said government should encourage local manufacturing of antihypertensive drugs to make them cheaper and more accessible, and mass awareness campaigns to enlighten the people about the burden of hypertension.

Chukwunenye said there are many herbal or natural remedies including acupuncture, fruits, vegetables, roots, nuts and snails but their efficacy and contribution to the management of hypertension need further evaluation.

Chairman of the Nigeria Heart Foundation (NHF) Hypertension Committee, Prof. Basden J. C. Onwubere, said a crucial first step for control of hypertension and achievement of the United Nations 2025 goal for a 25 per cent reduction in uncontrolled hypertension is to improve hypertension diagnosis and strategies have been put in place to encourage Blood Pressure (BP) screening and awareness programmes in communities.

Onwubere said to maintain adequate control of Hypertension, it is advisable to maintain the following lifestyles: reduce salt consumption and maintain policy of ‘no added salt’ after food has been prepared with appropriate quantity of salt; choose a healthy diet which includes vegetables and fruits; do not smoke as smoking has no known benefits; limit alcohol consumption; maintain healthy weight; avoid sedentary lifestyles and exercise daily.

A consultant pharmacist and a fellow of the West African Postgraduate College of Pharmacists, Dr. Joseph Madu, recommended: adequate health education and public enlightenment about the disease burden; formation of policies that will encourage patients and the less privileged to access care; policies to enhance access to free blood pressure checks at designated centres will be very helpful; lifestyle changes such as reduced salt and low calorie intake, brisk exercise such as a walk for 30 minutes daily, reduced alcohol and avoidance of tobacco intake etc.

Madu said hypertension has no known cure whether through herbal or orthodox medicine. He, however, said it could be managed to prevent morbidity and mortality. The clinical pharmacist said the danger in using herbal medications is that they are not standardised most times as to guarantee proper usage.

Meanwhile, researchers analysed hundreds of studies to identify a diet that optimises human health and longevity. They found that diets low in animal protein and high in complex carbohydrates that include periods of fasting are most beneficial for long-term health and life span.

However, the researchers note that their findings simply provide a foundation for understanding and that, in practice; diets should be tailored to individual needs and circumstances.

In around 440 B.C., the Greek physician Hippocrates said: “Let food be thy medicine and let thy medicine be food.”Although treating food, as medicine is a highly debated concept, recent studies have demonstrated the wisdom in this statement and how monitoring food quantity, type, and timing are crucial for good health.

However, what precisely makes up the optimal diet remains controversial. Growing evidence suggests optimal diets may depend on an interplay of health factors, including age, sex, and genetics.

Recently, researchers reviewed hundreds of nutrition studies from cellular to epidemiological perspectives to identify a “common denominator nutrition pattern” for healthy longevity.

They found that diets including mid-to-high levels of unrefined carbohydrates, a low but sufficient plant-based protein intake, and regular fish consumption were linked to an extended lifespan and health span.

Dr. Valter Longo, professor of gerontology and biological sciences at the University of Southern California, and one of the authors of the study, told Medical News Today: “First, diet here is intended as a nutritional lifestyle and not as a ‘weight-loss strategy’ although maintaining a healthy weight is key. All aspects of the diet are linked to long-term health and longevity.”

“I am delighted to see this review,” Dr. Pankaj Kapah, professor of gerontology at the University of Southern California, who was not involved in the study, told MNT.

The review was published in the journal Cell. For the study, the researchers analysed hundreds of studies examining nutrition and delayed ageing in short-lived species, nutrient response pathways, caloric restriction, fasting, and diets with various macronutrient and composition levels, such as the keto diet.

The studies analyzed nutrition and diet from multiple angles, from cellular and animal studies to clinical and epidemiological research investigating the lifestyles of centenarians.

In the end, the researchers found that the ‘longevity diet’ includes: a legume and whole grain-rich pescatarian or vegetarian diet; 30 per cent of calories from vegetable fats such as nuts and olive oil; a low but sufficient protein diet until age 65 and then moderate protein intake; low sugar and refined carbs; no red or processed meat; limited white meat; 12 hours of eating and 12 of fasting per day; and around three cycles of a five-day fasting-mimicking diet per year.

The researchers further noted that, rather than targeting a certain number of calories, diets should aim to keep Body Mass Index (BMI) under 25 and maintain ideal sex and age-specific body fat and lean body mass levels.

Moreover, they wrote that diets should be adapted to individual needs—especially for those over 65—to avoid malnourishment. Those over 65, for example, may become frail from a low protein diet.

For those without insulin resistance or obesity, high consumption of complex carbohydrates could reduce frailty in this age group and others, the researchers wrote, as it provides energy without increasing insulin and activating glucose signaling pathways.

The researchers also found that periodic fasting between the ages of 18 and 70 could reverse insulin resistance generated by a high calorie diet and regulate blood pressure, total cholesterol, and inflammation.

A recent study supports these findings. It found that changing from the typical Western diet to one rich in legumes, whole grains, and nuts with reduced red and processed meats is linked to an 8-year-longer life expectancy if started at age 60.

The researchers noted that diets involving calorie and protein restriction were consistently beneficial, whether in short-lived species or epidemiological studies and large clinical trials.

They further noted that low but sufficient protein, or a recommended protein intake with high levels of legume consumption, could increase the health span by reducing the intake of amino acids including methionine. Methionine has been linked to increased activity in various pro-aging cellular pathways.

“The diet is primarily plant-based which, based on other similar studies, and may contribute to lower risk of chronic conditions such as type 2 diabetes and cardiovascular disease.”

“Plant-based diets have also been associated with lower inflammation levels in multiple studies. As inflammation is the base of many diseases, this may contribute to the longevity factors as well,” she explained.

The researchers conclude that their findings provide solid foundations for future research into nutritional recommendations for healthy longevity.

When asked about the study’s limitations, Dr. Longo, Dr. Kapahi, and Kirkpatrick stressed that there is no ‘one-size-fits-all’ approach. The optimal diet, they say, may differ due to factors including sex, age, genetic makeup, and any sensitivities and intolerances, such as an intolerance to gluten.

Longo thus recommends people visit a dietician before undertaking a new diet. Kirkpatrick added that many of her patients visit her when making dietary changes to ensure they are sustainable in the long term.

Also, a major study suggests that hundreds of British men could be saved from prostate cancer each year if they lost weight.
Experts from the University of Oxford looked at measurements of over 2.5 million men.

Every five-point increase in Body Mass Index (BMI) — about 2.5st (35lbs) for the average British man — was associated with a 10 per cent greater odds of dying of prostate cancer.

Five points is enough to take someone from being of a healthy weight to overweight, or overweight to obese. The researchers estimate that bulging waistlines are responsible for 1,300 prostate cancer deaths in Britain each year.

Dr. Aurora Perez-Cornago and colleagues said: “We found that men with higher total and central adiposity have a higher risk of dying from prostate cancer than men with a healthy weight.

“Knowing more about factors that increase the risk of prostate cancer is key to preventing it.

“Age, family history and black ethnicity are known risk factors but they are not modifiable, and so it’s important to discover risk factors that it is possible to change.”

Also, scientists say eat all of your meals in a 12-hour window if you want to live longer.Restricting the food intake of mice to the most active hours of their day extended their lifespans by a third.

Whereas solely restricting calories only helped them live for 10 per cent longer, on average. It suggests the combination of sticking to a low-calorie diet and fasting is optimal for longevity.

Researchers claimed the findings show if you are dieting but eating late at night then you are not getting the full benefits.
Eating within a strict time window, known as intermittent fasting diet, has become one of the hottest fitness fads in recent years.

A-listers such as Jennifer Aniston and Nicole Kidman are said to be followers of intermittent fasting. Intermittent fasting involves switching between days of fasting and days of eating normally.

Intermittent fasting diets fall generally into two categories – time-restricted feeding, which narrows eating times to six-eight hours per day, also known as the 16:8 diet, and 5:2 intermittent fasting.

The 16:8 diet is a form of intermittent fasting, also known as Time Restricted Eating. Followers of the eating plan fast for 16 hours a day, and eat whatever they want in the remaining eight hours – typically between 10am and 6pm.

This may be more tolerable than the well-known 5:2 diet – where followers restrict their calories to 500–to-600 a day for two days a week and then eat as normal for the remaining five days.

In addition to weight loss, 16:8 intermittent fasting is believed to improve blood sugar control, boost brain function and help us live longer.

Many prefer to eat between noon and 8pm as this means they only need to fast overnight and skip breakfast, but can still eat lunch and dinner, along with a few snacks.

When you do eat, it is best to opt for healthy options like fruits, vegetables and whole grains. And drink water and unsweetened beverages.

Drawbacks of the fasting plan may be that people overindulge in the hours they can eat, leading to weight gain. It can also result in digestive problems over the long-term, as well as hunger, fatigue and weakness.

Dr. Joseph Takahashi, a molecular biologist from the Howard Hughes Medical Institute in Maryland in the US, and the lead author of the study, is so convinced by the findings that he has adopted a 12-hour restricted food diet himself.

In the study, published in the journal Science, Takahashi’s team looked at the impact of both diet and time of feeding on around over 500 mice over a four-year period.

The scientists used automated feeders to both control the amount the mice could eat and when. Some rodents were allowed to eat as much as they wanted, while others had their daily calories restricted to 30 to 40 per cent of what they would normally eat. These groups were also divided by feeding time, with some having 24-hour access to food.

Others were fed in a two-hour period at the beginning of either the night or day, and finally over a 12-hour period over the course of the day or the night.

The mice were weighed every few weeks and their activity levels were monitored for signs of ageing. Once mice started to reduce their food consumption or activity levels they were monitored more closely for signs of age related ailments.

The researchers found that mice fed the low-calorie diet at night, over either the two-hour or 12-hour period, lived the longest. After all the mice died, the scientists conducted autopsies to assess their general health as well as collect tissue samples for further analysis.

Age genes linked inflammation in the body tends to become more active as mice age, whereas genes that regulate metabolism become less active, causing or contributing to a number of age-related disorders.

From their analysis, Takahashi’s team found that mice on the nighttime calorie restricted diet exhibited less of these age-related changes.

Mice are nocturnal creatures so are most active at night. The researchers said the findings would be flipped when applying them to humans.

Meanwhile, researchers investigated how low carb diets reduce colorectal tumor growth in mice. They found that a molecule produced on keto diets suppresses tumor growth and think that these results may translate over to humans. The researchers have now initiated clinical trials to determine the molecule’s effect on human colorectal cancer.

Colorectal cancer (CRC) is the third most common cancer diagnosed in the United States. Studies have shown that the Western diet, high-sugar diets, and excessive consumption of animal protein — especially red meat — increase CRC risk.

Studies show that diets involving fasting and caloric restriction are protective against intestinal tumors in animal models. Whether they may translate over to humans remains unknown.

Understanding more about the mechanisms underlying the effects of various diets on tumor growth could help researchers develop treatments and preventative options for CRC.

Recently, researchers conducted a series of mouse studies investigating the underlying protective mechanisms behind a low-carb diet for CRC.

They found that beta-hydroxybutyrate (BHB) — an alternative-energy molecule produced in response to low carb diets — suppresses intestinal tumor growth.

“BHB is a small molecule produced in the liver in response to starvation or a ketogenic diet,” Dr. Anton Bilchik, surgical oncologist and chief of medicine at Saint John’s Cancer Institute at Providence Saint John’s Health Center in Santa Monica, CA, told Medical News Today.

“This new study demonstrates in a mice model that it prevents colorectal cancer by activating a growth slowing receptor Hcar2 which is found in the lining of the bowel. This receptor may play an important role in preventing cell growth within the intestine,” Bilchik added. He was not involved in the study.

The new study was published in Nature.
The researchers first sought to identify dietary interventions that affect intestinal tumor growth. To do so, they designed six diets with varying fat-to-carbohydrate ratios, including two ketogenic diets with 90 per cent fat-to-carbohydrate ratios from plant or animal sources.

After beginning the diets, the researchers induced CRC in the mice via standard chemical procedures. In doing so, they noted tumor numbers and sizes reduced when fat-to-carbohydrate ratios increased.
They also found that mice on keto diets survived for longer, and keto diets inhibited tumor development in a genetic model of CRC.

The keto diet also suppressed tumor growth when started after triggering CRC.

Meanwhile, cessation of the keto diet led to tumour regrowth, even if the diet had previously reduced tumor size.
The researchers wrote that their findings indicate that keto diets potently suppress colorectal tumor growth in both prevention and treatment models of CRC.

The researchers next investigated the underlying mechanisms behind tumour suppression.Through a series of experiments, they found that keto diets release BHB, which interacts with cells in the intestine to reduce and prevent tumor growth.

Dr. Maayan Levy, one of the study’s authors, told MNT: “BHB inhibits the growth and proliferation of intestinal epithelial cells. It achieves this by activating the transcriptional regulator Hopx. Hopx, in turn, reduces the expression of genes involved in cell division. How exactly Hopx exerts its gene-regulatory effects is unknown; this is something we’re currently investigating.”

To see how BHB works in humans, the researchers observed its effects on human cell lines. In doing so, they noted that BHB reduced the growth of organoids in both healthy donors and CRC cell lines and elevated Hopx expression.

They found, however, that only cell lines with HCAR2-HOPX responded to BHB, and that others such as HCT116 and RKO did not.
Finally, the researchers collected blood samples from 41 patients with CRC to assess the link between blood levels of BHB and Hopx levels. They found that BHB levels correlated positively with Hopx levels and negatively with cell cycle progression.

This, they wrote, suggests that BHB might increase Hopx levels and reduce CRC tumour growth in people.
The researchers conclude that oral or systemic interventions such as BHB could complement current prevention and treatment strategies for CRC.

When asked about the study’s limitations, Dr. Bilchick said: “While these studies are exciting and thought-provoking, little is known about how they will translate to human clinical efficacy. Positive clinical results could impact thousands of lives and reduce the development of colorectal cancer, particularly in young people where we are seeing a massive increase in incidence for unclear reasons.”

“One important aspect that our study has not yet addressed is the levels of circulating BHB and their duration that need to be achieved in order to observe a tumor-inhibitory effect,” added Levy.

“In other words, do BHB levels need to be elevated continuously? Is intermittent BHB supplementation effective? Are short bouts of BHB supplementation sufficient? If so, how frequent do these bouts need to be? We are actively investigating these important questions.”

While much remains unknown about BHB’s role in CRC, Dr. Levy explained that her team has initiated clinical trials to determine the effect of BHB on human colorectal cancer.

“What is encouraging is that in animal models, all the colorectal cancer types we have used to test the efficiency of BHB have responded to intervention,” she said. “Furthermore, intestinal organoids derived from colorectal cancer patients likewise respond to BHB treatment with reduced growth.”