Dr. Zorba Paster: Trip to barbershop reduces blood pressure
Dear Doc: I know you do not believe in food supplements (neither do I). However, my doctor has instructed me to take 4,000 milligrams of calcium and 5,000 IU (International Units) of vitamin D3 per day. And Omega 3. I have been taking 720 milligrams of fish oil per day. (I don’t care much for fish.)
Are these products worthwhile? I am a 76-year-old woman, quite healthy and not on hormone therapy. Thanks for your help. — J.L., from Sandpoint, Idaho
Dear J.L.: You’re right to ask. The $5-billion-a-year supplement industry is not my buddy. Why? Because there is so much hype and not much else.
Be that as it may, I take a no-harm-no-foul view — I know just because something hasn’t been studied doesn’t mean it doesn’t work. So if you are a “buyer beware” person, then experiment and see if it works for you.
On to calcium. We doctors and physician assistants and nurse practitioners have been recommending lots of calcium for years thinking this was the key to preventing osteoporosis and the end product, fractures. So we’ve been saying 1,800 mg daily without strong evidence backing up this magic number.
My read on the calcium issue is this: When you fall below 1,000 mg a day of calcium naturally in your diet, then you should think about how to get more calcium in your food — with dairy products topping the list. A container of yogurt has about 400 mg, for example. Do a Google search for “calcium foods” and see what you might eat to keep that number up. Eating foods containing calcium seems to be better than calcium supplementation.
But if you take the pill route, which is fine, then go with 1,000 mg a day along with a typical American diet; 4,000 mg is overkill and more likely to cause constipation.
Now, as for vitamin D, I still think D supplements might have a place. Long-term studies should be out soon that answer this question. Until that time, I think 2,000 IU daily will more than satisfy the D issue. A higher amount, 5,000 IU, will not hurt you but isn’t necessary. We don’t check for vitamin D levels unless there is a reason, such as an unexpected fracture.
On the fish oil question, eating fish is undoubtedly better. The best data shows twice-weekly fish consumption — especially fatty fish such as salmon — is the best. Fish oil might help with inflammation but the data on fish oil reducing heart attacks and strokes just isn’t there.
Yes, it does improve cholesterol levels but this is a cosmetic improvement. There are some people with massively elevated triglycerides who need to take fish oil daily, but they are a tiny group compared to the general population.
On another topic, let’s take a minute to look at the “barbershop study” of public health.
First off, remember when you could only get flu shots in your doctor’s office? How inconvenient was that? You had to make an appointment to get in — no walk-in service there.
It got so there was no way we could provide everybody with an in-office flu shot, so enter pharmacies. They joined in to offer flu shots to all takers and — bingo! — everybody who wants one now can get one. No excuse.
Our next step in community health is testing more people more often for high blood pressure. This is a big problem in all communities but especially in the African-American community, where hypertension is rampant and underdiagnosed. Enter barbershops.
The Cedars-Sinai California Heart Center in Los Angeles invited 52 barbershops to take the blood pressure of their clients. If the person had hypertension, a pharmacist would then treat them with a medication protocol developed by the health care team. They didn’t need to see a doctor, initially, to get treated — that was the key.
The average blood pressure of the men who came into the barbershops at the start of the study was 150 systolic, much too high. One year later, the average dropped to 120 systolic — right on the mark. Great results.
My spin: It’s time to look at more community outreach programs utilizing all health care providers. Having blood pressure measured in barbershops and connecting people, easily, to a community resource that doesn’t require a doctor visit may seem second-class, but what’s really second-class is not providing easy access to medications that can save lives. Stay well.