Emperor's New Clothes: Prehypertension Guidelines

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The Emperor's New Clothes: Aggressive New Guidelines

for " Prehypertension "

http://www.westonaprice.org/moderndiseases/prehypertension.html

By Paul J. Rosch, MD, FACP

 

Up until a few weeks ago, if you asked any one, including a doctor,

what was considered a normal or desirable adult blood pressure,

120/80 would have been the most frequent response. Not any more.

According to the new " official " guidelines, 120/80 puts you in a new

disease category called " prehypertension " and at increased risk for

heart attack, stroke, or kidney disease. The recommendations for

rectifying this potentially deadly disorder are the usual advice to

lose weight, avoid salt and sodium-rich foods, exercise regularly,

stop smoking and reduce stress.

 

However, we all know how difficult it is to achieve these goals,

much less maintain them. And even if you do, the results are not

that rewarding, even for patients with blood pressures of 160/100

and higher. People with prehypertension usually discover that none

of these lifestyle modification will normalize their blood pressure,

which means that medications will be required. Chalk another one up

for the drug companies.

 

The Emperor's New Clothes

 

The new guidelines are contained in the Seventh Report of the Joint

National Committee on Prevention, Detection, Evaluation, and

Treatment of High Blood Pressure (JNC-7), issued in May of 2003. The

measures proposed for treating high blood pressure in JNC-7 do not

differ greatly from those contained in the first JNC report, which

came out in 1977, namely life-style changes (lose weight, avoid salt

and sodium-rich foods, exercise regularly, stop smoking and reduce

stress) plus the administration of thiazide diuretics (medications to

decrease water retention) to those whose blood pressure does not

respond to diet and exercise.

 

These JNC-7 guidelines bring to mind the story of the vain emperor

gulled into parading through town naked by two tailors who had

convinced him that the cloth they used for his new clothes would be

invisible to anyone too stupid or incompetent to appreciate its

superior quality. The new disease of prehypertension proposed by JNC-

7 is like the emperor's new clothes--an invisible and imaginary

disease foisted on a gullible public. Even though its authoritative

proponents may be acting in good faith, there is reason to believe

they may have been unduly influenced by others with their own

private agenda.

 

Orthodox Advice

 

The first advice patients with high blood pressure generally receive

is to significantly restrict sodium intake. However, the vast

majority fail to respond to this measure unless they have certain

genetic traits. In some, calcium deficiency can be the culprit and

they improve with calcium supplementation. These individuals may

actually worsen on a low-sodium regimen since restricting

sodium calls for restricting the intake of dairy products, a major

source of dietary calcium. Others benefit from potassium and/or

magnesium supplements.

 

Jogging and running may help lower blood pressure for some people

but more often has little effect and can even cause a rise.

 

High blood pressure or hypertension, like fever, is not a diagnosis

like diabetes, but rather a description. It is simply an elevated

blood pressure reading on some measuring device. The condition can

have many different causes. That helps to explain why we have some

100 drugs to treat high blood pressure. Unfortunately, there is no

algorithm to guarantee which one will work best or be the safest for

any specific patient. Similarly, a fever of 103° in a patient

with lupus may require giving cortisone but if that identical 103°

temperature reading were due to tuberculosis, cortisone could bring

the fever down but might prove lethal. Conversely, appropriate

antibiotics would be an effective treatment for tuberculosis but

would provide little benefit in lupus.

 

Risk Factors and Other Fallacies

 

In order to successfully treat a disease, it is necessary to remove

or reduce its cause rather than its manifestations or markers.

Treating persistently elevated blood pressure or temperature is very

different from treating elevated blood sugar. The goal in diabetes

is simply to lower the blood sugar to normal; responses to

medication and/or diet are much more predictable and sustained

since the cause can almost always be identified.

 

For blood pressure, the situation is much more complicated. Much of

the " one blood pressure fits all " approach comes from confusion over

what a " risk factor " really represents. Most risk factors for heart

disease are merely " risk markers " that simply have some statistical

association with an increased incidence of coronary events. There

are over 300 risk factors for heart attacks, including a deep

earlobe crease, premature vertex baldness, high selenium toenail

levels, having a pot belly, having been born in northern Finland,

not having a daily nap or drinking more or less than one or two

glasses of wine a day. Attempting to treat or remove such markers

will accomplish nothing since they do not cause coronary disease.

The same can be true for lowering an elevated systolic or diastolic

blood pressure unless the treatment is directed at what is

causing the problem, which is usually not clear.

 

Hypertension and Heart Disease

 

High blood pressure is said to predispose an individual to heart

attack, stroke and kidney disease.

 

Surprisingly, no randomized clinical trials have ever proven that

lowering an elevated systolic blood pressure to 140 reduces the risk

for death due to coronary disease. A good example of this was the

multicenter Multiple Risk Factor Trial (MRFIT) designed to

demonstrate that reducing hypertension, high cholesterol and smoking

would lower coronary mortality. After screening some 350,000

middle-aged men, researchers selected close to 13,000 believed to be

at greater jeopardy because of a preponderance of these putative

risk factors. They were divided into a treatment group to lower

these markers and a control group that received usual care.

 

After ten years and $115 million, the treatment group substantially

achieved their objectives--they had lower cholesterol and lower

blood pressure than when they had started, and many had stopped

smoking. However, these conscientious patients fared no differently

from controls. In fact, a subset of hypertensives treated with

diuretics had the highest mortality rates, probably from

ventricular fibrillation due to potassium depletion. The MRFIT

objective was to get blood pressures below 140/90. One can only

wonder what the mortality rate would have been if under 120/80 had

been the goal.

 

As for stroke, some studies have shown that lowering blood pressure

can prevent stroke, but the absolute effect is less than 1 percent.

And only very high blood pressure will destroy kidney function.

 

Stress and Pseudohypertension

 

My personal experience has been that a significant percentage of

patients being treated for " essential hypertension " can stop their

medication without any adverse effects. When such individuals are

admitted to the hospital for surgery or some unrelated condition and

these drugs are discontinued deliberately or inadvertently, it is

not unusual for blood pressures to fall to normal levels and remain

there, only to rise again after discharge. Stress-related or

" white coat " hypertension is quite common. In one study published in

the Journal of the American Medical Association, more than one in

four patients with elevated blood pressures in the doctor's office

were found to have normal values on ambulatory monitoring. All were

taken off drugs with no adverse effects.

 

Decades ago, when healthy young men being examined for insurance

policies or entry into the armed services had high readings but no

retinopathy, albuminuria or other indication of sustained

hypertension, we used to reassure them and have them lie down and

relax in a quiet room. After 15 or 20 minutes, repeated measurements

were invariably much lower and usually normal. Busy doctors

don't have time for that today. It's much easier and safer for them

to prescribe a pill, since everyone knows that hypertension is

the " silent killer. " In addition, treating hypertension is easy,

doesn't take much time or energy and is apt to be quite remunerative

since periodic electrocardiograms and chest X-rays to monitor

cardiac size and laboratory tests are readily justified. The doctor

only needs to ask a few questions, the patient often does not need

to disrobe in an examining room and the entire encounter often takes

less than ten minutes.

 

A not uncommon scenario is that when the patient returns after the

initial diagnosis of hypertension has been made and a medication has

been prescribed, he or she is even more nervous, blood pressure is

still high or higher and the dose is increased. This may be repeated

on subsequent visits with prescriptions for additional drugs. The

result may be dizziness or other side effects that the patient now

attributes to a worsening of hypertension, causing even more stress.

 

It is also not generally appreciated that heart rate and blood

pressure shoot up whenever we speak or try to communicate in some

other way. The seminal investigations of this phenomenon have been

done by Jim Lynch who showed that such elevations are greater if we

are talking to someone of perceived higher social stature, more

rapidly than usual, and if the content of the conversation

deals with some important personal issue. Blood pressure rises in

deaf mutes when they use sign language but not when they move their

hands meaninglessly but with the same amount of energy. The only

time this does not occur is in schizophrenic patients off of

medication, possibly because they no longer communicate.

 

I have been involved in this research with Jim for over twenty-five

years. Although these transient spikes in both systolic and

diastolic pressure can be alarmingly high, patients are completely

unaware of this and have no symptoms. By using an automated blood

pressure device that displays systolic, diastolic and mean arterial

pressure on a monitor, it is possible to teach patients how

to lower their pressures.

 

We have also found that these rises are not blunted by any

antihypertensive drugs and are actually exaggerated by beta

blockers. It is not uncommon for anxious patients to talk

immediately prior to or even while the doctor is inflating the cuff,

which can increase blood pressure up to 50 percent in some

people. There is no good evidence that such hyperreactivity is

associated with any increased incidence of sustained hypertension.

The same is true for elite weight lifters, who can have pressures of

400/250 or higher when they perform the supreme Valsalva maneuver.

 

Another source of pseudohypertension is that the same-size cuff is

used for all adults, which can cause significantly false high

readings in fat arms. The width of the cuff should be 40 percent of

the circumference of the arm. This is important because of the large

number of obese people and others who are engaged in body building

activities.

 

Time of day, room temperature, a full bladder, eating, drinking or

smoking within the past hour, standing, sitting or supine can all

influence measurements.

 

Treating Numbers Instead of People

 

Authoritative advice for treating blood pressure has changed

dramatically over the years. Forty years ago, the chapter on

hypertension in Harrison's Textbook of Medicine stated " Whatever the

form of therapy selected, it must not be forgotten that the

physician who treats hypertension is treating the patient as

a whole, rather than the separate manifestations of a disease. The

first principle of the therapy of hypertension is the knowledge of

when to treat and when not to treat . . . . A woman who has

tolerated her diastolic pressure of 120 for 10 years without

symptoms or deterioration does not need immediate treatment for

hypertension. Marked elevation of systolic pressure, with little

or no rise in diastolic, does not constitute an indication for

depressor therapy. This is particularly true in the elderly or

arteriosclerotic patient, even though the diastolic pressure may

also be moderately elevated. " A physician following this advice

today would be liable for malpractice.

 

The chapter, which was written by John Merrill, a leading authority

on hypertension from Harvard, goes on to emphasize that " The

physician must constantly weigh the value of making his

patient 'blood pressure conscious' by a specific regimen and regular

follow-up, against real need for any particular form of therapy.

Above all, in treatment or prognostication, he must avoid engendering

in the patient a fear of the disease which may be unwarranted in our

present state of knowledge. " Contrast this with the current cookie

cutter approach of treating numbers that are often meaningless

instead of people.

 

There is absolutely nothing new about prehypertension, which was

previously referred to as " high normal " at levels higher than

120/80. This would still be a preferable description since nobody

knows whether these individuals will go on to develop sustained

hypertension or are at any significantly increased risk for its

complications. All these new guidelines do is convert 45 million

healthy Americans into new patients by creating fear. This is

precisely what the experts emphasized we should take pains never to

do! How could so many doctors have been so wrong for so many years?

 

Whatever happened to the Hippocratic dictum Primum non nocere (First

of all, do no harm)? It used to be the primary concern of all

doctors but seems to have now been sidelined or forgotten in the

frenetic and impersonal pace of modern medical practice.

 

JNC-7 Recommendations

 

The original 1977 JNC guidelines followed several studies showing

that blood pressure could be lowered with thiazide diuretics.

Subsequent JNC reports repeatedly recommended the use of diuretics

as initial treatment based on additional reports demonstrating their

efficacy.

 

Despite this, the use of diuretics actually declined over the next

decade or so, possibly because many went off patent and were no

longer profitable. In addition, the pharmaceutical companies began

to vigorously promote newer drugs and the 1993 JNC-5 guidelines

added angiotensin-converting enzyme (ACE) inhibitors and beta

blockers as first-line therapy. Their sponsors argued that

these more expensive drugs might be preferable since thiazide

therapy could contribute to diabetes and abnormal heart rhythms,

especially at higher doses.The new medications also had side effects

but their promoters claimed that they were more likely to reduce

complications such as heart attacks and stroke.

 

However, many were not as effective even at higher doses or when

combined with other new anithypertensives. Specialists soon found

that half of such patients with blood pressure readings above

160/100 on two or more of these drugs improved rapidly when

diuretics were added or their dosage was increased. JNC-6

removed recommendations for ACE inhibitors and beta-blockers and the

new guidelines are about the same as those proposed over 25 years

ago, save for this new and confusing diagnosis of prehypertension.

 

However, diuretics are not the most effective or safest treatment

for all hypertensives and other drugs are clearly superior for

certain patients. What is wrong is that physicians are treating a

reading on a blood pressure machine in a cookbook fashion rather

than the patient or the cause of the problem.

 

Guidelines for Guidelines

 

The law requires that all important Federal rules, including

guidelines that affect the public, must be written and promulgated

according to the Government Code. This code mandates formal

selection of a committee, pre-announcement of all meetings, open

meetings that encourage testimony from all interested parties as

well as written records, all of which must be preserved in a special

docket. Everything is then reviewed in order to provide a written

discussion of all the relevant evidence leading to the final rules

or guidelines that must be published in the Federal Register. In

addition, if the published guidelines are not consonant with a

logical review of the evidence presented, the recommendations may be

overturned by legal action.

 

Since the new JNC-7 guidelines seemed to fall under these rules, I

accessed the Federal Register but was unable to find anything

relevant. When I contacted the Government Printing Office to inquire

about this I received a reply confirming they had no JNC records and

was referred to a NIH web site.

 

This lack of adherence to procedure is remarkably reminiscent of the

National Cholesterol Education Program (NCEP) for the detection and

treatment of high cholesterol. The first NCEP report issued in 1988

was timed to coincide with the introduction of Mevacor, Merck's new

cholesterol-lowering drug. In an unprecedented action it was

released directly to the public, weeks before doctors could read the

scientific information on which it was based. The last set of

revised guidelines in 2001, that tripled the number of Americans

advised to take statins, was also publicized prematurely.

 

In both instances, the guidelines were published in the Journal of

the American Medical Association but not the Federal Register. There

was no public notice of any meetings, the meetings were not open to

the public, public input was not solicited, and detailed records and

testimony of committee meetings were not kept. The Joint National

Committee on Prevention, Detection, Evaluation, and Treatment of

High Blood Pressure (JNC) has followed the same format in order

to bypass Government rules and regulations.

 

When NIH officials were questioned about this lack of protocol, they

explained that the cholesterol and hypertension guidelines were

written by a non-government committee of experts that they had

selected and were therefore not subject to the Federal Register

regulations. However, these guidelines are presented by government

spokespersons at government press conferences and are promoted

in the media here and abroad as the latest government guidelines.

The new JNC-7 report made its debut at a special session of the

American Society of Hypertension Annual meeting in New York. This

took place on the same day in May as the National Heart, Lung, and

Blood Institute Press Conference in Washington and coincided with

appearance of the JNC " Express Report " on the Journal of the

American Medical Association web site.

 

Suspicions

 

My personal suspicion is that powerful pharmaceutical interests were

behind much of this, just as they are behind the creation of

National Hypertension Month in May. Although JNC-7 reverted to the

previous advice that inexpensive diuretics were the first choice, it

also emphasized that " Most patients with hypertension will require

two or more antihypertensive medications to achieve goal pressure. "

A Novartis spokesperson lavishly praised the report in a press

release emphasizing that " Inadequate control of blood pressure has

become a public health crisis. We are encouraged that new approaches

recommended by JNC-7 will provide impetus for improvement. " That's

hardly surprising. Novartis, with its 73,000 employees in 140

countries and US sales of $21 billion per year has all the

hypertension treatment bases covered. They manufacture Lopressor, a

beta blocker, Lotensin, an ACE inhibitor, Diovan, an angiotensin II

blocker, Lotrel, a combination ACE inhibitor and calcium channel

blocking agent, as well as products combining these with a thiazide

diuretic.

 

Despite all the hoopla, many physicians were not as enthusiastic.

Some were skeptical that the new guidelines offered anything that

was either new or helpful. Several prominent authorities on

hypertension denounced it as based on conclusions that were not only

unwarranted but also misleading.

 

The full study will not be published until the fall and the report

in the JAMA Express raised some eyebrows. This feature is designed

for rapid dissemination of new breakthroughs, for which JNC-7 hardly

qualified. The journal's peer review process time for this is 24-48

hours and all 33 JNC authors would have had to respond within 72

hours, which is highly doubtful. But that wasn't the only complaint.

The recommendation for diuretics as first-line therapy was

largely based on the Antihypertensive and Lipid-Lowering Treatment

to Prevent Heart Attack Trial (ALLHAT), another multi-million dollar

study that produced dubious conclusions. ALLHAT results were also

reported early in the JAMA Express and some feel that anything

dealing with statins receives this preferential treatment. This

holds true for other respected peer reviewed publications such

as The Lancet, which has also expedited statin studies despite the

fact that they show nothing new or significant. Conversely, it is

very hard to get anything negative about statins published, even

when the data is solid. Perhaps this has something to do with the

enormous revenues publications derive from statin advertisements.

 

John Laragh, Director of the Cardiovascular Center at the New York

Presbyterian Hospital-Cornell Medical Center, founded the American

Society of Hypertension, is Editor-in Chief of its Journal, and Past-

President of the International Society of Hypertension. He is one of

the world's leading authorities on hypertension because of his

delineation of the renin-angiotensin-aldosterone system, which

landed him on the cover of Time Magazine. I grew up with John, we

have been personal and professional friends for well over 50 years.

He was a founding Trustee of The American Institute of Stress of

which I am the president. I was tempted to ask him about his opinion

of the new guidelines, but didn't have to. His objections to this

and the ALLHAT study were vividly detailed at a press conference and

were summed up by his colleague, Larry Resnick, as

essentially " garbage. "

 

Laragh believes that patients with high renin hypertension are more

prone to have complications than low-renin, salt-sensitive

hypertensives and respond better to drugs other than diuretics.

Björn Folkow, another authority and recipient of the Hans Selye

award and numerous other honours, has emphasized the role of stress,

the sympathetic nervous system and catecholamines.

 

I suspect both these good friends to the decades

old " mosaic theory " that hypertension rarely has a single cause and

can result from dysequilibrium in the above and other contributory

components. Researchers are now focusing in on our old friend

inflammation as a cause that may explain its link with coronary

heart disease, obesity, diabetes and other disorders. Inflammatory

cytokines like Interleukin II released by deep abdominal fat cells

that contribute to insulin resistance and metabolic syndrome are

increased in hypertension and both angiotensin II and aldosterone

have been found to promote inflammation. Increased c-reactive

protein (CRP) levels were reported in newly diagnosed untreated

hypertensives at the same meeting and another paper showed a

correlation between elevated CRP and hypertension complications.

 

About the Author

Dr. Paul J Rosch, MD, FACP is president of the American Institute of

Stress,

www.stress.org

 

 

What is Normal Blood Pressure?

 

Blood pressure (BP) is essentially determined by cardiac output (CO)

or the force with which blood is pumped out of the left ventricle

and the degree of systemic vascular resistance (SVR) that is

encountered. This is much like Ohm's law governing the strength of

an electrical current, so that BP=CO x SVR. Hypertension can be

caused by increased cardiac output, increased vascular resistance or

both. Although the cause of essential or primary hypertension in a

patient may not be known, it is safe to say that it is mediated by

one or both of these two mechanisms.

 

Blood pressure readings are given with an upper and lower number.

The upper or systolic number is the pressure when your heart beats;

the lower or diastolic measurement is the pressure when your heart

relaxes between beats.

 

Just 25-30 years ago, doctors were taught that normal blood pressure

was the patient's age plus 100 over 90. Thus if you were 50 years

old, a blood pressure reading of 150/90 was considered completely

normal; if you were 70, then 170/90 was normal. This guideline

reflects the physiological fact that the systolic blood pressure

(like cholesterol levels) gradually rises with age. As the

blood vessels narrow and become more rigid, more pressure is

required to move the blood through the arteries and veins. In

general, the diastolic pressure rises until around age 55 and then

starts to decline.

 

The first Report of the Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High Blood Pressure (JNC-1),

in 1977, stipulated 120/80 as optimal and 120-129/80-84 as within

the normal range. High normal was 130-139/85-89 and Stage 1 or mild

hypertension was 140-159/90-99. Stage 2 (160-179/100-109), Stage 3

(179-209/100-110) and Stage 4 ( >210/>120) reflected increasing

degrees of severity. JNC-7 has decreed that a reading of 120/80,

formerly recognized as optimal, puts you in a category of " pre-

hypertension, " which must be treated with life-style changes and

drugs.

 

What should you do if one number is high and the other is normal or

low? Which is more important, the systolic (upper) or diastolic

(lower) measurement? The previous emphasis on diastolic pressure was

based on early studies on young people. A systolic pressure above

140 with a diastolic pressure below 90 is referred to as isolated

systolic hypertension. It is common in older individuals

due to hardening of the arteries and slight elevations were not

considered serious. Studies now show that an elevated systolic

pressure is an independent risk factor for complications that is far

greater than the risk associated with a high diastolic pressure in

older patients with hypertension. The same may apply to many older

individuals with arteriosclerotic vessels, where a higher

blood pressure is needed to maintain adequate blood flow to the

kidneys and other vital organs.

 

Nevertheless, some senior citizens will consistently complain of

weakness and dizziness if their blood pressures are lower than the

120/80 value that is now recommended. This is particularly true for

women, who normally tend to have higher blood pressures than men in

this age group.

 

Most patients with hypertension have no symptoms and blood pressure

elevations are often discovered during a routine physical

examination or if measurements are obtained in connection with

application for life insurance, employment or blood donation rather

than any complaint due to its presence.

 

Some Causes of Hypertension

 

Accepted causes of severely high blood pressure include:

 

KIDNEY DISEASE: Narrowing of the renal artery and kidney disease can

cause the release of renin, a powerful hormone that can increase

sodium retention and vascular resistance.

 

Primary aldosteronism and Cushing's disease: These conditions can

result in an increase of adrenal cortical hormones that also cause

sodium retention.

 

Pheochromocytoma is a tumor of the adrenal medulla that secretes

excess amounts of catecholamines like noradrenalin and adrenaline

that can increase peripheral resistance as well as cardiac output,

leading to high blood pressure.

 

DIABETES: In diabetics, red blood cells are often less deformable

and unable to squeeze through narrow capillaries.

 

ATHEROSCLEROSIS: Narrowing of the arteries requires greater pressure

to force blood through.

 

Other theories include:

 

DEFICIENCY OF CoQ10: CoQ10 deficiency impairs the ability of the

heart to pump blood properly, and leads to compensation with a

higher diastolic reading. Diastolic dysfunction is an impairment in

the relaxation (filling) phase of the cardiac cycle which is the

phase requiring much more ATP and CoQ10 than the systolic

(contraction ) phase. Dr. Peter Langsjoen, an expert on CoQ10 and

heart disease, has had excellent success treating high diastolic

blood pressure with this nutrient.

 

INCREASED BLOOD VISCOSITY: According to this theory, elevated blood

pressure is an adaptive response to an elevation in blood viscosity,

where the blood cells tend to clump together, impairing circulation

in the tiny capillaries. A common cause of increased viscosity is

stress. Sugar consumption can increase blood viscosity as well.

Smokers and those suffering from sleep apnea often have high

hematocrit readings (indicating increased viscosity) and frequently

suffer from hypertension.

 

It makes sense to treat high blood pressure by addressing the causes

of the above conditions, resorting to blood pressure-lowering drugs

only when these measures fail to bring down blood pressure that is

dangerously high.

 

Diet and Hypertension

 

There's not a lot of good science out there to provide specific

dietary guidelines for lowering blood pressure, but the following

suggestions may help:

 

Switch to unrefined salt; avoid commercial salt. This is the number

one treatment suggestion of our own Dr. Cowan who finds that the

simple measure of removing refined salt from the diet can bring down

high blood pressure in the majority of his patients. (And avoiding

commercial salt will also help you avoid processed foods, because

most contain gobs of refined salt.)

 

Use butter, avoid margarines and spreads containing trans fats.

Trans fatty acids inhibit biochemical processes in the cell

membranes. High blood pressure is a likely outcome of the ensuing

biochemical chaos.

 

Take cod liver oil: The fat-soluble vitamins in cod liver oil will

help you deal with stress, nourish the glands and organs and aid

mineral absorption. Prostaglandins that help normalize blood

pressure are made from DHA, a special fatty acid contained in cod

liver oil.

 

Get adequate protein. Studies indicate that dietary protein helps

normalize blood pressure.

 

Eat heart muscle or take vitamin CoQ10. Dr. Peter Langsjoen has

found that CoQ10 can help normalize high diastolic blood pressure in

a majority of cases.

 

Avoid refined sugar and fructose: Refined sugars increase blood

viscosity and tend to deplete many nutrients.

 

Eat plenty of fruits and vegetables, preferably organic.

 

Avoid exposure to cadmium in cigarettes, heavily sprayed produce and

farm chemicals. People with high blood pressure have three times

more cadmium in their bodies than others (Lancet 1976;i:717-8).

 

Use bone broths and drink hard water to provide minerals like

calcium and magnesium.

 

This article appeared in Wise Traditions in Food, Farming and the

Healing Arts, the quarterly magazine of the Weston A. Price

Foundation, Fall 2003. Copyright Notice: The material on this site

is copyrighted by the Weston A. Price Foundation.