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Medical Forum / General / Cardiology / June 2006Question for Dr. Chung
I am currently taking 300mg Karvea (Irbesartan) for BP a day. I started on this medication about 5 years ago, at the age of 30. My cardiologist at the time put me on this for 2 reasons, firstly to reduce my blood pressure as I was obese, and secondly to reduce the amount of ectopics I was getting, which was probably at least 50 a day. I had the usual myriad of Heart, Kidney, stress tests etc, with no major problems. The medication helped me along with magnesium, but now I am a third of the size, lean, fit, and I walk about 5 miles a day. I only get a few ectopics a day now (PVC's ?), and my BP ranges from 120 - 140. I am now 35 years old, and what I wanted to know, is there any health problems from taking the medication for many years longer? I am considered fairly young for BP meds, something I was hoping that I could reduce at least the dose by becoming fit and healthy. Thanks for all help. Dave > I am currently taking 300mg Karvea (Irbesartan) for BP a day. I started on this medication about 5 years > ago, at the age of 30. My cardiologist at the time put me on this for 2 reasons, firstly to reduce my blood [quoted text clipped - 7 lines] > I am now 35 years old, and what I wanted to know, is there any health problems from taking the > medication for many years longer? None that are known. YMMV. > I am considered fairly young for BP meds, something I was hoping > that I could reduce at least the dose by becoming fit and healthy. Folks come off of BP medications when they become lean&trim. Fit&healthy does not necessarily mean lean&trim. > Thanks for all help. You are welcome, Dave. All thanks and praises belong to the LORD, Whom I love with all my being. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/hsada Andrew B. Chung, MD/PhD says... > Folks come off of BP medications when they become > lean&trim. > Fit&healthy does not necessarily mean lean&trim. Can I pin you down on this, Doc? I'm 5'10", 170 lbs. I have a flat belly and no love handles. As a result of resistance training I'm pretty muscular. Bodyfat around 12%. I eat a lot, but my weight is stable. I'm over 50. I have hypertension, but had it before I started weight lifting and cardio work. As I recall, at 5'10", what I think you call my "optimum" weight would be 155 or maybe a little less. Are you saying that if I got down to that weight my BP would go down? Would that be the case if my bodyfat percentage did not also go down (i.e. - if I got down to 155 by stopping the weight training and dropped muscle mass), or are you assuming that in going to 155 I would drop mainly bodyfat. I guess what I had assumed was that "optimum" referred to men of average build, and that the optimum weight for a particular height was really just a surrogate for an ideal bodyfat percentage, and that someone who is more muscular than average would have that ideal bodyfat percentage at a somewhat higher than "optimal" weight. But when you say: > Fit&healthy does not necessarily mean lean&trim. then I wonder if my assumptions were wrong. Is muscle mass just as bad for you as fat deposits? What is it about "lean&trim" that effects blood pressure other than the bodyfat percentage that it implies. > Andrew B. Chung, MD/PhD says... > [quoted text clipped - 4 lines] > > Can I pin you down on this, Doc? Certainly. > I'm 5'10", 170 lbs. I > have a flat belly and no love handles. You may still have significant visceral adiposity especially if your waistline is more than 35 inches. > As a result of > resistance training I'm pretty muscular. Bodyfat around > 12%. 20 lbs of visceral fat may still be over your threshold for pathology. > I eat a lot, but my weight is stable. I'm over 50. > > I have hypertension, but had it before I started weight > lifting and cardio work. Isotonic exercise with weights do very little to lower blood pressure. > As I recall, at 5'10", what I think you call my "optimum" > weight would be 155 or maybe a little less. Would guess less than 150 lbs. > Are you saying > that if I got down to that weight my BP would go down? If you lose 20 lbs of visceral fat, it is likely your blood pressure in time will become normal off of medications. > Would that be the case if my bodyfat percentage did not also > go down (i.e. - if I got down to 155 by stopping the weight > training and dropped muscle mass), or are you assuming that > in going to 155 I would drop mainly bodyfat. If you reach your optimal weight by reducing your intake down to an optimal amount, you will lose only fat and not muscle. > I guess what I had assumed was that "optimum" referred to > men of average build, and that the optimum weight for a > particular height was really just a surrogate for an ideal > bodyfat percentage, and that someone who is more muscular > than average would have that ideal bodyfat percentage at a > somewhat higher than "optimal" weight. No. See above. > But when you say: > > > Fit&healthy does not necessarily mean lean&trim. > > then I wonder if my assumptions were wrong. Is muscle mass > just as bad for you as fat deposits? Visceral fat are not fat deposits but metabolically active tissue. > What is it about > "lean&trim" that effects blood pressure other than the > bodyfat percentage that it implies. Lowered serum levels of inflammatory cytokines. Prayerfully in Christ's amazing love, Andrew B. Chung Cardiologist, Atlanta, Georgia, USA http://tinyurl.com/m3gnu Andrew B. Chung, MD/PhD says... >> I'm 5'10", 170 lbs. I have a flat belly and no love >> handles. > You may still have significant visceral adiposity > especially if your waistline is more than 35 inches. Nah. My waist is 33. Chest is 42. >> Are you saying that if I got down to that weight my BP >> would go down? > If you lose 20 lbs of visceral fat, it is likely your > blood pressure in time will become normal off of > medications. Does visceral fat count in the bodfat percentage? If it does, then at 170 lbs, 12% bodyfat is only 20 lbs fat altogether. I would think you'd need a little fat here and there. > If you reach your optimal weight by reducing your intake > down to an optimal amount, you will lose only fat and > not muscle. Ok, so no cannibalizing of cardiac muscle, or any bad stuff like that. (Assuming I still eat enough protein.) I'll tell you what - at 150 or below, I would look awfully ripped, or downright scary. Maybe both. > Visceral fat are not fat deposits but metabolically > active tissue. > Lowered serum levels of inflammatory cytokines. Ok, I'll read up on this. Thanks very much for your response. > Andrew B. Chung, MD/PhD says... > [quoted text clipped - 5 lines] > > Nah. My waist is 33. Chest is 42. Are you measuring your waistline at the umbilicus (your belly button)? Many people with a waist of 33 (ie wearing pants that are 33 at the waist) actually have a waistline considerably larger because they wear their pants low at the hip. > >> Are you saying that if I got down to that weight my BP > >> would go down? [quoted text clipped - 4 lines] > > Does visceral fat count in the bodfat percentage? Not if the estimate is done by skinfold. > If it > does, then at 170 lbs, 12% bodyfat is only 20 lbs fat > altogether. I would think you'd need a little fat here and > there. Not around the vital organs (ie visceral fat). > > If you reach your optimal weight by reducing your intake > > down to an optimal amount, you will lose only fat and > > not muscle. > > Ok, so no cannibalizing of cardiac muscle, or any bad stuff > like that. (Assuming I still eat enough protein.) Actually, the body cannibalizes muscle when it runs out of carbs and not proteins. The amount of essential amino acids that we need is actually very little when there is enough carbs. > I'll tell you what - at 150 or below, I would look awfully > ripped, or downright scary. Maybe both. Vanity leads to the downfall of many. > > Visceral fat are not fat deposits but metabolically > > active tissue. [quoted text clipped - 3 lines] > Ok, I'll read up on this. Thanks very much for your > response. All thanks and praise belong to the LORD, Whom I love with all my heart, soul, mind, and strength. Prayerfully in Christ's amazing love, Andrew B. Chung Cardiologist, Atlanta, Georgia, USA http://tinyurl.com/m3gnu "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> > Actually, the body cannibalizes muscle when it runs out of carbs and > not proteins. The amount of essential amino acids that we need is > actually very little when there is enough carbs. I was always under ther impression as long as you ate your daily protein requirement then the body does not cannibalize muscle, it uses stored glycogen, body fat, and dietary fat > "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> > > Actually, the body cannibalizes muscle when it runs out of carbs and [quoted text clipped - 4 lines] > requirement then the body does not cannibalize muscle, it uses stored > glycogen, body fat, and dietary fat If carbohydrate intake is inadequate, eventually glycogen stores will be depleted and gluconeogenesis will require the breakdown of protein. OTOH, if protein intake is inadequate, the body can synthesize the non-essential amino acids from carbohydrates and recycle the essential ones. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/m3gnu >> "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> >> > Actually, the body cannibalizes muscle when it runs out of carbs and [quoted text clipped - 7 lines] > If carbohydrate intake is inadequate, eventually glycogen stores will > be depleted and gluconeogenesis will require the breakdown of protein. From daily dietary protien? > >> "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> > >> > Actually, the body cannibalizes muscle when it runs out of carbs and [quoted text clipped - 9 lines] > > From daily dietary protien? For someone who is trying to lose weight and has loss of appetite from low-carbing, daily dietary protein will typically be inadequate for gluconeogenesis and so the body will break down muscle. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/m3gnu >> >> "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> >> >> > Actually, the body cannibalizes muscle when it runs out of carbs and [quoted text clipped - 14 lines] > low-carbing, daily dietary protein will typically be inadequate for > gluconeogenesis and so the body will break down muscle. What about someone who is not trying to lose weight but prefers low carb to avoid blood sugar spikes (IGT) > >> >> "Andrew B. Chung, MD/PhD" <nospam2@heartmdphd.com> wrote in message >> > >> >> > Actually, the body cannibalizes muscle when it runs out of carbs and [quoted text clipped - 17 lines] > What about someone who is not trying to lose weight but prefers low carb to > avoid blood sugar spikes (IGT) It would be wiser to switch to low GI carbs rather than avoid carbs altogether for the concerns described above. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/m3gnu Andrew B. Chung, MD/PhD says... >> Nah. My waist is 33. Chest is 42. > Are you measuring your waistline at the umbilicus (your > belly button)? > Many people with a waist of 33 (ie wearing pants that > are 33 at the waist) actually have a waistline > considerably larger because they wear their pants low at > the hip. This morning, on an empty stomach but not sucking it in, using an official tape measure, measuring just barely snug, not tight, it's exactly 32.5" at the belly button. >> Does visceral fat count in the bodfat percentage? > Not if the estimate is done by skinfold. Yes, mine was done with calipers. I guess I'm still confused by one aspect of this. It still seems to me that for a given height the optimum weight of someone who is muscular will be higher than that of someone who isn't. If both have exactly the same amount of visceral fat, the guy who has muscles will weigh more than the guy who doesn't. Muscle mass has weight. But since there's no way to actually measure visceral fat short of a CAT or MRI scan, I don't know how to adjust for this difference. It looks like the waist/hip ratio (mine is .87) is the only measurement that would take it into account, at least to some extent. BMI certainly doesn't (a body builder would be deemed obese). > Andrew B. Chung, MD/PhD says... > [quoted text clipped - 11 lines] > using an official tape measure, measuring just barely snug, > not tight, it's exactly 32.5" at the belly button. That is reassuring. > >> Does visceral fat count in the bodfat percentage? > [quoted text clipped - 6 lines] > someone who is muscular will be higher than that of someone > who isn't. The optimum weight will vary individually. The only way to find out is to reduce intake down to an optimal amount and in time, the weight will plateau at optimum. > If both have exactly the same amount of visceral > fat, the guy who has muscles will weigh more than the guy > who doesn't. Muscle mass has weight. Thresholds for amount of visceral fats above which there is phenotypic expression of disease such as hypertension will vary individually. > But since there's no way to actually measure visceral fat > short of a CAT or MRI scan, I don't know how to adjust for > this difference. It looks like the waist/hip ratio (mine > is .87) is the only measurement that would take it into > account, at least to some extent. BMI certainly doesn't (a > body builder would be deemed obese). Simply eat less down to the right amount and in time you will be at your right weight sans the visceral fat, which is always pathological. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/m3gnu Andrew B. Chung, MD/PhD says... > The optimum weight will vary individually. The only way > to find out is to reduce intake down to an optimal > amount and in time, the weight will plateau at optimum. So, all roads lead to the 2-lb diet. I guess I should have known. Are there any allowances in that diet for those who are more active than average? > Andrew B. Chung, MD/PhD says... > [quoted text clipped - 3 lines] > > So, all roads lead to the 2-lb diet. The 2PD-OMER Approach is not a diet. > I guess I should have > known. You brought it up. > Are there any allowances in that diet for those who > are more active than average? No. If your body needs more, it will extract more (i.e. your gastrointestinal system will become more efficient). Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/m3gnu >> Andrew B. Chung, MD/PhD says... >> [quoted text clipped - 16 lines] >No. If your body needs more, it will extract more (i.e. your >gastrointestinal system will become more efficient). Yup. So you can do the Tour de France on two pounds of lettuce daily, and a quadriplegic can maintain a healthy weight on two pounds of butter daily. > I am now 35 years old, and what I wanted to know, is there any health problems from taking the > medication for many years longer? Just curious ... why would you ask a question like this of a physician drummed out of Florida, and currently with NO hospital affiliation? If you read this newsgroup, you MUST know he's a certified whacko. Why not ask your own doctor? > > I am now 35 years old, and what I wanted to know, is there any health problems from taking the > > medication for many years longer? [quoted text clipped - 3 lines] > you read this newsgroup, you MUST know he's a certified whacko. Why not > ask your own doctor? Sorry my helping others bother you so terribly. Please forgive all my iniquities. To understand this, simply surf the link under my name. Still praying for your poor enslaved soul, dear Al. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/hsada >> Just curious ... why would you ask a question like this of a physician >> drummed out of Florida, and currently with NO hospital affiliation? If [quoted text clipped - 3 lines] > Sorry my helping others bother you so terribly. Please forgive all my > iniquities. Bite me, ex-doctor in good standing in Florida. > > Al wrote:> > >> Just curious ... why would you ask a question like this of a physician [quoted text clipped - 6 lines] > > > Bite me, Preoccupation with matters of the flesh remains a tell for those who have satan's mark emblazoned on their foreheads. > ex-doctor in good standing in Florida. Actually, I have always been and remain a licensed and practicing Georgia physician, thankfully. To understand this exchange, simply surf the link under my name. Still praying for your poor enslaved soul, dear Al. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/gj98a >>> Sorry my helping others bother you so terribly. Please forgive all my >>> iniquities. [quoted text clipped - 10 lines] > > To understand this exchange, simply surf the link under my name. Surf my dick, Chung. And while we're at it, shove your satan's marks up your a.s, whacko. > >>> Sorry my helping others bother you so terribly. Please forgive all my > >>> iniquities. [quoted text clipped - 13 lines] > Surf my dick, Chung. And while we're at it, shove your satan's marks up > your a.s, whacko. Sorry my choice to remain openly Christian bothers you so terribly. Please forgive all my iniquities. Still praying for your poor enslaved soul, dear Al. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/gj98a > Sorry my choice to remain openly Christian bothers you so terribly. > Please forgive all my iniquities. Once again, Chung pulls stock non-answer #38 out of his a.s. > > Sorry my choice to remain openly Christian bothers you so terribly. > > Please forgive all my iniquities. > > Once again, Chung pulls stock non-answer #38 out of his a.s. When there are more than a few possible answers, the answers are no longer stock. To understand this exchange, simply surf the link under my sig. Still praying for your poor enslaved soul, dear Al. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/gj98a It seems to me I heard somewhere that Andrew B. Chung, MD/PhD wrote in article <1149699503.952986.29200@h76g2000cwa.googlegroups.com>: >Actually, I have always been and remain a licensed and practicing >Georgia physician, thankfully. If the period between August 3, 1995 and now is "always" you must have a very hard time dealing with the concept of "eternity."  SignatureDon Kirkman > It seems to me I heard somewhere that Andrew B. Chung, MD/PhD wrote in > article <1149699503.952986.29200@h76g2000cwa.googlegroups.com>: [quoted text clipped - 3 lines] > > If the period between August 3, 1995 and now is "always" It is because of continuity. > you must have a > very hard time dealing with the concept of "eternity." Without the LORD, your fantasies remain meaningless (Ecclesiastes). To understand this, simply surf the link under my sig. Still praying for your poor enslaved soul, dear Don. Prayerfully in Christ's amazing love, Andrew http://tinyurl.com/gj98a |
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