Has Disease Become the Rule, Rather Than the Exception?

Editor’s Note:  This post is a part of our Pretty Darn Thoughtful™️ series.  Although the information in it is based on science, it is not as heavily supported by clinical trials and medical society guidelines like much of the other information on this website.

I recently gave an interview for a magazine article about “pre-diseases” such as prehypertension and it led me to develop a new way of thinking about disease. I noted to the interviewer that over 90% of Americans will eventually develop hypertension, and saying this number out loud shocked me. It meant that disease has become the rule, rather than the exception. This caused me to think – “Instead of picturing ourselves as healthy and trying to avoid disease, should we picture ourselves as unhealthy and trying to heal ourselves?”

Some background on prehypertension: Older guidelines defined prehypertension as a range of blood pressures lower than hypertension. The 2017 guidelines, however, abandoned that term and instead used the phrase “elevated blood pressure”.

This got me thinking, “What is prehypertension?” Prediabetes is thought of as a condition that is likely to lead to type 2 diabetes. Similarly, the simplest definition of prehypertension would be a condition that is likely to lead to hypertension. BUT… in the United States, the lifetime risk of developing hypertension is well over 90%. You read that right… if you are an American alive in 2019, and you don’t have hypertension, you will almost certainly develop it. So that means… if you don’t have hypertension, you DO have prehypertension.

I’m sure you are saying, “That doesn’t seem right.” And it isn’t right. Things shouldn’t be this way. But they are.

You’re thinking – well, if everyone gets hypertension, maybe we are not defining it correctly, or maybe it’s really not that bad. These statements are not true. Hypertension is bad. We know that the risk of heart attack and stroke increases as blood pressure increases, not only in the range of hypertension, but in the lower range defined as elevated blood pressure.

Now you’re thinking – well, maybe hypertension is bad, but maybe it is a normal part of aging and maybe there isn’t anything we can do about it. These statements are also not true. A recent study showed that members of the Yanomami tribe in the Brazilian rain forest with no exposure to Western food or culture maintained the same low blood pressures from youth until at least age 60. Meanwhile, another tribe that had some exposure to Western food had the same low blood pressure while young, but blood pressure increased with age.

Maybe the Yanomami are the exception, rather than the rule? Nowadays they are, but their lifestyle bears more similarity to that of our ancestors than how we live today. As you may recall from my article on the Principles of Healthy Nutrition, for much of history, salt (sodium) was rare and precious. Only during the last few hundred years has sodium become plentiful. By my calculations, since life evolved out of the oceans 400 million years ago, sodium was scarce for 99.9999% of that time. As a result, our bodies have evolved to hang on to sodium, not to excrete it when we consume too much of it.

So, we have established that hypertension is not good, and not “normal”, but almost everyone gets it. This is a reflection of our society. Our default lifestyle has become so unhealthy that we are almost guaranteed to develop a lifestyle-associated disease. This isn’t anybody’s fault, this is just how it is. We have sedentary jobs and perceived limitations on time, so we don’t exercise as much as we should (or as vigorously as we should), and we don’t eat well.

The hypertension statistics I give above aren’t surprising considering that almost 80% of Americans consume fast food in a given week. The average American consumes 3700mg of sodium daily, well above the recommended 2300mg, and WAY above the 200mg our bodies actually need. Even worse, we don’t eat enough potassium. Potassium is found in fruits, vegetables, and dairy and helps our body to excrete sodium. On average, Americans take in about half of the 4700mg of potassium that is recommended daily.

When I talk to my patients about sodium, most of them lead with “I don’t add salt to anything.” Unfortunately, most of the salt in the country doesn’t come from the shaker, but rather what’s already in the food. If you eat out, whether it is fast food or fancy food, you will likely get a lot of sodium. A lot of things that we don’t even taste salty, like bread, contain a lot of sodium. Anything in a box, bag, pouch, or can, including vegetables, often has added salt for flavor and as a preservative.

In addition to a hypertension-inducing diet, about 80% of people don’t get the recommended amount of exercise. Exercise has numerous benefits, and the impact on the vascular system is clear. Blood pressure is lowered, likely through multiple mechanisms, including less stiffening of arteries, decreased sensitivity to sodium, and lower inflammation. Unfortunately, we work at jobs that don’t require much physical activity, but still leave us exhausted. We have a plethora of entertainment options that require only the click of a button and a comfortable couch. And all too often that entertainment is accompanied by a bag of chips or a bowl of ice cream.

Many of my patients did not give much thought to their health until they had a stroke or heart attack. But then they had such an event and made a commitment to improving their health. A diagnosis can be powerful motivation. Do you think a diagnosis of prehypertension for all would motivate us to be healthier? That the idea that we are unhealthy at baseline and have to work to be healthy would be a good mindset?

“A diagnosis can be powerful motivation.”

– Doctor T

None of this means you are doomed to be unhealthy. It just means that in our society, the DEFAULT state is unhealthiness, and that we have to WORK to be healthy. This requires a change in mindset. In the past, humans could just go about their lives and hope to not get injured or contract a serious infection. Now, we have to make an effort to choose and prepare healthy food and go out of our way to get exercise. This isn’t necessarily bad, it’s just the way it is. We can make it easier to make this effort by promoting a culture of health. Talk about health, nutrition, and exercise with your friends and family. Encourage each other to change diet and exercise patterns. Support each other when we fall back. And follow PagingDoctorT so that you have the knowledge, motivation, and resources to be healthy!

You can read the magazine article I mentioned on the Pittsburgh Magazine website here.